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A Shower of Benefits: Drinking Water and Healthy Housing

The American Public Health Association today hosts a Twitter chat on “What's in Your Water: The State of Water and Our Health” (#SafeWater). The state of the nation’s infrastructure that delivers drinking water to our homes is nothing short of appalling, with Flint being only the tip of the iceberg. It’s outdated, and like much of our roads, bridges, electrical grid and housing stock, it’s seriously underfunded and ill-maintained, causing high healthcare costs and needless suffering. At best, this is penny-wise and pound-foolish; at worst, it’s criminally negligent. Just today, Pew Charitable Trusts, Robert Wood Johnson Foundation, NCHH, and others released a major new report showing that the benefits of lead poisoning prevention far outweigh the costs.

The nation still has no health-based standard for lead in drinking water, and protocols for sampling for lead in water are all over the place and hard to interpret. The only real standard that does exist is designed to determine how well corrosion control treatments are working, not whether health is being adequately protected. The same is true for other contaminants, like PFAS/PFOS/PFOAs (e.g., perfluorooctanoic acid [PFOA], perfluorooctane sulfonate [PFOS], and other perfluoroalkyl substances [PFASs], which are chemicals used for stain-resistance, Teflon coatings for frying pans, and other purposes. We hear of outbreaks of legionella and other diseases related to poor water treatment standards.

How did we come to this mess? After all, indoor plumbing was installed in housing to help conquer tuberculosis, typhoid, and cholera as part of the sanitation movement—and it worked! But today, the reality is that the failure to invest in infrastructure maintenance and improvements has provided local water authorities with limited options and complex, delicately balanced water chemistry trade-offs. Adding or subtracting one water treatment option often leads to unintended outcomes resulting in dire public health consequences. In a previous blog, "Infrastructure and Mortgages," we wrote that lead in water and housing in general must be part of the nation’s infrastructure rebuilding.

Are we really going to allow our nation to be forced to buy millions of plastic bottles to access drinkable water, instead of a high-quality water supply system? We should also point out that the quality of that bottled water and all those plastic bottles have their own problems and environmental costs.

What does this mean for parents? I recently had the opportunity to sample the water in the home of a friend with a newborn baby. They had previously gut-rehabbed their home and had asked the local water and sewer authority to sample their water for lead content. The results suggested a very low level—but  this was after flushing the system for 5-10 minutes, which means it didn’t determine the presence of a lead service line or lead in solder for copper pipes, and it didn’t reflect the water they actually drank. (Do you know anyone who runs the faucet for five minutes before filling a glass or pot with water?) As part of the rehab, their contractor had replaced the lead service line on their private property but failed to notify the water authority, who would’ve replaced the section on the public side at the same time as the private side was being replaced. The mom and dad thought the problem had been taken care of, but they asked me to check just to be sure. When I sampled the water, I did a first-flush and then, using a back-of-the-envelope calculation, took a second sample after a two-minute flush, which I suspected would be the water that had stayed in the public side of the lead service line overnight. Sure enough, when I got the results back, the second sample was much higher than what the earlier testing had showed. I contacted the local water authority, and they confirmed that they had not replaced their public section of the lead pipe, but they said they would do so after I sent them the results, which I did.

Parents shouldn’t have to put up with such a scattershot, hit-or-miss approach. We have to do better. And we have to put our people back to work with good paying jobs to fix things like this, instead of waiting for children to get sick or overexposed to contaminants. Here’s what needs to happen:

