Houston children continue to be poisoned by lead even though childhood lead poisoning is considered the most preventable environmental disease among young children. In the past three years, almost 1,200 Houston children between 0 and 72 months old were found to have lead in their blood above the reference value of concern set by Centers for Disease Control and Prevention (5 ug/dL of blood). What’s worse, 300 children had lead levels 2 times higher than the reference value and almost 40 children had levels 5 times the reference value. These facts are of significant concern not only for the afflicted child and their family as they suffer health effects ranging from reduced IQ, learning delays, impaired hearing, reduced attention, kidney damage, coma, and convulsions, but also with respect to societal burden. Researchers indicate reducing blood levels to less than 1 ug/dL in US children would save approximately $1.2 trillion for the U.S. as a whole.
How can one determine if their child is at risk? If your house was built before 1978–lead paint on walls, doors, windows, and sills may be dangerous. A federal ban on high-lead paint was issued in 1977. Nationally, the largest source of exposure to children is through the dust from the lead-based paint in these older homes. In Houston, 425,711 of existing housing units were built prior to the ban, and many of these units are in increasingly dilapidated condition.
The Houston Health Department (HHD) has hosted the Lead-Based Paint Hazard Control Program (LBPHCP) for over 25 years, with the goal of providing a lead-safe home environment through home investigations and home lead abatement. In the past, HHD identified homes to refer to their LBPHCP by attending health fairs, driving around the city to locate homes that exhibited exterior signs of containing-lead-based paint, and generally by word-of-mouth. The process garnered only a handful of homes that met the eligibility requirements to qualify for the program.
Through the BUILD Health Challenge award, focused in the Near Northside (NNS) community of Houston, HHD has had the opportunity to work together with a community organization, Avenue CDC, and the Memorial Hermann hospital system to address these shortcomings and introduce process change. Avenue CDC helped to bridge the gap between HHD, Memorial Hermann, and the community residents, building the relationships and trust needed to mobilize residents and successfully implement interventions. Memorial Hermann provided the funding, service linkage, and follow-up to connect residents to resources. By working together with Avenue CDC and Memorial Hermann, HHD has revolutionized the system through which at-risk homes for lead paint in the NNS are referred to the LBPHCP.
Together, HHD and Avenue CDC identified NNS community leaders to attend “train the trainer” events where HHD personnel trained the community leaders on strategies for lead poisoning prevention, how to identify homes that potentially contain lead-based paint, and basic LBPHCP eligibility requirements to determine which homes would be suitable referrals for abatement. With help from Avenue CDC, these community leaders went on to train fellow community residents, and then organized community block-walks to locate at-risk homes that would meet eligibility criteria and refer them to the LBPHCP. Homes that were identified as at-risk for lead paint but unable to meet the criteria for the LBPHCP, due to reasons such as lack of insurance or the home being structurally unsound, are referred instead to Memorial Hermann to receive service linkage to appropriate outside resources. Once these homes receive the wrap-around services they require, HHD will be able to abate these homes and create lead-safe environments for these children.
Through this partnership and following a collective impact framework, HHD, Avenue CDC, and Memorial Hermann have made great strides towards their goal of creating a healthy home environment for NNS residents. The inception of the “train the trainer” workshops has increased community capacity regarding lead poisoning prevention strategies and knowledge of available resources, and these efforts have successfully mobilized the neighborhood residents to take charge of their own health. With the introduction of community blockwalks that allow neighbors to help neighbors as a method of obtaining referrals to the LBPHCP, HHD and Avenue CDC were able to introduce systems change that impact community health in a meaningful way. By applying these same principles to other aspects of the BUILD project, HHD, Avenue CDC, and Memorial Hermann will be able to bridge health and safety in NNS overall.
This guest blog is authored by Komal Sheth, MPH, a member of the Houston, TX, based BUILD awardee collaborative. Komal is the Childhood Blood Lead Screening Coordinator for the Houston Health Department, Bureau of Community & Children’s Environmental Health.