1. Engagement to Decrease Childhood Lead Poisoning: It Takes a Community Stanley J. Schaffer, M.D., M.S. WNY Lead Poisoning Resource Center – Rochester Office Department of Pediatrics University of Rochester

2. Where Are Rochester and Monroe County?

3. The Face of Rochester and Monroe County

4. Monroe County – A Picture of Contrasts
Suburban communities consistently rated among the best places to live in the nation
Yet, the City of Rochester has the 5th highest poverty rate in the U.S.

5. Typical Housing in Rochester

7. Rates of Children with BLLs > 10 mcg/dL in Monroe County, New York State and the U.S. Over Time

8. Factors Contributing to the Successful Lead Poisoning Prevention Efforts in Monroe County
Recognition that lead poisoning is a major problem in the community
Recognition that lead poisoning is a multifaceted problem intersecting health, housing and education and requiring a wide-ranging set of interventions
Establishment of the local lead coalition
Engagement of multiple stakeholders in the community
Extensive efforts to increase awareness among the general public
Collaboration between all levels of government and willingness of local government to mandate that rental properties be lead-safe
A willingness by everyone to recognize that ‘it is not someone else’s problem’ and that lead poisoning has significant societal costs borne by all
Recognition of the importance of having efforts driven by data

9. Recognition of the Problem of Lead Poisoning
Play the beginning and then from 5:00 to 8:33

10. Our Lead Problem in Rochester & Monroe County
The Situation in the Year 2000:
2% of U.S. children tested have BLLs > 10 mcg/dL
5% of NYS children tested have BLLs > 10 mcg/dL
7.4% of Monroe County tested children have BLLs > 10 mcg/dL
25% of children in high risk areas of Rochester have BLLs > 10 mcg/dL
In some neighborhoods in Rochester > 30% of children have BLLs > 10 mcg/dL

11. Factors Contributing to Lead Poisoning in Rochester
Old housing stock
High poverty rate
Low property values (mean $53,000) in much of the city
High rates of rental housing in poor neighborhoods (~85%)
Highly mobile impoverished population with few resources

12. Rochester’s Coalition to Prevent Lead Poisoning
Established in 2000
Monthly Standing Committee Meetings:
Government Relations Committee
Screening & Professional Education Committee

13. Organizations Having Ongoing Collaboration With the Coalition to Prevent Lead Poisoning
roberts
communications
Western New York Lead Poisoning Resource Center – Rochester Office

14. Rejection of Silos
Since lead poisoning is a problem that crosses disciplines affecting
health, education, housing and the criminal justice system,
it is not someone else’s problem; it’s everyone’s problem.

15. Efforts to Increase Awareness Among the General Public
Newspaper articles
Ads in publications, billboards
TV and radio shows
Pamphlets (in 8 languages)
Neighborhood outreach
DVDs available at libraries
Web page (letsmakeleadhistory.org)

16. Efforts to Increase Testing

17. Efforts by the City of Rochester to Address Lead Poisoning
Dedicated phone line to handle lead poisoning issues (as well as 3-1-1)
Availability of free visual home inspections
Development of the municipal lead law
Financial assistance for homeowners to address lead hazards

18. Rochester’s Efforts to Establish a Lead Law
2005 Amendment to Municipal Property Maintenance Code
Added lead to “Certificate of Occupancy” inspection requirements
Applied to pre-1978 rental housing
Law went into effect on July 1, 2006
Targeted “high risk” housing

19. Details of Rochester’s Housing Law
Visual inspection of all rental properties prior to Certificate of Occupancy being issued (now on a 3 year cycle for all rental properties)
Presumption that deteriorated paint = lead paint
Dust wipes in “high risk areas” if they PASS visual inspection
All violations must be addressed
Requires mitigation NOT removal of lead
Workers must have lead safe work practices training (owners may do work themselves)
Clearance testing by a certified private firm prior to C of O issuance

