Monday, May 3, 2004

Lead Astray in Ohio

Ohio is failing to protect children from lead poisoning

An estimated 19,000 children under age six in Ohio have unsafe levels of lead in their blood, according to a new analysis by the Environmental Working Group (EWG) that identifies high-risk counties and neighborhoods across the state. The study is based on lead poisoning risk criteria from the federal Centers for Disease Control and Ohio state health officials. Less than one third of these 19,000 children, just 5,700, have been identified and reported to the state by health care providers. This dramatic undercounting of lead poisoned children in Ohio is primarily due to the pervasive failure of doctors and HMOs to test children for lead. A law mandating testing of children in state designated high risk zip codes went into effect in Ohio on April 1, 2004.



County Estimated Children Poisoned
Cuyahoga 4,011
Franklin 1,495
Hamilton 1,489
Lucas 996
Montgomery 960
Summit 887
Stark 594
Total 10,432
  • More than half of the lead poisoned children in Ohio — some 10,400 children — live in seven metropolitan counties that contain the largest cities in the state.
  • Statewide, only one of every seven children ages one through five was tested for blood lead levels in 2002. In no county did testing rates exceed thirty percent.
  • In 58 of 88 counties in Ohio, at least 90% of children with a blood lead level above 10 ug/dL have not been identified because of low testing rates in these counties.
  • Half of the lead poisoned children in Ohio who were not identified live in just 9 counties.

This failure to test children for lead translates into a dramatic undercounting of the number of lead poisoned children in Ohio. The resulting undercount ensures that high-risk housing is not identified, which in turn undermines support for critical lead paint remediation efforts. Prevention is the cornerstone of any effective effort to eliminate lead poisoning in the future.

Lead is a proven neurotoxin that causes permanent loss of IQ and other brain damage at low levels of exposure, especially in children. The primary source of lead in the environment is lead paint in older homes, particularly those constructed before 1950. The small bits of flaking paint become lead-contaminated house dust that can stick to skin. Children eat flakes of paint, or ingest lead-contaminated dust each time they put their hands in their mouths or directly mouth a surface coated with dust.

click here for a larger image
Percentage of Children Lead Poisoned by County
[Click for more detail]

Urban counties are not the only areas where children are at risk. Seven of the ten counties with the highest percentage of children under six with unsafe amounts of lead in their blood are rural counties in the southeastern portion of the state. On average three out of every 100 children under age six in these counties has a blood lead level above 10 µg/dL.

EWG identified 224 zip codes in 51 counties that contain neighborhoods where more than five percent of children under age six are lead poisoned based on the current 10 ug/dL standard.

Table: Zip Code Hotspots

A growing body of science indicates that levels of lead thought to be safe by government health officials are, in fact, quite hazardous. Research results published in the New England Journal of Medicine in April, 2003 showed an average IQ decline of 7.4 points for children with blood lead levels currently deemed safe — 10 micrograms of lead per deciliter of blood (10 µg/dL) — when compared to children with blood lead levels less than 1 (Canfield et al. 2003). The estimate here of 19,000 lead poisoned children in Ohio considers only children with blood lead levels over 10 µg/dL. If the effects of lead poisoning at lower levels were included, thousands of additional children across Ohio could be affected.

Failing to prevent lead poisonings costs Ohio approximately $230 million a year in remedial education costs and lost taxes on future incomes. A new Ohio law requires universal testing of children in high risk neighborhoods, but the Bush Administration's 2005 budget recommends a 20 percent cut in support for lead poisoning prevention programs, including testing, which could severely hamper state efforts.

Federal law requires all health care providers that treat Medicaid children to test these patients for lead. Nearly half (48 percent) of children under age six in Ohio are eligible for Medicaid. It appears, however, that many health care providers receive payment for lead testing - which is paid in a lump sum that includes other services - but fail to do the tests or ensure that they are done. A 2003 report by the Ohio Department of Jobs and Family Services found pervasive failure on the part of Managed Care Health providors to test one and two year olds for blood lead levels. Not a single managed health care provider in the state tested more than one-third of two year olds on Medicaid in the period of 2000 to 2002. In some counties the testing rates are even worse.




Although progress has been made in reducing the percentage of children under age six with unsafe levels of lead in the blood, more than 19,000 children were lead poisoned in Ohio this year alone. No region or county in the state was spared, and no community was left untouched by this silent plague.

To ensure that future generations will not suffer the effects of lead poisoning that continue to cut short the potential of thousands of children today, we recommend:

  • A major increase in support for primary prevention efforts to remove lead paint from childrens' environments in Ohio.
  • Full enforcement of both federal and state lead testing requirements, with substantial fines for violators. Money from fines should be used to support lead paint remediation efforts.
  • Mandatory reporting and public disclosure of all blood lead results (without identifying information), not just results above 10 µg/dL.
  • A tightening, at the federal level, of the criteria for lead poisoning from 10 µg/dL, to 5 µg/dL.
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