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Childhood Lead Poisoning

A Perpetual Environmental Justice Issue?

Whitehead, LaToria S., PhD, MPH; Buchanan, Sharunda D., PhD, MS

Journal of Public Health Management and Practice: January/February 2019 - Volume 25 - Issue - p S115–S120
doi: 10.1097/PHH.0000000000000891
Practice Reports: Practice Full Report

As the amount of lead in the environment has significantly decreased with the removal of lead in gasoline and paint, the United States has made great strides in preventing lead poisoning or reducing levels of lead in young children's blood. Even so, lead exposure is not equal for all children—low-income and minority children continue to bear a disproportionate burden of exposure primarily through contact with deteriorating lead-based paint from older housing and potentially through drinking contaminated water resulting from failing leaded pipes, as evidenced by the recent events in Flint, Michigan. These facts suggest that childhood lead poisoning is an environmental justice issue worthy of public health consideration and action; “environmental justice” is focused on identifying and addressing disproportionately high and adverse effects of environmental hazards on low-income and minority communities. The question remains, however, as to whether addressing the quality-of-life “risk” factors associated with lead poisoning might eventually lead to reduction in exposure, as well as potentially resulting in adverse health effects. Utilizing an environmental justice framework and examining this issue through a multidimensional environmental justice lens, we contemplated the quality-of-life factors that may essentially predispose minority children and their families to lead poisoning. Specifically, we examined American Community Survey data (2012-2016) focused on comparing race/ethnicity with other sociodemographic variables known to be associated with risks for childhood lead poisoning. The results provide thought-provoking context for making progress toward eliminating lead poisoning as a major environmental justice concern.

Lead Poisoning Prevention and Environmental Health Tracking Branch, Division of Environmental Health Science and Practice (Dr Whitehead) and Office of Priority Projects and Innovation (Dr Buchanan), National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia.

Correspondence: LaToria S. Whitehead, PhD, MPH, Lead Poisoning Prevention and Environmental Health Tracking Branch, Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop F-58, Atlanta, GA 30341 (

The authors acknowledge Dr. Ginger Chew, CDC epidemiologist, for her contribution to the manuscript; Karna LLC contractors, Qaiyim J. Harris (senior business analyst) and Frederick Renshaw (project lead), for assisting with creation of the table included in the manuscript, and Dr. Vance Gray, Dean of the Division of Social Sciences at Atlanta Metropolitan State College, for assisting with the creation of the figure included in the manuscript.

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

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Lead and Environmental Justice

Exposure to lead can cause serious harm to a child's health. Even small amounts of lead can result in damage to the brain and nervous system, slowed growth and development, and learning and behavior problems.1,2 While there has been a significant reduction of lead in the environment over the past 40 years due to the removal of lead in gasoline and paint, millions of households with young children still experience high levels of lead.3 Many children, such as those in the recent Flint, Michigan, water crisis, tend to live in the poorest neighborhoods and are disproportionately African American and Hispanic.4,5 These conditions depict a modern day environmental justice issue likely facing similar communities and households struggling with compounded challenges of inadequate housing, unemployment, lack of access to health care, improper nutrition, and many other quality-of-life (QOL) issues that pose as risk factors for lead poisoning. Exposure to high levels of lead is entirely preventable and various conventional public health strategies have been undertaken to reduce children's lead exposure. This multifaceted, multisectoral issue may benefit from examination of utilizing an “environmental justice framework”—a multidimensional lens that allows public health officials and others to consider environmental disparities and QOL issues in a holistic fashion.6 This article examines lead exposure risks for racial and ethnic minorities as a result of concentrated poverty, unemployment, educational attainment, geographical inequities, and other sociodemographic factors that may potentially make a difference in eliminating lead as an environmental justice concern.

