Some People’s Water Crises Are More Urgent Than Others

October 3, 2016

A public epidemic has become public knowledge, thanks, in a manner of speaking, to egregious negligence by Michigan state and local Flint officials.

We’ve learned that millions of children are at risk of lead poisoning — or already have it. Undoubtedly adults too. And they can suffer a wide range of harms. But such research as we have focuses on young children because they’re at highest risk for lifelong damages.

So what then have our federal policymakers done since all this became common knowledge?

The U.S. Department of Housing and Urban Development has taken a first step toward strengthening protections against the most common sources of lead poisoning — old house paint and the soil around housing.

But I’ll defer that and focus here on water because it’s been made newly newsworthy by a cliffhanger we may see again.

The administration sent water, filters, funds and folks to Flint shortly after Michigan’s governor declared a state of emergency. But there are still reportedly problems with the water there. And they’ll cost many millions of dollars to fix.

Flint is hardly the only community with lead in the water that comes out of faucets in homes and schools. And, as with Flint, dumping some chemicals into the water supply won’t solve the problem. Lead pipes corrode and have to be replaced.

USA Today reports nearly 2,000 other water systems with higher lead levels than the maximum the Environmental Protection Agency has set as a trigger for action. They’re in all 50 states, it says.

In the District of Columbia too, it seems, though our big lead-in-the-water crisis supposedly ended in 2005 — not, however, because the District no longer has lead pipes. And not apparently because the chemicals added to the water protect us.

The agency responsible for public buildings recently found that over half the public school water systems it tested had lead levels higher than the EPA trigger.

That’s three times higher than what the Centers for Disease Control now says should trigger public health actions. So we’ve had a child health emergency for some time.

The Senate recently approved $220 million to address leaded water problems — this by an overwhelming majority. About $100 million would go to states with drinking water emergencies.

They’d get an additional $70 million to subsidize (not by much) loans for related infrastructure projects. Another $50 million would be divvied up among small, economically disadvantaged communities to help them comply with existing drinking water standards.

This much is fully offset in the much larger water resources development bill. The substantial investments needed to remedy water infrastructure problems would hinge on the outcomes of the annual budget process.

Leading Senate Democrats wanted the paid-for piece included in the continuing resolution needed to prevent a government shutdown. The Republican leadership would have none of it, though it included more than twice as much to aid recently-flooded communities, mainly in Louisiana.

A stalemate then because not enough Democrats would agree to vote on the CR unless it did something about both water crises. And the House couldn’t pass a CR without Democrats because too many Republicans there object to such a short-term stopgap.

A compromise forged by the House Speaker and Democratic Minority Leader averted this different sort of crisis. Seems that impending government shutdowns, like hangings, concentrate the mind wonderfully.

Basically, they agreed to amend the House version of the water resources bill. It had no funds for Flint or any other community whose residents, the youngest especially, are at risk of lead poisoning.

The amended bill, also passed by a large majority, would add $170 million. So there may be some money in the pipeline for some communities with lead in their water pipelines in the upcoming year.

But the $50 million difference in emergency spending is only one of many differences between the House and Senate bills. So negotiators will have a lot of work to do. And whatever they come up with will, of course, have to pass in both the House and Senate.

No such delay or doubts for the flooded communities, however, because their half million is in the CR. Some people’s water crises are more urgent than others.

Now, if lead-laden water had been flowing into members’ own homes — or out of the drinking fountains in their children’s schools ….


Progress Perhaps, But a Long Way to Go Before Every Kid Healthy

April 18, 2016

This is Every Kid Healthy Week, invented to celebrate what schools are doing to turn out healthy kids. Would that every kid were healthy — or even that schools could make them all so.

Not saying schools can’t do a lot, mind you. They can, for example, schedule daily physical activities and offer after-school and summer sports programs.

They can include nutrition in their curricula and get kids interested in healthful foods, e.g., by having gardens where they can plant and tend vegetables. And they can, of course, serve nutritious meals, even if Congress lets them off the hook somewhat.

They can also, in many cases, help ensure that kids who need those meals most actually get them by taking advantage of a new option called community eligibility. And a growing number of schools are.

That’s the good news. The bad news, also delivered shortly before this celebratory week, is that many children with dangerously high levels of lead in their blood are more likely to suffer toxic effects because they don’t get enough of the right kinds of things to eat. And no real news, alas, from Congress.

Free School Meals for More Poor Kids

Schools ordinarily require parents to apply for free or reduced-price meals for their children — and to reapply every year. This, needless to say, is a barrier, especially for parents who don’t read well and/or fear scrutiny by bureaucrats.

