Read our Coronavirus Coverage Here

North Carolina Health News

News. Policy. Trends. North Carolina.

Donate Now

Additional Thanks

Don't forget to register for our first ever Health Care Half Hour! Our moderator tomorrow morning will be journalist Taylor Knopf and our guests are Bob Ward, assistant public defender in Mecklenburg County and Laurie Coker, mental health advocate. us02web.zoom.us/meeting/regis…

Categories

school health

Photo shows Franklin, NC, a town in Macon County experiencing a coronavirus outbreak. Red brick buildings, a classic main street scene, set against a grey sky.

Population gains and losses create two Americas, and the difference is mostly along rural-urban lines

by

Population gains and losses create two Americas, and the difference is mostly along rural-urban lines - North Carolina Health News

For the past half century, the nation’s smallest counties have lost population about a third of the time. Meanwhile, population growth in the biggest cities was nearly uninterrupted. The difference has big implications for the future of American communities.

By Robert Cushing, The Daily Yonder, April 15, 2021

The graph compares population growth in large metro counties to small metros and nonmetro counties. Large metro counties include the core and suburban counties of metros of 1 million or more and the central counties of metros with 250,000 to 1 million. (Robert Cushing using Census population estimates)

The overwhelming population growth story of the past 50 years has been the increasing concentration of people in central cities and their suburbs. At the same time, growth has slowed in rural America and in smaller cities.

The central counties in the nation’s largest metropolitan areas (those with more than a million people) include just 2% of all counties, 59 of 3,142. But these few counties account for 24% the nation’s population growth over the past five decades.

The 951 counties considered the “most rural” today include 30% of all counties, but they account for only 2% of total population growth since 1970. (These are the rural counties that are not adjacent to any Metropolitan Statistical Area.) And the “most rural” counties have been generally losing population in the last decade, much as they did in the 1980s.

Using U.S. Bureau of Census annual population estimates, the graph at the top of this article contrasts the yearly population growth in 435 large metropolitan counties with growth in 2,707 small metropolitan and rural (nonmetropolitan) counties. (See note below on Yonder classifications for more details.)

The rate of overall population growth declined in the last decade, mostly due to waning rates in large metropolitan areas. But real growth in smaller areas is a fraction of growth in large areas. Also, negative effects of recession periods are more pronounced in the small areas. Since population estimates are based on births, deaths, and net migration, part of the decline in the small county population must be due to outmigration to large metro areas.

Since 1970, immigration has fueled some of the population growth depicted in the chart. The immigrant share of the U.S. population in 1970 was 4.7%, the lowest point in over a century (10% in 1850 and nearly 15% in 1910, an all-time high). Today, the immigrant share is now near that all-time high. Large urban areas seem to attract the dominant share of these flows. 

The Big Churn

As rural counties grew, they became urban. Rural America has been “losing” its fastest growing places because population growth has moved them into the metropolitan category. (We should note here that we are using current-day definitions of metropolitan and nonmetropolitan – synonymous with urban and rural for the purposes of this article.) Nearly half of the counties defined as “rural” in 1970 are now defined as urban.

Still, the geographic difference in population growth is remarkable. Recession years have a dampening effect on population growth everywhere, but even in the worst of times, during recessions and pandemics, the 59 large metropolitan areas were still absorbing 300,000 to 400,000 newcomers per year, while the 954 most rural counties were losing people.

The graph compares population change in central counties of major metropolitan areas (1 million or more residents) with population change in rural counties that are not adjacent to a metro area (the most rural counties in the nation). (Robert Cushing/U.S. Census)

The result is these two groups of counties are, in a sense, living in different countries. Where to build the next school can be an issue at one extreme. At the other, the question may be what is the next school to close. Growing counties need to tax and invest in infrastructure, whereas the declining counties are losing the population base needed to sustain the existing infrastructure.

(Robert Cushing/U.S. Census population estimates)

An astonishing 36% of all counties lost population over the past five decades. In the last decade, about half of all counties reported declines in population. That is the longest stretch of such magnitude in the past 50 years. The losses are uneven in terms of magnitude, duration, and location, and, some urban counties lost population during the past 50 years, and many small areas gained population.

So, it is not necessarily all big vs. small, but it is a zero-sum game. When a county “loses” population, that does not mean the population all died. Some undoubtedly did and were not replaced by a birth or a newcomer moving into the county. Many other losses resulted when people just moved and showed up as gains in other counties. Many “gains” in large metropolitan areas may be due to a baby boom or two, but more likely there were new folks moving into town.  

