Lead control: An investment with economic (and health) returns

Today marks the start of National Lead Poisoning Prevention Week (NLPPW), led by the CDC every year during the last full week of October.  But this year’s campaign is making the usual, costly mistake: it’s treating the prevention of childhood lead poisoning like an education issue, when really, it’s an economic issue. 

According to an in-depth analysis by the Economic Policy Institute, every $1 spent on controlling lead hazards results in a return of $17–$221 in reduced health care costs, higher lifetime earnings, tax revenue, reduced spending on special education, and significantly reduced criminal activity.  Emerging from the worst recession in generations, increased spending on lead control would be a smart investment for the economy, public health, and social justice.

Lead poisoning is thought to be the most preventable of pediatric health problems in the U.S., yet remains one of the most common.  The enduring prevalence of lead-based paint hazards in homes built before 1978 is primarily responsible.  This year’s NLPPW strategy, “Lead-Free Kids for a Healthy Future,” advises parents to have a certified inspector check for lead hazards in older homes and encourages them to take young children to a doctor for blood lead level testing.

{mosads}What do both parts of this strategy have in common?  Not only do they place responsibility for preventing high lead levels in children squarely on parents, but they are also unaffordable for many families. While lead poisoning can cross all barriers of race and income, most of the burden of this disease falls disproportionately on low-income families or families of color who more often live in older, poorer quality housing with lead paint hazards. 

Indeed, the National Health and Nutritional Survey consistently finds that on average, African-American and Latino children, as well as children below 200% of the poverty line, have the highest blood lead levels.  Children from low-income families are eight times more likely to be lead poisoned than children from high-income families.  African American children are five times more likely than white children to be lead poisoned.  There is consequently a significant imbalance in the socioeconomic and racial distribution of lead-related health risks including learning and developmental disabilities, lowered IQ, hearing and visual impairment, as well as antisocial, delinquent, and violent behavior. Children with high lead levels are, as adults, more likely to be unemployed, have a criminal record, and lack stable personal relationships.  These consequences extend beyond physical health—they are truly life altering and perpetuate trans-generational cycles of poverty and marginalization in low-income and minority communities.

We have celebrated great reductions in lead exposure since removal of lead from gasoline thirty years ago–the average white child’s blood lead level is now almost negligible.  However, government failure to eliminate exposure for children of every ethnicity and socioeconomic status is not only irresponsible but unjust.

Federally funded lead poisoning education programs like NLPPW are not effective as interventions when success relies on the ability of all families to solve the problem themselves.  Many families cannot pay for a home inspector, a lead paint removal contractor if lead is present, and many do not have access (due to lack of insurance or transportation) to health care for child screening.  Is it fair to blame them for their child’s lead exposure?

More federal funding should instead support the Department of Housing and Urban Development lead hazard control grants program which provides local and State governments the resources needed to eliminate lead paint hazards in low-income homes.  The proposed 2012 federal budget released this February allocates $96 million for these grants. However, it costs $9,000 per housing unit for full lead inspection and abatement—the proposed funding could at most cover 16,000 homes, less than 0.1% of the estimated homes still containing lead hazards. 

Using the most conservative estimate, full lead inspection and abatement would result in a $153,000 return on investment per home.  Complete eradication of all U.S. residential lead paint hazards, getting rid of this problem once and for all, would result in savings of over $3.5 trillion dollars.

The calculated benefits of lead hazard control are significant enough to demand increased federal spending on it, yet they do not even include the unquantifiable benefits of ameliorating a grave social injustice.

Rebecca Fuoco is a Fellow at the Center for Health Leadership in the U.C. Berkeley School of Public Health