Pillars of Governmental Environmental Public Health | A Guide to Scalable Environmental Public Health Programs
Lead Prevention
Program Overview and Core Services/Activities
PROGRAM
RECOMMENDED WORKLOAD 2–3 field activities per week
EDUCATION AND CREDENTIALS
EQUIPMENT
KEY METRICS
Lead Prevention
• Bachelor’s in science • REHS/RS credential • Lead risk assessor certification
• XRF analyzers • Dust wipe
• Blood lead level reductions • Number of
sampling supplies
properties deemed lead safe
• PPE • Educational
• Environmental assessment
demonstration kits
completion rates
Definition An EPH lead prevention program generally involves the sur- veillance, investigation, remediation referrals, and education of lead exposure in response to child blood lead detection. Exposure sources can occur from lead-based paint, lead water service lines, food, or lead-contaminated soil. Lead prevention programs usually have two main compo- nents: 1) exposure-driven intervention and 2) prevention, education, and outreach. It was noted by participants that the term “elevated child blood lead levels,” though still often used, is being reconsidered. This terminology shift emphasizes that there is no acceptable level of lead in the blood of chil- dren, with an understanding that testing instrument limitations can limit detection, and departments might choose to only investigate cases where results yield a reading of over 3.5 μg/L of lead per dL of blood per CDC and U.S. EPA guidelines.
Meaningful Outcome Measures
PURPOSE
METRIC
Program effectiveness
• Percentage of home inspections completed where lead hazards were identified and addressed annually * • Percentage of elevated blood lead level investigations completed within target timeframe annually * • Percentage of children with elevated levels whose blood lead levels returned to acceptable ranges within target timeframe annually * • Average number of lead prevention activities completed per staff member per week annually • Percentage reduction in children with elevated blood lead levels annually * • Number of public education events or contacts about lead exposures conducted per year
Workload management
Characteristics of a Successful Lead Prevention Program
Public health protection
A successful lead prevention program often has good community awareness and relationships so that the com- munities it serves feel comfortable using the services. The program engages communities, empowers nonprofit or community-based organizations to assist, and facilitates the relationships needed to protect the health of those in the communities. The program addresses the needs of the community by conducting surveillance and educational programs and, equally as important, helps the community follow through to remediate issues that are found through the surveillance.
Partner engagement
* EPH professionals who participated in focus groups, key informant interviews, and/or the national field survey consistently identified this metric as moderately to extremely useful. Based on the authority given to the EPH department, some can enforce remediation activities such as removal of lead-based paint from homes within their jurisdiction
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