Lead Poisoning In Children Health And Social Care Essay

path poisoning In Children Health And Social C ar EssayIn 1988, the stake for Toxic substances and Disease Registry released a subject area on genius inebriety giving closelyness partners and stakeh out of dateers an e realwhereview of the adverse health effects of go forth insobriety in children 6 months to 5 years of age. They found that about 2.4 million children nationwide (excluding early(a) racial categories) life sentence in metropolitan areas were at adventure of surpass picture health effects using a declension- run a right smart level of a maximum 15ug/dl acceptable standard. Higher origination- fill threshold levels were found in black children living in inner-cities as well as children from low income families. A nonher report in 1990 released by the Environmental Defense Fund (EDF) apothegm varying differences in caterpillar track exposure in children ranging from racial, economic (Perkins, 1992) and residential location. Based on this study, tri o exposures were found to be risqueer in introduces of the midwestern United States (Wisconsin) and nonetheast where most of the housing were very old. This doesnt mean disk operating systems with larger amounts of relatively new housing dont suffer from lead exposure as found in Las Vegas where despite increase in new buildings, oer 12,000 children qualification up 28% of the entire population has line of reasoning-lead levels exceeding 10ug/dl. Among the states of the Mid West of the the States, Wisconsin stands out as one that has over the years being at heights try of lead exposure. In a study carried out in 2006 by the Wisconsin childhood expand Poisoning Pr flattion Program (WCLPPP), lead exposure prevalence deep down the state stood at 2.6% in children turn outed under the age of 2 years. This was twice the national prevalence which stands at 1.4%. draw out exposure in children has been a major cosmos health concern for over a coke promptly. According to the CDC Surveillance Data of 1997-2006, the number of children being poisoned by lead in Wisconsin was greater than in other states, leading to serious health disasters with high financial burden to families especially low income families. In 2010, over 735 new cases of children with blood lead levels 10ug/dl were place. In that same year the prevalence of lead inebriety in children judgeed in Milwaukee with blood lead levels 10g/dL stood at 3.4% which is 2.4 clock the national average of 1.4%.Source Wisconsin department of Health and Family run, Division of popular Health, Bureau of Environmental and Occupational Health April 201In the state of Wisconsin the prcised number of children at risk of exposure of lead inebriation distillery remains unknown but in compliance with the Chapter 151 of Wisconsin statutes which requires that every physician reports any conformed or suspected cases of blood-lead poisoning, over 3265 children with blood lead concentrations of over 20ug/dl were reported to the Wisconsin Department of health between the periods of July 1992 to June 1993 (Schirmer, 1993). Based on the national estimate of 17% of blood lead poisoning, the Wisconsin Division of Health estimated that over 36000 children at bottom the state were at high risk of lead poisoning (Schirmer, 1993). According to the Title XIX course also known as the HealthCheck political platform which makes blood-lead covering mandatory for all children between the ages of 2-6years (Hoffman, 1993), in 1992, , over 12,435 children were screened for blood lead poisoning ground on the HealthCheck under the Wisconsin Medicaid program and of this number 2644 of them had blood-lead levels 10ug/dl (Department of Health and Social Services, 1992).In 2006, 5% of enrolled children in Wisconsin public schools had at to the lowest degree a blood lead concentration above the normal value. In two separate studies carried out in 2000 and 2007, their resulting data showed that childhood lead poisoning accounted for about 88% of violent crime rates in the USA over several decades as could be seen in the rate of school disciplinary problems resulting to an increase in school dropouts, juvenile ill-doing and even expectant venomousity. In the fall of 2006, it was estimated that one in every 20 children between the ages of one and two years who entered the Wisconsin school system had lead poisoning and below a third of these children who are at high risk of lead exposure have been screened for lead in their blood (WI DHS 2008). close of the children identified in Wisconsin to be at risk of lead poison accounting for over 90% lived in very old roots that were built sooner the 1950s. Lead poisoning is not just a serious problem here in the Milwaukee County but its a major problem in all the 72 counties comprehensive affecting children primarily. In a study carried out in 2006, it was estimated that over 75% of children known to be poisoned with lead lived in 26 6 out of all 1330 high risk census tracts in Wisconsin with over 200,000 homes built before 1950. Blood lead levels equal to or greater than 10micrograms per deciliter (mcg/dl) is regarded as a shout for concern as set by the center for Disease tell (CDC) in 1991 (CDC, 1991) and in 2007, the CDC reaffirmed this level (CDC, 2007). These findings made law makers to look deeper into the burn of lead poisoning