On June 10th 2024, Mark Walters at the York Dispatch published York County among top statewide for child lead poisoning, forcing a public reckoning.24 The article advances the conversation around lead poisoning in York City—a problem that lead-free advocates have long been discussing.
Lead poisoning should not just be a concern for children and parents; it should be a concern for the entire community.
Why is it important to increase lead testing in York City (and the County)? Due to York City’s older housing stock, increased lead testing is especially important. Many of the houses in York were built before 1978, meaning that lead paint may be more likely to be present and exposure risks are high (see Figure 3).23 Before 1978, lead paint had been used for painting walls, windowsills, and trims. Lead paint was heavily advertised from 1920 to the 1970s despite evidence of adverse health effects. The National Lead Company, which produced lead paint, created many adverts that illustrated lead paint as a “healthy” option for homes. In fact the company went as far as to promote lead paint for children to use with their mascot being a young “Dutch Boy.”15
Advertisement from 192615
Advertisement from 192815
By the 1970s, the US Department of Health began to publish about the dangers of lead paint; however, this was far too late. The use of lead had already become widespread, with lead paint prominently used in homes, on children’s toys, and in schools. One explanation for this delayed action was due to the Lead Industries Association (LIA), which consisted of major lead companies, lobbying and publishing propaganda. The LIA accused parents of children experiencing lead poisoning and blamed “slum” conditions for flaking paint. This propaganda pinned the issue of lead poisoning on the victim, rather than on the toxic lead. Independent researchers, advocates, and state/local governments were much faster to spread the word about lead poisoning, with research being conducted as early as the 1900s and state publications in the 1940s.12
Earlier this year, Bill Swartz, a longtime housing advocate and vocal large-scale lead abatement proponent, expressed his concerns about lead poisoning on York City youth in an opinion piece for the York Daily Record.21 Additionally, formal advocates like the Lead-Free Promise Project, founded in 2021, have galvanized organizations throughout the state to work towards three main goals: (1) Get lead out of homes, (2) Guarantee all children get tested twice for lead at ages one and two, and (3) Ensure all poisoned children are referred to Early Intervention services.8
What is lead?
Lead is, simply, a naturally occurring metal that is toxic to humans. Lead poisoning occurs through lead exposure of lead in any form. Common forms of lead exposure include lead paint, lead pipes, and lead dust contaminants, all of which can lead to lead poisoning.25 According to the World Health Organization (WHO), the two most common paths of lead exposure are through inhalation and ingestion. Inhalation of lead can occur by airborne dust and particles from burning lead.25 Ingestion of lead occurs from contaminated water, food, accidental eating of dust or paint chips, and hand to mouth behaviors.25 Due to these routes of exposure, young children are more likely to ingest lead than older children and adults. The reason for this increased risk is linked to common childhood behaviors such as crawling, hand to mouth behaviors like thumb sucking, and the tendency to put non-food items into their mouths. According to Marilou Yingling, Childhood Lead Poisoning Prevention Coordinator at City of York – Bureau of Health, the most common source of lead in York is peeling paint in structures that pre-date lead legislation enacted in the late 1970s.26 Yingling shared that, in her experience, many children in York with elevated blood lead levels have ingested paint chips, often from window sills or other structures in and around their homes.26 One initially puzzling case found that a set of siblings was being exposed by paint chips from an old garage while playing in an alley.26 These sources can often be difficult to identify and remediate, especially in a city like York which has so many older structures and homes throughout the city.
