Where Are Rochester and Monroe County?

1. Engagement to Decrease Childhood Lead Poisoning:It Takes a CommunityStanley J. Schaffer, M.D., M.S.WNY Lead Poisoning Resource Center – Rochester OfficeDepartment of PediatricsUniversity of Rochester

2. Where Are Rochester and Monroe County?

3. The Face of Rochester and Monroe County

4. Monroe County – A Picture of Contrasts • Suburban communities consistently rated among the best places to live in the nation • Yet, the City of Rochester has the 5th highest poverty rate in the U.S.

5. Typical Housing in Rochester

7. Rates of Children with BLLs > 10 mcg/dL in Monroe County, New York State and the U.S. Over Time

8. Factors Contributing to the Successful Lead Poisoning Prevention Efforts in Monroe County • Recognition that lead poisoning is a major problem in the community • Recognition that lead poisoning is a multifaceted problem intersecting health, housing and education and requiring a wide-ranging set of interventions • Establishment of the local lead coalition • Engagement of multiple stakeholders in the community • Extensive efforts to increase awareness among the general public • Collaboration between all levels of government and willingness of local government to mandate that rental properties be lead-safe • A willingness by everyone to recognize that ‘it is not someone else’s problem’ and that lead poisoning has significant societal costs borne by all • Recognition of the importance of having efforts driven by data

9. Recognition of the Problem of Lead Poisoning

10. Our Lead Problem in Rochester & Monroe County • The Situation in the Year 2000: • 2% of U.S. children tested have BLLs > 10 mcg/dL • 5% of NYS children tested have BLLs > 10 mcg/dL • 7.4% of Monroe County tested children have BLLs > 10 mcg/dL • 25% of children in high risk areas of Rochester have BLLs > 10 mcg/dL • In some neighborhoods in Rochester > 30% of children have BLLs > 10 mcg/dL

11. Factors Contributing to Lead Poisoning in Rochester • Old housing stock • High poverty rate • Low property values (mean $53,000) in much of the city • High rates of rental housing in poor neighborhoods (~85%) • Highly mobile impoverished population with few resources

12. Rochester’s Coalition to Prevent Lead Poisoning Established in 2000 Monthly Standing Committee Meetings: • Government Relations Committee • Screening & Professional Education Committee

13. Organizations Having Ongoing Collaboration With the Coalition to Prevent Lead Poisoning roberts communications Western New York Lead Poisoning Resource Center – Rochester Office

14. Rejection of Silos Since lead poisoning is a problem that crosses disciplines affecting health, education, housing and the criminal justice system, it is not someone else’s problem; it’s everyone’s problem.

15. Efforts to Increase Awareness Among the General Public • Newspaper articles • Ads in publications, billboards • TV and radio shows • Pamphlets (in 8 languages) • Neighborhood outreach • DVDs available at libraries • Web page (letsmakeleadhistory.org)

16. Efforts to Increase Testing

17. Efforts by the City of Rochester to Address Lead Poisoning • Dedicated phone line to handle lead poisoning issues (as well as 3-1-1) • Availability of free visual home inspections • Development of the municipal lead law • Financial assistance for homeowners to address lead hazards

18. Rochester’s Efforts to Establish a Lead Law • 2005 Amendment to Municipal Property Maintenance Code • Added lead to “Certificate of Occupancy” inspection requirements • Applied to pre-1978 rental housing • Law went into effect on July 1, 2006 • Targeted “high risk” housing

19. Details of Rochester’s Housing Law • Visual inspection of all rental properties prior to Certificate of Occupancy being issued (now on a 3 year cycle for all rental properties) • Presumption that deteriorated paint = lead paint • Dust wipes in “high risk areas” if they PASS visual inspection • All violations must be addressed • Requires mitigation NOT removal of lead • Workers must have lead safe work practices training (owners may do work themselves) • Clearance testing by a certified private firm prior to C of O issuance

20. Impact of Rochester’s Lead Law • Implementation Costs • 15,000 rental units inspected yearly at a total cost of $600,000 ($40/unit) • 8% of units fail the inspection • Average cost of $420 to identify each hazardous home Median Cost of Repairs if Lead Hazards Identified • $300 - $1,200 with higher costs in lower value properties • Many landlords are replacing windows • Repairs often enhance value of the property Additional Benefits • Landlords are becoming more proactive in maintaining their properties and are making improvements prior to inspection

21. Results of 8 Year Review of Rochester’s Lead-Based Paint Poisoning Ordinance Vacate orders for units with severe interior deteriorated paint or dust lead hazard – 515 issued in 8 years Citations for non-compliance of lead ordinance violations – 1,880

22. Application of Rochester’s Lead Law in Other Communities • Based on the Rochester experience, other cities have adopted or are in the process of adopting similar ordinances: • Toledo, Ohio • Cleveland, Ohio • Utica, New York • Seattle, Washington

23. Efforts by the Monroe County Department of Public Health to Address Lead Poisoning • Data collection and dissemination to help target interventions • Primary prevention grants • Environmental inspections at lower thresholds than are required by NYSDOH • Close collaboration with CPLP, City of Rochester, insurers, health systems, WNY Lead Poisoning Resource Center and others in efforts to increase blood lead testing rates among children • Offers free training for remodelers and renovators wishing to become EPA lead certified

24. Data Collection and Dissemination by MCDPH

25. Impact of Having Timely Data • Able to discern trends over time and to announce results to the media • Able to break out incidence rates for EBLLs by age categories and zip codes • Able to determine when testing fell off among city and suburban children • Able to determine that testing rates for 2 year olds were much lower than testing rates for 1 year olds

26. Monroe County DPH Environmental Inspections • Results of inspections shared with City of Rochester Housing Bureau • 2003 - MCDPH initiated environmental inspections for venous BLLs > 15 mcg/dL (NYS threshold was 20 mcg/dL until 2009) • 2008 - MCDPH received NYSDOH primary prevention grant to do risk assessment to identify environmental hazards in homes with children who have BLLs < 15 mcg/dL, pregnant women and newly arriving refugees • 2009 – MCDPH initiates routine environmental inspections of homes of children with venous BLLs > 10 mcg/dL • 2009-2012 data show that a lead hazard was identified in 80% of cases where homes were inspected as a result of BLLs of 10-14 mcg/dL • 2013 – MCDPH initiates routine environmental inspections of homes of children with venous BLLs > 8 mcg/dL and offers inspections to City of Rochester residents whose children have venous BLLs > 5 mcg/dL

27. Rates of Children with BLLs > 10 mcg/dL in Monroe County, New York State and the U.S. Over Time MCDPH gets a HUD grant for lead hazard control efforts CPLP established and major media campaign started MCDPH lowers threshold for home inspections to 15 mcg/dL City of Rochester adopts lead ordinance MCDPH lowers threshold for inspections to 10 mcg/dL

28. National Recognition for Local Efforts

29. The Future • Sustain progress • Avoid declaring victory too soon • Increase collaboration with school districts to identify children with a history of lead exposure who may be at risk for learning problems • Increase outreach to refugee populations and pregnant women

30. Lessons Learned AMERICA’S HEALTHIEST CITIES • Benefits of community approach • Dual emphasis on primary and secondary prevention • Collaboration of multiple entities toward achieving a common goal Gallup-Healthways Well-Being Index, January-February 2011

31. Our Common Goal