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THE ERADICATION OF CHILDHOOD LEAD POISONING

INTRODUCTION

The material that you are about to read represents the combined work of the
Committee of Hospitals of Brooklyn to Eradicate Lead Poisoning.

Lead Poisoning is a completely preventable medical, social, and economic disease. It occurs among children who are old enough to walk but not mature enough to be discriminating about what they eat. The necessary ingredients for the occurrence of lead intoxication are a young child with pica (eating of non-food substances), and old dilapidated housing with peeling, lead containing paint and plaster. The disease can be completely eradicated by correcting the toxic environment, primarily by the elimination of poor housing.

Obviously, the cost of such a total program would be very large. This, however, must be evaluated in terms of what is already being spent on long term hospitalization of threatened and affected children, screening programs and patch work repairs on inadequate housing that remains a potential menace. It is clear that lead poisoning is not merely a health problem but a deeply rooted social, economic and education equation which will be solved only through the combined involvement of housing, social and education as well as health agencies.

The three statements presented in this position paper are designed to:
inform you, to arouse, and involve you along with this committee and every
responsible segment of our city and nation who cares in the struggle that it will
take to move the agencies and agents of power in this nation to remove this
preventable malady from our midst.

Everyone from the President of the United States to the last man of us must try to break the gripping chains of bureaucracy and priority, to at once rid ourselves of this completely preventable disease. We cannot allow for less than eradication if we are to SAVE THE CHILDREN.

THE CAUSE AND EFFECT OF LEAD POISONING IN CHILDREN

Lead Poisoning in early childhood is a chronic disease which may involve most of the organs of the body including the brain, intestine, the kidney, the blood forming organs, and the heart.

Lead ingestion by young children is invariably associated with the phenomenon of pica, eating non-food material such as lead containing chips of old peeling paint and plaster. Since only a small amount of lead is absorbed from the intestine following each ingestion, repeated intake is necessary for intoxication to occur. It begins to accumulate significantly after 6 weeks of ingestion, and symptoms may occur in about 3 months. This further amplifies the need to identify these children early, because of the significant damage that can take place between ingestion and the appearance of symptoms. A few chips of paint may contain an excess of 100 times the safe amount of lead which may be ingested daily. Once the body has acquired an excessive load, the lead is stored in the tissues, chiefly bone, and is excreted in the urine, very slowly, over a long period of time.

When the lead load is sufficient, it causes overt intoxication with widely diffuse manifestations, such as constipation, anemia, kidney problems, vomiting, lethargy, convulsions, coma and, at times, mental retardation and even death. Children with evidence of intoxication must be hospitalized and promptly treated. Currently, efforts are being directed toward early detection of children with increased body lead, but before they demonstrate overt signs of poisoning. It has not been clearly established, but it is possible that long sustained low lead levels may be associated with long term, low grade brain toxicity. Some of the disruptive children in our schools may in fact, be examples of the subclinical effects of lead. These youngsters might have been spared the problems of adjustment that they now experience if they had been identified and promptly removed from their lead containing environment. In addition, they need to be helped with medication to assist in clearing the lead from their tissues to prevent the occurrence of severe toxic manifestations. These aims can be accomplished on an outpatient basis only if these children can be returned to housing that is lead free.

THE SOCIAL ASPECT OF CHILDHOOD LEAD POISONING

The persistence of lead poisoning in pre-school children living in our urban ghettos is one of the most significant indices of how far we still have to go to obtain optimum health for our children. The families of the children at risk are, for the most part, without the financial resources to provide their growing children during, and after conception, with the proper nutrition, housing, and other basic essentials to enable them to develop normally, both physically and mentally. Poverty remains implicated as the major cause of lead poisoning.

When ever we discuss health care in general and lead poisoning in particular, we are obligated to place heavy emphasis on a number of factors that are technically outside of the pure health consideration, but they nevertheless play a significant role in retarding the delivery of acceptable health care. The major cause of lead poisoning in children is inadequate, deteriorating housing which has not been corrected because of lack of funds. The fact is that so long as billions are going into defense when the health of the country requires the reconstruction of our slums, equality for minority groups, and the reconstruction of our economy, lack of "budget" is no excuse for the failure to remedy housing that kills young children and deprives them of their full potential. That this state of affairs continues to exist is but another example of the need to reorder our priorities so that they relate to the needs and concerns of people. The social ramifications of lead poisoning reaches into every aspect of ghetto community life, where the ill effects of poverty and poor housing dominates every phase of daily life.

It is apparent that the problem of lead poisoning reaches into and challenges the functioning of so many of our governmental institutions, and that it must be seen as much more than a medical problem and recognized for the tremendous socioeconomic governmental phenomenon that it is. We have seen sincere efforts made by some of our public health and other governmental officials stymied because of the bureaucracy, low priority and fragmentation of services that result in draining off the gains that could be made toward solving the problem. We must find a way

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to coordinate the efforts being made by various groups and governmental agencies into the effective vehicle that would end the fragmentation that is hurting the efforts of so many. We need the governmental officials, the politicians, the community, and the health agencies to work from an informed coordinated central. base and short of this we will simply continue fragmentation of effort and service by various well-intentioned groups and in the end do very little toward the eradication of lead poisoning.

