This article first appeared in the St. Louis Beacon, Nov. 12, 2010 - The lobby of the Winston Churchill Apartments at Cabanne and Belt avenues undoubtedly reminds some visitors of the elegance of a bygone era. It's a massive room with green and beige walls, a fireplace, eight comfortable sofas and lots of chairs, all on a shiny, marbled floor. The soft colors and quiet setting recall the time when the building and surrounding neighborhood were home to upper-middle class St. Louisans.
These days, tenants of modest means live in the eight-story building, now fully renovated after falling on hard times. One measure of protection offered the new tenants and unavailable to rich occupants decades earlier is lead-free paint. In fact, the rehabbed Winston Churchill apartments -- named, by the way, for the St. Louis poet and not the British statesman -- marked one of the turning points in the city's war against lead poisoning.
The developer's decision to make the building lead free in 2008 caused a light bulb to glow in the mind of Randy Mourning, a building division worker. He suggested that the city track developers spending millions of dollars to renovate buildings and encourage them to do the work in a lead-safe manner.
The idea, which earned Mourning a service award from Mayor Francis Slay, is one example of the public-private collaboration that has helped St. Louis make major strides against lead poisoning, says Jeanine Arrighi. She's the city's manager for children's environmental health. As is the case with many other illnesses, where children live influences the extent to which they are likely to be afflicted by lead poisoning.
When it comes to lead poisoning, bad housing is the biggest but not the only culprit, Arrighi says. She points to information from federal and state health officials who say lifestyles and bad eating habits also play a role. In addition to urging families to keep children out of the way of lead dust and lead-tainted paint chips, the officials says nutritious foods are a weapon to prevent the bodies of children from absorbing harmful levels of lead.
Getting A Handle On The Problem
To nobody's surprise, the problem is more severe in poorer neighborhoods on the north side. What is surprising, however, is that the city is finally getting a handle on the problem and is learning how to reduce and prevent it.
Children are considered to be lead poisoned when their bodies contain at least 10 micrograms of lead a deciliter of blood. Some scientists argue that even fewer micrograms can put children in the danger zone. Lead poisoning rates have been part of city Health Department reports for at least 39 years. During 27 of those years, the childhood lead poisoning rate has been 10 percent or higher -- and as much as 48.5 percent in 1992; 34 percent in 1972; 32.3 percent in 1973, and 31.1 percent in 2000.
"Right now," Arrighi beams, "the rate of lead poisoning in the city is a little under 3 percent. We've made tremendous gains. The drop in the lead poisoning rate in St. Louis was 71 percent in a period from 2000-2005. The rates in a number of other cities have dropped 61 percent. So we're doing better."
Aside from worrying about lead levels in general, Arrighi says the city keeps watch on the number of children with more than 20 micrograms of lead a deciliter of blood. That's the level at which the Centers for Disease Control and Prevention says intervention is absolutely required. In 2003, Arrighi says there were 217 such children. Last year, there were 68.
"I'm so proud of what everybody has done," she says, adding that the city's own intervention threshold is much lower -- 10 micrograms of lead a deciliter of blood.
Slay is elated, too, saying the results show that the city is doing more to protect vulnerable children.
More Work To Do
Everybody concedes, however, that even more needs to be done since the drop only refers to children who have been tested. Still, the decrease is substantial for a city that, until now, has been unable to get a handle on its lead problem.
So what made the difference?
Arrighi says the turnabout began after Slay set up Lead Safe St. Louis in 2003. Slay said the high lead levels were unacceptable, and he demanded that agencies work together to address the lead problem. The big challenge was to address lead contamination associated with windows and doors, Arrighi says.
"People in low-income households without air conditioning open their windows in the spring. The friction (from opening the windows) releases dust into the window sill and kids have easy access to that. That's a huge exposure risk. It's the lead dust that accumulates in the trough of the window. When the window is open, that accumulated dust blows into the room."
She adds that the location is "the perfect height for little ones at play to run their cars and trucks on the window stool along the trough." This exposes them to the lead dust. Meanwhile, the doors in these homes are a problem because opening and closing them knock paint chips and dust onto the floor.