Schools must bypass this process for children whose families receive SNAP (food stamp) benefits. They may also directly certify children who receive certain other federal benefits, e.g., Temporary Assistance for Needy Families.

They can do this, however, only if their computer system links to systems in other agencies and can perform data matches. For this and perhaps other reasons, they missed well over one in five eligible children in 2013-14, the latest year we have figures for.

The newest version of the Child Nutrition Act gives some schools another option that eliminates not only the application and technology barriers, but another — the stigma low-income children feel if they go to the cafeteria.

Schools with at least 40% of children who automatically qualify for free school meals may opt for community eligibility. In other words, they can expand eligibility for free school meals to the entire student community.

Last year was only the second that all high-poverty schools could seize this opportunity. More did, the Center on Budget and Policy Priorities and the Food Research and Action Center report.

Just over half of all schools that could had adopted community eligibility by the end of the school year. A lot of variation, as one might guess.

The District of Columbia reached 87%, second only to North Dakota. Less than a quarter of high-poverty schools in 10 states were adopters. But almost all states had more schools participating than during the first year when what had been a pilot program became an option nationwide.

Higher Lead Poisoning Risks Due to Poor Nutrition

We’re all familiar now with exposure to lead poisoning — from water, as in Flint, Michigan, which put the problem on the public radar screen, and from other sources, e.g., paint, contaminated soil.

And we’re familiar with the lifelong damages that lead in the body can cause, especially in young children, and with the fact that alarming numbers of those tested have dangerously high levels of lead in their blood.

These children are only the tip of the iceberg because states don’t test all children for lead poisoning — even apparently all children at high risk. But what we do know indicates that it’s far more common among children in high-poverty communities — presumably then among poor and near-poor children.

Certain vitamins and minerals can reduce lead absorption and/or the toxic effects of lead absorbed. So a well-balanced diet does even more for children’s health than what’s commonly said.

Looked at the other way, children at high risk of lead exposure are also at higher risk for harmful health effects because the foods they’re served at home are less likely to deliver enough of the protective nutrients.

The Urban Institute tries to show an actual link by focusing on a subset of high-poverty counties — those that tested at least 1,000 children and found at least 5% with blood lead levels over the Center for Disease Control’s high-risk threshold.

The five with the highest test results also had child food insecurity rates above the very high national average, it reports. Most of the rest of the counties it sampled had higher than average rates too.

So, wrapping back around, high-poverty schools have an extra incentive, were one needed, to opt for community eligibility.

What Only Congress Can Do, But Isn’t

Community eligibility can do only so much. Many low-income children are too young for even kindergarten, of course. They’ll need well-balanced meals and snacks in daycare programs.

School-age children will need the same during summer months, when their families now often have to stretch their too-low SNAP benefits to feed them as many as 10 extra meals a week.

The Urban Institute draws the connection. Only Congress can expand and strengthen the programs that are supposed to prevent hunger and malnutrition among low-income children.

It’s again let the umbrella for these programs — the Child Nutrition Act — expire, though it’s given the current law a brief extension.

The Senate has had a pretty good bill to reauthorize the CNA pending since late January. But the Majority Leader seems more preoccupied with the Supreme Court vacancy — and with proving that he and his Republican colleagues can get something done.

Don’t even look to the House, which is apparently looking to the Senate to pass its version of the CNA. It will, of course, have to vote on a bill sooner or later.

Seems that action there could, among other things, roll back progress on community eligibility, since the draft committee bill would raise the opt-in threshold to 60% of poor and near-poor students.

Action to help Flint get the lead out of its water — and to prevent more such crises — seems stalled too, by one lone Senator, who asserts that Michigan has plenty of money.

No concern about lead poisoning elsewhere, but rather that his colleagues would just “funnel taxpayer money to their own home states,” as if they don’t have corroding lead water pipes too.

More concern on the part of the Majority Leader to protect a dubious Senate custom than endangered children, it seemsĀ  — or perhaps more to prevent another intra-party rift.

Too soon to say how any of this will ultimately pan out. But it’s clear that Every Kid Healthy Week is a bittersweet occasion.

 


What Federal Policymakers Have Done and Can Do About Lead Poisoning … And What We Can Do to Prod Them

March 17, 2016

Picking up where I left off. As I said, the Flint water crisis in some ways unusual, in others not. Higher percents of young children have dangerously high blood lead levels in other poor communities for example.

And these are only children who’ve been tested — some unknown fraction. Not because the irreversible damages lead in the blood can cause have only recently been known. Not because the federal government has done nothing but compile data.

It hasn’t done all it can to protect children (and adults) from lead poisoning, however. In fact, some recent decisions have probably made matters worse.

