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Ignorance Is Not Bliss
Chapter 6 of A Strange Ignorance
http://www.azsba.org/lead6bliss.htm
For more articles on disabilities and special ed visit
www.bridges4kids.org.
Although the education community appears oblivious to the
devastating consequences of lead in the neighborhoods
surrounding "failing schools," increasingly they are becoming
the only ones to ignore the obvious.
Early in 2000, the wife of the then Vice-President of the
United States, Tipper Gore, honorary chair of the Campaign for
a Lead Safe America, unveiled what the Health and Human
Services department called: a comprehensive government-wide
strategy prepared by the President's Task Force on
Environmental Health Risks and Safety Risks to Children
outlining efforts to achieve a virtual end to childhood lead
poisoning in American within ten years.
"... few Medicaid children are screened for blood-lead
levels."
-1999 GAO report
A "Task Force" of experts convinced the highest levels of
government in the United States that lead poisoning was a
serious problem for children. The report of the task-force is
available at:
http://www.hud.gov/lea/leadhaz.pdf which is linked off of
the HHS Office of Healthy Homes and Lead Hazard Control
website where extensive information about the federal effort
is available at:
http://www.hud.gov/offices/lead/index.cfm. There
does not appear to be anything comparable on the U.S.
Department of Education website.
The Department of Housing and Urban Development (HUD) issued a
press release on October 24, 2001, announcing "over $67
million in grants aimed at protecting children in low-income
households from lead-based paint…." The grants were "$59
million in Lead Hazard Control grants to remove lead hazards
from approximately 7,000 privately owned homes in 16 states"
and $8 million in grants to fund local projects under HUD's
Healthy Homes Program for
Blood testing for children living in low-income housing;
Removal of lead-based paint hazards from privately owned
low-income homes and apartments; Inspecting and testing
low-income housing for the presence of lead hazards;
Temporarily relocating families during lead control work;
Community education and outreach; Job training for lead hazard
control workers; and, Collecting and analyzing data to
identify housing with lead hazards.
The federal Lead Hazard Reduction Act of 1992 already requires
landlords to notify tenants of the presence and hazards
associated with lead-based paints. Until recently the law has
been largely ignored. However, on July 11, 2001, the federal
Department of Housing and Urban Development (HUD) issued a
press release announcing that David D. Nuyen, a Washington,
D.C., area landlord, pleaded guilty for
… his failure to notify tenants of the presence and hazards
associated with lead-based paint. The case is the first-ever
criminal prosecution in the United States related to lead
hazard warnings that are required by the federal Lead Hazard
Reduction Act of 1992. ….
Nuyen will serve two years in prison under the terms of the
agreement. "The dangers of lead poisoning have been known for
years, but too many children continue to be exposed to lead
hazards," said John Cruden, the Acting Assistant Attorney
General in charge of the Justice Department's Environment
Division. "We will vigorously enforce the federal lead
disclosure requirements to protect the public and our children
from these unnecessary health risks."
The Vice President of the United States understands the lead
poisoning problem. The Department of Health and Human Services
has a major anti-lead effort. The United States Department of
Justice has instructed U.S. Attorneys to focus on the problem.
The United States Department of Education? It is a criminal
offense for landlords to remain ignorant of the devastating
effects of lead poisoning. Not so for educators. Yet.
Civilian juries seem to understand the problem. On November 7,
2001, the Baltimore Sun reported that a jury awarded $2.16
million to a "19-year-old Baltimore man who suffered lead
poisoning as a child" after he sued the landlords who owned
the buildings he was raised in. The Sun noted:
As an infant and toddler in the 1980s, Kendall Baker lived in
two East Baltimore houses where his blood lead levels rose to
four times the level now considered safe by the Centers for
Disease Control and Prevention…. As a result, Baker has
language and cognitive problems. He dropped out of high school
and works as a gravedigger, making $7.50 an hour….
On July 10, 2001, Kweisi Mfume, President & CEO of the
National Association for the Advancement of Colored People
(NAACP) issued a press release titled MFUME CALLS LEAD PAINT
POISONING "THE SILENT EPIDEMIC" that noted:
Ruth Ann Norton, Executive Director, of the Coalition to End
Childhood Lead Poisoning, said: "Lead is a neurotoxin that
damages the reading and reasoning ability of children.
