Achieving Equity in Lead Poisoning Prevention Policy Making

May 2019

A report synthesizing deliberations from a national meeting to improve the consideration of equity in lead poisoning prevention policy making.

Consensus Conference Summary

Across the United States, community members, advocates, and policy makers are designing and passing policies to prevent lead exposure and poisoning. As some of these policies are implemented, there is potential for unintended consequences, particularly for low-income communities and communities of color, who are often left out of decision-making processes.

In August 2018, nearly 40 experts from across the country came together at the Equity Analysis of Lead Policies Consensus Conference in Chicago. The goals of this consensus conference, were:

To explore the extent to which policy makers are implementing housing- and water-related lead prevention policies in consideration of equity impacts in low-income communities and communities of color, and to make recommendations to improve equity considerations in those communities.

Participants were experts on lead exposure and prevention programs and policies (see Appendix 1 in the PDF of the report for a list of participants) and came from a range of organizations, such as:

  • National and local advocacy groups (n=14)
  • Community-based organizations (n=8)
  • Utility agencies (n=6)
  • Academic institutions (n=5)
  • Federal and local health agencies (n=2)

The consensus conference drew upon the best professional judgment of participating experts and focused on understanding equity impacts and making recommendations in the following policy areas:

  1. Residential lead service line replacement
  2. Lead testing in water at schools and licensed childcare facilities
  3. Testing and remediation of lead-based paint hazards in housing

This proceedings document represents the deliberations from the meeting and is being published to make the wealth of information that was generated publicly available to a wider community. It is not the product of technical research, but rather a synthesis of group discussions by convened experts on how lead policies, if they are not implemented with an eye toward equity, could impact low-income people and communities of color.

Summary of Impacts  

Participants agreed that decision makers and advocates do not explicitly consider equity in lead prevention policy making. Invariably, this leads to unintended negative consequences for people of color and low-income communities, who already bear a disproportionate burden of lead exposure across the United States.

Equity Impacts Across All Prioritized Policies

Across all three prioritized policy areas, conference experts identified the following potential impacts:

  • Exacerbated inequities and mistrust resulting from poor community engagement: Government policy- and decision-making processes often exhibit a lack of meaningful inclusion and engagement that leads to community members feeling undervalued, tokenized, misrepresented, and expendable.  
  • Fragmented lead policy frameworks: A patchwork of laws, regulations, and financing frameworks, along with a siloed programmatic approach, leads to piecemeal strategies and a climate of competition across sources of lead and the settings in which it can be found (e.g., water and paint, schools and homes), communities, and advocates. The fragmentation reduces the effectiveness of programs, dissipates resources, and continues to place communities at risk.
  • Disproportionate cost of unfunded remediation: Communities that are already struggling financially are further impacted when they are required to bear the cost of implementing lead prevention policies. If they are financially unable to remediate exposure, people continue to experience health impacts.
  • Unfair stigmatization: Parents and families, especially Black mothers, are implicitly  and explicitly blamed in policy discussions about preventing exposure of children to lead because of assumptions about their housekeeping, parenting, or choices about where they live. And when children from low-income communities or communities of color are labeled as “lead poisoned,” it can exacerbate stereotypes or convey that these children are irreparably damaged.
Equity Impacts of Lead Service Line (LSL) Replacement Policies

When discussing lead service line replacement policies, conference experts agreed that the following impacts would occur if policy makers don’t explicitly consider equity:

  • Significant financial burdens threatening people and utilities: Policies requiring residents to pay for all or part of the cost of LSL replacement are particularly challenging for low-income people who are already struggling economically. Further, if replacement costs are covered through utility ratepayer increases, those increases can challenge the economic stability of low-income people or make basic water service unaffordable. State and federal policies that require LSL replacement without including funding support can also disproportionately burden smaller utilities that don’t have the rate base or other means to cover the costs.
  • Poorly implemented policies that exacerbate lead exposure: Conducting partial LSL replacement is the default LSL replacement policy across the United States. This approach can increase the risk of acute lead exposure by disrupting pipes, especially if pipes are then not flushed on a regular basis to clear lead that was disturbed during and after construction. In addition, if residents deny utilities access to properties due to lack of trust, prolonged lead exposure may result.
Equity Impacts of Policies to Test and Remediate Lead in Drinking Water in Schools and Childcare Facilities

