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MAP-IT in Action – In the Community: A County Health Department Addresses Lead Poisoning

Mobilize

Rob works for the Springfield County Health Department and was recently put in charge of their Lead Poisoning Prevention Program (LPPP). After looking at trend data, Rob sees that rates have not decreased in Springfield County as quickly as the rest of the State. He also reviews national data in Healthy People 2020 and finds that the county’s rates are higher than the national baseline and target measures. Rob contacts his State’s Healthy People Coordinator to learn more about statewide efforts to meet the environmental health objectives in Healthy People 2020. Rob then does a brief environmental scan to see what the best practices are for lead poisoning prevention and what actions similar communities have taken to address the problem.

After his initial research, Rob decides that the LPPP needs to take a new approach and brings together key stakeholders in the county to help develop a plan. He invites county representatives from housing, environmental health, and education and local public health commissioners to form the Springfield County Lead Poisoning Prevention Task Force.

Assess

Rob and the task force hold a day-long strategic planning meeting. The first half of the day is dedicated to going through data. They review data sources identified in the Environmental Health Healthy People 2020 section. There they find objective 8: Eliminate elevated blood lead levels in children. After reviewing the data for their State, they find that their county has the highest rates of childhood lead poisoning in the State; out of all children under age 6 who are tested, 5.2 percent have elevated blood lead levels. The national average is 4.4 percent, while the State average is 2.1 percent, with some counties reporting no cases of elevated blood lead levels.

While doing their assessment, the task force also finds that the county’s childhood asthma rates are 4 percent higher than the State average. They think that the lead prevention plan they develop may be able to also address some environmental causes and triggers of asthma.

The new public health commissioner from Franklin identified his city as having the most cases of elevated blood lead levels in the county, most of which are concentrated in 1 area with a number of large public housing units. Best practices in lead poisoning prevention suggest that the county health department should focus on high-rate areas, particularly public housing units and economically disadvantaged neighborhoods with houses built before 1978 (the year lead was removed from paint).

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Plan

During the afternoon of the strategic planning meeting, the task force agrees that they need to address elevated blood lead levels by improving the physical environment of the housing units. They also agree to include evidence-based interventions that will reduce rates of asthma.

Rob contacts a community-based organization (CBO) that has a long history of working with the public housing units and asks them to help develop a plan for the project. Rob works with other members of the county health department and Franklin city government to develop a proposal for the U.S. Department of Housing and Urban Development (HUD). The CBO signs a letter of support agreeing to collaborate on the project if funding is awarded.

They propose a pilot program that would remove lead paint and install air filters in the public housing units. The pilot program would also train some of the unemployed residents to assist in the renovations. They are able to link their proposal directly to national and State Healthy People 2020 objectives in both Respiratory Diseases and Environmental Health topic areas.

In addition to tracking blood lead levels, they decide to also monitor childhood asthma rates to see if they decline as a result of their focus on reducing dust and improving air quality.

HUD awards them funding for the project and notes their use of supporting data as a reason they were funded.

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Implement

The CBO is excited about the project and is responsible for communicating with residents about the improvements, responding to any concerns they may have, and supervising the training and employment component of the project.

Rob is responsible for overseeing the entire project and works closely with contractors to ensure the work is completed correctly. Lead paint is removed, and air filters are installed throughout the public housing units over a 2-year period.

Track

Rob carefully tracks the project’s progress and collects formal and informal data to measure the project’s impact. Elevated blood lead levels reported to the county health department are 0.75 percent lower after the project than before the improvements were made. Residents self-report feeling sick less often and having fewer asthma attacks. As a result of the project, residents also report high levels of satisfaction with the condition of their housing unit and the management of the public housing complex overall.

Rob hopes that by carefully tracking and evaluating the project, the county health department will receive funding to expand the project to all public housing units in the county. He expects that it may be difficult to continue funding the program through public grants, so he also contacts local and national businesses and private foundations that may be able to provide funding.

Rob works hard to keep the CBO and the local residents involved in the project, establishing “train-the-trainer” programs with residents in nearby public housing units and hosting ongoing community meetings and events.

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