Document QgRMY5eV1yNy6a8DezD85eo17

A survey of the problem of lead poisoning in children with emphasis on the defects in institutions which make this problem possible, and ivhat can be done. COMMUNITY ASPECTS OF CHILDHOOD LEAD POISOHIN Jean E. Moore, M.S.S. Th e fact that lead poisoning exists at all in the United States is bnt an problem is so well defined, so neatly packaged with both causes and cures other of the numerous manifestations known, that if we don't eliminate this of society's lack of interest and concern social crime, our society deserves all for its impoverished members. For the the disasters that have been forecast community, it represents just one more for it."f of the many burdens it must bear, re When we address ourselves to the act to, and fight against in order to community aspects of this problem, we survive in the hell of impoverishment. can approach it from several angles. Recent estimates indicate that "as many When we speak of community we can as 250,000 youngsters in the United consider the agencies and institutions-- States may have had lead poisoning last particularly health, housing, education, year . . -"1--mostly from eating lead- social services, and welfare; we can based paint that peels off sills .and walls. consider business and industry--par In a recent issue of Today's Health, ticularly real estate owners and the reference is made to a new screening housing industry; and we can zero in technique that purportedly can accom on the residents--the citizens who live plish, through one person, 1,000 anal in the community. yses per week by use of a simplified urinary test.* But, urgent and med ically important as all diagnostic tools The Institutional Community may be, they are not at the core of Institutions have a remarkable way of concern for people in most communities. identifying that which they see as the The majority of the people living in problem--more often that which is a the kind of conditions that spawn lead problem to them, their problem. They poisoning want out from the slum. They tend to operate unilaterally, in isolation want to know why measures are not one from the other--with as much con taken when there is a way to prevent cern for "turf" as the gangs that are needless death. The tragedy of it all is so highly criticized for their more obvi that we care so little and do even less ous murders and rampaging qualities. in addressing the basic issues involved in this problem. At tire recent national There are health agencies in some cities that carry responsibility for housing in conference on lead poisoning, Dr. Rene spections, and there are other cities Dubos is quoted as stating that "the t Lead Poisoning: A Preventable Childhood * Medical Briefs. Today's Health (Sept.), 1909. Disease of the Slums. Science (Sept. 5), 1969, p. 991. \ I 1430 VOL. 60, MO. 8, A.J.P.H. i- i N36914 CHILDHOOD LEAD POISONING which have separate departmental re sponsibilities. Still others have different alignments--sometimes not at all re lated to problem areas in a currently relevant way--which continue to func tion in earlier patterns geared to former needs and/or different populations and housing. In what resembles a constant ping-pong game, the child with lead poisoning may be batted between agen cies and legalities--for example, be tween a health department and a hous ing department, with neither deciding to play the game to a conclusion. Thus the community's child is inevitably the loser. Housing codes often provide for la beling a house unfit, based on a point system involving cumulative violations. The peeling of paint, in and of itself, would not be reason for the designation of "unfit," or for involving the reloca tion services that some communities (too few) make available in a planned and meaningful way. In Philadelphia,* however, according to the assistant hous ing director, the presence of lead paint . on walls is now cause for unfit designa tion and relocation assistance. Although enforcement against a landlord may be effective in cities where specific legisla tion prevents use of lead paint on in terior surface or on toys, it is apt to be as ineffective as other types of code en forcement. Code violation cases usually go through the machinations of the lower judiciary, in hearings resulting in relatively low fines; too frequently these are ridiculous charades of the enforce ment process. It has been my experience (in the housing end of things) that a number of variables can come into play on a local level when it has-been determined that a child is suffering from lead poisoning--values having a bearing on whether he lives or dies, and apart *21st Annual Community Orientation In stitute, Philadelphia, October 30, 1969. Panel on Housing. from his medical treatment. In one spe cific case that came to the attention of the relocation agency, a family with a child having lead poisoning was re located from an unfit house, that was also a lcad-infestcd building, to a stand ard dwelling--all pretty and painted. Later, through the child's increased ill ness, it was discovered that this house was a monster in disguise, the monster being paint with, lead underneath. This relocation action took place twice more, finally terminating in a new public hous ing unit. The other units, although su perficially standard, were located in that area of the city most often re stricted to the poverty population, largely made up of black and other nonwhite people, 'i.e., the ghetto. In the half-bulldozed shells found in similar sections of cities across the country, lead represents the artifact of the ages, an invisible inscription of the past em blazoned throughout layers of