  1. Make drinking water quality a clear part of the healthy homes strategy. There are currently eight key principles for such a home: A healthy home means one that is free of excessive moisture and mold, free of injury hazards, properly ventilated, well-maintained, clean, free of pests, thermally controlled, and free of contaminants. “Free of contaminants” includes a drinking water supply without lead or other contaminants.
  2. Locate exactly where drinking water lead pipes are located using state-of-the-art technologies. (We created technologies to locate lead in paint, and we can do it for water too).
  3. Improve water treatments to minimize lead and other chemicals and contaminants entering the drinking water system.
  4. Implement a long-term plan to replace all lead drinking water pipes
  5. Implement a plan to eliminate other contaminants and biological agents.
  6. Create a health-based exposure standard for lead in water like we have for lead in dust and soil and enforce it. The current EPA maximum contaminant level goals in drinking water for lead is “zero,” which doesn’t help anyone to make real decisions on taking action.
  7. Fund an infrastructure improvement program that includes improving children’s health. (It makes no sense to treat children only after they get sick—that’s expensive and causes needless suffering.)
  8. Ensure that the infrastructure work creates good paying jobs for our people. An estimate suggests that at least 75,000 jobs can be created for lead mitigation alone doing this type of work. 
  9. Implement the recommendations provided in National Environmental Health Partnership Council’s Environmental Health Playbook: Investing in a Robust Environmental Health System.
  10. Implement the National Safe and Healthy Housing Coalition's “Find It, Fix It, Fund It” campaign, which would save billions of dollars and protect our children.

The science is clear, and we must act on what it tells us, not ignore it or create some so-called “alternative facts.” That action must include all of us—parents, citizens, government, private and public entities, foundation, workers, engineers, scientists, and advocates. 

There is simply no reason to tolerate lead or other contaminants in our drinking water. I’m going back to my friend’s house to see what happens when that pipe gets replaced. But it should never have happened in the first place. And if we eliminate the lead, we eliminate exposures. We’ve taken lead out of food canning, gasoline, new paint, many consumer products, and we have efforts to address lead in existing homes—all of which have succeeded in reducing blood lead levels by more than 90% over the past several decades. But with over half a million children with too much lead, we can and must do better.


Dr. David Jacobs, former Director of the Lead Poisoning Prevention Program at the U.S. Department of Housing and Urban Development, is the Chief Scientist for the National Center for Healthy Housing and an adjunct professor at the University of Illinois at Chicago School of Public Health

Threats or Promises: Which Way for the Trump Administration on Childhood Lead Poisoning Prevention?

Recent news articles suggest that Trump’s EPA hopes to drastically cut funding and staff for its lead poisoning prevention programs ("EPA Memo Outlines Plans to Defund Lead-Paint Program," in Remodeling, April 4; and "Trump’s EPA Moves to Dismantle Programs that Protect Kids from Lead Paint," in The Washington Post, April 5). This follows on the heels of a high-level meeting between the EPA’s new administrator, Scott Pruitt, and the National Association of Home Builders (NAHB). NAHB complained about so-called “excessive” regulations, specifically EPA’s Renovation, Repair, and Painting (RRP) Rule

But it was exactly inadequate regulations that led to the Flint crisis and others like it, such as the East Chicago disaster in Indiana, the vice-president’s home state.
 
The fact is that congressional action and regulations have worked: Blood lead levels in the nation’s children have been greatly reduced  as a result of the implementation of statutes and regulations (see "U.S. Policies vs. Children's Average Blood Lead Levels" below). When we as a nation mandated the removal of lead from food canning, gasoline, new residential paint, plumbing and other sources, all through regulations, it worked. If anything, the regulations should be strengthened, not weakened, because over half a million children still have blood lead levels above the CDC reference value.1 

Some industries have supported these regulations over the years,2 but a few others have actively opposed them.3 Most recently for example, the National Association of Home Builders (NAHB) wants the EPA’s RRP regulation restricted to only pre-1960 housing, even though lead paint was not banned (by regulation) until 1978. They want “training” of their contractors to be only online, when in fact construction contractors don’t really learn that way. They want a new cost-benefit analysis, even though many previous studies have already shown that the benefits far outweigh the costs.4, 5 NAHB already succeeded in previous years in eliminating a dust testing requirement that has existed for years in federally assisted housing rehab work with scientifically proven positive results.6 (Children’s blood lead levels in assisted housing are lower than in non-assisted low-income housing, and dust testing [dust is one of the main ways children are exposed] is the major reason why). NAHB should protect the interests of its members by ensuring that homes are safe, not cutting corners and weakening laws and regulations that, if anything, need to be strengthened. And it should work to ensure that its member contractors don’t inadvertently do sloppy work that can cost $100,000 per house to clean up.7

Furthermore, preventing childhood lead poisoning not only protects children, it will create at least 75,000 good-paying jobs.8

During his campaign, the president promised to fix things that don’t work right. What better example is there that lead poisoning needs to be fixed than the 24 million homes that still have lead paint hazards, or the 6-10 million homes that still have lead water pipes? The solution is not to weaken regulations or to cut budgets but to strengthen them, putting the resources in place to end this preventable disease. Lead problems are a sign of our crumbling infrastructure, something the president also vowed to fix. We think that an infrastructure bill should include lead poisoning prevention. 