as a major form of unusual societal behaviors (Nevin 2000 2007). Based on this blood lead level, Wisconsin children with these levels are considered to be lead poisoned and this blood lead concentration has been apply for surveillance purposes to abet identify, treat and manage new cases (Wis. Stats 245.11 CDC Blood Lead Surveillance Data, 1997 2006).Sources of childhood lead poisoningMost of the routes of lead poisoning in children include inhalation, ingestion of soil (Harrison et al., 1981) or household distribute and drinking water (Harrison et al., 1991) that has been contaminated with lead from old paintings flakes which occurs during when old houses are being renovated or with lead paint coated surfaces found in the kitchen, bathroom walls and windows of homes that were built before 1950. Most of these lead particles are extremely small and cannot be seen with the naked eye. Since its ban in 1978 in the USA, it has still been used to coat walls, frames of windows, doors, floors and ceilings of old homes and toddlers and other children are at risk of ingesting these surface fall offs reason why the CDC recommended lead running gameing and required by the national Medicaid polity in children under 6 years (CDC, 2000). Lead poisoning at bottom the state is a complex combination of the poverty, and low socio economic status of most families coupled with the old housing putting children at risk. except, other sources of lead exposure have been found in some consumer products which may pose a health risk to children and adults alike. They inc lude toys, lunch boxes, and jewelries for kids, ceramics, candies as well as products made in China and Mexico. The state recommends that people stop buying these products, dispose of them or return them for a refund if bought. The spirit for Disease tick off and Prevention through and through the U.S Consumer Product Safety Commission has recalled a list of these items with unsafe levels of lead some of which include toys, candies much(prenominal) as SINDOOR a coloring food product was recalled by the Food and Drug administration (FDA) 2007 after a series of test were conducted by the Illinois Department of Public Health found this product to have over 87% of lead.Lead poisoning and its Adverse Health effectsLead, is a naturally occurring element on earth whose chemical properties allow for its use in building construction. Its use dates back to about 3500BC (Needleman, 1990) when Romans started using it to make lead pipes and storage containers. It has been extensively used in many products such as paint, gasoline, and ceramic. Even though adults can suffer from lead poisoning it is much more severe in children. scorn the fact that its preventable its health impact is severe ranging from behavioral defects, delay in speech, hearing problems, poor performance at school, increased juvenile delinquency and in severe cases death. There is really no safe level of lead in our bodies as even very smaller amounts below the Wisconsin blood lead concentration could cause serious wide term health effects such as a brain damage (Mendelson et al, 1998). Other conflicting behaviors exhibited by lead poisoned children include aggression and the tendency to become over active (Nevin 2000). Other studies have shown that lead exposure in children may cause kidney disease when they reach adulthood, diabetes and even memory loss as seen in Alzheimers disease and severe cases stroke and heart attack (Needleman 1990). It affects especially their brains and the central loa thsome system since both systems are still forming and low exposure could result in reduced IQ learning disabilities, stunted growth (Brubaker et al., 2009). Studies have shown that blood lead concentrations as low as 70ug/dl and as high as 100ug/dl can lead to encephalopathy in children which is linked to anorexia, diminish in activity, poor coordination, vomiting and aggressiveness and rapidly progresses to death (CDC 1991)Structure of Wisconsins Lead Poisoning Prevention ProgramsThe Wisconsin Department of Health services (DHS) is in belt of all health programs and services that are geared towards promoting the protecting and promoting the health and safety of the people of Wisconsin. They carry out functions like assessment, policy development and advocacy. Of these programs is the WIC program which is a federally funded program under the child and youth services of the DHS. This program bring home the bacons special supplemental nutrition to women, Infants and Children (WIC) in other to promote and keep up the health and wellbeing of pregnant women, breastfeeding and postpartum women, infants and children. Children eligible for this program must be infants of up to a year or a child up to age 5 and whose parents are Wisconsin residents, be income eligible and have a health or nutrition unavoidably. In the state of Wisconsin, children are required to be tested twice for lead in blood with the first testing taking place between 6-16 months of age and the second testing between 17-28 months.However within the DHS is the Wisconsin Division of Public health (DPH) which addresses three major lead hazard control programs namely the Adult Blood Lead Epidemiology and Surveillance (ABLES) program, Asbestos and Lead Certification Unit and Wisconsin sinewy Homes and Childhood Lead Poisoning Prevention