The negative effects of lead can be extreme and are irreversible. At high levels of lead exposure, severe outcomes, including death, have been documented.25 Additionally, high levels of lead exposure can result in brain and neurological damage.25 Lead poisoning has also been found to cause behavioral changes such as antisocial behavior and reduced attention span.25, 6 Catching lead exposure early is crucial to lessen the damaging effects of lead poisoning. The best way to catch lead exposure early is to attend well visits and request a blood lead test, even if you are unsure your child has been exposed, as lead can be in unexpected products like painted children’s toys and mini blinds.1
Although symptoms vary and can be difficult to detect, common symptoms of lead poisoning in children include developmental delays, irritability, loss of appetite, abdominal pain, vomiting, and seizures. In adults, lead poisoning manifests in the body through high blood pressure, muscle and joint pain, difficulties with concentration, and abdominal pain. Even premature birth, lower birth weight, and slowed growth can be indicative of lead poisoning.13
Research has long shown the negative effects of childhood lead exposure and poisoning on academic performance and behavior. Chandramouli and colleagues (2009) found that elevated blood lead levels had a significant effect on academic performance, specifically in reading, writing, math, and SAT scores.3 Additional research has found connections between lead exposure, antisocial behavior, delinquency, and crime.20 Sampson and Winter’s (2018) research shows that negative effects of lead poisoning can remain after childhood. These effects are life-long and ultimately affect the greater community. Lead poisoning should not just be a concern for children and parents; it should be a concern for the entire community. Bill Swartz suggests that solving the lead paint crisis would contribute to solving some of the larger, more complex issues facing York. He states, “Do we want to reduce the number of murders in York City, improve academic performance in York City schools and reduce behavioral issues? Here’s one way to do that: Address the lead paint crisis in York.”22
Testing and Results
Lead test results, whether positive or negative, have to be reported to the Pennsylvania Department of Health (DOH) through the Pennsylvania National Electronic Disease Surveillance System (PA-NEDSS).17 This is to aid the lead surveillance program, which aims to monitor the lead testing and lead levels throughout the state. The data also helps pinpoint areas where lead exposure may be high-risk and identify under tested populations.
It is well documented that impoverished and communities of color are disproportionately exposed to lead. A potential reason for racial disparities in blood lead levels is due to redlining. Redlining is the practice of denying financial services, such as home loans, to people of color (POC) to segregate the races. Historically, redlining confined POC to housing that was considered hazardous and deteriorated and barred them from “desirable” neighborhoods.7 The term redlining originates from the process of color coded maps given to lenders to illustrate where loans should and should not be granted for different races.7 There were four colors with different indications: red –“hazardous,” yellow –“decline,” blue –”desirable,” and green –”best.”14 The red color coding could be used to describe the physical and economical status of neighborhood as “hazardous” or “deteriorating”; however, a neighborhood could be redlined – colored red, deeming it “hazardous”– simply because POC were living there, “‘even if it was a solid middle- class neighborhood of single-family homes” (pg. 432).7
Karp describes how areas with high risk for lead exposure were areas that were redlined, meaning Black and Hispanic families were forced to live in high risk homes. Redlining contributes to the disproportionate elevated blood lead levels among Black and Hispanic children by limiting where Black and Hispanic families have access to buy or rent homes to areas of concentrated poverty and poor housing, while White families were given the opportunity of financial assistance to live in areas deemed as “best.”7
These disparities in lead levels can still be felt in York City, which may be explained by York’s distressing history of redlining dating back to the 1930s. Approximately 18% of the city redlined as “hazardous” and 45% yellowlined as “declining.”14 The effects of redlining are multigenerational with families today still experiencing the effects of discrimination in housing access.
