1. Lead Poisoning Prevention Policy John G. Belt, Ed.S, Chief Field Services Section, Ohio Department of Health

2. Lead is a potent neurotoxin At high levels of exposure there is damage to almost all organs and organ systems, culminating in death at excessive levels. At low levels of exposure there is damage to the central nervous system, IQ reduction, behavioral disorders, increased incidence of ADD, learning and developmental deficits in children

3. Where is it? Lead is widely distributed in the environment Leaded gasoline Lead based Paint Lead in plumbing Lead in foods, candies, cosmetics, pottery, hobbies, work place

4. Why is it in Paint - decreased drying time, durable, moisture Gasoline - engine knock Plumbing - easy to work with, pore structure Foods - candies, cosmetics, pottery, hobbies, work place

5. National Movement on Lead By the 1920 scientific and public awareness of Lead as an occupational and pediatric hazard was increasing. Lead was banned for household paint in the U.S. 1978 Lead was banned as a fuel additive in the United States beginning in 1996 Lead Service lines banned 1986 The Lead and Copper Rule, first issued in 1991

6. High Risk Zip Code Ohio Model Statistical modeling identified the most significant predictors for identification of children at risk for lead poisoning within a census tract. Census tract predictors were then applied to zip codes to identify children risk for lead poisoning based on where they live.

7. Lead Poisoning in Ohio

8. Ohio Elevated Blood Lead Levels 2009-2014

9. Statewide HRZ Codes Testing Rate

10. Medicaid Eligible Children who are Medicaid eligible are determined to be at risk for lead poisoning and must be tested.

11. Statewide Medicaid Testing Rates

12. If a child less than six years of age is determined not to reside in a high risk zip code and is not eligible for the Ohio Medicaid program then the healthcare provider must determine if the child is at risk for lead poisoning by administering the following questions to the parent or guardian of the child. If the answer is “yes” or “do not know” to any of the questions, the child should receive a blood lead test.

13. Outcomes on Lead Hazard Control Orders (LHCO) Issued for ODH Investigations Referred 1/1/2014-12/31/2014

14. Frequency of Identified Sources of Lead Exposure in Risk Assessments Conducted on Investigations Referred 2012-2015 Year2012201320142015 Risk Assessments414352449360 Lead Paint366329403256 Dust263247340199 Soil56709087 Water1101 Cosmetics0211 Food0003 Hobbies0335 Jewelry0001 Occupations24517 Toys1020 Mini Blinds1321 Other125814

15. Lead in Water Because of the end of the pipeline origin of most lead in drinking water, the USEPA regulations dealing with lead contamination in tap water are very different from what is considered protective of children’s health. Parents of children under the age of 6, pregnant and nursing mothers should be aware of this difference when making a decision on the source of their family’s drinking water

16. Lead in Plumbing Lead pipes used for centuries Lead corrodes, deposits scale that lines the pipe Lead scale is composed of a variety of lead Chlorine promotes the deposition of lead (IV) oxide (PbO 2 ), which is highly insoluble Orthophosphate

17. Water System Source: http://www.vox.com/2016/2/19/10972256/the-visual-guide-to-lead-poisoning

18. Corrosion Source: http://www.vox.com/2016/2/19/10972256/the-visual-guide-to-lead-poisoning

19. Lead in Service Lines and Home Source: http://www.vox.com/2016/2/19/10972256/the-visual-guide-to-lead-poisoning

20. All policy is not created equal Statute Rule Agency Program Protocols Model Expert comment Wag the dog

21. Influencing policy Opportunity to set policy Public comment period Expert comment Testifying before legislative bodies, rule making committees

22. Creating Policy Interest groups, HELP, OHHN Business interests Government who enforces the new policy

23. Creating policy a model position policy based on guidelines that were published by a recognized respected body American Public Health Association, American Academy of Pediatrics, etc.

24. Statute Written and enacted by its legislative authority, ratified by the highest executive in the government, and published. Statutes are used to declare policy. Sub. H.B. 248 124th General Assembly

25. Am. Sub. SB 162 LEAD SCREENING In 1994, Ohio passed law requiring licensure of persons performing lead abatement, lead inspections and risk assessments in structures. A structure is defined as any house. Requires lead screening of certain children. Requires laboratory reporting

26. Sub. H.B. 248 Enhanced laboratory reporting, Electronic data. Director shall identify EBLL and issue LHCO Medicaid data sharing requirement

27. Rule A government document that defines and details the implementation of a statute Chapter 3701-30 Lead Poisoning Prevention Program Chapter 3701-32 Lead Hazard Abatement Chapter 3701-82 Training Courses; Licensing; Laboratory

28. Agency OAC Rules Program policy Program protocol

29. Safe Safe is not always protective of health Safe is a relative term when it comes to policy Balancing between industry, interest, and government H 2 0 and Lead ≥15 ppb/15µg/L Lead dust 40µg/dL sq/ft LD50 in pesticides

30. No level of lead in humans has been found to be “safe” Reference value has nothing to with a level at which lead has not effect on the human body Reference value only determines a lead level at which children testing above the reference value have a blood lead level at or greater than 97.5 % of the population CDC’s Stance on BLLs

31. National Health and Nutrition Examination Survey 97.5th Percentile of Blood Lead Levels Used to update the reference value every 4 years Does not represent a blood lead level of government action Confirmation and retesting at this level and above Will be used for determining areas of risk and increased primary prevention

32. Legislative Improvements Expanding age range for public health lead investigations – Current = under six years of age – Recommendation = under eight years of age based on current research and anticipated guidance from CDC Expand enforcement options for noncompliant property owners – Record lead hazard control order on deed – Implement stricter penalties for noncompliant owners

33. Leads dangerous legacy Next steps No safe level of lead in the blood, body Integrated lead level Present dust standards not safe Present H 2 O level not safe How to investigate

34. Questions?