Congress could partly undo the damage, without first resolving the conflicts holding up action on next year’s budget. And with or without Congress, the administration could increase protection for millions of low-income families.

What the Federal Government Has Done (and Not)

Lead was recognized as a health hazard a long time ago. The federal government seems to have become energized in the 1970s — hence the leaded-paint ban I mentioned, plus related provisions in the Toxic Substances Control Act and the Safe Water Drinking Act.

Federal rules have required blood lead level tests and followup care for young children in Medicaid since 1989 — rules never effectively enforced, however. Congress mandated the phase-out of lead in gasoline a year later, setting 1996 as the deadline.

Congress acted again in 1992, requiring the U.S. Department of Housing and Urban Development to issue rules protecting some tenants and homeowners against leaded paint hazards.

Both the first version and the latest, issued in 1999, apply to federally-assisted housing of various sorts built before 1978, including public housing and housing subsidized by Housing Choice (formerly Section 8) vouchers.

The rules, among many things, require “environmental intervention” when a single test finds 20 micrograms of lead per deciliter of blood in children under six. The intervention trigger is just a tad lower if multiple tests are conducted.

We’ve learned more about levels of lead in blood since then. Heeding the research, the Centers for Disease Control twice ratcheted down its high-risk threshold. It’s been 5 micrograms per deciliter since 2012.

But HUD’s standard remains the same. And the trigger for action, as you can see, is damage already done. Young children are like the canaries coal miners once used to alert them to hazardous gases — by keeling over.

Squeeze on Targeted Lead Poisoning Prevention Funds

You’ll recall perhaps that Congress capped spending on programs that depend on its annual choices about a year before CDC last cut its lead blood level threshold in half.

Two programs that help fund lead poisoning prevention have gotten whacked far more than the caps themselves required, as the Coalition on Human Needs reports. One is now worth 28.6% less in real dollars than the year before Congress set the caps. The other, focused specifically on children has lost 55.6%.

What will happen for the upcoming fiscal year is anybody’s guess, since neither the House nor Senate has even set spending targets for the subcommittees that develop program-specific budget proposals.

What Congress Could Do Now

Congress doesn’t have to wait until Republican leaders resolve conflicts and the subcommittees do their work. It could act swiftly to channel some money to Flint and other communities with lead in their water. Because others there are, though we don’t know how many.

A bill awaiting action in the Senate (how often do I have to write this?) would provide $170 million to support urgently needed water infrastructure improvements, plus $17.5 million to monitor lead exposure and alert the public if excessive levels are found.

An additional $30 million would supplement funding for three programs to help prevent toxic lead exposure, with a special focus on pregnant women, mothers and their children.

The money wouldn’t restore what the two I mentioned have lost since 2010. Nor the third, which funds health-related screenings as one of many services for low-income pregnant women, babies and their mothers.

But “Congress has a lot of catching up to do,” as CHN’s monthly report says. So one can hope — if one’s still capable of that these days — that more Senators will sign on to the bill and press Majority Leader Mitch McConnell for a vote.

Meanwhile, Democrats in both the House and Senate have introduced bills that would require HUD to use CDC’s blood lead level maximum as its trigger for intervention.

They would also require HUD to strengthen its risk assessment standards, which now permit just a look around the place and altogether exempt efficiency units, even if small children live there — or will.

And they’d require HUD to make it possible for a family with a young child in a subsidized housing unit to move immediately if a lead hazard is found — and the hazard has already put the child at high risk. Why HUD wouldn’t have to swift children with less lead in their blood to safety I don’t know.

HUD may have to update its rules anyway. The Shriver Center, the Health Justice Project at Loyola University Chicago and nearly 30 allies have filed a petition calling on the agency to do so. Their proposals generally resemble what the House and Senate bills mandate, but they spell it all out and add some pieces.

What We Can Do

Advocates have created opportunities for concerned individuals to support both the pending Senate bill and the rulemaking petition.

Those of you with Senators can fire off emails urging them to get on board with the bill and press for a vote. And everybody, even disenfranchised District of Columbia residents, can sign the petition to HUD.

You know that all the brouhaha about Flint and lead poisoned children will die down, as such things always do. Even friendly Congress members will turn their attention elsewhere. HUD will surely be distracted by agency leadership changes — no matter how the Presidential race nets out.

So we need to do what we can now to get as much done as feasibly can be done now.

 


Finding a Teachable Moment in the Flint Water Crisis

March 14, 2016

We’ve all read about the lead-laden water in Flint, Michigan. Flint is far from the only community where tests have found alarmingly high numbers of children with alarmingly high levels of lead in their blood. And water isn’t the only source — not even the most common.