Children who are poisoned by lead are seven times more likely
to drop out of school but they also have a preponderance to be
more violent, to have Attention Deficit Disorder, to have
hearing loss and therefore they have a handicap of being able
to compete fairly."
The NAACP issued another press release on October 4, 2001,
which stated:
Mfume has been meeting with officials from several states to
begin a coordinated action against the lead paint industry. He
is asking the states to join the NAACP, which may file a class
action lawsuit against the industry to end the threat of lead
poisoning in children.
In November, 2000, California voters defeated Proposition 37
(dubbed by opponents the "polluter protection act") partly
because the real Erin Brockovich, who was the subject of the
Academy Award-winning Hollywood movie about corporate
polluters, campaigned against the proposition. The California
Catholic Conference provided this pre-election summary of the
ballot proposition:
In 1991 the Legislature authorized the collection of
'mitigation fees' from a paint company to pay for a lead
poisoning prevention program. In 1997 the California Supreme
Court upheld the collection of such fees. The sponsors of
Proposition 37 want to reclassify such fees as taxes, a more
stringent threshold (requiring a two-thirds vote of the
Legislature or voters).
This "lead poisoning prevention program," as described by The
San Diego Union-Tribune, "involved a surcharge on paint to
offset the cost of screening children for lead contamination."
The California Chamber of Commerce, California Taxpayers
Association, and California Manufacturers and Technology
Association supported Proposition 37 to stop the surcharges
that would fund the screening of children for lead, but the
proposition was opposed by the American Cancer Society,
California Nurses Association, League of California Cities,
and the League of Women Voters.
Soon after the voters rejected this "polluter protection act"
a San Francisco judge ordered the California Department of
Health Services to begin implementing the lead screening of
Medicaid children in California (see:
http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2000/12/01/MNL36289.DTL).
Although there is already a federal requirement that Medicaid
children be screened for lead poisoning, not much actual
screening occurs.
In January, 1999, the United States General Accounting Office
released a report titled "LEAD POISONING, Federal Health Care
Programs Are Not Effectively Reaching At-Risk Children." The
New York Times reported (August 22, 1999, pg. A1)
Federal investigators say most states are flouting a 1989 law
requiring that young children on Medicaid be tested for lead
poisoning. … The General Accounting Office [GAO], an
investigative arm of Congress, found that 'few Medicaid
children are screened for blood-lead levels,' even though the
problem of lead poisoning is concentrated among low-income
children on Medicaid.
In fact, the GAO report noted that Centers for Disease Control
(CDC) statistics show
More than 8 percent of the surveyed children aged 1 through 5
who were served by federal health care programs had a harmful
blood lead level, a rate almost five times the rate for
children who were not in these federal programs. Despite
federal policies, most children in or targeted by federal
health care programs have not been screened. For nearly,
two-thirds of the surveyed children aged 1 through 5
identified by CDC as having elevated lead levels, the blood
lead test conducted as part of the CDC survey was the first
such test they had received.
Read that carefully: nearly two-thirds of the children
actually found to be poisoned and who by law were supposed to
be screened by federal programs "have not been screened."
Conversely it means that for every child found to be lead
poisoned by federal programs, there are at least two other
poisoned children unidentified. Or put more simply, it means
that the actual rate of lead poisoning among children is at
least three times the official rate. The GAO report noted
One underlying reason for low screening rates is the
widespread belief among providers that lead exposure is no
longer a problem in their communities. Most state officials
GAO contacted lacked reliable, representative data on the
prevalence of elevated blood lead levels and the extent of
screening in their states. Another problem is that many
children are not receiving adequate preventive health care
services, visiting the doctor only when they are sick.
