Lead paint abatement programs

There is strong evidence that lead paint abatement programs reduce lead dust exposure when removal of the lead source is confirmed (NCHH-Jacobs 2009, Armstrong 2014, Levin 2008, Dixon 2012, Wilson 2015 ). Additional evidence is needed to confirm effects on blood lead levels, especially over the long-term, since blood lead levels can remain elevated for months or years after exposure (HIP-Lead 2017, Armstrong 2014, NCHH-Jacobs 2009).

Lead abatement can improve physical and mental health outcomes for children and adults by reducing developmental disorders, attention deficit hyperactivity disorder-related behaviors (ADHD), anemia, hypertension, and kidney and brain damage (Arora 2024, Coulton 2023, Armstrong 2014, Berg 2012, NCHH-Jacobs 2009). Newborn infants and fetuses are especially vulnerable to effects of lead exposure that disrupts brain development (Arora 2024, Vigeh 2014); a St. Louis-based study suggests prenatal screening and proactive lead hazard remediation can prevent exposure among some newborns (Berg 2012). Childhood lead exposure is associated with an increased likelihood that children and teenagers engage in adverse behaviors such as aggression, violence, crime, and risky sexual activity (Fesko 2023, Coulton 2023, Wolpaw Reyes 2015). Higher prenatal and childhood blood lead levels have been associated with increased adult arrest rates and arrests for violent offenses (Wright 2008). Reduced lead exposure may be linked to reductions in violent crime levels roughly twenty years after exposure would have occurred (NBER-Wolpaw Reyes 2007, Feigenbaum 2015).

Local lead laws are associated with reduced lead hazards for children, especially in rental properties (Korfmacher 2013, Korfmacher 2012), and local housing laws can support rehabilitation of older homes contaminated with lead (Korfmacher 2014). A Philadelphia court that enforces lead hazard laws appears to increase property remediation rates (Campbell 2013a). Public-private sector partnerships can increase efficiency in remediation, prevention, and support of early interventions for children exposed to lead (NCHH-Lead 2014). Abatement and childhood lead screening programs that focus on communities with homes built before 1978, when lead paint was commonly used, may most effectively identify and reduce lead poisoning (White 2015). Lead abatement laws requiring lead abatement from rental properties need to be designed to avoid unintended consequences, especially increased evictions of families with younger children (Fesko 2023). In an Ohio-based study, after lead abatement laws passed, landlords increased evictions of families with younger children instead of paying for lead abatement (Fesko 2023). Many state and local governments report that limited funds, staffing, and time can reduce local lead law enforcement (NCSL-Healthy housing).

Cost benefit analysis finds positive net benefits and a high rate of return for lead abatement programs overall (Cochrane-Nussbaumer-Streit 2020, Gould 2009). The Health Impact Project estimates that $84 billion in long-term benefits for each birth cohort could be generated by removing lead hazards and preventing childhood lead exposures (CDC-Lead CLPP, HIP-Lead 2017). Economic modeling suggests that future earnings and decreased medical costs for children who benefit from these programs range from 2-20 times the estimated costs of lead abatement (Jones 2012).

Lead paint abatement programs that direct resources to families who cannot undertake abatement without assistance have the potential to decrease disparities in lead exposure between children from families of color, with lower incomes, who do not own their homes, and children from white families, with higher incomes, who own their homes (Coulton 2023, White 2015, Korfmacher 2014, Reed 2011a, HIP-Lead 2017, NCHH-Lead 2014). Lead paint abatement programs that effectively remove lead hazards have the potential to reduce racial disparities in health, development, education, and socio-economic outcomes (Coulton 2023). Experts suggest comprehensive lead poisoning prevention interventions are needed to identify lead exposure risks, offer environmental testing, and take action to abate or contain lead found in paint, soil, and pipes, especially for communities of color that are systematically disadvantaged (Teye 2021). Comprehensive policies should consider lead exposure pathways including dust, soil, water, and air (Zartarian 2017).

Lead hazards are a persistent environmental injustice that disproportionately affects children of color, from families that immigrated to the U.S., living in urban areas, living in areas with lower incomes, and living in older, deteriorating homes (Teye 2021, Lynch 2020, White 2015, Balza 2024, Korfmacher 2014, HIP-Lead 2017). Disparities in blood lead levels (BLLs) between Black children and white children ages 1-5 years old have decreased in recent decades; however, disparities persist, with Black children suffering from higher BLLs and higher lead exposures than white children, even at the highest income and highest education levels (Teye 2021, White 2015). Black children, especially younger children, also have the highest outlier BLLs; the data show potentially thousands of Black children with BLLs of 40 μg/dL or more and no children from any other racial or ethnic group with BLLs that high (Teye 2021).