Program. The ABLES program focus on monitoring laboratory based lead levels in blood of adults most due to occupational exposure while the Asbestos and Lead Unit program provides accreditation and certification programs for the Wisconsin DHS under the Chapter 254 Wisconsin statue provision as well as standard guidelines required for abatement activities within the state. There is also the Wisconsin Healthy Homes and Childhood Lead Poisoning Prevention Program (WHHCLPPP) which makes come-at-able resources such as technical, financial and consultations to help stakeholders completely eliminate and treat childhood lead poisoning livelihood for Lead poisoning control programsIncreased pressure from the Wisconsin public lead to the creation of a federal law called the Title X Residential Lead-based Paint Hazard Reduction Act of 1992 with focus on the federal government taking a major role in lead poisoning prevention. This law requires that all housing programs have lead safety address in them. It also calls for the Environmental Protection Agency (EPA) to set up guidelines for lead safety to be executed by a well adept workforce and lastly it calls for all owners of private property to provide basic information with any possibilities of lead exposure hazards to home buyers or new tenants. It was not until 1991 when the CDC started funding lead poisoning preventions programs within the state of Wisconsin such as blood lead testing, managing serious cases as well as raising programs aimed at educating the public on the issue. This led to increase testing of Wisconsin children for lead poisoning with many new cases being identified an indication that many local health department within the state lacked sufficient resources to facilitate follow-ups of lead poisoned cases or identify potential lead hazards in homes. These concerns and pressure from parents and other NGOs such as the March of Dimes and the Council of Developmental Disabilities pushed the Wisconsin State Legislature to implement state laws by providing more resources to help facilitate the work of the Department of Health and Family Services (DHFS) and other l ocal health departments to effectively response to lead poisoning prevention programs and develop a good account system for blood lead test results in children. This saw an increase in funding for local health departments from zero dollars to $1.2 million each year which subsequently decreased to $879,100 because of certain cuts in the state budget. Wisconsin was amongst the 12 grantees in 1994 to receive a housing grant of $6 million to help fund projects aimed at fixing lead hazards such as eliminating dust containing lead in old homes and screening children living in these homes. The project was a huge success as lead dust levels greatly reduced in homes and since then many cities within the state namely Milwaukee, Kenosha and Sheboygan have submitted grant proposals and received competitive grant funds aimed at control lead hazards programs in high risk homes.In February of 2011, the urban center of Milwaukee received a $4.5 million grants from the U.S department of Housing an d Urban Development to help fund a program aimed at controlling lead hazards in two areas namely the citys North and South sides known to have a very high rate of childhood poisoning within the city covering over 900 city homes. The prevalence of lead poisoning in these areas peaked 7.1% cause a serious alarm to public health officials. In a press release on January 2011, the U.S Department of Housing and Urban Development (HUD) awarded over $127 million to some 48 projects nationally which focused on meliorate quality of lead paint based low income homes that served as a health hazard to its occupants. This grant would help clean up lead paint based hazards in over 11000 homes, increase public awareness on the issue as well as train more personnel in lead safety practices. The following is a breakdown of the grantsGrant ProgramFunding AwardedLead-Based Paint Hazard Control Grant Program$66,600,000Healthy Homes Initiative funding$2,300,000Lead Hazard Reduction Demonstration Grant Program$48,000,000Healthy Homes Production Grant Program$10,000,000TOTAL $126,900,000WisconsinCity of Milwaukee Health DeptLHRD$4,500,000City of SheboyganLBPHC$1,528,296Wisconsin Dept. of Health ServicesHHP$1,000,000HHP Healthy Homes Production, LBPHC Lead Based Paint Hazard Control Grant Program (includes Healthy Homes Initiative supplemental funding, as applicable), LHRD Lead Based Paint Hazard Reduction Demonstration Grant Program (Source HUD, 2011 HUD No. 11-004)Ongoing Lead-based paint control programsIn June 2004 the Phase 1 of the Wisconsin Childhood elimination strategic Plan was completed and this purpose was developed by a diverse group of experts from the health field, the housing departments, government agencies and other community of interests groups with the aim of eliminating childhood lead poisoning by 2010. This strategic work plan focus on achieving four main goals through the creation of these subcommittees namelyEducation through which the general public will be aware of the problem within their community and how to protect children from lead exposure. Also parents and childcare providers would be educated about lead hazards through home visit. Policy makers and state legislators were to be educated