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. CDCs 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 CDCs 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: