Introduction
The
Lead Poisoning Prevention Branch of
the Centers for Disease Control and Prevention (CDC) is fulfilling its commitment
to the 2010 goal through its grant program requiring that jurisdictions
develop and implement a strategic plan for elimination that includes
primary prevention, partnering, and program evaluation. Through this Building Blocks publication, the Branch now offers grantees and
others access to promising approaches, including protective public health
policies to reduce lead hazards and other promising strategies.
State and local childhood lead poisoning
prevention programs (CLPPPs) universally acknowledge the importance of
primary prevention and are beginning to address it in their strategic plans
and funding applications. However,
many programs’ primary prevention efforts are confined to parent education
about hygiene, nutrition, and housekeeping, despite research that makes
clear the limitations of these interventions for families whose homes pose
significant hazards. Inability to
institute durable primary prevention is caused in part by the pressure to
focus resources and attention on secondary prevention: identifying and
managing individual cases of elevated childhood BLL. Indeed, in communities where follow-up
on actual poisonings is limited to educating family members about lead
hazards and behavioral change (because public resources are not available
to control identified lead hazards and halt further exposure), meaningful
primary prevention can seem like an extremely remote target.
Programs facing these circumstances need ideas for sharing
responsibility within the jurisdiction for stopping repeat offenders,
expanding access to lead-safe housing, and ultimately arresting the cycle
of inferior housing continually producing new poisonings.
While no city or state with a significant
stock of leaded housing has successfully assembled all of the elements
needed to make primary prevention a reality across the jurisdiction, state
and local lead poisoning prevention programs across the country and their
partners in other agencies and the private sector have implemented a
multitude of innovative and successful primary prevention strategies over
past years. Workshops and
conferences periodically feature model programs, but the prospect of
replicating an entire program with multiple components and elements can be
daunting to the CLPPP seeking to evolve beyond screening and case
management. Difficulty in achieving
program transformation to primary prevention is only compounded within an
overwhelmed public agency that is surrounded by a change-resistant or
risk-averse political environment.
Since most successful primary prevention programs consist of
multiple elements, specific strategies can be considered individually or in
combination.
The multitude of innovative strategies to
identify, control, and prevent lead hazards in housing before a child is poisoned
that are currently being implemented across the country have never been
systematically documented or described in a way that makes information
about their design and implementation readily accessible. Programs and their jurisdictions need
this information at the “building block” level in order to decide which
strategies to pursue based on local needs and conditions. CDC’s Lead Poisoning Prevention Branch
contracted with the Alliance for Healthy Homes (formerly the Alliance to
End Childhood Lead Poisoning) to identify and describe individual building
blocks across the spectrum of primary prevention strategies in order to
create access to knowledge about tangible and realistic opportunities for
progress and program evolution in identifying, controlling, and preventing
lead poisoning and other housing-related health hazards.
Scope and Limitations
The research for Building Blocks for Primary Prevention: Protecting Children from
Lead-Based Paint Hazards was guided by the descriptions of primary prevention
in CDC’s 1997 screening guidelines and 2002 case management guidelines,
which emphasize eliminating and controlling toxic exposures at the
source. While primary prevention
necessarily encompasses activities that address all sources of exposure to
lead, Building Blocks is focused
on strategies for preventing and controlling lead hazards in housing, the
foremost cause of poisoning.
A strategy has
been considered for inclusion as a building block if it is sensitive to the
economics of affordable housing, consistent with the principles of public
health, holds the potential for broad-scale impact, stands a reasonable
possibility of implementation, and offers real promise for reducing lead
and other environmental health hazards in high-risk housing. Building blocks
are not only technical tools and program elements but also strategies such
as techniques for targeting high risk housing, leveraging opportunities,
innovative partnerships, enforcement mechanisms, expanded financial
resources, and new ways to bring lead safety and healthy homes tools into
broader use. A building block is more likely to be a key
ingredient of a prevention-based system, rather than an entire program.
The heart of the
challenge to public health agencies is leveraging action to make privately
owned housing lead-safe. Many
CLPPPs are increasingly viewing leveraging action to address lead hazards
in housing as a part of their leadership role. While public health program directors and
staff are clearly the primary audience for Building Blocks, some strategies entail fostering changes in
other organizations and systems to advance prevention in high-risk
housing. The summary of each building block is coupled with an illustration
of how the strategy has been implemented and contact information for at
least one individual who is knowledgeable about this activity.
Building Blocks has some
inherent limitations that deserve note.
The information listed in illustrations (partners, resources,
constraints) is not comprehensive but rather an enumeration of specific and
strong examples of a building block in play. Results of efforts to replicate a given building block will
vary depending on individual state and local laws, maturity of
partnerships, political will, and the existence and strength of
community-based partners. The
applicability of a building block selected for implementation will depend on the
maturity and capacity of the jurisdiction and its CLPPP.
Organization of Building Blocks
The description of each strategy is
structured according to the template (Appendix A) that has shaped the research and
compilation of Building Blocks.
The generalized information includes the title, brief summary,
potential applications and benefits (including scope of impact), and
critical elements such as staffing patterns, other resource needs,
institutional capacity, cost and timing considerations, and indication of
feasibility of implementation.
At least one real-world illustration
amplifies most building block descriptions, documenting: the scope and
particulars of the example in given jurisdiction or other target areas; the
staffing and other resources utilized; magnitude of its impact; factors
essential to implementation; limitations encountered; estimated potential
for replication; and specific contact information and references for
additional information. The
illustrations offer strong examples of how each strategy has been recently
implemented but do not provide an inclusive or exhaustive review of all
efforts to ever plumb the benefits of the given strategy.
The building blocks on this site are
grouped by the category that best fits their essential contribution to
primary prevention:
· Building Awareness and Public Support · Building Capacity for Lead Safety · Collaborations, Partnerships, and Incentives · Financing and Subsidies · Lead Safety and Healthy Homes Standards · Targeting High Risk Homes · Using Code Enforcement and Other Systems
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