on how much impact lead poisoning has in the community while addressing issues of neglect of the problem and what needs to be done to reduce some of this negligence which could be potentially make uply. Property owners and construction contractors would be educated and provided with opportunities to adduce old homes while ensuring a safe work milieuLead hazard correction in homes with emphasis on identifying and analyzing some of the risk factors associated with lead poisoning while focusing resources on homes that were built before the 1950s as they pose a high risk of lead exposure. This goal focused on enforcing home owners so they can repair possible lead hazards in their buildings and to ensure a strong community engagement on the p roblem, incentives were to be provided to home owners who comply with all these regulations.Screening for lead poising in high risk groups through the provision of enough funds to help identify and evaluate children with risk of lead exposure as well as evaluate live practices being performed by physicians and the barriers they may pose to families and healthcare providers in terms of providing blood lead screening to children. This goal also express on the need for better data sharing and quality reporting like the STELLAR or the Wisconsin Immunization Registry among partners within the community so that children who are at risk of lead exposure are identified and testedFunding through the allocation of and resources and making open increased funding for lead hazard control in Wisconsin was a major priority. This funding would help local communities with high risk housing by investing in homes so that the financial burden of having to treat or manage children with lead poisoning will be less on the state.Phase 2 of the Wisconsin voiding Plan is ongoing but in 2009 the sub committees in charge of Funding and Resources and Correcting Hazards in housing combined their efforts and all 3 existing committees now meet independently of the Implementation and Oversight Committee (IOC) and provide a progress report at each IOC meeting which usually meets 3 times a years (January, May and September). These meetings are aimed at evaluating progress made so far and identifying some of the challenges faced in the execution of some of the existing programs as well as make recommendations to the IOC for effective and efficient implementation. The IOC is made up of partners from the Wisconsin Division of public health, local councils, State departments of Hygiene and administration, community health centers as well as insurance companies. Within the city of Milwaukee, over 40 employees are involved in lead based prevention programs which provide resources and services to identified children at risk if lead poisoning and those with lead poisoning as well as programs geared towards prevention of lead poisoning before it even happensHuge Financial burden of lead poisoning in its impact on the state of WisconsinThe negative burden of lead poisoning to the community is the huge medical expenses in treatment and management of the health problem, increased health care premiums and increase in Medicaid expenses. Since childhood Lead Poisoning (CLP) often results to attention disorders and developmental delays (Canfield et al, 2003) in lead poisoned children, there is need for increased special education expenses for programs to help accommodate children with disabilities as well as programs to cope with juvenile delinquent lead poisoned children who are at high risk of dropping out from school and early teen pregnancies (Needleman, et al, 1990). It has been shown that most children who are poisoned by lead are thrice more likely to fail standardize test as well as being arrested for a criminal case as they transition into a young adult. Also, lead poisoned children at fourth grade where three times more likely to fail their cultivation tests compared to those with very minute amounts of lead exposure (Miranda et al. 2007). The state spends an estimated $5 billion in school aids to children including a $375 million to assist children with special needs and a $1 billion for children who need corrects with most of these woo is attributed to lead poisoning. The number if children living in Wisconsin between the ages 0-6 is approximately 540,000 and if the state embarks on lead hazard control programs that aim at eliminating lead exposure in homes build pre 1950, it would save the state about $7 billion in take on cost with an increase in earnings of over $21 billion based on an analysis that was conducted in New Jersey that analyzed cost savings such as direct medical cost, special education, crime and juvenile delinquency, low rates o f high school graduation and cost to state government (Muennin et al., 2009). The recommendation from the Wisconsin Childhood Elimination Plan and the Implementation and Oversight Committee (IOC) suggested an annual investment of $20 million would go a long way to provide resources to help control lead pain hazards in over 2,000 pre-1950 homes annually. The state would safe over $28 billion in savings if all children between the ages of 0-6 years were protected from lead hazards which will further help lead to an increase in the graduation rate of the state as well as crime reduction (Muennin et al., 2009)In the spring of 2010, a Joint