From Toxic Paint to Safe Futures: Cleveland Clinic’s Bold Plan to End Lead Exposure

00:00:01:00 - 00:00:21:06
Tom Haederle
Welcome to Advancing Health. Homes built before 1978 did not have the prohibition against the use of lead based paint that's in place today. Let's hear what one proactive city is doing to protect its residents against this environmental danger.

00:00:21:09 - 00:00:50:03
Tom Haederle
Hi everyone. I'm Tom Haederle, senior communication specialist with the American Hospital Association. Thank you so much for joining us today. We've all heard the phrase "get the lead out," meaning get moving, pick up the pace. But in Cleveland, Ohio, those words have a more literal meaning. Our two guests today will talk about the massive effort to reduce and eliminate lead poisoning in the city's population, especially among kids who are four times more likely to have elevated levels of lead in their blood than the national average.

00:00:50:05 - 00:01:03:04
Tom Haederle
So joining me to talk about this effort are two experts from Cleveland Clinic. Vickie Johnson, executive vice president and chief community officer and pediatrician Dr. Roopa Thakur. Thank you both for joining me on Advancing Health today. Appreciate you being here.

00:01:03:10 - 00:01:05:02
Vickie Johnson
We're glad to be here.

00:01:05:04 - 00:01:21:12
Tom Haederle
Well, Vicki, maybe we can start with you to bring this into focus. A lot of people may assume that the problem of lead poisoning is a thing of the past. Why is the problem of exposure to lead in the environment so acute in Cleveland, to the point where it's become Cleveland Clinic's top priority for community health?

00:01:21:14 - 00:01:59:12
Vickie Johnson
It is our number one public health priority, because 90% of Cleveland's homes were built before 1978, which means that lead is in the paint in the homes. And as the home deteriorates, it's likely to poison those children living in the homes. So we talk about this as a public health crisis with a housing solution. So often the solution isn't very clear on so many issues, but this is one where we know where the problem is, and we have an ability to partner with others to address it.

00:01:59:14 - 00:02:08:29
Tom Haederle
Is it a matter of the deterioration of the paint itself as time goes on that releases more and more lead into the environment or into the atmosphere? Is that what's going on?

00:02:09:01 - 00:02:34:13
Roopa Thakur, M.D.
Yes, exactly. So, paint deteriorates over time, especially in areas of high friction. So if you think about a door frames, window sills, areas where you're opening and closing a lot, areas that are tread on a lot. So porches and decks are a common source in Ohio. But as the paint chips or rubs off, it creates lead dust that then settles on the floor or settles on the carpet.

00:02:34:15 - 00:02:40:24
Roopa Thakur, M.D.
And then our little ones, who are playing on those floors pick up that lead dust and either inhale or ingest it.

00:02:40:26 - 00:02:49:05
Tom Haederle
So it's really everywhere. And Dr. Thakur, what is the effect of high levels of lead exposure on the human body and particularly in children?

00:02:49:07 - 00:03:09:18
Roopa Thakur, M.D.
Yeah. So we think about our little ones, especially at one and two years old, because that's when their brains are actively growing. We know from the CDC that even the lowest levels of lead exposure can damage the brain and nervous system, can slow growth and development, and can lead to learning and behavior problems. So it can definitely prevent children from getting to their full potential.

00:03:09:27 - 00:03:20:15
Roopa Thakur, M.D.
But we also can see - because lead affects every single organ system in the body - we might see bone problems, we might see kidney problems, liver problems, heart problems as an effect of lead poisoning.

00:03:20:17 - 00:03:31:22
Tom Haederle -
Are the effects less dramatic on full grown adults? If somebody moves into a house, you know, in midlife that happens to be a house built before 1978, are they at the same level of risk or not so much?

00:03:31:24 - 00:03:41:03
Roopa Thakur, M.D.
We definitely can see health effects in adults, but because the brain has kind of fully grown by then, the effects are different. We don't tend to see those same lifelong effects.

00:03:41:05 - 00:03:54:28
Tom Haederle
I know that Cleveland Clinic recently pledged $55 million to the Let's Save Cleveland Coalition and the United Way of Greater Cleveland. How will these funds be used to address the problem of lead exposure in people's homes? What's the plan for the money?

00:03:55:00 - 00:04:22:19
Vickie Johnson
So it's been about three years since we've made that commitment. And we worked with the Lead Safe Coalition to identify the greatest need. So the dollars primarily are allocated to remove the lead from the house. Primarily. But we also have other initiatives such as workforce development, marketing evaluation. We have a budget for that. And most excitingly, we have a budget for childcare centers.

00:04:22:26 - 00:04:39:08
Vickie Johnson
Once we got involved in the coalition, we thought, yes, kids live in homes, but also little ones who go to childcare spend as much time during the week there as they do at home. And that's when we launched the Let's Save Childcare Center initiative.

00:04:39:10 - 00:04:46:09
Tom Haederle
Are these grants that people have to apply for, or how would they go about getting some of that available money to do the clean up?

00:04:46:11 - 00:05:13:13
Vickie Johnson
Absolutely. Yes. There are grants and there's also incentives. As you can imagine, even when resources are available, it takes time to educate the public that the funds are available, that there's an issue that can be resolved. In many cases, we're talking about a landlord and not necessarily a homeowner. So it's different in terms of how you need to engage with those different populations, the homeowner versus the landlord.

00:05:13:20 - 00:05:39:16
Vickie Johnson
Resources are available as incentives. If you apply for Let's Save Cleveland dollars, which is a grant, then there's an incentive available for you just to get utilization increase so that we can address the issue. This is a sense of urgency, and we want every child in the city of Cleveland, you know, for us, as a beginning. We also collaborate with partners on a county level.

