[wtpp] Dumbing Down The Children
- =======================Electronic Edition=======================
. RACHEL'S ENVIRONMENT & HEALTH WEEKLY #687 .
. ---February 17, 2000--- .
. HEADLINES: .
. DUMBING DOWN THE CHILDREN-PART 1 .
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DUMBING DOWN THE CHILDREN-PART 1
The NEW YORK TIMES reported in 1999 that, "Federal investigators say most
states are flouting a 1989 law requiring that young children on Medicaid be
tested for lead poisoning. As a result, they say, hundreds of thousands of
children exposed to dangerously high levels of lead are neither tested nor
The TIMES explained that, "The General Accounting Office [GAO], an
investigative arm of Congress, found that 'few Medicaid children are
screened for blood-lead levels,' even though the problem of lead poisoning
is concentrated among low-income children on Medicaid." Medicaid is a
federal medical insurance program for poor people. In the U.S. today, more
than 40% of all poor people are children.
Today nearly a million children (983,000) in the U.S. younger than 5 are
believed to suffer from low-level lead poisoning, according to the federal
Centers for Disease Control. Low-level lead poisoning can cause permanent
learning disabilities, hyperactivity, poor motor coordination, and other
developmental deficits. Indeed, reduced IQ, hearing loss and diminished
stature are associated with lead levels considerably lower than the 10
micrograms of lead per tenth-of-a-liter of blood now deemed "acceptable" by
the U.S. government.
Supplementing and corroborating the GAO study, the state auditor of
California, Kurt R. Sjoberg, reached a similar conclusion about Medicaid
compliance in a separate 1999 report. "'Thousands of lead-poisoned children
have been allowed to suffer needlessly,' because California has not complied
with the federal requirement to test them for lead poisoning, Mr. Sjoberg
said," according to the TIMES.
Federal rules require that children in the Medicaid program be tested for
lead poisoning at age 12 months and again at age two years. The GAO report
found that states varied considerably in their compliance with this federal
law. Washington State tested fewer than 1% of eligible children; New Jersey
tested 40%. Alabama performed best, testing the highest proportion but
still fewer than half (46%) of all eligible children.
The TIMES also reported that many states simply don't keep the necessary
records to know whether they are complying with federal law or not. "Many
states, including Connecticut [the wealthiest state in the Union] said they
did not have statewide data on testing rates or the prevalence of lead
poisoning," the TIMES reported. The question occurs, why would a state not
maintain records to assess the size of this problem and the steps being
taken to solve it?
From a state's perspective, the problem isn't one of cost. A lead
poisoning test is relatively cheap at $10 or less and besides the federal
Medicaid program pays 100% of the costs of testing. If a child is found to
have elevated lead levels, Medicaid will pay 100% of the costs of treatment.
(Medicaid will NOT pay to test water, paint or house dust to find the source
of the contamination, however.)
To summarize: An 11-year-old federal law requires all children up to age 2
in the Medicaid program to be tested for lead poisoning. Medicaid pays all
the costs. The purpose of the law is to catch signs of lead poisoning early
in hopes of limiting the damage to the child's central nervous system. Lead
poisoning, even at low levels, can leave a permanent legacy of slow
learning, hearing impairment, cardiovascular disease, behavioral problems
and delinquent behavior.2 But the states are thumbing their noses at the
federal law, thus allowing these debilitating medical conditions to develop
in tens of thousands of American children each year.
Why? Why are governments refusing to comply with a public health law
intended to protect children?
Here are a few preliminary reasons:
** Dr. Maxine D. Hayes, the acting health officer for Washington state, gave
a states-rights explanation: "We don't think it's right for the Federal
Government to dictate what states should do," she told the NEW YORK TIMES.
Dr. Hayes seems to be asserting a state's right to ignore the poisoning of
its children and to disregard federal law if it chooses to do so, a dubious
legal proposition at best (leaving aside the ethical issues it raises). The
question still remains, why would a state government choose to do such a
** Washington state does participate in the federal Medicaid program. The
state's Medicaid director gave the TIMES a different explanation: "We don't
believe we have much of a problem with lead exposure here." However, this is
speculation and the purpose of the lead-testing program is to lay such
speculation to rest by producing hard evidence. Bitter experience shows that
testing is likely to identify some lead-poisoned children who live in homes
built prior to 1978, particularly homes that have been poorly maintained.
Eighty percent of housing built before 1978 contains some lead-based paint,
which in poorly-maintained buildings is by now probably turning into a fine
powdery dust, which toddlers may get on their hands and then into their
mouths. But of course without testing, a state official is free to speculate
that his or her state is, miraculously, an exception to this general rule.
The question remains, why would a state medical officer choose to speculate
rather than acquire hard data?
** Many states have turned over their Medicaid responsibilities to health
maintenance organizations (HMOs) but have neglected to specify the full
range of services they expect HMOs to provide, so lead testing has often
slipped through the cracks. The question remains: since Uncle Sam is picking
up the tab, why don't states require lead testing when they negotiate
contracts with HMOs?
The long and the short of it seems to be that most state governments have
designed policies that assure that the lead-poisoning of children continues,
and the federal government seems paralyzed in the face of this rebellion.
The question remains, Why?
* * *
There are two major sources of lead in the environment, both of them human
in origin. The first is leaded gasoline, which was outlawed in the U.S. in
1976 but which left a residue of about 5.9 million metric tonnes (13 billion
pounds) of lead in the environment in the form of a fine, toxic dust.