At HUD, the new Secretary, Dr. Ben Carson, promised to “enhance” lead poisoning prevention and healthy housing, proposing to increase the budget for that program from $110 million to $130 million. But at the same time, the proposed HUD budget wipes out the multi-billion-dollar Community Development Block Grant (CDBG) program. Many local jurisdictions use CDBG to provide their local “match” funding, anywhere from 10% - 25%, for lead hazard control. So, even though the proposed increased funding for the lead program is welcome, it appears that with the CDBG proposed elimination, the net effect will reduce, not increase, the total HUD resources to protect our children from lead poisoning. Why give with one hand only to take away more with the other? 

The National Safe and Healthy Housing Coalition has produced a number of recommendations that will protect our children

We urge the new administration and the new Congress to act on those recommendations to improve (not weaken) regulations and to propose a budget that will get the job done.

Instead of paying over $50 billion a year for lead poisoning, let’s solve the problem, not eliminate EPA programs or reduce HUD funding. At its beginning, the Flint fiasco was supposedly an attempt to save money, and NAHB’s wishes sound just like that, don’t they? We cannot afford another Flint, and we cannot afford to continue to pay the high costs of needlessly poisoned children. In Flint and across the nation, we will now spend far more now than had we acted to solve the problem in the first place. And we do know how to solve it. We should act on what we know, put our people to work, protect our children, and stop wasting money by caving in to a few narrow short-sighted industries at the expense of the rest of us.





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1 Wheeler, W., & Brown, M. J. (2013, April 5). Blood lead levels in children aged 1–5 years — United States, 1999–2010. Morbidity and Mortality Weekly Report (MMWR), 62(13), 245-248. Retrieved April 6, 2017, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6213a3.htm

2 National Safe and Healthy Housing Coalition. (2016). Declaration of the Lead and Environmental Hazards Association. Retrieved April 6, 2017, from  http://www.nchh.org//Portals/0/Contents/LEHA_Declaration_2016.pdf 

3 Jacobs, D. E. (2016 July-August). Lead poisoning: Focusing on the fix. Journal of Public Health Management and Practice, 22(4):326-330. doi: 10.1097/PHH.0000000000000430. Retrieved from http://journals.lww.com/jphmp/Citation/2016/07000/Lead_Poisoning___Focusing_on_the_Fix.2.aspx
   
4 Gould, E. (2009, July). Childhood lead poisoning: Conservative estimates of the social and economic benefits of lead hazard control. Environmental Health Perspectives, 117(7), 1162-1167. Retrieved April 6, 2017, from https://ehp.niehs.nih.gov/wp-content/uploads/117/7/ehp.0800408.pdf

5 Nevin, R., Jacobs, D. E., Berg, M., & Cohen, J. (2008, March). Monetary benefits of preventing childhood lead poisoning with lead-safe window replacement, Environmental Research, 106(3), 410-419. Retrieved April 6, 2017, from http://www.ncbi.nlm.nih.gov/pubmed/17961540
 
6 Ahrens, K. A., Haley, B. A., Rossen, L. M., Lloyd, P. C., & Aoki, Y. (2016, November). Housing assistance and blood lead levels: Children in the United States, 2005-2012. American Journal of Public Health, 106(11), 2049-2056. Retrieved April 6, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/27631737
 
7 Jacobs, D. E., Mielke, H., & Pavur, N. (2003, February). The high cost of improper removal of lead-based paint from housing: A case report. Environmental Health Perspectives, 111(2), 185-186. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1241348/
 
8 National Center for Healthy Housing & National Safe and Healthy Housing Coalition (2017, February). Find It, Fix It, Fund It: A lead elimination action drive: Policy recommendations to Congress and the new administration. Retrieved April 6, 2017, from http://bit.ly/FFFAdmin

9 Jacobs, D., & Weinberg, A. (2017, February 22). Infrastructure and mortgages: What about the kids? National Center for Healthy Housing website. Retrieved April 6, 2017, from http://bit.ly/Infra_Kids



Dr. David Jacobs, former Director of the Lead Poisoning Prevention Program at the U.S. Department of Housing and Urban Development, is the Chief Scientist for the National Center for Healthy Housing and an adjunct professor at the University of Illinois at Chicago School of Public Health

Infrastructure and Mortgages: What about the Kids?