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The Environmental Justice Movement

The concept of environmental justice began as a movement in the 1980s stemming from the highly organized Civil Rights Movement of the 1950s, 1960s, and 1970s. The movement focused on achieving social justice, while also accomplishing political goals motivated by human rights, injustice, and alleviating the disproportionate burden of environmental hazards shouldered by people of color and low-income communities.7 Those involved in the environmental justice movement felt that a healthy environment was a necessary component of a healthy life and set out to ensure fairness among all people regardless of their background. At the First National People of Color Environmental Leadership Summit in 1991, the principles of environmental justice were broadened from focusing on disproportionate exposures to environmental toxins and pollution to include other social or quality-of-life issues, such as housing, transportation, employment, food access, inclusion, empowerment, and others.8 The intersection of social justice and environmental stewardship became a catalyst for environmental justice, and subsequently, government officials began creating policies to address environmental inequities and injustices. In 1994, the Clinton Administration issued Executive Order 12898, Federal Actions to address Environmental Justice in Minority and Low-Income Populations, requiring “federal agencies make achieving environmental justice part of their mission.” This included analyzing the environmental effects on human health, economic, and social factors.9 Later in 2011, the Obama Administration issued a Memorandum of Understanding to reinvigorate federal agency responsibility for achieving environmental justice.10

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The Environmental Justice Framework and Childhood Lead Poisoning

As the environmental justice movement emerged, a framework was created to address underlying causes that may contribute to and produce environmental inequities, applying a racial equity and social justice lens around environmental protection. This foundation is built on the principle that every American has the right to equal protection around laws and regulations for health, housing, transportation, employment, and the environment.7,11 The holistic framework seeks to prevent environmental threats before they occur, examining the built environment and its impact on public health, governmental policies, and private practices, while addressing institutionalized discriminatory practices. Academicians and community members created this framework that calls for government policy makers to adopt the precautionary principle, where scientific analysis shows the possibility of harm, and to make decisions that protect vulnerable communities.7,11

Lower-income households are often more exposed to job insecurity, unemployment, underperforming schools, noise, crowded homes, and lack of access to healthy foods and transportation (Figure).11 An environmental justice approach to childhood lead poisoning is a coordinated and comprehensive one that includes the creation of multilevel and multisectoral policies and partnerships. This includes the creation of jobs and job training; providing access to reliable transportation and food systems; providing safe, healthy, and affordable home ownership; and fostering ideas from those within and outside of low-income and minority neighborhoods to make a change.



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Exposure Sources

Historically, lead exposure has come from multiple sources, including manufacturing, lead-based paint, leaded gasoline, and leaded pipes used for drinking water. Lead-based paint and the contaminated dust in homes and soil are the primary sources of childhood exposure.3 Although lead-based paints were banned for use in housing in 1978, many US children today live in homes that were built prior to that time. According to Jacobs et al,12 the greatest risk for lead-based paint hazards occurs in older units with low-income families. Among the approximately 24 million housing units in the United States that have deteriorated lead-based paint and elevated levels of lead-contaminated house dust, more than 4 million are homes to 1 or more young children aged 1 to 5 years.3 Lead contamination in drinking water is also a major public health concern, as demonstrated in Flint, Michigan, that drew national attention to authorities' improper switching of water sources and treatment of old lead service lines. The US Environmental Protection Agency (EPA) estimates that roughly 6.5 to 10 million homes and buildings have service lines that are at least partially made of lead.13

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Exposure Disparities

Children are a particularly vulnerable population with respect to lead exposure because the developing brain is more susceptible to its effects than the adult brain. However, lead exposure is not equal for all children—historical evidence demonstrates that black children tend to have higher blood lead levels than white children.14 A recent study suggests that children with blood lead levels at or above Centers for Disease Control and Prevention's reference value are likely to be younger than 3 years, of non-Hispanic black race/ethnicity, and reside in lower-income households—thereby, pointing toward a classic environmental justice issue.15

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Lead Poisoning: A Multifaceted Issue

Lead poisoning is a multifaceted issue. The potential to avoid exposure to lead and its threatening, deleterious effects has been postulated to be particularly difficult for some minorities due to such circumstances as “racial residential segregation” and the complex issues that arise from it.16

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Racial residential segregation

Racial residential segregation, defined as the physical separation of racial groups through residential means, is a historical, systemic condition that has blighted the lives of many people of color for years.17–19 During the 20th century, most blacks were living in dilapidated housing in the worst areas of the cities, and due to the proximity of these areas to central businesses, many areas were displaced by clearance projects initiated by urban renewal programs.20 Many blacks were not able to afford housing options that were available to whites; therefore, public housing in neighborhoods overwhelmed with dilapidated public buildings, alcohol outlets, check cashing stores, fast-food services, unsafe roads, and disparate levels of environmental hazards such as lead poisoning was the only option. Thus, the QOL for minorities housed in these areas was impoverished, futile, and isolated from society.20