Flint has prompted a spate of news reports and op-eds on toxic lead exposure, as you’ve probably noted. It’s also prompted federal-level initiatives to ramp up prevention. I’ll defer these to a separate post and deal here with the basics — many new to me and perhaps to some of you also.

Harms Excessive Lead Levels Do

When lead gets into our bodies, they distribute it to organs like our livers, kidneys and brains. They confuse it with essential nutrients and try to use it, instead of them to build and repair bones, muscles and brain connections.

Damages to young children are especially severe. This is partly because their bodies absorb relatively more lead. And it’s more likely to get into their bodies, especially if they live in homes where the paint on the walls and/or woodwork is still lead-based.

You know how babies are. They crawl around on the floor, which may have paint dust or flecks on it. They put their hands in their mouths. They chew on things — and can reach more things to chew on as they learn to toddle.

Those first few years are when the brain does much of its development work, making connections among cells at an extraordinarily high rate.

This, if I understand correctly, is why lead in the body then can result in a range of irreversible damages, e.g., learning disabilities, attention deficit disorder, difficulties coordinating so-called small motor actions like picking up something with a finger and a thumb.

For somewhat similar reasons, babies may be born with damaged brains if their mothers have lead in their systems — or dead because their mothers miscarry.

Flint Children Just the Tip of the Iceberg

In one respect, the Flint crisis is as particular as the decisions that led to it. In another, it’s one case among many that haven’t gotten the popular media attention they deserve. Nor the rush to remedy — even belatedly, as in Michigan.

New York Times columnist Nicholas Kristof cites two communities, a state and a large part of a second where tests have found higher percents of children with dangerously high levels of lead in their blood.

The Detroit News fills in with more communities in Michigan. A reporter, also for the Times, adds Cleveland and several other cities. Vox reports 18 in Pennsylvania where a higher percent of children tested in the danger range than in Flint.

All told, well over half a million young children have blood lead levels higher than the maximum the Centers for Disease Control uses for its risk analyses, according to the Center’s (somewhat dated) estimate.

Where the Lead Comes From

Flint isn’t the only community where corrosion in publicly-owned water pipes has released lead into tap water. Some fellow District of Columbia residents will recall our own lead-infused water crisis.

The most common sources of lead poisoning in children, however, are lead-based paint in their homes and soil that’s got flakes of lead-based exterior paint in it and/or deposits of lead that was in the exhaust emitted by cars and trucks before Congress mandated a gradual phase-out of leaded gasoline.

Not an Equal Opportunity Risk

Flint is an extraordinarily poor community, with a poverty rate of 40%, according to the latest Census survey. The rate soars to nearly 71% for children under five, the highest-risk age group. The community is also predominantly black — not unrelated, one assumes, to the poverty rates.

The poverty rate in Cleveland, also predominantly black, is barely lower — and the rate for children under five somewhat over 64%. More than 17% of the young children tested there (most weren’t) had blood lead levels over the CDC high-risk threshold. Recent tests found a 26.5% toxic rate in one poor part of the city.

CDC has found high blood lead levels in relatively more black children nationwide. It (indirectly) attributes this to older housing and poverty.

But it’s not the age of the house that matters. It’s whether the house was repainted since 1978, when a federal rule banned lead in house paint — and whether the new paint still completely masks the old, if it was. Whether it’s always masked the old matters too.

Fair to assume that poor families are more likely to live in poorly-maintained buildings — and in buildings closer to highways, bus terminals and the like, which were sources of lead that’s still in the soil.

What About Race in the Place

Experts interviewed by Cleveland Plain Dealer reporters attribute the persistent risks to racism. On the one hand, red-lining policies concentrated blacks in neighborhoods then neglected, they say.

On the other hand, evidence of lead poisoning in children was shrugged off or blamed on the kids and their parents. Sound familiar? That may be history now. But Cleveland’s failures to investigate and require remedies isn’t — and not only due to funding shortages, it seems.

Congressman Dan Kildee, who represents Flint, says that race was “the single greatest determinant” of what happened there, referring, it seems, to how the governor and his people discounted residents’ complaints.

Huffington Post reporters go further, citing the waste auto factories dumped into the Flint River as one, but not the only example of environmental racism. It’s nevertheless hard to pinpoint racism when poverty seems a factor too.

“It’s not just about black lives mattering,” says a sociologist who studies impoverished communities. “Poor people’s lives don’t matter.” The water crisis, he adds, “just made everybody notice” what had been going on for a long time.

Perhaps the crisis will prove “a teachable moment for America,” as a former CDC director says. A lot of lessons for state and local officials. Some for Congress and at least one federal agency too.

Of which more shortly.