The magazine of the UW School of Public Health

Download full issue PDF. Spring/Summer 2017
Volume 34, Number 1

Inside this issue


No Safe Threshold: Understanding and Preventing Childhood Lead Exposure

The UW Northwest Pediatric Environmental Health Specialty Unit educates clinicians, public health officials, and families to prevent childhood exposure to lead and other contaminants.

By Deborah Gardner

The UW Northwest Pediatric Environmental Health Specialty Unit educates clinicians, public health officials, and families to prevent childhood exposure to lead and other contaminants.

Reducing childhood lead poisoning is one of the last half-century’s largest public health achievements. However, eliminating its presence in children’s environments remains stubbornly difficult. Education and research can help, according to an evidence-based UW children’s environmental health training and consultation team.

Children in the Pacific Northwest are exposed to lead through a variety of sources, including old paint, dust, contaminated soil, solder in pipes, industrial air pollution, and unregulated imported products, including toys, cosmetics, pottery, or folk remedies. The places children live, learn, and play, such as older housing, backyards, or schools, can pose a risk. In 2016, high lead levels were found in the water supply of some neighborhoods in Tacoma, Washington. In Portland, Oregon, residents learned that Portland Public Schools administrators had suppressed information about lead in school water.

There is no safe level of childhood lead exposure. Research shows that lead can permanently affect cognitive and behavioral development. “We have to take lead out of the environment of children and remove exposure because current science suggests that damage to the brain or other health effects is irreversible and effective treatments for modest-to-low levels of exposure don’t exist,” said Catherine Karr, a Professor in the Departments of Environmental and Occupational Health Sciences and Pediatrics. “We need to focus our efforts on primary prevention to improve population health.”

Karr is also the Director of the University of Washington Northwest Pediatric Environmental Health Specialty Unit (PEHSU), which is part of a network of centers that respond to requests for training, referrals, evidence, fact sheets, and consultation about pediatric environmental health from Northwest clinicians, public health officials, and families. “There is an increasing amount of data on child health and environmental factors,” said Karr. “But sometimes it sits in academic journals and doesn’t efficiently get integrated into practice. Our network ensures that people on the front line of public health or clinics have up-to-date evidence-based information and can put it to use.” Lead is one of PEHSU’s most commonly requested topics.

Sometimes those requests are personal. Karr remembers a mother calling about a teenage son for whom blood tests revealed lead levels warranting immediate treatment and prevention of further exposure. “Finding the source of his exposure proved very difficult,” recalled Karr. PEHSU and the health department worked together, examining potential sources and sampling water, soil, and paint. They detected nothing. Karr suggested using X-ray fluorescence, or XRF, a lead-detecting technology, to examine everything in the child’s environment, even his clothes and bedding. “This is a great tool; you point it at something and get an immediate result,” said Karr. They aimed at a sheepskin rug he’d slept with for years. The XRF lit up. It was a humbling reminder that some exposures are atypical and hard to identify—or prevent.

PEHSU addresses various and cumulative children’s environmental health topics. The combined impact of multiple exposures and social inequities leave some children disparately affected by environmental agents such as lead and cadmium. PEHSU addresses contaminant concerns in the context of a child’s overall health status and environmental conditions.

Paying attention to lead can help bring to light concerns about other toxicants. This happened in Portland’s Multnomah County, where leaders sought PEHSU’s help responding to concerns about cadmium and other pollutants—while simultaneously the city was in the news about lead in school water. Paul Lewis, MD, MPH, Multnomah County Health Officer, found PEHSU’s support essential. “We leaned heavily on them as a regional resource,” said Lewis.

Between February and June 2016, Multnomah worked with PEHSU to respond to heightened public concern about cadmium, arsenic, and air pollution. This reflects something PEHSU emphasizes about successful evidence-based practice: a single training or contact often isn’t enough.

PEHSU kept doctors and the public informed, releasing clinician updates about air pollution and heavy metal exposure. “They provided critical guidance on how to navigate through this and offered information to families and to doctors,” said Lewis. Karr presented to medical providers and collaborated with other advisers and toxicologists. “We were able to publish PEHSU’s contact information in all of our communications so that if clinicians or families had concerns about their test results they could get expert individual-level consultation,” said Lewis.

This shorter-term work contributed to systems change. Multnomah’s attention to cadmium and lead prompted Oregon to implement Cleaner Air Oregon, an initiative to establish statewide health-based environmental standards.

Momentum on lead prevention continues. Healthy People 2020 seeks to reduce child blood lead levels. In Washington State, Governor Jay Inslee issued a 2016 directive to increase lead screening and reduce exposure. The Department of Health established evidence-based recommendations for preventing, testing, and reporting children’s blood-lead levels. Karr hopes to see clinicians versed in these guidelines—and state and local health departments equipped to track lead exposure through blood-lead data, and respond when problems are discovered. Many entities will need to play a role, and PEHSU is ready to help.