Aside from more collaboration among city agencies, Arrigh says landlords have bought into the program. They became partners in the fight against lead around 2007 after the city set up a window replacement program, an idea first suggested by a local advocacy group called Health and Environmental Justice. The idea is based on a similar program in Milwaukee that replaced faulty windows. Under that program, the city foots the bill for up to 10 replacement windows a unit, with each window costing up to $200. In exchange for this free upgrade, landlords agree to allow inspectors to check the property. The landlords also agree to remediate any other lead hazards identified during the inspection. City officials say the program is out of money for now, but they hope to revive it.
Arrighi believes the window replacement program led once reluctant landlords to embrace the city's programs.
"We saw hundreds of landlords participating," she says because the new energy-efficient windows added value to their property.
Creative Funding
Plenty of other challenges have appeared along the way, one of the biggest being money. The city addressed that in part by setting up a lead remediation fund, financed by a $2 charge for every $1,000 of the estimated value of a building permit. Arrighi says the fund has generated about $1 million a year, with the proceeds used as matching funds to help the city capture close to $20 million in federal lead grants in the past decade.
Arrighi stresses that it's really in everybody's best interest to address the lead hazard. She says the city's efforts so far have prevented 4,000 children from being poisoned by lead. She points to a study that found the estimated economic benefits of lead-poisoning prevention:
"If you have two 2-year-old children and one is lead poisoned and the other isn't, the one with lead poisoning would be expected to earn $723,000 less (over a lifetime) than the one who isn't," says Arrighi.
Multiply those earnings times 4,000 kids, Arrighi says, and the public will see a benefit of $2.9 billion, compared to the estimated $20 million the city invested in its anti-lead program.
She adds that the public shouldn't forget that prevention also helps avoid the cost of treating the physical and mental disabilities that can result. She adds that other studies are "correlating lead poisoning to crime rates in communities." While conceding that the theory is controversial, Arrighi adds that some researchers believe lead poisoning "impairs the development of children to make good discretionary decisions. Behavior is not easy for them to control."
Besides the city's own funding efforts, Sen. Christopher S. Bond, R-Mo., persuaded federal housing officials to give millions of dollars more to fight lead in St. Louis. He requested that Grace Hill health system run the program. It was limited to between six and nine zip codes having the highest prevalence of lead. The program made sure that homes of poor mothers in those zip codes were lead safe before their babies were born. Grace Hill officials said funding for that program has run out. The city is continuing it, Arrighi says, through relationships with the OB-GYN clinics at Barnes-Jewish Hospital and St. Mary's Health Center. Staffs at those clinics refer pregnant women to the city's program, which makes sure the homes are lead safe before the mothers give birth.
In addition, Arrighi says, the city lends families high-efficiency vacuum cleaners. Fifteen of them were bought through grants from the Environmental Protection Agency and the Department of Housing and Urban Development.
A Natural For The Job
Arrighi probably had no idea the city would make even this amount of progress when she landed the job as coordinator of the city's anti-lead initiative. She turned out to be a natural for the job for several reasons. Although she has a degree in architecture, Arrighi was an environmental consultant with an environmental training business and had done her first lead inspection in 1991. Her own business and work experience, she says, had helped her "understand how the renovation, repair and repainting process can disturb lead if the contractors aren't using appropriate work practices."
The city's success against lead raises a question. Why has it not been as effective in tackling some other health problems, including sexually transmitted diseases?
"I suppose our success in the last six or seven years has been because the mayor really prioritized this and said it's just not acceptable and we have to turn this around," Arrighi says.
The mayor also stressed that the city couldn't solve the problem alone, she says. That led to partnerships with community groups, such as the Child Day Care Association, Catholic Charities and the Jewish Community Relations Council. The latter, she said established a speakers bureau and reached out to the medical community to encourage doctors to increase testing rates for lead. The day care association worked with home-based day-care centers to encourage them to undertake lead remediation of their properties.
Meanwhile, she argues, some public-private partnerships, like the city's anti-lead initiative, can freeing up public-health workers. They can then "look at other health issues and how we can address them, asking what are their causes and the barriers in our way to eliminating those causes."
One such issue, says Dr. William Kincaid, is asthma. He's head of the St. Louis Asthma Coalition. In fact, he and Arrighi say the city is gearing up to use its experience in addressing lead poisoning to wage a similar campaign against childhood asthma.
This story was written with the assistance of the Dennis A. Hunt Fund for Health Journalism, which is administered by the California Endowment Health Journalism Fellowships, a program of USC's Annenberg School for Communication and Journalism. Funding for health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization whose vision is to improve the health of the people in the communities it serves.
