Mind and Body

Blinded by the lead

Missing from the discussion about improving education in the Providence schools is 30 years of data, research and analysis that shows high blood lead levels in children may be the root cause of problems in education attainment and behavioral disruption

Photo by Richard Asinof

Students at Francis J. Varieur Elementary School in Pawtucket, who helped provide the backdrop for Gov. Gina Raimondo's staged press event in September of 2016 to announce her launch of a new strategic initiative to improve reading scores by third graders in Rhode Island. Research that showed a direct correlation between reductions in childhood lead poisoning and improvements in third-grade reading levels has still not been integrated as part of the strategic initiative.

By Richard Asinof
Posted 8/19/19
The root causes of educational dysfunction in the Providence school system may be linked to systemic childhood lead poisoning, with research and analysis of some 30 years worth of data and evidence to back up the findings. But nowhere in the current plan of action being developed for the state’s takeover of the city school system can that information and analysis be found.
Has the new state education commissioner, Infante-Green, read the research studies conducted on the impact of lead poisoning on student performance conducted by Aizer and Currie? When will the R.I. General Assembly step up to the plate and explore the dimensions of lead contamination of drinking water in Rhode Island? If asthma is the leading cause of chronic school absenteeism, can the incidence of asthma be tied directly to sick school buildings? Can the practice of mindfulness improve educational outcomes in Rhode Island? As in health, where 80 percent of outcomes are tied to what happens outside the doctor’s or nurse’s offices, is there a way to resurrect the successful Child Opportunity Zone initiative to develop community solutions outside of the classroom, in coordination with Health Equity Zones? What kind of relationship exists between Deborah Gist, the former state commissioner of education, and Infante-Green, the current commissioner, given that they are both principals in Chiefs for Change, one of the organizations listed as a key partner of the Johns Hopkins Institute for Education Policy?
As the evidence connecting environmental hazards and chronic health problems and poor educational attainment keeps growing, some states are taking action. Last week, in the face of inaction by the federal government under President Trump, the state of California banned the use of the toxic pesticide, chlorpyrifos, which has been linked to harming brain development in babies. “We’ve had enough evidence,” said California Secretary of Environmental Protection Jared Blumenfeld. “California is saying enough is enough. We need to take action to protect human health.”

PROVIDENCE – The constant drip, drip, drip of the bathroom shower faucet in my apartment provides a constant grim reminder that the problems Rhode Island is encountering with its educational system may have its pervasive roots in events happening outside the classroom in what pediatrician Dr. Mona Hanna-Attisha from Flint, Michigan, described as “what the eyes don’t see.”

[Testing performed on the apartment building’s water system found lead contamination at 40 parts per billion, significantly higher than the 15 parts per billion safety standard established by the U.S. Environmental Protection Agency. While there is now a water filter attached to the kitchen water tap, there is no filter on the shower fixture. The problem, it appears, is with the pipes connecting the municipal water source to the building.]

The dangers of lead poisoning lurk in all kinds of sources – from the water we imbibe, from the polluted air we breathe, and from the lead paint in aging buildings where we live. Lead in the bloodstream of young children is particularly deleterious to their developing brains.

From poor performance on reading and math standardized test scores to behavioral problems leading to increased probability of getting suspended from school and being placed in juvenile detention, these outcomes can be traced directly to the impacts of lead poisoning on Rhode Island children, impacts that are magnified by economic and health disparities.

“Once [lead] is in your blood stream, it’s an irreversible neurotoxin,” Hanna-Attishi said. Though not everyone exposed to lead will have problems, toxic stressors such as poverty, poor nutrition and split families can influence lead’s impact on cognition and behavior.

Lead is not the only toxic stressor that influences educational outcomes, which includes domestic violence, mental health and behavioral health issues, and public safety issues. But because of the irreversible quality of many of its impacts, it requires attention.