In 1933, a report was submitted to the Federal Housing Administration, created from the National Housing Act of 193421 by a consultant, offering his view on the most favorable racial populations to the least favorable to occupy areas for housing.20 In 1938, the underwriting manual for banks directed loan officers to avoid blending racially mixed neighborhoods:

Areas surrounding a location are to be investigated to determine whether incompatible racial and social groups are present, for the purpose of making a prediction regarding the probability of a location being invaded by such groups. If a neighborhood is to retain stability, it is necessary that properties shall continue to be occupied by the same social and racial classes. A change in social or racial occupancy generally contributes to instability and decline in values.20,22

By 1950, the Federal Housing Administration modified the underwriting manual to delete negative recommendations regarding racially mixed areas, but actions against these recommendations were not addressed. Title VIII of the Civil Rights Act of 1968 outlawed racial discrimination in housing, but many African Americans still faced discrimination.23 The redlining regime, in which red lines were drawn around neighborhoods considered poor investments, or lacking economic and social stability and thus risky for insurance companies, was another barrier for poor black communities attempting to acquire housing.23 Although the extent of racial segregation has declined in the United States, it remains higher for African Americans than for Hispanics, Asians and Pacific Islanders, and American Indians and Alaska Natives.17 Many researchers conclude that residential segregation is one of the fundamental causes of racial differences in health because of its connection to limited access to employment opportunities, education, nutritious foods, quality housing, and transportation.24–26

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Sociodemographic Data That Underlie Issues of Childhood Lead Poisoning

Utilizing the environmental justice framework, we focused on selected sociodemographic characteristics that typically surround childhood lead poisoning. We examined data from the American Community Survey—a nationwide survey conducted by the US Census Bureau every year to provide communities with demographic, social, economic, and housing data.27 Using 2012-2016 American Community Survey data, we tabulated percentages of US population and households by race/ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic/Latino) with selected sociodemographic characteristics: below poverty (percentage of total US population below the poverty level); unemployment (percentage of US population ≥16 years unemployed); educational attainment (percentage of US population ≥25 years as a high school graduate or higher, or bachelor's degree or higher); food assistance (percentage of US households who did and did not participate in the US Department of Agriculture Food and Nutrition Service's Supplemental Nutrition Assistance Program [SNAP]); and housing (percentage of US households owner-occupied vs rental-occupied homes).

In keeping with the conventions of the Census Bureau, unemployment was calculated as a number and percentage of the civilian labor force. Poverty was calculated measuring income thresholds that vary by family size and composition. When a family's total income is less than the family's threshold, every individual in that family is considered in “poverty.” Educational attainment refers to the highest level of education that an individual has completed. Food assistance, as a proxy for nutritional status, represents households participating in US Department of Agriculture's SNAP for low-income households as defined by the household's poverty level. Housing, as a characteristic, was viewed from an ownership perspective—whether a family lived in an owner-occupied house or rental housing.

As shown in Supplemental Digital Content Table 1, available at, selected Sociodemographic Characteristics of US Population and Households by Race/Ethnicity (2012-2016) shows relatively large differences in average percentages of minority non-Hispanic black and Hispanic/Latino populations in comparison with the majority non-Hispanic white population for all selected sociodemographic characteristics over the 5-year period.

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Percent below poverty

Based upon the American Community Survey (2012-2016), the average percentage of non-Hispanic blacks (26.3%) and Hispanic/Latino Americans (23.7%) below poverty level in the United States was more than double that of non-Hispanic whites (10.6%) (see Supplemental Digital Content Table 1, available at

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The average percentage of unemployed non-Hispanic blacks older than 16 years (15.3%) was more than twice that of non-Hispanic whites (7.3%) over the 5-year period. The average percentage of Hispanic/Latinos 16 years of age or older (10.5%) experiencing unemployment was also higher than non-Hispanic white counterparts (7.3%) (see Supplemental Digital Content Table 1, available at Unemployment contributes to poverty, yet individuals with higher-economic status tend to have better health.28 Racial/ethnic minority families who are poor have a higher risk for lead exposure.

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Educational attainment

The average percentage of the non-Hispanic white population older than 25 years attaining education—both graduating high school and receiving a bachelor's degree or higher, respectively 91.4%, 32.7%, exceeded the average percentage of non-Hispanic blacks (83.2%, 19.1%) and Hispanic/Latinos (64.1%, 13.9%) in this category as well (see Supplemental Digital Content Table 1, available at Higher educational attainment may provide an opportunity to gain quality employment.