Color coded map of York City from 193011
The 2020 Childhood Lead Surveillance Annual Report found that 60 children in York City, PA (aged 0 to 71 months) had confirmed elevated lead levels, which was 9.79% of children tested and 1.52% of the population. Yet only about 15% of children in York City are tested for blood lead levels, which indicates that the actual number of children with elevated lead levels may be much higher. Despite non-Hispanic, White children being tested more, non-Hispanic Black/African American youth are more likely to have elevated levels due to systemic inequalities that exist within the housing market and healthcare system. In York County, 121 youth below the age of 6 had elevated blood lead levels.5
The 2021 Childhood Lead Surveillance Annual Report found that around 16% of children aged 0 to 71 months were tested in York City, which was a slight increase from the prior year. In York City, 70 out of 551 children tested had confirmed elevated blood lead levels over or equal to 5 μg/dL, which is 2.06% of children aged 0 to 72 months in York City. As the number of youth tested increases, the number of known elevated blood lead levels may rise. Additionally, the racial disparities in lead poisoning are exposed on a county level. In the 2021 report, Hispanic children were tested the most (24%) and had the largest percentage of confirmed elevated blood lead levels (0.97%) in York County. Despite Black youth being tested less than White youth (17% and 19%, respectively), Black youth had more confirmed elevated blood lead levels than White youth (.72% and .44%, respectively) in York County.4
Figure 1. Number of York City children aged 0 to 71 months tested for lead in 20212
Comparing York City to larger cities like Philadelphia, it becomes apparent that lead poisoning in York City is likely more prevalent than reported. While only 16% of children aged 0 to 71 months (which is a total of 551 children) were tested for lead poisoning in York City, nearly 27% of children aged 0 to 72 months (which is a total of 32,517 children) were tested in Philadelphia. Despite Philadelphia testing more children than York, York had a higher percentage of children with confirmed elevated lead blood lead levels than Philadelphia (2.06% vs 1.23% [whole population] or 12.7% vs 4.6% [of those tested], respectively). Increased testing of York City children could provide a clearer picture of how extensive lead poisoning is in York City and the need for policy changes to protect children from lead exposure.4
Figure 2. Comparison of confirmed EBLL by percentage of those tested.2
Furthermore, water pipes are another concern for lead poisoning. Since 2017, the York Water Company has replaced all known company lines that contained lead; however, individual home lines built before 1934 may be at risk of lead contaminated water.27 The York Water Company has stated that individual water pipes can be replaced at no cost if an owner finds that their pipes are made of lead.27 While lead pipes can become cause for concern over time, lead paint remains the largest concern and should be carefully monitored according to Yingling.26
In 1978, the United States government created a federal ban on lead paint. The ban was issued through the Consumer Product Safety Commission for residential use of lead paint.19 This was the first federal ban of lead paint in the United States; however, many cities banned lead paint in the years prior. When assessing the risk of lead exposure, the year of 1978 is important. Houses built before 1978 are at a higher risk of containing lead paint and thus a higher risk of lead exposure. Many proposed policies target homes built before 1978 because of the likelihood of lead paint being used.
Figure 2. Comparison of confirmed EBLL by percentage of those tested.2
There are federal requirements for children who receive medical assistance or CHIP to have a blood lead test at age one and age two.1 The current state level policy regarding children and blood lead level testing is not adequate. Under the Childhood Blood Lead Test Act of 2022 (Act No. 150 of 2022), it is encouraged that lead testing be performed by age two and treatment begins if needed. Act 150 does not require, but highly recommends, that healthcare providers consider lead testing for children, especially under the age of two. In an attempt to better prevent long lasting lead poisoning effects, Senate Bill 514 was proposed to amend Act No. 150. Senate Bill 514 proposed to require children under the age of two to have a blood lead test by their healthcare provider (with the exception of parental opt-out). Requiring children to be tested for lead poisoning would increase the chances of catching exposure early. Unfortunately, Senate Bill 514 was “tabled” in June of 2023. This means that the bill has not moved forward.16
One of the biggest advocates for Senate Bill 514 and addressing the lead crisis is the Lead-Free Promise Project. The Lead-Free Promise Project is a Pennsylvania based advocacy group that focuses on lead poisoning throughout Pennsylvania.8 The project provides easy access to understandable lead statistics to promote knowledge on the risks of lead poisoning. One of their flyers focuses on lead statistics in York County, which found that over 200 children were poisoned each year.10 If you’re interested in more information about lead poisoning or steps to take, check out the Lead-Free Promise Project’s resource page and toolkit.
