Robin Brown rushed her 4-year-old daughter to University Hospitals on a September day in 1999. Her pediatrician had tested for lead and the results came back—70 micrograms per deciliter. For context, the Centers for Disease Control and Prevention updated their database in 2012 to consider elevated levels to be anything above 5 micrograms per deciliter. After seven hours of waiting, Brown’s daughter was admitted to the hospital for one week to undergo chelation therapy—a treatment method used to detoxify a body of metals such as lead. During this entire process, no one—not a single physician, social worker or other professional—took a moment to explain to Brown what lead was and its impacts on her daughter. The pediatrician never followed-up and the hospital physicians kept their backs turned, instead focusing on interns. It was not until Brown was connected with another parent of a child who was poisoned that she began to understand the complexity of lead poisoning in Cleveland.  

Brown’s story is not an isolated incident. Lead poisoning is an all too common reality in Cleveland. While cities such as Flint, Michigan received publicity following the awful lead poisoning of many people due to the city switching water supplies (with leaders aware of the consequences), the degree of poisoning in Cleveland due to pre-1978 lead paint remains in the shadows. 

The extent of poisoning is especially unbeknownst to many people in University Circle. Given the presence of three internationally known biomedical and healthcare centers—Case Western Reserve University, University Hospitals and Cleveland Clinic—within a mile of one another, many people fall into a trap of believing an abundance of resources should translate into excellent health outcomes for the surrounding communities. In reality, though, the neighborhoods contiguous to University Circle have some of the worst maternal mortality and lead poisoning rates in the country, with an estimated 30 to 50 percent of children under the age of 6 being lead-poisoned. 

Awareness and education are two of the key issues around lead poisoning. There is a lack of awareness about the prevalence of lead poisoning in communities that are not experiencing it themselves. Or, in the case of University Circle, residents don’t realize that having quality infrastructure in place is not enough to ensure adequate access, affordability or positive outcomes. However, even people in communities where lead housing is prevalent are not made aware of this danger. 

Moreover, the infrastructure addressing lead poisoning is incomplete, letting thousands of families reside in unsafe housing. Brown had moved to a new house one month prior to the discovery of her daughter’s poisoning. The hospital social worker required a lead assessment of her house. Upon discovery that the house was indeed lead-free, Brown informed the Department of Health inspector that she had just moved out of a rental property that was likely the source of the lead; Brown was informed that it didn’t matter, it wasn’t her current residence, so they wouldn’t be inspecting it. Other tenants live there now, likely with children.  

Herein lies another part of the problem—a lack of incentive or dedication to provide holistic lead-safety inspections. This theme is also seen in testing, as children above the age of 6 are considered less susceptible to the effects of lead, so they are not given tests. When Brown’s daughter turned 7, physicians planned to stop testing her; however, Brown was persistent, insisting that her daughter’s levels were still elevated the year prior and thus needed continued monitoring.

Lead poisoning affects young children most severely because it affects their development, which is why children under the age of 6 are prioritized for treatment. If left untreated, lead poisoning can result in irreversible neurological effects, including hindering an individual’s ability to learn and socialize. Perhaps the most tragic part of lead poisoning is that, for the most part, it is preventable. 

In Cleveland, lead poisoning is a result of old paint in homes, particularly rental properties. This paint can chip off or peel away, especially along window sills that may not be properly waterproofed. When children are playing, it is easy for them to accidentally ingest pieces of the paint either as residues or dust particles. As a result, Cleveland is in dire need of an initiative to inspect all properties and safely renovate those with dangerous toxins. Fortunately, after decades of work by organizers, activists and parents, the city of Cleveland passed the Lead Safe Certificate ordinance in 2019 that requires all rental properties to be inspected over a two-year period starting in 2021. 

This certificate is an amazing step, as it will start to shed light on all the houses and families that the city has largely ignored. Many people in the city, including Brown prior to her daughter’s poisoning, do not know that lead poisoning remains a problem. They are living in homes or renting an apartment and have no awareness that they could be exposing their children to lead. This represents a failure—one that will hopefully start to be rectified by the ordinance. 

