Questions & Answers
The State of the City and County: An Issue Briefing on Lead Poisoning in Chicago and Cook County
Following the presentations, the audience engaged with the panelists in a Q & A session. Click on the questions below to reveal the answer below.
Questions and Answers
Jacobs: Illinois should require that lead poisoning be listed as a condition that triggers a special needs assessment within the educational system. Illinois should adopt new legislation requiring inspection and disclosure of information on the presence of lead pipes and lead paint hazards at the time of sale or lease in each pre 1978 housing unit. Illinois should adopt new legislation authorizing a lawsuit against the Lead Industries Association and paint and plumbing manufacturers to require those industries to contribute to the cost of eliminating lead pipes and lead based paint hazards in Illinois homes, instead of simply requiring homeowners and property owners to bear the cost of this source of lead poisoning alone.
Binns: Iron does not act to lower lead in the body, but is necessary to lower the absorption of lead that may be ingested. Iron is absorbed by enzymes in the gut. Lead and iron compete for this absorption. If iron status is low, then the gut enzymes are increased in order to more efficiently absorb the iron that the body ingests. The gut enzymes cannot differentiate between lead and iron, so lead ingested is more efficiently absorbed in the iron-deficiency state. The very low iron state is found by looking at the blood and checking for anemia (low blood count) and looking for small red blood cells and red blood cells that are not uniform in size. However, by the time the blood count changes to show these findings the iron status in the body is very low. In order to “catch” early iron deficiency, tests such as a ferritin level (ferritin is a protein that carries iron in the body) need to be done. There is some debate about what level of Ferritin is needed. Based on national studies in adults, a ferritin level of 12 ng/mL and higher is often considered to be normal. However, most laboratories have a normal range extending to about 350 ng/dl. It has been reported that a ferritin level of at least 45 ng/dL is needed to prevent the brain changes causing “restless leg syndrome.” So, a “healthy” ferritin may need to be higher than 12 ng/dL. For the children I see who have had elevated blood lead levels, I recommend maintaining a ferritin level of at least 25 ng/dL and I recommend that families provide iron sources in the child’s diet and a daily multivitamin that includes iron. Many toddlers don’t eat much meat, so looking for cereals with the 90-100% iron on the label might be an option for some. I recommend to include a fruit at every meal, as combining Vitamin C (from the fruit) and the iron in the other foods increases the efficiency of the iron absorption by 4 times. Iron is an essential element in brain development. Low iron in the brain has lasting negative effects on child development apart from its role in promoting absorption of lead. Providing a healthy diet for children can help promote brain development.
Binns: Lead is more loosely bound in the blood and all soft tissues (liver, brain, kidney. etc) as compared to the tight binding of lead in bone and teeth. When lead in the body is in a “steady-state”, most body lead is stored in the bone, with about 90% of lead stored in bone for an adult and 70% for a child. The release from bone is very slow. About 25% of the body burden of lead is in the soft tissues and 5% in the blood. The only type of lead that is measured for clinical use is the lead in the blood. The body works to maintain an equilibrium for lead across all the various types of tissues/bone. There is a small amount of daily excretion of lead in the urine (about 50 micrograms per day in an adult and about 15 micrograms per day in an infant). As the lead is lost in the urine the lead moves between compartments to re-establish a new equilibrium.
CCDPH: This is difficult to answer for all of suburban Cook County, as each of the 143 school districts (comprising 700 schools) is a separate entity and there is no provision requiring them to report lead abatement activities to the local health department.
Further, traditionally lead prevention focuses on lead poisoning in children 6 months to 6 years of age. For the most part, efforts are focused on pre-school aged lead exposure. Screening of children typically occurs prior to school entry – either through blood test or risk screening. Once in school, children are not re-screened. Few cases of school-aged lead poisoning are reported through existing surveillance.
The current LPP Act permits CCDPH to conduct environmental assessment/testing of lead-based paint hazards in homes of children with confirmed lead poisoning or referred by their physician.
Unless invited by each school district, CCDPH does not have authority to test for lead paint in school buildings. In addition, given the number of schools buildings, CCDPH’s current capacity limits its ability to conduct these assessments routinely.