The Yonder Population Mobility Table

With so many moving parts and so much churning over so many years, we use a form of mobility table to summarize (and simplify) the net results. Since all the moving parts are additive components, the table can serve as a benchmark and can be disaggregated by time period or geography for more detailed comparisons.

Table: Daily Yonder/Robert Cushing Source: US Census, OMB Get the data Created with Datawrapper

Table: Daily Yonder Get the data Created with Datawrapper

Note both the population gains and population losses are expressed as proportion of each total. The difference between the two tells something about each Yonder category.

The biggest (Major Metro Core) and the smallest two types (Rural, Adjacent to Metro County and Rural, Not Adjacent to Metro County) have substantial losses.

Notice the 17% net gain for the Major Metro Suburban counties and 8% net gain for Medium Metro Core counties.  They seem to be soaking up folks from everywhere else, including the counties in or near the metro area.

As far as population growth is concerned, the most rural places seem to be in a downward trajectory.

Robert Cushing is a retired professor of sociology at the University of Texas Austin. He is the coauthor, with Bill Bishop, of The Big Sort: Why the Clustering of Like-Minded America Is Tearing Us Apart.

Notes

See the U.S. Census website for a fuller discussion of the use and construction of mobility tables.

County Classifications

  • Major Metro Core: Central counties of metropolitan areas of 1 million residents or more.
  • Major Metropolitan Suburban: Suburban counties of metropolitan areas of 1 million residents or more.
  • Major Metro Exurbs: Outlying counties located within a Major Metropolitan Area but where a majority of the population lives in nonurbanized (or rural) settings, as defined by the Census.
  • Medium Metro Core: Central counties of metropolitan areas with 250,000 to 999,999 residents.
  • Medium Metro Suburban: Suburban counties of metropolitan areas with 250,000 to 999,999 residents.
  • Small Metro: All counties that are in a metropolitan area under 250,000 residents.
  • Rural, Adjacent: Nonmetropolitan counties that are adjacent to a metropolitan area.
  • Rural, Not Adjacent: Nonmetropolitan counties that are not adjacent to a metropolitan area.
shows the back of a wheelchair, with an old and wizened hand on the arm of the chair

Project ECHO resounds throughout WNC

by

Project ECHO resounds throughout WNC - North Carolina Health News

Long-term care facilities use a “guided practice” model to mitigate the coronavirus.

By Melba Newsome

Each Monday at noon, Janice Somers closes her office door at Westwood Hills Nursing and Rehabilitation and puts her phone on Do Not Disturb. For the next 90 minutes, the nurse administrator and four team members join hundreds of employees from over a hundred North and South Carolina facilities for the Nursing Home COVID-19 Action Network, a four-month online course designed to establish common guidelines for infection control in nursing homes.

The training is a way to share best practices and other practical information. But Somers says the camaraderie is important, too.

“I want to know what other people are doing,” says Somers. “We’ve all been so isolated. Ever since March, everything is a Zoom meeting.”

ad reminding readers to support our COVID coverage

Long-term care facilities have been ground zero for the COVID-19 pandemic but many proved ill-equipped for the challenge. Though facilities are required to have someone focusing on infection control, only 3 percent of those staff have taken a basic infection control course. The North Carolina Health Care Facilities Association, the statewide industry group for skilled nursing facilities, sent out a memo about an upcoming course being offered by the Mountain Area Health Education Center and Somers signed right up.

Nursing Home COVID-19 Action Network’s training series is just one of eight pandemic-related continuing education series operated by MAHEC using this model. They include screening/treating COVID-19 in primary care; acute care for hospital inpatient; and developing resilience in the healthcare workforce.

A way to expand learning

After seeing patients wait a long time to be treated for hepatitis C, Sanjeev Arora, a liver specialist at the University of New Mexico Health Sciences Center in Albuquerque, got the idea of teaching rural physicians how to screen, diagnose and treat patients.

Arora believed that if patients didn’t have to drive six hours to see him, many more of these hepatitis cases could be treated effectively.

That’s where Project ECHO comes in. Instead of moving people, the ECHO (Extension for Community Healthcare Outcomes) model, using remote learning technology to involve people who are actually delivering the care in the teaching process. The technique moves knowledge out to more people, allowing for expanded treatment capacity and making better health care available, particularly in remote and rural areas.

