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A Shower of Benefits: Drinking Water and Healthy Housing

The American Public Health Association today hosts a Twitter chat on “What's in Your Water: The State of Water and Our Health” (#SafeWater). The state of the nation’s infrastructure that delivers drinking water to our homes is nothing short of appalling, with Flint being only the tip of the iceberg. It’s outdated, and like much of our roads, bridges, electrical grid and housing stock, it’s seriously underfunded and ill-maintained, causing high healthcare costs and needless suffering. At best, this is penny-wise and pound-foolish; at worst, it’s criminally negligent. Just today, Pew Charitable Trusts, Robert Wood Johnson Foundation, NCHH, and others released a major new report showing that the benefits of lead poisoning prevention far outweigh the costs.

The nation still has no health-based standard for lead in drinking water, and protocols for sampling for lead in water are all over the place and hard to interpret. The only real standard that does exist is designed to determine how well corrosion control treatments are working, not whether health is being adequately protected. The same is true for other contaminants, like PFAS/PFOS/PFOAs (e.g., perfluorooctanoic acid [PFOA], perfluorooctane sulfonate [PFOS], and other perfluoroalkyl substances [PFASs], which are chemicals used for stain-resistance, Teflon coatings for frying pans, and other purposes. We hear of outbreaks of legionella and other diseases related to poor water treatment standards.

How did we come to this mess? After all, indoor plumbing was installed in housing to help conquer tuberculosis, typhoid, and cholera as part of the sanitation movement—and it worked! But today, the reality is that the failure to invest in infrastructure maintenance and improvements has provided local water authorities with limited options and complex, delicately balanced water chemistry trade-offs. Adding or subtracting one water treatment option often leads to unintended outcomes resulting in dire public health consequences. In a previous blog, "Infrastructure and Mortgages," we wrote that lead in water and housing in general must be part of the nation’s infrastructure rebuilding.

Are we really going to allow our nation to be forced to buy millions of plastic bottles to access drinkable water, instead of a high-quality water supply system? We should also point out that the quality of that bottled water and all those plastic bottles have their own problems and environmental costs.

What does this mean for parents? I recently had the opportunity to sample the water in the home of a friend with a newborn baby. They had previously gut-rehabbed their home and had asked the local water and sewer authority to sample their water for lead content. The results suggested a very low level—but  this was after flushing the system for 5-10 minutes, which means it didn’t determine the presence of a lead service line or lead in solder for copper pipes, and it didn’t reflect the water they actually drank. (Do you know anyone who runs the faucet for five minutes before filling a glass or pot with water?) As part of the rehab, their contractor had replaced the lead service line on their private property but failed to notify the water authority, who would’ve replaced the section on the public side at the same time as the private side was being replaced. The mom and dad thought the problem had been taken care of, but they asked me to check just to be sure. When I sampled the water, I did a first-flush and then, using a back-of-the-envelope calculation, took a second sample after a two-minute flush, which I suspected would be the water that had stayed in the public side of the lead service line overnight. Sure enough, when I got the results back, the second sample was much higher than what the earlier testing had showed. I contacted the local water authority, and they confirmed that they had not replaced their public section of the lead pipe, but they said they would do so after I sent them the results, which I did.

Parents shouldn’t have to put up with such a scattershot, hit-or-miss approach. We have to do better. And we have to put our people back to work with good paying jobs to fix things like this, instead of waiting for children to get sick or overexposed to contaminants. Here’s what needs to happen:

