Philadelphia Medicine Fall/Winter 2019 - 23

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There are many reasons for this disconnect. Some physicians
have seen the national trends of decreasing lead levels and have not
appreciated that the trends are less impressive in some communities.
They may not know that most children have medical coverage
which almost universally covers screening blood lead tests. In other
circumstances when an elevated blood lead level has been identified,
physicians may not be aware of the resources available to evaluate
the sources at home, child care facilities and other places the child
may spend time. The frustration of knowing of an ongoing harm
and not being able to help can serve to disincentivize testing.
The most effective way to protect children from lead in the
home is removing all the lead paint using an EPA certified lead
contractor. Since that is extremely costly, secondary prevention
approaches include thorough cleaning using wet mops and wipes.
Sweeping and dry-dusting is not recommended since it spreads
lead dust around the home. Surfaces in the home, especially
windowsills and floors, should be wiped down at least once a week
but ideally more frequently. All renovations done in a home built
before 1978 should be done by a lead certified contractor or the
entire home may become lead contaminated.
Although these strategies are expected to reduce overall lead
exposure, they have not been proven to be effective at eliminating
elevated blood lead levels. History has documented that solving
the problem of lead poisoning nationally and in Philadelphia
cannot be accomplished by counseling or treatment alone. For
this reason, the Environmental Subcommittee of the Section on
Public Health and Preventive Medicine of the College of Physicians
of Philadelphia worked to produce and disseminate an Issue Brief
detailing the scientific evidence supporting the need to take primary
prevention steps. The issue brief, along with live testimony, provided
City Council members with the science supporting the need for
primary prevention of lead exposure and evidence that initiatives
like the expansion of the lead-safe certification of rental housing
law had been successful in other communities to protect children.
In addition to the lead-safe certification of rental housing law,
it is now the law in Philadelphia that doctors must test children
for blood lead at one and two years of age. Twenty states require
blood lead testing; New York, New Jersey, Delaware and Maryland
are among them. The Commonwealth of Pennsylvania is also
considering universal blood lead testing. Bills on the matter are
currently in committee (SB312, HB79).

As more children are tested, we will be better able to assess the
areas of highest risk and design targeted interventions. As physicians
find children who have unexpected elevated blood lead levels, there
should be renewed enthusiasm for testing and referrals to the Lead
and Healthy Homes Program (https://www.phila.gov/programs/leadand-healthy-homes-program/) which goes out to homes to evaluate
lead sources and risks.
Some might say that physicians across the country have dropped
the ball when it comes to testing at-risk children. But recent legislative
initiatives in Philadelphia targeting primary prevention by reducing
the lead risk in homes coupled with universal testing, may help us
recover our own fumble. Eliminating lead poisoning completely will
require our vigilance for as long as lead paint remains on the walls
of our buildings.
Dr. Howarth is an occupational and environmental medicine physician
who directs community engagement for the University of Pennsylvania's
Center of Excellence in Environmental Toxicology. The Community
Engagement Core (CEC) at the Center of Excellence in Environmental
Toxicology (CEET) is committed to the study and mitigation of lead
exposure in Philadelphia. The CEC is involved in numerous projects
around the city, ranging from educational outreach on lead exposure, to
informing legislators, regulators, and medical professionals, to testing
lead in soil around the city. Visit our website at http://ceet.upenn.edu/.
community-outreach-engagement/ for more information on our work in
Philadelphia communities and resources on lead. *
Fall/Winter 2019 : Philadelphia Medicine 23

Philadelphia Medicine Fall/Winter 2019

Table of Contents for the Digital Edition of Philadelphia Medicine Fall/Winter 2019