[Congressional Record Volume 145, Number 146 (Monday, October 25, 1999)]
[Extensions of Remarks]
[Pages E2179-E2181]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




           NATIONAL CHILDHOOD LEAD POISONING PREVENTION WEEK

                                 ______
                                 

                          HON. CARRIE P. MEEK

                               of florida

                    in the house of representatives

                        Monday, October 25, 1999

  Mrs. MEEK of Florida. Mr. Speaker, last week the Senate passed, by 
unanimous consent, a resolution which designates this week--October 24, 
1999, through October 30, 1999--and a similar week next year as 
``National Childhood Lead Poisoning Prevention Week.'' I would like to 
take this opportunity to inform my colleagues about the very serious 
problem of childhood lead poisoning.
  Lead poisoning is a leading environmental health hazard to children 
in the United States. According to the United States Center for Disease 
Control and Prevention, 890,000 preschool children in the United States 
have harmful levels of lead in their blood which can cause serious, 
long-term harm to children, including reduced intelligence and 
attention span, behavior problems, learning disabilities, and impaired 
growth. Children from low-income families are 8 times more likely to be 
poisoned by lead than those from high income families.
  Mr. Speaker, I have worked with the Alliance to End Childhood Lead 
Poisoning and other concerned groups to help address this problem. I 
would like to submit the following article from the American Journal of 
Public Health which further details the lead poisoning problem and 
strategies to combat it.

        [From the American Journal of Public Health, June 1999]

     Protecting Children From Lead Poisoning and Building Healthy 
                              Communities

       Lead's toxicity to human organs and systems has been 
     extensively documented for over 2 millennia. The 20th century 
     is remarkable for the dispersal of lead throughout the human 
     environment, making lead poisoning a community health problem 
     of global dimensions.\1\ Young children are at highest risk 
     because of lead's neurotoxic effects, which reduce 
     intelligence and attention span and cause learning 
     difficulties and behavior problems.\2,3\ Blood lead screening 
     and surveillance are important tools, but primary prevention 
     requires controlling sources of exposure. Although the 
     challenge varies from country to country, the steps needed to 
     eliminate this disease are now apparent.


               Evidence That Environmental Controls Work

       Over the past quarter century, progress on childhood lead 
     poisoning in the United States has been remarkable: the mean 
     blood lead level of US children fell by 80%, and the number 
     of children with elevated blood leads declined by 90%.\4,5\ 
     These changes did not occur spontaneously or by chance. 
     Strict regulation of many lead uses, enacted after decades of 
     determined industry opposition, has gradually detoxified the 
     air, water, and food supply. The evidence is clear that 
     controlling ongoing sources of lead exposure produces 
     immediate and significant health benefits, which typically 
     far outweigh the costs.\6\ The difficulty of cleaning up once 
     lead contaminates the environment underscores the urgency of 
     controlling it at the source.


                     The Legacy of Lead-Based Paint

       Despite impressive progress, lead poisoning remains a 
     serious environmental health hazard in the United States: 
     4.4% of all children aged 1 to 5 years have elevated blood 
     lead levels (≥10 μg/dL).\5\ Lead-based paint in nearly 
     two thirds of all U.S. housing poses by far the greatest 
     remaining challenge.\7\ (In particular communities and 
     populations, a variety of other sources and pathways also 
     expose children to lead.) While children can be severely 
     poisoned by eating paint chips, the principal pathway is 
     chronic exposure to settled lead dust, which gets on 
     children's

[[Page E2180]]

