Status of Lead in Detroit How are the children?', 'Kasserian Ingera?’ All the children are well. Maasai tribe of Kenya and Tanzania  Security and welfare of the children as the foremost symbol of the community’s health. Leseliey R. Welch, MPH, MBA Deputy Director welchl@detroitmi.gov

Every baby is my baby. We in public health often talk about children and families as if they are not us and we are not them. They are us and we are them. If we were conscious of this in all of our work, how would it inform what we do? What we recommend? What we spend? What we risk? All 163,000 kids in Detroit are my kids.

Status of Lead in Detroit What do we know? What are we doing? What do we recommend?

Lead Report 2016 What do we know? Number of children with EBLL in Detroit is going down. (Rigorous analysis shows this is a true decrease.) There is a significant disparity between EBLL among Detroit children and those in other parts of the state. It is mostly a housing problem in Detroit. ( Local public health infrastructure and proactive action is important. Lead Report 2016

Number of children w/EBLL is dropping. The number of children w/elevated blood lead levels (EBLL) in Detroit is dropping. Detroit EBLL have decreased as a result of various efforts: -removal of blighted homes -abatement of homes with lead -continued education and outreach.

Because we tested fewer people? The decrease is not due to reduction in funding and lead testing. Analysis adjusted for the number the number of cases that would have occurred if the number tested remained the same. If the same number of people were tested, the prevalence of EBLL would still be lower. Detroit EBLL have decreased as a result of various efforts: -removal of blighted homes -abatement of homes with lead -continued education and outreach.

Because we tested different people? The decrease is not due to selection of different children for lead testing. Shows that there was no decrease in the proportion of children tested who were on Medicaid between 2009 - 2015. It also shows that the proportion of children on Medicaid coverage who had an EBLL decreased over time. Detroit EBLL have decreased as a result of various efforts: -removal of blighted homes -abatement of homes with lead -continued education and outreach.

Because we tested different people? The decrease is not due to selection of different children for lead testing. Know each area of the city is impacted differently by lead exposure and poisoning. Suggests no substantial change in the proportion of children tested with the highest likelihood of having an EBLL. EBLL in our highest risk zip codes are decreasing. Detroit EBLL have decreased as a result of various efforts: -removal of blighted homes -abatement of homes with lead -continued education and outreach.

We still have a challenge. EBLLS among children in Detroit are still high. Children in Detroit are still 4 times more likely to EBLL than children in the rest of the state. -6.7% of Detroit children screened 2014 had EBLL (SMeyer/MDHHS Data) EBLL found in DHD clinics disproportionately high-more than 50% of 66 children screened by DHD recently had EBLLs. Detroit and Wayne County make up 30% of children tested in Michigan. Need resource allocation to match our need.

Housing & Health Housing is the most common source for lead exposure. 93% of housing in Detroit carries risk for lead. EBLLs impact long-term development. Low exposure linked to behavioral and learning challenges. Link lead exposure and vacant housing, to mental illness and crime.

LEAD SAFE DETROIT What are we doing? Improving local public health infrastructure. Local public health infrastructure and proactive action is important. Lead Safe Detroit School Water Testing Lead Prevention and Intervention Program LEAD SAFE DETROIT

Department Structure & Programs Administration Special Projects Health Policy & Planning Healthy Childhood Healthy Maternity Healthy Places Healthy Lives Violence Prevention Mobile Services Maternal Health - Other Immunizations Lead Women, Infants, Children (WIC) Program Chronic Disease Infectious Disease Environmental Health & Food Safety Public Health Emergency Preparedness Child Health - Other Animal Care & Control

Metrics

Lead Safe Detroit -City Departments Health Building, Safety, Engineering and Environmental Housing and Revitalization Water and Sewerage -Detroit Land Bank -Detroit Building Authority -CLEARCorps -Michigan Department of Health and Human Services Citywide task force on lead to make sure that any children with elevated blood lead levels receive all the services for which they are eligible.

Lead Testing in Schools Urge public schools, charter schools and early childhood facilities – such as day cares, preschools and Head Starts – to test drinking water for the presence of lead. National best practices and recent recommendations of the W.K. Kellogg Foundation. The Children’s Hospital of Michigan Foundation is generously supporting this effort with a $135,000 grant. So far 19 DPS schools have tested positive for high levels of lead or copper.

Health Department Lead Program The mission of the Lead Prevention and Intervention Program is to prevent and treat lead poisoned children and facilitate the reduction of environmental hazards in the home. Education Case Management Investigations and Referrals Lead Screening and Testing Integration into Immunizations and WIC Health Department had not done testing since 2011. Reinitiated in 2016. Have tested 66 children through Immunizations clinic and health fair. Planning integration of lead testing into WIC Clinics. ACKNOWLEDGE TEAMS PRESENT (LEAD, IMMS, WIC INTEG)!

LEAD SCREENING What do we recommend? Number of children with EBLL in Detroit is going down. (Rigorous analysis shows this is a true decrease.) There is a significant disparity between EBLL among Detroit children and those in other parts of the state. It is mostly a housing problem in Detroit. ( Local public health infrastructure and proactive action is important. LEAD SCREENING

Annual Screening Recommend annual screening for all children 9 months – 6 years of age. Order of referral prioritizes medical home as ideal source of care.

Lead Report 2016 Available Online

Leseliey R. Welch, MPH, MBA Deputy Director welchl@detroitmi.gov Thank you! Leseliey R. Welch, MPH, MBA Deputy Director welchl@detroitmi.gov