In a two-part series on the ongoing risk of lead poisoning in Milwaukee, Milwaukee Neighborhood News Service reports on how diminished federal funding for lead-abatement efforts prompted the City to limit subsidies to six North Side ZIP codes, leaving owners of old homes in other neighborhoods scrambling for help. The series also looks at how Sixteenth Street Community Health Centers responds to elevated blood lead levels in children on the South Side.
Part One: Risk of poisoning from lead-based paint remains, despite city's progress
On a mild March afternoon, 3-year-old Christopher Martinez sits at the kitchen table watching videos on an iPhone. The boy’s face is illuminated by the screen and a bit of light streaming in from two nearby windows. On the other side of the table, Christopher’s parents, Armando Martinez and Ana Sanchez, observe him. Concern shows on their faces.
The family, including 1-year-old Melanie, moved into their South Side home three months ago, unaware of the potential danger facing the children. The real estate agent did not mention anything about lead-based paint in the house, built in 1908. Lead paint remains the leading cause of lead poisoning in Milwaukee; the U.S. Consumer Product Safety Commission banned lead-based paint in 1978.
The older the paint, the more likely it is to chip when windows are opened and closed, creating dangerous lead dust. Young children are at the greatest risk for ingesting the dust because of their curious nature and hand-to-mouth behaviors, said Ofelia Mondragon, lead hazard reduction program manager at the Social Development Commission.
Martinez and Sanchez are not eligible for the Milwaukee Health Department’s current lead prevention program, despite living in a home more than 100 years old. The home is located in the 53215 ZIP code on the South Side, while the city’s program focuses on six ZIP codes on the North Side.
Following revelations about lead contamination of water in Flint, Michigan, Milwaukee residents began questioning lead dangers here. In January, Milwaukee Water Works, a city agency, sent a letter to Martinez and Sanchez — and owners of 70,000 other properties — warning them that a lead service line carries water from the main line into their house and recommending measures to ensure the water is safe to drink.
Nervous about her children, Sanchez scheduled a home visit from the Sixteenth Street Community Health Centers’ Community Lead Outreach Program. An outreach worker discovered lead-based paint chips around the windows, and informed Sanchez that her family’s home does not qualify for subsidized lead abatement from the city.
The program subsidizes lead abatement in six city ZIP codes on the North Side – 53206, 53208, 53209, 53210, 53212 and 53216. The city’s current three-year, $3.9 million grant for lead abatement from the U.S. Department of Housing and Urban Development has made 205 units lead safe, out of the goal of 710, over a year after the program began.
The six North Side ZIP codes account for 75 percent of lead-poisoned children, according to the city. For a property in those ZIP codes to be eligible, it must have been built in 1950 or before, and be up to date on property taxes. Rental properties must house low-income residents.
The majority of housing units on the North Side are rental properties, according to Sarah DeRoo, health communications officer at the health department. “Targeting these areas where not only are the most children lead-poisoned, but where there is more turnover in residential housing, helps us to ensure that rental units where low-income families move in and out of throughout the year are lead-safe,” wrote DeRoo in an email.
The current HUD grant allows the city to cover 80 percent of the cost to replace the windows in houses with lead paint. The average cost to the property owner in 2016 (through March) was $765. The cost to the homeowner varies depending on the amount of work that needs to be done on the property.
Diminishing funds nationwide for lead abatement forced the health department to narrow its focus to neighborhoods on the North Side, said Paul Biedrzycki, director of disease control and environmental health at the health department.
The city’s lead poisoning prevention program, nearly 20 years old, lowered the rate of lead poisoning to a fraction of what it was in the 1990s. Milwaukee has been national leader in lead poisoning prevention, Biedrzycki said. The federal government’s lead prevention model, proactively removing paint before poisoning occurs, is based on the Milwaukee model. Before the change, health departments typically reacted only after children were found to have lead poisoning.
“Chasing or following elevated blood lead levels in the community was not addressing the root of the problem,” Biedrzycki said.
Since the city’s lead prevention program began in 1997, more than 17,000 housing units have been made lead safe, DeRoo said.
Nevertheless, Biedrzycki estimates that 130,000 housing units may still be hazardous.
“Unfortunately our successes are our own worst enemy,” Biedrzycki noted, explaining that a nationwide decline in lead poisoning resulted in lower levels of federal funding for local health departments. The budget for the Centers for Disease Control and Prevention Healthy Homes and Lead Poisoning Prevention Program was reduced from $29 to $2 million for the 2013 fiscal year.
Lead poisoning damages childhood development and is especially dangerous for brain and body development in children under 6 years old. Signs of lead poisoning may not be apparent until the child begins school.
A blood test determines whether a child is lead-poisoned. According to the CDC, there is no identified safe blood lead level for children. The CDC lowered its recommended intervention level from 10 micrograms of lead per deciliter of blood to 5 micrograms after negative health effects were documented among children with lead levels lower than 10 micrograms.
The prevalence of at least 10 micrograms of lead per deciliter of blood) among tested children under 6 years old in Milwaukee decreased from 31.9 percent in 1997 to 2.7 percent in 2014. The same trend appears when the lead threshold is lower. In 2003, 38 percent of children tested had blood lead levels above 5 micrograms per deciliter. By 2014, that dropped to 10 percent (see chart, below).
