Voices from the Field
Lead poisoning has devastating consequences for early childhood health and development. While significant progress has been made in reducing the hazards posed by lead-based paint, collective action is necessary to sustain and expand recent policy gains. PHP supports Public Citizens for Children and Youth in mobilizing diverse partners to prevent childhood lead poisoning.
In 2017, PHP took an important step to address policy issues that affect childhood health and development through our support for Public Citizens for Children and Youth’s (PCCY) work to prevent childhood lead poisoning. PCCY has been at the forefront of local lead poisoning prevention campaigns for almost two decades—from educating the public about the scope and scale of the problem to engaging cross-sector partners, including government officials, in designing and implementing solutions. Their strategies have evolved over time to respond to changing circumstances, based on knowledge gained from research, practice, and community engagement.
PCCY’s lead work started 20 years ago with a program to loan families vacuums with high efficiency particulate air (HEPA) filters to more safely remove lead-based paint dust in their homes. Shortly thereafter, PCCY released a landmark report in 2002, Un-leaded Only: Toward a Safer City for Children, to increase public awareness and mobilize political will to prevent childhood lead poisoning.
The report underlined the danger that lead exposure poses to young children’s health, causing damage to the brain and nervous system and slowing growth and development. The report named lead-based paint as the major source of lead poisoning in Philadelphia and identified children under the age of five whose families live in houses that were built before 1978 (when lead-based paint was banned for residential use) as the most vulnerable.
Reflecting on who is most affected, PCCY Health Policy Director Colleen McCauley noted, “Both then and now, these children are primarily, but not exclusively, minority and low income. Lead poisoning is a social justice issue that propels me, PCCY and our partners to drive towards its elimination so that all kids have a better chance to fulfill their potential.”
In Unleaded Only, PCCY underscored the gravity of current challenges and the potential for progress, emphasizing that, “lead poisoning has been and remains an entirely preventable condition.” What followed was a multi-year effort aimed at generating “resolve” from members of the public and policymakers to “spend the necessary resources and … take action.”
Advocating for Public Sector Program and Policy Development
PCCY partnered with legal advocates, physicians, nurses, and representatives from community organizations to form the Childhood Lead Poisoning Prevention Coalition and to advocate for a $1.5 million increase in the City’s budget for lead poisoning prevention. The campaign included outreach to key City of Philadelphia government stakeholders and City Council members, a letter-writing campaign, a newspaper editorial and articles on lead poisoning, a hearing on lead poisoning as part of the City of Philadelphia’s budget process, and an expert panel that testified at the public hearing.
Collaboration between advocates like PCCY and allies within the City of Philadelphia government resulted in meaningful public sector program and policy development aimed at reducing childhood lead poisoning. Key successes included increasing coordination across the City of Philadelphia’s health and housing agencies to support property owners in removing lead hazards from their homes and expanding prevention programs to proactively find and remove lead hazards in homes with infants and young children. In addition to local resources, the City of Philadelphia government benefited from federal funding through the Department of Housing and Urban Development that helped to remediate the costs of lead hazard control work for low-income property owners.
With continued strong advocacy and persistence, in December 2011, PCCY’s and the Childhood Lead Poisoning Prevention Coalition’s efforts to prevent childhood lead poisoning achieved a notable legislative success: Philadelphia City Council passed the Lead Paint Disclosure Law. The law requires owners of rental properties built before 1978 – estimated to be 95% of all city rental units – in which a child, age 6 or under, resided to:
- Test and certify the property is Lead Safe or Lead Free;
- Provide a certificate to tenant(s) for signature;
- Provide a signed copy of the certificate to the Health Department;
- Attest to the Department of Licenses and Inspection upon application or annual renewal of a rental license that lead certification has been submitted to the Health Department.
The passage of the Lead Paint Disclosure Law constituted important progress. However, PCCY knew that assessing the law’s implementation over time would be critical to evaluating its success. In fact, the resulting data indicated significant challenges. Of the 551,000 housing units built before 1978, 26,000 were believed to be rental properties with children age 6 or under (not all of these properties had rental licenses). Yet, between December 2012 and January 2018, only 4,418 Lead Safe or Lead Free certificates had been submitted to the Health Department —suggesting that the law was having limited impact.
Ongoing engagement and analysis to understand the story behind the data identified key obstacles to effective enforcement and compliance. One of the main barriers to enforcing the law was not being able to identify which rental properties have children living in them. One of the main barriers to complying with the law was the inability of low-income rental property owners to afford testing and remediation.
