1. 1 City of New Orleans Health Department Lead Poisoning in New Orleans Safe & Healthy Homes Initiative Presented by: Kevin U. Stephens, Sr., MD, JD Director City of New Orleans Health Department

2. 2 Lead in New Orleans: Where is It?

3. 3 City of New Orleans Health Department Distribution in City

4. 4 City of New Orleans Health Department Minority Population

5. 5 City of New Orleans Health Department Occupancy Rates of Renters

6. 6 City of New Orleans Health Department Housing Built Pre-1950

7. 7 City of New Orleans Health Department

8. 8 Lead in New Orleans Lead in fuel and paint has been on the decline in the US

9. 9 City of New Orleans Health Department A Story of Differential Affectation Certain zip codes in New Orleans have far higher concentrations of housing built before 1950 than others: Children living in urban areas are more likely to have elevated blood lead levels The vectors by which lead enters a child’s environment has historically been lead-based paint and the burning of leaded automobile fuel The age of housing is the single most important risk factor in assessing a child’s risk for lead poisoning

10. 10 City of New Orleans Health Department A Unique Housing Stock 1416 properties are responsible for EBLs 233 properties responsible for multiple EBLs 3 multifamily properties responsible for EBLs = 0.2% 227 properties in Public Housing = 16% 83% of housing in New Orleans built before the ban on lead- based paint in 1978 still has not been lead-abated

11. 11 City of New Orleans Health Department New Orleans Lead Poisoning Prevention Program Initiated in February, 1971 Federal funds allocated under the Emergency Act of 1971 The New Orleans Childhood Lead Poisoning Prevention Program (NOCLPPP) established in June, 1972

12. 12 City of New Orleans Health Department Mission Identify and reduce lead poisoning morbidity in children 6 months – 6 years of age –Blood screening –Comprehensive follow-up services Screening is required throughout the entirety of Orleans Parish

13. 13 City of New Orleans Health Department Goals Early identification –Lead Poisoning Risk Assessment Questionnaire –Blood lead levels beginning at 6 months of age Identify children with undue lead absorption –Screen all children at ages 1-2

14. 14 City of New Orleans Health Department Goals Follow-up of all positive screenings for proper evaluation and management Monitor the quality and timeliness of the follow-up and treatment Prompt identification of the source Educate the patient to reduce further exposure Eliminate the source

15. 15 City of New Orleans Health Department Goals Early identification –Iron deficiency and anemia Screening and intervention –By dietary and/or medical iron supplementation –Nutrition counseling to correct the iron deficiency state and/or iron deficiency anemia

16. 16 City of New Orleans Health Department Screening Procedure & Schedule At 6 months of age, Lead Poisoning Risk Assessment Questionnaire is administered Positive answers –Considered High-Risk –Blood lead tests done then and yearly until age 6 Negative answers –Considered low-risk –Blood lead tests done at ages 1 & 2 –Screen with Questionnaire until positive answer or age 6

17. 17 City of New Orleans Health Department Screening Blood levels (capillary blood) –<10  g/dl: normal –10-14  g/dl: possible lead poisoning, follow-up in 3 months –>15  g/dl: requires re-testing using venous blood –>15  g/dl venous blood: confirmed lead poisoning

18. 18 City of New Orleans Health Department Screening Performed routinely by NOHD’s seven maternal-child health clinics At community outreach screenings at invited events –Health fairs –Daycare centers –PTO meetings –Church events By clinical personnel following OSHA and CLIR guidelines

19. 19 City of New Orleans Health Department Private Care Providers Provides care and follow-up NOCLPPP provides –Housing inspection for levels > 15  g/dl –Education –Literature –CDC manual –Copy of environmental follow-up

20. 20 City of New Orleans Health Department Summary of Lead Data in Orleans Parish in 2003 8,503 children screened, 22.8% of population 1,217 children had EBLL, 14.3% 254 children had levels of >20 ug/dl Males 648, Females 564

21. 21 City of New Orleans Health Department Summary of Lead Data in Orleans Parish in 1999 6,577 children screened, 17.7% of population 1,672 children had EBLL, 25.4% 317 children had levels of >20  g/dl

22. 22 City of New Orleans Health Department Lead Levels in Orleans Parish 1999, 2002 and 2003 Increased screening levels Decreased levels of EBLLs Decrease levels of EBLLs >20  g/dl

23. 23 City of New Orleans Health Department Lead Hazard Control Grant New Orleans and the Neighborhood 1 (formerly Division of Housing and Neighborhood Development) received a grant from the U.S. Conference of Mayors to develop a Lead-Safe House The Lead-Safe House is the first of its kind in the U.S.: –This previously blighted property is utilized to temporarily house families while their home is lead-abated –The Lead-Safe House is located at 1909 Foucher Street, within the Mayor’s Central City Strategic Improvement Zone

24. 24 City of New Orleans Health Department Lead Safe House Renovations

25. 25 City of New Orleans Health Department Lead Safe House Renovations

26. 26 City of New Orleans Health Department Other Initiatives The Division of Environmental Health within the NOHD aided in the passage of a ban on dry sanding of paint in Orleans Parish The Health Department has jurisdiction in deciding cases where lead abatement orders are violated

27. 27 City of New Orleans Health Department Problems with Current Lead Ordinances The areas with the highest percentage of children with elevated blood lead levels have the highest percentage of houses built prior to 1950. In these areas, the percentage of houses built prior to 1950 range from 47% to 83%. Currently there is an estimate of 109,345 houses in Orleans Parish built prior to 1950.

28. 28 City of New Orleans Health Department Proposed Lead Ordinance Every house built prior to 1950 must be certified by a lead inspector as “Lead Safe” prior to Act of Sale. “Lead Safe” means no immediate threat of lead exposure exists. If lead is known to exist, abatement or encapsulation will be required. If buyer has or will have children under the age of 6 in the household, “Lead Free” certification will be highly suggested.

29. 29 City of New Orleans Health Department Proposed Lead Ordinance Any child found to have a confirmed EBLL (>10  g/dl ) and an environmental lead inspection reveals existing environmental lead hazards in the home, the owner will be required to make the home “Lead Safe” within three months of the initial inspection. If owner does not comply with lead abatement, the house may be declared “unfit for human habitation” by the Health Director.

30. 30 City of New Orleans Health Department Proposed Lead Ordinance A random inspection of “lead safe” compliance may be performed, with sanctions imposed for any violations cited. Possible sanctions include “Lead Free” certifications, fines, and/or suspensions of license.

31. 31 City of New Orleans Health Department Proposed National Legislation Income tax credit should be offered to any homeowner to offset the expense incurred for lead abatement. Developers will be given tax credits for abatement of apartment complexes or rental units.

32. 32 City of New Orleans Health Department Office of Safety and Permits 2004: 617 Lead Paint Applications –Brought paint sample and applied for exterior sanding permits, in compliance with dry sanding ordinance 2005: 92 Applications as of March 8, 2005. Scheduled to receive three portable XRF lead testing devices –One each for NOHD, Safety and Permits and Neighborhood 1

33. 33 City of New Orleans Health Department The End