Over the past decade, childhood lead poisoning rates have declined in Philadelphia and across the nation. As a result, people seem to have stopped paying attention, however the problem has not gone away. It received new visibility from two recent articles in the Philadelphia Inquirer that highlighted its magnitude and the need for legislative action. Yet, the "urgency" of making Philadelphia lead safe is not "new," it is enduring.

Philadelphia used to be one of the most progressive cities when it came to lead safety. In addition to establishing the country's first Lead Court in 2002 and passing the 2012 lead law which holds landlords accountable for ensuring rental properties are lead safe, Philadelphia's Department of Public Health (PDPH) Childhood Lead Poisoning Prevention Program (CLPPP) was also overseeing one of the country's most innovative and successful lead poisoning prevention action plans.

A critical piece of CLPPP's overall city-wide strategy to prevent lead poisoning was the Lead Safe Babies program.  Administered by non-profit partner the National Nurse-led Care Consortium (NNCC), an affiliate of Public Health Management Corporation, and funded by the Centers for Disease Control and Prevention and other federal agencies, Lead Safe Babies offered low-income pregnant women and mothers in-home lead safety education and lead dust wipe testing to determine if dangerous levels of lead were present in the home, along with simple supplies to prevent children from ingesting lead paint dust, the city's most common lead hazard.

From 2002 to 2011, Lead Safe Babies staff at CLPPP, NNCC and other subcontracted agencies provided over 10,000 families with in-home lead poisoning prevention education, home assessments and lead testing. In 2005, the U.S Environmental Protection Agency highlighted Lead Safe Babies as a national best practice for the prevention of lead poisoning by awarding the program its Children's Environmental Health Award. Perhaps the most important legacy of Lead Safe Babies was that it promoted a model of lead poisoning prevention where children did not need to be poisoned before they could receive services.

However, as rates of lead poisoning went down, so did funding to support lead safety education and remediation. For several years, CLPPP did not receive any CDC funding and when funding resumed in 2014, it was a quarter the amount it had been.  Some primary prevention programs like Lead Safe Babies were discontinued due to lack of funding.

NNCC still offers limited environmental home visiting services through its state-funded Safe and Healthy Homes program, but it can only educate a few hundred families per year.  And PDPH, due to funding cuts, can only provide limited lead-specific services, mostly after harm has been done to a child.

NNCC's Philadelphia Nurse-Family Partnership (NFP), a program serving over 600 low-income first time mothers, focuses on providing families comprehensive nurse-led home visiting services that promote maternal and child health, improve health outcomes and enhance self-sufficiency.

Philadelphia NFP routinely refers families to NNCC's Healthy Homes program but has recently been able to turn to a new resource to ensure that families can keep their children safe from lead: lawyers. A key goal of its Nursing-Legal Partnership—a program that combines the NFP model with aspects of the Medical-Legal Partnership (MLP) approach—is to improve housing conditions. Nursing-Legal Partnership lawyers embedded with NFP work with NFP nurses to screen clients and families for legal issues. When lead-related issues arise, the lawyers advocate for families in housing court, work with the City's Licenses and Inspections Department, and negotiate with landlords to protect tenant rights. For example, tenants cannot fine landlords for not complying with the 2012 lead law, but they can withhold rent without being evicted if lead issues are not remediated.

The fight to make Philadelphia lead safe for children cannot succeed if it relies on the courts, or continues to have limited resources. Philadelphia's housing stock continues to age, and the city's lowest-income children are at the highest risk. The city needs resources to enforce its laws. Residents need advocates to assert their rights. Landlords need to recognize their role in keeping our community healthy.

Funding levels for lead poisoning prevention services, like Lead Safe Babies, should be restored.  The effort to prevent lead poisoning needs to be both cross sectional and interprofessional. The only way this will happen is if city, state and federal policymakers ensure that preventing childhood lead poisoning remains a priority even after the headlines fade. Philadelphia's children deserve as much.


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