PROVIDENCE – The story begins in a crowded elevator, riding up to the fourth floor to the R.I. Department of Environmental Management offices at 235 Promenade St. in the Foundry complex, a journey deep into the labyrinth of state agencies and quasi-publics housed there.

ConvergenceRI was traveling with Pilar McCloud, the executive director of the local NAACP Youth Council, along with a number of students who had recently returned from their second trip to Flint, Mich., having donated more than 170 cases of bottled water to churches in the community. A third trip is being planned.

McCloud and her students had been invited to attend a news conference on May 23 hosted by Sen. Jack Reed, at which McCloud spoke briefly. [McCloud is a talk show host of What’z Da Buzz on Source Nation and the founder and CEO of A Sweet Creation youth organization.]

But, in large part, McCloud and the students’ apparent role was to serve as a backdrop behind Sen. Jack Reed and Dr. Linda Birnbaum, director of the National Institute for Environmental Health Sciences, a kind of made-for-TV picture postcard, in living color, while Reed and Birnbaum did a brief 15-minute dog-and-pony show staged for the benefit of the local news media, to showcase renewed federal efforts to combat lead poisoning.

The student members of the Youth Council were being employed as extras in the staged event to deliver a managed message: in the wake of the Flint, Mich., tragedy, new Senate legislation, known as the True LEADership Act [really, who would make up such a name?], would deliver, if enacted, some $70 billion, mostly for water infrastructure investments, through loans, grants and tax credits to combat lead poisoning.

The only real drama, unplanned, was when of one the students holding up a banner [“A Sweet Creation, ASC what you can do for your community, Unity in Our Community”] fainted; Birnbaum appropriately stepped out of her role as speaker to administer first aid to the student.

The only real news took place behind closed doors at the DEM offices, before the news conference, where Reed’s staff had assembled a number of representatives from government agencies and advocacy groups to discuss strategies to address lead poisoning.

There were high-level folks from the R.I. Department of Health, the R.I. Department of Environmental Management, the R.I. Attorney General’s office, the new state Infrastructure Bank, the chair of the local branch of the Green & Healthy Homes Initiative, the Childhood Lead Action Project, and Rhode Island KIDS COUNT, among others.

It was not a big endorsement of transparency or open government, to be sure, for state officials and Sen. Reed to conduct the meeting in private, with no access permitted by the news media, or the public – including members of the NAACP Youth Council.

Why exclude the members of the Youth Council from the meeting and a chance to converse with Reed and Birnbaum? Good question.

No safe level for lead
Birnbaum told the private gathering that the Centers for Disease Control and Prevention was considering taking action to lower the threshold of lead poisoning in children, to declare that there is no safe level, participants in the private meeting told ConvergenceRI. [Now, that’s some real news.]

The current CDC threshold is 5 micrograms of lead per deciliter of blood

Recognition that there was no safe level of lead was “acknowledged” by Reed and Birnbaum at the news conference; but there was no direct mention of any planned federal policy change.

Further, as advocates at the meeting told Birnbaum and Reed, the problem is funding, not know-how, in support of programs to eliminate lead poisoning in children in Rhode Island.

Exit stage right. Most of the participants in that closed-door meeting quickly departed as the news media were allowed in for the staged news conference.

[The news media was also not invited to the meetings held later that afternoon with Brown University officials working on the research about deleterious health impacts of toxics in the environment, related to Superfund sites. This appeared to be a decision made by Reed staffers or Brown officials, rather than by Birnbaum herself, who encouraged ConvergenceRI to follow up with her.]

Context, content and nuance
The import of the staged news conference, in part, was to provide an opportunity for Reed and Birnbaum to champion Reed’s co-sponsorship of the True LEADership Act in the Senate, a bill that, if enacted, promised to deliver some $70 billion, mostly for water infrastructure investments through loans, grants and tax credits, to protect against lead poisoning.

