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A sign warns of potential lead hazards Feb. 11, 2022, at the site of the Pruitt Igoe Housing Apartment Complex in north St. Louis. The National Geospatial Intelligence Agency dropped the site as a potential space for its new headquarters, in part, due to the presence of toxins.
Lisa Pascoe poses with her 2-year-old daughter on March 23 at their home in Clarkson Valley. Pascoe’s older child, a son, had elevated levels of lead in his blood as a toddler.
A sign warns of potential lead hazards Feb. 11, 2022, at the site of the Pruitt Igoe Housing Apartment Complex in north St. Louis. The National Geospatial Intelligence Agency dropped the site as a potential space for its new headquarters, in part, due to the presence of toxins.
Lisa Pascoe poses with her 2-year-old daughter on March 23 at their home in Clarkson Valley. Pascoe’s older child, a son, had elevated levels of lead in his blood as a toddler.
When the pediatrician recommended Lisa Pascoe have her then-toddler tested for lead poisoning, she thought there was no way he could be at risk. Everything in her South St. Louis home had been remodeled.
But then the nurse called to say her son’s blood lead level was dangerously high — five times the level federal health officials then deemed elevated. Pascoe said she was “completely shocked.”
“After you hang up on the phone, you kind of go through this process of ‘Oh my gosh, my kid is lead poisoned. What does that mean? What do I do?’” she said.
That same week, St. Louis city health workers came out to test the home to identify the source of the lead. The culprit? The paint on the home’s front window. Friction caused by opening and closing the window caused lead dust to collect in the mulch and soil outside of the house, right where her son played every day.
A decade later, the psychological scars remain. Pascoe and her toddler ended up leaving their St. Louis home to escape lead hazards. To this day, she’s cautious about making sure her son, now a preteen, and her 2-year-old daughter aren’t exposed to lead so she doesn’t have to relive the nightmare.
Pascoe’s son was one of almost 4,700 Missouri children with dangerous levels of lead in their blood in the state’s 2012 report — decades after the U.S. started phasing lead out of gasoline and banned it in new residential paint and water pipes. Although cases have fallen precipitously since the mid-20th century, lead is a persistent poison that affects thousands of families each year, particularly low-income communities and families of color.
Eradicating it has been a decadeslong battle.
Omaha, Nebraska, has been cleaning up contaminated soil from two smelters for more than 20 years. The Argentine neighborhood of what is now Kansas City, Kansas, grew up around a smelter that produced tens of thousands of tons of lead as well as silver and zinc. About 60% of homes in Iowa were built before 1960, when residential lead-based paint was still used. Missouri is the No. 1 producer of lead in the U.S.
The four states have some of the highest numbers for lead water pipes per capita in the country. While representative data on the prevalence of lead poisoning is hard to come by because screening rates lag in many areas, one study published last year found that the four states struggled with some of the highest rates of lead poisoning.
“We know that there is no safe level, that even at really low levels, it can affect intellectual growth, cognitive development. We can prevent that type of harm,” said Elizabeth Friedman, a physician and director of the Pediatric Environmental Health Specialty Unit for Kansas, Missouri, Nebraska and Iowa. “So why wouldn’t we?”
David Cwiertny, director of the Center for Health Effects of Environmental Contamination at the University of Iowa, said it’s “unacceptable” for anyone to be exposed to lead.
“We should go to the ends of the Earth to invest in staff and preventing it from happening if we can,” Cwiertny said.
At Pascoe’s St. Louis home, workers encapsulated the flaking paint and replaced the top layer of tainted soil outside the home. During encapsulation, lead paint is coated and sealed to prevent the release of lead dust or paint chips. Her toddler’s blood lead level began to drop from its high of 25 micrograms per deciliter.
But that wasn’t enough to keep his lead level low.
Even though Pascoe kept her son from playing outside, cleaned regularly with a vacuum cleaner equipped with a HEPA filter provided by the health department and wiped off everything that could track lead dust in the home, her son’s level hovered at 6 micrograms per deciliter for nearly a year.
In 2013, Pascoe and her son moved out of the city and into a home without lead in St. Louis County. Finally, his levels dropped below 1.