Children with blood lead levels at or above 10 micrograms are eligible to receive Childhood Lead Poisoning Prevention Program follow-up services from the city. Depending on the blood lead level, the city’s response may include assigning a public health case manager and doing a risk assessment of the housing environment.
There are many possible sources of lead exposure – soil, water, food, toys, jewelry and the surrounding neighborhood – which makes determining the main source of poisoning difficult once the level is below 10, Biedrzycki said. Ingesting lead causes poisoning, whether inhaling lead dust or swallowing contaminated water. Old homes are particularly risky because of the likelihood of lead paint.
“I think this really is a legacy issue for our country,” Biedrzycki said. “We know a lot about lead, we know a lot about how to reduce exposure. Now we just have to connect the dots.”
Part Two: Sixteenth Street Health Centers tackles hazards of lead paint in South Side homes
Carmen Reinmund, lead program coordinator at Sixteenth Street Community Health Centers, vacuums dust from the windowsills of a South Side home with a special filter. She presses strips of duct tape over chipped paint. Reinmund is completing temporary lead abatement work at the home of Armando Martinez and Ana Sanchez, who have two young children. The family’s home, built in 1908, has lead paint, the leading cause of lead poisoning in Milwaukee.
Martinez and Sanchez recently became aware of the danger of childhood lead poisoning and turned to Sixteenth Street’s Community Lead Outreach Program for help. Reinmund informed the couple that they do not qualify for a lead abatement subsidy from the city because of where they live.
The Milwaukee Health Department’s current lead prevention program is focused on six ZIP codes on the North Side. The city has not provided subsidies for lead abatement citywide since 2014. Groups such as Sixteenth Street and the Social Development Commission (SDC) now focus on temporary abatement services, education and blood tests.
Ben Gramling, director of environmental health at Sixteenth Street, explained that the clinic has an agreement with the health department to continue providing information, but the subsidies Sixteenth Street formerly offered residents are gone.
“The health department made the strategic decision to drive much of its resources into the North Side ZIP codes that have not seen the same kinds of decrease in lead poisoning prevalence rates that we’ve seen on the South Side,” Gramling said. The six North Side ZIP codes account for 75 percent of lead-poisoned children, according to the city.
The average cost of window replacement through the city’s Childhood Lead Poisoning Prevention Program is $5,246, according to Sarah DeRoo, health communications officer at the Milwaukee Health Department. Residents in the six ZIP codes who qualify for the program can reduce their cost to an average of $765.
Gramling said that it would be a mistake to think that the problem has been solved on the South Side. “Some people might think that we have collectively solved the problem on the South Side, and that would be unfortunate for people to conclude because there is still a lot of environmental lead that exists on the South Side.”
More options needed
Martinez and Sanchez live in the 53215 ZIP code, where the average residential property was built in 1920, according to data from the city. An outreach worker from Sixteenth Street found lead paint in their home, but the most recent blood test showed that the children do not have elevated blood lead levels. Martinez and Sanchez intend to apply for a loan to remove the paint from the STRONG Homes program.
Reinmund suggested the program to the couple as an option, although it is not specifically designed to pay for lead removal. The city’s Targeted Investment Neighborhoods program is another option, but it is only available in specific areas, and the family’s home is not in one of those communities. The programs are practical choices for some residents because they can get loans to do more renovation work than just lead abatement, Gramling said, but residents wanting to do small, specific projects can have trouble getting loans.
“Our experience is showing that we need more options for homeowners,” Gramling said. “What we would ultimately like to see are options that might support smaller grants or loans to homeowners that might cover costs.”
Reinmund said she knows about one successful TIN applicant from the approximately 30 people she helped apply since the citywide lead abatement subsidy ended.
About 25 property owners Reinmund worked with completed a lead safe renovation course to service properties themselves. The class costs approximately $260, Reinmund said, but people in the 53204 and 53215 ZIP codes can take it for free.
The Sixteenth Street Health Centers’ lead program tracks about 1,700 families and 2,500 children. Outreach workers from the clinic set goals with families to lower children’s blood lead levels or lower the risk of exposure. A follow-up visit is typically done within six months of the first visit, depending on the child’s blood lead levels and age.
Sixteenth Street offers lead testing at three clinic locations, during home visits and at various community events throughout the year. In-home tests are paid for by a state grant. Testing in clinics is typically covered by insurance or the clinic itself, if the family is uninsured. Other testing locations across the city include primary care providers, Women, Infants, and Children clinics and some Head Start programs.
Following the Centers for Disease Control and Prevention’s recommendation, Sixteenth Street has used 5 micrograms of lead per deciliter of blood as a benchmark for interventions such as home visits since 2012. The city health department makes home visits when the blood level is above 10.
Measuring at a lower threshold allows outreach workers to make a difference sooner, Gramling said. “We are able to provide cost-effective services to kids who are below that threshold of 10 with the intent of keeping them below 10.”
Ofelia Mondragon, lead hazard reduction program manager at the Social Development Commission, said she is disappointed that lead abatement programs do not have the funding to help more people. She said that ending the subsidy program throughout the city took away potential help from “thousands and thousands” of families with young children.
Gramling added that awareness about the risk of lead poisoning has not reached everyone in the city, which is why the clinic continues to educate residents.
“Quite a few people have a very limited understanding, or no understanding, of the fact that lead is still a problem,” he said. “It still very much exists and will continue to exist for an extended period of time, and our children are at risk.”
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