Bill Swartz suggests that the city enact local ordinances requiring proactive, annual lead testing in all rental units within the city. Swartz suggests that this will help identify rental units that are exposing children to lead. Indeed, this type of legislation is not unique. Swartz clarified that “six Pennsylvania municipalities have passed ordinances requiring all landlords with units built before 1978 to provide a lead-safe certification from a certified dust wipe technician prior to the issuance of a rental license or occupancy permit.”22 The Lead-Free Promise Project has created a strategy for municipalities to address lead hazards, which includes six steps. 1. Leverage current municipal ordinances, such as rental inspections, to include observation of peeling or flaking paint, in addition to informing landlords about the risks of lead paint. 2. Refer homeowners to lead remediation services or housing rehabilitation programs including programs that lower the cost of removing lead hazards. 3. Apply for HUD funding to support lead remediation and abatement. 4. Establish a Municipal Lead Hazard Reduction Program by utilizing funding from the American Rescue Plan (ARPA). 5. Update maintenance codes and include proactive lead hazard testing for rental units. 6. Join the Lead-Free Promise Project, which aims to help municipalities secure additional funding and provide necessary lead data.9
Additionally, Yingling supports the idea of required blood lead testing for children and annual home screenings.26 Yingling emphasizes the importance of preventative interventions, as no level of lead is safe.26 Preventative measures, such as annual rental testing, help lower the likelihood of lead exposure for children and adults. Annual rental lead tests would work in addition to the requirement of lead paint disclosures in lease agreements by closing the loophole of not testing so no disclosure is required. Likewise, preventative measures may help decrease the need for expensive early intervention services and long term negative health outcomes. Required blood lead testing is essential to ensuring that children exposed to lead are given the necessary interventions to limit the amount of damage caused by lead poisoning.
Get the Lead Out
Removing the lead from homes can be a formidable challenge due to cost, time, and availability of specialists. There are two primary methods to remove lead paint from homes: Abatement and Renovation, Repair, and Painting (RRP). There are a multitude of differences between the methods.
Lead abatement intends to permanently remove lead paint hazards from a home or structure and requires specialized techniques. Due to the use of specialized techniques and the hazards of working with lead, a special training and certification process needs to be completed to become a lead abatement contractor. In Pennsylvania, the fee for the initial training course is $2,422.50; however, contractors will end up paying more for the application fee, certification for other employees, and annual recertification renewal courses. These costs quickly add up and can be difficult for contractors in certain municipalities, as courses are not offered often or in convenient locations. Seemingly, an individual in York would have to travel at least an hour to access lead abatement training.18
In comparison, lead remediation through Renovation, Repair, and Painting (RRP) does not permanently remove lead hazards, but rather reduces lead paint hazards. In RRP, reduction of lead hazards can be completed in multiple ways. In some cases, lead paint in good condition (no peeling or flaking) can be painted over and sealed. Similar to abatement, RRP is hazardous for workers and requires special certification; however, this certification is much cheaper than abatement training. For example, ProActive Safety Solutions is offering RRP training for $270 in Harrisburg, PA.18 Additionally, training is easier to locate through the EPA website. RRP has several advantages compared to abatement: as families can remain in the home (just not in the room where renovations are occurring), certification is more accessible, and the cost of remediation is cheaper for the homeowner. Despite these advantages, it is essential to note that RRP does not permanently remove lead paint hazards; therefore, children should still exercise caution around areas where lead paint was present.
Currently, the use of federal Housing and Urban Development (HUD) funds to address lead paint requires lead abatement services. This requirement makes spending the HUD funding difficult according to Yingling, as there are not many lead abatement contractors in the York area.26 Additionally, lead abatement requires residents of the household to be removed, which means staying in a hotel or with family while the work is being completed. Temporarily displacing the family can be costly and may be unfavorable for some families. Yingling also mentions that some families do not meet the income requirements due to having a large number of individuals living within the home.26 Some households have up to five adults, all of which receive some form of income, which pushes them past the eligibility threshold, but not enough to pay for abatement or RRP on their own. Due to these challenges Yingling suggests the acceptance of RRP rather than the requirement of lead abatement, arguing that funding could more adequately be spent to help low income families if HUD requirements were changed to allow RRP to address lead paint in homes.26
Resources
If you are concerned that you or your child has been exposed to lead, contact your medical provider or a clinic and ask for a lead test. If you are concerned that your home has lead hazards present, seek resources on the City of York’s Bureau of Health’s lead poisoning webpage. Any other lead related questions can be directed to Pennsylvania Lead Information Line (LIL) at 800-440-LEAD (5323). The negative impacts of lead on children’s health and life outcomes are clear. The lead issue in York City needs to be addressed to improve the life outcomes of youth and the overall community.
