Fw: #687: DUMBING DOWN THE CHILDREN--PART 1

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> . .

> . 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

> treated. " [1]

>

> 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.[2]

>

> 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.[3]

> 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.[4]

>

> 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.[1]

>

> 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. , 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. 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

> 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.[2] 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.[5] 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.[5]

>

> 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.[3]

>

> 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.[1] The following year Gibson urged that, " [T]he use of

> lead-based paint within the reach of children should be

> prohibited by law. " [6] 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;[2] 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.[7] In 1917, a physician at s

> 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. " [7] 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. " [7]

> 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. " [7]

>

> 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. " [7] The federal Centers for Disease Control

> concurred in 1979, saying, " Lead poisoning in children from paint

> was recognized early in this century. " [7] But recognizing a

> problem and acting upon it are two different things.

>

> [More next week.]

> ==============

>

> [1] Pear, " States Called Lax on Tests for Lead in Poor

> Children, " NEW YORK TIMES August 22, 1999, pg. A1.

>

> [2] 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.

>

> [3] W. Mielke and L. Reagan, " Soil Is an Important

> Pathway of Human Lead Exposure, " ENVIRONMENTAL HEALTH

> PERSPECTIVES Vol. 106, Supplement 1 (February 1998), pgs.

> 217-229.

>

> [4] 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.

>

> [5] 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.

>

> [6] Gerald Markowitz and 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.

>

> [7] 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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