photo: Toxic lead paint peels from a window frame on a rowhouse in Baltimore, Maryland.
Toxic lead paint peels from a window frame on a rowhouse in Baltimore, Maryland. Barbara Haddock Taylor/Baltimore Sun/Tribune News Service via Getty Images

Decades after federal regulations banned the use of the deadly metal in paint, gasoline, and plumbing, the effects of lead continue to be felt across America’s cities.

His mother remembers the window he loved so much. It was at the back of the house she was renting in northeast Baltimore, the house where her son, Deshawn Fisher, was born in 1993. This particular window was in Deshawn’s bedroom, and as he grew from an infant to a toddler, he enjoyed watching the world outside through the glass.

The frame of that same window was covered in flaking lead-based paint. By the time Deshawn was two years old, the level of lead in his bloodstream registered 11 micrograms per deciliter—six micrograms higher than the five-microgram poisoning threshold instituted by the Centers for Disease Control and Prevention in 2012. As Fisher grew up, he developed behavioral problems and ADHD. His IQ level was seven points lower than it should have been, the results of a baby’s life around lead dust and paint chips.

According to the Centers for Disease Control, there is no safe amount of lead in children’s blood. Even a level of 1 microgram per deciliter of blood of this harmful and sometimes deadly neurotoxin is enough to lower IQ by several points. Lead wreaks havoc on the mind and body; irritability, mood disorders, appetite loss, and developmental delays are all symptoms of exposure. “A sugar-size packet of lead dust throughout a two-bedroom home is enough to create a lead-poisoned child,” says Helen Meier, an epidemiology professor at the University of Wisconsin-Milwaukee’s school of public health.

For decades, lead served as a critical component in the pipes, paint, and petrol of America’s rural and urban topography. Over the second half of the 20th century, as evidence piled up regarding the negative health effects generated by chronic, low-level exposure, the law finally caught up. Starting in the 1970s, federal provisions gradually took effect to restrict or ban lead-based paint, leaded gasoline, and the use of lead pipes in plumbing.

But the specter of lead still looms in cities across the country, and its effects continue to be felt. The latest exhibit is Newark, New Jersey, where improperly treated drinking water is corroding the city’s lead service lines, allowing the toxic element to flow through residents’ faucets.

Today, about half a million American kids between the ages of 1 and 5 have a blood-lead level that exceeds 5 micrograms per deciliter. And it’s a problem that disproportionately affects children of color, according to the CDC. The impact of this contamination in American cities could be enormous. One provocative hypothesis, for example, draws a direct connection between lead exposure as a child and crime later in life. “Higher levels of lead exposure are correlated with lower test scores and higher rates of criminal activity,” says Kevin Schnepel, an economics professor at Canada’s Simon Fraser University and co-author of the 2017 research paper “Life after Lead.”

Roughly $15 billion is spent in the U.S. annually to handle new cases of lead poisoning. Fully eradicating the toxin in our towns and cities means replacing 7 million lead service lines, remediating lead paint in 38 million housing units, and cleaning up countless tons of soil contaminated by the lead spewed into the air by automobiles. One estimated price tag: About half a trillion dollars.

It’s a daunting figure. But what if the costs of failing to finally reckon with the effects of this contaminant are far worse?

***

“Verily, we live in an age of lead,” trumpeted Baltimore’s Afro-American newspaper in September 1906. While the article noted that iron was a “precious metal” imperative to the new industrial age, its main point was that too few people realized “how useful, if not absolutely necessary, to modern civilization” lead had become.

An abundant metal that doesn’t rust and is easy to shape, lead has long been the stuff that cities were made of—a history that Parisians were reminded of when the lead-tiled roof of the Notre Dame Cathedral went up in flames in April, spreading clouds of contamination across the city.

