Philadelphia’s Path to Lead Safety: Challenges and Solutions
Over the past decade, the City of Philadelphia has made steady progress in reducing the number of children exposed to lead in the home. Since 2011, the Philadelphia’s Lead Safe/Lead Free Law has required landlords to obtain lead safety and inspection certifications for all homes with children. The law was amended in 2019 to include all rental properties regardless of if children were in the property. According to the Philadelphia Department of Public Health (PDPH), 95% of all licensed rental properties have been certified as lead-safe or lead-free since 2020. The city also provides resources for private homeowners to receive lead remediation funding through the Lead and Healthy Homes Program (LHHP).
While Philadelphia has been successful in reducing home lead hazards, the city has struggled to keep up with childhood lead screening recommendations. The CDC currently recommends to screen all children at age one and two for elevated blood lead levels. In 2021, PDPH found that only a quarter of children received the recommended lead screening by age three. The PDPH also reported that of those children screened, 3.6% were identified to have an elevated blood lead level greater than the recommended reference value. On October 28th, 2021 the CDC updated the blood lead reference value from 5.0 μg/dL to 3.5 μg/dL in order to identify and provide support to more children with lead exposure. In July 2022, PDPH expanded lead prevention and remediation services to align with the new guidelines.
With more conservative recommendations for both home lead remediation and childhood lead screening it is reasonable to ask; will the City of Philadelphia be able to maintain its success in home lead safety and what is needed to improve the city’s lead screening capabilities?
The City of Philadelphia has long struggled with maintaining an adequate number of building inspectors. Between 2019 and 2022 a third of Philadelphia’s field inspectors left the Department of Licenses and Inspections leaving the city reliant on external contractors to perform lead surveillance certifications. It took Philadelphia ten months to adopt the CDC’s new blood lead reference value recommendations. In New York City, there was a five-month delay until the city Board of Health adopted the new guidelines. These delays have been attributed to both bureaucratic complexities as well as health department limitations. Following the adoption of the new recommendations, the New York City Health Department said it expected a 50% annual increase in caseloads of children with elevated blood lead levels. In an already strained public health department Philadelphia will likely need to expand its inspector workforce to meet the increasing demand.
Philadelphia’s poor lead screening rate of 25% stands drastically below cities like New York City which had approximately 50% children tested at ages one and two. There have been two prevailing approaches to improving childhood lead screening rates: public awareness campaigns and clinical reforms. Public awareness campaigns focused on providing information regarding lead poisoning and the value of testing have been successful at targeting high-risk populations. Clinical reforms such as developing electronic medical record standard order sets have been proven to increase provider lead screening rates. In order for Philadelphia to adequately meet the need of the community a combination of both public campaigns and clinical interventions should be implemented.
The Pennsylvania House of Representatives recently passed Senate Bill 522 aimed at increasing access to lead tests for children and pregnant women. The act encourages providers to administer lead screening tests to children under 24 months old and pregnant women at risk for lead exposure across Pennsylvania. The implications of this policy will be far-reaching, leading to an increase in screening rates and thus subsequent caseloads for public health departments across the state.
The PDPH should welcome this policy as a means to further enforce a struggling screening recommendation. The city should use this momentum to establish benchmarks for targeted lead screening rates in the coming years. However, the PDPH needs to prepare for the inevitable uptake in home lead remediation cases across all zip codes in Philadelphia. A structured plan, including an estimation of increased rates and caseloads, should be developed to best assess the needs of the city. Through both appropriate adoption and enforcement of these new policies, Philadelphia will be able to not only increase childhood lead screening rates, but further strengthen the public health department for future health hazards.