Toxic Neglect: The weight of lead by Plain Dealer Contest

SUNDAY, OCTOBER 25, 2015 | SECTION L

A Plain Dealer Special Report

PHOTOILLUSTRATION BY ANDREA LEVY | THE PLAIN DEALER

The weight of lead A toxic menace still stalks the city’s children, silently poisoning their futures Brie Zeltner and Rachel Dissell bzeltner@plaind.com and rdissell@plaind.com

In the past five years, lead poisoning has set at least 10,000 Cleveland area children on a potential path to failure

before they’ve even finished kindergarten. ¶ It’s a path that leads to two of Cleveland’s most pressing and bedeviling problems: poor school performance and violence. ¶ The problem isn’t a new one. We’ve known about it for decades. ¶ Yet we have failed to fix it — a choice that costs us millions every year and stands in the way of the region’s hopes for sustained economic growth. ¶ The poisonings are entirely preventable. ¶ And though the dangers of lead poisoning have been known for more than a century, the threat to children remains. ¶ Other cities across the nation have found solutions, recognizing that cleaning up lead in homes would save millions in health, education and criminal justice costs down the line. Their smart, low-cost preventive solutions have left little excuse for inaction. So what’s stopping us? ¶ The Plain Dealer spent months digging into the history of lead poisoning in the area, analyzed data to better measure the scope of the problem, and questioned local political and public health leaders about the logic behind their strategies. Or lack of any proactive ones. ¶ We also talked to cities that refused to accept more generations of lead-poisoned children and instead began to clean up unhealthy homes. ¶ “[I]t takes commitment, the resources and a coordinated effort to eliminate this devastating disease,” U.S. Rep. Louis Stokes said in 1990. ¶ But our region’s response has remained stubbornly reactionary rather than preventive, piecemeal rather than comprehensive, and almost wholly dependent on federal dollars. ¶ City officials also fail to enforce the laws to hold property owners accountable for lead hazards, rules meant see LEAD | L5 to protect babies and toddlers from being poisoned in their homes.

Code enforcement mostly does too little too late. L2 | Young and vulnerable bear the brunt of lead’s

ts. L6 | Race traps poor families. L8

The Plain Dealer | cleveland.com

Sunday, October 25, 2015

The weight of lead

PLAIN DEALER SPECIAL REPORT

How contamination goes unabated Poor code enforcement leaves children at risk in dangerous homes Rachel Dissell and Brie Zeltner In 2006, Cleveland City Council passed a law aimed at enticing landlords to voluntarily prove their homes were safe from lead-based paint hazards that continue to cause irreversible brain damage and lifelong health problems for small children. Nine years later, not one has done so. The failed effort is, in many ways, symbolic of the city’s overall strategy for combating childhood lead poisoning — well-intentioned but ineffective. After decades of work, the city has a stable of programs, polices and laws to fight its lead poisoning problem, which is among the worst in the nation. But its efforts, which span multiple city departments, are largely outmoded, tenuously funded and mired in bureaucracy. In its current state, the system is one that: 3 Responds only when children are already irreversibly harmed and does little, beyond providing basic educational information, to prevent children from being poisoned. 3 Has confusing laws that in many cases are ignored or not fully enforced. 3 Sidesteps basic housing-code enforcement, which experts say is vital to creating a sustainable lead-poisoning prevention program. Cleveland’s approach is one that in 2012 the Centers for Disease Control and Prevention told cities “should no longer be acceptable practice.” City officials rely almost completely on a lifeline of federal grants and have struggled in the past two years to respond to lead poisoning cases that leave children hospitalized, let alone the thousands of other children exposed at lower levels, which can still inhibit their ability to read, do well in school and earn a living. In 2012, the federal government stripped Cleveland of its grant because progress in fixing lead-laden properties was too slow. The following year, Cleveland missed out on millions when it wasn’t picked for one of the competitive grants. After that, the city was forced to spend $850,000 from its own budget to keep the programs afloat. During that time, Cleveland employed only two lead inspectors for the whole city, one each in the public health and community development departments. The city went into survival mode, deploying lead inspectors mainly in “hospital cases” where children showed levels of lead in their blood eight times higher than the current standard. When they got reports of children poisoned at lower levels, they mailed parents educational materials, and said they’d be out to inspect when they could. The city also relied on Cuyahoga County ’s board of health for help in 47 homes.

Lead-poisoned children children in ‘hot’ census tracts Lead-poisoned

“Have you dealt with the City of Cleveland building department for anything?” he said. “They make it so difﬁcult to want to do business with them.”

The Kirwan Institute for the Study of Race and Ethnicity created maps for The Plain Dealer to illustrate estimates of the scope of Greater Cleveland's lead poisoning problem.

Children under 6 estimated to be lead poisoned in “hot,” or heavily leadcontaminated, census tract

Inspections lack teeth

The map below uses a model created for the Ohio Department of Health to determine how many children under 6 are lead poisoned in census tracts. The model is conservative because it only considers areas deemed "high risk" for lead poisoning.

12.2% - 15%

We sought estimates because screening for lead poisoning is very low, only between 20-30 percent of children who should be screened get tested.

15.1% - 18.8% 18.9% - 23.4%

The Ohio Department of Health deﬁnes a “hot” census tract as one where the estimated percentage of children who are lead-poisoned (meaning a concentration of ﬁve micrograms or more of lead per deciliter of blood) is 12 percent or greater.

23.5% - 27.3% 27.4% - 30.6% 30.7% - 35% 35.1% - 45% 45.1% - 49.7% Cleveland

90 490

271

71 480

480

SOURCE: Kirwan Institute for the Study of Race and Ethnicity

At the time, city ofﬁcials said the loss of the vital money was “unacceptable” and blamed Jonathan Brandt, who headed its Lead Hazard Control program for more than a decade. Brandt, who was placed on paid leave and later laid off, said the problem was systemic and existed long before he was picked in 1999 to run the lead hazard program. That was right after another time the city had lost lead funds. Brandt said he was never able to gain high-level support or cooperation among departments for a comprehensive approach to lead poisoning. “It’s not a priority in the city, as much rhetoric as there is, it’s absolutely not a priority,” he recently told The Plain Dealer. Brandt said ofﬁcials refused to allocate money from the city budget despite knowing thousands of children were being poisoned each year. “ We put more money into baiting for mosquitoes to curb West Nile virus and to prevent rabies in raccoons than we put into lead poisoning the entire time I worked in the city,” Brandt said. (City officials did not supply budget numbers requested by The Plain Dealer to show what’s been spent on lead poisoning prevention or remediation aside from what’s required by grants.)

Too little, too late Cleveland’s approach to lead poisoning essentially has been the same for well over a half century. It reacts to poisoned children, instead of making sure children are never exposed to lead at all. That’s the way it was when Jack Wilt directed the city’s health response in the decades leading up to his retirement in 1986. Wilt said the city was advised by the Centers for Disease Control and Prevention in the 1970s that it needed to be looking for lead in homes. “It always seemed an impossible task to test every house in the city,” said Wilt, who is now 88 and retired in Arizona. “We felt it was more important to test kids and investigate their homes so we could help the kids having a problem immediately,” he said. More than 87 percent of Cleveland’s houses were built before 1970 and, therefore, likely contain lead paint, which was officially banned in 1978. Over half of those homes are rental units, which more often have ﬂaking, deteriorating paint that chips and turns into a fine dust, coating surfaces and settling into the soil where children play. City officials have, over the years, come up with a number of laws and policies to target the toxin, but most sidestepped the

THE PLAIN DEALER

solution of enforcing the city’s existing housing codes. Those codes prohibit deteriorating paint and other conditions that pose risks for lead poisoning. The U.S. Department of Housing and Urban Development, which oversees national leadabatement efforts, has urged cities to tackle the problem in homes for more than two decades. More recently, there’s been “a big shift to primary prevention,” said Matthew Ammon, director of HUD’s Ofﬁce of Healthy Homes and Lead Hazard Control, who was in Cleveland in September. Ammon said with funding cuts and much work to be done, “There is no way a program can survive living on a single grant source.”

Laws are not enforced In 2004, city lawmakers passed a set of nuisance laws that, among other things, allowed the city to take property owners to court for failure to abate their homes. They also created a rental registry, and required landlords to pay $35 a year to list their homes and apartments so the city could keep track of their maintenance. A little more than one-third of the city’s rental units were registered as of Aug. 28. The law also requires a $5 “lead inspection” fee from landlords who don’t have a certiﬁcate prov-

ing their home is lead-free or that hazards are being addressed. No one’s collecting that fee, according to employees in the city’s rental registration office. The city does little to enforce its own rental-registration law. Landlords can be cited in court for failing to comply, but a Cleveland Municipal Court spokesman said no such cases were filed by the city in the past five years. Building & Housing Director Ronald O’Leary did not respond to a reporter’s questions about the rental registry, the fees collected and what the money is used for. Many other cities use rental registrations, and HUD has for decades recommended that cities use registries, rental inspections or certificates to ensure that homes are safe from hazards, including lead. A number of suburbs, including South Euclid, Cleveland Heights, Lakewood, Euclid, Parma, Parma Heights and Garfield Heights have rental registries that require yearly or periodic inspections. Ralph McGreevy, with the Northeast Ohio Apartment Association, said there’s a simple reason property owners never jumped at the chance to register their properties as “lead free,” which can help them legally if a lead-poisoned tenant sued.

State law requires public health officials to investigate when a child’s blood test finds 10 micrograms of lead per deciliter or more of blood. A Plain Dealer review of recent city lead inspection and assessment records raises questions about whe ther Cleveland is inspecting all of the potentially hazardous homes, and how many of the property owners cited are made to remove or remediate the dangerous toxin. In five years, from 2010 to 2014, more than 2,577 homes or apartments were linked to at least one child poisoned by lead, according to Ohio Department of Health data provided by The Kirwan Institute for Race and Ethnicity. But health department records show inspections were conducted in fewer than 900, or roughly 35 percent of the cases. When homes were inspected, property owners were cited almost 70 percent of the time, the inspection records showed. How many of those hazards were cleaned up? That’s unclear. In an interview with The Plain Dealer, Environment Commissioner Chantez Williams said that many property owners struggle to afford repairs. The city provides grants when they have federal funding, but not all property owners are eligible. But Williams said most eventually complied with orders to control the lead. How long that takes varies from a few months to a few years, the records show. If homes aren’t fixed, inspectors can ask city prosecutors to file charges against the property owners. But they’ve filed fewer than 100 of those cases since 2010, and a slim few appear to result in abatement or remediation of lead. For example, in Februar y 2014, city inspectors found lead hazards at a duplex on the 3300 block of West 41st Street after a child was poisoned. The owner failed to fix the hazards and was told the property needed to be vacated, according to city officials. When a reporter visited the house on Aug. 20, a grandmother was living there with several children placed in her care by the county, one of whom had been caught putting paint chips falling from the side of the home into her mouth. At least four lead-poisoned children have lived at that address in the past decade, state records show. The city inspected again on Aug. 24 and again found additional lead hazards. After The Plain Dealer and Cleveland Councilman Brian Cummins asked health officials about the home, charges were filed against the owner. He’ ll appear in court next month.