     hands and toys and is ingested through normal hand-to-mouth 
     behavior.\8\ Recent research has confirmed the important role 
     of interior lead dust and the need for more protective 
     standards.\9\
       Two distinct scenarios account for most lead poisoning in 
     U.S. children: paint deterioration because of poor 
     maintenance and remodeling projects that inadvertently 
     release lead particles. Remodeling and repainting projects 
     that fail to control and clean up lead dust likely account 
     for 5% to 10% of poisonings,\10\ a challenge that 
     conventional health education and limited training can 
     overcome. The dominant scenario of poisoning among U.S. 
     children is unattended deteriorating paint and lead dust 
     hazards in older, low-income housing. Water damage and 
     excessive moisture are the principal causes of paint 
     deterioration as well as of a multitude of other health 
     hazards. For example, moisture encourages the growth of mold, 
     mildew, mites, and microbes, which contributes to asthma and 
     other respiratory problems.\11\
       In the 1980s, many considered the presence of leaded paint 
     a health hazard. Paralyzed by the insuperable difficulties of 
     full removal (the cost alone is estimated at $500 
     billion),\12\ the public health response was confined almost 
     entirely to belatedly reacting to already poisoned children. 
     Despite its appeal at many levels, literally ``getting the 
     lead out'' of U.S. housing is not a feasible primary 
     prevention strategy. Research has validated the effectiveness 
     of strategies that safely manage leaded paint in 
     place\13\-\15\ and has shown that poor paint 
     condition is a stronger predictor of risk than the paint's 
     lead content.\8\ Rather than removing lead paint from a few 
     properties, the more effective path to protecting children at 
     risk is to make housing lead safe, a formidable but 
     surmountable public health challenge.


          Protecting Children At risk Requires New Approaches

       Continuation of current strategies is unlikely to provide 
     near-term protection to children living in low-income housing 
     in distressed communities, who are at highest risk for lead 
     poisoning. Four shifts in approach are required to eradicate 
     childhood lead poisoning in the United States.

        Make Lead Safety an Integral Part of Housing Activities

       Recognition that poor housing condition is a root cause of 
     lead hazards demands a shift from the traditional approach 
     whereby experts deal with one environmental hazard at a time. 
     Rather than being viewed as the province of a small corps of 
     experts conducting one-time interventions, lead safety in 
     older housing must be integrated into various activities. 
     While ``abatement contractors'' are needed for complex 
     projects, techniques for controlling moisture and lead dust 
     must be incorporated into all housing activities, remodeling, 
     and vacancy treatments. Basic training in moisture control 
     and lead safety will arm painters, remodelers, maintenance 
     staff with vital skills and can help build indigenous 
     capacity within communities at high risk for lead poisoning. 
     Housing codes must be updated and enforced to ensure control 
     of moisture and lead dust hazards.

       Identify and Control Lead Hazards Before Poisoning Occurs

       Preventing poisoning requires demystifying the detection of 
     property-specific lead hazards, the vast majority of which 
     have never been identified, much less controlled. While only 
     a certified lead expert can declare a property ``safe'' for 
     legal purposes,\16\ visual inspections for maintenance 
     deficiencies can trigger corrective preventive measures. 
     Sending a chip of peeling paint or a single ``dust wipe'' to 
     an environmental laboratory for analysis (about $5 per 
     sample) is sufficient to detect a hazard in a high-risk 
     property. Because deteriorated paint and dust lead levels on 
     floors and other surfaces are strong predictors of risk, 
     health departments need to screen high-risk housing as well 
     as test children's blood lead levels. Parents, property 
     owners, contractors, and community residents can be trained 
     in a single day to conduct visual maintenance checks and 
     environmental sampling. Environmental samples provide 
     property-specific information that can transform the federal 
     lead-based paint ``right-to-know'' law from an empty promise 
     to a catalyst for action.\17\

                  Secure New Resources for Prevention

       Both the public and private sectors need to dedicate 
     additional resources to controlling housing-related health 
     hazards. The lead, petroleum, and paint industries need to 
     contribute their share to prevention through either the 
     courts or the Congress. Managed care providers can reduce 
     health care costs for asthma and lead poisoning by making 
     strategic investments to address environmental hazards in 
     housing before children are exposed. In particular, the 
     Medicaid program, which serves children at high risk for lead 
     poisoning,\18\ should explore ways to support the early 
     identification and control of health hazards in high-risk 
     housing. Medicaid must also start screening all young 
     children as required \19\ and provide the recommended follow-
     up services.\20\ Government support for affordable housing 
     should be increased to recognize the importance of decent 
     housing in controlling environmental health hazards and 
     reducing health care and education costs.