Damn the lead, damn the lies
The damage caused by pervasive elevated levels of lead in children’s blood in Rhode Island has never been a secret. All of the information is public and easily accessed. Yet, for all the angst captured in the recent report by Johns Hopkins Institute of Education Policy, paid for by a $50,000 contribution by the Partnership for Rhode Island, a group of 12 CEOs, there was no mention of the impact of lead poisoning on educational outcomes. None. De nada.

Here’s what was missing from the report and the current conversation:

Research by Anna Aizer, a Brown University economist, and Janet Currie, a Princeton economist, “Lead and Juvenile Delinquency: New Evidence from Linked Birth, School and Juvenile Detention,” published in May of 2017 in the National Bureau of Economic Research as a working paper, examined the relationship between lead exposure in children and future criminal activity and cognitive development.

The statistically significant findings revealed that the prevalence of lead poisoning in young children resulted in an increased probability of getting suspended from school and placed in juvenile detention.

The findings were based upon an analysis of what the authors called “a unique dataset linking preschool blood lead levels, birth, school and detention data for 120,000 children born [between] 1990-2004 in Rhode Island.”

From that data, Aizer and Currie estimate the impact of lead poisoning on behavior: school suspensions and juvenile detention. What they found was that even a small increase in lead increased the probability of suspension from school by 6.4 to 9.3 percent, as well the probability of detention by 27-74 percent [for boys].

Two factors make the research relevant as the nation grapples how to respond to the public health crisis in lead poisoning, as evidenced by what happened in Flint, Mich., and what is now being repeated in Newark, N.J.

Rhode Island, where Aizer and Currie focused their study, presented some unique research opportunities. Unlike most states, the number of children in Rhode Island who get screened for lead is high, close to 80 percent. Rhode Island children are also screened three times on average during their first six years of life. This means that the chances of getting an accurate measure of lead exposure are significantly higher than usual.

In their research, in which Aizer and Currie studied Rhode Island children born between 1990 and 2004, they were able to access state health department data on each child’s preschool blood lead levels from 1994 to 2010, and then linked that information to school suspension data for the 2007-2008 and 2013-2014 school years. The researchers also compared this information to data from the state’s juvenile detention facility and all Rhode Island correctional institutions.

Translated, the research had a strong statistical base on which to measure how childhood lead poisoning affected future outcomes in school suspensions, detentions and delinquency.

The larger import from the study is whether the research findings will result in policy changes in priorities to remove lead from housing and the environment as the most effective return on investment to improve educational and behavioral outcomes.

Attention deficit disorder by policy makers
The most recent study builds upon previous research by Aizer and Currie, published in August of 2016, also published as a working paper by the National Bureau of Economic Research, which found that reducing children’s lead levels had significant positive effects on third-grade reading test scores in Rhode Island, especially for black and Hispanic students.

The co-authors included Dr. Peter Simon, then an associate clinical professor in Pediatrics and Epidemiology at Brown University, and Dr. Patrick Vivier, an associate professor of Community Health and Pediatrics at Brown University, a pediatrician affiliated with Hasbro Children’s Hospital, and a member of the executive committee of the new Hassenfeld Child Health Innovation Institute. As ConvergenceRI reported:

The study constructed an individual-level longitudinal dataset that linked preschool blood lead levels with third-grade test scores for eight birth cohorts of Rhode Island children born between 1997 and 2005. It found that decreases in average blood lead levels reduced the probability of below proficient reading skills.

The story continued: “Poor and minority children are more likely to be exposed to lead, suggesting that lead poisoning may be one of the causes of continuing gaps in test scores between disadvantaged and other children,” the study concluded.

Translated, if you want to improve test score performances in Rhode Island, the priority should be given to invest in removing lead from the environment – from substandard, poorly maintained older housing, from drinking water, and from the soil.

Drawing a line in the sand
On Sept. 14, 2016, Gov. Gina Raimondo traveled to the Francis J. Varieur Elementary School in Pawtucket, where she officially announced that she was drawing a line in the sand, with a deadline of 2025, promising that three out of four third-graders in Rhode Island will be reading at the appropriate grade levels. [See link to ConvergenceRI story below.]

