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
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
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 thing?
** 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
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 their mouths.
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
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
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.]
--Peter Montague (National Writers Union, UAW Local 1981/AFL-CIO)
 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.
 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.}}