Page 20 - Delaware Medical Journal - January/February 2020

PUBLIC HEALTH
GEOGRAPHIC AREAS OF RISK
A recently published report by the Delaware Division of Public Health compiled the reported data from 2010 to 2017 and identified the 34 ZIP codes in Delaware (out of a total of 96 ZIP codes) with the highest numbers of children with elevated blood lead levels (above the CDC’s reference level of concern). The eight ZIP codes with
the highest number of children include
and 19713) as well as 19973 in Seaford and 19947 in Georgetown.3
Given the limited data available to produce this analysis, there may be additional ZIP codes in Delaware with high numbers of children with elevated lead levels. It is possible, for instance, that the “highest” ZIP code for elevated blood lead levels in Delaware might, if the data were more accurate, actually be the second or third highest, and
that some “safer” ZIP codes would be of even more concern than the data currently indicate. Nonetheless, it is clear that:
exposed will do nothing to protect more children from exposure unless the state invests in primary prevention.
Lead poisoning is entirely preventable, and the Committee’s task will be to understand current Delaware policies and outcomes and then identify and recommend strategies that will reliably eliminate elevated lead levels among children in this state. Four related subcommittees will explore testing and compliance, real estate sales and home/ apartment rentals, epidemiological study and environmental surveillance, and education and parental engagement. Solutions for our state may include a myriad of both primary and secondary prevention efforts such as directing resources to remediation in currently identified lead “hot spots,” adoption of “lead free” or “lead safe”
CONTRIBUTING AUTHOR
housing certificates, or further analysis of compliance to Delaware’s current statute for testing 12-month-olds. We must ask ourselves how Delaware can move from the almost exclusive focus on testing and gathering data on lead poisoning to a systematic approach to solving the problem.
I encourage this to serve as your call to action — to engage and participate in forthcoming Childhood Lead Poisoning Advisory Committee
and subcommittee meetings. The Committee will meet next on January 23, 2020 from 11:30-1:30 in the Tatnall Building, Dover. All committee and subcommittee meetings, agendas, and meeting minutes are posted on the Delaware Public Meeting Calendar, https://publicmeetings.delaware.gov.
1.
There are a number of lead “hot spots” in Delaware. These are in areas with older housing stock and lower-income families. As is the case nationally, lead poisoning is largely (but not exclusively) a problem faced by poorer families with limited capacity to move to better housing or remediate the contaminated housing on their own.
Without a public policy commitment to primary prevention in these high-risk areas, children will continue to be poisoned. Testing asymptomatic children after they have been
■ JONATHAN M. MILLER, MD is the Medical Director of Value-Based Care for Nemours Children’s Health System. Dr. Miller is an academic general pediatrician and hospitalist who joined NAIDHC in 2013. In his role, he is leading Nemours’ transition to Value-Based Care, including oversight of Primary Care, Population Health, and the creation of Delaware Children’s Health Network (DCHN, the only pediatric clinically integrated network in DE).
REFERENCES
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2. 3.
For children enrolled in Medicaid, 24-month blood lead level screening (a capillary blood test) is already a requirement. Since 1987, the Centers for Medicare and Medicaid Services has mandated that all children enrolled in Medicaid receive a capillary blood test at 24 months, or between the ages of 24 and 72 months, if the child has no record of a past blood lead level screening. (CMS, State Medicaid Manual 5123.2 (d) (1)).
Centers for Disease Control and Prevention, Preventing Lead Exposure in Young Children: A Housing-Based Approach to Primary Prevention of Lead Poisoning. 2004.
Kuang, J. (2019, June 24). Worst Part of Delaware for Elevated Blood Lead Levels Is in These ZIP Codes, Data Shows. Delaware Online. Retrieved from www.delawareonline. com/story/news/2019/06/24/high-lead-levels-impact-more-kids-wilmington-than-rest- state-data/1511596001.
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Del Med J | January/February 2020 | Vol. 92 | No. 1