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Housing and Urban Development, are a significant step in attacking this problem.

Question. How much of the $974 million will be needed for the first year of the Strategic Plan? Why has the Administration not sought the full amount of such first year funding?

Answer. The first year of the Strategic Plan calls for $111 million. This represents a shared commitment by the private and public sectors, not an entirely public sector effort.

Question. How much of the $974 million will be needed for each of the other four years of the Strategic Plan? What level of federal funding does the Administration intend to seek for the second through fifth years of the Strategic Plan?

Answer the following are the combined National costs in millions of dollars of the first 5-years of the Strategic Plan which represents Federal and non-Federal costs.

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Question. How will the shortfall between the amounts of Federal funding sought in the budget and the amounts recommended in the Strategic Plan be funded?

Answer. This Plan is a strategic plan, not an implementation plan. Strategies will be developed to increase State and local government and private sector support for the necessary actions to eliminate childhood lead poisoning.

Question. The Strategic Plan identifies reducing exposure to environmental lead from water, food, air, soil and the work place as one of the four major program elements in the effort to eliminate childhood lead poisoning, but it provides few specific recommendations for federal action in this area. Furthermore, it does not include any funding recommendations for this major program element. Why is this portion of the strategy so limited in its recommendations? Why is funding for this element not addressed in the Strategic Plan?

Answer. The strategic Plan addresses primarily lead-based paint because of the higher priority as a source of lead for children with the highest blood lead levels and who are, thus, more likely to suffer from lead poisoning. Furthermore, efforts to reduce lead exposure to environmental lead in water and air are already well underway at the Environmental Protection Agency. The Food and Drug Administration is continuing to increase its regulation of sources of lead contamination of food. Worker issues are being addressed by NIOSH and OSHA, using existing funding. Soil remediation is addressed in the plan, mainly as a research question. We do not yet have enough information to embark on a national campaign to abate U.S. soils; we estimate it will take at least another 5 years to develop the information necessary to determine which soils constitute a hazard to children and at what

levels, and to determine the cost-effectiveness of alternative soil abatement methods.

Question. It has been estimated that there are some three to four million children in the United States with blood lead levels high enough to adversely affect intelligence and behavior, of whom an estimated 250,000 children meet the current definition of lead poisoning. It has also been estimated that about 13.6 million children under age 7 live in homes with lead-based paint, of whom 2 million live in deteriorated housing with peeling lead paint or other high risk of lead exposure.

How many of these lead poisoned and adversely affected children would be identified by screening programs funded at the levels recommended for five years in the Strategic Plan? How many would be identified at the level of funding called for in the Administration's FY 1992 budget?

Answer. The Strategic Plan calls for $25 million for childhood lead poisoning prevention programs for the first three years, $35 million for the fourth year, and $45 million for the fifth year. This would allow screening of around 3 million children in addition to the approximately 1 million children receiving lead screening services under other existing Federal, State, and local programs. About 1-3% of these additional children would be expected to have lead poisoning using the definition in the 1985 CDC statement on Preventing Lead Poisoning in Young Children. CDC is expected to revise that level downward in the near future; the number of children identified as lead poisoned would increase around 10-fold.

In Fiscal Year 1992, at a funding level of $15 million, an estimated 276,000 children will be screened through the CDC categorical grants for lead poisoning prevention. Between 3,000 and 9,000 will probably meet the current definition for lead poisoning.

Question. How many lead-painted housing units would be a bated at levels of funding recommended in the five-year Strategic Plan? How many under the Administration's FY 1992 budget?

Answer. The costs of a batement vary greatly according to the size and kind of housing unit, the region of the country, and other factors. For this plan, we assumed that an average abatement costs around $6,500. The plan states that within 3 years, resources should be made available to perform 20,000 to 30,000 more abatements annually than are currently being performed. The resources suggested in the plan would be enough to abate the homes of all lead-poisoned children currently being identified by childhood lead poisoning prevention programs that have no other source of funding for abatement. (As the amount of screening increases, the estimate of additional units to be abated annually will also need to be adjusted.) These resources would also make it possible to have demonstration projects and to abate units in the second priority group, homes that have a large potential for poisoning children. The unit cost of abatement is likely to decrease over the next several years as new abatement methods are

developed and the infrastructure for abatement increases, which will allow more homes to be abated for a given amount of money.

The Administration's 1992 budget for the Department of Housing & Urban Development (HUD) calls for an increase of $25 million to be earmarked for abatement. Using the same estimate of $6,500 to abate a unit, this increase would pay for around 4,000 a batements. Lead abatement is also an eligible activity under many other HUD assistance programs, such as public housing modernization, property improvement loans, and community development action grants. However, since lead abatement is not the only purpose of these programs, it is difficult to estimate how much of their funds are used for lead abatement.

Question. At these funding levels, how long will it take to eliminate childhood lead poisoning in this country?

Answer. The Strategic Plan envisions that a concerted society-wide effort could virtually eliminate childhood lead poisoning in 20 years. However, the funding levels called for in the Strategic Plan are for a shared effort by the private and public sectors, not just for Federal government costs.

