While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
The Problem: Thousands of Baltimore children were exposed to—and poisoned by—lead in their own homes, but cleaning up conditions meant taking on landlords with lots of political clout.
Grantee Background: During childhood visits to her grandmother’s New York home, Ruth Ann Norton would draw sketches of dilapidated houses—with ways to improve them. “I wanted to make communities better,” she recalls. “I never understood why houses had to be in poor condition.” Later, as a young investment banker in Baltimore, Norton got interested in community re-development, supporting groups trying to get guns off the streets.
She enjoyed a lot of professional success, very early and very fast. But ambition got the best of her. Norton was convicted on a wire fraud charge, and served 10 months in federal prison. The experience gave her pause. Upon her prison release, Norton considered moving to a city where no one knew her, but decided to return to Baltimore. “I think people do have to take responsibility,” she says. “I didn’t want that to be the chapter written on my life. It is not the character or the values of how I was brought up.”
Looking to make a contribution to the community rather than return to the financial world, Norton called a friend who was then chairman of the Enterprise Foundation, a national nonprofit organization for community development. When her friend called back, he launched into the issue of Baltimore’s lead poisoning problem. As it turned out, he thought he was calling a different person: Ann Norton, chief of staff in U.S. Sen. Barbara Mikulski’s office. “But what he was saying really piqued my interest,” Norton says. “I was floored to discover we had 15,000 kids in Maryland getting poisoned by something that I thought was history.”
In 1993, a small volunteer organization, the Coalition to End Childhood Lead Poisoning, had just secured its nonprofit status and was looking for an executive director. Norton went for an interview wearing a business suit, only to find the staff in jeans. Despite the odd start, she got the job, and spent her first week walking through West Baltimore, talking to parents. “They could tell me the lead rates of their children and who was treating them, but it was kind of accepted that lead would be pervasive and the lead poisoning rates would be high,” she recalls. “It was morally outrageous to me.” The residents said they were afraid to complain about their houses, because if they told their landlord that their child had lead poisoning, they would be evicted and out on the street.
At that time, the city health department was dealing with thousands of cases of lead poisoning in children—but only after their lead levels reached 45-65 (the U.S. Centers for Disease Control and Prevention today puts the danger level at 10). “The health department was not forcing housing to fix the problem,” says Norton, “which struck me as stupid and clearly unjust.” So she and her colleagues went to every clinic in the city, asking them to refer children with elevated blood levels to them with the promise that the Coalition to End Childhood Lead Poisoning would help secure repairs to the contaminated houses. “That was a wake-up call for the health department,” Norton says. “It was an embarrassment to them. You have 40 people on staff, and they can’t get out and do this? The department changed its policy after that.”
Tackling the lead problem meant taking on a politically entrenched group of rental property owners and their allies in the state Legislature. To do so, Norton took a page from their book: “Make sure your data is the best, make sure your message is clear, and make sure you stay on message. They were focused on what it cost them and their business. Our business was around kids and we had standards we wanted met.”
One way she began to win over legislators was to frame the cause as a workforce issue—children with physical and cognitive impairments will not grow up to be productive workers; in fact, their disabilities will make them a drain on scarce community resources.
In 1994, the state Legislature passed a major piece of legislation to stiffen enforcement of lead abatement, followed by 16 other laws to empower people to deal with housing issues. By 2003, the work of the Coalition to End Childhood Lead Poisoning was credited with achieving a 97 percent decrease in childhood lead poisoning in Baltimore, and a 94 percent decrease statewide.
In 2005, the Robert Wood Johnson Foundation named Norton a Community Health Leader for her steadfast work to engage the community and city and state government to eliminate the problem of childhood lead poisoning from housing.
Results: The coalition’s work has been featured in the media, including a five-day series in November 2007 on the CBS Early Show, which told the story of Jamia Handy, a 26-year-old nursing student whose baby girl was admitted to the intensive care unit with a lead level of 82 shortly after the family had moved to a nice house in Northeast Baltimore.
The problem? Friction from opening and closing the windows was producing lead dust, a powerful reminder that visibly dilapidated houses are not the sole culprits. The coalition is now partnering with other organizations in dealing with other environmental hazards—mold, toxins and airflow—that cause health issues such as asthma. Now, when a crew is called in, it looks at the total environmental health of a house and addresses all issues together.
“If you applied common sense and basic justice to our health issues, we could tear down a lot of barriers and get away from wasting a lot of money after the fact,” Norton says. “Then we could really make change.”
RWJF Perspective: Since 1993, RWJF has recognized unsung and inspiring individuals who work in their communities—often among the most disenfranchised populations—to address some of the nation's most intractable health care problems. Formal recognition by the Foundation of these and their programs often launches them to greater levels of influence and extends their reach to serve more vulnerable populations.
RWJF provides a financial award to 10 individuals and their organizations each year, and connects the with one another so they can build their programs upon the wisdom and experience of their peers and previous award winners.
“Community Health Leaders are characterized by three specific traits—they are courageous, they are creative and they are committed,” says CHL National Program Director Janice Ford Griffin. “The Foundation recognizes the tremendous resource of experiences among the Leaders and we look forward to mining that resource as we consider future initiatives.”
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