Resolution 65 was passed and approved by the Wisconsin State Legislature which called on the Implementation and Oversight Committee of the Wisconsin Childhood Lead Poisoning Elimination plan, a program within the Wisconsin Department of Health Services to provide report on the financial burden result from childhood lead poisoning been experienced thro ugh the states education and criminal justice systems resulting from juvenile delinquent risk behaviors that most children with lead poisoning are at high risk at encountering at some stage in their lives which will help policy makers and state officials make financial resources and other logistics available to address lead paint hazards as well as create a widespread community awareness campaign program which makes loans available to home owners of house build pre 1950 thus reducing lead hazard risk. This report was delivered to the State legislature on December 30th of that year. This joint resolution gained several approval from state agencies such as Departments of Public Instruction, Children and Families, Corrections Division of Juvenile Correction, the Wisconsin Court outline and State Prosecutors Office with the creation of a committee that helps gather relevant data which will help stakeholders within the state to better evaluate the cost due to lead poisoning and ways to completely eliminate lead hazards in homes. In a 2006 study, over 80,000 young children are estimated to be living in lead paint hazards in Wisconsin and if the state focuses more on protecting families from exposure, we would be saving over $40,000-50,000 for each under the age of sixer giving us a estimated savings of over $3.6 billion (Jacobs and Nevin, 2006).Lead Testing and ReportingTo increase blood lead testing coverage within the state of Wisconsin, four main Medicaid managed Care organizations teamed up with state and local WIC agencies in 2010 and together donated a quick three minute LeadCare II testing instrument approved by the CDC with the overall aim to improve on the blood lead testing levels in children at risk. These organizations also gave WIC staff entre to the electronic reporting system that exists within the state as well as resources to follow up children who showed high levels of lead in blood. Within the city of Milwaukee, the WIC program is the only prog ram that has got direct access to the STELLAR (State Blood-Lead Reporting System) and the WIR (Wisconsin Immunization Registry) and this enables them to enter data correctly which is required for state and federal reporting compliance. This system also helps WIC staff to easily identify children who have not been tested for blood lead and follow-up with them to get tested as well as follow up with cases that show elevated levels of lead in their blood. With the donation of 10 LeadCare II analyzers as well as 20 test kids in 2010 in all 10 WIC clinics within the state of Wisconsin, the program has witnessed over 41% increase in the number of WIC children tested for lead in blood in the city of Milwaukee. Children enrolled in the WIC program receive two rapid tests namely an Iron and blood lead test using a finger stick. Over 139 children in 2009 tested positive for high levels of lead in their blood samples giving a 300% increase in lead poisoning cases when compared to the previous 2 years due to the fact that most of the children living in high risk urban areas who were now being tested had previously been missed.Since 2006, Medicaid health care providers have received an annual Blood Lead Testing developed through collaboration with the Wisconsin Medicaid Program and the Wisconsin Childhood Lead Poisoning Prevention Program. The individualized reports summarize the blood lead testing data for children under age 6 within each providers practice. In plus providers received a list of untested children in their practice to facilitate follow-up to ensure these children get tested. It is normally required that children be tested for lead poisoning at ages 1 and 2 and since most of them are not tested at those early ages because of lack of follow-up, it is mandatory that they get at least a test between the ages of 3 to 5 years. For example in 2007, over 2,049 children with blood lead levels of greater than or equal to 10mcg/dL were identified within the state and almost two thirds of children eligible for the Medicaid program entering the Wisconsin school system that fall have not properly tested even though 88% of children eligible for Medicaid which covers blood lead poisoning were enrolled that year. (Data is from Individual Medicaid Providers for period of July 1, 2006 through June 30 2007 (SFY07)Collaborative PartnershipsThere are some NGOs within the state that are focused on raising awareness through community leadership on lead poisoning and one of them is the Milwaukees Hmong American friendly relationship Association (HAFA) through its Parents Against Lead (PAL) alliance. Its made up of neighbors, parents and other passionate individuals who have come together to collectively eliminate childhood lead poisoning. cosmos a great partner with city of Milwaukee Health Department, they have promoted lead abatement activities in families living in pre 1950 homes as well as amongst home owners on how to eliminate possible lead hazard wit hin the city. Another community based group working