The University of Rochester Medical Center Partners to Eliminate Lead Poisoning
Although the federal government banned the use of lead-based paint in 1978, families living in older homes are still susceptible to lead exposure through chipping paint, dust, and soil contamination. Approximately 63,000 housing units in the city of Rochester, New York, and 90 percent of residential properties in Monroe County were built prior to 1950, well before the ban on lead-based paint. A review of blood lead levels in the late 1990s showed that approximately 40 percent of children attending Rochester Elementary School #17 had a history of elevated lead levels, an alarming finding for former principal Ralph Spezio, who sought the help of civic leaders, educators, and researchers to reduce childhood lead poisoning. In 2000, University of Rochester Medical Center (URMC) researchers, clinicians, and staff joined with other community stakeholders to form the Coalition to Prevent Lead Poisoning (CPLP) to educate residents, healthcare providers, and property owners about lead hazards and how to make houses safe. In recognition of their efforts to bring about policy change, CPLP and the University of Rochester, along with the city of Rochester, Monroe County, and Empire Justice, received the U.S. Environmental Protection Agency’s 2009 Environmental Justice Achievement Award.
In 2004, CPLP, the University of Rochester, and the United Way cohosted a Community Lead Summit that brought together city officials and community leaders who pledged to end childhood lead poisoning. The summit resulted in the Rochester Lead-Based Paint Poisoning Prevention Ordinance, which took effect in 2006 and was the first ordinance of its kind in the state outside of New York City. The ordinance attempts to prevent future cases of lead poisoning by mitigating residents’ exposure to in-home lead hazards. To determine whether lead is present in residential properties, the ordinance establishes a multistep risk assessment process. All rental housing must have interior and exterior visual inspections for deteriorated paint and soil hazards before renewing or applying for a certificate of occupancy. Tenants may also file a complaint to prompt an inspection of their individual unit and common areas. Properties with five units or fewer in high-risk areas (neighborhoods identified by the Monroe County Department of Public Health as having historically high blood lead levels) that pass the visual inspection must also have a dust-wipe test to determine whether a lead dust hazard exists. Rather than full paint removal, the ordinance requires lead-hazard stabilization through cost-efficient, temporary treatment such as removing loose paint, covering chipped areas with new paint or other sealants, and cleaning using a high-efficiency particulate air vacuum and lead-specific detergents. Workers using these treatments must comply with lead-safe work practices.
In the first 4 years under the ordinance, the city visually inspected the interiors of 58,177 units, of which 94 percent passed. Of these, 17,050 units also received dust-wipe tests, and 89 percent of them were deemed lead safe. These findings exceeded expectations based on previous assessments in high-risk areas, which officials believe reflects landlords’ efforts to avoid citations from the city. Data gathered from 2012 focus groups and telephone surveys indicated that lead-hazard stabilization was not a significant cost burden for landlords. Most property owners performed the minimum repairs required for inspection such as cleaning and sealing lead paint, whereas others undertook more extensive repairs such as replacing windows.
Making Housing Lead Safe
Outreach and research conducted by URMC experts have helped the community understand the nature of the lead contamination problem. For example the Community Outreach and Engagement Core (COEC) at URMC’s Environmental Health Sciences Center worked with the “Get the Lead Out” project from 2003 to 2004, which assessed approximately 70 homes in the high-risk Jay–Orchard Street community. In 2006, COEC and other partners opened Rochester’s Healthy Home. The house featured hands-on exhibits to demonstrate how to use safe, low-cost cleaning techniques and other low-cost interventions to address or prevent hazards from in-home contaminants such as lead, asbestos, carbon monoxide, and mold. After attracting more than 3,500 visitors in 3 years, the Healthy Home closed, and the Rochester Healthy Homes Partnership formed in 2010 to coordinate information sharing, new partnerships, and speaking engagements about reducing in-home environmental hazards. Currently, COEC maintains the Virtual Healthy Home website, which allows online visitors to view interactive displays and tour the original Healthy Home.
Federal funding has helped Rochester landlords effectively repair lead hazards in their properties. From 2003 to 2009, HUD Lead-Based Paint Hazard Control grants and local programs provided $45 million to landlords to reduce lead hazards in more than 1,200 units. From 2014 to 2017, the Monroe County Department of Public Health received a $3.27 million HUD Lead-Based Paint Hazard Control grant, more than half of which was allocated for lead hazard control and repairs in more than 200 units. The county used the remainder for Reimbursement Homeowner grants, capped at $18,000 per unit, to stabilize lead hazards in pre-1978 housing. For each homeowner grant, a maximum of $1,500 could be used for healthy home interventions such as energy-efficient upgrades and mitigating other in-home environmental health issues such as mold, pests, and general sanitation.
URMC and many community stakeholders have made substantial strides in reducing childhood lead poisoning. Advocating for Rochester’s lead ordinance, maintaining strong partnerships, and securing funding for lead hazard reduction were critical steps. Because of these efforts, the number of Rochester children under age 6 with elevated blood lead levels declined from 900 in 2004 to 191 in 2016. This decline was for children with 10 or more micrograms of lead per deciliter of blood — the level of concern until 2012, when 5 micrograms per deciliter became the level at which children are identified as being exposed to lead and requiring case management. Rochester’s lead ordinance and other collaborative efforts are a model for other cities facing similar challenges, says Katrina Korfmacher, associate professor of environmental medicine and director of COEC at the University of Rochester. Elizabeth McDade, program manager at CPLP, agrees, noting that alleviating lead hazards required consensus building and the realization that the challenge could only be resolved with all stakeholders at the table. URMC and other partners see the need to persist in their efforts to ensure that children’s lead exposure continues to decline. Information sharing and community education about lead hazards and treatments must be ongoing, and stabilizing lead hazards will require consistent monitoring to prevent exposure.