After the news conference, when questioned by Simon, Raimondo said that she was unfamiliar with the study. Simon responded by saying he would send her a copy, which he did; but to date, Simon said that he has never received a response.

At the news event, Raimondo said that under the new strategic reading initiative, results were going to be tracked by the Governor’s performance management team, as a way of making the effort accountable. Yet, the data used in the study published in the National Bureau of Economic Research had all been taken from existing Rhode Island data sources.

As ConvergenceRI asked at that time: “Would the performance management team identify and track the correlation between reduced lead exposure and increased third-grade reading levels, using the methodology of the study? And, would it also correlate the results with the successful efforts of the Pawtucket Housing Department to enforce the housing codes to protect children and families? Good questions.

The takeaways
The ongoing research by Aizer and Currie documents the continuing impacts of childhood lead poisoning as children age into young adults, directly affecting educational achievement and economic attainment.

For all the efforts now underway by the state to improve the preparation of students to enter the workforce, the best return on investment may be to eliminate lead from substandard housing in Rhode Island, which will both improve third-grade reading skills and lower future school suspensions and detentions.

And, as the state moves to take over city control of the Providence school system with a mission to improve educational outcomes for the next generation of Rhode Islanders, the failure to address [some might call it willful ignorance] childhood lead poisoning as a root cause may doom the best efforts of administrators and teachers to change the curve of educational outcomes.

“Although each person's story is different, we know that lead poisoning in early childhood can cause lifelong challenges for an individual, including behavioral problems, trouble learning in school, and even higher risk of heart disease,” said Laura Brion, executive director of the Childhood Lead Action Project. “These problems are even more visible on the community level, if you know how to look for them.”

Moving forward, Brion believes that the solutions must include investments focused on the community level. “Lead poisoning highlights the need for community investment on multiple levels, including investment in schools,” she said. “We already know that every child deserves an education tailored to their individual talents, interests, and challenges. For communities where some of these challenges may be exacerbated by lead poisoning, this support becomes all the more crucial.”

For Simon, a retired pediatrician and epidemiologist, creating a solution depends on fully analyzing the existing 30 years of data on lead poisoning in Rhode Island in a comprehensive fashion. The first step, he argued, would be to develop a five-year plan that identifies the likely mix of lead sources in all neighborhoods in both urban and suburban Rhode Island, as well as a way to score the risks.

“We would need to agree on the way to use the best data we have on lead in soil, water and interior dust and paint,” he said.

To do that, of course, requires the political will, and that will has been sadly lacking in the R.I. General Assembly.

A failure to act or to even meet

In March of 2018, ConvergenceRI reported on a study published by The Lancet conducted by Dr. Bruce Lanphear, which found that approximately 412,000 deaths a year in the U.S. from heart disease could be attributable to low level lead exposure. [See link below to ConvergenceRI story, “The pb funk.”]

In the study, Lanphear, a professor of Health Science at Simon Fraser University in British Columbia, posited that low-level lead exposure is an important but largely overlooked key risk factor for heart disease mortality for adults in the U.S. Translated, adults – and not just children – are life-long victims of low levels of lead poisoning, leading to their death from heart disease.

The second part of the story examined why a legislative commission created in 2016 and again in 2017 to look at the problem of lead in drinking water in Rhode Island never met.

As ConvergenceRI wrote: In the midst of March Madness, to borrow an apt phrase from the late Johnny Most, the infamous Boston Celtics announcer, that he used to describe a basketball player who was dribbling with no apparent purpose, the R.I. General Assembly, and in particular, House Speaker Nicholas Mattiello, appear to be “fiddling and diddling” when it comes to addressing the threat of lead in drinking water in Rhode Island.

In 2016, and again in 2017, the R.I. House of Representatives enacted a legislative study commission to examine the problem of lead in drinking water in Rhode Island. The 2016 study commission never met. The 2017 study commission’s term expired on March 2, 2018, without ever having met once.

