Bayview's Jesus Garcia has a son enrolled in a local Head Start school, but has never heard that he should ask his son's doctor to check for lead poisoning. He's not alone. Neither did half of the other parents informally surveyed in front of Head Start schools in the Bayview Hunters Point on a recent weekday afternoon.
Children who live in poverty or near the poverty line, such as those who take advantage of programs such as Head Start, are eight times more likely to be poisoned by lead compared to children from affluent families, says Jane Malone, a project manager with Alliance to End Childhood Lead Poisoning, a national advocacy group on the issue.
Lead poisoning causes serious and permanent damage to children's brain and nervous system. It has been linked to learning disabilities, reduced I.Q., organ damage, aggressive anti-social behavior and attention-deficit disorder in children. All of these factors can directly influence how well the child will do in school, and as an adult later in life. This is the number one environmentally-caused disease in children, according to the federal statistics, and it is 100 percent preventable.
Lead poisoning is a significant problem in San Francisco, particularly in low-income neighborhoods where interior and exterior paint has been poorly maintained for buildings built pre-1978 when lead was a significant ingredient in paint. A 1998 survey conducted by the city health department estimated that 14 percent of 1-year-old children in the Bayview Hunters Point who had been tested had lead poisoning, according to Healthy Children Organizing Project (HCOP), a local advocacy group on environmentally-related childhood diseases. That is a rough estimate, since few children are actually being screened. African-American children are among those least likely to seek screening, according a 1997 San Francisco Department of Public Health report. Of those screened, only 14 percent were African American. Latinos comprised 42 percent of those screened; Asians comprised 34 percent of those screened. Only 10 percent of the screenings were of Caucasian children.
According to a San Francisco Department of Public Health 1998 report, 61 percent of the children living in the Bayview Hunters Point were eligible for Medi-Cal. All children receiving Medicaid should automatically be screened for lead poisoning, but only 35 percent of those children actually are, according to that same report.
Preliminary data from an unreleased 2002 report shows that San Francisco is doing only slightly better at closing the gap. Data from the draft report of the Director of Health's Report on the Comprehensive Environmental Lead Poisoning Prevention Program for San Francisco (also known in shorthand as the "1609 Report", after the city health code, Article 26, Section 1609, it falls under) says that 50 percent of Medi-Cal recipients haven't received their first lead test by the time they were 2 years old. Nationally, 8.5 percent of child Medicaid recipients have lead poisoning exposure, according to a national survey cited in the city report.
While Medi-Cal recipients are entitled to lead tests, they are not mandatory. However, parents should demand that they are performed on their children early, say child health experts. To see if a child has lead poisoning, all that is required is a simple blood sample. However, doctors are not automatically performing lead tests as required by the state 1991 Childhood Lead Poisoning Prevention Act, which says that any child whose family income is less than 200 percent of the poverty level (less than $36,200 per year for a family of four) should automatically be screened for lead poisoning at age 1 and 2 years old.
"There's not much teeth for me in that arena," says Karen Cohn, program manager of Children's Environmental Health Promotion Environmental Health section of the health department. "We don't regulate how Medi-Cal is compensated. Nobody wants to punish doctors. Nobody wants to create disincentives for doctors to treat poor people. We have sent a letter to every family clinician in the city on record to update them about the new lead-poisoning prevention mandates, and we will continue to offer resources to health care offices to accomplish this goal."
California Department of Health Services, the agency that oversees healthcare of all children in the state, lost a lawsuit in December, 2000 for failing to enact regulations requiring doctors to test children for lead poisoning, as mandated by the 1991 statute.
"Something is terribly wrong with our public health system when protecting children from totally preventable diseases is not among its highest priorities," said Neil Gendel, director of the Healthy Children Organizing Project, the lead plaintiff in the lawsuit against the state. "It is too late for thousands of children because of the Department's failure to act, but it is not too late for thousands of others if the Department acts effectively and acts now."
The state Department of Health Services is currently drafting guidelines to distribute to all healthcare workers, to ensure that all lead-poisoning vulnerable kids in California are identified and screened, to comply with the California Superior Court's judgment. "The children that would have [lead poisoning] would be our population," says Jayne Garcia (no relation to Jesus Garcia), the health services manager for San Francisco Head Start.