During the 2016 election season, Donald Trump (the Republican presidential nominee, now president) proposed spending $1 trillion dollars on infrastructure to put people to work and rebuild the sinews of the nation. Democrats have also called for infrastructure improvements. Those improvements must include making our homes and schools safe for our children. In its recent (January 2) editorial, "Housing that Ruins Your Finances and Your Health," The New York Times wrote, “One solution would be for Fannie Mae to eliminate dangerous lead conditions in foreclosed homes.” But lead requirements are antiquated or nonexistent not only at Fannie Mae but also at Freddie Mac and HUD’s FHA single-family mortgage insurance program. These federal housing programs are the only ones that were not reformed back in 1999 and are long overdue to be fixed.

In years past, both parties worked together to reduce childhood lead poisoning. But Flint is only the tip of the iceberg, and parents of lead-poisoned children are demanding that we do more to put a stop to the needless suffering. Lead poisoning costs us an estimated $50 billion annually for healthcare, substandard school performance, and lost work productivity (2008 dollars).1 The real tragedy is that we know how to fix lead hazards. The disasters in Flint and elsewhere could have been prevented and will now cost much more than if we had made the necessary upfront investments and reforms. The inadequate lead requirements at FHA, Fannie Mae, and Freddie Mac should comply with HUD lead-safe housing regulations, but they currently do not.

Traditionally, infrastructure spending only goes for roads and bridges and the basic equipment and structures that are needed for a country to function properly. But many are surprised to learn that the lead services lines bringing water into their homes are NOT part of the “infrastructure” and that the burden was on families to replace them. They are also surprised that home inspections required by mortgage companies do not include lead inspections. 

We think infrastructure and federally guaranteed mortgages should be used to make our homes safe for our children. Indeed, we have “shared” our homes with guests and friends and, of course, our families. But 37 million homes built before 1978 have lead paint,2 and at least six million homes have lead water service lines. This “shared” lead has poisoned millions of our children, sometimes poisoning one child after another as one family leaves and another moves in. Existing FHA, Fannie, and Freddie underwriting standards are part of the problem, but they could be part of the solution.

The biggest culprit is old single-pane painted windows, which have the highest lead paint and lead dust levels of any building component. Replacing windows is already a proven strategy. In a pilot program, Illinois replaced lead-contaminated windows in Peoria and Chicago in 500 homes,3 resulting in huge and sustained lead dust reductions not only on windows but also on floors; and many other studies have reached similar conclusions.

The time has come to replace all those old contaminated windows, those lead drinking water pipes, and the other lead hazards in our homes. Enormous benefits follow if infrastructure funds are used to address lead in homes:
  • First, over 75,000 jobs – good-paying jobs for both made-in-America window manufacturing and installation workers;
  • Second, increased property values anywhere from $5,900 to $14,300 per home4
  • Third, a return on investment of at least $17 per dollar spent on lead remediation or removal5
  • Fourth, up to $500 per household saved each year on reduced fuel bills, because new windows are more energy efficient.6 
With the right infrastructure improvements, we can all share safe drinking water and lead-safe homes. 

The evidence is clear – whether in small towns or big cities, rural or urban: We all win when we eliminate lead hazards and protect our children. Our traditional approach has been to respond only after a child is poisoned, but there is no reason to wait until the damage has already been done. We should test our homes and schools, not just our children’s blood. And we should insist that housing finance institutions like FHA, Fannie, and Freddie do the right thing and eliminate those hazards before children are poisoned.