In America, lead was the ideal material to fashion the snaking pipes that made up vast plumbing systems underneath cities. Lead-based paint—nothing more than metallic lead corroded by an acid into a fine white powder and then mixed with linseed oil—was known for being brighter, shinier, and more durable than other paints. The very rich of the late 19th and early 20th centuries used it inside and outside of their homes; in the 1930s, lead paint, because of its toughness, was mandated for use in public housing. Lead-acid batteries cranked the automobiles Americans drove; leaded gasoline—infused with tetraethyl lead, developed by General Motors—burst onto the scene in 1923. The additive boosted power and stopped engine “knocking.” (It also poisoned the GM engineer who developed the technique, and killed several Standard Oil workers in the refinery that made leaded gasoline.)  

Artifacts from the age of lead. Banned for decades, the toxic metal remains inescapable in older American cities. (Kate Munsch/Reuters)

“It’s everywhere; it’s like the skin of the urban landscape,” says Leif Fredrickson, an environmental historian writing a book about Baltimore’s history of lead poisoning. “One of the classic quotes from a doctor in the 1920s is that children will grow up in a world of lead.”

This despite a steadily increasing body of scientific knowledge that identified lead as extremely dangerous. The first observations of neurologic effects from lead exposure were recorded in Brisbane, Australia, in the 1890s. A Sherwin-Williams newsletter from 1899 published research noting “white lead is a deadly cumulative poison.” Its risks are exacerbated by another quality: It’s sweet, making flakes of lead paint an especially enticing treat to babies and toddlers fond of plumbing the contours of the world through their taste buds. Several countries in Europe banned lead paint indoors five years after evidence emerged in 1904 linking it to childhood poisoning; in 1922, members of the League of Nations banned lead paint outright. One notable exception: the United States.

“Everybody knew lead was toxic,” writes Mona Hanna-Attisha, the doctor who helped expose the lead crisis in Flint, in her book What the Eyes Don’t See, published in early 2019. “[B]ut what it did to the human body was insidious and invisible, while its benefit to industry was tangible and quantifiable in dollars.”

What makes lead poisoning so pernicious is that, in small doses, there are no immediate signs of what it does to a child’s health. But once lead gets into the body—whether via inhalation, ingestion, or just from contact, as tetraethyl lead can be absorbed directly through the skin—it interrupts hemoglobin function in cells, crowds out calcium in bone, and erodes gray matter in the brain regions required to perform executive functions, like being able to pay attention and control or manage our impulses and emotions.

Beginning in 1971 with the Lead-Based Paint Poisoning Prevention Act, federal law did its part to slowly phase out lead from meaningful parts of urban infrastructure. In 1978 came a federal ban on using lead paint in residential cases. In 1986, a federal ban on using lead service lines in any new plumbing. That same year, leaded gasoline was finally taken off the market in the U.S; it was banned outright a decade later.

The fallout from so many decades of using lead to construct America persists. Belched into the air by cars and industry over decades, it has settled in the soil of school yards and neighborhood playgrounds. So widespread was its use in 20th-century America that just about every U.S. city bears the burden of lead, and investigations by news outlets into the damage wrought by lead in urban centers are easy to find: Los Angeles, St. Louis, Chicago, Milwaukee, New Orleans, and, perhaps most notoriously, Flint. About 38 million U.S. homes built before 1977 hide lead paint, the most common source of lead exposure for American kids. The U.S. Department of Housing and Urban Development estimates that 62,000 public housing units require lead abatement. And millions of underground lead pipes remain, still delivering drinking water in cities large and small.

While the burden of lead is shared by many American cities, its health impacts aren’t. Trace the instances of lead exposure in countless locations across the U.S., and you’ll find the same pattern: It’s predominantly an issue in lower-income, minority communities.

***

Baltimore may now be a cautionary example of the perils of lead contamination, but the city was also a pioneer in trying to curb its effects: In 1950, it was the first to ban lead-based paint in home construction. By then, however, the damage had largely been done. Hypersegregated by race and income, lower-income neighborhoods on the east and west sides of the city today bear the brunt of the effects of lead exposure.