Head Start in San Francisco currently requires children to be tested for anemia and tuberculosis before they are enrolled, but lead poisoning tests are not.
"We make [specific health tests] mandatory based on what the state and city requires," Garcia continued. "We teach parents to advocate on their child's behalf, but even so, they miss things. About a quarter of the parents have to go back to the doctor get the anemia test done."
Garcia says she will revisit the issue of required lead testing in the next quarterly policy meeting, scheduled for February, to see if lead testing should be required for all Head Start students, which serves children aged 3 to 5 years old.
The number one cause of lead poisoning of children is from lead-based paint, and contaminated dust and soil found in older homes, according the San Francisco Department of Public Health. As of 1997, 94 percent of the homes in San Francisco were built before 1978 when lead was an ingredient in paint. Of that, 68 percent of those homes were built before 1950, when house paints contained as much as 50 percent lead.
The danger is when paint is deteriorating and cracking, creating flakes of paint that can come in contact with children's skin, or can be ingested by hand-to-mouth contact. Painted windowsills, with the natural friction of opening and closing the window, is a particular pernicious source of lead dust. Lead dust can stick to children's hands and toys that they can put in their mouth.
"If the paint is intact and in good condition, leave it alone," advises Linda Salas, building manager with the Mayor's Office of Housing, an agency that was awarded $2 million dollars from the Office of Housing and Urban Development to remediate lead hazards for low-income homeowners and housing that serves low-income people. "Lead is not a hazard unless it is airborne."
Lead paint can never be completely eradicated, said Salas, only stabilized so that it no longer causes a threat. Eventually, lead from substrate layers of paint will leach through to new paint coats. However, as long as the paint is smooth, and not cracking, it should not be a significant health threat, she said.
Other ways to protect people from lead paint exposure is to erect a barrier against the painted surface. For example, if the floor was previously painted with lead-based paint, cover it with tile or linoleum. Old walls can be enclosed in new drywall.
"The important thing is to work safely," says Jane Malone, project manager of the Alliance to End Childhood Lead Poisoning. Routine home maintenance work needs to be done safely, or we're not going to solve this problem."
Other sources of lead poisoning include foreign ceramics that may have used lead in the glaze. Also, traditional foreign folk remedies can be a culprit. Alkohl, alarcon, azarcon, bala goli, coral, chasard, greta, kandu, kohl, luiga, maria luisa, pay-loo-ah and rueda all contain lead and should be avoided.
"I know that azarcon and greta are used in Mexican home remedies for stomach aches, and contain as much as 80 percent lead," said Salas. "Lead numbs the nerve endings in the stomach so the child gets immediate relief, but of course we know the damage inflicted is much worse than a stomach ache."
By kids being exposed to lead poisoning, it is setting them up for academic challenges later down the road. Lead poisoning has long-term effects on how able the child will be as an adult. Learning disabilities, lowered I.Q. and anti-social behavior makes it more difficult for the child to learn and to be taught in a normal classroom setting.
"Research shows that getting kids on the right track [educationally] makes a difference in what they become in as adults," says Brian Lee, California policy director with Fight Crime: Invest in Kids, an organization dedicated to reducing crime by investing in child-related activities. "Kids who do better in school are the kids who are less likely to get in trouble with the law."
"Symptoms of lead exposure are not always immediately apparent; regular screening and early diagnosis are the most important means to minimizing damage," according Michael Keys, attorney with Bay Area Legal Aid, and one of the attorneys involved in the lawsuit against state Department of Health Services, in a statement.
"It's much better if we can prevent kids from getting poisoned in the first place," says Gendel. "Testing kids just finds the canaries already in the coal mine."
One of the easiest ways to prevent lead poisoning is to wash your child's hands and toys often with soap. To remove lead dust inside your home, wet wipe windowsills, damp mop floors and wash or steam-clean rugs on a regular basis. Good nutrition can also help reduce lead poisoning. Foods with calcium, iron and vitamin C can help protect from absorbing lead into their bloodstream.