Study Finds Lead Testing Insufficient

Only a fraction of the tens of thousands of young children with high levels of lead in their blood are being tested and treated in California, despite the state’s pledge nearly 10 years ago to protect these youngsters from lead poisoning.

A new study to be released today by the Environmental Working Group, a nonprofit research organization, contends that 212,000 children ages 1 through 5 had harmful blood levels of lead between 1992 and 1998. Yet state officials identified and treated fewer than 15,000, or about 7%, according to the report.

In Los Angeles County, the group found that fewer than 9% of 85,421 lead-poisoned children had been identified.

A state health official said that the report distorts the extent of the problem and that in recent years much progress has been made in reducing lead levels in California and the rest of the nation.

But Dr. Susan Cummins, chief of the state’s childhood lead poisoning prevention branch, acknowledged that the state is not nearly as far along as it might be. By her count, about 127,000 young children have elevated lead levels in their blood, and just 18,000, or about 14%, have been identified.

“The reason the program is behind is because it has been underfunded for a very long period of time,” Cummins said.

Funding became sparse in the mid-1990s, when lead-producing companies launched a legal challenge to state-mandated fees for prevention of lead poisoning, she said. The fees ultimately were upheld by the California Supreme Court, but prevention efforts were stalled.

Also delayed were regulations to create a better reporting system that would track all lead test results in young children. These rules still are mired in the approval process.

Another obstacle, Cummins said, is that doctors who treat the impoverished and minority children who are most vulnerable to lead poisoning often have “a thousand other” health problems to deal with and don’t give lead testing the attention it deserves.

“There’s been a huge battle in the pediatric community over this,” said Dr. Mark Miller, who sits on the environmental health committee of the American Academy of Pediatrics. “I think pediatricians want to do the right thing but they haven’t been fully convinced of the priority of doing this testing . . . and they are reluctant to give kids another [needle] poke.”

The environmental group faults physicians for not following through with state-mandated testing of children on Medi-Cal and other publicly funded health care programs. It reserves most of its criticism, however, for the state, calling its performance “abysmal.” In particular, it accuses the state of failing to enforce its testing laws and to implement a reporting system.

Lead poisoning has been linked to neurological and behavioral problems, reduced IQ and dental decay, and is particularly harmful to the developing bodies of young children.

“This tragedy costs the state vast sums for special education, medical care and [eventual] lost earnings for lead-poisoned children,” the report states. “Reducing the average level of lead in California children’s blood by just 10% would save more than $800 million a year.”

Lead poisoning is a complex problem because it sometimes is “silent”--without readily discernible symptoms or with symptoms that can be confused with those of other maladies.

Current research indicates there is no demonstrably safe level of lead exposure, so setting acceptable standards is difficult. And there is so much lead contamination in the environment that officials concede they cannot achieve what would be ideal--eradication.

The populations considered most vulnerable live in economically distressed inner cities or rural areas where there is a significant amount of pre-1950s housing coated in lead paint that is chipping off. In Los Angeles County, for example, critical “hot spots” are in east and south-central Los Angeles and near Long Beach Harbor. But the risk is widespread and includes Santa Monica, the San Fernando Valley, Pasadena and Rosemead as well.

Statewide, hot spots are found in San Francisco, Alameda County, San Diego, Sacramento and Fresno.

California’s uphill battle against lead poisoning is hardly unique. Dr. Herbert Needleman, a professor of psychiatry and pediatrics at the University of Pittsburgh, said that as soon as the federal government--in the early 1990s--stopped advising lead testing for every young child and moved to a policy of targeting high-risk populations, the “steam went out” of the testing and treatment effort nationwide.

“It became a disease of ‘those people, not us’ ” said Needleman, who advised the Environmental Working Group on its report. Politicians perceived lead poisoning as a problem with no constituency, he said, and pediatricians “did not find it an exciting disease.”

Yet California stands out, according to the Environmental Working Group, because of a pledge it made to settle a lawsuit by the NAACP and other civil rights and environmental groups in 1991. At that time, the group contends, state officials promised to overhaul the lead-poisoning prevention program and to test and treat the many thousands of children at high risk.

But “nothing has changed” since then, the report contends.

Cummins does not agree. She says the state has gone from testing 500 children a year in 1991 to more than 250,000 today. It has a plan to target high-risk groups, prevention programs in most public health departments and a training program to guide workers in lead-related construction projects. It is awaiting approval for statewide reporting requirements and launching an education campaign for health care providers.

“Things have changed a lot,” Cummins said. But, she added, “We have a long way to go.”

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Hot Spots for Lead

Between 1992 and 1998, there were an estimated 85,421 children in Los Angeles County with lead poisoning, according to the Environmental Working Group. It says the state identified only 7,296 of those children. Shown below are areas the environmental group highlighted as risky.

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Sources: Environmental Working Group report, based on data from the Centers for Disease Control and Prevention and U.S. Census data.