Washington State’s Efforts to Prevent and Respond to Childhood Lead Exposure

Background

In May 2016, in the wake of recent detections of lead in drinking water systems in the state, Governor Jay Inslee issued a directive to the state Department of Health and partner agencies to reduce lead exposure in Washington State. The directive instructs the Department of Health to take a series of actions to reduce lead exposure and help those with lead poisoning. It calls for additional investments in and funding for foundational public health services and infrastructure to help prevent, reduce, and remediate lead from water as well as other sources, such as paint.

The governor’s instructions focus on reducing environmental exposures to lead and making sure that children with lead poisoning receive all necessary case management and public health services. It directs the state Department of Health to take the actions and report back to the governor on budget and policy recommendations relating to these actions.

Partner with Other Sectors to Prevent and Reduce Lead Exposure

Governor Inslee’s directive instructs the Department of Health to work with schools, child care facilities, residential landlords, and public water system operators to prevent and reduce exposure to lead.

Key Partner: Schools

The directive instructs the Department of Health, the Washington State Board of Health, and the Office of Financial Management to review and update school health and safety regulations as needed (also known as the “School Rule”). They also should compile a budget decision package to put the regulations in place, beginning with those that pertain to lead exposure.

The Department of Health must continue providing technical assistance and guidance related to voluntary water quality testing schools can perform. This will help ensure that testing meets water sample collection protocol standards. In addition, the Department is asked to conduct workshops for schools that will heighten awareness about water quality and how to correctly test and repair any problems they find.

Key Partner: Child Care Settings

The directive instructs the Departments of Early Learning and Health, in collaboration with the Office of Financial Management, to determine the need for and feasibility of requiring child care providers located in buildings constructed before 1978 to complete an evaluation for potential sources of lead exposure. This includes drinking water testing.

Key Partner: Residential Landlords

The directive instructs the Department of Health to assess the feasibility of possible policy changes associated with developing a Lead Rental Inspection and Registry program. This step would require residential rental properties built prior to 1978 to register and complete a lead inspection and show proof of safety every time new tenants move in.

Key Partner: Public Water System Operators

The directive instructs the Washington State Department of Health to work with large public water system operators (those with more than 15 home/business connections or that serve 25 or more people per day for more than 60 days annually) to identify within two years all lead service lines and lead components in water distribution systems.

The directive also instructs the health department to make the removal of lead service lines and other lead components a top priority when it provides low-interest loans to eligible public water systems to address public health concerns. The department is also directed to work with stakeholders to develop policy and budget proposals, with the aim of removing all lead service lines and lead components in large public water systems within 15 years. This would make Washington State the first state to set such a goal.

Improve Lead Screening Rates and Provide Case Management and Remediation Services

To help those who already have lead poisoning, the governor has asked the Department of Health to work with the Healthcare Authority and the Office of the Insurance Commissioner to increase lead screening rates for the children on Medicaid at highest risk, provide case management services to children with lead poisoning and their families, and determine whether private payers provide coverage for lead screening and case management services or if further coverage policy change is called for.

Governor Inslee also asked the Department of Health to work with stakeholders and other partners to make the blood level monitoring system more efficient. This step entails transitioning the Child Blood Lead Registry to a fully electronic reporting system–and developing an adequate funding mechanism so that local health departments can fully implement home visits and other investigative work necessary to identify and remediate lead exposure.

Federal Funds to Expedite Lead Removal in Drinking Systems

Finally, the governor has asked the Department of Health to partner with the Department of Ecology and the Environmental Protection Agency to seek federal funds to expedite lead removal in drinking systems, require lead testing in childcare settings, and support revisions to the federal Lead and Copper Rule. The rule requires water utilities to monitor drinking water, control corrosion, and inform the public when lead or copper concentrations exceed a designated threshold.

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In August, 2017, the Health Impact Project, a collaboration between the Robert Wood Johnson Foundation (RWJF) and Pew Charitable Trusts released: Ten Policies to Prevent and Respond to Childhood Lead Exposure. The Trust for America’s Health (TFAH), National Center for Healthy Housing (NCHH), Urban Institute, Altarum Institute, Child Trends and many researchers and partners contributed to the report. TFAH and NCHH worked with Pew, RWJF and local advocates and officials to put together the above case study about lead poisoning and prevention initiatives.

The case study does not attempt to capture everything a location is doing on lead, but aims to highlight some of the important work.