Getting the Lead Out

Jordan April is establishing a national database that will empower residents facing health concerns about lead exposure in their homes.

Jordan April at UNC's law library
Master's student Jordan April studies lead exposure in homes and is developing a database of state laws to help people exposed. (photo by Alyssa LaFaro)
April 13th, 2023

It was a hot summer day in Syracuse, New York, and once again, Jordan April found herself holding her breath as she looked at the building in front of her. Nothing about the situation was new: the sweat on her brow, the heat radiating from the blacktop, her concern mirrored on her companion’s face. The home they approached looked almost apocalyptic. Some of its windows were broken. Its roof was sagging.

For April, this sight had become routine. She hoped this one was a land bank property, owned by a local non-profit organization to redevelop the estate to community standards. She whispered the same familiar prayer: that no one lived here, that no one could live here for someone else’s profit. She was usually wrong.

That was 2018, when April spent her summer in Syracuse working on landlord-tenant cases for the underprivileged. She interviewed people seeking legal aid and helped establish a grassroots campaign to combat lead poisoning in the city. Most of the people who find themselves in landlord-tenant court don’t know their rights. Oftentimes, they can’t seek legal aid until the day of the trial.

April would learn about these tenants’ situations to assist the legal aid attorneys doing pro bono work. During that time, a number of cases focused on the same thing: lead.

According to the Centers for Disease Control and Prevention (CDC), children exposed to lead can experience brain and nervous system damage, slowed growth and development, and issues with learning, behavior, speech and hearing. Exposure can occur from paint in homes built before 1978, water from lead pipes, contaminated soil, or certain goods such as toys, candies, or jewelry.

There is no blood lead level found to be safe, but the CDC identifies 3.5 micrograms per deciliter as the blood lead reference value as of October 2021. This number represents children in the 97.5th percentile of blood lead distribution for children under 6 across the United States.

The agency estimates that approximately 500,000 children across the United States have a blood lead level at or above the reference value.

While that summer in Syracuse eventually ended, April’s work with lead didn’t. She continued doing projects and conducting research on the prevalence of lead in American housing. That journey took her to the National Center for Healthy Housing (NCHH) and to UNC-Chapel Hill, where she’s currently working on a dual master’s degree in city and regional planning and public health. Along the way, she realized how pervasive the problem is — and how little is being done to prevent it.

“There are very limited centralized sources of guidance for what the states are doing,” she says. “The CDC does provide recommendations for case management and the medical side. The Department of Housing and Urban Development has one chapter on how to inspect a home of a child with elevated blood lead levels. But that’s really the only guidance that exists.”

She decided to change that.

Reading between the lines

Last year, April had the chance to work with NCHH once again, for her public health practicum at Carolina. The NCHH had a table from 2020 detailing each state’s lead testing and case management protocols. Case management occurs when an elevated blood lead level is found in a child. It usually entails lead poisoning education for the parents and an interview about what the potential exposures could be. Follow-up testing is usually performed to make sure the child’s blood lead level is decreasing, indicating an end to the exposure.

In 2021, the CDC changed the national blood lead reference value, the number used for many states as the threshold for case management implementation. NCHH asked April to create an updated table, showing how states have adopted the new guidelines. It was during this project that she noticed an even larger gap: There was no existing database for environmental testing.

Like almost all lead protocols, screening and testing procedures vary based on the state. Testing recommendation protocols can even differ based on the zip code. If a child is discovered to have lead poisoning, case management is the first step. In several states, it occurs when the blood lead level of the patient is at or above the reference value.

The additional and more comprehensive step of environmental investigation occurs when a child’s blood lead level is severely elevated, such as 10 or 15. In this case, an inspection is initiated at the child’s home to search for the lead source and remediate it.

“One of the biggest things is making sure it doesn’t happen again,” April stresses.

Jordan April

Jordan April (photo by Alyssa LaFaro)

Environmental investigations also vary state by state. This includes what triggers an investigation, what is tested, and who pays for and performs the remediation. The variance makes it hard to keep track of the specific lead protocols for each state.