Question. The Strategic Plan addresses the childhood lead poisoning problem. While children are obviously the number one priority of a lead poisoning prevention program, lead poisoning is a serious problem for adults as well. The work place, food and water have been identified as major sources of lead exposure for adults and older children. Adverse effects of lead may include impaired reproductive capabilities and high blood pressure. Senior adults may be at particular risk due to the mobilization of lead in their bones during osteoporosis or as part of the normal aging process.

Do you agree that we also need a strategic plan to address adult lead poisoning prevention?

Answer. Occupational lead poisoning is a significant public health problem, although childhood lead poisoning is a higher priority public health concern. Workers in certain industries and certain specific work places are highly exposed (blood levels greater than 25 micrograms per deciliter of whole blood). Based on case reports of elevated blood lead levels from seven state health departments, NIOSH estimates that more than 16,000 workers nationwide are highly exposed. Larger populations of workers are exposed at lower levels for which health effects have not been proven safe.

The Department of Housing and Urban Development (HUD) has organized an interagency task force of policy-level officials to discuss lead exposure issues of common concern and map a joint strategy for mitigating this hazard. Dr. James 0. Mason, the Assistant Secretary for Health and head of the Public Health Service, is the designate representative for our Department to this task force. We believe that the issue of occupational lead exposure will be an appropriate agenda item of this group since solutions to this problem, like the problem of childhood poisoning from lead-based paint, will require coordinated actions from a number of Government agencies.


How quickly could such a plan be developed ?

Answer. It is too early to say what the timetable of this interagency task force will be for developing recommendations, but we expect that it would take a minimum of eight months or more to conduct the necessary discussions, research, and consultations with the public and scientific communities in order to reach a consensus on a feasible plan of action.


Will HHS commit to preparing to such a plan?

Answer. HHS is committed to working with HUD, EPA, and the other interagency task force members in developing strategies to address this public health concern.

Question. Can we really expect lead screening of young children to become universal when testing methods are so clumsy, time-consuming, and expensive? I agree with your statement that one of our immediate research needs is to develop new, cheap blood lead testing methods. How much money is in the Department's budget for development of such a new blood lead test?


Answer. Although venous blood sampling takes more skill than capillary sampling, parental acceptance of it has been very good. For example, in the Chicago screening program, all samples are

In a door-to-door survey in California, the preferred method of blood sampling was changed from capillary to venous part way through the survey because of a high rate of false positives. The investigators reported no change in the rate of participation when this change was made.

The Centers for Disease Control (CDC) is doing several things to make blood lead testing easier. We are working with 4 manufacturers of instruments for measuring lead levels to develop a cheap, easy-to-use method for measuring lead levels in blood. We will also be funding a study of methods for collecting capillary blood that is not contaminated with lead. If such a method can be shown to work, it will obviate the need for collecting a venous blood sample. In addition to work being conducted by state and local governments, the CDC is putting $30,000 in extramural funds into this effort. We estimate that we will be spending around $100,000 in intramural resources (mostly for staff time and laboratory processing). The private sector is also expending funds. We believe that this spending will be adequate to address this issue.

Question. Shouldn't we be spending a substantial amount of money on this effort?

Answer. We believe that this spending will be adequate to address these issues. We will be assessing our progress in answering these important questions and will put more resources into this work if it is necessary.

Question. The public does not appear to be as aware of lead hazards as it is of other health hazards like smoking, alcohol or perhaps even radon. In addition, there appears to be resistance by private physicians to performing blood lead tests.

It seems that the time is right for a major public education campaign to alert parents, teachers, day care center operators and other about the dangers of lead and the ways to protect against it. Also, encouraging private doctors to routinely screen their young patients for lead would seem to be a highly cost -effective way to increase the number of screened children, since the government would generally not have to pay the testing costs.

Does the Department's FY 1992 budget (or that of any other agency) contain funding for such public and private physician education efforts?

Answer. In 1990 ATSDR released the Environmental Case Study on Lead, one of ATSDR's Case Studies in Environmental Medicine. This publication describes the health effects of lead and appropriate evaluation and clinical management of childhood lead poisoning. It has been distributed to over 30,000 pediatricians. In addition, some of the State childhood lead poisoning prevention screening programs funded by CDC also provide health care practitioner education. States may also use program funds for public education about childhood lead poisoning.



Question. Dr. Roper, how significant a problem is lead poisoning in our nation?


Answer. In 1984, the last year for which estimates are available, between and 4 million children in the United States had blood lead levels above 15 ug/dL. These are levels high enough to cause decreased intelligence, behavioral disturbances, developmental delays, and a host of other adverse effects.

Question. Will the increase proposed in the President's budget be used both for expansion of existing programs as well as supporting new ones?

Answer. The President's budget for FY 1992 proposes $14.949 million for an increase of $7.159 million over 1991, the expansion of CDC's childhood lead poisoning prevention grant program. This will permit CDC to continue funding the 7 State and local program initially funded in FY 1990 and the additional 6 or more programs we will fund in this fiscal year. In addition, it will allow support for around 10 new state- and community-based programs.

Question. In your judgement, how much would be required to initiate screening in all communities suspected to be at risk for lead contamination?

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