The Arizona Health Care Cost Containment System (AHCCCS -
pronounced "access") is the Medicaid provider for indigent
children in Arizona. The Arizona Department of Health Services
published a report in 2000 titled "Childhood Lead Poisoning
Prevalence Rates in Children Enrolled in AHCCCS" on blood lead
screening for children "ages five years and younger" which
noted that AHCCCS only screened "11% of the AHCCCS population
for this age group." In other words, slightly over one-tenth
(11%) of those indigent children who managed to surmount the
bureaucracy to actually qualify for AHCCCS were ultimately
screened for lead poisoning.
Indigent children represent the population most likely to be
affected by lead poisoning (five times as likely according to
the GAO report). Yet only a minority will qualify for AHCCCS
because surmounting the bureaucracy is not easy. In a weeklong
Tucson Citizen newspaper series on children's health care in
southern Arizona in May, 2000, a Tucson pediatrician wrote in
a guest column:
I know that our Medicaid system is held up as a national model
of how to provide health care to the poor while containing
costs. Yet, from my perspective, AHCCCS is a failure. It
should be called BARRIER. Despite changes in the past few
years, it still is very difficult to apply for AHCCCS and to
maintain AHCCCS eligibility.
Children of parents who earn more than the limits to be
ineligible for AHCCCS can be served by a federal matching-fund
program implemented in Arizona as "KidsCare." A Tucson Citizen
article on November 28, 2000, reported:
Parents already face obstacles to enrolling their children in
KidsCare, the state's 2-year-old health-care program for poor
children, said Dana Wolfe Naimark, assistant director of the
Children's Action Alliance. A lack of enrollment in KidsCare
lost the state $76 million in federal matching funds for the
program earlier this year. In particular, public schools are
still banned from contracting with the state to do outreach
for the program, Wolfe Naimark said. Outreach through the
schools could add thousands of youngsters to the KidsCare
program. Ironically, state law requires any child who would be
covered under the program to go without health coverage
entirely for six months before enrollment.
But even among the few eligible indigent children who did
manage to qualify for AHCCCS, where blood lead screening is
mandated by federal law, only 11% were actually screened. The
AHCCCS Medicaid system in Arizona is funded in a manner that
encourages doctors not to look for, nor find, medical
problems. Arizona uses an "HMO" model for AHCCCS, and such
"managed care" programs, according to a report by U.S. Surgeon
General David Satcher, "may also lead to denial of needed
treatment." Doctors are paid a fixed amount per patient from
which to treat all ailments they discover.
Thus for doctors to discover asymptomatic ailments such as
lead poisoning is economically foolhardy, a point made clear
by Dr. Stephen Ragusea, a clinical psychologist at the Child,
Adult, and Family Psychological Center in Pennsylvania in
commenting on managed care in general: "So, the only incentive
to us is to provide less care. My group thinks that's
inherently unethical." (see:
http://www.erasethestigma.org/stories/kids.html)
Compounding that, children in Arizona who are undocumented
immigrants from Mexico are generally not eligible for
low-income healthcare. Yet these children attend Arizona
schools and are the most likely to be severely affected by
lead poisoning. Not only do they have the exposure to lead
paint in low-income housing, but they commonly bring
lead-glazed ceramicware for food use with them from Mexico,
and typically employ the lead-laced folk remedies Azarcon and
Greta. Indeed the Arizona Department of Health Services has an
active advertising campaign to dissuade Hispanics from using
these remedies. In addition, Mexico has not outlawed leaded
fuel and many immigrants have elevated blood lead levels
absorbed from ambient air pollution.
Therefore the children most likely to be suffering from the
preventable brain damage of lead poisoning that results in
poor academics and disruptive behaviors in Arizona schools are
excluded from the screening and treatment for lead poisoning.
These same children are required to be taught by "failing
schools" because politicians claim "All Children Can Learn"
even though it is the politicians that determine these
children are ineligible for health care that might detect the
poisoning that prevents them from learning.
As a consequence, each actual case of lead poisoning detected
in Arizona children likely resulted from only the 11% of the
AHCCCS population that was screened. That, in turn, means for
each child found to be lead poisoned there are likely nine
more lead poisoned children among those 89% who were not
screened. In addition, since only about one-third of the
indigent population overcomes the bureaucratic barriers to
qualify for healthcare, there are likely to be another twenty
undetected lead poisoned children for each detected case of
lead poisoning left unseen in the two-thirds of the eligible
population that did not qualify. Therefore it is extremely
likely there are actually 30 times more lead poisoned Arizona
children than actually discovered.