The model was so successful it has been replicated all across the country, particularly in areas when geographic and socioeconomic barriers make access to specialty care difficult, if not impossible. Topics include advanced disease management techniques for conditions ranging from Type II diabetes, epilepsy and chronic obstructive pulmonary disease to substance use disorders and other complex behavioral health problems.

Bringing Project ECHO to MAHEC

When Lourdes Lorenz-Miller, MSN, trained to bring Project ECHO to MAHEC in September 2017, she was told that it takes six months to get similar programs up and running.

A month later, UNC Health Sciences at MAHEC became one of the first academic health centers in the state to offer a continuing education ECHO for rural physicians. In January 2018, they unveiled the school nurse ECHO, followed by one for treating chronic pain in patients with opioid use disorder.

“Project ECHO allows us to share what we have learned with providers and their patients across the region,” says Lorenz-Miller. “ECHO learning isn’t from up top but from each other who are on the front lines. It has the potential to address health challenges in a big way by reaching more people. That is what makes this model so exciting.”

To date, MAHEC has developed 10 different ECHO series: chronic pain management, behavioral health, rural medicine, high-risk prenatal care, geriatric care, oral health, adverse childhood experiences and school health. These workshops have trained more than 8,000 participants from all 16 WNC counties and 96 counties statewide.

The training model

The training sessions follow a standard pattern. Actual case studies are submitted by participants or experts in advance for feedback and recommendations for next steps. In each training session, MAHEC’s experts share specialized knowledge in real-time with providers who, in turn, share their first-hand experiences. The other participants on the call get a chance to weigh in with suggestions and tips about what’s worked for them in similar situations.

Nurses, physicians and pharmacists receive continuing education credits for participating.

Programs are paid for in a variety of different ways. For example, the ulcerative colitis ECHO is free to participants because it attracts sponsors. In contrast, an eight-week school nurse training costs $115.

The nursing home ECHO is supported by the federal Agency for Healthcare Research and Quality (AHRQ) in collaboration with the non-profit Institute for Healthcare Improvement (IHI).

Participating nursing homes receive a $6,000 stipend.

The training program is designed to meet five key benchmarks:

  • keep the virus from entering nursing homes;
  • identify infected residents and staff;
  • prevent spread between staff, residents and visitors;
  • provide safe and appropriate care to residents with mild and asymptomatic cases of the virus;
  • ensure staff is adequately trained to implement best-practice safety measures.

Somers and her staff welcomed the detailed plan.

“The information stream has been very confusing, not only for physicians but for people that work in clinics and nursing homes because there wasn’t any kind of national strategy,” says Somers. “The CDC was saying something, the state was saying something else and there was a lot of confusion. This way everybody gets the same training and information.”

Most of the participants work for standalone facilities and struggle to keep abreast of ever-changing directives. However, Westwood is one of many nursing homes owned and operated by Principle Long Term Care. Somers and her team have relied on the corporate office to sort through and keep them informed on the latest coronavirus-related news and policies.

Nonetheless, she still believed there were reasons to participate in the ECHO, like hearing from someone going through the same thing.

“It’s an unbelievable experience when you find out that COVID is in your building and that the staff has got COVID,” says Somers. “It takes long hours and everybody has to do many different jobs.

“One night, my job was to collect trash in all the rooms because the housekeepers were out. Thank goodness my dietary staff never went down because I would have had to be in there cooking and that might have been a problem.”

Steve North and Amanda Martin of the Center for Rural Health Innovation, which administers the Spruce Pine-based MY Health-e-Schools program.

School-based health centers fill rural provider vacuum

by

School-based health centers fill rural provider vacuum - North Carolina Health News

Making healthcare available to students, faculty and staff on campus is vital to well-being in rural areas.

By Melba Newsome

Growing up in a small town in central Wisconsin, many of Steve North’s relatives and friends assumed he would follow his father into medicine but North had other ideas. He earned a liberal arts degree at the University of Wisconsin-Madison in 1993 but, instead of applying for medical school, he applied for Teach for America.

For the next two years, North taught 5th- through 8th-grade exceptional education in Edgecombe County where he saw how unaddressed medical problems kept his students from reaching their academic potential.

ad reminding readers to support our COVID coverage

“The kids were frequently coming to school sick or missing lots of school,” recalls North. “I started doing some reading and got turned on to the idea of school-based health centers (SBHC), which were relatively new on the national scene at the time.”