When discussing policies to test and remediate lead in drinking water in schools and childcare facilities, experts agreed on the following impacts:

  • Insufficient testing protocols, which create more problems: With no federal requirement for lead testing or disclosure in schools or childcare facilities, if and how lead is detected varies, testing protocols are inconsistently applied, mitigation thresholds and strategies differ, and disclosure requirements are unclear. All of this makes it hard to monitor whether issues are adequately addressed and can create a false sense of security among families who are unaware of exposure risk.
  • Enormous financial challenges for local school districts and childcare facilities: Testing and remediation recommendations or requirements often don’t come with funding and vary by school district and facility. Moreover, affluent schools and facilities are both less likely to have lead issues because their buildings are newer and more likely to be financially equipped to address them should they emerge. Implementing water testing and remediation can threaten the financial stability of smaller districts and childcare facilities that are already struggling with basic maintenance expenses.
  • Children falling through the cracks: Gaps in drinking water testing and remediation policies leave children vulnerable — for example, testing policies that require only public schools to test water leave out children in private schools, and policies that cover only licensed facilities leave out children in unlicensed facilities.
Equity Impacts of Policies to Test and Remediate Lead-Based Paint Hazards in Housing

When discussing policies to test and remediate lead paint hazards in housing, experts agreed to the following impacts:

  • Few protections for low-income tenants: Unless protective measures are in place, tenants who report the presence of lead paint hazards can face retaliation from landlords (e.g., eviction, increased rent), a false sense of safety from interim control measures that temporarily address hazards, and displacement during the abatement process. Ineffective enforcement of lead policies also allows landlords to continue to rent units with unabated lead hazards, with these “repeat offender” units exposing current and future tenants to lead.
  • Barriers to remediation for low-income homeowners: Low-income homeowners may have a hard time complying with testing and remediation requirements due to barriers in accessing government funding (e.g., inadequate credit, owing back taxes). Many lead grant programs are set aside for rental units and unavailable to owner-occupied units, and there is often not enough equity in a home to pay for remediation. Given that few municipalities provide full funding for remediation, homeowners may be unable to cover the costs of remediation, which can lead to fines or, in the case of landlords, being forced to stop leasing units.
  • Threat of housing displacement among low-income communities: Gentrification and displacement are risks when new policies don’t include implementation funds and there are inadequate tenant and eviction protections in place. Unfunded remediation requirements may result in the loss of affordable housing if property owners stop leasing or abandon homes that are too expensive to remediate. And, without measures to maintain housing affordability, low-income families may be unable to afford improved units if rents are increased to pay for remediation.

Summary of Recommendations

Conference participants agreed that there are practical and feasible solutions to address the aforementioned equity impacts, and there was enthusiasm and momentum to advance these recommendations collectively. Importantly, these recommendations are not a comprehensive list of all possible solutions to improve lead policies in the areas considered, but are intended as a starting point to inform policy makers and advocates.

Recommendations Across All Prioritized Policies

Across all policies, experts made the following recommendations:

  • Ensure meaningful community engagement and prioritize community needs in decision making: Decision makers should structure their policy processes with affected communities, ensuring that those who are most impacted are prioritized and represented in all phases of policy development: problem and solution identification, policy development and implementation, and monitoring and evaluation. Policy makers and researchers should also value lived experience on equal footing with other forms of data used in decision making.
  • Implement a holistic lead remediation framework that addresses multiple sources of lead simultaneously and employs permanent remediation methods: Policies to remediate lead should focus on prevention and systemic solutions that don’t silo or separate lead sources for correction. Lead elimination efforts should shift to permanent solutions, particularly for low-income communities that lack resources to maintain interim solutions and may be exposed to recurring and new environmental hazards. The highest policy standard is to eliminate lead in homes, schools, and childcare facilities, with adequate implementation funding, along with full disclosure of any testing results and remediation actions.
  • Develop and implement a national public awareness campaign that elevates the need for comprehensive lead exposure reduction and compels policy action: Lead must be framed as a national priority so that new standards and efforts compel action across all communities. This can be done through a national communications and policy campaign with funding from federal and private sources, with cross-sector leadership by community, public health, environmental, housing, and consumer organizations.
  • Prioritize funding for lead prevention and remediation programs based on communities that need it most: There are many existing methods and indicators combining housing age, poverty, and other predictors of risk that can be used to prioritize funding. Where new data are necessary to predict risk, the focus should be on screening homes rather than children as a more preventive approach.
Recommendations for Lead Service Line Replacement Policies