As part of our new national infrastructure initiative, let’s include solving the lead problem. We urge the new president and Congress to protect our children. Let’s not wait for another Flint or another poisoned child. Get Fannie, Freddie, and FHA to do the right thing. Get rid of those old lead-contaminated windows and old lead pipes and put our people back to work to protect our children and our future.

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1 Tresande, L., & Liu, Y. (2011, May). Reducing the staggering costs of environmental disease in children. Health Affairs 30(5), 863. Retrieved February 21, 2017,
from http://content.healthaffairs.org/content/30/5/863.long
2 Cox, D. C., Dewalt, G., O'Haver, R., Salatino, B. (2011, April). American healthy homes survey: Lead and arsenic findings. Washington, DC: U.S. Department of Housing and Urban Development. Retrieved February 21, 2017, from  https://portal.hud.gov/hudportal/documents/huddoc?id=AHHS_Report.pdf
3 Jacobs, D. E., Tobin, M.,Targos, L., Clarkson, D., Dixon, S. L. Breysse, J., et al. (2016, September-October). Replacing windows reduces childhood lead exposure: Results from a state-funded program. Journal of Public Health Management & Practice, 22(5), 482-491. Retrieved February 21, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/26910871
4 Nevin, R., Jacobs, D. E., Berg, M., & Cohen, J. (2008, March). Monetary benefits of preventing childhood lead poisoning with lead-safe window replacement, Environmental Research, 106(3), 410-419. Retrieved February 21, 2017, from http://www.ncbi.nlm.nih.gov/pubmed/17961540
5 Gould, E. (2009, July). Childhood lead poisoning: Conservative estimates of the social and economic benefits of lead hazard control. Environmental Health Perspectives, 117(7), 1162-1167. Retrieved February 21, 2017, from https://ehp.niehs.nih.gov/wp-content/uploads/117/7/ehp.0800408.pdf
6 Nevin, R., Jacobs, D. E., Berg, M., & Cohen, J. (2008, March). Monetary benefits of preventing childhood lead poisoning with lead-safe window replacement, Environmental Research, 106(3), 410-419. Retrieved February 21, 2017, from http://www.ncbi.nlm.nih.gov/pubmed/17961540



Related: Portuguese Translation
Infraestrutura e hipotecas: E as crianças: "Infrastructure and Mortgages: What about the Kids?" was translated into Portuguese by Artur Weber and Adelina Domingos. Note that this article was not translated by NCHH; therefore, we cannot be responsible for any errors or omissions in the translation. [url]


 
Dr. David Jacobs, former Director of the Lead Poisoning Prevention Program at the U.S. Department of Housing and Urban Development, is the Chief Scientist for the National Center for Healthy Housing and an adjunct professor at the University of Illinois at Chicago School of Public Health

Anita Weinberg is a Clinical Professor and the Director of the ChildLaw Policy Institute at Loyola University Chicago School of Law, which spearheaded lead poisoning prevention efforts in Illinois for over 10 years.

Stand Up and Be Counted in the Fight Against Lead Poisoning



Lead poisoning—you know, it seems like we should’ve had this problem licked by now.

Every year, we (NCHH and our partners) get out and stomp the figurative pavement, reminding people—parents, teachers, doctors, members of Congress, the President—that lead is still a very real and dangerous problem. And every year, despite our best efforts, more kids are exposed to lead. This year, we heard of a city (Flint, Michigan) that was exposed to dangerous levels of lead in its water.

All of this despite the fact we’ve known lead was poisonous for over 100 years and despite the fact that lead-based paint was banned in the U.S. back in 1978. That's nearly 40 years ago. The banning of lead-based paint in homes was a major victory, but the war rages on: While no new lead-based paint is being manufactured for residential use here in the United States, lead is still being used in other types of paint. Meanwhile, the lead-based paint that exists in older homes continues to disintegrate into poisonous dust. Lead exposure also comes from aging pipes entering homes and schools, from soil, and in consumer products.

According to Dr. David Jacobs, NCHH's Chief Scientist, "Lead is […] one of the best studied toxic substances that we know of. It’s one of the metals that you don’t need in your body; it has no useful biological value whatsoever. It creates a range of effects [including] neurodevelopmental effects for children at an early age, but it also causes cancer, kidney disease, and many other adverse health effects."