Only a fraction of hazards are caught, fixed Rachel Dissell and Brie Zeltner If a child suffers lead poisoning in Cleveland, parents have one place to turn: the city’s health department, which is supposed to investigate what’s making the child sick and make sure it gets ﬁxed. But over the past five years, the city failed to inspect at least half of the homes or apartments where one or more lead-poisoned children lived, records show. When city lead inspectors did investigate and identify a hazard, it got ﬁxed less than half the time,

leaving hundreds of known lead hazards unaddressed and the threat to children remaining. Two city departments, health and community development, deal with lead in homes. Health department inspectors are supposed to check for hazards and hold property owners accountable for making homes safe. Community development manages grant money from the federal government to assist with cleanup. Starting four months ago, The Plain Dealer began requesting data from the city, state and federal entities to determine how lead

hazards were being addressed in Cleveland. We used data tabulated by Ohio State University’s Kirwan Institute for the Study of Race and Ethnicity showing the number of Cleveland homes and apartments linked in a state database to blood tests from children who were lead poisoned between 2010 and 2014. We compared that to records on nearly 900 lead investigations conducted by health department inspectors. Of the homes that were inspected in those ﬁve years, the city cited nearly 70 percent of the homes,

duplexes or apartments that contained lead hazards, according to health department records. Owners have followed orders to remove or remediate hazards in 225 cases, according to health department records. For nearly 400 houses or apartments where the city found hazards, there are no records to prove they’ve been cleaned up. A city spokesman Thursday said the health department’s division of environment gives ﬁrst priority to children who have the highest blood-lead. City ofﬁcials last week said that

records kept by the community development department to report the city’s progress to U.S. Department of Housing and Urban Development show more homes were ﬁxed. A spreadsheet provided by city spokesman Dan Ball on Tuesday showed 562 addresses of homes and apartments the city reported to HUD as “cleared” of lead hazards during the same period of 2010 through 2014. Ball on Thursday said in an email that, to qualify for the HUD money, a home didn’t need to be identiﬁed as a hazard by a city inspector. So the two lists would not

be identical. “The Community Development HUD Program accepts all applicants who qualify — not just applicants referred by the Health Department,” he said. The Plain Dealer requested from HUD the information on more than 4,000 lead-laden homes cleaned up with taxpayer money in August. After reporters asked for the data a second time in a federal Freedom of Information Act request, HUD ofﬁcials agreed to turn over the information. But they’ve yet to do so. see INSPECT | L3

TOXIC NEGLECT: THE HIGH COST OF LEAD POISONING

Cost of lead abatement Eliminating lead from aging homes isn’t cheap. It can cost $7,000 on average to eradicate it — though less expensive alternatives for controlling it exist.

“It’s not a priority in the city, as much rhetoric as there is, it’s absolutely not a priority. We put more money into baiting for mosquitoes to curb West Nile virus and to prevent rabies in raccoons than we put into lead poisoning the entire time I worked in the city.” Jonathan Brandt, Former head of Cleveland’s Lead Hazard Control program

Sunday, October 25, 2015

The Plain Dealer | cleveland.com

The weight of lead

PLAIN DEALER SPECIAL REPORT

A grandmother loses out to lead

PHOTOGRAPHS BY GUS CHAN / THE PLAIN DEALER

Stephanie Thomas was cited by the city for lead hazards in her home, and her grandchildren have been diagnosed with elevated lead levels. Her home was later sold at a sheriff ’s sale.

Rachel Dissell and Brie Zeltner It was Stephanie Thomas’ dream to own a home. The 46-year-old grandmother knew the rent-to-own colonial she’d moved into on Lenacrave Avenue needed work. She didn’t know, though, that her new home was chock full of a dangerous toxin that would soon poison two of her grandchildren, land her in court and ultimately threaten to leave her homeless. Thomas’ story is just one example that illustrates a slowmoving and disjointed system that responds to lead-poisoned children in Cleveland, one where the outcome doesn’t necessarily eliminate the poison. Thomas’ story began in early December of 2012, when the Cleveland Health Department cited her after her 1- and 2-year-old grandkids tested high for levels of lead in their blood. A city inspector found the lead was coming from her three-bedroom home in the Mount Pleasant neighborhood. The city gave Thomas time to ﬁx the problems, which included lead-based paint peeling from the outside of her home and its toxic dust from old doors and windows. The city’s Environment Commissioner Chantez Williams said, in general, the city starts by giving property owners 90 days to ﬁx

INSPECT from L2

In an interview with The Plain Dealer, Environment Commissioner Chantez Williams said most owners comply with the citations. Many, however, struggle to come up with the money for repairs, he said. The city doesn’t have specific compliance guidelines, but usually gives homeowners 90 days to fix identified problems, he said, and often allows extensions. If hazards aren’t fixed or controlled, the health department can ask city prosecutors to file charges against the property owners in Cleveland Municipal court.

Housing Court Judge Ray Pianka put Thomas in a diversion program so she could be given more time to do the work. He also, as he does in many cases, ordered her not to have children staying in the home. Court staff referred her to city programs that could have helped with the repairs, but she said she didn’t qualify for some of them because she was behind on her taxes. The largest of these programs is federally funded with grants from the U.S. Department of Housing

and Urban Development. The city failed to get one of those grants in 2013 and has had little money to assist homeowners like Thomas since then. The city recently was awarded a $3.3 million grant to restart those programs. A city program did help Thomas get exterior paint. She and her father did the work, covering over the dangerous old layers of paint. She also replaced several windows but said the work was a bit overwhelming. Thomas paid for the work with tax returns and later, after she

was deemed disabled, with money from Social Security payments. A roof leak and a busted pipe that caused extensive water damage over the winter set Thomas back once again. Soon she was facing foreclosure. Pianka eventually found her guilty and placed her on two years of probation but waived the court fines and fees she couldn’t afford. Situations like Thomas’ are difficult for the court if a person doesn’t have the resources to fix their home, Pianka said. The judge said he takes a different approach with landlords. He can order them not to rent the home to families with children, to pay to relocate a family while repairs are made or to deposit money with the court to put toward repairs. Pianka can fine people up to $2,000 and even put them in jail. But that punishment doesn’t solve the problem if a homeowner can’t afford to fix the hazard, he said. “I’m at a point where I just don’t want to worry and stress about this any more,” Thomas said in July. “I’m at the point where I want to let it go, but finding a place I can afford is going to be hard.” In May, more than two years after she was cited, Thomas’ home was sold at a sheriff ’s sale to a Cleveland area real-estate holding company called Lakeside REO Ventures. It’s not clear whether the company knew about the hazard when it bought the home, one of at least 200 other properties it

the landlord denied to her the lead that poisoned her son was from the home. The inspection report shows dangerous lead dust or other hazards were found on the home’s exterior, including on the front porch and also inside the house. Holmes said she suspected nothing was done to clean up the problem after she left. She appears to be right. About 17 months later, when a reporter visited the home on Aug. 20, a mother and three children were living there. The mother, who didn’t want her name used, said the landlord told her the problem had been ﬁxed. City records provided to The Plain Dealer did not show any

record of any cleanup. The landlord listed on the report couldn’t be reached for comment and didn’t answer the door of a home listed as her residence on the same street. “I really don’t want someone to get away with this,” Holmes said. “Not only did my son get poisoned, but other kids could be too.” Information provided to The Plain Dealer by the state health department showed that 220 different Cleveland homes poisoned multiple children in the past decade. Cleveland Housing Court Judge Raymond Pianka has the power to order property owners to relocate families with children or not rent to them if there’s a lead hazard in a home. But the city doesn’t frequently

file the cases, he said. From 2010 through 2014, city prosecutors filed fewer than 100 cases charging owners for failing to fix lead hazards, according to records provided by the court. The Plain Dealer found several cases where homeowners were charged and then properties were sold or transferred into a new owner’s name. A few ended up back in court. When cases do end up in court, lead is not always cleaned up. Less than a quarter of the court cases filed from 2010 to 2014 appear to result in cleanup, according to city records of “cleared” properties, meaning dangers could remain. The Plain Dealer asked the city prosecutor’s office in July for

a hazard, though they can ask for an extension. “They try to do the right thing,” Williams said. “But what we’re ﬁnding is that they don’t have the necessary resources to do those things, so it takes them a little bit more time to do that.” Thomas’ case, though, dragged out for three years, through failed attempts to ﬁx the problem, after her grandchildren moved out of the home, which ultimately went into foreclosure and was sold at a sheriff’s sale.

Few cases end up in court Thomas’ case was one of fewer than 100 filed with the Cleveland Housing Court in the past five years. The number is astonishingly small, considering the thousands of Cleveland children who were lead-poisoned during that time and the more than 600 homes or apartments cited by the city as hazards. Public records provided by the city to The Plain Dealer revealed that, during the five years from 2009 through 2014, it took anywhere from a few months to two years for criminal cases to be filed for failure to abate lead nuisances. That’s the time it took from initial citation to taking a case to court. In Thomas’ case, a misdemeanor charge for not abiding by the city health code was filed in Housing Court eight months after she was initially cited.

But that process is far from efﬁcient. The Plain Dealer identified dozens of properties where there were long and unexplained time lags between city inspections and action against owners. In March 2014, a city inspector found lead hazards in a downstairs unit of a duplex on West 30th Street after a toddler who lived there was lead-poisoned. Josh Holmes, now 3, was hospitalized with such high levels of the toxin in his blood that doctors would not allow him to return to the home. His family was featured in the series “Lead Crisis: Abandoned” done this year by IdeaStream, a partnership between WCPN and WVIZ. Ebony Holmes, his mother, said

The peeling paint on the porch of Stephanie Thomas’ home was a primary source of lead into the home.

owns in Cuyahoga County. A call to Lakeside REO for comment was not returned. Pianka said he tried to ensure that the next owner would be aware that Thomas’ home was a lead hazard, and that they could be held liable if the lead harmed someone. His staff filed a special affidavit that appears on the county fiscal website noting the lead problems. However, it was filed the month after the home had been sold. Thomas questioned the fairness of the situation. “I look around the neighborhood and I see other peeling houses, some are abandoned and others have paint just falling off of them,” she said from her front porch. “Are these people getting cited? Or is it just the people who are trying to get the problems fixed or who will show up at court like me that are getting all the violations?” The answer to the first part of Thomas’ question is no. The city rarely cites people for lead hazards unless a child is poisoned. Pianka said health code violation cases are criminal cases, and so the cases follow the owners, not the properties. “We can hold the previous owner liable for not fixing the hazard but not the new owner,” Pianka said. “Unless the city brings a new case, nothing can be done.”

recent lead hazard cases to determine if the city was dropping some of the cases. Officials still have not provided the records. Cleveland’s law department, through a city spokesman, would not answer a specific question about whether hazards had to be remediated or abated before its prosecutors would drop a case. The department said the city can make a motion for a case to be dropped. “But ultimately it is up to the Court” as to whether the case is dismissed, the city said in an email. But Pianka said it can’t work that way. “What happens if I say ‘No, I’m not dismissing it,’” he asked. “Would I get off the bench and prosecute it?”

TOXIC NEGLECT: THE HIGH COST OF LEAD POISONING

Loss of earnings from lead exposure across the nation Lead poisoning, even at low levels, causes diminished intelligence and learning problems. That makes for one of the largest economic impacts from the toxin — loss of earnings and lost tax revenue.