Much of that powdery lead is still moving around in soil and house dust.
Furthermore leaded gasoline is still being used in many countries outside
the U.S., so contamination of the atmosphere continues, producing a steady
toxic fallout. Without human help, nature does produce some lead dust,
but humans now produce 19 times as much as nature produces each year-a
startling reminder of how numerous market-based decisions can add up to an
intractable problem of enormous proportions.
The second major source of lead dust is lead in paint. Lead, the soft, gray
metal makes an excellent white pigment, and paint made with white lead
pigment provides a high-quality, durable protective coating. Eventually,
however, even lead-based paint deteriorates. It begins to flake, peel and
disintegrate into a fine, powdery dust, which is toxic. Lead in paint was
restricted on a voluntary basis by the paint industry in 1955, but voluntary
compliance proved ineffective so, in 1970, Congress outlawed leaded paint
for interior uses. However there is evidence that leaded paint was used
illegally inside buildings until at least 1978. Between 4 and 5 million
metric tonnes (approximately 10 billion pounds) of lead were used in paint
in the U.S. between 1889 and 1979 and much of it remains where it was
originally put, slowly deteriorating into a toxic dust. An estimated 42
million families live in homes containing an average of 140 pounds of lead
in paint. If it has not been covered, this paint is a constant danger to
toddlers who often pick up the dust on their hands, then transfer it into
The danger of lead in paint was first identified 96 years ago when J.
Lockhart Gibson, an Australian physician, published the first report in a
medical journal describing children poisoned by lead-based paint. Gibson
specifically described the dangers to children from lead-based paint on the
walls and verandas of houses. The following year Gibson urged that,
"[T]he use of lead-based paint within the reach of children should be
prohibited by law." Australia finally took Gibson's advice in 1922, 50
years before the U.S. took similar action.
Unfortunately, lead is extremely toxic, especially to children whose
developing nervous systems are particularly susceptible to lead poisoning.
As little as 10 micrograms ingested daily can poison a child; a microgram
is a millionth of a gram and there are 28 grams in an ounce. With 10
micrograms being a toxic daily quantity, the 10 million metric tonnes of
lead introduced into the environment by humans during the 20th century
creates an almost unbelievably large "sink" of toxic powder available in
soil and in house dust, waiting to cause brain damage in toddlers.
Lead poisoning of children in the U.S. was first described in medical
literature in 1914. In 1917, a physician at Johns Hopkins University in
Baltimore suggested that, if physicians looked harder for lead poisoning in
children, they would find more of it. A pediatric textbook in 1923 described
8 cases of childhood lead poisoning: "The poisoning was caused in each
instance by the child's nibbling and swallowing the paint from his crib or
furniture." In 1924 an article in the JOURNAL OF THE AMERICAN MEDICAL
ASSOCIATION said, "There are many mild cases of lead poisoning in children,
manifested by spasms or colic." The article pinpointed the source of the
problem as window sills, porch railings, and crib railings coated with lead
paint. In 1926, an article in the AMERICAN JOURNAL OF DISEASES OF CHILDREN
said, "Lead poisoning is of relatively frequent occurrence in children."
Jane Lin-Fu, a well-known lead researcher, summarizes the early history of
childhood lead poisoning in the U.S. this way: "By the 1920s... severe forms
of childhood lead poisoning were recognized, and it became obvious that the
illness was quite common in the U.S." The federal Centers for Disease
Control concurred in 1979, saying, "Lead poisoning in children from paint
was recognized early in this century." But recognizing a problem and
acting upon it are two different things.
[More next week.]
 Robert Pear, "States Called Lax on Tests for Lead in Poor Children," NEW
YORK TIMES August 22, 1999, pg. A1.
 Laura E. Montgomery and others, "The Effects of Poverty, Race, and
Family Structure on US Children's Health: Data from the NHIS, 1978 through
1980 and 1989 through 1991," AMERICAN JOURNAL OF PUBLIC HEALTH Vol. 86, No.
10 (October 1996), pgs. 1401-1405.
 Howard W. Mielke and Patrick L. Reagan, "Soil Is an Important Pathway of
Human Lead Exposure," ENVIRONMENTAL HEALTH PERSPECTIVES Vol. 106, Supplement
1 (February 1998), pgs. 217-229.
 Institute of Medicine (U.S.) and National Institute of Public Health
(Mexico), LEAD IN THE AMERICAS (Washington, D.C. and Cuernavaca, Morelos,
Mexico: Institute of Medicine and National Institute of Public Health,
1996), pg. 62.
 Jerome O. Nriagu and Jozef M. Pacyna, "Quantitative assessment of
worldwide contamination of air, water and soils by trace metals," NATURE
Vol. 333 (May 12, 1988), pgs. 134-139.
 Gerald Markowitz and David Rosner, "'Cater to the Children:' The Role of
the Lead Industry in a Public Health Tragedy, 1900-1955," AMERICAN JOURNAL
OF PUBLIC HEALTH Vol. 90, No. 1 (January 2000), pgs. 36-46.
 Richard Rabin, "Warnings Unheeded: A History of Child Lead
Poisoning," AMERICAN JOURNAL OF PUBLIC HEALTH Vol. 79, No. 12
(December 1989), pgs. 1668-1674.}}
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