As director of the National Center for Environmental Health (NCEH), we are committed to preventing premature death and disease among Americans attributable to current and emerging environmental health hazards. Through science and practice, we promote a healthy environment and prevent premature death, avoidable illness, and disability caused by noninfectious, nonoccupational environmental and related factors. We are especially committed to safeguarding the health of vulnerable populations—such as children, the elderly, and people with disabilities—from certain environmental hazards, such as lead exposure among children.
NCEH’s public health strategies cover the human lifespan, a critical focus of which is promotion of child health from birth through adolescence, with childhood lead poisoning prevention being an essential national priority. NCEH’s Childhood Lead Poisoning and Prevention Program (CLPPP), which last year celebrated 30 years of support to state and local childhood lead poisoning prevention programs, upholds the ultimate vision of eliminating childhood lead poisoning as a public health problem and is committed to the Healthy People 2030 goals of reducing blood lead levels in children aged one to five years and eliminating differences in average risk based on race and social class. CLPPP achieves these goals by developing programs and recommendations to prevent childhood lead poisoning; educating the public and health care providers about childhood lead poisoning; providing funding to state and local health departments, tribes, and territories; and conducting surveillance and research to determine the effectiveness of prevention efforts at the federal, state, and local levels.
The economic benefits of reducing lead exposure among children are estimated at $213 billion annually.1 Currently, CDC and NCEH fund 62 jurisdictions (48 states, five major cities, seven counties, the District of Columbia, and Puerto Rico) to develop and maintain strong childhood lead poisoning prevention programs and conduct blood lead surveillance activities (Figure 1). CDC and NCEH also support the Flint, Michigan, Lead Exposure Registry in response to the 2014 Flint water crisis.
FIGURE 1— Fiscal Year 2021 Childhood Lead Poisoning Prevention Recipients: CDC
Note. Funding was for September 30, 2021–September 29, 2022.
Since 1989, NCEH has hosted federal advisory committees for childhood lead poisoning prevention. The current committee, known as the Lead Exposure and Prevention Advisory Committee (LEPAC), was chartered in 2018 and activated in 2020. The LEPAC is a panel of environmental science and program experts who provide guidance on research, education, and best practices regarding childhood lead poisoning prevention to the US Department of Health and Human Services and to the CDC.
Although no safe lead exposure level has been established, the CDC uses a blood lead reference value as a tool to identify children with higher levels of lead in their blood compared with 97.5% of children in the country. In October 2021, LEPAC approved lowering the blood lead reference value from 5 micrograms per deciliter (µg/dl) of blood to 3.5 µg/dl of blood, which enables health care providers, parents, and others to identify children at risk earlier and implement appropriate interventions.
Some success stories include the response to the 2014 Flint, Michigan, water crisis, which was a detrimental manmade public health emergency in which tens of thousands of the city’s residents, including children, were exposed to high levels of lead through their water sources. As of May 2022, a total of 18 000 people had fully enrolled in the Flint Registry, and 26 500 referrals have been made to critical health and environmental services. The most common referrals are for health care access, neurodevelopmental assessment, education services, lead inspection and abatement, and pipe replacement. Since launching, the Flint Registry has filled previously unmet needs, improving the lives of Flint residents.
The Philadelphia Department of Public Health supported the expansion of a lead paint disclosure law. Beginning in October 2020, landlords in 11 zip codes (of 46) with the highest proportion of children with elevated blood lead levels were required to obtain a lead-free or lead-safe certification before issuing or renewing rental leases—regardless of whether children live at the property. The remaining zip codes in Philadelphia will be phased in over a two-year period.
In 2021, the CDC launched the CORE Health Equity Science and Intervention Strategy to integrate health equity into all agency plans and programs. In response, CLPPP developed specific goals aimed at addressing health disparities in childhood lead poisoning. To help achieve this, NCEH will focus on closing gaps in childhood lead testing by 2024 by increasing blood lead screening rates up to 50% among Medicaid recipient children aged zero to three years. The center will encourage funded childhood lead poisoning prevention programs to create agreements with Medicaid partners to promote blood lead screening, provide services to lead-exposed children, and share data as appropriate. CDC and NCEH will continue to support the Pediatric Environmental Health Specialty Units, which are regional centers of excellence for support to clinicians serving patient concerns associated with environmental hazards, including lead. Both funded state programs and Pediatric Environmental Health Specialty Units support lead elimination by providing technical assistance, education, and outreach to communities, providers, and parents and guardians. CDC- and NCEH-funded public health programs will work closely with other state and federal agencies to monitor and track the impact on blood lead levels.
ACKNOWLEDGMENTS
I acknowledge and thank Tanya Telfair LeBlanc, PhD, Erik Svendsen, PhD, and Paul Allwood, PhD, for their input on this editorial.
CONFLICTS OF INTEREST
The author has no conflicts of interest to declare.