colorful paint. It took the intricate planning of a number of people, working across sev eral agency lines to effectuate one re location action of the family described above. To avoid such red tape, the uti lization of the relocation services in a community should be an integral part of activities involving cases of lead poi soning, and all other types of housing/ health violations that may require move ment as well as other remedial actions to a property. But rarely, with the ex ception of crash experimental programs in a few cities, are paint chips rou. finely taken from peeling paint in in spections to determine if a house is leadfree. I understand that a method, similar to detection with a geiger counter, has been or is being developed to detect lead without defacing the paint. When this is available, what will our hang-up then be for not securing this kind of data? Probably another cost-benefit analysis proving the "inefficiency" of such routines--a device behind which AUGUST, 1970 1431 there invariably lies a maze of bureau cratic unconcern for the community. Poverty, Housing, and Discrimination Make no mistake about it, when we talk of housing containing lead,-we are addressing the community problems of poverty and of the crowded urban ghetto inhabited by the black and other minorities. These citizens, referred to in the report of die National Advisory Commission on Civil Disorders, are "condemned by segregation and poverty to live in decaying slums of our city . . "Today," the report states, "after more than three decades of frag mented and grossly underfunded federal housing programs, decent housing re mains a chronic problem for the disad vantaged urban household. Fifty-six per cent of the country's nonwhite fami lies live in neighborhoods marked by substandard housing and general urban blight."t We are really talking about a lack of commitment to enable families to break out of the poisoned ghetto. We are talking about locking people in to the death--through decidely racist policies. For, regardless of the legislation on the books for fair housing, for low-income bousing, for the prevention of real estate discrimination, for the prosecution of vio lations, and so on, agencies do not ef fectively carry out the mandates. Fur thermore, mandates are ofttimes is sued tongue-in-cheek--with little in tent toward change. Realtors lock people in, poverty holds them tight, and ra cism provides the glue. Program Approaches Methods do exist to bring agencies together to concertediy attack lead poi-* * Report of the National Commission on Civil Disorders, March, 1968, Chapter 17, Sec tion IV "Housing." t Ibid. soning or other problems--if agencies wish to use them. These involve the formation of agency-resource commit tees and use of the multiserviee con ference for the planning and develop ment of solutions to identified prob lems such as lead' poisoning. Further more, the use of a centralized relocation service can be a valuable answer to the need to remove a family from the en vironment--providing the ability exists to secure pretesting of the new, housing unit before completion of the move. The comprehensive planning concept, cutting across many problem areas, is perhaps best exemplified in the Model Cities legislation in which the concept of joint planning and implementation to effectuate change within a community involves numerous groups. In Model Cities, agencies and residents are cur rently working together--identifying areas of concern and priorities in the fields of manpower, economic develop ment, health, education, recreation, wel fare, crime, housing, transportation, and social services--for the avowed purpose .of bringing together all forces in the community to attack the total problems of the community. Each area of concern is so vitally interrelated with the others that the total approach of all groups--: federal, state, local, private and public, and citizen participation--will hopefully eliminate the basic causes of the existent conditions. To realize this as sumes a great deal on the part of all participants, and no one can envisage smooth and easy going in this most diffi cult of processes. Very few of the first-round model cities in this region contained specific reference to lead poisoning, in their ini tial applications. Furthermore, I do not recall that any of the first-year plans emanating from those cities contained specific projects aimed at the elimina tion of lead poisoning. In most communities there is a basic 1432 ' ' *'* -- -* - v.m DUP050312567 CHILDHOOD LEAD POISONING problem in fighting lead poisoning. To the people who live in blight, however, isolating "lead" as a crusading issue is somewhat difficult because of the many other related hut more obvious commu nity concerns. Citizens are suspicious of causes. They are tired of being "used" for studies. Nevertheless, the community can be aroused and involved. Social agencies have formed teams to help families scrape walls. Case conferences tighten up the fragmented proliferated delivery of services. Skilled psychiatric delinea tion of causal factors presents data on oral needs of certain children, on the overindulgent mother, or on the per petuation of dependency needs {that may also come from a hungry stomach). But at what point do we stop addressing tire palliative to grapple with the basic pol icy issues that cause perpetuation of the roadblocks to solution? Resident Involvement Residents are tired of waiting for the many things promised but never de livered, and of the stop-gap measures that occasionally but rarely involve them. Too few communities have in vited resident participation in evolv ing a plan of attack that could result in wholesale rehabilitation of houses or of the scraping and sampling of paint. More importantly, too few agencies de velop. community input to work-training ladders into the health professions, using urgent problems as a rallying point. Fewer still have added trained commu nity organization staff as liaison with the community, let alone, as community advocates. Therefore residents develop their own power. Perhaps the residents' greatest weapon, when aroused, is group pres sure. The Pillage Voice, (Sept. 18,1969) tells of citizen concern and of the or ganization known as Citizen Committee to End Lead Poisoning.