In attempting to explain away why the commission had never met, House spokesperson Larry Berman said: “Although a commission to continue the study of lead in drinking water was approved last year, the panel never met. The sponsor of the bill [2017-H6035] learned that the R.I. Department of Health has been reviewing this issue and the House is awaiting the department’s assessment until moving forward. I do not anticipate a commission working on the issue this session.”

Berman’s explanation, however, was contradicted by the R.I. Department of Health, whose spokesman, Joseph Wendelken, shared correspondence sent by the agency on May 1, 2017, to legislative leaders, including a baseline evaluation of lead in water in schools, in day care and in public water systems, three days before the study commission was enacted by the House.

Further, the agency asked to become a member of the study commission, endorsing the effort. [See link to ConvergenceRI story below, “There are Flints everywhere.”]

Ignorance is bliss?
In two weeks, on Sept. 3, the classrooms in Providence will again be open for the first day of school, with many of the issues regarding whether the buildings themselves are “sick” unresolved.

The recent reporting by the Boston Globe’s Dan McGowan, in his story, “We fact checked the worst rumors about the Providence schools,” was glaring in its omissions, in ConvergenceRI's opinion. McGowan, for whatever reason, failed to explore any of the details offered by Hope High School teacher Betsy Taylor in her story, “A teacher speaks her mind,” published by ConvergenceRI in the July 22 edition. [See link to story below.]

Just to refresh McGowan’s memory, Taylor wrote: “Another perk of my job is that each morning I must carefully inspect my desk and keyboard for rodent excrement, keeping bleach solution and paper towels at the ready. Sometimes I will find they have literally shredded papers left out on my desk overnight.”

Taylor continued: “I open my desk drawers for supplies and roaches scurry for the back corners. There are two things for which I harbor authentic phobias: roaches and rats. For this reason, I can no longer use my desk. I now use a regular table, so there are [fewer] places for vermin to hide. I am mindful not to lean against walls or leave water bottles uncapped. First thing in the morning, if you are lucky, you will notice pest control guys walking around the halls with buckets of dead or dying mice, courtesy of glue traps set in plain sight.”

What Taylor offered in her story was first-hand experience, as a teacher, not rumors. Why did McGowan fail to interview her about the conditions in her classroom in the basement of Hope High School? Good question. He had been present at the July 19 news conference held by Providence Mayor Jorge Elorza when Taylor interrupted the proceedings.

More warning signs
In both the Johns Hopkins Institute for Education Policy report and in the presentation at Hope High School on July 2, the new state commissioner of education, Angélica Infante-Green, compared the performance of the Providence school system with that of Newark, N.J., a comparison that needed to have an asterisk attached, as detailed by ConvergenceRI in the story published in the July 15 edition, “The importance of being earnest about education in RI.” [See link below to the story.]

Newark, it turned out, had been the recipient of some $200 million in investments by wealthy advocates of public education reform, which included the state taking over the Newark schools. [The Partnership for Rhode Island, the group of 12 CEOs from many of the state’s largest employers, paid $15,000 to support the “speaking tour” by Infante-Green to build up a sense of outrage in advance of being granted authority to take over the Providence schools.]

Newark, however, may also resemble Providence in a more disturbing fashion: large-scale lead contamination of its drinking water. The problem had been known for years, but in the past few weeks, became much more urgent, when it was discovered that the water filters distributed to families to help alleviate the problems of an old, broken water infrastructure, did not provide adequate protection from lead.

In an emergency response, bottled water is being distributed to families in the northern Jersey city in an attempt to alleviate the crisis. Hanna-Attisha, the pediatrician who provided the data backing up the claims of a major increase in the elevated levels of lead in blood in the children of Flint as a result of the decision to switch drinking water sources from Lake Michigan to the polluted Flint River, was quoted in the news media as saying that the conditions in Newark is what now keeps her up at night.


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