Ruth Ann Norton, president and CEO of the Baltimore nonprofit Green and Healthy Homes Initiative, is one of the current advocates for eliminating childhood lead poisoning in the city. Since she started her job in 1993, close to 40,000 children in Baltimore have been poisoned with blood-lead levels higher than 10 micrograms per deciliter. “If you care about health, you must care about lead poisoning,” she says. “But if you care about opportunity, which is tied deeply into racial equity, we must eradicate lead.”

Doing so, as Norton says, is not a technical challenge: It’s just a matter of time, money, and political willpower.

“There’s still an ongoing low-level lead poisoning crisis taking place,” says Lawrence Brown, a lead researcher in his own right and a professor in the school of community health and policy at Morgan State University in Baltimore.

The effects of childhood lead exposure are not distributed equally in cities like Baltimore. The interactive map below uses 2018 lead test data from the Maryland Department of the Environment and U.S. Census Bureau figures to map the city’s toxic burden. In it, you can see how lower-income neighborhoods are still seeing high levels of child lead exposure, and explore the data on your own.

(Matthew Gerring/CityLab)

Epidemiologists discovered an association between lead poisoning and lower IQs and behavioral problems in the 1970s. And in recent years, some of the loudest calls for widespread remediation of lead hazards sound from those studying the link between lead exposure and crime. The lead-crime hypothesis comes courtesy of Rick Nevin, a former HUD consultant; it’s well explained by an article Kevin Drum wrote for Mother Jones in 2013. In short: Environmental lead exposure—primarily from leaded gas, secondarily from lead paint—can explain the dramatic spike in urban crime in the U.S. from 1960 to 1990. After lead was phased out by federal provision through the ’70s and ’80s, crime levels dropped in the ’90s, since children weren’t registering blood-lead levels of 10 micrograms per deciliter and higher.

Proponents of this linkage say that eradicating all environmental lead exposure, despite its cost, would naturally lead to one big benefit: about a 10 percent drop in crime, equalling about $150 billion in corresponding societal benefits, year after year.

It’s compelling, and various studies and articles by other researchers have shown a similar relationship between reducing lead exposure and a reduction in crime rates later on. Nonetheless, not all who have researched the link are wholly convinced of its merit.

“There’s a lot of plausibility for thinking that lead exposure leads to brain changes, that leads to behavioral issues, that then leads to trouble, or doing things that can be categorized as crime,” says lead historian Fredrickson. “But it’s fraught.” (The relevant back-and-forth conversation about this between Fredrickson and others can be found on Twitter.)

In “Life after Lead,” Schnepel and co-author Stephen Billings study a cohort of kids in Charlotte, North Carolina. From their comparison between a control group and a lead-exposed group, they are able to show a decrease in the rate of criminal activity among the kids exposed to lead who are randomly assigned some sort of intervention. The question they still have to answer is what part of the intervention decreased crime: Was it removing lead paint in a child’s home? Or was it, for instance, simply having a guidance counselor more involved with a child acting out in class?

“Our paper certainly contributes to the idea that lead is a really important factor in criminal behavior in communities, but it’s not proof of that by any means,” Schnepel says.

What isn’t clear, in other words, is whether the correlation between lead and crime is perhaps better explained by uncontrolled factors, as University of Queensland researcher Wayne Hall points out. (Couldn’t it just be that a child grows up in a neighborhood where both crime and lead exposure are already common?)

Everyone agrees that lead should be cleaned up as a public health prerogative. But Brown isn’t interested in splitting hairs over the degree of association between lead exposure and crime. It’s all interconnected, he insists.

“The literature on the effects of lead poisoning is very clear,” says Brown, who is leaving Morgan State to be the new director of County Health Rankings & Roadmaps at the University of Wisconsin Population Health Institute. “But then you can also map how what happens early on in education leads to this domino effect that’s going to impact the future trajectory of those children later in life.”

