Chapter 2 - Early failures and the seeds of success

Abstract

In 1971 the US Surgeon General issued a call for widespread blood lead testing in children, suggesting that 60–80µg/dL should trigger certain actions, far higher than today’s reference blood lead reference value of 3.5µg/dL. In 1978 the Centers for Disease Control and Prevention (CDC) issued its first advisory on childhood lead poisoning, aimed primarily at medical management of clinical symptoms, with limited discussion of lead paint inspection and remediation. Blood lead testing revealed exposures after they had already occurred and chelation therapy was not effective for the vast majority of poisoned children. In 1985 CDC issued another lead poisoning prevention statement over the objections of the lead industry. The first national population blood lead study did not occur until the late 1970s through the National Health and Nutrition Examination Survey (NHANES), which reported large disparities by income, urbanization, and race (older homes most likely to have lead paint were not reported). The 1988 NHANES was the first to report higher exposures in older housing from paint. The move to block grants under the Reagan Administration in the 1980s ended most of the nation’s blood lead screening programs, which did not restart until the end of that decade. The housing profession largely referred the problem to health professionals, despite the 1938 Housing Act that required “decent safe and sanitary housing.” Research showed that simply removing lead paint failed: it increased (not decreased) exposures because the importance of lead dust control was not yet understood. Many children were readmitted to the hospital after such paint removal (such methods are now banned). Yet local governments and courts persisted in attempting dangerous paint removal, despite the evidence of harm. Lawsuits proliferated, threatening the viability of low-income housing but failing to provide relief for most lead-poisoned children. The large scale of the problem and the discovery of the importance of lead dust and improved remediation methods became clear by the end of the 1980s.