Childhood lead poisoning is widely recognized as one of the most significant environmental health problems impacting children in the United States (Landrigan et al. 2002), as well as many other countries (WHO 2010; Jacobs 2011). Lead is one of the longest-known, best-understood, and most well-monitored environmental toxins. Most (but not all) children with elevated blood lead levels are exposed to lead through lead hazards in older housing.
More than half a million children in the United States still have blood lead levels above the Centers for Disease Control and Prevention reference value of 5 micrograms per deciliter (or µg/dL) (CDC, 2013). The National Toxicology Program of the National Institutes of Health (NIH) has concluded that there is now sufficient scientific evidence that even below the CDC level, children can experience decreased academic achievement and IQ, and increased incidence of attention-related behaviors and problem behaviors (NTP, 2012). Population-wide rates of elevated blood lead levels have declined since lead was removed from paint, food cans, gasoline and other sources by federal law in the 1970’s, and since industrial emissions and water lead levels were reduced (Levin et al., 2008), but elevated rates of lead poisoning persist in certain areas and among low-income and minority children, and others who continue to be disproportionately affected (Levin et al., 2008). Therefore, there is increasing interest in the potential of local housing policies to reduce lead hazards.
The federal bans on lead in new paint and gasoline did not eliminate risks from existing lead paint in older homes. To address remaining risks, Title X of the federal 1992 Housing and Community Development Act took several steps to reduce lead hazards in housing. In 1996, the US Department of Housing and Urban Development (HUD) and the US Environmental Protection Agency (EPA) started requiring disclosure of known lead hazards in all pre-1978 housing. HUD phased in lead safety requirements for federally assisted housing and established federal grants for housing rehabilitation. By 2000, government-assisted housing had lower levels of lead paint hazards compared to non-assisted low-income housing (Jacobs et al. 2002). Additionally, as of 2010, the EPA regulates renovation, repair and painting practices in pre-1978 housing.
At the state level, legislatures have adopted a variety of policy approaches. Most rely on secondary prevention: identifying children with elevated blood lead levels through blood lead screening programs and then removing the lead hazards from these children’s environments. Unfortunately, secondary prevention does not protect children from the permanent injuries caused by lead poisoning. Research has clearly established that medical treatment for a child with lead poisoning is necessary but has limited effect. The best solution is to prevent exposure in the first place (Brown and Meehan 2004, 8–9, Lanphear et al. 2005). For this reason, there is interest in the effectiveness of housing-based primary prevention policies—laws that aim to identify and fix lead hazards before children become poisoned. Several states, notably Maryland, Massachusetts, Washington, DC, and Rhode Island, have housing-based primary prevention laws (Brown et al. 2001; Mares 2003; Breysse et al. 2007). However, statewide or local primary prevention laws have not been implemented in most jurisdictions.
Thus, privately-owned pre-1978 housing remains a major source of children’s exposure to lead and resulting elevated blood lead levels. To fill this gap, in recent years a number of innovative local policies have been enacted (Brown, 2005; Korfmacher and Hanley, 2013). Although they differ in terms of target housing, mechanism, and enforcement strategy, these local policy approaches aim to reduce childhood lead poisoning by reducing the prevalence of lead hazards in high-risk housing, and do so by improving maintenance practices and controlling lead hazards. This Knowledge Asset summarizes the rationale underlying local housing policies and their effectiveness.