THE DOLLARS AND "SENSE" COST OF LEAD POISONING

The menace of lead poisoning and its tragic effects on the children of our ghetto communities, is not only a serious medical and social problem, but it is also a very serious economic problem that should be of concern to all. It is often difficult to maintain a high level of interest in a problem that does not affect oneself directly. So it must be made clear that we are all affected, at least financially, by the continued existence of lead poisoning.

The price that we are paying to handle it by current methods may be above and beyond what it would cost to eliminate it at its source. It has been clearly established that old and deteriorating housing conditions where the paint and plaster are peeling from their surfaces, is the source of the lead that poisons and intoxicates the children. If this source were not available, there would be no lead poisoning. It is this fact that makes lead poisoning a completely preventable disease.

That our society continues to tolerate a lethal poison within our midst is a terrible commentary on our order of priorities; a willful disregard for the loss that we all inevitably suffer when potential human resources are unfulfilled, maimed, and rendered dependent on the society.

The present method of treating this illness consists of two parts: firstly, medical treatment that retards the effect of the lead poison; and secondly, the period that the child spends in the hospital after treatment while his home is being repaired. The first process takes about 7 days to complete; the second requires as many as 50 days; which is a total of approximately 57 days that the child may spend in the hospital because of lead poisoning. It should be noted that many children have returned to homes that have not been repaired and have re-ingested the poisoned paint or plaster and have had to be hospitalized again and again.

We know that almost every child that is hospitalized with lead poisoning is eligible for Medicaid. Since hospital rates are frequently in excess of $100.00 per day and the typical hospital stay is 57 days per child, it can cost more than $5, 700.00 per child. Even if the length of the hospital stay is cut in half it would still be over $3,000.00 per child. Repeated admissions, of course, double and triple these figures. These figures must be looked at in relationship to the cost of rehabilitating an apartment which has been estimated by private contractors at approximately $2,000.00 per unit. As has been repeatedly stated above, the only way to insure against lead poisoning and its tragic effect is to remove the poisoned substances from the apartment. When we contrast the cost of $2,000.00 to do this against the $5,700.00 or more per child that can be spent to treat it medically (these figures do not take into account the loss of potential because of the irreversible damage

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to the children and the proportion of deaths that regularly occur) the gross misallocation of resources becomes clear.

Indeed, the figures that we are presenting here suggest that for every child
hospitalized with lead poisoning who stays the time required to have his home
repaired, we are spending enough money to completely renovate 3 apartments.
Here we have only discussed the financial aspect of lead poisoning. We must
also consider the waste of medical and technical staffs which could be devoted to
seeking methods to prevent and treat other illnesses (such as Sickle Cell Anemia).

In lieu of a sweeping new housing construction program, we must focus our energies on the project of rehabilitating effectively those dangerous homes in which our patients and children are forced to live. We must now discuss a serious apartment rehabilitation program that does not suffer from the fragmentation and lack of clarity that is hopelessly apparent in many of the programs presently in operation.

We should also consider the incalculable hardship visited upon the family of those children who are brain damaged. The endless clinic visits; the severe emotional strain of watching a once healthy child now functioning at less than his original capacity and the endless search for special schools that are too few in number to serve the children in need.

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How much talent is wasted because of this absolutely preventable disease. the height of immorality to allow a completely eradicable disease like lead poisoning to exist unchecked within our midst The price is too high and time is running out...

RECOMMENDATIONS

The body of the paper has already expressed our feelings that the priorities of this nation are not geared toward meeting the needs of the larger population. The existence of lead poisoning verifies this statement.

Lead Poisoning is completely preventable and the solution to the lead problem requires only one recommendation which we will state as: The Elimination Of All Substandard Housing In This Country.

There are interim programs to be initiated until the housing goal is completed. The children being treated for Lead Poisoning must not return to a poisoning environment after treatment. An extended care facility is essential if we are to stop the cycle of repeated lead ingestion and poisoning.

Funds must be made available to expand existing programs and to develop adequate community screening programs and concomitant back-up facilities. Appropriation of funds to implement the "Lead -Based Paint Poisoning Prevention Act" (Public Law 91-695) must be immediately accomplished. The cost for hospital care is extremely high. Other sources of funds must be made available to eliminate environmental lead.

There are things each of us can do. If you are a private citizen, you can write
to your legislative leaders and urge them to pass legislation and appropriate funds
to create better housing. If you are a physician or health worker, you can educate

parents and colleagues to the dangers of lead poisoning. If you are the parent of a lead poisoned child you can take all precautions within your home to eliminate or lessen the dangers. Have your children checked at a clinic for lead poisoning. You can join or form a parent's action group to help pressure those who can bring about change. If you are a state or federal legislator you can use all of your power to appropriate the funds needed. If you are the President of this nation you can help change the priorities and use some of this nation's wealth to bring health and equal opportunity to millions of our citizens.

If you want further information as to how you can help, please write or call:
Lead Poisoning Information, Kings County Hospital, 451 Clarkson Ave. Brooklyn,
New York Att: Social Service, Pediatric OPD, Ground Floor, A Building,
IN 2-4000, Ext. 6795, 6793, 6827.

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