Available data suggest that children living in households with higher education levels have lower rates of lead exposure than children living in households with less formal education, and as income levels increase, BLLs among children decrease (Teye 2021). Children from families with lower income levels living in areas with higher risk of lead exposure experience negative brain development and cognitive outcomes more than children from families with higher income levels living in the same higher risk areas (Marshall 2020a). Children from families with lower incomes also have higher risks of nutritional problems, especially iron deficiency, which can increase lead absorption and elevate BLLs (Hauptman 2023).

Lead abatement laws have the potential to increase housing discrimination against and evictions of families with young children from landlords trying to avoid the costs of lead abatement (Fesko 2023). Evictions are disproportionately experienced by families living in urban areas with low incomes, often neighborhoods of color (Fesko 2023). Evictions harm families and reduce economic and social stability, employment opportunities, education outcomes, and mental health, and increase experiences of homelessness (Fesko 2023).

By the late 19^th century, lead’s toxic and harmful effects were known, yet the lead industry and many businesses profited from selling lead for use in paint, pipes, and gasoline. Lead was also part of many consumer goods, including toys and household appliances. By the 1950s, millions of children had been poisoned by lead, either chronically or acutely, and public health officials had documented the irreversible effects of childhood lead poisoning from lead exposures in paint and contaminated water (HIP-Lead 2017, Bloomberg-Bliss 2016). Powerful leaders of the lead industry avoided responsibility for knowingly selling products containing toxic lead and claimed lead poisoning was only a problem among individuals and families of color and those living in poverty, falsely suggesting that education about the risks of lead paint was all that was needed (Bloomberg-Bliss 2016).

Formerly redlined neighborhoods are more likely to be communities of color with lower incomes and fewer resources, affected by polluting industries and waste dumping sites, comprised of older and deteriorating houses with lead-based paint, located near lead-polluting industries, and surrounded by heavy traffic with residual effects from leaded gasoline pollution (Teye 2021, Lynch 2020). Children of color experience disproportionate adverse exposures, including to lead, living in racially segregated, formerly redlined neighborhoods. Government disinvestment and the systematic concentration of poverty has increased and exacerbated lead hazards as housing stock deteriorates, lead water service lines degrade, and industry and waste dumping sites further contaminate the air and soil (Hauptman 2023, Howarth 2023, Bravo 2022, HIP-Lead 2017).

The Lead-Based Paint Poisoning Prevention Act in 1971 banned lead paint as of 1978 and identified paint chips as the primary lead hazard in homes. The Residential Lead-Based Paint Hazard Reduction Act of 1992 included lead-contaminated dust and soil in the definition of lead hazards and moved towards prevention of poisoning rather than reaction to poisoning as the national strategy for addressing lead hazards (Dignam 2019, Hauptman 2023). This legislation mandates removal of lead hazards and the adoption of lead safety requirements for federally assisted housing and requires landlords and sellers for private housing to disclose information about potential lead-based paint and other lead hazards (NCSL-Healthy housing). The U.S. Environmental Protection Agency also adopted the Lead-Based Paint Renovation, Repair and Painting (RRP) Rule in 2010 to establish training and certification requirements for all contractors encountering and disturbing lead paint in homes (NCSL-Healthy housing).

Legislation and lead hazard removal has reduced childhood lead exposure, with population level decreases in BLLs since the 1970s (Dignam 2019). As of 2010, 23 states have adopted comprehensive lead prevention laws (Hauptman 2023). Several local and state governments have adopted legislation that requires lead testing for children at age 1 or 2, including Philadelphia and Pittsburgh, as well as Connecticut, Delaware, Maryland, New Jersey, and New York (Howarth 2023). However, roughly half a million children age 1 to 5 still have BLLs at or above 5 μg/dL, when it is known that there is no safe blood lead level and significant disparities in lead exposure by race, ethnicity, and income remain (Dignam 2019, Hauptman 2023). Although a federal program to provide nationwide lead abatement would require allocating significant funds, cost benefit analysis suggests benefits of $17-$221 for every dollar invested in lead paint hazard control due to reduced health care, special education, and crime costs as well as increased lifetime earnings and tax revenue (Gould 2009). Government decisions about what it is worth to save communities and people suffering from lead hazard exposure are value judgments that have been influenced by explicit and implicit bias with disastrous effects for many communities of color (Bloomberg-Bliss 2016). The World Health Organization estimates that lead exposure worldwide accounts for over 1 million deaths annually and over 24 million years of healthy life lost (Balza 2024), and as of January 2024, only 48% of countries have banned lead paint (WHO-Lead paint).