  1. Make drinking water quality a clear part of the healthy homes strategy. There are currently eight key principles for such a home: A healthy home means one that is free of excessive moisture and mold, free of injury hazards, properly ventilated, well-maintained, clean, free of pests, thermally controlled, and free of contaminants. “Free of contaminants” includes a drinking water supply without lead or other contaminants.
  2. Locate exactly where drinking water lead pipes are located using state-of-the-art technologies. (We created technologies to locate lead in paint, and we can do it for water too).
  3. Improve water treatments to minimize lead and other chemicals and contaminants entering the drinking water system.
  4. Implement a long-term plan to replace all lead drinking water pipes
  5. Implement a plan to eliminate other contaminants and biological agents.
  6. Create a health-based exposure standard for lead in water like we have for lead in dust and soil and enforce it. The current EPA maximum contaminant level goals in drinking water for lead is “zero,” which doesn’t help anyone to make real decisions on taking action.
  7. Fund an infrastructure improvement program that includes improving children’s health. (It makes no sense to treat children only after they get sick—that’s expensive and causes needless suffering.)
  8. Ensure that the infrastructure work creates good paying jobs for our people. An estimate suggests that at least 75,000 jobs can be created for lead mitigation alone doing this type of work. 
  9. Implement the recommendations provided in National Environmental Health Partnership Council’s Environmental Health Playbook: Investing in a Robust Environmental Health System.
  10. Implement the National Safe and Healthy Housing Coalition's “Find It, Fix It, Fund It” campaign, which would save billions of dollars and protect our children.

The science is clear, and we must act on what it tells us, not ignore it or create some so-called “alternative facts.” That action must include all of us—parents, citizens, government, private and public entities, foundation, workers, engineers, scientists, and advocates. 

There is simply no reason to tolerate lead or other contaminants in our drinking water. I’m going back to my friend’s house to see what happens when that pipe gets replaced. But it should never have happened in the first place. And if we eliminate the lead, we eliminate exposures. We’ve taken lead out of food canning, gasoline, new paint, many consumer products, and we have efforts to address lead in existing homes—all of which have succeeded in reducing blood lead levels by more than 90% over the past several decades. But with over half a million children with too much lead, we can and must do better.


Dr. David Jacobs, former Director of the Lead Poisoning Prevention Program at the U.S. Department of Housing and Urban Development, is the Chief Scientist for the National Center for Healthy Housing and an adjunct professor at the University of Illinois at Chicago School of Public Health

Stand Up and Be Counted in the Fight Against Lead Poisoning



Lead poisoning—you know, it seems like we should’ve had this problem licked by now.

Every year, we (NCHH and our partners) get out and stomp the figurative pavement, reminding people—parents, teachers, doctors, members of Congress, the President—that lead is still a very real and dangerous problem. And every year, despite our best efforts, more kids are exposed to lead. This year, we heard of a city (Flint, Michigan) that was exposed to dangerous levels of lead in its water.

All of this despite the fact we’ve known lead was poisonous for over 100 years and despite the fact that lead-based paint was banned in the U.S. back in 1978. That's nearly 40 years ago. The banning of lead-based paint in homes was a major victory, but the war rages on: While no new lead-based paint is being manufactured for residential use here in the United States, lead is still being used in other types of paint. Meanwhile, the lead-based paint that exists in older homes continues to disintegrate into poisonous dust. Lead exposure also comes from aging pipes entering homes and schools, from soil, and in consumer products.

According to Dr. David Jacobs, NCHH's Chief Scientist, "Lead is […] one of the best studied toxic substances that we know of. It’s one of the metals that you don’t need in your body; it has no useful biological value whatsoever. It creates a range of effects [including] neurodevelopmental effects for children at an early age, but it also causes cancer, kidney disease, and many other adverse health effects."

Today, there are still over 500,000 children with elevated blood lead levels in the U.S. Untold numbers of adults—possibly in the millions—struggle daily with the lifelong consequences of their own childhood lead exposure: decreased IQ and cognitive function, developmental delays, and behavioral problems. It’s both unfortunate and unacceptable for any child to be harmed by lead exposure, yet it continues to happen every day, regardless of race, creed, color, or social strata, though children of color and those living in low-income housing have been affected most.

