Find It Fix It Fund It · 2017. 11. 10. · • 2016 –Declaration on Flint from LEHA, Grantees...

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Find It, Fix It, Fund It & Recent Efforts to Eliminate Childhood Lead Poisoning

David E. Jacobs, PhD, CIH

2017 New England Lead Conference

Nov 1, 2017 Nashua New Hampshire

Find It Fix It Fund It

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Number of Lead Poisoned ChildrenUsing Historical Blood Lead Values

• Late 1970’s 3‐4 Million

• Late 1980’s 1.7 Million

• Early 1990’s 890,000

• 1999‐2002 310,000

• 2007‐2008 250,000

• 2012 530,000 (ref value)

Source: Centers for Disease Control and Prevention

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U.S. Policies vs. Children’s Average Blood Lead Levels

0.016 µg/dL

Source:Smith, D. R., Flegal, A. R. (1992, November). The public health implications of humans’ natural levels of lead. American Journal of Public Health, 82(11), 1565‐1566.

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1991

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Lead PoisoningAustralia, Late 1800’s

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• 2012 – Declaration of the Lead and Environmental Hazards Association and the National Association of Lead and Healthy Homes Grantees

• 2016 – Declaration on Flint from LEHA, Grantees and the National Safe and Healthy Housing Coalition

• 2016 – Launch of Find It Fix It Fund It Campaign

• 2016 – Environmental Defense Fund Messaging Meeting

• 2016 – Lead Strategies (Earthjustice, GHHI, FFF, etc) Released

• 2016 – National Lead Summit

• 2017 – American Academy of Pediatrics Statement

• 2017 – Testimony to EPA and HUD on Lead Regulations

• 2017 – Letters to Congress on Appropriations

• 2017 – 10 Policies to Respond to Childhood Lead Poisoning – Pew Report

A Few Recent Actions on Lead Poisoning Prevention

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Overall Strategy

•Locate exactly where lead problems are

•Take action to eliminate those problems using proven methods

•Raise the necessary human and financial resources to get the job done

Goals

• All our children should be healthy, able to learn, and grow into productive adults, but lead poisoning damages children’s brains.

• We can and should address this problem within five years by eliminating lead exposures from housing, water, consumer products, and other sources.

• We should also help children already exposed by providing follow‐up services.

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Who is in the Campaign

• Parents of children with elevated blood‐lead levels

• Housing agencies, organizations, and associations

• Clean drinking water advocates and practitioners

• Public health officials, agencies, organizations, and associations

• Community‐based organizations

• Academics and researchers

• Pediatricians and pediatric clinics and associations

• Children’s advocates

• Legal advocates for disadvantaged families and communities

• Environmental and environmental justice organizations

• Philanthropists

• Policymakers

• Antipoverty budget advocates

• Businesses and business associations

• Labor Civil rights organizations

• Artists Teachers and educational organizations

Benefits

• Enables children to perform well at school and succeed in life

• Cuts public health costs• Improves property value• Can help reduce crime, because lead exposure is linked to adverse behavior later in life

• Provides 75,000 – 150,000 jobs• Enables surveillance of exposed children in all 50 states and all rural, suburban, and urban areas

• Connects families to the services their children need

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Recommendations should be tailored by audience, capacity, and interest

• About 50 recommendations for local, state, and national policymakers, and citizens

• Recommendations are organized into four areas: Finding and Eliminating Exposures; Surveillance and Follow‐up of Poisoned Children; Financing; and Infrastructure and Jobs

• Recommendations were developed by consensus and intended to stimulate actions

Key Recommendations 1

• Provide incentives and requirements to locate lead problems in homes, schools, and areas frequented by children

• Increase inspections and risk assessment.

• Examples include tax credits, underwriting standards for mortgage institutions like Fannie, Freddie, FHA, appropriations, and philanthropic contributions.

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Key Recommendations 2• Make lead hazard control part of infrastructure improvements.

• We think infrastructure and federally guaranteed mortgages should be used to make our homes safe for our children. Indeed, we have “shared” our homes with guests and friends and, of course, our families. This “shared” lead has poisoned millions of our children, sometimes poisoning one child after another.

Infrastructure and Mortgages: What about the Kids?by David Jacobs and Anita Weinberg

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What Is Infrastructure?

• Traditionally, infrastructure spending only goes for roads and bridges and the basic equipment and structures that are needed for a country to function properly.

• But many are surprised to learn that the lead services lines bringing water into their homes are NOT part of the “infrastructure” and that the burden was on families to replace them.

• They are also surprised that home inspections required by mortgage companies do not (usually) include lead inspections.


• Replace all single pane windows in pre‐1960 housing (windows have the highest levels of paint and contaminated dust).

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CLEAR WIN (n=95 houses)

0

20

40

60

80

100

120

Floors Sills Wells

Percent Reduction in Lead Dust One Year After Window Replacement (all p<0.001)

Percent Reduction in LeadDust One Year AfterWindow Replacement

Clear Win Job CreationPeoria Chicago ClearWin Total

Replacement Windows 2316 5431 7747

Assembly hrs (1.333) 3,088 7,241 10,329

R‐5 additional hours (0.3125) 724 1,697 2,421

Indirect labor hours (0.3) 695 1,629 2,324

Total Manufacturing Hours 4,507 10,568 15,074

FTE Jobs 2.25 5.28 7.54

FTE Jobs/Program Year 1.13 2.64 3.77

Window Installation hrs (3.5) 8,106 19,009 27,115

Additional hours 70 1,325 1,395

Total Installation hours 8,176 20,334 28,509

FTE Jobs 4.09 10.17 14.25


FTE Jobs 2.10 3.94 6.03


FTE Jobs 8.44 19.39 27.82


On Site

Installation

and

Contracting

Local

Administration

ClearWin

Total

Table 13: Direct and Indirect Job Creation

Window

Manufacturing

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Costs & BenefitsHealth benefits Limited in this analysis to lost lifetime earnings due to reduced IQ