What he learned persuaded North to finally follow in his father’s footsteps and he was accepted to medical school at UNC Chapel Hill.

While practicing family and adolescent care medicine in Bakersville, a remote mountain town with fewer than 500 residents, North continued to look for ways to provide better care to the children he served. A Jim Bernstein Community Health Leadership Fellowship gave him the support and resources to start the Center for Rural Health Innovation, a non-profit dedicated to improving rural access to health care. That led to the formation of Health-e-Schools, remote clinics that provide primary care and behavioral health services for school kids.

A doctor’s office on campus

North Carolina has been trying to solve the state’s provider scarcity problem for decades with varying degrees of success. In the western part of the state, the doctor-to-patient ratio can be as high as one to 2,000 in some of the most remote areas. School-based health clinics (SBHCs) bring together educators and health practitioners to bridge the health care and education gap and help reduce the disparities that impact school children in rural burgs.

SBHCs are essentially doctors’ offices conveniently located on campus to provide a range of health care services for students, as well as for teachers and staff. For many rural, low-income residents in health care deserts, these clinics are their only access to care.

With permission from a parent or guardian, students are enrolled at the beginning of the school year and can take advantage of available resources. In addition to seeking medical attention for acute issues such as ear and stomach aches, enrollees can also receive chronic disease management, immunizations, well-child checkups, sports physicals, adolescent medicine consultants, and hearing and vision screenings.

North Carolina law also allows minors to seek medical health services for the prevention, diagnosis and treatment of sexually transmitted diseases, pregnancy, substance misuse or emotional disturbances without parental consent.

Additionally, these clinics also help reduce the number of days of classes missed by students.

“This is a good thing because when they come back after being out for a couple of days, they’re behind and it takes a while for them to get back up to speed,” said North. “If that happens more frequently with chronic absenteeism, it can be really tough to bring students back on track.”

SBHCs continue to expand

SBHCs continue to grow across the country and the state, particularly in areas with a shortage of health care providers. Some are funded through private grants but many others are supported by state and federal appropriations. Most partner with the local school district and a community health organization, such as a community health center, hospital or local health department. All are committed to serving every student, regardless of insurance or ability to pay.

When North and the Center for Rural Health Innovation launched Health-e Schools in 2011, the program served just three schools. Now, it reaches more than 25,000 students in 80 schools across three western counties, McDowell, Mitchell and Yancey.

“Parents might work 30 miles in one direction and children go to school 20 miles in the other,” said North. “Before this, when that inevitable call comes in that said ‘Johnny is sick,’ parents had to drive to school, pick up the child and go to the doctor’s office. A lot of those people would end up in the ER who probably didn’t need to be there.”

Shows a man smiling behind a mask worn to prevent transmission of COVID-19. He's standing next to a sign for the Health-e Schools sign for a clinic site at Greenlee School.
Jason Hall, principal of Greenlee Primary School in the Mitchell County town of Spruce Pine shows off his school’s affiliation with Health-e Schools. Photo credit: Lacey Jones, RHI

Similar alliances operate all across the state. Blue Ridge Health operates 13 SBHCs in Henderson, Buncombe, Swaine, Jackson, Rutherford and Polk counties. Many of their students have an hour-long bus ride to and from school so the convenience of on-site clinics means a child doesn’t have to miss a day of school just to see a doctor.

On the other end of the state, the Pender Alliance for Teen Health (PATH) operates three SBHCs in southeastern Pender County, filling a big gap in a place where families routinely drive 50 miles one-way to see a health care provider.

“We have certainly improved their access,” said Kimberly Collins, lead nurse for Pender County Schools. “More kids are getting their annual physicals and getting vaccinated on time. Our staff is able to see them for whatever needs they might have without having to leave work or take a whole day off, or even a half a day off.”

Using high-definition video conferencing with specially equipped stethoscopes and cameras, a centrally located health care provider can examine students at multiple schools without traveling.

As these programs continue to grow, equipping them with these tools becomes more economical, said North.

“It used to cost $30,000 to put telemedicine technology in a school,” he said. “We can now equip a school nurse for about $2,000, with a better piece of equipment that they can take from school to school.”