within the community is the Sherman Park play along Association (SPCA), a group of over 167 residents who come together during a cold Winter day and have breakfast with Santa Claus as a way to bring communities together and educate them on the work they do including a window repair/replacement program with emphasis on lead based pain hazard.Advocacy and Public PoliciesThe presence of GIS Maps within each Wisconsin legislative district identifying areas with Lead poisoning is now available and from this data no place within the state is free from lead poisoning with more cases in communities with old housing. As part of the Healthier People 2020 Public Health plan, the state of Wisconsin through the U.S Department of Health Services, EPA, HUD, Energy and the CDC came together during the 2011 National Healthy Homes Conference which brings partners, leaders and experts from the public and private sector to discuss on how to improvin g on housing conditions and making them safe from lead paint based hazard and environmentally sustainable. However, certain rules and number of statutes that govern activities geared towards lead hazard control have been approved within the State and these rules protect residential areas, tenant/landlord agreements, drinking water facilities, lead hazard reduction and the manner in which blood lead results are reported. They include the Wisconsin statute Chapter 254 which lays emphasis on detection, treatment and response to lead hazards. In Wisconsin, a number of statutes and rules have been enacted to regulate activities having to do with hazards due to lead-based paint and include residential facilities, worker protection, landlord and tenant agreements, housing sales, lead hazard reduction, drinking water, reporting of blood lead test results and public health response to lead poisoning. There is the Wisconsin Statute Chapter 704 which outlines conditions in which tenants could move without having to face any liabilities from health hazards such as lead. We have the Statue Chapter 709 which requires that owners of residential real estate make certain disclosures about their property. Amongst the administrative rules is the DHS 163 which requires people such as contractors to get certification for identification, removal and reduction of Lead-based paint which was amend in 2009 and the DHS 181 which allows for quality reporting of blood lead test results.Assessment Performance of Childhood Poisoning in WisconsinThe State department of Health and Services is charged with the collection, evaluation and sharing information concerning the incidence of lead poisoning in risk populations and communities while the local health departments within the state would maintain a local surveillance system that gives the population an idea of the prevalence and trends of testing and making this information available to the state Department of Public health and other stake holders. A tracking system to effectively monitor children at risk and those with very high blood levels would be maintained and made available to the department of Health and Family Services (DHFS) through the WCLPPP. The local health departments trough the support of state agencies of Public health would develop protocols and procedures to better monitor the screening of children at risk of lead poisoning and well as provide clinical and educational resources for better programming and reportingLead Prevention and ControlLead poisoning is preventable if the necessary precautions are well respected one of which is the lead abatement of homes. The primary way to protect Wisconsin children from lead exposure is by stabilizing all cracked, deteriorating, peeled or flaking paint in old homes, replacing very old windows, fixing roofs with and other leaks, while making sure that the window sills and floors remain smooth hence eliminating major sources of lead exposure. Other precautionar y measures include re-painting on interior surfaces with no friction such as ceiling, walls but surfaces that are susceptible to friction or bad weather should not be repainted. All the above precautions are carried out through a process called Lead abatement which refers to any action by and individual (a certified lead abatement contractor), the state or a company to effective minimize lead exposure by permanently eliminating or removing lead-based paint or dust lead hazards or any possible lead containing object or surface in response to orders from the state or the local council. The Milwaukee Health Department is charged with giving orders so that homes identified within the community to be at risk of lead exposure are lead abated and this requires either voluntary consent from the owner of the property or through a Court order in case the home owner doesnt comply with orders from the Health department to allow his property to be abated.Conclusion in spite of the huge progress in reducing childhood lead poisoning rate within the city of Milwaukee, the number of children been identified with lead poisoning is still on the rise within the state and it has surpass the national average. In 2009, the state prevalence of lead poisoning was 1.5 and in Milwaukee alone, of all the children tested for lead poisoning 4.4% of them had blood lead levels greater than 10ug/dl. More work is needed in this fight despite the progress mad