Prove your humanity

Lead exposure continues to be a health risk for children in Pennsylvania. And while the crisis in Flint, Michigan has brought attention to the issue of lead in drinking water, children are more commonly exposed to lead through paint in older housing. But despite the well-known risks of lead toxicity, it’s not mandated that all children be tested for lead. Allegheny County Health Department director Karen Hacker recently penned an op-ed about this issue, and Kara Holsopple caught up with her to talk about the challenges of getting more kids tested.

The Allegheny Front: So why are children especially vulnerable to lead exposure?

Karen Hacker: So this has to do with the impact of lead on the developing brain. And we know that having early exposure to high levels of lead can lead to learning and behavioral problems. By the time you’re five or six, you’re just not impacted in the same way. Technically, we would like to see lead testing twice before 24 months—once at nine to 12 months and once at 24 months.

AF: And this is not something doctors would necessarily do as part of a regular battery of tests?

KH: Some do, and some don’t. It’s hard for us to really get a handle on the volume. We definitely know that lead testing has increased over the years, and that’s a good thing. But we should also remember that lead testing is not done in the office; there is not a rapid lead test. And so as a result, you have to send someone to a laboratory to have it done. We also believe that there may be recommendations that aren’t necessarily followed through on when someone actually doesn’t go to get the lead test.

LISTEN: “Why Aren’t More Kids Tested for Lead?”

AF: Is there any level of lead in the blood that’s considered safe?

KH: At this point in time, according to the Centers for Disease Control (CDC), there is no safe blood lead level. There was a time when the CDC thought that anything over 10 micrograms of lead per deciliter of blood was a level of concern. Now, they’re asking to be concerned about anyone who is over 5, monitoring someone to see if the level is going up or down.

AF: You wrote in your op-ed that the Centers for Disease Control and Prevention recently changed their recommendations about lead levels and the threshold that’s considered an elevated level. How does that impact getting more kids tested for lead?

KH: I’m not sure it does. The resources we’ve had here at the health department to be able to follow children are very limited. Most of those dollars come from the federal government, and over time, there has been a diminution of that. In Pennsylvania, pediatricians are not required to do lead testing. It’s recommended—certainly for Medicaid children—but it’s not required. And I think that as those changes have been made, we would certainly like to encourage more testing. There are only a few states that have mandated lead testing. But I do think it would make sense, given what we know about lead and the damage it can do to a child’s brain, that we should be investing more resources in encouraging all children to be tested.

AF: In the absence of adequate funding for lead testing, what can be done to move the needle on this problem?

KH: In the past, there was much better communication to the public about the dangers of lead. When lead testing increased, our rates of childhood lead poisoning definitely decreased. I think like with many public health issues, you take your foot off the pedal and you move onto other things that are important. I think the situation in Flint, Michigan has raised the question about lead again and put it on the front page. Clearly, in Flint, they’re talking much more about the water. But let’s not forget that we still have problems in our housing stock.

AF: Has what’s happened in Flint changed your priorities?

KH: We’ve been talking about this since I got here. But I think it has made me revisit the problem. And the other thing that’s happened simultaneously is these shift in the federal dollars that we’ve been getting. We’ve had resources from the federal government to address lead. But the most recent shift in the grant has shifted completely away from lead to injury prevention. And we cannot stop doing this work, and we’ve either got to figure out how to absorb it internally or look for new resources. Our plan at this point is that our housing inspectors are being trained in lead inspection strategies. And we are also looking at shifting some of our positions to determine whether we can use them for lead inspection. You know, one of the challenges with public health is that we’re somewhat invisible until there is a crisis. And then there’s a crisis, and we never have the resources that we really need to prevent that crisis.


Karen Hacker is the director of the Allegheny County Health Department. You can read her op-ed on lead testing in children here.