194,000 U.S. children poisoned by lead in 2006 translates to $165 billion to $233 billion in potential lifetime earnings loss

“Have you dealt with the City of Cleveland building department for anything? They make it so difficult to want to do business with them.” Ralph McGreevy, Northeast Ohio Apartment Association

The Plain Dealer | cleveland.com

Sunday, October 25, 2015

The weight of lead

PLAIN DEALER SPECIAL REPORT

Common myths about lead poisoning Who’s really at risk? And who’s at fault? Brie Zeltner and Rachel Dissell To many people, lead poisoning evokes a very particular picture: A toddler is sitting on the floor in a squalid apartment or ramshackle house, and paint is peeling off the walls in long strips. The baby, equally dirty and neglected, is pulling paint chips off the wall and eating them, a dazed expression on his face. It’s a picture of the past. But the problem of lead poisoning is still very much on the scene today. Over the past 10 years, more than 40,000 Cuyahoga County children have tested positive for lead poisoning, some over multiple years. In the past five years, 10,000 children have been poisoned. The myths and misinformation embedded in that timeworn image of lead poisoning — whom it affects, where they live, how they’re exposed, and who is at fault — have hindered efforts to confront one of the few public health threats that has a clear solution and a huge potential payoff, for kids and taxpayers alike. Myth: Lead poisoning isn’t a problem anymore. We took the lead out of paint and gas. Fact: There may not be any new lead being added to paint or gasoline, but there’s enough left over to poison thousands of area children every year, said Kim Foreman of Environmental Health Watch, a local nonprofit. Banning lead in paint in 1978 and phasing lead out of gasoline in the 1980s and ’90s has made a big difference, without a doubt. By some estimates, those policy changes decreased lead exposure by 90 percent. But the lead already in older communities is abundant, invisible and tough for homeowners to eliminate themselves, Foreman said. She’s been working on the problem for 17 years, and has seen more than one generation of the region’s children affected,

in many of the same neighborhoods. “It’s probably the longest-lasting childhood epidemic in American history,” said David Rosner, co-director of the Center for the History & Ethics of Public Health at Columbia University. Myth: Only kids who eat paint chips get lead poisoning. Fact: “That’s completely wrong,” said Kim Dietrich, a neuropsychologist at the University of Cincinnati who is an expert on lead poisoning. “Peeling paint can be a source of lead exposure, but it’s not that important a source.” Children are more often poisoned by ingesting tiny particles of lead in dust — paint ground down over time or from soil tracked in on shoes — which they pick up on their hands during normal play. Lead dust clings to surfaces such as windowsills, ﬂoors and toys, and is hard to clean up. The image of the lead-poisoned child as abnormal or neglected is not only wrong, but it was intentionally placed in the American psyche by the lead industry itself, which had a vested interest in shifting the blame from their products, said Rosner, co-author of the book “Lead Wars: The Politics of Science and the Fate of America’s Children.” In some of the more odious of their internal communications on the topic, a top official at the trade group representing lead paint manufacturers in the 1950s described lead poisoning as a problem “of the slums” confined to “Negro and Puerto Rican” children with “relatively ineducable” parents who could not be trusted to protect them, Rosner’s research revealed. Myth: Only poor, inner-city children are lead poisoned. Fact: Lead can be found in any housing built before 1978, when lead paint was finally banned. Hazards are most likely to be found in e ven older homes

Getting household lead under control

The Centers for Disease Control and Prevention estimate that there are currently 500,000 children nationwide who are lead poisoned.

Abating or completely removing lead can be costly. But here are some interim steps you can take to protect your family if you’ve found lead hazards in your home, or think you might. Inspect interior doorways for chipped or peeling paint, especially at the level where toddlers might grab as they learn to stand and walk.

Wipe or vacuum out window sills often to clear any chipped or ﬂaking paint. If there is a lot of chipping, wet the area down ﬁrst with a spray bottle. Dust from peeling outdoor paint can also be carried inside through open windows and settle in window troughs and on sills and baseboards.

If you can’t paint over or replace these areas, cover them with contact paper or duct tape. Give your pets’ paws a wash before they come in.

If you have bare dirt around your home or driveway, cover it with at least six inches of mulch.

Put a stiff, bristled rug outside the door to catch dust before it comes into the home.

Remove all shoes and place them on an indoor rug or in a basket to prevent lead dust from getting tracked into the home.

It’s a good idea to buy inexpensive rugs and replace them frequently.

Vacuum carpeted surfaces at least once a week. Use a HEPA vacuum followed by a steam cleaner, if possible.

Wear gloves so lead particles don’t get on your hands or under your nails and transfer to your children.

For hard-surface ﬂoors: The two-bucket mopping method Mop frequently using the two-bucket method, if possible.

 Fill bucket #1 with warm water and a household cleaner.  Fill bucket #2 with clean rinse water.  Dip mop into bucket #1 and clean ﬂoor. Then dip the mop into

bucket #2 to rinse and squeeze before returning it to the cleaning solution. Dispose of the water by pouring it down the toilet. BRIE ZELTNER, WILLIAM NEFF | THE PLAIN DEALER

— those built before 1950. In Cuyahoga County, that’s about 187,000 homes, says John Sobolewski, supervisor of the county’s lead-poisoning prevention program. Many of those homes are in suburbs such as Lakewood, Cleveland Heights and Rocky River.

Myth: Only kids with very high levels of lead in their blood are harmed. Fact: Even low levels of lead in a child’s blood may have long-term effects on learning and behavior. A host of studies now link exposure to low levels of lead with

low test scores in kindergarten and third grade, behavior problems, attention deﬁcit/hyperactivity disorder, and physical health problems throughout life, said Dr. Bruce Lanphear, an expert on the effects of environmental toxins on children at Simon Fraser University in Canada.

Myth: If parents just watched their kids more closely, there wouldn’t be a problem.

Fact: Even well-supervised children can be at risk. Poisoning occurs when young children do what is perfectly natural to them — putting their hands, toys and other objects into their mouths. In their internal communications throughout the 1950s and ’60s, the lead paint manufacturers’ trade groups repeated the falsehood that negligent, unteachable parents were to blame, Rosner said. Doctors and public health workers repeated it, too. In a 1959 story in The Plain Dealer, Cleveland coroner Dr. Samuel Gerber warned area parents to keep their children from chewing the windowsills and to “give them something to chew on that contains no lead pigment.” The prevailing message was “if parents would only stop their children from crawling on the floor and putting things in their mouths or touching the walls, they wouldn’t have this,” explained Rosner. “If you were a middle-class parent, you certainly would watch your child and there wouldn’t be any danger if you just kept your house neat and did the normal things that middle class parents do.” Anyone who has ever cared for a child can appreciate how ludicrous the idea is. “You can’t prevent your young babies from bringing their hands to their mouth, and it would be wrong to do it, because that’s just a natural behavior,” said Dietrich. “If you’re living in one of these older homes, it requires a great deal of vigilance to keep the floors clean enough for the kids to play on and not dose themselves with lead.” “It was a kid’s problem, a parent’s problem or a societal problem, but it’s never our problem,” said Rosner, referring to the paint industry. “It’s never the fact that we put this poison on the walls and profited from it.”

Other cities employ effective lead strategies Rachel Dissell and Brie Zeltner

Greater Cleveland continues to have one of the worst lead-poisoning problems in the nation with more than 10,000 children poisoned in the past five years. In some urban pockets, as many as half of children under 6 are likely to be poisoned. The problem, though, is preventable. ¶ Below are some solutions used in other cities that could work here but would require signiﬁcant political support. Others are so common-sense you might wonder why they aren’t being used already.

1. Code enforcement 2. Get more kids screened as prevention The goal: Preventing exposure to lead for all children, rather than using children as “lead detectors” and reacting after they are poisoned.

The goal: Identify more children who inhale or ingest lead so they can be treated and their homes cleaned up to prevent further damage.

What’s happening here: Though some effort is put into educating parents in neighborhoods with a lot of older, deteriorating homes about the dangers of lead, little to no priority is given to removing the hazards before the harm is done.

What’s happening here: Screening rates for childhood lead exposure are dismal here. Though Ohio laws and Medicaid rules require certain children be screened for the toxin, in Cleveland and Cuyahoga County only about 20 percent to 30 percent of the kids who should get tested do. Ohio health ofﬁcials created highrisk ZIP codes and screening tools to help doctors and parents ﬁgure out which children need to be tested. But the testing laws aren’t enforced, and the number of children getting screened has barely budged in Cuyahoga County in a decade.

Who’s trying to do it right: Though no city has completely eliminated lead poisoning, some, such as Rochester, New York, have significantly cut exposure to the heavy metal by deploying code enforcers to look for and cite lead hazards in homes built before 1978, when lead was banned in paint. It requires some investment in training, but routine inspections are quicker and can cover far more ground. Some cities concentrate the inspections on rentals, which are at greater risk for hazards or in certain geographic areas where lead-poisoning cases are historically high.

Who’s trying to do it right: Some states, such as Massachusetts, Rhode Island and Connecticut, require universal screening of children at certain ages. In some of those states, and in the District of Columbia, doctors must provide parents with proof their child has been screened before they enroll in a day care or school, similar to how parents here must provide vaccination records before enrolling their child.

3. Create lead-safe registries

4. Enforce existing 5. Use the power of the courts lead-related laws

The goal: Create a public registry of homes with no lead hazards or where lead has been eliminated or remediated. Parents or caregivers can search for healthy homes for their children.

The goal: Enforce existing laws to protect children from exposure to lead-based paint and prevent the same homes from poisoning children again and again.

What’s happening here: Cleveland and Cuyahoga County both have programs to inspect and help remediate homes where lead hazards are identiﬁed, using grants from the U.S. Department of Housing and Urban Development. But they do not have registries to share information about the homes they help fix — even though HUD has encouraged “lead safe” housing registries for more than a decade.

What’s happening here: Cleveland has lead-related laws on the books, though a Plain Dealer review of records showed that not a lot of muscle goes into enforcing them. Who’s trying to do it right: Cities such as Grand Rapids, Michigan, more aggressively enforce their laws, which force landlords to register rental units and ensure they are safe.

The goal: Make property owners follow the law or swiftly end up in front of a judge. What’s happening here: City attorneys can file charges against property owners if they fail to fix lead issues that have damaged children or put them at risk. Prosecutors rarely do, and it often takes a year or more to get a case to court. Even that doesn’t always fix the problem. Sometimes cases are dropped or properties are transferred into new owners’ names, putting more children into harm’s way. Who’s trying to do it right: Philadelphia created a “Lead Court” in 2002 specifically to handle leadhazard cases. Researchers found the effort reduced lead hazards eight times faster than before. Closer to home, in Mahoning County, health officials used a different strategy, assigning a special municipal prosecutor to file nuisance cases against noncompliant landlords in Common Pleas Court under anti-blight and disclosure laws.

Who’s trying to do it right: Many cities, counties and states make lead remediation or inspection information accessible in online registries that are simple to create and inexpensive to maintain. Close to home, you can ﬁnd them in places such as Akron and Michigan.

6. Protect foster children

The goal: Don’t put children who are in county custody or foster placements in homes that could poison them.