Behavioral care a gaping need

A study in JAMA Pediatrics found that 72 percent of North Carolina children diagnosed with a behavioral health condition waited more than a year to meet with a licensed mental health provider. According to a brief from the North Carolina Institute of Medicine, this is due in large part to the shortage of specialized instructional support personnel such as nurses, counselors, psychologists and social workers. For example, the recommended ratio is one social worker for every 250 students. North Carolina has one for every 1,427 students, according to the NC IOM report.

Lack of high-speed internet can complicate telehealth delivery in rural communities but SBHCs have made great strides in using technology to connect students to counselors, psychologists and social workers.

In September 2018, Hurricane Florence dropped more than 40 inches of rain in one day on Pender County. Up to 70 percent of the county was under water, 3,000 homes were damaged, and tens of thousands of residents were displaced. Schools remained closed for 29 days while families tried to rebuild or relocate.

By the time the coronavirus pandemic hit 18 months later, hundreds of families still lacked permanent housing.

“The pandemic is like a second wave gut punch for Pender County,” said Sandy Rowe, PATH executive director. “We were still reeling from Florence. With the poverty, remote areas and the domestic violence against our kids, they are feeling like they can’t count on anything.

“We’ve focused on doing what we can to reach them and offer services early enough in the process so that we don’t have a bigger problem later on.”

When a post-Hurricane Florence mental health risk assessment found that 30 percent of the children were at risk for depression, PATH stepped in to add two full-time teletherapy counselors and a health coach to its team of providers. It also boosted preventive measures by developing a mindfulness curriculum for teachers.

Blue Ridge has on-staff counselors for district students and Health-e-Schools partners with Mission Health to address the needs of students with complex mental health issues. Instead of missing school and possibly driving an hour to see a therapist, they can see a mental health provider and still get back to class before the school day ends.

There is a growing recognition of the value SBHCs have to their communities. In 2016, the Federal Office of Rural Health Policy and the Health Resources and Services Administration encouraged expanding access to SBHCs and provided more than $6 million in grants for rural telehealth programs. Last year, HRSA awarded $11 million to SBHCs for technological upgrades.

This is a win-win that bodes well for the growth of SBHCs, particularly in rural areas.

Melba Newsome is a 2020 EWA Reporting Fellow. This story is produced as part of EWA’s drive to support enterprising journalism that informs the public about consequential issues in education. 

This 2006 photograph showed a nurse in the process of administering an intramuscular vaccination to an adolescent girl whose sister, mother, and grandmother watched from the background.

Pandemic causes immunization rates to dip

by

Pandemic causes immunization rates to dip - North Carolina Health News

Fear of being exposed to the coronavirus is contributing to parents skipping child well visits and their vaccinations.

By Melba Newsome 

When Kim Wilson got pregnant three years ago, she joined an online community group for expectant and new moms. Members shared advice and offered support with few disagreements, except when the discussion turned to immunizations. Wilson recalls some moms being dead set against vaccinating their children, having bought into the debunked reports of harm and conspiracy theories. She shared those concerns with her pediatrician who took the time to explain the risks and benefits to her.

shows a beautiful african american woman with an adorable little african american girl who has all her vaccinations. They are hugging.
Kim Wilson and her 2-year-old daughter Lauren Grace, who is up to date on her vaccinations, so far. Wilson has gotten into debates in online community groups where other young mothers have expressed suspicion of vaccines. Photo courtesy: Kim Wilson

“I told her I was scared and she showed me the studies and what the numbers looked like,” says Wilson. “She helped me understand that the risk is so much greater of not being vaccinated.”

That means her daughter, 2-year-old Lauren Grace, is up to date on her immunizations and Wilson has since encouraged other mothers to do the same. But the vaccine debate is heating up again in the online forum, this time for a different reason.

“Some moms still don’t want to get them and others are just afraid to go to the doctor’s office because they fear they’ll catch the virus,” says Wilson.

The Morbidity and Mortality Weekly Report from the CDC detailed a decline in child vaccinations during COVID-19 in the state of Michigan. Fear of contracting the coronavirus has kept many parents from taking their children to doctors for well-child visits.

That trend has been noted in North Carolina too. N.C. Department of Health and Human Services tracks and documents immunization ordering and vaccines administered in the state’s immunization registry, which shows a dramatic drop.

Public health and infectious disease experts worry that this decline could endanger the 93 to 95 percent vaccination rate necessary for herd immunity against diseases such as measles, mumps and whooping cough.