***

The dimming of the age of lead has been, in many ways, a great public health success story. In the late 1970s, the average American kid had about 15 micrograms; today, that average is about 1, according to the latest CDC data.

In particular, more states have prioritized screening children for lead poisoning early on. The sorts of problems that Deshawn Fisher experienced—hyperactivity, an inability to pay attention, behavioral disorders—usually don’t present themselves until someone reaches elementary school, which is why testing children before age 5 is encouraged.

In 2016, Maryland made it a requirement to test every child under 2 for lead; as the Baltimore Sun reported in 2018, the state managed to screen just under half of all children in 2017. Stricter requirements for Maryland landlords to cover or remove lead-based paint in their properties has also led to a decrease in the number of cases of lead poisoning in Baltimore. This fall, Baltimore received a $9.7 million federal grant to address lead paint in homes.

That’s cause for celebration, since it means fewer kids being poisoned to the degree they once were. In the 1950s, it wasn’t uncommon to see children—especially black children in Baltimore, according to Fredrickson—testing positive for levels of lead above 40 micrograms per deciliter, requiring stays in hospital intensive care units.

Yet thinking the fight against lead exposure is over simply because of lower microgram readings would be premature, especially given our growing understanding of what lead does to the body. In the wake of the lead crisis in Flint in 2014, researchers found that blood-lead levels in children increased by only 0.11 micrograms per deciliter. But as of the start of this school year, one in five students in Flint public schools are now eligible for special education, compared to one in eight in 2012-2013, the year before the lead crisis.

In Baltimore, the shadow of lead passed over generations of kids who sometimes weren’t even made aware of the danger.

Kondwani Fidel is a poet from East Baltimore whose new book, Hummingbirds in The Trenches, explores growing up in the city’s underinvested communities. He vividly recalls officials doing inspection of lead “hot spots” in his house and the houses of his friends. What the 26-year-old can’t recall is when those officials broke down the true effects of lead exposure—because it never happened. It was only later in life when lead’s impact was truly understood. Fidel remembers sitting on the stoop one day and having to read the comments underneath a post on Facebook to one of his childhood friends—a friend who grew up in a home with lead—because his friend couldn’t read.

“Lead-paint poisoning, that’s traumatizing even thinking about it,” Fidel says. “You’re not able to operate in life. You don’t have a fair chance at life. So you’re already defeated.”

Norton likes to point out that just three granules of sugar’s worth of lead ingested by a child is enough to have permanent, irreversible, lifelong cognitive impacts. As of this year, Illinois and Ohio joined Michigan in being the only three states where developmental therapies are available for children with even very low levels of lead in their blood.

“When I was first involved in these cases, there was no good science that showed lead levels under 20 [micrograms per deciliter] causes these problems,” says malpractice attorney Michael A. Pulver. “In the 25 years I’ve been doing them, it’s the same story over and over again: school failure, attention problems, hyperactivity.”

Hundreds of lawsuits piled up in the wake of poisonings in cities like Baltimore—not only against negligent landlords, but also against the paint industry. This legal fallout is another manifestation of lead’s lingering impact on urban America. In the spring, a federal jury awarded three men in Milwaukee $2 million apiece after they sued several paint companies that they claimed were responsible for the lead poisoning they received as toddlers. Last July, three former lead paint manufacturers agreed to a $305 million settlement in California to help remediate contamination in older homes in Oakland, San Diego, Los Angeles, and several other counties and cities.

That same month, Deshawn Fisher was awarded $2.3 million after a successful lawsuit brought against the owner of the rental property where he spent his first years. Pulver represented him. Fisher told the court he had to repeat grades in school, and while he managed to earn a high school diploma, he’s been unable to complete college courses. In court, the owner of the rental home testified that he’d never inspected the property for lead paint.

And it all started with a window, a simple childhood pleasure of Fisher’s that now frames his adult life.

Interactive maps created by Matthew Gerring

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