In theory, primary prevention has always been the goal of childhood lead poisoning prevention programs. In practice, however, most programs focus exclusively on secondary prevention, dealing with children who have already been poisoned. As programs shift the emphasis to primary prevention, their efforts must be designed to systematically identify and remediate environmental sources of lead, including, most importantly dwellings containing old lead paint.
The shift from case management to community-level intervention will require a fundamental shift in perspective. The focus must shift from the individual child to the population of children at risk and the environment in which they live. The purpose of community-level intervention is to identify and respond to sources, not cases, of lead poisoning. The responsibility for addressing lead poisoning will have to be expanded beyond health agencies to include a variety of housing, environmental, and social service agencies at the local, county, state, and national level.
What is the Government Doing About the Problem of Lead in Water?
The U.S. Environmental Protection Agency reported as of May, 1993 that the latest round of monitoring for lead in drinking water shows that 819 large and medium-sized pubic water systems exceed the lead action level of 15 parts per billion (ppb) established under the Safe Drinking Water Act (SDWA). An action level requires pubic water systems to take corrosion control measures to reduce lead levels, perform additional monitoring and inform the public. These 819 systems provide drinking water from approximately 30 million people across the nation.
In October 1992, EPA reported the results of monitoring conducted between July 1992 and June 1992. EPA now has compiled the results of required monitoring conducted between July 1992 and December 1992 by over 7,500 large and medium-sized public water systems. Monitoring results release as of May, from the large systems represent their second round of testing.
These monitoring results do not represent average drinking water lead levels in these communities. Systems are required to test the tap water in high-risk residences, those served by lead service lines or containing lead interior piping or copper piping with lead solder installed after 1982, where the higher lead levels are expected to be found. Under the law, systems exceed the lead action level if more than 10 percent of monitored high-risk residences have drinking water lead levels of more than 15 ppb.
The 10 large, serving over 50,000 people, public water systems with the highest reported lead levels are: Charleston, SC, at 165 ppb; Utica, NY at 160 ppb; Newton, MA at 110 ppb; Yonkers, NY at 110 ppb; Waltham, MA at 76 ppb; Brookline, MA at 72 ppb; and Taylor, MI at 69 ppb.
The 10 medium-sized, serving between 3,301 and 50,000 people, pubic water systems with the highest reported lead levels are: U.S. Marine Corps Camp Lejeune-Hadnot Point, NC at 484 ppb; Grosse Pointe Park, MI at 324 ppb; Goose Creek, SC at 257 ppb; Honesdale, PA at 210 ppb; Mangum, OK at 191 ppb; U.S. Marine Corps Camp Lejeune-New River, NC at 189 ppb; Clewiston, FL at 166 ppb; Stockton State College in Pomona, NJ at 160 ppb; Marcy, NY at 160 ppb; and New Hartford, NY at 160 ppb.
There are 1,100 large and medium systems that did not complete the required monitoring. These systems are targets for EPA or state action. Since December 31, 1992, EPA and states have issued 427 notices of violation and 145 proposed or final administrative orders to public water systems for failure to conduct required lead monitoring. These orders specify the actions systems need to take to comply with the monitoring and reporting requirements. they also require the system to notify the public of failure to monitor. Failure to comply with the terms of the orders can lead to additional enforcement actions, including penalties. Further enforcement actions against the remaining monitoring/reporting violators are planned.
In June 1991, EPA issues new regulations which apply to approximately 85,000 drinking water systems that regularly serve at least 25 people. These regulations required all large water systems to complete the first round of monitoring by June 1992 and a second round by December 31, 1992. In addition, medium-sized systems were also required to complete their first round of monitoring by December 31, 1992. Small systems, those serving 3,300 and fewer people, must compete a round of monitoring by December 31, 1993, regardless of the monitoring results. Smaller systems are required to install corrosion control treatment if more than 10 percent of the monitored, high-risk household taps exceed 15 ppb. Most corrosion control efforts will attain full effect in systems of all sizes by 1997.
Although an exceedance of the lead action level by itself is not a violation of the regulation, it does trigger additional requirements for public water systems, including public education, additional monitoring, and corrosion control treatment. All 819 systems with high lead levels were required to notify their customers of their elevated lead levels and to offer tips on how to minimize drinking water lead exposure through an EPA developed public education program.
Corrosion control treatment generally involves the addition of any of a variety of mineral compounds such as lime, calcium carbonate, and orthophosphate. These compounds reduce the corrosivity of the water and leave a protective coating of minerals on pipes, minimizing the amount of lead leaching from pipes into the drinking water. If any system still exceeds the lead action level after optimal corrosion control is installed, it must replace the lead service lines in its distribution system to reduce tap water lead levels further.