“We are very concerned about the significant drop in immunization rates, particularly for children,” Amy Adams Ellis, NCDHHS public information specialist, wrote in an email. “Vaccinations protect everyone from dangerous and potentially deadly diseases, such as polio, tetanus, and diphtheria. Well child visits and immunizations continue to be important during this time. Families should contact their health care provider to discuss well child visit options during this time and how to keep immunizations up to date.”

shows two lines, the blue line fro 2019 shows consistent vaccinations week to week, but the red line shows a drop off in vaccinations once the COVID-19 pandemic closed much of the state.
Graph shows difference in childhood vaccinations administered during corresponding weeks in 2019 and 2020. Data courtesy: NC DHHS

Safer patient care

North Carolina has put the force of law behind requiring vaccinations against certain diseases on a recommended schedule. Immunization records are checked when a child enters an early childhood program. Clinics and family practices across the state are working to assuage concerns about the vaccinations and encouraging parents to stay current on their child’s immunizations and maintain regular wellness visits.

The Levine Children’s Hospital in Charlotte has redesigned its care model to minimize the risk of exposure to COVID-19 to parents and children when they visit the hospital. They have implemented enhanced cleaning and everybody wears masks and PPE. Parents and children are also asked to do so. Waiting rooms are now virtual. Patients wait in their cars until they receive a text or email letting them know the doctor is ready to see them.

ad reminding readers to support our COVID coverage

Dr. Lisa Reed, a family practice physician at the MAHEC Family Health Center in Asheville, says the vaccination rates for kindergarteners in Buncombe are around 95 percent, which is lower than the rest of the state. The non-vaccination numbers in Asheville and Buncombe County were driven by parental preference.

The pandemic has pushed non-vaccination numbers higher across the state overall, as numbers provided by DHHS to NC Health News show.

Reed describes the coronavirus as “an explosion at the heart of everything that happens in medicine” when nearly all patient care was put on hold.

“For about a month, we had a really big decline in all wellness visits for children,” she said. “We needed to create an entirely new system to do that wellness care, and then outreach to our patients to get them back on the schedule.”

Shows a really cute little girl holding her doll.
Two-year-old Lauren Grace is up to date on her vaccinations, according to her mother, Kim Wilson. Photo courtesy: Kim Wilson

MAHEC has since implemented a blended telehealth model to streamline the process and make the clinic a safe space for wellness visits. Logistical changes for in-person care include a new specialty clinic for pediatric wellness visits. Patients complete the preliminary paperwork by phone so when they arrive for labs, shots or a physical exam, they are escorted into special clean rooms right away. Anyone with a respiratory complaint or fever is seen in a separate area of the clinic.

In the meantime, Reed and her colleagues are playing catch up on immunizing kids who have scheduled vaccines due.

“We’re doing outreach, talking to parents about what the experience will be like and then bringing them into the office in a way that they’re not being exposed to anyone who’s sick,” she said.

Vaccinate early

Charlotte Mecklenburg Schools leaders are pushing this as the perfect time to get vaccinations and prevent the mad rush to catch up on immunizations once restrictions are eased.

“Some people have a more relaxed schedule,” CMS School Health Specialist Monica Adamian said in a media release. “They can get out there and go to their doctor’s office or to the health department and get those immunizations now.”

Stay-at-home orders that went into effect in March may have had the unintended effect of reducing the risks of contracting diseases like measles because in-person interactions were greatly limited. But in an op-ed published in the Charlotte Observer, Lavanya Vasudevan, assistant professor in the Department of Family Medicine and Community Health at Duke, warns that won’t continue.

“Now that some states are easing restrictions and allowing people to move about in their communities, there is a fear of outbreaks for diseases like influenza and especially measles,” wrote Vasudevan.

Reed says medical professionals worry that in six months or a year, there will be outbreaks of measles or pertussis because children have fallen behind on their vaccines.

“It’s absolutely imperative that we as a community support these families so that they can get in and get their kids vaccinated,” says Reed. “The health department doesn’t need extra outbreaks. They’re gonna be so busy with this coronavirus outbreak for many months going forward.”

a little boy drinks at a water fountain that appears to be in the hallway of a school. Children are particularly vulnerable to lead exposure, and they can get it through drinking contaminated water.

Lawmaker will again attempt to get lead out of water in schools, daycare centers

by

Lawmaker will again attempt to get lead out of water in schools, daycare centers - North Carolina Health News

North Carolina does not test for lead in drinking water in schools and child care centers. State Rep. Harry Warren hopes to change that soon.