What’s happening here: Cuyahoga County screens children placed in foster homes for lead poisoning. It does not, however, inspect the foster or relatives’ homes to make sure they are lead safe. County case workers are supposed to assess homes for safety, though they have no specific training to detect lead hazards.

Who’s trying to do it right: In the District of Columbia, inspectors assess foster homes before children are placed. City ofﬁcials in Rochester, New York, also give social workers direct access to their lead-inspection records so taxpayer funds don’t pay for children and families to live in hazardous homes.

TOXIC NEGLECT: THE HIGH COST OF LEAD POISONING

2013 Direct medical costs per lead-poisoned child under 6 in Cuyahoga County Lead levels of 10-20 micrograms per deciliter Lead levels of 20-45 micrograms per deciliter Lead levels of 45-70 micrograms per deciliter Lead levels above 70 micrograms per deciliter

Cost per child

Cuyahoga County total

$84 $1,171 $1,522 $3,926

$41,244 $119,442 $27,396 $7,852

“If we change the system to a prevention model, my belief is that the housing stock would get better.” Kim Foreman, Environmental Health Watch

Sunday, October 25, 2015

The Plain Dealer | cleveland.com

The weight of lead

PLAIN DEALER SPECIAL REPORT

GUS CHAN / THE PLAIN DEALER

Darrick Wade kneels by the grave of his son, Demetrius, at Cleveland Memorial Gardens. Demetrius died in 2007 at age 24. He was diagnosed as a child with lead poisoning while living in public housing.

LEAD from L1

In Cleveland, doctors and public health officials have been working on lead poisoning in some form, whether haphazard or routine, since County Coroner Samuel Gerber first noticed dozens of children convulsing and dying of lead exposure in the 1950s. In 1992, two years after Stokes’ speech, federal lawmakers approved the Lead-Based Paint Hazard Reduction Act with the ambitious goal to implement “a broad program to evaluate and reduce lead-based paint hazards in the Nation’s housing stock.” Since 1993, $2.3 billion in federal money has been spent to deal with those hazards, but mostly after children have become sick. Cleveland and Cuyahoga County have spent $57 million of that — $50 million of which has been used to slowly reduce lead hazards in homes after a child has received a positive lead test. Working on a few hundred homes per grant, the two entities have cleaned up roughly 4,300 homes since 1993. That’s out of more than 187,000 the county estimates are hazards, due to the year they were built and the likely presence of lead-based paint. These efforts, combined with the work of environmental activists, health officials and housing advocates, have reduced by half the number of children who, when screened, have high levels of lead in their blood. “I would say that is pretty impressive impact,” Cuyahoga County Health Commissioner Terry Allan said. “We certainly have more work to do.” More work, indeed. Roughly two-thirds of children at risk for poisoning are not being screened for the toxin, and in some parts of Cleveland and East Cleveland as many as a third to half are predicted to be poisoned, based on an analysis the Kirwan Institute for Race and Ethnicity at Ohio State University completed for The Plain Dealer using Ohio Department of Health data. The area’s low screening rate, while a common problem across the country, is not inevitable. Other cities have made changes and done better. Since the county and city inspect only the homes of children who are

already poisoned, they doom other children to new exposure every year. “Over the last 15 years we’ve had 40,000 kids who have been poisoned in Cuyahoga County,” said John Sobolewski, who supervises the county Board of Health’s lead poisoning program. “That’s a lot of kids.” About 80 percent of the children who are poisoned each year within the county live in the city of Cleveland. Mayor Frank Jackson, who has recently held news conferences decrying neighborhood gun violence, responded through a spokesman, via email, after repeated queries about his plans to combat lead poisoning: “The City of Cleveland is committed to reducing high levels of lead contamination in homes and working towards eliminating lead poisoning in children. With assistance from agencies like Cuyahoga County and the U.S. Department of Housing and Urban Development, we will continue to identify resources to address this quality of life issue.” Cleveland has had a hard time, on more than one occasion, holding onto the federal resources Jackson refers to, though. In 2012, HUD stripped the health department of its federal grant because it wasn’t fixing houses quickly enough. After that, the city was denied a grant, and for nearly three years could help families only if their children had extremely high levels of lead in their blood — levels high enough to hospitalize them. The city lost its funding, or nearly did, at least twice before that, too. It recently heralded receiving its latest $3.7 million HUD grant.

lead’s poisons are invisible. After children are exposed, the effects often don’t show up until years later, when they struggle with reading, or problems crop up in behavior or health. Others are less forgiving in identifying the reasons for a lack of action. “The reason we don’t respond is because of who is being poisoned,” said Robert Cole, an attorney with the nonproﬁt Advocates for Basic Legal Equality Inc., which is working to address lead poisoning in Toledo. “If this was a different group of children, we wouldn’t tolerate this as a society, community or a city.” Lead poisoning disproportionately affects poor black and Hispanic families who live in older, deteriorating homes closer to the city’s core. “They put the problems of society on things, like no fathers and other things but it is more than that — it is lead,” said Darrick Wade, who ﬁled a lawsuit against the Cuyahoga Metropolitan Housing Authority in 1992 when his son Demetrius and other children who lived at Lakeview Terrace were lead poisoned. Demetrius Wade died in 2007 at age 24. Though it’s impossible to directly link Demetrius’ death to his lead exposure, he suffered from a number of diseases that have been linked to the toxin, including chronic kidney disease and heart disease. “For him to die so young is just a shame,” said Darrick Wade. “For nobody to care it is still happening is even worse.”

What Cleveland doesn’t do Cleveland mayors have called childhood lead poisoning a priority for decades, though none has enacted the local reforms the federal government has long said are needed. In the early 1990s, Mayor Mike White stepped up the rhetoric after health department screening revealed that 86 percent of young children in the Glenville neighborhood and nearly 77 percent in the Kinsman neighborhood were poisoned by the toxin. “Lead erodes the school performance of our children, it undermines housing values, it saps the vitality of our future work force and ultimately threatens economic potential, which is central to our survival as a major metropolis,” White said. White’s public health department convened a meeting with more than 50 health experts to brainstorm ways to tackle lead poisoning. The group launched projects and set goals. Very little changed. Mayor Jane Campbell had ambitious goals for reducing lead poisoning when she took ofﬁce in 2002, expressing a desire to “become a national model” in handling the issue. Despite her administration’s optimism and best efforts, the city didn’t have enough money to tackle the problem systemically, she said. “When I was there the city didn’t have enough resources to pay the police and ﬁre,” Campbell said in a recent interview. That chronic lack of funding is compounded by a building and housing department that’s historically

Cost of the status quo Researcher Dr. Bruce Lanphear often fumes about the lack of action on childhood lead poisoning. For decades, he’s witnessed and studied the devastating impacts of the toxin on IQ and health. Lanphear said the problem is the same now as it was then. Lead still isn’t a priority. Unlike childhood diseases that have vaccines, he said, no one has ﬁgured out how to proﬁt from preventing lead exposure. “If someone could make a buck, or a lot of money to protect children from lead poisoning it would be done,” he said. Part of the problem may be that

been “very stressed,” she said. Those most familiar with the lead poisoning problem locally, including health officials, doctors and housing advocates, say progress can only be made with the help and cooperation of this stressed department and one other — public health. But if the city’s public health and housing departments were stressed when Campbell was in ofﬁce, they’re in crisis now. The public health department has lost almost 60 percent of its staff since 2005, according to city budget records. Building and Housing has lost nearly a third of its code-enforcement staff, which includes the inspectors who examine Cleveland homes for code violations, such as peeling paint, a primary source of lead poisoning. Other cities making headway in prevention have used their code enforcers to help spot and cite peeling paint, vastly augmenting the efforts of lead inspectors. They also share information with residents, including databases to track rental properties and registries that show which properties are safe for children. Cleveland doesn’t do this, and ofﬁcials wouldn’t say why. “Building and Housing used to have 100 inspectors,” said Dr. Dorr Dearborn, professor emeritus at Case Western Reserve University and a lead-poisoning expert who has been advocating for children for decades. “We’ve been asking for years for them to be pulled into this and be trained to do this work, and no one above has ever responded.” Interim Building & Housing Department Director Ron O’Leary did not respond to requests for comment.

What Cleveland could do

LONNIE TIMMONS III | PLAIN DEALER FILE

In the 1990s, city ofﬁcials stepped up screening efforts for lead, but have not committed to preventing exposure.

Ten years ago, Rochester, New York, like Cleveland, had among the worst lead-poisoning rates in the country. Today, about 5 percent of children there screened have lead in their blood at a level that the Centers for Disease Control says should trigger action. That is roughly an 80 percent drop in the number of children poisoned over those 10 years. (Cleveland’s rate was about 14 percent last year.) Former Rochester city councilman Wade Norwood said it was a “tidal wave of facts” that led to the passage of that city’s lead ordi-

nance in 2005, which has greatly reduced children’s lead exposure there. “There was a moral, scientific and community imperative that the ordinance pass,” said Norwood, who helped write the legislation. In Cleveland, a sustainable plan to proactively address lead poisoning — any coherent plan, for that matter — seems a long way off. There are advocates for prevention in Cleveland, but their efforts have been hampered by lack of funding and leadership. A tiny pilot program that showed promise in preventing lead poisoning in the homes of expectant mothers fizzled out when a grant ended. Another small pilot in a neighborhood near MetroHealth Medical Center will use home inspections in hopes of preventing lead exposure and asthma in children, but it is also dependent on grant funding and city buy-in. “I’m trying to get people to see that the housing is causing the illness, not to chase sick kids around,” said Kim Foreman of Environmental Health Watch, who is heading the BUILD Health project. Foreman has been working on lead poisoning in Cleveland for more than a decade. Her nonprofit works closely with the county and city health departments, and she’s careful in expressing her frustration. “If we change the system to a prevention model, my belief is that the housing stock would get better,” she said. After months of public records requests from The Plain Dealer, delayed meetings with city officials and repeated requests for information, a spokesman abruptly presented an emailed city response to its lead problem. The document, titled “City of Cleveland Lead Prevention Strategies Department Matrix,” was familiar. Inside was a list of 10 strategies for preventing lead poisoning, outlined by the Department of Housing and Urban Development in 2002. The Plain Dealer had emailed the same list to a city official days earlier. Cleveland’s “matrix” was dated Sept. 25, 2015. At the end, it read, “Our departments are committed to eliminating lead poisoning and building a healthy Cleveland.”

TOXIC NEGLECT: THE HIGH COST OF LEAD POISONING

Healthcare costs associated with lead poisoning

$195,934 Minimum annual lead-related healthcare costs Costs are fairly straightforward: follow-up screening, chelation treatments for moderate cases and hospitalization for severe lead poisoning cases. Also included are home visits to identify the source of lead in a child’s environment.