Today, there are still over 500,000 children with elevated blood lead levels in the U.S. Untold numbers of adults—possibly in the millions—struggle daily with the lifelong consequences of their own childhood lead exposure: decreased IQ and cognitive function, developmental delays, and behavioral problems. It’s both unfortunate and unacceptable for any child to be harmed by lead exposure, yet it continues to happen every day, regardless of race, creed, color, or social strata, though children of color and those living in low-income housing have been affected most.

Advocacy groups, philanthropic organizations, and federal, state, and local governments have done much to educate the public about lead hazards—a herculean task. NCHH and its allies in this war on lead poisoning have also made great progress over the last 40-plus years. The studies we and our partners have done, the research we’ve provided, the articles we’ve written, and our advocacy efforts have resulted in a significant reduction in the number of Americans with elevated blood lead levels, as well as medical treatment for those affected. We’re proud of our work, and we’re proud of all the others who’ve joined us in the fight.

Now we need for you to join us as well, and we need you today. NCHH and the National Safe and Healthy Housing Coalition have just created a petition entitled “Tell Congress to End Lead Poisoning Now” that outlines a comprehensive strategy to end lead poisoning within five years.

Take a few minutes to check out the petition. Now we want you to sign it. Yes, YOU. And then we want everyone you know to sign it as well, which means that we need you to share it with people you know and ask them to share it too. Sign it, share it, and change the world—just a little.

Some of you have probably already signed the petition. You read the title and said, “I’m IN!” (Thank you!) Maybe you’re in because someone in your family has been exposed to lead. Maybe there’s lead in your house or apartment right now, and you don’t have the money you need to make your home safe once and for all. Or maybe you know someone down the street, one street over, or someone who goes to school with your kids, who’s been touched in some way by lead poisoning. Maybe you know someone who’s sitting in jail, and you think that maybe his or her life would be completely different right now if only they hadn’t been exposed to lead.

But maybe you haven’t gotten around to signing the petition just yet. We know that some of you are thinking, I don’t know anyone with this problem or This isn’t really a problem for me. But it really is. Whether or not we realize it, we’re all affected by lead poisoning:
  • Because families move into older homes every day.
  • Because children attend older schools every day.
  • Because some kid visits his or her grandparents’ home every day.
  • Because water flows through old pipes every single day.
  • And because lead poisoning can lead to learning disabilities, impulse control issues, and violent behavior, we pay tax money to fund educational services, law enforcement efforts and the judicial system to fix lead-related problems after they’ve happened. 
We want to tell Congress to invest more in the system upfront so that problems don’t happen. It’s a sound investment in our collective future: The return on investment for lead poisoning prevention is estimated at no less than $17 for every $1 spent.

As NCHH’s David Jacobs and Amanda Reddy commented in a recent editorial, lead poisoning is preventable, and we know how to prevent it; but our investment has to be more widespread and sustained.

Help us tell Congress that it is time to end childhood lead poisoning. Won’t you help us to reach our goal of 20,000 signatures? Stand up and be counted: Please sign the petition right away and share it with your friends, associates, and family.

Democrats Add Eliminating Lead Poisoning to Party Platform



On July 9, 2016, history was made: A major U.S. political party added the words "we must make it a national priority to eradicate lead poisoning" to its platform. Never in the history of American politics has a major party called for the elimination of lead poisoning explicitly as a portion of its platform.

That finally changed late Saturday night as the Democratic Platform Committee approved Amendment 176 to add the following language to their platform:

"Democrats believe we must make it a national priority to eradicate lead poisoning which disproportionately impacts low-income children and children of color and can lead to lifelong health and educational challenges, as a public health threat. We will prioritize hiring and training workers from affected communities to clean up toxic brownfields and expand clean energy, energy efficiency, and resilient infrastructure."

As a nonpartisan organization, NCHH hopes that all of the political parties will recognize the importance of this provision and add it to their respective platforms. The health, safety, and well-being of America’s children is important to all Americans.

Kudos to platform committee members Mara Keisling and Mary Kay Henry, President of the Service Employees International Union (SEIU), for promoting and offering this amendment. 

Watch a video of the amendment's introduction by Mara Keisling and its subsequent approval here.

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