• What neighborhoods in your community have higher lead paint exposure risks? Who has the decision-making power to prioritize reducing disproportionate lead exposure risks in your community? How could local lead laws support new maintenance requirements and lead abatement? How could local laws be designed to prevent landlords from increasing evictions to avoid new lead abatement requirements?
• Is your community abating lead hazards before children are exposed, as is recommended to prevent irreversible serious harm, or reacting to blood lead level tests after lead exposures have occurred?
• What lead poisoning prevention interventions exist in your community? Are these interventions comprehensive, with additional funding available for households that need help to remove lead hazards? What funding could be made available to prevent lead poisoning through abatement or removal of lead hazards?
• Are all pathways to lead exposure considered and addressed through preventative lead poisoning efforts in your community? What partnerships or collaborations could support addressing lead hazards in contaminated dust, soil, water, and air? How can your community gather support and coordinate efforts from public agencies, community organizations, grant funders, property owners, the public, and others for comprehensive lead poisoning prevention?

As of 2021, 45 states have legislation to address lead hazards, primarily lead paint and lead dust (NCSL-Lead statutes 2021). In some states, such as Maryland, Massachusetts, and Rhode Island laws focus on identifying and fixing lead paint hazards before children are exposed (NCSL-Healthy housing, Korfmacher 2014). Maryland laws require inspection and remediation of lead hazards in older, rental properties and have established strong state and local enforcement measures, including heavy fines for noncompliance (NCSL-Healthy housing). Many states have universal lead screening and reporting for all children ages 1 and 2, as in Maine and Maryland (NCSL-Healthy housing). Some state laws, as in Ohio and Massachusetts, require investigations into potential sources of exposure after lead exposure has been documented, and mandate addressing lead hazards in rental units before they can be re-rented (NCSL-Healthy housing, HIP-Lead 2017). Many state agencies also support lead hazard reduction. The New York State Department of Health, for example, supports regional lead resource centers in New York City, Syracuse, and Buffalo that work to improve lead testing, education, and prevention activities through partnerships with local medical providers and departments of health (NYS DOH-RLRCs). The U.S. Environmental Protection Agency (EPA) also administers lead-based paint programs in affiliated territories and on most tribal lands (US EPA-LPAEP). Four tribes developed and run their own EPA-authorized programs: Bois Forte Band of Chippewa; Cherokee Nation; Lower Sioux Indian Community; and Upper Sioux Community (US EPA-TAS).

Some cities have lead hazard reduction laws. Rochester, NY, for example, adopted a Lead-Based Paint Poisoning Prevention Ordinance in 2006 that requires lead paint inspections for rental units within the city limits (Rochester-Lead paint) and uses neighborhood-level BLL data to prioritize enforcement of local lead abatement laws (HIP-Lead 2017). Burlington, VT (Burlington-Lead paint); New York City (NYC-Lead paint); Philadelphia, PA (Philadelphia-Lead paint); and Washington, D.C. (DC-Lead paint) are additional examples of cities with ordinances regarding assessment of lead hazards in rental units. In some cities, as in Washington, D.C., prohibitions against lead paint hazards include rental homes, child care and pre-kindergarten facilities, common areas of multi-family properties, and other areas where children spend time (HIP-Lead 2017).

The Centers for Disease Control and Prevention (CDC) Childhood lead poisoning prevention program provides funding for blood lead level surveillance in 29 states, Washington, D.C. and five other cities (CDC-CLPP Data). The 10 regional offices of the U.S. EPA each have a designated Regional Lead Coordinator who oversees lead-poisoning prevention, training, and enforcement efforts in the region (US EPA-Lead contacts).

CDC-Lead CLPP - Centers for Disease Control and Prevention (CDC), National Center for Environmental Health. Childhood Lead Poisoning Prevention (CLPP) program.

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* Journal subscription may be required for access.

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