New York State Department of Health. n.d. “Sources of Lead.” Accessed 9 March 2018; Sarah Boyce, Kimberly Hood, and Patty Malgieri. 2002. “Lead Poisoning Among Young Children in Monroe County: A Needs Assessment, Projection Model, and Next Steps,” 19–20. Accessed 12 April 2018; U.S. Census Bureau. American Fact Finder. n.d. “Rochester city, New York: DP04: Selected Housing Characteristics — 2012 American Community Survey 5-Year Estimate.” Accessed 16 April 2018; Coalition to Prevent Lead Poisoning. n.d. “About the Coalition to Prevent Lead Poisoning,” 6. Accessed 7 March 2018; Katrina Smith Korfmacher. 2008. “Collaborating for Primary Prevention: Rochester's New Lead Law,” Journal of Public Health Management and Practice 14:4, 401–2; Interview with Elizabeth McDade, program manager at the Coalition to Prevent Lead Poisoning, 2 April 2018; Email correspondence from Katrina Korfmacher, associate professor of environmental medicine and director of the Community Outreach and Engagement Core at the University of Rochester, 23 March 2018; Interview with Katrina Korfmacher, 28 March 2018; Katrina Smith Korfmacher. 2010. “Boundary Networks and Rochester’s ‘Smart’ Lead Law: The Use of Multidisciplinary Information in a Collaborative Policy Process,” New Solutions 20:3, 319. Accessed 7 March 2018; University of Rochester Medical Center. 2009. “Rochester Recognized by EPA for Lead Abatement Efforts,” press release, 14 December. Accessed 8 May 2018.×
Katrina Smith Korfmacher. 2008. “Collaborating for Primary Prevention: Rochester's New Lead Law,” Journal of Public Health Management and Practice 14:4, 404; Coalition to Prevent Lead Poisoning. n.d. “About the Coalition to Prevent Lead Poisoning,” 7–8, Accessed 7 March 2018; City of Rochester. n.d. “Lead Paint — Get Prepared.” Accessed 19 March 2018; Stanley Schaffer. 2015. “Future Directions to Address Lead Poisoning,” panel discussion video at Collaboration to Overcome Lead Poisoning: The 2015 Upstate NY Lead Conference, University of Rochester Medical Center. Accessed 19 March 2018; City of Rochester, New York. 2005. “City Code Chapter 90, Article III: Lead-Based Paint Poisoning Prevention.” Accessed 9 March 2018.×
Katrina Korfmacher, Maria Ayoob, and Rebecca Morley. 2012. “Rochester’s Lead Law: Evaluation of a Local Environmental Health Policy Innovation.” Environmental Health Perspectives 120:2, 311–3, 315. Accessed 23 March 2018; City of Rochester. 2017. “Lead Year Eleven Statistics.” Accessed 13 April 2018.×
Katrina Smith Korfmacher. 2010. “Boundary Networks and Rochester’s ‘Smart’ Lead Law: The Use of Multidisciplinary Information in a Collaborative Policy Process.” New Solutions 20:3, 321, 324; Email correspondence from Katrina Korfmacher, associate professor of environmental medicine and director of the Community Outreach and Engagement Core at the University of Rochester, 23 March 2018; Liam O’Fallon. 2004. “Go for the GLO.” Environmental Health Perspectives 112:6, A351. Accessed 12 March 2018; Interview with Katrina Korfmacher, 28 March 2018; Katrina Smith Korfmacher and Valerie George. n.d. “Rochester’s Healthy Home: An Innovative Hands‐on Environmental Health Demonstration Project,” 5–6, 9, 13, 16–7, 29. Accessed 12 March 2018; Rochester Healthy Homes Partnership. 2013. “2013 Activities Report.” Accessed 12 March 2018; University of Rochester Medical Center. n.d. “Healthy Homes.” Accessed 7 March 2018.×
Katrina Korfmacher, Maria Ayoob, and Rebecca Morley. 2012. “Rochester’s Lead Law: Evaluation of a Local Environmental Health Policy Innovation,” Environmental Health Perspectives 120:2, 313. Accessed 23 March 2018; Monroe County Department of Public Health. n.d. “Lead Hazard Control & Healthy Home Grant (2014–2017): $18000 Reimbursement Grant Fact Sheet/Application.” Accessed 13 March 2018; Monroe County. 2017. “Housing and Urban Development (HUD) Lead Hazard Control Grant, 2014–2017.” Accessed 7 March 2018.×
Monroe County. 2016. “Monroe County Children (0–72 months) Screened for Lead: 2004–2016.” Accessed 18 April 2018; Centers for Disease Control and Prevention. 2017. “What Do Parents Need to Know to Protect Their Children?” Accessed 7 March 2018; Interview with Katrina Korfmacher, 28 March 2018; Interview with Elizabeth McDade, 2 April 2018; Katrina Korfmacher, Maria Ayoob, and Rebecca Morley. 2012. “Rochester’s Lead Law: Evaluation of a Local Environmental Health Policy Innovation,” Environmental Health Perspectives 120:2, 315. Accessed 23 March 2018.×