        Make Healthful Housing a National Environmental Priority

       Protecting at-risk children from lead hazards in their 
     homes requires reintegrating housing into public health and 
     environmental health practice. The environmental and public 
     health communities and those who fund their research, 
     advocacy, and policy work must begin to shift attention from 
     the ambient environment to confront the reality that 
     substandard housing in distressed communities is the leading 
     environmental health threat to U.S. children. There is no 
     more chilling example of environmental injustice than 
     concentrations of substandard housing in low-income urban 
     neighborhoods, reflected by the fact that low-income children 
     and Black children are at 8 times and 5 times higher risk for 
     lead poisoning, respectively, than other U.S. children.\5\ 
     Without leadership by the environmental, public health, 
     medical, and philanthropic communities, the accelerating 
     deterioration of housing in distressed communities will 
     increasingly threaten health, spread blight, and devastate 
     low-income families.


                          The Global Challenge

       The causes of lead poisoning vary country by country and 
     community by community.\21\ Because significant sources of 
     lead exposure remain largely unregulated in most countries, 
     both developed and developing, lead poisoning is typically 
     more widespread and severe in other countries than in the 
     United States.
       A common excuse for delaying control at the source is the 
     perceived need to determine the exact extent of the problem 
     and the specific contribution of each source. Environmental 
     and health officials must not allow industry's demands for 
     screening, surveillance, or epidemiological studies to 
     preempt or postpone the control of obvious and serious 
     sources of exposure. Where dispersive uses of lead continue, 
     the self-evidence of both the problem and the remedy demands 
     action. The ready availability of superior, practicable 
     alternatives makes the continued use of lead inexcusable in 
     any product with the potential for broad exposure (e.g., 
     gasoline, paint, plumbing supplies, food cans, printing ink, 
     fertilizer, and children's toys).
       Leaded gasoline, the foremost cause of global lead 
     exposure, is the obvious first candidate for control in the 
     more than 150 countries in which it is still in use.\22\ All 
     automobile engines can operate on unleaded gasoline,\23\ and 
     superior, cost-competitive alternatives are readily available 
     to replace lead or reduce engine octane demand.\24\ Removing 
     lead from gasoline is the single greatest step to preventing 
     lead poisoning as well as a prerequisite to achieving other 
     air quality improvements through the introduction of 
     catalytic converters and modern engine technology.\25\ There 
     is no excuse for leaded gasoline use to continue in any 
     country after the end of this century.
         Don Ryan, MURP, Alliance To End Childhood Lead Poisoning, 
           Washington, DC; Barry Levy, MD, MPH, Barry S. Levy 
           Associates, Sherborn, Mass; Stephanie Pollack, JD, 
           Conservation Law Foundation, Boston, Mass; Bailus 
           Walker, Jr, PhD, MPH, Howard University Cancer Center, 
           Washington, DC.


