Illinois lawmakers have approved new rules aimed at identifying more children age 6 and younger with lead poisoning and triggering earlier intervention efforts to locate the source — bringing advocates’ long-fought efforts to eradicate this scourge of childhood development one step closer to fruition.
Now, advocates and health departments are turning to the next critical need: more state funding in order to pull off the ambitious changes. The Illinois Department of Health received about $10 million this fiscal year to send nurses and inspectors into the homes of children who test positive for lead poisoning, and to prepare the department to meet new mandates.
The new rules lower the level of lead in a young child’s blood that prompts required intervention — from 10 micrograms per deciliter to five.
According to preliminary state figures, about 20 children in Jackson County, 35 in Franklin County and nearly 75 in Williamson County tested positive for lead poisoning in 2017. The threshold is a blood-lead level of at least five micrograms per deciliter as determined by a finger prick, which is less certain than a blood draw. The vast majority of those children were not eligible for services under the old rules.
The department estimates it will need about $5 million more next fiscal year in order to fully implement the changes, said IDPH spokeswoman Melaney Arnold. Bob Palmer, policy director for Housing Action Illinois, a statewide coalition that advocates for safe, affordable housing, said he hopes that lawmakers and the governor will agree to fund the promise they made to better protect children.
An additional 6,000 children across the state could be eligible for environmental assessments of their homes and nurse case management — far more than the estimated 1,000 children who qualify for such services under the old rules, Palmer said.
This, of course, comes with a price tag.
“The rates of childhood lead poisoning in Illinois are high compared to other states, and the state in recent years has been making real progress in reducing childhood lead poisoning. I think the rules that were just approved reflect a commitment to continuing to make progress,” Palmer said. “But the rules don’t mean anything if there’s not the financial resources to implement them — to provide the nurse case management and do the environmental follow-up. We’re hopeful that will be in the budget.”
The state’s budget-making process will begin in earnest after Gov. J.B. Pritzker unveils his budget proposal on Feb. 20.
Even trace amounts of lead in a child’s blood can cause behavioral problems, developmental delays and other health issues; these health risks are particularly acute for children age 6 and under. Children in Southern Illinois are particularly vulnerable to lead poisoning because so much of the region’s housing stock was built before 1978, when the federal government banned the manufacture of lead-based paint for consumer use.
The new rules were prompted by a measure lawmakers approved last August to bring the state’s intervention standards in line with the level recommended by the U.S. Centers for Disease Control and Prevention. The agency proposed rules shortly thereafter, which received the sign-off of the General Assembly Joint Committee on Administrative Rules in mid-January.
The department is in the final states of editing the rules, which will become effective once they are officially forwarded to the Secretary of State's Office and published in the Illinois Register.
Karen Brown, director of nursing for the Jackson County Health Department, said that the department assigned nurse case managers to only a handful of children every year that tested at the previous threshold for intervention. As that threshold is lowered, Brown said she anticipates that the number of children the department serves will at least double.
The role of a nurse case manager is to provide education to parents about ways they can reduce potential exposure to lead, such as by concealing chipping paint, especially around window sills, and wiping up dust that could contain lead-paint flecks.
The agency also has an employee on staff that is trained to investigate various potential lead sources, such as paint or water, in the home a child that tests positive. Even if the water source itself is free of lead as required by law, some older homes’ plumbing systems were built with lead piping and lead soldering, which were not banned by the Environmental Protection Agency until 1986.
Brown said other sources of lead that a child may be exposed to include old toys, or the dust that is created by working on old cars with lead-based parts.
Children are apt to put their hands in their mouths, and they are drawn to lead paint chips or dust because the element has a sweet taste.
“It’s going to take more money to be able to respond to the increase in elevated cases now that the threshold is lower,” Brown said. “But the reason it’s so important is we want to reduce the possibility of brain damage and the effects of lead on the child’s brain that can be with them throughout their life. That’s really important, especially when the brain is developing. Even at small amounts, it can have a negative impact.”
The rules also provide for increased enforcement authority and penalties for violators of the state’s lead prevention laws, including property owners who fail to perform lead remediation on property where children with elevated levels of lead in their blood live, according to IDPH.