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Households receiving food assistance in past 12 months

The average percentages of both non-Hispanic blacks (27.1%) and Hispanic/Latinos (21.3%) who received SNAP benefits in the previous 12 months of 2012 through 2016 almost tripled the percentage of non-Hispanic white households (8.5%) who received benefits during the same time period (see Supplemental Digital Content Table 1, available at Historical research has shown that healthy foods with calcium, iron, and vitamin C can mitigate lead exposure in children.29 Food assistance may be necessary for low-income and minority households to gain access to fresh and healthy foods in their neighborhoods. Since past research has demonstrated that low-income and minority households tend to have fewer supermarkets in their neighborhoods and less access to large supermarkets than their white counterparts, the lack of options can lead to nutrition disparities.30,31

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Housing (home ownership)

The average percentage of non-Hispanic blacks (58.1%) who occupied rented homes doubled that of non-Hispanic white households (28.6%), and slightly exceeded the average percentage of Hispanic/Latino households (54.2%) (see Supplemental Digital Content Table 1, available at

Many low-income and minority populations live in inadequate rental or public housing units with severe or moderate physical problems. According to a nationally representative random sample of housing units evaluated, 17% of government-supported, low-income housing had lead hazards, but 35% of all low-income housing had lead hazards.12 In a population-based survey that was a follow-up to the study by Jacobs et al, rental housing had a higher percentage of lead-based paint hazards than owner-occupied housing (25% vs 20%, not tested for statistical significance)32 (see Supplemental Digital Content Table 1, available at

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Although our review is limited by the availability of data that would have potentially allowed us to make correlations specifically for young children, overall, our findings suggest that QOL issues associated with disparate lead exposure risks tend to be unequally distributed across racial/ethnic and socioeconomic lines. Specifically, findings from Supplemental Digital Content Table 1, available at suggest that minority populations, particularly non-Hispanic blacks and Hispanic/Latinos, are more likely to live at or below poverty, be unemployed, and attain less education—both high school and college—than whites. In addition, Supplemental Digital Content Table 1, available at findings suggest that minorities are more likely to receive food assistance and live in rental housing than non-Hispanic whites, possibly due to racial segregation and other systemic social conditions. Future studies could further explore associations of children with elevated blood lead levels to income, unemployment rate, educational attainment, health care, and environmental infrastructure, including pre-1978 housing, access to transportation, nutritious foods, jobs, and racial segregation. Applying the environmental justice framework will provide a method to examine these disparities in a holistic fashion, beyond childhood lead poisoning.

In conclusion, our findings suggest that focusing on reducing disparities in socioeconomic circumstances could possibly lead to reducing disparities in lead exposure. Environmental justice calls for all to live in a healthy environment, free of environmental burdens, and free to be our best selves. To accomplish environmental justice is to examine the conditions that make up and affect humans' relationship to the environment, such as public health, income, employment, access to nutritious food, adequate housing and green space, and other quality-of-life issues. The environmental justice framework allows us to examine these issues in a holistic fashion, connecting one to the other, creating a multifaceted approach.

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Implications for Policy & Practice

  • Healthy People 2020 is a major public health planning initiative that seeks to eliminate lead exposure in young children.33 Specifically, the goals are to reduce the number of young children with blood-lead levels greater than or equal to the Centers for Disease Control and Prevention's reference value, as well as reduce mean blood levels overall.
  • Given the many facets of lead poisoning as an environmental justice issue, achieving these goals in the next few years will not be possible without the collaboration of everyone—local, state, and federal government, public and private sector partners, and everyday citizens who are concerned about justice for all. For example, a study of 2 states compared blood-lead levels among children. One state had a strict lead enforcement policy and the other did not. The odds of a child with blood-lead level of 10 µg/dL or greater were 4.6-fold higher for addresses in the state without strict lead enforcement, adjusting for factors such as income, race, and receiving public assistance.34
  • Our findings suggest that multilevel and multisectoral partnership and polices targeting job training, affordable housing, access to reliable transportation, and food systems may help reduce childhood lead poisoning in vulnerable communities.11
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childhood lead poisoning; environmental justice; environmental justice framework

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