By Greg Barnes

Parents of students at Red Oak Elementary School in Nash County were never notified after federal officials found excessive levels of lead in the school’s water in July 2015.

Instead, school administrators posted a notice on a brick wall in the school’s kitchen. Under state law, it was the only notification they were required to provide, despite the dangers that lead poses to children.

According to the U.S. Environmental Protection Agency, even low levels of lead exposure to children can damage their nervous systems and cause learning disabilities, stunted growth, hearing loss, low IQ and impaired formation and function of blood cells. And a new study published this week in JAMA Psychiatry adds to the growing body of research that lead exposure can have adverse mental health effects as children grow.

But the children at Red Oak Elementary were out for summer break when the high lead levels were detected. By the time they returned to classes, the Asheville Citizen Times reported, subsequent tests showed that the lead levels had dropped to below 15 parts per billion, the level the EPA sets as the threshold for safe water provided by public utilities.

Nothing else was done at the school. Nothing had to be.

North Carolina has no law requiring testing and remediation of excessive levels of lead in the state’s more than 100 school systems. It has no law saying parents have to be told when high lead levels are found.

State lawmakers in the North Carolina General Assembly tried to change that in 2016 and again in 2017. House members introduced bills that would have required testing for lead in schools and daycares and remediation when the levels exceeded the 15 parts per billion threshold. Both bills died in committee.

Former state Rep. Mike Hager, the primary sponsor of the initial bill, blames a lack of commitment and concerns over funding.

Hager said lawmakers, school administrators and others thought it would cost too much to test all of the schools and childcare centers and remove faucets and fixtures — possibly even entire plumbing systems — in those facilities where excessive lead levels were found.

Before a federal law took effect in 1988, schools, homes and other buildings commonly used lead solder to join pipes. They also used brass fittings, faucets and fixtures that contained lead. The lead can — and often does — leach into drinking water.

Hager estimated that it would cost roughly $4 million to $5 million to test and remediate the lead in schools and daycares, a small price to pay, he said, in a $22.2 billion budget.

“To me, it’s a no-brainer,” Hager said. “I couldn’t figure out why it didn’t catch fire. Three years and Flint, Michigan, later, and still nothing has been done that I know of.”

Echoes of Flint

School systems and state governments across the country began to take a second look at lead in schools in 2015, at the start of the Flint water crisis.

That city had changed its water source from Lake Huron and the Detroit River to the less expensive – and more polluted – Flint River. Changes in water processing caused lead to leach from the water pipes, exposing more than 100,000 people to potentially harmful levels. The pipes continue to be replaced today. A state report in 2016 estimated that it would cost $80 million to replace about 10,000 lead water lines in the city. The entire cost of fixing the problems was estimated at $216 million.

Sponsored

Hager, the former Republican state representative from Rutherford County, said he started working on his bill to remove lead from schools and childcare centers after USA Today published a series of articles on the subject in 2016.

Analyzing EPA data, the national newspaper found that nearly 2,000 water systems in the United States — including schools and daycares — could be contaminated with lead. Hager said the article mentioned that North Carolina was among the states with the worst problems.

Armed with the same data the EPA had used, Hager and other lawmakers drafted a bill citing 79 public schools or child care centers in 44 North Carolina counties that had been found to contain excessive levels of lead.

Hager said he doesn’t have a list of the 79 schools and centers. The state departments of Public Instruction, Health and Human Services and Environmental Quality all say they don’t have one, either.

That means there is no way of knowing whether the lead problems in those buildings were eliminated, or if parents were even notified.

shows a typical hallway drinking water fountain
Photo credit: MarkBuckawicki, Wikimedia Creative Commons

According to the CDC, in the past, a child could have a blood level of 10 micrograms per deciliter of blood, before health officials got concerned. But in 2012, the agency revised its “level of concern” downward to 5 micrograms per deciliter of blood.

Now, the EPA emphasizes that there is no safe level of lead exposure. Its maximum contaminant level for lead is 0 parts per billion in drinking water. The U.S. Food and Drug Administration caps the lead level in bottled water at 5 parts per billion, and the American National Standards Institute sets it at 10 parts per billion for certified water filters.

No requirement for action

In July, the U.S. Government Accountability Office released a report that said only 43 percent of school districts nationwide tested for lead in school drinking water in 2016 or 2017. Those schools tested serve 35 million students. An estimated 41 percent of the nation’s school districts, serving 12 million students, had not tested for lead at all, and another 16 percent of systems did not respond to the government survey.

