California isn’t testing enough children for lead, prompting legislation

Reviewed by James Ives, M.Psych. (Editor)Mar 26 2020

In some parts of California, a higher percentage of children who were tested had elevated levels of toxic lead in their blood than in Flint, Michigan, during the height of that city's water crisis.

More than 5% of children under age 6 in nine mostly rural California counties had blood lead levels in 2015 that put them above state and federal reporting guidelines for lead exposure — at least 4.5 micrograms of lead per deciliter of blood — according to the most detailed data from the California Department of Public Health. Across the state, 1.4% of children who were tested, or about 7,650 kids, had elevated blood lead levels that year.

By comparison, when images of discolored water flowing from Flint's taps made national news in 2015, 3.7% of Flint children under 6 who were tested had elevated lead levels, according to a study published in the Journal of Pediatrics.

California's worrisome numbers were highlighted in a January report by the state auditor, which also found that more than 2 million children were not tested as required over a period of nine years.

The auditor faulted the state departments of Public Health and Health Care Services for failing to ensure children receive the tests, and for not taking prescribed actions to reduce childhood lead exposure in high-risk areas.

In response to the audit, the state Department of Public Health released 2018 data in early March showing that slightly fewer children were tested statewide than in 2015 and that the percentage of children with unacceptable lead levels did not decrease. The department did not release specific data for many of the rural counties that previously had high percentages of children with elevated blood lead levels.

State lawmakers also responded to the audit by introducing five bills to get more children tested as required, expand mandated testing to more children and improve follow-up care for children with elevated blood lead levels.

They "treat us like we're a wasteland," said Assembly member Cristina Garcia (D-Bell Gardens), author of one of the bills.

Garcia represents a Los Angeles County district where the soil in and around thousands of homes was contaminated with lead and arsenic by the Exide Technologies battery recycling plant in Vernon. A massive cleanup effort was launched after the plant closed in 2015. Despite tens of millions of dollars allocated for remediation, local officials and residents say more funding is needed because only a few hundred homes have been cleaned up, and thousands are still contaminated.

California's top health care officials said they're taking the auditor's findings seriously. Dr. Sonia Angell, director of the Department of Public Health, said the department is working on a plan to improve its oversight of childhood lead testing and coordinate with local officials to reduce children's exposure to the toxic metal.

"While it is impossible to eradicate all lead in the environment, there is more we can do to protect our children," Angell acknowledged in a prepared statement.

Industrial emissions can cause concentrated exposure in some areas, but the most common source of lead exposure in children is lead paint in old homes, where young children ingest the neurotoxin through small flakes and paint dust. Lead paint was phased out in the 1970s but still exists in older houses and apartments, especially poorly maintained ones.

Lead can also leach into the water from old pipes. That was the case in Flint, where the local water authority didn't properly treat water from the Flint River, which caused lead from old pipes to seep into the drinking water.

Exposure to lead has been linked to health and developmental problems, including learning and hearing disabilities, lower IQs, behavioral problems, hyperactivity and delayed puberty, according to the U.S. Environmental Protection Agency.

"There's a really long and extensive body of evidence that shows that any amount of exposure to lead can be harmful," said Jill Johnston, assistant professor of preventive medicine at the University of Southern California.

Researchers have found that low socioeconomic status is a risk factor for lead contamination. In California, efforts to address lead exposure have focused on children enrolled in Medi-Cal, the state Medicaid program for low-income people.

Federal and state laws require children enrolled in Medi-Cal to have blood lead tests at 1 and 2 years of age. Children under 6 are supposed to receive a makeup test if they were not tested when they were 2 years old.

About half of California children are enrolled in Medi-Cal.

The auditor's report found that about half of the eligible children enrolled in Medi-Cal from fiscal years 2009-10 through 2017-18 — about 1.4 million kids — did not receive any of the state-mandated lead tests. And about 740,000 children missed one of the mandated tests.

In addition to kids on Medi-Cal, state regulations mandate that any child with an official risk factor, such as living in a home built before 1978, get tested. Garcia said that the list of official risk factors is not up to date with current research and that her proposed legislation would update it.

The auditor's report does not pinpoint why so many children are not getting the tests, but the auditor recommended the state Department of Public Health update the risk factors, and inform health care providers about those risk factors and the testing requirements by this month.

Angell said the department would "issue regulations for public comment on enhanced screening requirements and data reporting for lead exposure" by August.

The data the department released in early March in response to the audit did not include results at the ZIP code level. A department spokesperson said that data is expected to be released this spring.

"If the department was taking this more seriously, what we received today would have provided more details," Garcia said via email in early March.

"We need to have a regularly updated map showing what the blood lead levels are geographically and in a more granular manner."

Richard Figueroa, then-acting director of the Department of Health Care Services, said the department "will do more to ensure that required blood lead tests are occurring." The department will implement a public outreach campaign to inform families covered by Medi-Cal how to get their children tested, he said, and by June will require managed care plans to identify children who have not been tested and remind participating health care providers about the testing requirement.

Garcia said she does not trust the state agencies to fix these problems on their own. "They're OK with blowing through deadlines and not prioritizing these communities," she said, "even though we have a real serious public health risk."

It is a matter that hits close to home for her.

"My sister and I used to joke that if we didn't grow up in the place that we did, we might be geniuses," Garcia said.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.