“You can’t prevent your young babies from bringing their hands to their mouth, and it would be wrong to do it, because that’s just a natural behavior. If you’re living in one of these older homes, it requires a great deal of vigilance to keep the floors clean enough for the kids to play on and not dose themselves with lead.” Kim Dietrich, neuropsychologist at the University of Cincinnati

The Plain Dealer | cleveland.com

The weight of lead

Sunday, October 25, 2015 PLAIN DEALER SPECIAL REPORT

Growing kids are most vulnerable Brie Zeltner and Rachel Dissell In November 2013, an Iraqi family seeking refuge from war at home moved into a 100-year-old duplex on Cleveland’s West Side. Seven months later, their infant daughter, Haneen Alwaeli, had such high levels of lead in her blood that she had to spend 10 days in the hospital while doctors used chemical treatments to pull the heavy metal from her system. Social workers at MetroHealth Medical Center, around the corner from the Bush Avenue home where Haneen had been exposed to old, flaking lead-based paint, wouldn’t release the girl until she had a nontoxic place to live. Every year in our region, more than a dozen infants and toddlers like Haneen are hospitalized when blood tests find lead at dangerously high levels in their bodies. Their cases are the worst of the worst, with lead levels from nine to 14 times higher than the threshold set by the Centers for Disease Control and Prevention. Another 2,000 children — at least that we know of by testing — are poisoned by lead in Cuyahoga County every year at amounts that don’t send them to the hospital but do irreversibe damage to their brains, nerves and growing bodies. Far more are likely harmed but never tested. And as research on the toxin advances, it becomes increasingly clear that even very small doses of lead have big consequences for little children. Kim Dietrich, a neuropsychologist at the University of Cincinnati, is monitoring the health of a group of children who were diagnosed with lead poisoning in the late 1970s. His team’s study is one of the longestrunning examinations of the lifelong health effects of the metal. As his team follows the group of Cincinnati children, who are now in their 30s, they’re gathering valuable information on how far into a child’s future the damage reaches. When those kids became young adults, the research team scanned their brains and found the areas associated with impulse control and judgment had shrunk in volume, and that it was related to the early lead exposure. They’ve also established a correlation between this early exposure to lead and an increased risk of violent criminal behavior in early adulthood. Dietrich is now checking the women in the group for early signs of osteoporosis caused by the lead in their bones. To Dietrich and others in the field, it’s painfully obvious that babies poisoned with a potent neurotoxin have devastating lifelong consequences, including diminished IQs, lower test scores, higher school-dropout rates, violent crime, high blood pressure and chronic kidney disease. “This is a major health crisis,” said Dr. Bruce Lanphear a professor of children’s environmental health at Simon Fraser University in Vancouver, British Columbia, and former director of Cincinnati Children’s Hospital’s Environmental Health Center. “These kids really have an acquired brain injury from their lead exposure,” said Jay Schneider, a pathology professor at Thomas Jefferson University in Philadelphia. “If they had a traumatic brain injury, we’d have a whole suite of services in place to take care of them.” Yet lead poisoning, one of the biggest public health threats facing children in our region, is not on the public radar. “Children are still being hospitalized for chelation therapy [to remove toxins] for lead poisoning at our hospital every week,” Dietrich said. “Once it happens, it’s pretty much irreversible. Preventing exposure in the first place is where all our efforts and all our dollars need to be focused.” It was after a routine doctor’s visit that the level of lead in little Haneen Alwaeli’s blood was discovered — a shocking 125 micrograms per deciliter that led to her hospitalization in June of 2014. That’s 25 times higher than the current level of 5 micrograms per deciliter that triggers monitoring. At amounts as high as Haneen’s,

LISA DEJONG / THE PLAIN DEALER

Haneen Alwaeli, 3, appeared fully recovered this summer, a little more than a year after she was diagnosed with life-threatening levels of lead in her blood. She modeled her favorite purple dress from the porch of her family’s new home, which they moved into to escape the lead hazards that poisoned her. children can lose control of their body movements, fall into a coma, suffer from brain swelling, seizures or irreversible organ damage. It’s rare now, but lead poisoning still kills children; in 2006 a 4-yearold Minnesota boy died after swallowing the small, near-pure lead charm he found on a friend’s sneaker. But even at comparatively low levels of exposure, children suffer serious consequences. At exposure levels between 5 and 10 micrograms per deciliter — once

deemed “safe”— it’s now clear that lead impairs children’s brain development, knocking off IQ points and causing ADHD-like symptoms and antisocial behavior, said Lanphear. In 2003, Lanphear and a team of researchers at Cincinnati Children’s began tracking a group of 400 families to measure the impact of exposure to lead and other toxins. Their study, called the Health Outcomes and Measures of the Environment, or HOME, was one of the ﬁrst to establish that, as with

Lead’s impact on the young

many other toxins, a child’s brain takes the biggest hit from lead upon initial exposure, even at low doses. Many other studies have since confirmed the HOME findings, and long-term follow-up over several decades has conﬁrmed that the IQ deﬁcits last into adulthood. Researchers in Boston estimated that for every 1 microgram per deciliter of lead in the blood during the ages of 4 to 10 years old, adult IQ is reduced by two points. Exposure to lead, on average, lowers IQ by 5 points across the

Brain Even small amounts of lead can profoundly affect a child’s development and behavior. Symptoms can include developmental delays, poor speech and language understanding, hyperactivity, aggressive or impulsive behavior and poor problem-solving skills.

Lead is toxic to everyone, but it's much harder on children. Their growing bodies absorb it and retain it more readily than adult bodies, and the damage it causes during key developmental stages can cast a very long shadow.

Internal organs The kidneys are the body’s ﬁltration system, and lead can build up there, damaging the organs permanently.

What’s a “high” lead level? That used to be an easy question to answer. The Centers for Disease Control and Prevention used to set “levels of concern” for public health ofﬁcials to help identify children who may be at risk of behavioral problems, learning disabilities and health effects from lead exposure. Over the years, those levels of concern, measured in micrograms of lead per deciliter of blood, have dropped to lower numbers as new evidence has shown that even small amounts of lead are harmful.

Bloodstream Lead can damage red blood cells and limit their ability to carry oxygen to the body’s organs, causing anemia. Bones Most lead ends up here. It can interfere with the production of blood cells and the absorption of calcium, which is essential for strong bones, teeth, muscles and nerve function. Lead may also be released from bones during periods of growth.

In 2012 the CDC told public health ofﬁcials that any lead in a child’s blood is a cause for concern. The agency also changed its language, citing 5 micrograms per deciliter, once considered below concern, as the new “reference level.”

SOURCES: National Institutes of Health; Centers for Disease Control and Prevention; Mayo Clinic

The CDC estimates that 500,000 U.S. children have that much or more lead in their blood. WILLIAM NEFF | THE PLAIN DEALER

population, Lanphear said. It may not seem like a lot, but that small downward shift across the population of American children results in a theoretical 57 percent increase in the number of kids who fall into the “extremely low” IQ category. Anne Evens, former director of Chicago’s lead poisoning prevention program, set out to make lead’s impact on IQ more tangible by instead measuring an outcome almost every parent, educator and elected official is interested in: test scores. “What I found was that kids even with very low levels of lead exposure scored significantly lower on standardized reading and math tests in third grade,” said Evens, whose study of Chicagoarea third graders linked lower levels of lead exposure to poor school performance. Kids with even low lead exposure were also 30 percent more likely to fail the third grade. When lead enters the body, whether inhaled in fine particles or swallowed when a contaminated toy or hand is placed in the mouth, the heavy metal first ends up in the bloodstream. Once in the blood, lead can be excreted in body waste. If it’s not eliminated from the body, lead remains in the blood from 28 to 36 days after exposure and travels throughout the body. In a child’s teeth and growing bones, lead can be deposited and then stored for decades. In the blood, the metal crowds out iron in red blood cells. For all these reasons, lead exposure can cause anemia, or a destruction of the red blood cells; deficiencies in vitamin D and the minerals calcium and iron; and damage to almost all of the body’s organs and tissues. For the past 15 years, pathology professor Schneider has been studying the effects of lead exposure on the developing brain at a microscopic level. He’s also been trying to understand how the labobserved changes to the brain translate into real-life behaviors. He hopes their work might help make life easier for these kids. “ O n e t h i n g t h at w e h av e learned is that lead acts differently in males and females,” said Schneider. They’ve also found that different parts of the brain are more sensitive to the effects of lead than others. A lot of the impact of lead also depends on the intensity and duration of the exposure, as well as when in life a child is exposed. Researchers now know that not only does genetic makeup help

determine a child’s vulnerability to lead poisoning, but lead itself influences the behavior or “expression” of a child’s genes through the action of proteins attached to DNA. “When you put all that together, it’s easier to understand why there’s no specific behavioral signature for lead poisoning in kids; every kid is going to be a little bit different.” Like other environmental toxins, lead poses a particular danger to babies and small children, said Kathy Schoch, the nurse case manager for Cuyahoga County’s lead poisoning prevention program. First, because of their small size, children will receive much higher doses by weight than adults exposed to the same amount. Children also absorb lead at a higher rate: Adults absorb between 5 percent and 10 percent of the lead they ingest, while children can absorb four to five times as much, according to the World Health Organization. Lead is also very dangerous to children because it is chemically similar to both iron and calcium, Schoch explained. As children grow, they need more calcium and iron to build their developing bones and circulatory systems. “Lead follows the same channels of absorption as calcium and iron and will compete for that space within the child’s body,” said Schoch. It follows, then, that kids who don’t have healthy diets are more vulnerable to lead poisoning, she said. If a child is already deficient in calcium or iron, there may be a tendency for the body to mistakenly grab more lead from the blood to replace the missing nutrients. Adults tend to eat more-balanced diets and so are less vulnerable. Dietrich at the University of Cincinnati said a full stomach can help block lead absorption. It’s a child’s activity level, and the way they interact with the world, that perhaps accounts for the majority of their increased exposure risk. Until the age of 5 or 6, infants and toddlers spend a lot of time on their hands and knees, exploring the world with their fingers, and putting toys and hands in their mouths. Lead dust, which is invisible and accumulates on floors, windowsills, toys and other surfaces, is easily transferred from children’s hands to their mouths. “Adults will usually wash their hands if they are dirty or prior to eating,” Schoch said. “Hand washing is not a priority for a child.”

TOXIC NEGLECT: THE HIGH COST OF LEAD POISONING

Estimated local costs of ADHD linked to lead poisoning There is a strong association between lead poisoning and attention deficit hyperactivity disorder. Researchers estimate that 20 percent of ADHD cases may be attributable to lead poisoning.

21% of kids diagnosed with ADHD are also lead poisoned $648 Annual cost to treat an ADHD patient $34.9 million Estimate to treat ADHD cases related to lead exposure

“These kids really have an acquired brain injury from their lead exposure. If they had a traumatic brain injury, we’d have a whole suite of services in place to take care of them.” Jay Schneider, Pathology professor, Thomas Jefferson University

Sunday, October 25, 2015

The Plain Dealer | cleveland.com

The weight of lead

PLAIN DEALER SPECIAL REPORT

Haneen’s story: A poisoned refuge

LISA DEJONG / THE PLAIN DEALER

Haneen Alwaeli, 3, peers into the front entryway of her rented home on the West Side of Cleveland. Her family moved here from unstable Iraq only for her to be hospitalized with lead poisoning.