Many of the school districts that did not test were in rural areas.

According to the report, elevated lead levels were found in an estimated 37 percent of the school districts tested. All school districts with excessive lead levels took steps to reduce or eliminate exposure, including replacing water fountains, installing filters or new fixtures, or providing bottled water, the report said.

Citing the EPA, the report said at least eight states require schools to test for lead as of 2017. The rest of the states, including North Carolina, have no such provision.

But that could soon change.

State Rep. Harry Warren, a Republican from Salisbury, said he plans to reintroduce a bill he co-sponsored in 2017 that was almost identical to the bill Hager wrote.

Like those before it, Warren’s new bill would require the state’s child care centers and public schools to test for lead and remediate it when found above the 15 parts per billion threshold. Warren said he plans to reintroduce the bill in February.

Only this time he plans to have a better analysis of the costs involved.

Warren believes his original bill died because of concerns about costs, who would pay and pressing unrelated issues facing the General Assembly in 2017. Before reintroducing the bill, he said, he plans to glean information from the Charlotte-Mecklenburg and Guilford County school systems, both of which tested their water in the past several years.

Warren said he hopes the results from those school systems will give lawmakers a better understanding of the money that would be needed should his bill pass.

Some districts taking action

In the Charlotte-Mecklenburg school system, lead tests were voluntarily conducted in 2017 on more than 1,600 water fountains and fixtures at 58 of the system’s 176 schools.

The tests, targeting elementary and K-8 schools in old buildings, found 27 schools with unsafe lead levels, including one where the level at a sink in a school cafeteria measured 28 times higher than the 15 parts per billion threshold, according to The Charlotte Observer. The school system paid a consultant about $230,000 to conduct the tests. Additional tests are planned.

In Guilford County, voluntary testing found three schools with elevated lead levels. That school system is replacing fountains and faucets where lead is known to have been used and plans to test many more of its schools this year. Testing for 10 schools initially sampled cost $14,000, according to the Greensboro News & Record.

Warren said the new bill’s sponsors are wondering “can we project an average cost? Can we develop a grant program or funding? How does it work if we assist counties?

NC Health News stories about children's issues made possible in part thanks to sponsorship by Health Decisions Resources, providing grants for health education.

“I don’t think it will be all that much money when you get right down to it,” he said.

Warren could soon have additional ammunition to help him get his bill passed.

On Jan. 7, Gov. Roy Cooper’s office sent the EPA a notice of intent to participate in a federal grant program authorized by the Water Infrastructure Improvements for the Nation Act. The grant designates $20 million in funding to states. If approved, the state Department of Health and Human Services would be the grant recipient.

The lead debate

Despite a renewed push for legislation, a question remains as to how serious of a threat lead poses in schools’ drinking water.

While the EPA stresses that any lead exposure can be harmful, Dr. Michael Beuhler, medical director for the Carolinas Poison Center, counters that lead standards in water are based on an entire lifetime of consumption by vulnerable people, such as young children and pregnant women.

Students’ water intake at school each day is likely less than 1 percent of their total consumption of fluids, Beuhler said.

“Lead is part of our environment,” he said in an email. “We try to limit it, but it is there at very low levels. This water isn’t likely adding anything significant to their underlying exposure unless there is a very strange type exposure, like a child living in the school and consuming just the school water.”

Beuhler questioned whether legislation to test for lead “could be a veiled attempt to drive small schools/daycare out of business due to the cost of testing their water unless there was funding offered and the testing scheduling made sense. Or maybe a lab in N.C. that is going to make money hand over fist with more water samples being done?”

According to DHHS, about 150,000 children in North Carolina are tested for lead exposure every year. That includes nearly half of the state’s children between the ages of 1 and 2. The most common exposure is from lead paint.

A state report in 2014  — North Carolina Childhood Blood Lead Surveillance Data — illustrates the pervasiveness of lead in children in this state. The report, the most recent available, shows that 122,481 children between the ages of 1 and 2 were tested for lead exposure in 2012-13. Of those, 1,643 had blood lead levels above 5 micrograms per deciliter.

shows an empty hallway, lined with lockers, blue on one side, yellow on the other side
[email]
[email]
[zip]
[zip]
[listGroups]
[listGroups]
[email]
[email]
[zip]
[zip]
[listGroups]
[listGroups]