But considering that the population of children most likely to
be lead poisoned (from deteriorating paint, imported pottery,
folk medicines and air pollution) are undocumented immigrants
(a consequence of laborers and hospitality workers from Mexico
being low-paid) who are not eligible for healthcare, there are
far more than just 30 lead poisoned children in Arizona
schools for each one actually discovered. The population where
we know there are 30 times as many lead poisoned children as
we actually find, does not include the population in Arizona
schools most likely to be lead poisoned.
But ironically, even this vastly understates the problem.
Detected cases of lead poisoning are defined as blood lead
levels above the 10 microgram/dL level. Recent medical
research has shown that the most damage from lead poisoning
occurs at lead exposures BELOW the 10 microgram/dL level. Thus
the children we find are only the extreme cases, a small
percentage of those who actually suffer from lead poisoning.
So even though those children found to be lead poisoned in
Arizona represent only a tiny fraction (certainly less than
one-thirtieth, maybe less than one percent) of those who
likely are "officially" lead poisoned, even that greater group
is only a tiny fraction of those who have brain damaging blood
lead levels below that "official" level.
If we only count blood lead levels above 20 micrograms/dL we
have a far smaller number of children than those with blood
lead levels between 10-20 micrograms/dL because those above 20
micrograms/dL are extreme cases. Likewise, the number of
children with blood lead levels between 1-10 micrograms/dL is
a far larger population than those above 10 micrograms/dL. So
the number of children who are officially designated as lead
poisoned, even if we count the thirty times more we know exist
from official surveys, and even if we count the children we
know must be in the immigrant population that we do not count,
that combined total is certainly smaller than the count of
children who have brain damaging blood lead levels below 10
micrograms/dL. And all of these children will be concentrated
in schools around low-income neighborhoods.
Thus for every single case of lead poisoning discovered among
low-income children in Arizona, hundreds more have been
overlooked and are attending public schools.
BUT, in addition, it is important to understand that blood
lead levels only measure existing toxicity. As the 1991
Newsweek cover story noted "While it can be removed from the
bloodstream through chelation, most of the lead that is
absorbed into a child's brain sits there, literally, forever."
Just because there is no lead detected in the blood of
children when they are tested, does not mean it wasn't there
creating irreversible damage during their early brain
development. So, even though there may be a hundred times as
many children with brain damaging blood lead levels equal to
those actually "officially" detected, and even though there
may be a hundred times more than that with brain-damaging
blood lead levels below that official standard, even that does
not count those Arizona children whose brains have been
permanently crippled by lead poisoning in their early
development but who currently lack lead in their blood.
Thus for every single case of lead poisoning discovered among
low-income children in Arizona, hundreds more have been
overlooked and are attending public schools. And that
population will not be spread evenly across the geography of
Arizona schools. They will be concentrated in the low-income
neighborhoods around schools that become labeled as "failing."
These "asymptomatic" brain-damaged children will sit in
ordinary classrooms with unsuspecting teachers and fail to
learn. Schools staffed by professional educators using the
most effective educational techniques on children whose brains
are jammed with a neurotoxic metal that prevents them from
learning, prevents them from paying attention, prevents them
often from even attending, will not be able to overcome the
physiological damage that occurred years before the children
ever set foot in a school.
We know this has to be true because the lead is out there in
the low-income housing environment, and it is foolish to think
children in any low-income neighborhood are not being exposed
to it. A federal Housing and Urban Development report issued
in April, 2001, titled "National Survey of Lead and Allergens
in Housing" concluded its executive summary with "one in three
homes with resident children under 6 years old have
significant lead-based paint hazards." This is an overall
average, however, that would indicate the percentage in
low-income housing is much higher: well over one-third of
low-income children are exposed to environmental lead. But
even if it only applies to low-income neighborhoods, one in
three homes in those neighborhoods are crippling the brains of
the children who reside in them. This is not speculation,
"significant lead-based paint hazards" means that those homes
which are not poisoning the children were not counted in the
one-third statistic.
