BALTIMORE, Md.—An estimated 85,087 occupied homes in Baltimore have “dangerous lead hazards,” according to a recent report from the Abell Foundation, a local public policy think tank. Fixing the problem would cost between $2.5 billion and $4.2 billion, the report said.

Meeting this need “would require vast resources from federal, state, and local funders, as well as coordination across different levels of government and the private sector,” wrote Luke Scrivener, the study’s author.

Lead is a neurotoxin that, according to the Centers for Disease Control and Prevention, has no known safe blood lead level in children. The potential consequences of being exposed to it are legion. The conditions lead has been linked to include, but are not limited to, ADHD, reduced IQ, anemia, seizures, renal failure and brain swelling. On the societal level, high rates of lead exposure correlate with increased crime and incarceration, lower earning potential, poorer academic performance and shortened lifespans.

The number of children who tested positive for elevated blood levels in Baltimore dropped an astounding 97 percent from 1992 to 2016. But that achievement means little to the remaining children and their families, who may be dealing with mood swings, hearing loss and poor impulse control from lead exposure.

In Baltimore, lead-based paint hazards account for 78 percent of the remaining lead exposure risk, according to the Maryland Department of Environment. Hazard control, a less rigorous standard of lead paint intervention, is only an impermanent solution that would require between $851 million and $1.4 billion to carry out, said Scrivener.

Having adopted a measure to ban leaded paint as far back as 1950, Baltimore stands out as the American city that’s fought to clean up lead for the longest time.

“Blood lead levels have come down greatly because there have been a number of policies adopted with regard to paint, dust, soil, water, food, air and the rest,” said David Jacobs, chief scientist at the National Center for Healthy Housing. “And those policies have worked but we still need to do much more to finish the job.

“We’re not quite there yet,” he said.

Lead’s Long, Poisonous History

Lead exposure has a centuries-long history. The ancient Greeks and Romans used lead, a malleable, rust-resistant and naturally occurring element, to create water pipes and containers. Lead paint was later used on the canvasses of artists and on home interiors and exteriors because of its durability. In the 1920s, leaded gasoline was introduced, and the particles from car exhaust, in addition to fouling the air, drifted to the ground and mixed with dust and soil where people, especially children, could ingest or inhale it.

For much of the time that lead has been in use, its dangers have been recognized. The ancients thought it caused constipation and “pallid color.” By the industrial revolution, its occupational hazards were so well-known, they received mention in the writings of Charles Dickens and Benjamin Franklin. In the early 20th century, scientists protested unsuccessfully against the addition of lead to gasoline, which today still contributes significantly to lead levels in Americans. Lead paint in houses and office buildings was commonplace. And for decades, study of its health effects was largely dominated by lead industry-sponsored research, stifling scientific outcries about its risks until the 1960s.

Lead levels have declined dramatically over the last several decades through a combination of legislation, testing, education and remediation. Today, at least in the United States, most of the remaining risk of exposure comes from paint inside the home. This happens largely as paint deteriorates and mixes with dust, for example, when painted surfaces are scraped in opening or closing windows and doors or as people walk up and down stairs. It can also occur when homes are renovated or remediated without proper precautions. Children have also been known to eat lead paint chips, which taste sweet.

Children absorb lead into their bloodstream four to five times more quickly than adults. And Black people absorb lead more efficiently than whites, research has found, putting them at particular risk.

Calcium, which can help protect against lead poisoning, is also absorbed more efficiently in Blacks, studies find, but Blacks living in cities tend to be calcium deficient, and so are less protected.

“If you’re better at absorbing calcium, on average, and you live in a lead containment environment, then you’re going to have a higher blood lead concentration,” said Bruce Lanphear, a professor at Simon Fraser University who researched the link between lead absorption and race.

Lanphear was also the co-author of a 1996 study that found that Black households contained “significantly higher” amounts of lead dust than white households.

In Round and Round it Goes: The Epidemiology of Childhood Lead Poisoning, 1950-1990, Barbara Berney, an emeritus associate professor at the City University of New York’s School of Public Health, described the connection between housing, race and health.

“Lead poisoning resulted from bad housing conditions,” she wrote. “Blacks were forced into bad housing by discrimination. The housing was allowed to deteriorate by gouging landlords and city housing officials, who did little to eliminate the problem or protect the health of the children affected.”

‘We Know How to Fix This Problem’

In Baltimore, 966 homes have been reported by the city as posing a risk of lead exposure, although the Abell Foundation report suggests that the true number could be in the tens of thousands. According to the report, the cost of reducing the lead in homes with known hazards would range from $9.7 million to $16.4 million, while abatement would cost between $29 million and $48.3 million.

The Abell study said that most lead inspections of homes and the documentation of hazards occur in reaction to cases of children who through blood tests are found to have elevated blood lead levels.

“The fact is most homes have not been inspected for lead paint hazards,” Jacobs said about housing nationwide.

Landlords in Maryland are supposed to meet a minimum reduction standard for lead paint in rental units built before 1978, the year that lead paint was banned in the United States. But they’re not always up to the task.

Camille Burke, director of the Baltimore City Health Department’s Childhood Lead Poisoning Prevention Program, said the city sometimes files lawsuits to “push the landlord to do what they should be doing.”

Despite the reluctance of some landlords, rentals still have more protections in place against lead than owner-occupied homes, said Joshua Sharfstein, a vice dean of public health at Johns Hopkins University. 

Removing lead from “low-income homeowner-occupied housing is a huge, huge opportunity, not only for health and stability, but intergenerational wealth transfer,” said Ruth Ann Norton, the president and CEO of Green and Healthy Homes Initiative, a Baltimore nonprofit dedicated to reducing residential health hazards.

Even though lead remediation techniques have improved over the years, it can still be an incredibly expensive investment for families. According to Burke, lead abatement projects can range anywhere from $5,000 to $100,000. And it can cost far beyond that depending on the age of the home.

“Landlords can deduct the cost of lead abatement as a business expense. But if you’re a homeowner, low income or otherwise, you don’t get to do that. So that doesn’t seem fair,” said Jacobs.

Baltimore’s primary source of funding for lead intervention comes from the federal Department of Housing and Urban Development’s Office of Lead Hazard Control. In 2019, the city received $9.7 million in grants, but they come with limitations, such as what type of housing they can be used for. The grants are also directed at shorter-term fixes as opposed to abatement projects.

“Even with increasing funding allocations from the federal government, the city is only scratching the surface of the widespread lead paint hazards,” said Scrivener, the Abell study author.

Other sources of funding include Medicare and Medicaid. Scrivener also suggested that Baltimore could follow the lead of Lead-Free Families in Lancaster, Pennsylvania—a 10-year, $50 million childhood lead poisoning prevention initiative and the first to be initially funded entirely by a health care system.

“What will happen in that community is pretty immediate,” said Norton, whose organization helped to design the initiative. When lead is abated, “You start to see the changes in reading scores within six years and you start to see the earning quotients change within a decade [to a] decade and a half.”

“We know how to fix this problem,” Jacobs said. “The techniques are there. We just have to implement them.”

As Burke put it: “Having a safe, healthy space to live in is something that we all deserve.”