Prevention Agenda - Healthy Mothers, Healthy Babies, Healthy Children - Childhood Lead Poisoning Prevention
The Burden of Childhood Lead Poisoning
Lead is among the most common environmental toxins for young children in NYS. Children are most commonly exposed to lead by the ingestion of paint chips or dirt that is contaminated with lead. In 2008 in NYS, 3,010 children were diagnosed with lead poisoning. Lead poisoning is an important cause of learning disabilities, anemia, and growth problems. Children exposed to lead may have problems with paying attention and being aggressive. Elimination of childhood lead poisoning is essential to improving the lives of children in NYS, especially socio-economically disadvantaged children who are disproportionately affected by lead poisoning. NYS has made significant progress towards reducing both the incidence and severity of childhood lead poisoning, but it remains a serious public health problem.
According to a study published in 2009, every dollar invested in lead paint hazard control results in a return of $17-$221 or a net savings of $181-269 billion. The benefits are attributed to higher lifetime earnings, increased tax revenue, lower health care costs and the direct costs for crime, and reduced need for special education.1
Because medical treatment options for lead poisoning are limited, it is critical that children be protected from lead exposure before they become lead poisoned. Early identification of children with elevated blood lead levels through routine blood lead testing is essential to assure coordination of follow-up services to minimize harmful effects and prevent further exposure to lead. Under current NYS Public Health Law and implementing regulations, health care providers are required to test all children for lead at or around age one year and again around age two years. Health care providers are also required to assess all children ages six months to 72 months at least once annually for lead exposure, with blood lead testing for all children found to be at risk based on those assessments. Approximately 66% of children born in 2005 were tested for lead at or around age one year and about 62% at or around age two. About 88% of children received at least one lead test by age 36 months, and almost 48% (47.5%) of children born in 2005 received at least two tests by age three years.
- Gould E. Childhood lead poisoning: conservative estimates of the social and economic benefits of lead hazard control. Environmental Health Perspectives. 2009 July;117(7):1162-1167.
- By the year 2013, increase the percentage of New York children who had at least one lead screening test by 36 months of age to at least 96%. (Baseline: 77% of NYS excluding NYC, 2002 birth cohort, NYS Childhood Lead Poisoning Prevention Program data).
Indicators for Tracking Public Health Priority Areas
Each community's progress towards reaching these Prevention Agenda Objectives will be tracked so members can see how close each community is to meeting the objectives.
See also objectives and indicators under the Healthy Environment - Lead in the Home.
- Increase the percent of children receiving blood lead screening tests at or around age one year
- Increase the percent of children receiving blood lead screening tests at or around age two years
- Increase the percent of children receiving at least one blood lead screening test by age 36 months (CDC national comparison measure)
- Increase the percent of children receiving at least two lead tests by age 36 months
- Reduce the number and rate of elevated blood lead levels among children under age six years
Data and Statistics
- Eliminating Childhood Lead Poisoning in New York State: 2006-2007 Surveillance Report
- This report summarizes the status of childhood lead testing and lead poisoning in NYS, excluding New York City (NYC), for children less than six years of age. It contains several new measures to more effectively assess and monitor progress toward the elimination of childhood lead poisoning by 2010. Historical data have been included to show trends over time for these new measures.
- New York State County Health Assessment Indicators
- Reports contain maternal and child related statistics, including blood lead levels among children, and are organized by topic and county of residence.
New York State Department of Health Programs
The NYSDOH supports a strong statewide network of programs and resource centers to prevent childhood lead poisoning, and help those children who have been exposed to lead. The NYSDOH oversees the following initiatives to eliminate lead poisoning in NYS:
- The Childhood Lead Poisoning Primary Prevention Program
- Local Health Department Lead Poisoning Prevention Programs
- Regional Lead Resource Centers.
- Childhood Lead Primary Prevention Program
The reports describe NYSDOH's innovative primary prevention pilot project that began in 2007 and became a permanent program in 2009. The reports compile the data collected in Year 1 and Year 2. The Program has expanded from its original 7 counties and New York City to 15 counties including NYC. Programs can be found in the counties of Albany, Broome, Dutchess, Erie, Monroe, Niagara, Onondaga, Oneida, Orange, Rensselaer, Schenectady, Ulster and Westchester, as well as in New York City. The Program's funding has also increased based on early successes from $3 million in 2007 to $8 million in the 2010-2011 contract year.
- Local Health Department Lead Poisoning Prevention Programs
- The NYSDOH provides funding, educational materials, and technical support to 57 county health departments and the New York City Department of Health and Mental Hygiene to:
- Provide public and professional education on childhood lead poisoning prevention;
- Promote lead screening (blood lead testing) of children;
- Help children with lead poisoning through blood lead monitoring, risk reduction education, medical evaluation and treatment, and environmental management. Specific services depend on the child’s blood lead level; and
- Identify and reduce lead hazards before children become lead poisoned.
- Regional Lead Resource Centers
- The NYSDOH supports three Regional Lead Resource Centers (RLRCs) that provide:
- Offer education and technical assistance to health care providers and local health departments within their target areas to improve lead screening, prevention education and other clinical prevention activities. RLRCs use a variety of outreach and education methods including newsletters, web-based media, grand rounds, meetings, and other strategies;
- Provide clinical consultation on the medical management and case coordination of children and pregnant women with lead poisoning, including education and direct technical assistance to health care providers and local health department lead program staff; and
- Serve as regional clearinghouses for lead poisoning prevention information.