In response to equity impacts that are specific to LSL replacement policies, experts agreed to the following:

  • Prioritize full LSL replacement and avoid partial replacement: Any LSL replacement policies should always require full LSL replacement to ensure that lead pipes are removed from both private and public property. If this is not immediately viable, policy makers should pursue intermediate solutions to reduce the risk of lead exposure from drinking water, including providing water filters and timely and accurate information to residents. Short-term interventions should not be viewed as an alternative to the goal of full lead service line replacement.
  • Ensure that LSL policies have ample funding for all stages of implementation: Prior to implementing LSLR policies, public and private entities should allocate sufficient funding to utilities to develop and implement replacement plans without jeopardizing water affordability for residents in their service areas.  
  • Include implementation funding for low-income residents in any policies requiring full LSL replacement: Utilities must implement comprehensive policies for low-income residents to minimize economic pressures and protect against the impacts of water rate increases, shutoffs, and residential property liens resulting from unpaid bills. Approaches could include avoiding regressive payment structures, basing any ratepayer increases on a tiered-income system, providing on- bill financing with zero percent interest tied to the property, and providing direct resources for bill payment and conservation assistance. Grant and loan programs should be designed with low-income consumers in mind.
  • Require that utilities invest in more effective and meaningful communications with communities: Utilities should commit to mandated reporting of lead issues within a reasonable timeframe, reporting of compliance issues through multiple channels and languages, and providing a consistent point of contact for water quality questions. Utilities should also coordinate with public health agencies to educate communities about water quality broadly, and LSL replacement specifically, and to establish a clear understanding around the harm caused by lead in water. Accessible information about the presence of lead service lines in homes should be made available by utilities.
Recommendations for Policies to Test and Remediate Lead in Drinking Water in Schools and Childcare Facilities

In response to equity impacts that are specific to testing and remediation of drinking water policies in schools and childcare facilities, experts agreed on the following:

  • Provide financial resources to schools and childcare facilities to achieve the ultimate goal of remediation, along with support to properly install and maintain filtration systems: Since schools and childcare facilities typically lack funding to address remediation, it is imperative that these sites receive the ample funding needed to carry out testing, disclosure, and remediation. They also need support to ensure they are: using the best technologies, following manufacturer requirements for installation and monitoring of filtration systems, and maintaining devices appropriately.
  • Improve and standardize testing and disclosure requirements: Testing should be required — and not voluntary — at school and childcare sites, and protocols should ensure that tests demonstrate a tap is safe for drinking. Testing should reoccur routinely, on a public schedule. Following testing, schools and childcare facilities should disclose results and remediation plans in a timely fashion and in a way that is informative and clear for parents, families, and communities. In the absence of reliable test results, schools and childcare facilities should provide filtered water stations and refillable bottles.
  • Target prevention and remediation efforts at all places where children engage: Policies should target all sites where children reside or engage, including unlicensed childcare providers and park and community facilities where summer programs, after-school programs, and sports activities take place.
Recommendations for Policies to Test and Remediate Lead-Based Paint Hazards in Housing

In response to equity impacts that are specific to lead paint hazard testing and remediation policies in housing, experts agreed on the following:

  • Protect the financial well-being of tenants and low-income homeowners during remediation: Numerous strategies could mitigate the cost and disruption of lead paint inspection and remediation for low-income residents, including: exempting tenants from paying rent to noncompliant landlords; ensuring code compliance as a condition of occupancy; and, as with federal and state grant programs, requiring that programs offering funding for remediation have affordability criteria.
  • Include requirements for temporary housing during remediation to minimize household instability, and implement long-term anti-displacement strategies to ensure tenant protection: Laws requiring remediation should provide funding for temporary relocation of low-income families to ensure economic and housing stability during remediation. In strong housing markets, municipalities should implement anti-displacement strategies, such as just cause eviction and rent control, to maintain affordability of the units after remediation.

View the full proceedings report