Lead is a dangerous metal commonly used in water pipes, paint, gasoline and household products until the late 20th century, decades after scientists began sounding the alarm about its danger.
In high doses, lead can be fatal. Even after the source of the exposure is eliminated, long-term effects of the metal linger.
“Once a kid is exposed to lead, it is not reversible,” said Dr. Justina Yohannan, a licensed psychologist based in Atlanta.
Officials with the World Health Organization warn there is no safe level of lead in blood. Even levels as low as 5 micrograms per deciliter can cause behavioral difficulties and learning problems in children.
Lead-poisoned children may have trouble with language processing, memory, attention and impulsivity, Yohannan said. Many require special education services in school.
The Centers for Disease Control and Prevention last year updated its blood lead reference value to 3.5 micrograms per deciliter from 5. The reference value represents the 2.5% of children with the most elevated blood lead levels who should be prioritized for investigations and resources. It’s not a health standard, and the CDC leaves it to state and local authorities to determine at what levels they will take action depending on state laws, local ordinances and the resources they have available.
Lead poisoning also disproportionately affects Black children and kids in low-income neighborhoods. Black children in Missouri are nearly twice as likely to suffer lead poisoning as their white peers.
“This has happened because of the racist historical practices and policies that continue to segregate children and families of color into older, sometimes less-maintained, overburdened and underresourced neighborhoods where lead exposures are more common,” Friedman said.
While many cities have grants or loans available to help remediate homes, low-income families in rental housing don’t always have the final say.
Amy Roberts, who runs the lead poisoning prevention program in Kansas City, Missouri, said landlords are often cooperative and allow for repairs when their tenants’ children are lead poisoned. But not always.
It’s illegal to evict a family because of lead exposure, Roberts said. But if a landlord has cause to evict a family that they haven’t acted on, they might do so rather than deal with the health department coming in.
“They’ll say, ‘Well, we didn’t evict them because of the lead. We evicted them because they were behind on their rent,’” Roberts said. “So would they have allowed them to stay if we hadn’t gotten involved because of the lead? It’s hard to know.”
By the time the U.S. started phasing lead out of gasoline, banned it in residential paint in the 1970s and outlawed lead water pipes in 1986, scientists had been warning of the dangers of lead for decades.
The legacy of lead is well documented among adults who grew up surrounded by the metal.
Forty years ago, more than 90% of children had blood lead levels above 10 micrograms per deciliter, almost triple the CDC’s new reference value, updated to 3.5 micrograms per deciliter in October. Researchers estimated last month that just over half of Americans alive today were exposed to high lead levels as children, especially those born between 1951 and 1980.
Childhood exposure to the metal causes a 70% increase in the risk of cardiovascular disease mortality. Acute lead poisoning results in noticeable symptoms, including loss of appetite, constipation and stomach pain, fatigue and a blue tinge around the gums.
But lead poisoning now is nearly always chronic, low-level poisoning that may not show obvious symptoms. It can manifest later in behavioral challenges, lowered IQ and increased risk of cardiovascular disease.
Before 1970, blood lead levels were considered elevated above 60 micrograms per deciliter. The surgeon general reduced that to 40 in 1970. The CDC reduced it to 30 in 1978; 25 in 1985; 10 in 1991; 5 in 2012; and 3.5 last year.
The Pascoes are vigilant about researching the products the family uses now. Their 2-year-old daughter only uses toys and crayons that are lead-free, and the family eats from glass dishes to avoid contact with lead that could leach into food from ceramic plates and bowls.
Other parents are often shocked when Pascoe tells them about her son’s lead poisoning. She warns other families, especially in older houses, to get a home lead assessment.
“I thought it was a thing of the past,” she said, “that lead poisoning had just been something I’d heard about in the ’90s.”
Missouri Independent is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a public charity. It can be found at missouriindependent.com. The Iowa Capital-Dispatch’s Jared Strong contributed to this report.
Over the next few months, The Missouri Independent and NPR’s Midwest Newsroom are collaborating to investigate high levels of lead in children of Iowa, Kansas, Missouri and Nebraska. By analyzing scientific research, delving into state and local data and interviewing parents, experts and advocates from across the country, the project will shed light on a public health disaster that continues to poison children every year.
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