Brie Zeltner and Rachel Dissell It only took seven months living in a West Side duplex for Haneen Alwaeli, one of the youngest members of Cleveland’s refugee population, to be hospitalized for lead poisoning. The little girl, less than 2 years old at the time, spent 10 days in the pediatric acute care unit at MetroHealth Medical Center in the summer of 2014, enduring painful injections and IV treatments in an attempt to extract the dangerous heavy metal from her blood. Haneen, a stocky and cheerful toddler, had always been healthy. Her parents, Ahmed Alwaeli and Sabreen Dulaimi, had never heard of lead poisoning. Suddenly, they knew quite a lot about it. They learned their toddler had enough of the heavy metal in her blood — 125 micrograms per deciliter — to send her into convulsions, cause a coma,

or even kill her. They learned that the old Brooklyn Centre home where the family lived was poisoning her with its ﬂaking, leadbased paint. “I was very sad; I was worried I was going to lose her,” Haneen’s father told The Plain Dealer in August, speaking through an interpreter in his native Arabic. “We came here to get away from all this struggle and then this happened to Haneen,” her mother said. “I want her to live a normal life like other kids.”

An alarming discovery Haneen was just 14 months old when she and her family arrived in the United States from Iraq in November 2013. Her father, who worked for an American security contractor in his native Baghdad, was still recovering from surgery after an improvised explosive device detonated near his car a few months earlier. A Shaker Heights refugee assis-

tance group, Us Together, found the family housing in the upstairs unit of a home on Bush Avenue owned by another former Iraqi refugee, Ali Albandr. The group also helped find Alwaeli a part-time job at the Cheesecake Factory. At a routine doctor’s appointment for Haneen and her sister, Baneen, at Neighborhood Family Practice a couple of months after they first arrived, the younger girl’s blood showed an alarming level of lead exposure — 36 micrograms per deciliter. The Centers for Disease Control’s reference level is 5 micrograms per deciliter. Baneen, who was 5 at the time, had a small amount of lead in her blood but not enough to trigger concern. At lead levels as high as Haneen’s, city or county health departments have to inspect the child’s home to find the source of the poisoning. City health inspectors cited the Bush Avenue home for lead hazards in January 2014, according to records. Albandr, the home-

owner, was given seven months to ﬁx the problem. Albandr said he wasn’t aware of the lead hazards in the home when he bought it and his lawyer has assured him he’s not responsible. He said he and the Alwaeli family are friends, and he feels terrible about what happened to Haneen. Multiple attempts to reach the refugee placement group were unsuccessful. Over the next few months, the level of lead in Haneen’s blood continued to climb. By June, she was referred to MetroHealth’s lead clinic. There, she tested at 125. Immediately, the hospital called the little girl’s father to bring her back in. In the hospital, the toddler’s stomach and intestines were ﬂushed out — twice — to remove any lead she’d swallowed after Xrays of her belly showed a buildup of the metal in her gut. Any adult who’s had to endure the prep for a colonoscopy knows how miserable that process is.

As soon as the chelation chemicals brought the lead down to below 45 micrograms per deciliter, Haneen could go home, the doctors told her parents. But not back to the Bush Avenue home. Alwaeli was panicked. He’d move anywhere, he told Catholic Charities. Just please keep my family together, he asked.

Anxiety for the future A year after her hospitalization, Haneen appears completely normal. She’s cheerful and outgoing despite her limited English, showing off a new purple outﬁt she likes and a seedling she grew in a plastic bucket that sits soaking up the sun on the front porch of the family’s new rented home. The Alwaeli family is grateful to be here. “We live here, and it’s good,” Alwaeli said, referring to the city inspection that showed no lead hazards in their Woodbridge Av-

enue home. “We’re thankful.” An early-intervention specialist with the Centers for Families and Children who visits Haneen weekly at home says she’s on track developmentally. Yet her family still worries. They know that it’s often not until years later that the effects of lead poisoning show up. In early October, the city ﬁnally mailed a notice of noncompliance and order to vacate to Albandr, 22 months after the home was ﬁrst inspected and 16 months after Haneen was hospitalized. Both units of the home have been vacant since the day the Alwaelis left, he said. He can’t afford the roughly $9,000 in repairs the city demands, but is still trying to comply, he said. He won’t rent either unit until he’s sure they’re safe, though no hazards have been cited in the downstairs apartment. “I don’t want to take responsibility for someone else’s health,” Albandr said. “I do care.”

What to do if your child has lead poisoning Brie Zeltner and Rachel Dissell

To many parents, the news their child has been poisoned with a heavy metal that causes brain damage comes as a sucker punch. Lead poisoning? In 2015? The knockout comes when they learn that there’s no way to remove all of the poison from their baby’s body. ¶ If a child you love has been diagnosed with lead poisoning, there are things you can do to lessen the harm. The first thing every doctor and public health expert recommends: Make sure you remove all lead from your child’s environment, or move your child to a lead-free home. Proper home inspections and repairs are the ﬁrst steps in protecting children from further harm. Experts also recommend the following: 3 If your home has lead pipes, allow the water to run for 45 seconds before using any water your child will drink. Boiling water does not remove lead. 3 Use soap and water to wash your child’s hands frequently, especially

before eating. Tip your child’s hands downward so that dirt and lead particles rinse off and down the drain. Don’t rely on hand sanitizer; it won’t remove lead dust. 3 Be careful of cheaply made toys that may contain lead. Toys may have lead in paint, metal and plastic pieces, particularly if they are imported. To ﬁnd a list of recalled toys, check cpsc.gov or call 1-800-638-2772. For more from the CDC on lead in toys, check cdc.gov/nceh/lead/tips/toys.htm. 3 Take off your shoes. Much of the lead dust that enters homes comes in via the dirt on shoes and feet and on the paws of pets. Remove shoes when entering the home,

and clean your dog’s paws if they spend time in bare dirt outside. Good nutrition can also help any child cope with lead exposure. A full stomach makes it less likely a child will absorb any lead that’s ingested, and kids with more nutritious diets may be less affected by lead poisoning, because lead can take the place of iron and calcium in the body. If your kids are deﬁcient in either of these minerals, the body will be more likely to take up lead to replace them. Doctors, researchers and public health experts recommend the following if your child has lead poisoning:

3 Increase iron in your child’s diet. Doctors often recommend an iron supplement for kids with lead poisoning, but you can also introduce iron-rich foods, such as dark green leafy vegetables, lean red meats or poultry, tuna, salmon, ﬁsh, raisins, dates, prunes, dried beans, peas, nuts or sunﬂower seeds. 3 Serve more calcium-rich foods. These include milk, cheese, yogurt, green leafy vegetables, tofu, salmon and peanuts. Vitamin C can also help the body absorb less lead. Foods rich in vitamin C include oranges, grapefruit, limes, lemons, strawberries, cantaloupe, kiwi, potatoes, sweet potatoes, tomatoes, broccoli, and bell peppers.

Every child’s growing brain needs daily stimulation to reach its full potential. This is even more important for a child who has suffered damage from lead poisoning, says Jay Schneider, a pathology professor at Thomas Jefferson University in Philadelphia who studies the effects of lead poisoning on the brain. Other ways to find help: If you have a child under 3 with lead poisoning and live in Cuyahoga County, and would like help with enrichment opportunities, you can call Help Me Grow at 216-698-7500 to learn more about available services. Help Me

Grow is a free program offered statewide for children under 3, and includes a service called Bright Beginnings, a home-visiting program that focuses on child development. You can also find more information about Bright Beginnings on its website. (helpmegrow.org/en-US/Bright Beginnings.aspx) There are also enrichment programs for families with children over 3, including Head Start, which also offers parent workshops and a home-based program. You can learn more about Head Start’s programs at ceogc. org/programs/head-start-services or by calling 216-589-9922.

TOXIC NEGLECT: THE HIGH COST OF LEAD POISONING

Special education costs $7,500 -$8,500 900 20% $12 million

Average extra cost for a student’s special education Cleveland students with lead levels 25 micrograms per deciliter in past decade Percentage of those kids needing special education help for nine years Additional cost to taxpayers to educate those children

“We came here to get away from all this struggle and then this happened to Haneen. I want her to live a normal life like other kids.” Sabreen Dulaimi, on her daughter’s exposure to toxic lead levels after immigrating to Cleveland

The Plain Dealer | cleveland.com

Sunday, October 25, 2015

The weight of lead

PLAIN DEALER SPECIAL REPORT

Minority children are more at risk

GUS CHAN / THE PLAIN DEALER

Najaveon Dunlap rides his bike through the Glenville apartment where he and his mother live. A city inspection revealed lead-based paint hazards throughout the apartment, which led to the 3-year-old’s lead poisoning diagnosis.

Brie Zeltner and Rachel Dissell Kim Foreman has watched the effects of lead poisoning on Cleveland children for almost 20 years. She’s seen more than one generation of a single family poisoned in the same homes. She knows which pockets of the city have been hardest hit, and she knows why. A long history of discrimination and racial segregation has concentrated the poorest minority families in the worst housing in the city, she says. As a result, they’re living in mostly aging, badly maintained rental units. “This is about equity and disparities,” says Foreman, executive director of Environmental Health Watch, a nonprofit that works with city and county ofﬁcials to address lead and other environmental health hazards in Cleveland. “It’s not about emotion. This is our history.” From 1999 to 2004, black children nationally were 1.6 times more likely to test positive for lead in their blood than were white children, according to the Centers for Disease Control and Prevention. Black children were nearly three times more likely to have highly elevated bloodlead levels. In Cuyahoga County,

neighborhoods with majority black populations have the highest rates of lead poisoning. It’s a history many people would prefer to ignore, but Foreman is past caring about that. “That’s the real story,” she says. “That’s what we need to talk about.”

Poor housing for the poor In Cleveland and many other big cities, some housing experts argue the lead-poisoning story begins with federal “redlining” policy in the 1930s. The policy, which outlined areas deemed unsafe for home loans because of their high population of foreignborn or black residents, effectively barred these residents from homeownership and the ability to build wealth, concentrating poor people in speciﬁc neighborhoods. Those neighborhoods are still the poorest in the city, with the highest levels of exposure to air pollution and environmental toxins. Chronic asthma, a disease that is twice as common among black children as the rest of the population, is rampant here. So are childhood obesity, high blood pressure and diabetes. “You can look at maps of the city and see these connections to health and housing,” Foreman says.

Kids who live in these neighborhoods are more likely to live near highways and industrial areas, which increase their risk of exposure to pollutants. There’s no question that poorer, minority children have levels of lead in their blood, said Dr. Bruce Lanphear, a professor of children’s environmental health at Simon Fraser University in Vancouver and former director of Cincinnati Children’s Hospital’s Environmental Health Center. Anyone who lives in a home built before 1978, when lead paint was banned, is at risk for lead poisoning. Low-income families who rent, though, often have no recourse when that paint is deteriorating. They can’t move, fear eviction if they complain, and don’t know where to turn for help. “You can’t just pick up and move when you have no resources and no one to fall back on,” Foreman says. Minority children appear to be at higher risk of lead poisoning independent of income level, though, according to some research. Black children have blood-lead levels 50 percent higher than other races, regardless of age and family income, Lanphear said. While it’s unclear why, it may be a result of genetic differences in the way lead is absorbed in the body.