When you’re dealing with blood lead levels this high, lives are on the line, and it’s important to make sure it’s being handled correctly. While working at NCHH, April realized it was virtually impossible for states and localities to be held accountable.

The last time any study has been done for this is in 1999,” she says. “That’s the only study that exists at all that I’ve found. There is a large gap in the literature for analyzing whether or not these protocols are effective, what the results are, and how well states are doing in completing these things.”

Creating a nationwide database

April dove right in, searching in every place she could, trying to compile a comprehensive resource for each state’s environmental investigation protocols. But she quickly realized she had to narrow down her initial study to only 15 states — for her master’s project at least.

“That enables me to go far deeper in what each state’s laws and administrative codes are for what is required to be tested, what results will trigger action, and any guidance for workers.”

Her search has been frustrating. Looking from the outside, there is a severe lack of information on what guidelines states implement. When April can find what she’s looking for, it’s typically the bare minimum.

“They only adopt by reference whatever the current federal regulation is,” she says. “States aren’t very motivated to alter their guidelines below the federal government. And usually, they only have to be at the federal government level because that’s what they need to be at to receive federal funding.”

While April’s work now may be constrained by the time and access afforded to a master’s student, her ambition has not been curbed.

“I want to cover all 50 states because that can show variance in what these programs look like, and at the federal level, what further strategy needs to occur in order to better these programs.”

If April achieves her goal, it will change the future of lead safety policy. A database providing information on each states’ environmental investigation protocols would not only create a new centralized resource, but a robust instrument of accountability.

“A state-by-state database allows experts to know which states are doing what,” she says. “This can inform states in their own policy revision and creation.”

Access to this information will enable lawmakers to see what their state is doing well and where they need to improve. If an official can see how other states operationalize screening and investigations, it will hopefully motivate them to work for change in their own state. This kind of reference and accountability aids federal agencies, too. The CDC has already taken an interest in April’s work.

“Last year, I showed my findings to the CDC lead branch,” she says. “I picked out why testing rates are so low. Where can the CDC strategize and further improve lead response and lead management recommendations for the states to follow through with?”

The database she’s creating will answer this question and act as a guide for the CDC, allowing them to enact targeted policy recommendations, filling gaps in protection found at the state level.

Additionally, public interest attorneys, like the ones April was working with back in Syracuse, will be able to use the database to easily find the guidelines implemented in their state. If protocols weren’t followed to properly protect a client, it will be more obvious than ever. The lawyer won’t have to go searching through a messy lead policy — because April will have already done it for them.

Having peace of mind

April’s ideas aren’t limited to just a database. She is already thinking about what comes next.

“I think there needs to be a perspective shift on how lead-safe housing is established and enforced,” she says. “Currently, the system is largely responsive — it waits for a child to be poisoned before any action can take place. The best policy that is being utilized in some cities throughout the U.S. is proactive rental inspection.”

Proactive rental inspections require an examination of any property to deem it safe from lead contaminants before it can be inhabited. This requires builders, landlords, companies, and cities to all be responsible with their properties.

Additionally, April clarifies that remediating housing already contaminated with lead is not typically invasive. Most of the time, temporary relocation isn’t required, and when it is, it’s usually short term.

“Thankfully, there are accessible and relatively affordable solutions to bring properties up to code.”

In a beautiful way, April’s work brings her right back to that hot Syracuse summer. The reason she was visiting so many houses? That grassroots campaign she was working so hard to start? All of it was a call for the city to implement proactive rental inspection.

April hopes that eventually, there will be certainty that no home can poison a child — because the hazards will have already been remediated.

Jordan April is a dual master’s student in the Department of City and Regional Planning within the UNC College of Arts and Sciences and in the Health Equity, Social  Justice, and Human Rights (EQUITY) concentration within the UNC Gillings School of Global Public Health.