CCDPH: Again, this is a difficult question to answer, as there may be abatement happening that we are not aware of. There are 125 municipalities in suburban Cook County, each with their own building departments; some have local renovation funds that may fund some abatement.
What we can provide is information on CCDPH-funded lead abatement in suburban Cook and Chicago:
The Cook County Department of Public Health Lead Poisoning Prevention Grant Program funds lead abatement in low-income units where child or pregnant women with elevated blood-lead levels reside or spend a significant amount of time. Since 2002, CCPDH has provided over $10.9 million to fund abatement activities in over 1,060 units. (The numbers include abatement in suburban Cook and Chicago, but do not include Chicago abatement funded by federal dollars).
In units where the owner’s income is too great to qualify for CCPDH-funded remediation, or in those units where owners elect not to apply for the grant program, homeowners conduct their own remediation, which may not involve complete abatement (i.e. wet scrape and repaint vs. window replacement).
In either case, once remediation is complete, CCDPH preforms clearances and assures that the source of the lead exposure has been corrected.
CCDPH: The IL Lead Poisoning Prevention Act and was recently amended to allow the provision of lead home investigation and case management services to pregnant women with elevated blood lead levels. Previously, the childhood lead poisoning prevention programs in local health departments were focused solely on providing case management and home investigation only to children 6 years of age and under.
The IL Department of Public Health can provide more information about their adult blood lead registry:
CCDPH: We do not track children eligible for Early Intervention (EI )services due to elevated blood lead levels, but could consider trying to gather that data if it would be helpful to groups working on this issue. As a department, we are very interested in the provision of EI services to children with lead exposure, and have completed research on EI eligibility criteria as it relates to lead poisoning. We participated in making recommendations to the IL Early Learning Council around lead poisoning services for young children, which included using lead exposure as a criterion that would make children eligible for EI services.
CCDPH: In suburban Cook County in 2013 (most recent data available)
- 3.8% of total tests of children 6 years and younger were 5-9µg/dL
- 0.5% of total tests of children 6 years and younger were 10µg/dL or greater
CCDPH: The Cook County Department of Public Health Lead Poisoning Prevention Grant Program funds lead abatement in low-income units where child or pregnant women with elevated blood-lead levels reside or spend a significant amount of time. Funds from this grant program can be used to temporarily relocate families during grant-funded remediation activities, if needed.
CCDPH: I’m not able to answer for IL, but the Cook County Department of Public Health has completed preliminary analysis of projected costs for lowering the intervention level for our jurisdiction, and is continuing to engage in budget and staffing exploratory conversations. We anticipate needing approximately $4M in additional funding to intervene at blood lead levels of 5µg/dL and greater, most of which would pay for new nursing and lead risk assessor staff positions.
While the science indicates that lowering that intervention level makes sense, the perceived cost is great; many health departments have experienced a reduction in lead program funding and staffing in recent years, and adding children with lower blood-lead levels to the caseloads would, in many cases, increase the numbers of children requiring services beyond current service capacity. This is not a reason not to do it, but does represent a difficult reality in an already limited and contentious budget environment in IL.
CCDPH: There are many resources on the EPA website that can help families protect their children during renovation. Please visit: https://www.epa.gov/lead. Please also see the next question below.
CCDPH: EPA renovation resources can provide information on lead-safe renovation (see previous question). We often refer tenants with questions about renovations to the municipality, which will often provide information or an on-site consultation if residents are concerned about the way work is being conducted. Even if CCDPH is not involved in funding the remediation, we can be a resource for questions about lead-safe work practices, and our program can provide resources and referrals to tenants with questions.
CCDPH: In the CCDPH Lead Poisoning Prevention Grant program in suburban Cook County, only lead abatement contractors licensed by and in good standing with the state of Illinois are eligible to conduct remediation activities. Contractors that have opted in to mailings are sent requests for quotes based on the work specifications at each property to be remediated. Most times, but not exclusively, the job is awarded to the lowest bidder.
For additional information, send questions to CHRC@LUC.edu