Preventing Lead Poisoning in Young Children: Chapter 5

• Table of Contents
• Chapter 1. Introduction
• Chapter 2. Background
• Chapter 3. Sources and Pathways of Lead Exposure
• Chapter 4. The Role of the Pediatric Health-Care Provider
• Chapter 5. The Role of State and Local Public Agencies
  • Public Health Agencies
  • Housing Agencies
  • Environmental Agencies
• Chapter 6. Screening
• Chapter 7. Diagnostic Evaluation and Medical Management of Children with Blood Lead Levels > or = to 20 µg/dL
• Chapter 8. Management of Lead Hazards in the Environment of the Individual Child
• Chapter 9. Management of Lead Hazards in the Community
• Appendix I. Capillary Sampling Protocol
• Appendix II. Summary for the Pediatric Health-Care Provider
• Tables
• Figures

Chapter 5. The Role of State and Local Public Agencies

A variety of local, state and federal agencies play a role in preventing childhood lead poisoning. Pediatric health-care providers and parents should know about what these agencies do so that they can use these resources effectively. In turn, these agencies must coordinate their activities to ensure that all aspects of childhood lead poisoning prevention—health, housing, and environment—are being addressed, and to provide the most comprehensive and cost effective services to at-risk children, their parents, and their health-care providers.

Government operations vary widely from state to state. In some states, city or local government takes the leading role in providing Public Health Services such as lead poisoning prevention. In other states, county or state agencies take the lead role. Similarly, housing and environmental agencies with responsibility for addressing lead hazards may exist at the local, county, or state level.

Public Health Agencies

In most cities and some towns, counties, and states, lead poisoning prevention programs are included within the public health department or agency. Traditionally, these programs have focused on screening for lead poisoning and ensuring medical or environmental followup for children identified as being poisoned. Many also undertake public education activities, but, historically, lack of resources has limited these agencies' ability to focus on primary prevention.

A comprehensive, multifaceted approach to preventing childhood lead poisoning would include screening and surveillance, risk identification, primary prevention activities, interagency coordination, and services for poisoned children.

Screening

As explained in Chapter 6, screening children for lead poisoning is important both to identify poisoned children and to provide data that can be used to target communitywide interventions. Public health agencies should have the primary responsibility for ensuring that children receive necessary blood lead screening. While it is not realistic for public agencies to actually perform most of the required screening, these agencies must work with individual and institutional pediatric health care providers to ensure that the private sector provides as much screening as possible. Screening by public agencies should focus on children who would not otherwise receive it in the private sector.

Surveillance and Risk Assessment

Before a public health agency can design and implement a primary prevention plan, the agency must assess the sources of lead in the community, exposure patterns, and high-risk populations. The lead public health agency should generally take responsibility for the types of risk assessment activities described in Chapter 9, soliciting cooperation and assistance from housing and environmental agencies when appropriate. As explained in Chapter 9, blood lead screening provides data for assessing the extent and nature of a given community's lead problem. Public health agencies should also take the lead in conducting or coordinating the collection of the environmental, housing, and demographic data needed to undertake a community-based risk assessment.

Primary Prevention

One of the most important themes of this document is the need to identify and remove sources of exposure to lead before children are harmed, that is, the need for primary prevention. Public health agencies must take a leading role in designing and implementing primary prevention programs. One important activity for public health agencies is to use the data collected from screening and surveillance to develop a primary prevention plan designed to target resources to the most pervasive sources and the highest risk populations.

Interagency Coordination

Public health agencies cannot be expected to implement primary prevention activities by themselves. Many steps that must be taken lie within the expertise or jurisdiction of other government agencies, especially those dealing with housing or the environment. To prevent lead poisoning, all public agencies with a connection to this problem need to be enlisted in the effort. The activities of different types of agencies at different levels of government must be coordinated, preferably through formal arrangements under which the different agencies meet and consult. Public health agencies should take the lead in organizing interagency task forces or committees and in ensuring that all involved agencies communicate regularly.

Providing Services to Poisoned Children

Public health agencies have traditionally been responsible for ensuring that lead-poisoned children receive appropriate medical and environmental followup, often through a formal case-management system. Until lead poisoning has successfully been eradicated, public health agencies will have to devote much of their lead-poisoning prevention resources to case management services for poisoned children.

Housing Agencies

Most states, and some cities and counties, have agencies with the responsibility for regulating housing quality or developing policies to ensure that people are provided with safe and affordable housing. As the focus shifts from severely poisoned children to lead hazards in children's environments, the role of housing agencies will expand. A comprehensive, multifaceted role for housing agencies would include providing services to poisoned children; enforcing housing codes; educating the public; and making regulations and policies to increase the number of safe and effective abatements.

Environmental Agencies

Most states, and some cities and counties, have agencies responsible for regulating exposures to toxic substances in the environment. Traditionally, such agencies have dealt with exposure to lead in the air, in drinking water, and in hazardous and solid waste, but have had little or no role in addressing the hazards associated with lead in paint. Some environmental agencies have begun to address the problems of toxic substances in housing, such as asbestos and radon, and they may also be willing to join an interagency effort to reduce exposure to lead hazards in housing. A comprehensive, multifaceted role for environmental agencies would include participation in interagency efforts, multimedia lead hazard reduction programs, monitoring, and regulation.