By Catherine Clabby
North Carolina’s General Assembly appears poised to beef up state standards required to protect more children from lead at home and in the other places they frequent.
If that happens, North Carolina’s threshold for intervening after a blood test reveals lead contamination in a child will finally match Centers of Disease Control and Prevention recommendations that have been in place for five years.
It means more children in North Carolina with dangerous levels of lead in their blood will likely receive the protections they deserve, said Tom Vitaglione, a senior fellow at the advocacy group NC Child.
“The number of exposed children has dropped fairly dramatically in North Carolina,” said Vitaglione, a former state public health official. “We’re really close to the finish line. Now let’s get there.”
Consistent with Gov. Roy Cooper’s budget plan, both the House and Senate budget bills call for lowering the designation of “confirmed lead poisoning” to a concentration of 10 micrograms per deciliter (µg/dL) in the blood of a child younger than six, down from the previous standard of 20 µg/dL.
An “elevated blood lead” ranking would move to concentrations of 5 down from 10 µg/dL.
In “poisoning” cases, state Department of Health and Human Services officials can require that lead risks in children’s residences, or other places such as child care centers, be removed. When elevated lead is recorded, the Department of Health and Human Services, with consent, can investigate lead exposure risks and tell family members and property owners what they find.
The more aggressive response is expected to produce a four-fold increase in state investigations of lead exposure sources from an average of 130 a year to more than 500 annually, according to a state Division of Public Health budget request.
There is likely less lead in air, water, soil and buildings in North Carolina and all of the United State than ever before. Credit for that goes to policies that, over decades, phased out or limited lead in gasoline, paint, toys and other products. Levels of lead detected in children in this state have fallen too.
But no level of lead exposure is now deemed safe for a fetus or a young child.
That’s a good thing because children with a blood lead concentration of 5 μg/dL or greater can experience IQ score deficits, scientists say. Poor school performance, attention deficits and serious behavior problems have all been tied to blood lead levels of less than 5 μg/dL, the U.S. National Toxicology Program concluded in 2012.
Americans were reminded of the dangers of lead in 2015 when high levels were detected in the blood of children in Flint, Mich. after city officials switched to cheaper drinking water supplies that were corrosive and leached lead from old pipes and plumbing fixtures.
Such a danger has flared in North Carolina on a much smaller scale. Lead levels detected in the blood of young children in Greenville and Durham in 2005 and 2006 was traced to corrosive water that apparently extracted lead from lead-based solder (banned since 1987) in the children’s homes.
But lead paint poses the biggest exposure risk today. Lead-based paint was banned for use in housing in 1978 but it remains on walls and window frames in older and poorly maintained homes. Young kids, who naturally explore their environments with their hands and mouths, are at greatest risk of ingesting lead paint chips or dust, indoors and out.
Rather than wait for the state to embrace the CDC standards, some counties, including Guilford, adopted them independently in recent years.
Advocacy in NC
Well aware of the persistent statewide risk, NC Child approached state DHHS officials in June 2016 about the state’s failure to adequately collect and circulate data on lead detected in North Carolina, as it had once done.
That was work traditionally completed by the state’s Childhood Lead Poisoning Prevention Program (CLPP) but the program started falling behind after losing federal and state funding starting in 2011.
Citing decreases in staff and an influx of incomplete data from clinic-based blood testing equipment, public health officials in March and November recruited volunteers at the UNC Gillings School of Public Health to help with the backlog. “Due to loss of personnel and other resources, monitoring of file submissions has been inadequate for the past few years, resulting in a considerable backlog of follow up for incomplete or inaccurate lead testing data,” one request for help read.
That meant public health officials couldn’t know where all the lead exposure problems were turning up, NC Child executive director Michelle Hughes wrote last summer to former state health deputy secretary Randall Williams and public health director Danny Staley.
“Currently we have no idea how many North Carolina children exceed the ‘new’ (as of 2012) CDC blood lead level of 5 µg/dL, or in which counties, ages or ethnic groups,” Hughes wrote. “Without a strong surveillance program, lead-poisoned children can slip through the cracks, and lead hazards continue unabated to harm additional children.”
Republican Gov. Pat McCrory’s DHHS responded well in 2016 and took steps to catch up on the backlog, Vitaglione said. Data on lead tests published on the state website now date to 2014.
Officials also started the tasks needed to work up the legislative budget plans that are now close to being approved, he said.
The House’s version of the budget calls for investigating the source of lead in the blood of pregnant women as well as children but neither the Senate language nor Cooper’s budget language has that in it.
Rep. Greg Murphy (R-Greenville), a physician and advocate in budget negotiations for more aggressive interventions, said this week he believes both children and pregnant women will be included in the final bill sent to the governor by the legislature.
But who pays?
In a written request to speed up how soon they investigate the source of lead found in children, DHHS officials say they’ll need more staff to get the job done. They proposed funding additional positions with $559,045 in annual Medicaid funds. But federal Medicaid officials must first allow the state to receive payments normally dispersed to managed care entities.
If federal Medicaid officials give the green light, the money would allow DHHS to double an environmental investigation staff from six to 12. Other DHHS staff would be committed to the project as well.
Vitaglione said he is hopeful the new standards and the plan to get Medicaid money to fund more lead investigations is just a first step to attacking all potential sources of lead that children encounter. He and other child health advocates supported a bill last year that would have mandated screening drinking water in older schools for lead.
That bill died in the Senate.
One obstacle to passage of that bill was the lack of money to pay for needed repairs on old school buildings, Vitaglione said. He hopes that child health advocates, school officials and other government officials can collaborate in coming months to find whatever money is needed.