Advocacy groups, philanthropic organizations, and federal, state, and local governments have done much to educate the public about lead hazards—a herculean task. NCHH and its allies in this war on lead poisoning have also made great progress over the last 40-plus years. The studies we and our partners have done, the research we’ve provided, the articles we’ve written, and our advocacy efforts have resulted in a significant reduction in the number of Americans with elevated blood lead levels, as well as medical treatment for those affected. We’re proud of our work, and we’re proud of all the others who’ve joined us in the fight.

Now we need for you to join us as well, and we need you today. NCHH and the National Safe and Healthy Housing Coalition have just created a petition entitled “Tell Congress to End Lead Poisoning Now” that outlines a comprehensive strategy to end lead poisoning within five years.

Take a few minutes to check out the petition. Now we want you to sign it. Yes, YOU. And then we want everyone you know to sign it as well, which means that we need you to share it with people you know and ask them to share it too. Sign it, share it, and change the world—just a little.

Some of you have probably already signed the petition. You read the title and said, “I’m IN!” (Thank you!) Maybe you’re in because someone in your family has been exposed to lead. Maybe there’s lead in your house or apartment right now, and you don’t have the money you need to make your home safe once and for all. Or maybe you know someone down the street, one street over, or someone who goes to school with your kids, who’s been touched in some way by lead poisoning. Maybe you know someone who’s sitting in jail, and you think that maybe his or her life would be completely different right now if only they hadn’t been exposed to lead.

But maybe you haven’t gotten around to signing the petition just yet. We know that some of you are thinking, I don’t know anyone with this problem or This isn’t really a problem for me. But it really is. Whether or not we realize it, we’re all affected by lead poisoning:
  • Because families move into older homes every day.
  • Because children attend older schools every day.
  • Because some kid visits his or her grandparents’ home every day.
  • Because water flows through old pipes every single day.
  • And because lead poisoning can lead to learning disabilities, impulse control issues, and violent behavior, we pay tax money to fund educational services, law enforcement efforts and the judicial system to fix lead-related problems after they’ve happened. 
We want to tell Congress to invest more in the system upfront so that problems don’t happen. It’s a sound investment in our collective future: The return on investment for lead poisoning prevention is estimated at no less than $17 for every $1 spent.

As NCHH’s David Jacobs and Amanda Reddy commented in a recent editorial, lead poisoning is preventable, and we know how to prevent it; but our investment has to be more widespread and sustained.

Help us tell Congress that it is time to end childhood lead poisoning. Won’t you help us to reach our goal of 20,000 signatures? Stand up and be counted: Please sign the petition right away and share it with your friends, associates, and family.

CDC Releases Latest Blood Lead Data, Confirming that 535,000 Children Have High Levels and Disparities Persist

CDC Releases Latest Blood Lead Data, Confirming that 535,000 Children Have High Levels and Disparities Persist. (Hard to Believe that CDC and Congress Cut the Funding, Isn’t It?)

Children belonging to families with a low income (130% of poverty level)  are more than three times as likely children in higher income families to have high blood lead levels. The mean blood lead level for low income children is 1.6 µg/dL,  or .6 µg/dL higher than children in higher income households (1.2 µg/dL ).  Medicaid-enrolled children also have higher blood lead levels, and are more likely to have high blood levels, than non-Medicaid enrolled children. Non-Hispanic black children are more than twice as likely as non-Hispanic white children to have BLLs at or above 5 µg/dL. The mean blood lead level for non-Hispanic black children  is 1.8 µg/dL, while non-Hispanic white children have a mean BLL  of 1.3 µg/dL. 

National Childhood Lead Poisoning Prevention Week

I had the good fortune to be working for Senator Jack Reed in 1999 when he introduced a resolution (S. Res 199) to establish National Childhood Lead Poisoning Prevention Week in October. It is both ironic and sad that during the one week each year when we celebrate childhood lead poisoning prevention, we are simultaneously engaged in a battle to protect one of the key federal childhood lead poisoning prevention programs from evisceration.

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