Concentrating the poison County public health officials boast of a near 90 percent drop in the level of lead poisoning since the late 1990s. It’s true; lead levels have dropped substantially across the nation over the same period, largely thanks to the EPA’s complete ban of leaded gasoline for cars in 1996 and efforts to reduce lead exposure in homes. But as children’s lead levels have dropped everywhere, lead poisoning has been concentrated further among those who cannot escape the hazardous homes and tainted soils of their neighborhoods. In Cleveland, parents who ﬁnd out their kids are poisoned by lead don’t even have the option of looking for another safe place to live; the city has no registry of lead-safe homes. The result? In some areas on the city’s East Side, and in parts of East Cleveland, one-third to one-half of children are likely poisoned by lead in their homes. In cities such as Beachwood, Pepper Pike and Avon Lake, it’s hard to find any children with lead poisoning. The stark disparity has contributed to the myth that the problem isn’t that big, experts say.

“It’s our society mindset to put it into the category that it doesn’t affect me, and it’s just [the inner city] and they have so many problems, what’s one more?” says Dr. Dorr Dearborn, a pediatric lung specialist and former director of the Mary Ann Swetland Center for Environmental Health at Case Western Reserve University. “If this was a different group of children, we wouldn’t tolerate this as a society, community or a city,” says Bob Cole, an attorney working on lead-poisoning advocacy in Toledo. Instead, national policy for decades has used primarily poor, minority children as household lead detectors, cleaning up hazards only after a child is exposed and irreversibly harmed.

History of shifting blame David Rosner, co-director of the Center for the History & Ethics of Public Health at Columbia University, says that racism and classism are deeply rooted in the nation’s response to lead poisoning. Trade associations for the leadpigment industry as far back as the 1950s tried to shift the blame by portraying victims as diseased children with irresponsible parents, to ease the fears of middleclass America.

“They literally said that ‘Negro and Puerto Rican’ children were the problem and middle-class parents had nothing to worry about,” said Rosner, co-author of “Lead Wars: The Politics of Science and the Fate of America’s Children.” In the late 1950s, The Plain Dealer referred to the leadpoisoned children in Cleveland neighborhoods as “paint nibblers” who would eat anything they can, “be it bugs, dirt, crayons, pebbles — or paint.” Doctors believed children got sicker in the summer because they could more easily peel and eat paint off the outside of buildings. It’s more likely children became ill because they were playing in soil that was highly contaminated with lead from ground-up paint chips and leaded-gasoline emissions. In the 1970s, when it became clear that even low-level exposure to lead could cause behavioral and learning issues for children, the same trade associations insinuated that losing a little ground in school was not so important to the largely poor, minority children being poisoned, Rosner said. But the implications of marginalizing the victims of lead poisoning are immense, Rosner said. “We end up allowing children’s lives to be destroyed.”

Do poisoned brains turn to criminal minds? Rachel Dissell and Brie Zeltner At the end of a deadly summer and early fall that saw bystanders, teenagers and babies gunned down in the city, people are searching for explanations for the violence. Is it gangs? Drugs? Guns? No one is talking about lead poisoning. The link between childhood exposure to the heavy-metal toxin and crime, long viewed with skepticism, has gained support among researchers and scientists who study the brain and crime trends. In Greater Cleveland, home to a lead-poisoning problem among the worst in the nation, nobody is exploring the connection to see whether preventing poisoning would also reduce crime.

Establishing a link The link between lead and crime began to gain attention in the 1990s, when a forecasted explosion in violent crime, especially among black teens, didn’t happen.

That’s when the federal government hired Rick Nevin, an economist and consultant, to ﬁgure out how cost-effective it might be to remove lead from homes across the country. Crime wasn’t a big part of the original equation. But Nevin made the link, publishing multiple studies, showing the drop in crime coincided with the United States’ phase-out of lead from gasoline in the 1970s and 1980s and downward trends for murder, robbery and juvenile crimes. In 2007, in part to pacify naysayers, Nevin completed another study that showed the reductions in violent crime also followed in the roughly 18 to 20 years after airborne-lead exposure declined in places such as Britain, France, Australia and Canada. Nevin now believes that no other factor — neither absent fathers, employment opportunities, nor access to abortion — can explain the drop. Most Americans seem unaware of these enormous overall drops in crime because most attention is spent on crime-of-the-day news, he says.

The murder-arrest rate for juveniles is half of what it was in the 1960s, he said, and the country continues to see unprecedented drops in violent crime. That creates another problem, Nevin said. “People assume this is an interesting historical perspective on crime but that the lead problem, it’s over,” Nevin said. But in Cleveland, lead-based paint from older homes is still poisoning thousands of children each year, and likely many more who are never tested.

Following the children Compelling evidence linking lead exposure to violent crime comes from University of Cincinnati researchers who followed children poisoned by lead in the 1980s and examined their brains — and their arrest records. “Not only did we ﬁnd that this early lead exposure itself was associated with an increased risk of engaging in criminal behavior, particularly violent criminal behavior,” said Kim Dietrich, a pro-

fessor of epidemiology who has studied this group of children for decades. “But it’s also associated with reductions in volume of the areas of the brain associated with impulse control and judgment.” Dietrich and others have found that when children ingested or inhaled lead, even in small amounts, it could damage the areas of the brain responsible for regulating emotions, impulsivity and attention. The metal disrupts other parts of the brain responsible for reasoning and judgment. Dr. Herbert Needleman, a pediatrician and pioneer in lead research at the University of Pittsburgh, also found evidence that lead poisoning was prevalent in youth who committed crimes. Needleman studied the bones of two groups of Pennsylvania youth: high school students and convicted juvenile delinquents. He measured the levels of lead in the shin bones of each group using X-rays. Delinquent youths had almost eight times the amount of lead in their bones than did high school students

who had not been in trouble. Many experts are cautious about oversimplifying the relationship between crime and lead exposure because of the many other environmental factors and policies believed to contribute to criminal behavior. “Kids who have high lead levels are not doomed to commit crimes,” said Dr. Andrew Garner, a pediatrician at University Hospitals and president of the Ohio chapter of the American Academy of Pediatrics. “We don’t want this to become a self-fulﬁlling prophecy.” It’s understanding how lead disrupts the developing brain on a cellular level that’s more helpful to Garner. Poverty, neglect and toxic stress can have similar effects, though. The good news, Garner says, is that developing brains are highly capable of adapting. “If a child is bad at math, we don’t say it sucks to be you,” he said “We give them some extra training.” We can teach kids exposed to lead to self-regulate — if we know that’s the problem.

What’s driving violence in Cleveland?

Mike Walker has heard a lot of discussion over the years about lead poisoning as a public health issue. But Walker, who heads the Partnership for a Safer Cleveland, hasn’t seen much done to explore whether Cleveland’s lead-poisoning problem is driving the violence plaguing certain city neighborhoods, he said. It could be because people don’ t see the connec tion as hard science, he said. Or because, as with lead poisoning, more money is put toward reacting to crime than preventing it. But Walker said it might be time for a deeper look, based on the lack of rational thinking he hears when talking to young people involved in crimes, like recent retaliatory shootings. “Why do these guys get in a car to do a drive-by,” he said. “Is it because their brains aren’t working?

TOXIC NEGLECT: THE HIGH COST OF LEAD POISONING

Local cost of lead-linked crime

Cost of lead-poisoning linked local crimes tops $4 million per year

Studies have linked lead poisoning to at least 10 percent of juvenile crime. Only looking at incarcerated juveniles in Ohio, and not all the other costs associated, that could amount to about $10 million a year.

$53,554 $502,000 $364,700 $2.12 million $1.1 million

Cost for 2.9% of 55 murders attributed to lead poisoning Cost for 3.7% of 417 rapes Cost for 0.4% of 3,490 robberies Cost for 5.1% of 1,789 aggravated assaults Cost for 2.9 percent of burglaries

“Kids who have high lead levels are not doomed to commit crimes.” Dr. Andrew Garner, Pediatrician

Sunday, October 25, 2015

The Plain Dealer | cleveland.com

The weight of lead

PLAIN DEALER SPECIAL REPORT

Najaveon’s story: A mother’s panic

PHOTOGRAPHS BY GUS CHAN / THE PLAIN DEALER

Najaveon Dunlap, 3, looks out the window of the apartment he shares with his mother. The home is right near his preschool, the Wade Early Learning Center, where he recently enrolled.

Rachel Dissell and Brie Zeltner Najaveon Dunlap knows the needle is coming. His mother, Shamara Henderson, tightens her hold on his little body. “Be still, OK,” Henderson tells him, holding the 3-year-old firmly in her lap. “Just a little poke because you’re a big boy.” Najaveon yelps but quickly recovers and collects a SpiderMan sticker, his reward for making it through a monthly blood draw to determine how much lead is still flowing through his veins. Last time, tests showed Najaveon was lead-poisoned at a level four times higher than what normally sparks action. Henderson hopes this test will be better. Her son’s lead poisoning panics her, a single mother studying to become a dental assistant. If the lead in his blood keeps increasing, a city health worker told her he might need to be hospitalized. Henderson was terrified; she’s so protective of him she even hates to see him go to the dentist for a filling. Fo r n ow, the preschool er shows no outward signs of lead poisoning. His mother didn’t suspect he’d been harmed until a routine blood test at a doctor’s visit came back high. He zooms around, chattering about his toys and asking a constant stream of questions. But his mother worries for his future. Health workers told her that lead poisoning can cause problems with reading and learning. She’s always looking for signs that the lead has harmed him. If his stomach hurts, is it lead? If he’s temperamental, is it the lead? “He flourishes so much now, and I don’t want him to be left behind,” Henderson said.

Shamara Henderson sits in her living room with her son, Najaveon Dunlap. “I’m freaking out thinking that every time he touches something there’s probably lead dust on it. It’s so…ugh,” she says.

A landlord’s denial Najaveon’s diagnosis was the beginning of a nightmare for Henderson, one that many families in similar circumstances across the city endure. Fear for her child turned to fear of eviction and homelessness when she informed her landlord, Marlon Wells, about her son’s lead poisoning. Henderson said she told Wells after the ﬁrst test that there might be lead in the tiny upstairs apartment on Garfield Avenue she’s shared with her son for more than two years. Wells denied any problems with the house, to Henderson and to The Plain Dealer. A real estate holding company incorporated by Wells acquired the foreclosed home in 2012. It was then transferred into Wells’

name and then in May to the name of another of his real estate holding companies, Frazee Properties LLC. “My house has been inspected inside and out for lead,” Wells said. “I’ve checked on the kid,” he said. “I’m concerned for him, but what I want to know is why the city hasn’t checked his day care or the family home where they spend time.” “He’s trying to point the ﬁnger at everyone else,” Henderson said. It took four months for the city inspector to make it to Henderson’s home to assess it for hazards. In the meantime, Henderson said, Wells came to paint the ﬂaking upstairs porch and cover it with plywood. He also yanked out three windows, two of which were in Najaveon’s bedroom.

Henderson said she called city officials, and they told her he had to stop immediately — that unless he was certified to do the work he could be creating a worse hazard just feet from where her son slept. Wells says he’s done plenty of lead cleanup. He’s a certified renovator. Since Wells didn’t lay down tarps or wet down the area, city health workers advised Henderson to wipe down all of her son’s toys — the fire trucks, cars and superheroes — with soap and water. Henderson also bought a vacuum with a special filter to suck up all the dust since the city didn’t have any to loan out. “I’m freaking out thinking that every time he touches something there’s probably lead dust on it. It’s so…ugh.”

