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The Nation's Health
Wisconsin resident Tory Lowe got bad news following a medical exam of his 4-year-old son. Lowe’s family lives in a low-income neighborhood in North Milwaukee. Many homes have lead pipes that can contaminate drinking water.
As a precaution, the family drinks only bottled water and has a filter on the kitchen tap. But despite those steps, in 2017 doctors told Lowe that his son, Troy, had high levels of lead in his blood.
“I couldn’t believe it,” Lowe told The Nation’s Health. “We don’t have lead paint.”
It turned out that Troy had been drinking from the bathroom sink.
Though lead paint, dust and soil are the biggest risks for high blood lead levels in children, lead in water can have dangerous consequences as well. While the U.S. has some of the world’s safest public water supplies, in some cases, up to 20% of a person’s exposure to lead can come from tap water, according to the U.S. Environmental Protection Agency.
Any level of lead in blood is unsafe in children, but the health risk multiplies when levels surpass 5 micrograms per deciliter, according to the Centers for Disease Control and Prevention. In Troy Lowe’s case, his measurement was 6 micrograms per deciliter.
An estimated 4 million U.S. households have children who are exposed to high levels of lead. Lead exposure can cause fatigue, joint ache, constipation and memory loss, and is particularly dangerous for infants and children. Developmental problems involving learning, behavior, speech and hearing can result. When blood lead levels reach 45 micrograms per deciliter, CDC recommends that medical treatment be considered.
People from racial and ethnic minority groups who live in low-income neighborhoods are most at risk for lead poisoning, according to CDC. A big contributor to that risk is old water service pipes that have lead in them, which can leach into the water. Up to 10 million U.S. homes are served by lead service lines, according to the Environmental Defense Fund. More communities across the U.S. are working to replace lead service lines, sharing plans to replace more than 380,000 pipes in their water systems. But cost can be a barrier.
In most communities, utilities own the pipes up to residential property lines and are responsible for maintaining and replacing them. But property owners are generally responsible for replacing lead service lines on their own property. That can cost thousands of dollars, creating a financial burden.
Moreover, in disadvantaged neighborhoods, many people are renters, so landlords make the decision whether to replace lead pipes in a house or apartment.
“Landlords are not directly affected by the risk,” Catherine Klinger-Kutcher, MPH, a social innovation specialist at the national Green & Healthy Homes Initiative, told The Nation’s Health. “It has been a bit of a challenge to get them to change lead pipes.”
Many people in North Milwaukee, including Lowe, are renters, and many of the properties have private lead service lines, city records show.
“They move you in, and if you don’t know about it, you don’t know about it,” Lowe said.
Since the water contamination in 2015 in Flint, Michigan — caused by officials switching to a new water source that corroded lead pipes, leaching the metal into the tap water of thousands of households — hundreds of U.S. towns, cities and counties have become more proactive about replacing lead pipe lines. But the challenge for many communities and residents is paying the cost of replacement.
Installation in the U.S. of lead service lines for homes and commercial buildings began in the 1800s and persisted in high volume into the 1920s, when the dangers of lead to human health became better known. Even so, some cities such as Chicago installed lead pipes into the 1980s. Most lead service lines are in cities and counties in the Northeast and upper Midwest.
Corrosion control chemicals have had success containing the metal. But since the contamination in Flint, the push to completely replace lead service lines has gained momentum.
“The goal is to fully remove all lead from the water main to the house,” Stephen Estes-Smargiassi, MCRP, director of planning and sustainability for the Massachusetts Water Resources Authority, told The Nation’s Health.
More communities looking for solutions
Many U.S communities are finding cost-effective ways to pay for replacement of lead service lines, and dozens of other communities have already completed work.
In Green Bay, Wisconsin, population 104,000, the city water utility worked closely with Brown County Public Health to create a strategy to replace all lead service lines. In January 2016, the city set the ambitious goal of eliminating lead pipes from Green Bay by the end of 2020.
City workers identified 1,782 utility-owned and 230 privately-owned lead service lines. By May 1 of this year, only 484 utility-owned pipes and 16 privately-owned pipes were left to replace. Through grants and other means, Green Bay has funded the replacement of all privately owned lead pipes.
“We felt it was important that it didn’t matter if (homeowners) didn’t have the income to replace their pipes,” Nancy Quirk, general manager of Green Bay Water Utility, told The Nation’s Health. “It was important to get the lead out.”
Several states, including Indiana, Missouri, New Jersey, Pennsylvania and Wisconsin, have enacted laws and policies allowing an increase in user rates within a water system to fund lead-pipe replacement on private property, Tom Neltner, JD, chemical policy director at the Environmental Defense Fund, told The Nation’s Health.
A variety of funding strategies are being used in Massachusetts, which has an estimated 220,000 lead service lines, according to the 2016 American Water Works Association Survey. Boston, population 685,000, pays up to $2,000 of the pipe replacement, Estes-Smargiassi, of the state water authority, said. Newton, population 89,000, offers 10-year no-interest loans, and other Boston suburbs pay the entire private property cost.
Boston city and public health workers also identified a situation that fell through the cracks of lead-water oversight: home-based day care centers. State-run day care centers are routinely tested for contaminated water, but not day care services in people’s homes, Estes-Smargiassi said. Boston now offers free water testing for these centers.
“We are trying to make sure that people with potential risk know the risk and understand their options to take action,” Estes-Smargiassi said.
In October 2016, the Cincinnati City Council passed an ordinance for a strategy to eliminate an estimated 39,000 lead service lines in the city within 15 years. The strategy would also offer property owners no-interest financing options. Help Eliminate Lead Pipes, a financial assistance program, offers a 30% credit that is applied to the final bill for pipe replacement after other cost participation benefits have been applied from Greater Cincinnati Water Works.
“We worked hard to make this as affordable as we could,” said Verna Arnette, city water treatment superintendent.
Meanwhile, renters in Cincinnati, population 300,000, are becoming more aware of lead pipes. In July 2017, the city passed an ordinance requiring landlords to disclose lead service lines to potential renters.
APHA is involved in work to replace lead service lines nationally and is a partner in the Lead Service Line Replacement Collaborative, which offers a roadmap, tools and resources to communities for changing lead pipes.
“We value being part of the collaborative, as it is a multi-disciplinary group working together to hasten lead service line replacement across the U.S.,” Kate Robb, MSPH, APHA’s senior program manager for environmental health, told The Nation’s Health. “Collaboration is key to ensuring healthy home environments.”
Health workers can help reduce exposure to lead in water in their communities by sharing information, according to Cynthia McCarthy, who worked in the Cincinnati Health Department’s Childhood Lead Poisoning Prevention Program for 13 years.
For example, people can help avoid contamination by installing water filters and using cold instead of hot water from the tap, she said.
McCarthy recently joined the city’s Greater City Water Works Enhanced Lead Program. Having now been employed on both sides of the issue, she lauds the synergy that develops when public health advocates collaborate on city projects.
“Having local health departments partner with their water utility is beneficial for both entities in understanding the health implications of lead poisoning and the hazards specific to lead in water,” McCarthy told The Nation’s Health.
For more on lead contamination, visit www.cdc.gov/lead and www.apha.org/lead.
For more on lead service line replacement, visit the Lead Service Line Replacement Collaborative at www.lslr-collaborative.org.
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