                               References

     \1\ Florini K. Krumbhaar GC, Silbergeld EK. Legacy of Lead: 
     America's Continuing Epidemic of Childhood Lead Poisoning. 
     Washington, DC: Environmental Defense Fund; 1990.
     \2\ National Research Council. Measuring Lead Exposure in 
     Infants, Children, and Other Sensitive Populations. 
     Washington, DC: National Academy Press; 1993.
     \3\ Schwartz J. Low-level lead exposure and children's IQ: a 
     meta-analysis and search for a threshold. Environ. Res. 1994; 
     65:42-55.
     \4\ Pirkle JL, Brody DJ, Gunter RA, et al. The decline in 
     blood lead levels in the United States. The National Health 
     and Nutrition Examination Surveys (NHANES). JAMA. 1994; 
     272:284-291.
     \5\ Centers for Disease Control and Prevention. Update: blood 
     lead levels--United States, 1991-1994 [published erratum 
     appears in MMWR Morb Mortal Wkly Rep. 1997; 46:607]. MMWR 
     Morb Mortal Wkly Rep. 1997; 46:141-146.
     \6\ Salkever DS. Updated estimates of earnings benefits from 
     reduced exposure of children to environmental lead. Environ 
     Res. 1995; 70:1-6.
     \7\ Westat. Report on the National Survey of Lead-Based Paint 
     in Housing. Washington, DC: Environmental Protection Agency; 
     1995. EPA report 747-R95-005.
     \8\ Lanphear BP, Burgoon DA, Rust SW, et al. Environmental 
     exposures to lead and urban children's blood levels. Environ 
     Res. 1998; 76:120-130.
     \9\ Lanphear BP, Matte TD, Rogers J, et al. The contribution 
     of lead-contaminated house dust and residential soil to 
     children's blood lead levels. Environ Res. 1998; 79:51-68.
     \10\ Centers for Disease Control and Prevention. Chilfen with 
     elevated blood lead levels attributed to home renovation and 
     remodeling activities--New York, 1993-1994. MMWR Morb Mortal 
     Wkly Rep. 1997; 45:1120-1123.
     \11\ Hope A, Patterson R, Burge H, eds. Indoor Allergens: 
     Assessing and Controlling Adverse Health Effects. Institute 
     of Medicine. Washington, DC: National Academy Press; 1993.
     \12\ US Dept of Housing and Urban Development. Report to 
     Congress: Comprehensive and Workable Plan for the Abatement 
     of Lead-Based Paint in Privately Owned Housing. Washington, 
     DC: US Dept of Housing and Urban Development; 1990.
     \13\ KKI Repair and Maintenance Research Team. Lead-Based 
     Paint Abatement and Repair and Maintenance Study in 
     Baltimore: Findings Based on Two Years of Follow-Up. 
     Washington, DC: Environmental Protection Agency; 1997. EPA 
     report 747-R-97-005.
     \14\ Battelle Memorial Institute. Review of Studies 
     Addressing Lead Abatement Effectiveness. Washington, DC: 
     Environmental Protection Agency; 1995. EPA report 747-R-95-
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     \15\ National Center for Lead-Safe Housing and University of 
     Cincinnati. National Evaluation of the HUD Lead-Based Paint 
     Hazard Control Grant Program: Fifth Interim Report. Columbia, 
     Md: National Center for Lead-Safe Housing; 1998.

[[Page E2181]]

     \16\ US Dept of Housing and Urban Development. Putting the 
     Pieces Together: Controlling Lead Hazards in the Nation's 
     Housing. Washington, DC: US Dept of Housing and Urban 
     Development; 1995. Publication HUD-1547-LBP.
     \17\ Disclosure of Known Lead-Based Paint Hazards Upon Sale 
     or Lease of Residential Property. 35 CFR pt 35 subpt H and 40 
     CFR pt 745 subpt F (1996).
     \18\ US General Accounting Office. Lead Poisoning: Federal 
     Health Care Programs Are Not Effectively Reaching At-Risk 
     Children. Washington, DC: US General Accounting Office; 1999. 
     Publication GAO/HEHS-99-18.
     \19\ State Medicaid Manual Sec. 5132.2, revision 12 (1998). 
     Washington, DC: Health Care Financing Administration; update 
     of 42 USC Sec. 1396d(r)(1) (1989).
     \20\ Centers for Disease Control. Preventing Lead Poisoning 
     in Young Children. Atlanta, Ga: Centers for Disease Control; 
     1991
     \21\ Rapuano M, Florini K. The Global dimensions of Lead 
     Poisoning. Washington, DC: Alliance To End Childhood Lead 
     Poisoning and Environmental Defense Fund; 1994.
     \22\ Lovei M. Phasing Out Lead From Gasoline: World-Wide 
     Experience and Policy Implications. Washington, DC: The World 
     Bank; 1996. Paper no. 040.
     \23\ Environmental Protection Agency. Costs and Benefits of 
     Reducing Lead in Gasoline: Final Regulatory Impact Analysis. 
     Washington, DC: Environmental Protection Agency, 1985. EPA 
     report 230-05-85-006.
     \24\ Alliance To End Childhood Lead Poisoning. Myths and 
     Realities of Phasing Out Leaded Gasoline. Washington, DC: 
     Alliance To End Childhood Lead Poisoning; 1997.
     \25\ Alliance To End Childhood Lead Poisoning. International 
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     Alliance To End Childhood Lead Poisoning; 1995.

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