The City of Phoenix has an active "lead abatement" program.
Virtually the entire central core of Phoenix (see:
http://www.ci.phoenix.az.us/NSD/enterprise.html) and
several neighborhood islands (see:
http://www.ci.phoenix.az.us/NSD/nia.html), have been
declared lead risk areas. The city has an active policy of
remediating homes which house children under six years of age.
However, even the City of Phoenix program exists only because
the City receives special funding from the federal government.
The City of Phoenix itself spends no money on lead abatement,
expending only the federal grant money it receives.
By all measures, the City of Phoenix program is outstanding.
Homes selected for lead abatement are pre-tested and
post-tested both inside and outside to locate the problems and
ensure they have been remediated. In the last four years the
City of Phoenix has completed lead abatement on 600 homes
within the ten square mile area designated for lead abatement.
They remediate approximately 6 to 8 homes a month.
The U.S. Department of Housing and Urban Development (HUD)
cites the Phoenix program as exemplary and utilizes the City
of Phoenix lead abatement training video. One of the bullets
under the "Revitalization Division" in the Neighborhood
Services homepage on the City of Phoenix website shows "Remediates
lead hazards in privately owned low-income housing," and the
webpage for the Revitalization Division has a link to "More
information about Lead Hazard Control Program." However, the
Phoenix program primarily "remediates" by covering the lead
with new paint, only removing the lead-based paint on surfaces
that are likely to be contacted by small children, such as
window sills. This increases the efficacy of scarce dollars in
protecting children, but much of the lead, though temporarily
sequestered, remains.
Still, the Arizona Department of Health Services annual report
on lead poisoning (see:
http://www.hs.state.az.us/edc/oeh/pbannual99.htm for the
1999 report, the 2000 report is out but was not listed on the
website) lists two central Phoenix zip codes as having the
most reported childhood lead poisoning cases in Arizona.
Among Arizona cities, however, the Phoenix abatement program
appears to be an anomaly. Tucson has a housing program and
Slum Abatement and Blight Enforcement Response (SABER)
program. When asked what lead abatement programs were active
in Tucson, a program manager involved in the SABER program
said "None that I know of." The City website for Tucson's
housing program states:
The Community Services Department operates several programs to
assist lower income homeowners to repair their homes. These
include such programs as emergency home repair, home repair
for elderly persons, deferred loans, and target neighborhoods.
Together these programs assist approximately 200 families
annually, and provide reinvestment in some of the community's
poorest neighborhoods. (see:
http://www.ci.tucson.az.us/csd/Housing/Home_Repairs/home_repairs.html)
But there is no mention of lead poisoning or the hazards of
rehabilitating older homes that contain lead paint.
Another page for the City of Tucson Housing Rehabilitation
Collaboration page, posted in October, 2000, notes:
DID YOU KNOW THAT ………
56,000 of the housing units within the City of Tucson are 50
years old or older. This is approximately 30% of the City's
housing stock. By the year 2010, it is estimated that 87,000
units will be over 50 years old. While newer homes are being
constructed outside the City center, many homes in the older
urban neighborhoods are in need of repair. Many of the
families living in these older homes do not have the resources
to make necessary repairs and neighborhoods continue to
decline. (see: http://www.ci.tucson.az.us/csd/Housing/Home_Repairs/Rehab_2000/rehab_2000.html)
Again, there is no reference to lead or lead abatement.
While children's history books tell them of the post-WWII
housing boom, the explosion of tract housing ("Levittowns")
and the transformation of America into a suburban society, it
doesn't mention that these homes were painted with lead-based
paints banned in other industrialized countries in the first
quarter of the twentieth century. Paints that were not banned
in the United States until the last quarter. Paints that were
advertised for use in children's rooms that now are laced with
lead. Paints that now, thirty or forty or fifty years later,
are peeling and powdering in old neighborhoods where
low-income infants crawl on floors and put their lead-dust
encrusted fingers, as well as everything they find, in their
mouths. And scientists say that lead paint chips have a sweet
taste.
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