Eliminating Childhood Lead Poisoning in New York State by 2010

IV. Challenges to Lead Poisoning Elimination in New York

Clearly new evidence is emerging that even levels of lead previously thought to be safe can have significant health effects for young children, which can ultimately result in large societal costs both financially and in terms of lost human potential. New strategies must be developed that have the ability to overcome the current challenges that face elimination of lead poisoning in New York State. The assessment presented in Sections I-III helps define opportunities that exist within New York State for the prevention and ultimately the elimination of childhood lead poisoning by the year 2010 and beyond.

Education
Since new evidence is emerging about the dangers of even relatively low levels of lead, we must ensure that new strategies include continuing education of health care providers, consumers, and policymakers. Current education efforts should be expanded to incorporate new information about the effects of low lead levels, identification of potential lead hazards, and feasible and effective methods to make environments lead safe. In addition, public health officials can help focus educational messages highlighting the significant societal burden that lead poisoning imposes — an outcome that is no less real than the individual adverse health effects of lead, but more difficult to accurately communicate.

Screening:
While universal screening of one and two-year olds is the law of the land in New York, more can be done to ensure that this is indeed the standard of pediatric practice. Evidence from NYSDOH clearly demonstrates that having a normal blood screen for lead at one year old does not eliminate the possibility of having lead poisoning at age two. Furthermore, in order to monitor elimination efforts, screening must be increased and surveillance must be kept high.

Housing:
As already described in this document, the biggest potential source of lead for New York State's children is older housing stock. This is very likely the most difficult challenge to overcome and new strategies will have to address the inherent problems associated with older housing stock. Location of problem housing, how it is maintained, safe and effective solutions for lead hazard control, and compliance with code regulations all need to be considered. At the same time, in addressing these issues care must be taken not to negatively affect the housing market for low-income residents.

Primary Prevention:
Despite educational initiatives, increased screening and surveillance, and targeted lead hazard controls, it is apparent that in order to achieve elimination additional primary prevention education and housing initiatives will be required. Based on the collective evidence presented below, there is consensus among researchers, health care providers, and policymakers that primary prevention strategies must be strengthened to achieve elimination of childhood lead poisoning. In New York State, both universal strategies and strategies targeting high-risk communities must be employed to achieve elimination of childhood lead poisoning.

The Case for Lead Poisoning Elimination

  • Even at moderately elevated blood levels commonly observed among young children, lead is associated with measurable detrimental effects on cognitive, behavioral, and social-emotional developmental outcomes;
  • The harmful effects of lead occur even at concentrations below the current "level of concern" of 10 mcg/dL. Lead may in fact exert the largest incremental effects on IQ at blood levels below 10 mcg/dL. These findings are consistent with basic science studies of lead neurotoxicity, and support the conclusion that there may be no identifiable threshold of safety for lead exposure among young children;
  • The cognitive effects of lead toxicity are believed to be irreversible, and there is no evidence that medical treatment in the form of chelation benefits children with elevated blood lead levels in the low to moderate range;
  • Small declines in average IQ scores and other developmental outcome measures at an aggregate level represent substantial health, social, and economic costs at a population level;
  • Focusing on average lead levels in a population masks the susceptibility of individual children to the effects of lead. Children already at high risk for a range of health and developmental problems due to socio-economic disadvantage are the most likely to be exposed to lead, and appear to be most vulnerable to its debilitating effects.
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