Programs to screen, treat lead poisoning in children face budget ax

Fifteen years ago, Liz Colon was shocked when she got the call from her pediatrician. Her 1-year-old son had tested positive for lead poisoning.

Colon had recently bought a house in Providence, R.I., and within a few months her baby was back in the hospital and the local health department was helping her identify the source of the lead.

Nearly two decades later, Colon, who went on to work for the Childhood Lead Action Project, says that without the lead screening and health department efforts, her son likely would have faced major health problems without her understanding why.

"If it wasn't for that screening," she said, "I would have never known."

The program that helped Colon's son is now in jeopardy because of a steep budget cut buried deep in the $1 trillion spending measure Congress passed before the holidays. Congress quietly slashed the Centers for Disease Control and Prevention's lead prevention grant program by 94 percent -- from more than $30 million to $2 million.


Colon, public health advocates and scientists say the cut will have a devastating effect on local health programs. And contrary to common belief that lead poisoning in children is no longer a significant problem, nearly half-a-million children in the country likely have levels of lead in their blood that would exceed a recent CDC science panel threshold recommendation for lead poisoning.

"The good news is that blood lead levels are dropping in the United States," said Perry Gottesfeld, a member of CDC's science advisory panel. "The bad news is there are still 450,000 children that have levels above what we think should be acted on."

"It's a large group of children," he added. "It's a significant problem."

Lead is highly toxic to children, who are typically exposed to it from paint in homes built before 1978, when the metal was banned from residential properties. It can also accumulate in soil and other areas around houses.

Gottesfeld noted that there is no safe level of lead in a child's blood. Exposures to even low levels can lead to neurological effects such as lower IQ. It can also cause cardiovascular, immunological and hormone system effects.

Last week, Gottesfeld's CDC Advisory Committee on Childhood Lead Poisoning Prevention recommended the agency lower the threshold of lead in blood that qualifies as lead poisoning by half -- from 10 micrograms of lead per deciliter of blood to 5 micrograms. The move has been 20 years in the making, and CDC has never rejected one of the panel's recommendations (Greenwire, Jan. 5).

The result, simply put, is there are a lot more children in the country who are classified as having lead poisoning. But with the recent budget cuts, programs designed to screen and treat children will be severely strained, said Robert Pestronk, executive director of the National Association of County and City Health Officials.

"The grim reality of the situation is that this is a preventable problem," he said. "What's going to happen is an inability to act to prevent these very serious symptoms from happening in the first place."

CDC's lead program funds local health departments. The money goes to screening children before kindergarten. If the test comes back positive, the CDC money is used to provide services to the family, as well as send someone to their residence to conduct an environmental inspection and determine where the lead exposure originated. The family can then use that information to either remediate the problem or pressure their landlord to make renovations.

In cities with older housing, such as St. Louis, the program makes an enormous difference and has been successful, said Judith Riehl, the executive director of the St. Louis Lead Prevention Coalition.

But because of the budget cut, St. Louis is now struggling to figure out how to pay for the program. Cities also rely on grants from the Department of Housing and Urban Development for building remediation, but those grants are also drying up, she said.

"We have a tendency in this country to have a crisis of the day or decade and then we move on before we solve anything," Riehl said. "We've basically said a couple thousand children being poisoned isn't a problem anymore, so let's move on to something else."

Anatomy of a budget cut

Rebecca Morley, the executive director of the National Center for Healthy Housing, said the events leading up to the budget cut were "the worst collision of politics I have ever seen."

Even though Congress passed the spending bill, Morley notably pointed the finger at President Obama. In his budget request last year, Obama asked Congress to merge CDC's lead efforts with its asthma program and cut the entire budget by half -- the first time the lead program would have seen a cut since its inception, Morley said.

That, Morley said, "sent the signal that the program is potentially expendable."

And unlike most budget issues, the key stakeholders in support of the CDC lead program cannot lobby because they typically work for local health departments or agencies, Morley said.

The cut is particularly surprising because CDC saw an increase in its overall budget, Morley said. One reason for that is CDC Director Thomas Frieden has not listed the lead program on his top priority list. The issues on that list, Morley said, all saw an increase.

Ruth Ann Norton, the executive director of the Coalition to End Childhood Lead Poisoning in Baltimore, said the budget slash threatens to undermine a program that is close to accomplishing its goals.

"You have one of the most successful public policy and government investments in the past decade," Norton said, "and what they are saying is you're not quite there, but we're going to eliminate the funding."

Pestronk predicted that the funding will return in the future because the problem is not going away. But, he added, advocates and parents will have to speak out.

"People have an expectation that when something like this is discovered something can be done," he said. "This isn't something that people can do themselves. It needs government support and incentives."



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