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33 J.L. Med. & Ethics 40 (2005)
Enforcement of Lead Hazard Remediation to Protect Childhood Development

handle is hein.journals/medeth33 and id is 912 raw text is: CONCURRENT SESSIONS Enforcement of Lead Hazard Remediation to Protect Childhood Development Anne Evens, Beverly J. Gard, and Mary Jean Brown (Moderator) Mary Jean Brown The nation has an ambitious goal from the Healthy People 2010 objectives to eliminate lead poisoning as a public health problem in the United States by 2010. The Lead Poisoning Prevention Branch of the Centers for Disease Control and Prevention (CDC) takes this goal very seriously as do partners at the Environmental Protection Agency (EPA) and the U.S. Department of Housing and Urban Development (HUD). Childhood lead poisoning is a completely preventa- ble illness. We know what the causes are, how chil- dren get it, and how to prevent it. Essentially, the way to prevent it is to control or eliminate sources of lead in the environments around children. Given enough exposure, children and adults can die from elevated blood lead levels. This happens rarely, but it is not impossible. The last child who died from lead poisoning in the United States lived in Manches- ter, New Hampshire and she died in April of 2000. However, most children with elevated blood lead lev- els have levels at or above 10 micrograms per deciliter (Mg/dL). Children who have these elevated levels have no overt symptoms. Sometimes they may be tired or may not be eating properly, but for most children, ele- vated blood levels occur between 18 and 28 months when these behavior trends may occur anyway. The only way to determine if a child has had too much lead exposure is to do a blood lead test. In many places in the country, blood lead testing is required by law. All areas receiving CDC lead prevention grant funds are required to develop a strategy for their jurisdiction to target children most at risk for exposure and ensure that those children are tested. In addition, any child who is enrolled in Medicaid is required to be tested at 12 and 24 months and older children who have never been tested have to be tested when they are identified. Most children with elevated blood lead levels will have some learning and behavioral problems, and some may have emotional problems. Dr. Herbert Needleman's study,, looking at 2,000 children in Charlestown and Sommerville, Massa- chusetts in the late 1970's, collected two teeth from second graders and ranked children on how much lead was in their teeth. Lead is stored deep in the bones and therefore, teeth can be used to determine historic exposure to lead. He ranked the children by the amount of blood lead levels in their teeth and had their teachers evaluate these children on how they were doing in the classroom. The children with the highest tooth lead levels were doing the least well in all evaluative categories except for hyperactivity. The researchers thought that this may have been due to the fact that second grade teachers may not have wanted to diagnose hyperactivity on a checklist. Children in the higher categories are statistically worse off than children in the lower categories. Lead poisoning follows a step-wise progression called the dose-response curve, which reveals that the toxic chemical that is examined is the cause of the effects that are seen. Similar studies have been conduct- ed across continents, socioeconomic classes, and racial and language groups and consistently it is found that higher blood levels affect children's performance in school and their life achievement. New data suggests that even at blood lead levels less than ten we find that children have subtle but significant neurological effects that affect their ability to sit still in a classroom, learn to read, and understand math. We have not yet found a safe blood lead level for children. THE JOURNAL OF LAW, MEDICINE & ETHICS

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