00:05:39:16 - 00:05:46:28
Vickie Johnson
But we want every child to live in a lead safe environment for the reasons that Dr. Thakur explained just a moment ago.

00:05:47:01 - 00:05:56:03
Tom Haederle
In terms of what actually needs to be done, is it painting over that original layer of dangerous paint, or does it physically have to be stripped from the wall and replaced entirely?

00:05:56:05 - 00:06:30:10
Vickie Johnson
It's both. So in Cleveland, we have two different approaches. It's making a unit lead safe, which is encapsulating. Yes, you can paint over with the special paint and we can wrap an area that has paint with aluminum or vinyl, if you think about outside a home. And we can also replace and tear out, which is more lead free than let's say, can you put a brand new deck on the porch as opposed to scraping, painting, which you would then have to repeat every couple of years?

00:06:30:15 - 00:06:47:20
Vickie Johnson
So it's two different approaches. It really depends on the state, the current state of the unit as to which method is best. We believe that lead safe is best for the immediate. And then when we can make units lead free as well.

00:06:47:22 - 00:07:09:09
Tom Haederle
A question for both of you. The immediate goal, of course, is to improve the environment and make it healthier, and especially for young kids who are still developing. What are some of the other benefits that we realize from dealing with this problem in terms of health care, lost earnings, societal costs that that have spiraled, I guess, because of the prevalence of lead in the city's homes?

00:07:09:11 - 00:07:43:27
Roopa Thakur, M.D.
So there's actually been a study done by Case Western Reserve University a few years ago that looked at the downstream effects of lead poisoning in our community's children. And what they found was that when you look at the dollars spent on various therapies that those children require over time, if you look at the public benefit spending on some of the services that those patients require as they become adolescents or young adults, many of them deal with homelessness, unemployment, they have several mental health issues and ADHD that can affect their ability to be to remain employed.

00:07:43:29 - 00:08:03:24
Roopa Thakur, M.D.
And so when we think about the long term spending on those public benefits as well as then, you know, there is a subset that is at higher risk for incarceration or juvenile detention, and we look at the spending there. Their data showed that each dollar invested in lead poisoning prevention can have as much as $220 return on investment.

00:08:03:27 - 00:08:17:06
Tom Haederle
Wow. That's impressive. Dr. Thakur, I wonder, is there any reason to think that there will ever be an effective treatment for the damage caused by chronic lead exposure? Or will prevention always remain the best solution?

00:08:17:09 - 00:08:36:01
Roopa Thakur, M.D.
Prevention is our best option. As far as we know, there is no cure for lead poisoning. Once it's happened, we can try to mediate results as best as we can with the therapies that we can provide, such as occupational, physical or speech therapy. But there's no way to reverse the damage that's been done.

00:08:36:03 - 00:08:56:01
Tom Haederle
Sobering message. Final question for both of you. And I know this is not a box checked, this is not a done initiative. But what you've learned so far, and what Cleveland Clinic's experience has been in helping the city deal with this problem. What advice would you have for other health systems across the country that may be looking at the same problem?

00:08:56:01 - 00:08:58:24
Tom Haederle
And also considering, you know, how do we tackle this?

00:08:58:26 - 00:09:27:06
Vickie Johnson
This work takes a long time, and we need to be patient with the results that we hope for. For example, Cleveland has over $100 million available with all of the investors. It's not just Cleveland Clinic. They're other partners that are involved. And so we thought for once, money resources was not an issue. So we just thought that people would run in and take advantage of these resources.

00:09:27:06 - 00:09:50:20
Vickie Johnson
And in a couple of years and five years, we thought our problem would be fixed. And that is not the case. That's not the case. In fact, only a small percent of the resources overall for the Let's Save home piece of it - not testing, not screening, not marketing, not evaluation. A a small percent of the resources have been utilized.

00:09:50:24 - 00:10:19:00
Vickie Johnson
We're still trying to educate the population on the danger of lead poisoning and we're taking different approaches to deal with this. Knocking on doors, going to war club meetings, working with the faith community, childcare centers, state, county, city, public housing, you name it. Everyone is trying to address the issue. There are over 400 members in the coalition.

00:10:19:02 - 00:10:39:14
Vickie Johnson
And when I say members, these are representatives of organizations. So we have thousands of people who are working together on this policy, government. We're trying and we're not satisfied with where we are today, but we're all committed to stay until we accomplish our goal.

00:10:39:17 - 00:10:47:25
Tom Haederle
It sounds like the takeaway message here is there's also a big messaging dimension to this whole initiative that people have to pay attention to.

00:10:47:28 - 00:11:08:00
Roopa Thakur, M.D.
I'll add to that as well, that, you know, Vicky's talking about partnerships. When we think about what we knew about lead poisoning in Cleveland 15 years ago, compared to what we know now, a lot of that required breaking down barriers between all the different silos that we're working on this separately. So our public health departments had the data.

00:11:08:03 - 00:11:16:25
Roopa Thakur, M.D.
We knew clinically what was happening with our patients. But to bridge the gap, to understand well, where is the lead coming from? It takes a lot of people working together.

00:11:16:27 - 00:11:33:18
Tom Haederle
Well, thank you so much for helping shed some light on a very serious problem that is probably more widespread than most people are aware of in other cities as well. Thank you so much again for being on Advancing Health today, and best of luck in this important work you're doing as you work to improve the health of the people of Cleveland.

00:11:33:20 - 00:11:42:01
Tom Haederle
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