20. Impact of Rochester’s Lead Law
Implementation Costs
15,000 rental units inspected yearly at a total cost of $600,000 ($40/unit)
8% of units fail the inspection
Average cost of $420 to identify each hazardous home
Median Cost of Repairs if Lead Hazards Identified
$300 - $1,200 with higher costs in lower value properties
Many landlords are replacing windows
Repairs often enhance value of the property
Additional Benefits
Landlords are becoming more proactive in maintaining their properties and are making improvements prior to inspection

21. # (%) Failing Inspection
Results of 8 Year Review of Rochester’s Lead-Based Paint Poisoning Ordinance
# of Inspections
# (%) Failing Inspection
Exterior Visual Inspections (Structures)
73,534
9,987 (14%)
Interior Visual Inspections (Units)
115,634
5,804 (5%)
Interior Dust Wipe Testing (Units)
29,330
3,182 (11%)
Vacate orders for units with severe interior deteriorated paint or dust lead hazard – 515 issued in 8 years
Citations for non-compliance of lead ordinance violations – 1,880

22. Application of Rochester’s Lead Law in Other Communities
Based on the Rochester experience, other cities have adopted or are in the process of adopting similar ordinances:
Toledo, Ohio
Cleveland, Ohio
Utica, New York
Seattle, Washington

23. Efforts by the Monroe County Department of Public Health to Address Lead Poisoning
Data collection and dissemination to help target interventions
Primary prevention grants
Environmental inspections at lower thresholds than are required by NYSDOH
Close collaboration with CPLP, City of Rochester, insurers, health systems, WNY Lead Poisoning Resource Center and others in efforts to increase blood lead testing rates among children
Offers free training for remodelers and renovators wishing to become EPA lead certified

24. Data Collection and Dissemination by MCDPH

25. Impact of Having Timely Data
Able to discern trends over time and to announce results to the media
Able to break out incidence rates for EBLLs by age categories and zip codes
Able to determine when testing fell off among city and suburban children
Able to determine that testing rates for 2 year olds were much lower than testing rates for 1 year olds

26. Monroe County DPH Environmental Inspections
Results of inspections shared with City of Rochester Housing Bureau
MCDPH initiated environmental inspections for venous BLLs > 15 mcg/dL (NYS threshold was 20 mcg/dL until 2009)
MCDPH received NYSDOH primary prevention grant to do risk assessment to identify environmental hazards in homes with children who have BLLs < 15 mcg/dL, pregnant women and newly arriving refugees
2009 – MCDPH initiates routine environmental inspections of homes of children with venous BLLs > 10 mcg/dL
data show that a lead hazard was identified in 80% of cases where homes were inspected as a result of BLLs of mcg/dL
2013 – MCDPH initiates routine environmental inspections of homes of children with venous BLLs > 8 mcg/dL and offers inspections to City of Rochester residents whose children have venous BLLs > 5 mcg/dL

27. Rates of Children with BLLs > 10 mcg/dL in Monroe County, New York State and the U.S. Over Time
MCDPH gets a HUD grant for lead hazard control efforts
CPLP established and major media campaign started
MCDPH lowers threshold for home inspections to 15 mcg/dL
City of Rochester adopts lead ordinance
MCDPH lowers threshold for inspections to 10 mcg/dL

28. National Recognition for Local Efforts

29. The Future Sustain progress Avoid declaring victory too soon
Increase collaboration with school districts to identify children with a history of lead exposure who may be at risk for learning problems
Increase outreach to refugee populations and pregnant women

30. Lessons Learned Benefits of community approach
AMERICA’S HEALTHIEST CITIES
Benefits of community approach
Dual emphasis on primary and secondary prevention
Collaboration of multiple entities toward achieving a common goal
Rank
LARGE CITIES IN AMERICA 1
San Jose-Sunnyvale-Santa Clara, CA 2
Washington-Arlington-Alexandria, DC area 3
San Francisco-Oakland-Fremont, CA 4
Minneapolis-St. Paul-Bloomington, MN-WI 5
Charlotte-Gastonia-Concord, NC-SC 6
Raleigh-Cary, NC 7
Salt Lake City, UT 8
Rochester, NY 9
San Diego-Carlsbad-San Marcos, CA 10
Austin-Round Rock, TX
Gallup-Healthways Well-Being Index, January-February 2011

31. Our Common Goal