Najaveon tested positive for lead poisoning at a time when the city had no federal grants to pay for its lead-hazard programs and only two inspectors to investigate the source of lead in homes. The inspector who ﬁnally came to Najaveon’s home canceled several times to respond to more serious cases. Henderson asked her if she and her son should move. “And she said, ‘Yes, but no. I can’t say that you need to move, but you need to move, so if anyone ever asks, I didn’t say that,” Henderson said. After that, Henderson waited for months for the report. She later was told the inspector was on leave from her job. After Najaveon’s lead poisoning worsened, the city hired a private

lead-risk assessor to reinspect the home in September. The report cited lead hazards throughout the home. It also stated that Najaveon’s lead levels probably worsened, at least in part, due to the landlord’s window removal. Henderson wants to move as soon as possible but is getting county assistance with her rent while she is a student. The vouchers, she said, couldn’t be transferred to another landlord until she had the city’s report and could prove to the county there was a lead problem in her current apartment. In the meantime, Henderson said her landlord raised the rent by $125. Wells said she hasn’t paid, and so he filed to evict her. Often tenants end up moving after they find out their child has been lead poisoned, which creates financial burdens and causes children to change schools, said Angela Shuckahosee, executive director of the Cleveland Tenants Organization. But that doesn’t solve the bigger problem if the hazards go unabated. Other families then may move in, subjecting their children to the same poison. The tenants organization soon will be working under contract with the city to do public presentations and work with tenants and landlords who want to get grants to abate lead. Henderson said she’s worried about how she’ll find a lead-safe home in the same neighborhood so her son can stay at Wade Early Learning Center, the preschool he loves. It could be a struggle. The St. Clair-Superior neighborhood where Henderson and her son live is among the worst in the city for lead poisoning cases. But Najaveon’s most recent blood test result just came back. The lead in his blood is more than five times above the threshold now. “How will I find a place that I know is safe?” she said recently, looking around her apartment. “I had no way of knowing this place wasn’t safe. It looked fine.”

TOXIC NEGLECT: THE HIGH COST OF LEAD POISONING

Lead-induced diminished IQ and lost earnings 1 microgram per deciliter of lead in a child’s blood = 1/2 IQ point lost

10 micrograms per deciliter of lead in a child’s blood = 5 IQ points lost

1 IQ point lost = 2.4% loss in lifetime earnings

5 IQ points lost = 12% loss in lifetime earnings

Calculations based on Elise Gould, Economic Policy Institute study, 2009

“How will I find a place that I know is safe? I had no way of knowing this place wasn’t safe. It looked fine.” Shamara Henderson, whose son was exposed to lead.

L10

The Plain Dealer | cleveland.com

Sunday, October 25, 2015

The weight of lead

PLAIN DEALER SPECIAL REPORT

GUS CHAN / THE PLAIN DEALER

Local and national studies show children with high lead levels arrive at school behind their peers, struggle to catch up, and are more likely to fail key math and reading tests.

Perpetuating a legacy of failure Brie Zeltner and Rachel Dissell Every year, thousands of 5-yearolds enter kindergarten classrooms in the city of Cleveland. Within a month or so, their teachers ask them a set of questions to determine how ready they are to read: Can you tell me a word that rhymes with ball? Does cat rhyme with dog? Can you show me the capital letter in this sentence? Their answers are powerful predictors of whether the children will pass third-grade reading tests, a matter of huge concern for a school district that ranks second from the bottom of 580 Ohio districts on this key measure of early learning. Lead-poisoned children have a hard time answering these simple questions; the more of the toxin in their blood, the worse they do. The Cleveland children who scored the lowest on this test were twice as likely to be lead-poisoned than kids who scored higher. Those were the conclusions of a 2012 study of the effect of lead poisoning on thousands of Cleveland kindergartners commissioned by Invest in Children, Cuyahoga County’s early-childhood initiative. Our region has a huge leadpoisoning problem: more than 10,000 children have been poisoned in the county in the past five years, primarily in low-income neighborhoods. We also have a school-performance problem: Cleveland ranks near the bottom in school performance statewide, and Cuyahoga County is home to six of the state’s 14 worst-performing school districts. The two are inextricably linked, say education and policy experts. School districts and states that

continue to ignore this, they say, pay a high price in special education dollars and money wasted on ineffective programs and solutions to ﬁx failing schools. In some parts of the country, state education departments and individual school systems have taken notice and are trying to change the odds — both for their arriving kindergartners and the staff who will teach them. Here in Cleveland, where a multimillion-dollar taxpayerfunded plan is under way to improve the failing public schools, no one seems to be paying much attention to the lead factor.

Starting out behind Lead affects Cleveland children even before kindergarten. In an unpublished report completed in June, Case Western Reserve University and Invest in Children examined the effect of lead poisoning on children enrolled in the county’s universal pre-kindergarten (UPK) programs. The children in the study were put into three groups. Those with no record of a lead test, meaning they were far less likely to have ever been exposed to lead; children who had positive lead levels below 5 micrograms per deciliter, the current threshold that triggers monitoring; and children with lead levels above 5. All of the “no test” kids did much better on every evaluation than the children with lead in their blood, and the kids with more lead in their blood did the worst. The children with lead exposure ﬁnished the year’s program behind even where the “no test” kids started. “When they arrive in preschool they’re signiﬁcantly behind developmentally, and that continues

even after exposure to high-quality preschool environments,” said Rob Fischer, a study author and co-director of the Center on Urban Poverty and Community Development at CWRU. “We’re not saying that high-quality early care doesn’t work with lead-exposed children, just that they need more than we’re currently offering them.” There are several reasons why the data should matter to Cleveland schools: 3 78 percent of the 620 preschool kids countywide enrolled in the UPK study tested positive for lead before starting school. The majority of those kids were in Cleveland and on the East Side. 3 In a report commissioned by the Cleveland schools after the 2007 shooting at SuccessTech Academy, a Washington, D.C.based consulting team identiﬁed the city’s high rate of lead poisoning as one of eight factors placing students in the district at risk for “poor school outcomes, emotional and behavioral problems and disorders, and violence.” 3 It costs about $7,500 to $8,500 per child on top of regular per-pupil spending to educate children with special needs in Cleveland schools, according to a district spokeswoman. About 10,000 children receive these services, but the district could not say how many of these children are lead poisoned. 3 The district participated in the 2012 kindergarten study, sharing test records due to a “mutual interest” in how lead poisoning in the city is affecting children, said Chris Kippes, the county epidemiologist who performed the statistical analysis. The idea was “this would be a good way of tailoring an education plan around the needs of kids with lead poisoning,” he said. Yet there’s no indication that the studies have made an impres-

sion on the district. None of the 6,000 children in the kindergarten group is being followed to further track the specific effects of lead on their education, according to Kippes and Fischer. In fact, the Cleveland School District and CEO Eric Gordon declined to discuss the studies, directing inquiries instead to the Washington, D.C.-based consultant who helped write the report after the SuccessTech shooting. That report led to the creation of the district’s “social and emotional learning” program, which helps students manage emotions and deal effectively with conflict. The program is not designed specifically for kids with lead poisoning, nor does any of the program’s literature mention the issue, but the district says it incidentally helps many of these children who have behavioral issues. In an emailed statement, a district spokeswoman said the district is “aware of this health concern in our city and others” and relies on its head nurse, who sits on the mayor’s “Action Team for Lead” to share information about students with “agency and county health officials that are able to more directly address the health issues and needs of children affected by high exposure to lead.”

An obstacle for teachers Cleveland teachers union members say addressing lead poisoning among students isn’t a priority in the schools. “Unfortunately the priority right now is test scores,” said Mary Moore, a special education teacher at Willson, a K-8 school on the city’s East Side. Moore and David Quolke, teacher’s union president, said that the majority of teachers in the district likely don’t know

the impact lead poisoning is having on their students. Those who are aware and suggest that lead poisoning may play a role in their students’ performance, Moore said, are “basically told that we’re making excuses.” They say the district does not have enough nurses to follow up on children who have high lead tests and that too many children arrive at school with no record of being tested. “I think teachers see the signs and symptoms of lead poisoning in their classrooms every day — that’s a given,” said Patricia Forrai-Gunter, chapter chair of the district’s school nurses, who works in a preschool assessment clinic. “I see kids that are 3 years old and under, and they are coming in with high lead levels every day.” A district spokeswoman said the schools can’t intervene more directly due to “HIPAA [privacy] laws that prevent us from knowing which of our students has lead effect/poisoning.” But the Ohio Department of Health said parents can simply sign a form releasing the information to school districts. At that point the information becomes part of a child’s educational record and is no longer governed by HIPAA. Lead poisoning is recognized under the Individuals with Disabilities Education Act (IDEA), a federal law that requires schools to evaluate the needs of children with disabilities for appropriate services. The district is likely providing individualized education plan (IEP) services to many children affected by lead, even if it doesn’t know the heavy metal is the cause of their learning or behavioral problems. It’s too hard to untangle the effects of poverty and abuse from lead, Fischer said. That idea is questionable,

however. Several larger studies of the impacts of lead poisoning on school testing have separated out other contributors to a child’s readiness to learn, such as family income and parents’ education levels. Three separate studies of more than 100,000 kids in North Carolina, Rhode Island and Chicago found that even low-level lead exposure was associated with decreased test scores, grade failure and lower likelihood of being in gifted programs. Importantly, the results held even when factors such as race, primary language and family income were taken into account. So while, to some, lead poisoning may seem like just one of a million factors contributing to a Cleveland child’s long odds at success, to others it’s an obvious and significant handicap that would make school difﬁcult for any child. “Lead poisoning is a brain injury, after all,” said David Jacobs, research director at the National Center for Healthy Homes and former top ofﬁcial at the U.S. Department of Housing and Urban Development. It’s in the best interest of schools to pay attention to lead poisoning, he said. Jacobs compares it to the federal school lunch program, which some opposed before they realized hungry children can’t learn. “It’s the same with lead poisoning,” he said. Ignoring the problem, he said, is a missed opportunity for schools to boost their students’ test scores and teacher performance. It’s also wasting a lot of money. “We can have the best teachers in the world, and in many cases we do, but the children’s ability to learn is inhibited by a factor that’s really quite preventable,” he said.

TOXIC NEGLECT: THE HIGH COST OF LEAD POISONING

For more on the lead poisoning project, go to cleveland.com/kids-health Cleveland doesn’t have a lead-safe registry, so we made one: bit.ly/ccomleadregistry How Rochester responded to its lead poisoning problem: bit.ly/ccomleadrochester A look at the steep costs of lead poisoning: bit.ly/ccomleadcost Dismal lead poisoning screening skews the scope of the problem: bit.ly/ccomleadscreen Video illustration by Plain Dealer artist Andrea Levy: bit.ly/ccomleadsilentviolence

About this report For the past several months, Plain Dealer reporters Brie Zeltner and Rachel Dissell have requested dozens of documents from city, county, state and federal officials; worked with Ohio State University’s Kirwan Institute for the Study of Race and Ethnicity to analyze data; and interviewed parents, children, public officials, doctors, housing and environmental advocates. The reporters also searched the country for other cities that are handling the problem better. Zeltner covers health issues; Dissell is on the enterprise team.