Over the past five years in Cuyahoga County more than 13 percent of young children screened for lead had the toxin in their blood.
That, however, is based on a very low screening rate — 20 to 30 percent of children at best.
Even in areas where children are most vulnerable to lead poisoning due to older homes, deteriorating and flaking lead-based paint, and a high proportion of low-income families or rental properties, screening rates are dismal.
The real number of kids likely to be poisoned is staggering, according to an analysis The Kirwan Institute for Race and Ethnicity at Ohio State University recently completed for The Plain Dealer.
Lead poisoning likely undetected in many
In nearly 70 residential pockets in Cuyahoga County as many as one in three children younger than 6 is likely being poisoned by lead, the analysis found.
Kirwan Senior Researcher David Norris used a model created for and used by the Ohio Department of Health to estimate how many children might be lead poisoned.
Norris cautioned the estimates were conservative because only high-risk areas, identified using census tracts, where 12 percent or more of children are likely exposed to lead were considered. The high-risk status is based on a host of factors, including the age of the homes and previous lead testing results.
It’s the same information the state uses to tell parents and doctors which children should be screened for lead poisoning.
There are a number of possible reasons for the stark difference between current testing data and Kirwan’s estimates.
For example, children who are screened may have parents more aware of the dangers posed by lead. Those not screened may be less likely to see a doctor or have the time or resources to follow up with testing. Both possibilities would result in an underestimate of the number of children truly poisoned by lead.
Using only the current testing data makes the lead poisoning problem seem much smaller than it actually is, Norris said. When public health officials say that 50 percent fewer children countywide are being lead poisoned now than in 2004, for example, it’s because they are only considering the kids currently tested.
Not the kids who should be tested, Norris said.
The gap in reported lead poisoning rates and the predicted levels affected suburban areas too. Suburbs with older housing such as Fairview Park, Rocky River and Shaker Heights likely have significant numbers of lead poisoned children not being screened, according to the analysis.
In a few suburban neighborhoods, up to 10 to 20 percent of children under 6 could be poisoned.
In some urban pockets the gulf between predicted exposure and actual testing is much wider. In an area around the historic Shrine Church of St. Stanislaus in Slavic Village, as many as 40 percent of children under age 6 could be lead poisoned, the estimates showed. But it appears few of those are being caught through screening. In 2012, less than 8 percent of screened children tested positive for the toxin.
Norris said areas with the worst lead poisoning problems — Cleveland and East Cleveland in our region — are often those in the urban core with high poverty levels subject to historic redlining practices and long-term disinvestment.
“It’s a racial justice issue and it’s social justice issue,” said Norris.
Does anyone do it better?
There are two main approaches when it comes to lead screening: targeted testing and universal testing.
New York, Massachusetts and Rhode Island require all children to be screened before they enter school or daycare. The same is true for the District of Columbia, where doctors must give parents certificates proving their children were tested between the ages of 1 and 2.
Parents then provide the certificates to their child’s licensed day care centers or schools when enrolling their kids in pre-kindergarten, kindergarten or first grade, the same as they do with vaccination records.
Schools in the District have an agreement to alert officials about children who haven’t been screened, said Pierre Erville, who runs the District’s Lead and Healthy Housing Division.
According to the District, the law has helped between 50 and 60 percent of children get screened by about age 2.
Ohio follows the targeted screening model, recommended by the Centers for Disease Control. In theory, it calls for testing of all children under 6 considered high risk for lead poisoning due to where they live or the age of their homes.
Printable flyers on the Ohio Department of Health web site say “TEST — IT’S OHIO LAW!” in capital letters, along with a list of more than 500 high-risk zip codes in the state, but “there is not any type of enforcement,” department spokeswoman Melanie Amato said in an email.
“We can target areas where there is low testing and follow up with the physicians to see why. We then will go and hold classes for the practice and teach them the value of lead testing. [The department] has never used enforcement on physicians,” she wrote.
Ohio children served by Medicaid are also required to be screened twice before the age of 2. But in the past seven years, only 21 percent of those children were screened through their Medicaid providers, according to health screening data reported by Ohio to the federal government.
Ohio Medicaid spokesman Sam Rossi said Medicaid is required to pay for the screenings but isn’t responsible for ensuring providers follow screening law. He said some children may have been screened at health clinics or places other than their doctor’s offices.
In Cuyahoga County there are some free screening clinics outside doctor’s offices, such as those provided by county health departments and schools, but the majority are performed in doctor’s offices and hospital clinics.