Kristie Houck is the Urban Collaborative Scholar-in-Residence at York College of Pennsylvania (YCP). During her time at YCP, Kristie has focused on housing research in York City. She is expected to graduate in May 2025 with a Masters of Public Policy and Administration (MPPA). Previously, Kristie’s professional experience was working with at-risk youth and their families involved in Children and Youth Services. Kristie can be found on Linkedin.
References
1 | Center for Disease Control and Prevention. (2024). Testing for lead poisoning in children. U.S. Department of Health and Human Services. https://www.cdc.gov/lead-
2 | Conrad, H. (2024). Figures 1-3.
3 | Chandramouli, K., Steer, C. D., Ellis, M., & Emond, A. M. (2009). Effects of early childhood lead exposure on academic performance and behaviour of school age children. Archives of disease in childhood, 94(11), 844-848. https://doi.org/10.1136/adc.
4 | Childhood Lead Poisoning Prevention Program. (2023). 2021 childhood lead surveillance annual report. Pennsylvania Department of Health. https://www.health.pa.gov/
5 | Childhood Lead Poisoning Prevention Program. (2022). 2020 childhood lead surveillance annual report. Pennsylvania Department of Health. https://www.health.pa.gov/
6 | Hullinger, L. (2021). York County, city officials to talk about childhood lead exposure and behavior issues. York Dispatch. https://www.yorkdispatch.com/
7 | Karp, R. J. (2023). Redlining and lead poisoning: causes and consequences. Journal of Health Care for the Poor and Underserved, 34(1), 431-446. https://doi.org/10.1016/j.
8 | Lead-Free Promise Project. (n.d.). Protecting PA kids by ending lead paint poisoning. https://paleadfree.org/
9 | Lead-Free Promise Project. (n.d.). Using municipal codes and other strategies to protect pa children from lead paint poisoning & improve property values. https://paleadfree.org/wp-
10 | Lead-Free Promise Project. (n.d.). York County fact sheet. https://paleadfree.org/wp-
11 | Mapping Inequality. (n.d.). York, Pennsylvania. https://dsl.richmond.edu/
12 | Markowitz, G., & Rosner, D. (2000). ” Cater to the children”: the role of the lead industry in a public health tragedy, 1900-1955. American journal of public health, 90(1), 36. doi: 10.2105/ajph.90.1.36
13 | Mayo Clinic. (2022). Lead Poisoning. https://www.mayoclinic.org/
14 | McClure, J. (2019). Redlining in York. How government policies kept African Americans poor and segregated. York Daily Record. https://www.ydr.com/story/
15 | National Library of Medicine. (n.d.). This lead is killing us: A history of citizens fighting lead poisoning in their communities. https://www.nlm.nih.gov/
16 | PA S.B. 514, 2023-2024 Sess. (2024). https://www.legis.state.pa.us/
17 | Pennsylvania Department of Health. (n.d.) https://www.health.pa.gov/
18 | Pennsylvania Department of Labor & Industry. (2024). Lead certification system. https://www.dli.pa.gov/
19 | Rocha, A., & Trujillo, K. A. (2019). Neurotoxicity of low-level lead exposure: History, mechanisms of action, and behavioral effects in humans and preclinical models. Neurotoxicology, 73, 58-80. https://doi.org/10.1016/j.
20 | Sampson, R.J., & Winter, A.S. (2018). Poisoned development: Assessing childhood lead exposure as a cause of crime in a birth cohort followed through adolescence. Criminology, 56(2), 269-301. https://doi.org/10.1111/1745-
21 | Swartz, W. (2024). York City must address its lead exposure crisis | opinion. York Daily Record. https://www.ydr.com/story/
22 | W. Swartz, personal communication, July 2024
23 | United States Census Bureau. (2022). York City: Year structure built. https://data.census.gov/table/
24 | Walters, M. (2024). York County among top statewide for child lead poisoning, forcing a public reckoning. York Dispatch. https://www.yorkdispatch.com/
25 | World Health Organization. (2023). Lead poisoning. https://www.who.int/news-room/
26 | M. Yingling, personal communication/interview, July 2024
27 | York Water Company. (n.d.). Lead information. https://www.yorkwater.com/