Moreover, the city, in partnership with other private and public partners, has raised millions of dollars to help landlords pay for needed renovations so that “finances” can no longer be an excuse to not fix a problem. In addition, the Lead Safe Resource Center has recently been established on Euclid Ave. to help connect people with education resources as well as grants to pay for housing renovations. Diana King, another mother whose child was poisoned by lead, is an intake specialist at the center and a parent representative for the Ohio Lead Free Kids Coalition, along with Brown. King emphasizes that lead poisoning is a complex crisis that involves racism, redlining, healthcare and housing issues.

While the certificate is a step in the right direction, it is still only that—a single step. Moreover, organizers who worked for this bill are disappointed in the timeframe and logistics of its implementation. 

Spencer Wells of Cleveland Lead Advocates for Safe Housing (CLASH) emphasized that the plan their organization had put forth—which was nearly identical to the one that the city eventually adopted after many years of challenges—was on a timeframe of two months, rather than two years. While Wells recognizes that two years can still be effective, he’s disappointed that the plan may really end up taking more than five years. 

“The delay in implementation has not been used well,” Wells said. “Landlords are not sure what’s happening.” Wells elaborated that it has been over one and a half years since the ordinance was passed, and the city has done very little to help explain its impacts on tenants or the responsibility of landlords. 

In January 2021, landlords from two different zip codes of Cleveland will receive notices that they must complete and provide proof of lead assessments of their properties within two months. This will continue every quarter until all the zip codes have been reached. Moreover, the logistics of the bill remain largely unclear, resulting in landlords calling community organizers, like Wells, because they are unable to understand or receive information from the city or Department of Health. 

The city has been attending Lead Safe Cleveland Coalition meetings to explain how the process will work come January; however, it’s critical that landlords and tenants not in attendance are still informed of the upcoming changes.  

The ordinance is unequivocally critical, but its passage means the city needs to stand by it and ensure its implementation and effectiveness. This support will especially be needed in the spring when organizers predict landlords will try to sue the city. Citing a similar complication in Toledo, Wells emphasized that a court case could draw the two-year implementation timeframe out even longer. 

CLASH reports that four children are diagnosed with lead poisoning every day in Cleveland. However, this does not include the children who go undiagnosed, the hundreds of children who are currently poisoned and unaware. 

As such, Brown echoed King’s advice that we need to address lead poisoning as a multi-faceted issue. This includes engaging the community and professionals in a discussion about lead poisoning. Not only should healthcare providers know the dangers and prevalence of poisoning in Cleveland, but a more focused curriculum needs to be introduced and emphasized in education, policing and social work. 

“You have a degree,” Brown said, “but I live with it. We have to think beyond an office because we live with our children every day.” 

Brown and other affected parents have talked with social work classes at Cleveland State University and CWRU medical students to emphasize that when a child is poisoned, it not only affects them, but their entire family.  

Brown’s point is critical to understanding where we need to go from here. We cannot only emphasize textbook problems or hypothetical situations. The professionals in our communities need to be equipped with the knowledge of lead poisoning’s effects, including beyond the physiological ones. 

All teachers should be versed with a special-education curriculum so that they can brainstorm creative ways to educate children who learn differently. Social workers and police officers need to understand the prevalence of undiagnosed lead poisoning and how this may alter children’s behavior, making them more erratic or irritable. Juvenile incarceration will only exacerbate the symptoms of lead poisoning. 

Lead poisoning is afflicting our neighbors, our community. Children are falling through the cracks and then being left behind because they are developmentally delayed due to lead poisoning. Entire families are being ignored because it’s supposedly cheaper to continue poisoning children than to invest in infrastructure to inspect houses and mandate annual lead tests. We can certainly commend the tireless work of organizers and the passage of the Lead Safe Certificate, but this is not an be-all end-all solution, it is merely the first step.