Despite the Lead Paint Disclosure Law’s slow start, the City’s multi-pronged efforts to prevent lead poisoning had resulted in significant improvements over time. Between 2006 and 2015, the number of children under the age of six in Philadelphia who tested positive for high levels of lead had fallen by approximately 76%. However, Philadelphia’s lead exposure rate remained much higher than the national average and significantly surpassed the lead exposure rate of surrounding counties.
Evolving Strategies based on Lessons Learned
The rate of change – as demonstrated in the most recent data available – appeared to have stalled. The result was that in 2016, according to the Philadelphia Department of Public Health, 2320 children under the age of six using any specimen source (1580 children using a more stringent testing standard of only venous blood specimens) were identified as having blood lead levels above 5 micrograms per deciliter, the level at which the Centers for Disease Control and Prevention (CDC) recommends that public health action be initiated for children between the ages of 1-5 years old.
PCCY quickly jumped into action and re-animated citywide lead prevention efforts. They asked the new Philadelphia Mayor James Kenney to create a Philadelphia Lead Poisoning Prevention Advisory Group with representation from the city and private sector and leadership from Health Commissioner Thomas Farley.
In June 2017, the advisory group issued its report and recommendations, which included expanding the City’s Lead Paint Disclosure Law to apply to all pre-1978 properties; not just those with children under the age of six. The recommendation to expand the law was based on the reality of how often tenants move in and out of city rental properties. Advocates also stressed the importance of removing any incentive by property owners to discriminate against families with young children in order to avoid the cost of compliance.
In November 2017, after six months of organizing and reviewing best practices from other cities, PCCY organized a summit to re-launch the Philadelphia Lead Poisoning Prevention Coalition. The Summit highlighted the recommendations from the Lead Poisoning Prevention Advisory Group created by the mayor and fostered robust dialogue on what action cross-sector stakeholders could take towards implementing the Advisory Group’s recommendations. Key emphasis was placed on the importance of changing the Philadelphia Lead Disclosure Law to be more enforceable and expanding it to apply to all properties built before 1978 with an increase in funding to assist landlords with financial hardships in affording the cost of compliance.
PCCY Executive Director Donna Cooper notes, “Unlike cancer, diabetes or other horrific threats to child health, we can eradicate lead poisoning through better public policy. With the momentum of the summit and renewed commitment of Coalition members, key stakeholders, and Health Commissioner Farley, PCCY is charging forward because lead poisoning has been and remains an entirely preventable condition.”
Mobilizing Partners to Sustain and Expand Gains
PCCY’s ambitious goal is to change Philadelphia’s Lead Paint Disclosure Law to include all rental units built before 1978 and to require the renewal of lead safe certification every two years regardless of changes in tenancy. To make progress towards that goal, PCCY aims to develop research briefs and policy analyses aimed at demonstrating the health impacts of lead exposure and the viability of policy change, educate City Council members and other policy makers about the importance of taking action, and increase the number of coalition members. In December 2018, PCCY published a policy report – Making Philadelphia’s Lead Disclosure Law Universal Will Improve the Health of the City’s Babies – making the case for a universal inspection requirement to ensure that all children are protected.
In conjunction with their local efforts, PCCY has engaged with a broad network of national partners because childhood lead poisoning extends beyond Philadelphia to affect many other cities. While the Flint, Michigan water crisis sharply raised national public awareness about the dangers of childhood lead exposure, ample opportunities remain to increase knowledge-sharing and collaboration across communities.
In December 2017, PCCY initiated a multi-state conversation with child advocacy organizations from six states and the national organization, Partnerships for America’s Children, about mounting a multi-state child lead poisoning prevention campaign. “Philadelphia is a unique city with unique conditions and history,” PCCY Health Director Colleen McCauley notes. “At the same time, we have a lot to learn from other cities with laws and conditions similar to Philadelphia. What are their best practices? How have they overcome barriers we are experiencing? And in turn, how can we contribute to sharing what we’ve learned and accomplished so that others can benefit?”
PCCY’s commitment to promoting a healthier future for all children is far-reaching and critical to its work to prevent childhood lead poisoning over time. “There is no medical cure for lead poisoning,” says PCCY Executive Director Donna Cooper, “but advocacy can help ‘cure’ it by building stronger public will for strategies to remove lead hazards from kids’ homes so they are never poisoned in the first place.”
Update: To learn about the progress of the Lead Free Philly Campaign since this article was initially published – including the passage of an expanded Lead Paint Disclosure Law, read the September 27, 2019 edition of the PCCY newsletter.