Table 7. ClearWin Costs and Benefits in Peoria and Chicago (n=466 units)

ClearWin Long Term Monetized Benefits Total

Installed Window Cost (A)* $3,071,841

Number of Windows replaced 7747

Long Term Energy Benefit $1,529,974

Other Market (Home Resale) Value $770,885

Total Market & Energy Value at $297/window (B) $2,300,859

Housing built before 1940 (health benefit= $24,571 per child) $3,341,656

Housing built 1940‐1959 (health benefit= $10,068 per child) $251,700

Housing built 1960‐79 (health benefit= $2,572 per child) $18,004

Total Monetized Health Benefit (C) $3,611,360

Administrative Cost (D)* $380,000

Total Benefits (B + C) $5,912,219

Total Costs (A + D)* $3,451,841

Net Benefits (B + C ‐ A ‐ D) $2,460,378


• Update all standards and laws to reflect the latest research, especially the EPA lead dust standard and EPA water regulations.

• Eliminate the loopholes in the lead disclosure law; require an inspection

• The Section 8 voucher program requires only a visual assessment instead of actual lead measurements

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• Optimize water corrosion control and begin to eliminate all lead water pipes – Madison, Minneapolis, others.

• If a poisoned child is identified, ensure that their home is inspected and remediated before another child is harmed.

• If the child is in an apartment building, ensure all similar apartments with children are inspected and remediated.

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Read the report at www.pewtrusts.org/lead

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• Includes the most recently data on blood lead levels 2011‐2014 National Health and Nutrition Examination Survey

• Updated IQ/blood lead effect sizes from the literature

• Measures an intervention for a single future birth cohort 4 million children in 2018

Comparison to Previous Cost-Benefit Analyses

• Hypothetical “all blood lead levels at zero”o Most gains are for children with blood lead levels under 2 ug/dLo Benefits are mainly derived from increased earnings, resulting from higher IQs

• Modeled four primary prevention policies• Lead‐paint hazard control, lead service line replacement, enforcement of EPA’s

renovation rule, and removal of lead from aircraft fuel

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Water • Reduce lead in drinking water in homes built before1986 and other places children frequent.

Paint• Remove lead paint hazards from low-income housing built before 1960 and other places children spend time. •3. Increase enforcement of the federal renovation, repair, and painting rule.

Other Sources

• 4. Reduce lead in food and consumer products. • 5. Reduce air lead emissions. • 6. Clean up contaminated soil.

Screening & Follow-Up

•7. Improve blood lead testing.•8. Ensure access to developmental and neuropsychological assessments and high quality education & care programs.

Data & Research

• 9. Improve public access to local data.• 10. Fill gaps in research.

10 Best Bets

Do Benefits Justify Costs?

The standard criterion for deciding whether a government program can be justified economically is the discounted monetized value of expected return on investment (ROI).

Assign monetary values to benefits and costs, discounting future benefits and costs using an appropriate discount rate (3% or 7%), and subtracting discounted costs from discounted benefits.

Programs with positive net present value (NPV) increase social resources and are generally preferred.

Programs with negative net present value should generally be avoided.

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Examples: General Recommendation & Specific Tactics

Replace lead contaminated windows

Inspect homes – Disclosure

Financing remediation – Tax credits, grants, mortgage, others

Medicaid waivers

Updated standards

Codes & Renovation Repair and Painting Rule Enforcement

Benefits Likely Underestimated

Intangible Benefits (e.g. stress on parents and children, avoided lead paint litigation, special property maintenance, premature mortality from lead exposure in childhood, premature memory loss, treatment of dental caries associated with lead exposure, liver, kidney and other diseases associated with lead exposure, lead‐associated criminal behavior costs beyond juvenile delinquency)

Discount Rate – Do We Invest in Children?

Children born in 2018 and some who move into remediated homes

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Policy In Action: City of Rochester Lead Ordinance Highlights

• Adopted in December 2005

• Proactive visual assessment & lead dust wipe testing

• Approximately 14,000 units visually inspected each year through the Certificate of Occupancy

• All rentals must have their Certificates renewed every three or six years

• All Enforcement Officers are cross‐trained to perform new and existing building inspections and lead dust wipe testing

• Number of resident children at or above 10 ug/dL have been reduced by more than 82% since 2005

Rochester Blood Lead Levels

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Any property built before 1978 and occupied by a child under 6 must be “deleaded” by removing or covering lead paint hazards.

Homeowners cost for abating lead hazards (including replacement of windows) mitigated though income tax credits of $500 to $1,500

Surcharges of $25 to $100 on certain professional licenses = $2.5 million annually for the Lead Education and Training Trust Account

In 2016, just 686 children under age 6 had blood lead levels of 10 μg/dL or greater down from 3,095 children in 2001

Policy In Action: Massachusetts (1971)

Many More Policies in Action

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“Until effective standards for the domestic environment are devised, it is likely that children will continue to be employed as biological indicators of substandard housing.”

Donald Barltrop, 1974

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National Safe and Healthy Housing Coalition http://www.nchh.org/Policy/National-Safe-and-Healthy-Housing-Coalition.aspx

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www.nchh.org @NCHH facebook.com/HealthyHousing

Find It Fix It Fund It · 2017. 11. 10. · • 2016 –Declaration on Flint from LEHA, Grantees...

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