The legislation was drafted in response to the ongoing crisis in Flint, where as many as 8,000 children under the age of six – an entire generation of children in that community – became potential victims of elevated lead levels in their blood as a result of budget-motivated decisions to switch drinking water sources to highly corrosive water from the Flint River, supported by state officials and state managers.

As a result of the man-made tragedy and travesty in Flint, there has been a hue and cry to look at the nation’s aging water infrastructure and the potential threat from lead in the water and to push for federal investment to repair it.

Translated, the news media has responded to what happened in Flint with numerous investigative stories about the apparent dangers of lead in water systems across the nation, from school bubblers to city taps. Fear sells.

At the same time, the public impression is that lead poisoning from other sources has been successfully dealt with, and here in Rhode Island, the problem has been diminished to the point where, as one communications executive from Massachusetts recently told ConvergenceRI: “Lead poisoning is no longer a problem; it’s only a few kids a year,” he insisted.

A month ago, at the release of the Rhode Island KIDS COUNT Factbook, Reed and others had championed the fact that the state, as one of its achievements for children over the last two decades, had significantly reduced lead poisoning in children in Rhode Island.

But, as Laura Brion, community organizer pointed out in her brief talk at the news conference on May 23, it was not all about good news. [Brion was, at first, inadvertently skipped over by Reed].

“One thing we need to be honest about,” Brion began, “was that although we’ve made progress in reducing lead poisoning in children, we have not eliminated it.”

For the last few years, she continued, “There have been about 1,000 new children poisoned with lead for the first time.”

Brion continued: “We need to take a hard look at the fact that although we know how to reduce lead poisoning, [if we want to eliminate childhood lead poisoning], we’re going to have to fund the programs that do that work at a level that’s adequate to get the job done.”

Further, Brion said: “We’re going to have to look at the way laws are being enforced to really protect children.”

Finally, Brion connected the lead poisoning of children to the racial, economic and health disparities in Rhode Island. “This is matter of social justice,” she said. “The people who are disproportionately affected are low-income families and children of color. Getting serious about lead poisoning means that we get serious about equity and equality.”

What the numbers tell us
What wasn’t said: The number of new cases of children in Rhode Island with elevated blood lead levels was 943 in 2015, according to the R.I. Department of Health, based on a standard of 5 micrograms of lead per deciliter of blood. But, if there was no safe level of lead, as Birnbaum and Reed both agreed, wouldn’t that number would jump substantially?

Measuring lead levels in children, as required by state law, is but a snapshot in time – and that snapshot may prove to be very misleading.

One-half of all children entering kindergarten in Providence in 2014-2015 were not compliant with state regulations that they be tested twice; most were only tested once, according to data from the R.I. Department of Education and the R.I. Department of Health analyzed by DataSparkRI. Did that mean that parents whose children had tested below the current threshold of 5 micrograms of lead did not get a second test, as required? Which agency is responsible for enforcing compliance?

More importantly, lead poisoning is not just a childhood affliction that disappears; in fact, it tends to become magnified as afflicted children grow up and become adults – in behavioral issues, in poor school performance, in the capability to read at a third-grade level, in special education and health costs, and finally, in a likelihood of interaction with the criminal justice system. Lead poisoning in children can cause irreversible brain damage; these outcomes have been well documented in research.

What that means is this: the long-term cost of lead-poisoned children, at roughly 1,000 children a year under age six [using an outdated standard], is a substantial economic and health burden in Rhode Island.

And, while it is accurate to point out and applaud that the number of lead-poisoned children has dropped from more than 6,000 cases in 2002 to less than 1,000 in 2015, the reality is that many of those 6,000 childhood cases reported in 2002 are now 20 years old, and in large part, they are likely to be severely burdened as adults by the lifetime impacts of lead poisoning, which magnify with age. Does the tragic story of Freddie Gray in Baltimore ring a bell?

The bottom line: Rhode Island still has a steady steam of newly poisoned six-year-old children – about 1,000 a year – that are part of that lead pipeline flowing toward a lifetime struggle with disability.

