A new study suggests that lead inspection and removal regulations for public housing have been effective over time, reducing the risk of lead exposure for residents. After decades of high lead levels in its housing stock, it’s a sliver of hope for the U.S. Department of Housing and Urban Development (HUD) that remediation and safety efforts are working.

Researchers at Columbia University Mailman School of Public Health and Tufts Medical Center used measurements from HUD and the National Health and Nutrition Examination Survey to look at nearly 20 years of data on residents’ blood lead levels, taken between 1999 and 2018. They compared people living in federal housing with those who were presumed to be on the waiting list for it while living in private market low-income housing. They found that, on average, HUD residents had blood lead levels that were 11.4 percent lower than those waiting for housing assistance. The biggest gap was for those over age 61, whose levels were 14.2 percent lower. For children in the 6 to 11 and 12 to 19 age ranges, while their levels were slightly lower, the difference was not considered statistically significant.  

Nationwide, 75 percent of HUD households are women-led; the program is also an important housing stock for people with disabilities and the elderly. 

According to a 1995 national survey conducted by the Environmental Protection Agency on the prevalence of lead-based paint in housing, 86 percent of public housing complexes built before 1980 had lead-based paint somewhere in their buildings, compared to 83 percent of private housing. But starting in 1987, public housing became the first housing type in the nation that was required to be fully inspected for lead. And in 1992, the Residential Lead-Based Paint Hazard Reduction Act required that public housing officials actively remove lead-based paint from units. 

The study’s results showed that the changes have made a difference, said lead author MyDzung Chu. “It really reiterates the importance of using these policies as a social structural safety net for low-income families to provide better quality housing,” said Chu, an assistant professor at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center. “Black and Hispanic households, as well as female-headed households, are the largest proportion of those that receive HUD housing assistance and so they really have the most to gain from improvements in federal health policy.” 

The Centers for Disease Control and Prevention has determined there are no safe levels of lead exposure for humans. Lead is particularly dangerous for small children, who are exposed through dust and chippings that accumulate in houses with lead-based paint. “It goes from the soil or the dust in the house to a child’s hands or a dropped cookie, or an outside toy, or blanket dragged around outside and brought into the house and a baby chews on it when he takes a nap,” said Mary Jean Brown, an adjunct professor at the Harvard T.H. Chan School of Public Health who has studied lead in housing for many decades.  

Lead exposure has been linked to learning and development delays. “There’s been some preliminary research that if you are like 7 years old and you have a high blood lead level, that is very predictive if you’re not doing well in school,” she said.  

This particular study, which was published in March in the journal Environmental Health Perspectives, only analyzed residents age 6 and older. But previous research that studied children younger than 6 — the population most at risk to the dangers of lead exposure — came up with similar results, showing that children living in public housing had lower lead levels than low-income children who didn’t receive housing assistance. 

“It’s a good step that adds to the body of literature that we have on reducing childrens’ exposure to lead-based paint,” said Holly Davies, a senior toxicologist for the Washington State Department of Health, who reviewed the study. “Because there is no safe level of lead identified, it is important to lower all of the sources of lead that we can. That includes legacy sources such as lead in paint and soil and also sources in new products such as cookware.”

But still, she would have liked the researchers to include younger children: “They didn’t include children 0 to 5, who are the children that we are most concerned about further exposure to lead, because they are still developing.”

To Brown, what’s most notable is that lead levels were lower in adults, who are less likely to ingest lead in the same way that young children do. 

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While the problem of lead in low-income housing is improving, it’s still a significant public health challenge, with 34.6 million homes in the United States estimated to have lead-based paint. According to the latest American Healthy Homes Survey, approximately 19.9 percent of private housing units have lead-based paint hazards, and 11.1 percent of government-supported units have them. 

And some public housing authorities across the U.S. have come under scrutiny in the last decade for their failure to properly look for and remediate lead in their housing units. In places like New York City, and in East Chicago, Indiana, thousands of public housing residents were found to be exposed to high levels of lead as a result.

The study suggests that when there’s compliance, the rules HUD has to follow compared to owners on the private market has reduced lead exposure. But still, “there’s a difference between being safer and being safe,” said Jonathan Wilson, deputy director of the nonprofit National Center for Healthy Housing, an advocacy organization. He pointed to reporting from the Chicago Tribune in 2015 that found that people living in Section 8 housing, now known as the Housing Choice Voucher program run by HUD, were being exposed to high levels of lead. The program allows residents to rent from private landlords with the help of a federal subsidy. It has grown to make up the largest share of residents of any of HUD’s housing assistance programs, providing a home to more than 2 million low-income families, nearly double those that live in public housing. 

“So you can be safer than the house down the street that doesn’t have a voucher, but that doesn’t necessarily mean that you’re not going to get poisoned,” Wilson said. “I think that’s a critical distinction.” 

It’s a distinction that the study makes in its findings, too. While overall, subsidized housing was less risky for lead exposure compared to low-income housing on the private market, the voucher program offered the least protection. This could mean that the problems found in Chicago are more prevalent across the country. 

“I think what we’re finding is there are more stringent inspection policies in public housing, compared to the other … housing types,” said Chu. The voucher program, for example, only requires that owners do a visual inspection for lead, rather than testing paint chips and dust, which is required in public housing units. 

“Lead-contaminated house dust is virtually invisible to people,” Brown said. “You can’t see it. So they could walk in, and whoever is certifying this house doesn’t see anything peeling, and doesn’t take a dust wipe sample, doesn’t take a soil sample, and walks out and says it’s fine.” 

In 2018, the Government Accountability Office (GAO) released a report finding that HUD was failing in a number of ways to mitigate the risks of lead, and didn’t have a plan to hold public housing authorities accountable for not addressing lead problems. The office made several recommendations to HUD, which Jill Naamane, a director at GAO, said have mostly been addressed by the agency since the reports release, including an effort to try out new inspection methods to better detect lead in voucher units. 

“What we heard was that they didn’t have the authority to just change that inspection standard on their own, and that they would have to request authority from Congress to change it,” said Naamane — a request the agency hasn’t made yet.

In a statement emailed to The 19th, a HUD spokesperson wrote that the agency is still piloting a new lead-based paint risk assessment in housing choice voucher units, and that once they have the results, they’ll give their recommendations to Congress. “The pilot will also consider the impacts to search times for families with vouchers, the time to lease, and landlord participation,” they wrote. 

The agency has also updated its visual inspection rules for lead-based paint in Housing Choice Voucher units, they wrote, and public housing authorities managing those units must adopt those standards by October.

But lead contamination issues are overshadowed by the general need for housing. Apartment rents have risen by 32 percent since 2017, according to the Center on Budget and Policy Priorities, a left-leaning think tank, pushing more people into older and deteriorating housing. Meanwhile, the supply of public housing has continued to shrink after decades of disinvestment in the program. Only a quarter of the people who are eligible for HUD housing receive assistance. 

“The thing that everybody’s talking about is related to housing and the affordability crisis,” said Naamane. “Embedded in that is safe and affordable housing units, but it’s not really what we’re hearing about on the Hill right now.”