There are three regional lead resource centers located at Montefiore Medical Center in New York City, State University of New York Upstate Medical Center in Syracuse, and Kaleida Health/Women & Children’s Hospital of Buffalo. These centers are strategically placed to provide statewide coverage. The Syracuse and Buffalo-based centers partner with Albany Medical College and University of Rochester, respectively, to assist with regional coverage.
The NYSDOH, in collaboration with a number of strategic partners, has developed a statewide plan to eliminate childhood lead poisoning. The plan outlines goals, objectives and strategies related to both primary and secondary prevention of lead poisoning. Published in 2004, the plan provides a general framework to be adapted to changing needs, evidence and opportunities.
Strategies – The Evidence Base for Effective Interventions
- Preventing Lead Poisoning in Young Children. Atlanta: Centers for Disease Control and Prevention (2005).
- This comprehensive document includes recommendations for states and localities to prevent lead poisoning, including strategies to improve lead testing/screening of children. The report highlights recommendations to establish formal agreements among health, social services, housing, and legal agencies to increase sharing of data and educational information. In its communications with state lead poisoning prevention programs, CDC has specifically highlighted collaboration between state and local lead poisoning prevention and WIC programs to improve lead testing of at-risk children.
- Interpreting and managing blood lead levels below 10 ug/dL in children and reducing childhood exposures to lead: recommendations from CDC's Advisory Committee on Childhood Lead Poisoning Prevention. MMWR Recommendations and Reports. 2007 Nov 2;56(RR-8):1-16.
- This report highlights CDC recommendations for blood lead testing of at-risk children in the context of emerging evidence regarding the adverse effects of blood lead levels below 10 mcg/dL. The report was also published in the Journal Pediatrics (120;e1285-e1298, 2007).
- Lead exposure in children: prevention, detection and management. American Academy of Pediatrics Committee on Environmental Health. Pediatrics 2005;116:1036-1046.
- This policy statement of the American Academy of Pediatrics summarizes literature and recommendations for both pediatric health care providers and state and local governments related to prevention, screening and treatment/management of childhood lead poisoning. The statement highlights the importance of routine lead screening and testing, with emphasis on state requirements and federal Medicaid requirements. The 2005 statement updates previously published AAP policy statements on this topic.
- Public health detailing: a strategy to improve the delivery of clinical preventive services in New York City. Public Health Reports. 2006 May–Jun; 121(3): 228–234.
- Public health detailing is emerging as a best practice approach for improving a variety of health care services, including preventive practices. Public health detailing may be an effective and feasible strategy to improve routine lead testing of young children by increasing health care provider/staff knowledge, implementation of clinical tools and greater use of patient education materials.
- Alliance for Healthy Homes
- The Alliance for Healthy Homes is a national, nonprofit, public interest organization working to prevent and eliminate hazards in homes that can harm the health of children, families, and other residents. The website has a variety of information such as newsletters, discussion groups, presentations and information on trainings and conferences.
- Centers for Disease Control and Prevention (CDC) - Lead
- The CDC website has information including state-level lead surveillance data, prevention tips, publications, state level and local programs, policy resources, tools and training.
- U.S. Environmental Protection Agency - Lead in Paint, Dust and Soil
- The website has basic information about lead, grants, information on EPA requirements for lead abatement professionals, and other resources.
- National Institutes of Health
- The website contains a comprehensive collection of lead-related information including an overview of diagnosis and symptoms, prevention and screening guidelines, specific conditions, videos, clinical trials, journal articles, glossaries, directories, law and policy, and statistics.
- U.S. Consumer and Product Safety Commission Recalls and Product Safety News
- This website has information on products, including those recalled for lead hazards.
- National Center for Healthy Housing (NCHH)
- The National Center for Healthy Housing is a nonprofit organization working towards establishing healthy, green, and safe homes for families across all income levels through research, education, training, and policy efforts. NCHH provides educational programs, tools and resources to help the public create and maintains healthy homes.
Return on Investment
- Gould E. Childhood lead poisoning: conservative estimates of the social and economic benefits of lead hazard control. Environmental Health Perspectives. July 2009;117(7):1162-1167.
- According to this study published in 2009, every dollar invested in lead paint hazard control results in a return of $17-$221 or a net savings of $181-269 billion. The benefits are attributed to higher lifetime earnings, increased tax revenue, lower health care costs and the direct costs for crime, and reduced need for special education.
- Brown, MJ, Costs and benefits of enforcing housing policies to prevent childhood lead poisoning. Medical Decision Making, 2002, 22(6):482-492.
- The author conducted a decision analysis using population-based data that compared recurrence of childhood lead exposure in two urban areas with different enforcement capacity, and cost data from a federal project and from medical and public health literature. Strict enforcement prevented additional cases, resulting in $45,360 savings from decreased medical and education costs and increased productivity for protected children. The savings were not realized if the probability of recurrence in limited units was 44% lower than estimated, or if fewer children were identified in limited versus strict enforcement units. This analysis suggests that strict enforcement of housing policies are needed to prevent childhood blood lead elevations. It will lead to decreased societal costs due to the avoidance of future medical and special education, and to increased productivity of resident children.
Partners in the State’s childhood lead poisoning prevention efforts include:
- New York State Local Health Departments
- Regional Lead Resource Centers
- Bureau of Refugee and Immigrant Assistance Programs and Providers
- New York State Advisory Council on Lead Poisoning Prevention
More InformationBureau of Maternal and Child Health
Lead Poisoning Prevention Program
Corning Tower, Room 1805
Empire State Plaza
Albany, NY 12237 Troy, NY 12180-2216
Phone: (518) 402-5706
Fax: (518) 486-7268
Childhood Lead Poisoning Prevention Program
Division of Environmental Health Protection
547 River Street
Troy, NY 12180-2216
Phone: (518) 402-7600