Lead in water systems vs. lead paint in housing
One of the undercurrents at the news conference was a discussion about the priorities about how the federal money proposed under the new legislation would first be spent: upgrading water systems or addressing the problems of lead paint in older housing.

ConvergenceRI asked: Can you talk about the role of investments in healthy housing in addressing the root causes of the scourge of lead? At the state level, does there need to be additional resources – perhaps an increase in the planned state housing bond from $40 million to $100 million – to address the elimination of lead?

Housing and lead poisoning of children are directly related, Reed answered. “Most of the exposure comes from the home.” Rhode Island, he continued, has the largest amount of pre-1940 rental housing in the county. All of that was [probably] painted with lead paint several times over. So we have to do much, much more.”

Birnbaum concurred. “I think homes today are a major source of lead poisoning of children,” she said. Sen. Reed is absolutely right, she continued. “The major source is from old paint in homes. There are opportunities to prevent exposure from occurring by remediation.”

As Lynn Arditi, reporter with The Providence Journal [who is now covering the health care beat, replacing Richard Salit], detailed in her story, the biggest threat to children from lead poisoning in Rhode Island comes from old housing, not the water system.

Her lede sentence captured the facts and the nuance well: “Residents worried about lead in their drinking water following the water crisis in Flint, Michigan, should pay more attention to their walls and soil, a leading toxicologist said Monday.”

Solutions
To remove lead from housing, what’s needed is to make investments in healthy, safe, affordable housing and in rehabilitation of existing housing.

The cost to do so will be expensive – unless, of course, the externalities of the true costs of lead poisoning are factored in. These include: the costs of special education for students who have been lead poisoned; the medical costs incurred by children and their families as a result of lead poisoning; the economic costs when students do not have the capability to read at a third-grade level as a result of lead poisoning; the costs and challenges to the behavioral health and mental health care systems as a result of the continued impacts of lead poisoning in adolescents and adults, including school suspensions; and, the increasing costs incurred by the criminal justice system as a result of the impacts lead poisoning.

New research is underway by Anna Aizer, associate professor of Economics and Public Policy at Brown University, which is tracking the correlation of adolescents and adults that were lead poisoned as children in Rhode Island and their interactions with the criminal justice system. The potential findings could help connect the dots economically about the future costs of the impacts of lead poisoning.

David E. Jacobs, Ph.D., recently published his three-point plan for eliminating lead, entitled “Find It, Fix It, Fund It,” in the June issue of the Journal of Public Health Management and Practice.

Jacobs called for the following action plan:

• Find It: Create comprehensive programs to increase testing for lead in homes and water pipes, and expand screening for children who are at risk, especially among Medicaid-eligible children. Jacobs criticized the inadequacy of the current medical model, through which lead-exposed children are not identified until after they have been poisoned.

• Fix It: Once lead hazards have been identified, corrective action needs to be taken immediately, using proven interim methods, according to Jacobs. In addition, long-term, full-scale programs are needed to eliminate all residential lead paint from U.S. housing stock and all lead drinking-water pipes. As part of this effort, Jacobs pointed to the need for special education assessment and programs for lead-poisoned children.

• Fund It: Jacobs makes the case that fixing lead hazards is an economically sound investment, with a cost-effectiveness even higher than that of childhood vaccines. He also calls for accountability for companies that have continued to produce lead-contaminated products, long after the hazards have been recognized.

Jacobs, who is the chief scientist at the National Center for Healthy Housing, also asked what he believed to be a critical question that has often gone unasked: “How did that lead get into our pipes and our paint in the first place?

According to Jacobs, the industrial groups and paint companies have not only continued to make lead-containing products, but also continued to attempt to block public health efforts to stop these sources of lead contamination.

“Industry must help pay to help fix the problem, not just pay their lawyers to drag out court cases for decades and overturn verdicts that have held them accountable,” Jacobs wrote.