* The article de scribes their feelings of pain and frus tration in fighting the bureaucratic webs that enfold them in their struggle for change. Rent strikes, community pressures such as boycotts, picketing of realtors, use of legal services--all of these and more--continue to develop in the com munity over major housing issues, and in areas of specific concern such as lead poisoning. Perhaps citizen reaction to needless deaths may reach high pitch in some few communities. Nevertheless, many residents see these crusades as another evidence of the grand design that produces lots of motion with no real movement, either intended or ac complished. They begin to realize thal their so-called inertia, or their "para noid" reactions, are reactions of hate, caused by years of being opted out of the human race. Today, no community agencies can plan among themselves, without the com munity's residents. Community groups will be included in, or you can forget the grand schemata. One of the great early hopes of the Model Cities program has been that the inclusion of residents in the planning and decision-making processes will enable the evolution of valid methods of change. This docs not mean that what residents have said about agencies has been found palatable by agencies, or that agencies--health agencies--have agreed with residents. Quite the reverse! It is a hard and diffi cult process. In most Model City plans, residents spoke of many over-all and specific prob lems; of decay of housing in the con text of poverty, undereducation and un deremployment. They expressed fear and grave doubts over the ability of the establishment to deliver in either gross terms or in specifics. They wanted in* *The Village Voice (New York City). *"' 49 (Sept IB), 1969. AUGUST. 1970 14) t DUP050312568 ,N'' on the decisions of how and what hap* 1 m pened in their communities and over ' ; priorities of what to attack first. ,)V Health centers got "hung-up" not on whether there would be a multipliasic 'Screening mechanism, or a specific test for lead levels, or referrals between ` \' . health and. welfare agencies. They got " : ' caught in the question of who was ulti- J;'inately going to have some say in the ' .;. decisions of how and what that health ; center did. Residents were willing to 'forfeit thousands of dollars in grants ' '\:'when such monies had strings tacked , , ^,'j' pnto them relating to specific agencies . 'y..,} that residents felt had been completely ',v: NV-; unresponsive to community concerns. One community literally told a state ' " health department that it could keep its ' : $100,000 if it was going to go through 1 the old channels. The department's methods were "suspect" because people had been treated condescendingly, with a lack of concern for the whole person and Iris dignity as a human being. When we talk about the community . aspects of lead poisoning, we must, of ' course, address ourselves to methods of cure, to immediate measures of a stop gap nature, and to mobilizing commu nity pressures and cooperation; but we cannot avoid the larger community fac tors that are operating. These include ", the matter of racism that permeates our entire society--both in attitude and, more important, in behavior toward spe, ( ; cifie groups of people who are thereby ' 1 ' committed to closed, poisoned housing. Summary Agencies must work together with community residents in developing spe cific methods of identifying poor hous ing and lead-infested units; methods of removal can and must be developed, through legal channels and through community pressures; landlords must be made to uphold codes adequately de signed and enforced to include removal of paint layers. The use of relocation services as a resource is a basic tool-- but only when coupled with adequate methods of securing and screening the new unit. Unfair housing is no longer just unfair--it is illegal! Most im portant, the behavior manifested in our governmental and other structures that perpetuates these conditions must change. The institutions that fail to respond to the obvious must be rattled; they must recognize that their time is limited. Agencies that refuse to involve them selves in the destinies of these commu nities, officials who ignore their con stituents, who bureaucratically block ways of dealing with specific problems such as lead poisoning, and who choose to be guided by insidious, sometimes unconscious, but all too often, frightfully conscious racist motivations, must be forced to change. We diagnose and treat patients and clients. It would appear that, more often than not, wc are focusing on the wrong target. Mrs. Moore is Associate Professor and Director, New Career Ladders in Social Welfare, Temple University School of Social Administration (1824 North Park Mall), Philadelphia, Pa. 19122 Tliis paper was presented before the Laboratory Section of the American Public Health Association at the Ninety-Seventh Annual Meeting in Phila delphia, Pa., November 11,1969. 1434 VOL. 60, NO. 8. A.J.P.H. DUP050312569