Philadelphia Lead Court ‘Gets the Lead Out’ of Older Homes

May 6, 2013, 12:20 PM

file Carla Campbell, School of Public Health at Drexel University

While residential use of lead-based paint has been banned in the U.S. since 1978, millions of homes still have the paint, and the health dangers it brings with it, on their walls. Lead paint has been linked to cognitive and behavior issues as well as anemia and even death, especially in young children because their brains are still developing. But according to the Centers for Disease Control and Prevention, about half a million children ages 1 through 5 have potentially dangerous blood lead levels.

In Philadelphia, according to the 2009 American Housing Survey data, 91.6 percent of the housing units were built before 1978. Exacerbating the issue, close to 30 percent of families live in poverty, which can delay household maintenance and lead to peeling paint—a major lead risk to children in older homes. Studies also show that the number of children in Philadelphia with elevated blood levels is higher than the national average.

“This problem requires a public health solution since [preventing childhood] lead exposure...involves multiple stakeholders, including the child and parents, the property owner, and the local authorities who make and enforce laws, ordinances and codes,” says Carla Campbell an associate teaching professor in the School of Public Health at Drexel University. Campbell is the author of a new study on a lead court established in Philadelphia in 2003. The lead court is designed to speed the cleanup of lead hazards in apartments and rented homes. Campbell’s research was funded by the Public Health Law Research, a project of the Robert Wood Johnson Foundation, based at the Temple University School of Law. Campbell’s study appears in a special issue of the Journal of Health Politics, Policy and Law focused on public health law research.

NewPublicHealth recently spoke with Carla Campbell about Philadelphia’s lead court and the implications of its success for other public health issues.

NewPublicHealth: What did your study find?

Carla Campbell: We looked at the improvements in lead remediation in homes before and after the [Philadelphia Lead] Court was established. We found that five years after the court was in place, there was an eight-fold improvement in home lead remediation. We think the lead court could be replicated in other cities with similar enforcement problems.

NPH: What were some of the key features that made the lead court so successful?

Carla Campbell: Philadelphia did not have a formal system for dealing with people who were not following health department orders to improve the lead situation in a home. The city would send out letters and emails and homeowners were typically unresponsive. And the health department alone didn’t have the clout to hold the homeowners accountable. While occasionally the health department might do the remediation itself, it wasn’t funded to do that in many cases. By 2002, there was a backlog in the number of properties that had been identified with lead hazards. At that point the health commissioner created what was called the Philadelphia Lead Abatement Strike Team, a multi-departmental taskforce that convened representatives from the key city departments and agencies.

By talking through the problems, the determination was made to create a special court that would have judges and other staff educated about childhood lead poisoning, how it’s prevented and remediated, and the repercussions for a home that has been identified with lead hazards.

What I think made it successful is that these property owners were finally held accountable by a judge. To be compliant with the judge's orders seemed to be of a higher order than the health department orders to do the remediation. The judges were also able to levy fines for noncompliance. The court provided an alternative setting where there were more sticks, so to speak, and a few carrots such as wanting to stay in good faith with the law.

NPH: What models did Philadelphia draw on in order to help create a successful program?

Carla Campbell: There was a tuberculosis court in the city, though that was a much easier health problem because non-compliant people who came before the court would be sent to the hospital for treatment. With the lead issue, you’ve got the landlord, you’ve got the city, and you’ve got the family of the child. There are more stakeholders in the process. But I think the city used that model. And we did find a model for a lead court in Chicago and, Ohio, though I’d say that the TB court served as the strongest model for the idea that you were going to convene a court to deal with a specific public health problem that needed that degree of authority.

In the course of my research I’d learned about other specialized courts. Successful ones have been around issues including mental health issues, family, drugs, domestic violence and one that deals with people who drive under the influence. I could see courts being helpful for other housing-related issues such as asthma triggers that need to be remediated in order to improve the health of family members.

NPH: What else is needed to reduce the health issue of lead contamination in homes?

Carla Campbell: Ideally, we would prevent children from being exposed to lead in the first place. We do know that the adverse effects, for the most part, can't be reversed.

The reason kids are at so much risk is that they are typically have so much hand-to-mouth activity that doesn’t abate until about three or four years of age. And so if they're touching floors or windowsills or banisters or porch rails with lead-contaminated house dust, and then touching their hands to their mouths hundreds of times a day, they can ingest very small quantities of lead. If that continues day after day, they can build up a burden of lead.

The Centers for Disease Control and Prevention has been calling for earlier lead poisoning prevention since 2004 or so. The recommendations have been to screen high-risk housing. The older the housing, typically the more concentrated the lead paint. And properties in deteriorating condition are more likely to have paint chipping and peeling, which can become house dust kids breathe in. We need to get rid of some of the worst of the housing by demolishing the houses. They cause a lot of lead exposure in the meantime.

This commentary originally appeared on the RWJF New Public Health blog.