Creating a Lead-Free Future with the Lead Hazard Reduction Project
Milwaukee, WIChildhood lead poisoning—which causes irreversible brain damage—has long been a challenge in Milwaukee, an older industrial city with many homes built before lead paint was outlawed, especially in the city’s lower-income Black and immigrant communities. While the City has made tremendous progress to reduce extremely high blood levels by 90 percent over the past 20 years, lead contamination persists and the pandemic increased children’s exposures to lead due to school closures and quarantining. Recognizing lead poisoning as a significant public health and equity issue, the City allocated more than $25 million in ARPA recovery funds to start up the Lead Hazard Reduction Project delivered by the Milwaukee Health Department. As Tyler Weber, the Deputy Health Commissioner for Milwaukee explains, “there’s a deep need to fix our housing stock to prevent this mass poisoning across our City.”
Why this investment?
Milwaukee has some of the highest rates of childhood lead poisoning in the country, with an average of more than 2,000 children testing as having elevated blood lead levels every year. Children under age six are especially susceptible to lead poisoning, which can cause brain damage, a diminished ability to learn, violence, and premature death.
The most common way young children are exposed to dangerous amounts of lead is through chipping, peeling, and cracking lead paint in older homes. In Milwaukee, there are an estimated 200,000 housing units built before 1978, when lead paint was banned by the federal government. Lead contamination is worse in Black and immigrant communities that have been subject to racist policies and practices such as redlining as well as disinvestment.
For years, the Coalition for Lead Emergencies, along with community members, churches, parish nurses, and parents of lead poisoned children, have been advocating for stronger interventions, enhanced transparency of data, and improved state policies to address lead poisoning. The ARPA funds provided a unique opportunity to address lead dangers in the City, a problem that the City and the health department has wanted to take meaningful action against but have been lacking the funding and infrastructure to do so. With the goal to reduce childhood lead exposures and lead hazards in Milwaukee households, the City of Milwaukee invested $25 million of ARPA funds to support a series of lead abatement activities.
What is this investment?
Milwaukee’s Lead Hazard Reduction Project aims to serve 400 households where lead poisoned children live and consists of a series of activities, including providing:
- Nurse case management through phone calls, health education, and home visits to children with elevated blood lead levels of 10 micrograms per deciliter to provide general support, education, and referrals;
- Social worker support for families with complex challenges;
- Lead water filters and lead safe home kits to all residents receiving the service; and
- Lead hazard reduction, with an average of $40,000 per unit, including coordination with community partners and non-profits working with local contractors to ensure that households are abated of lead.
The Milwaukee Health Department is working closely with community partners and nonprofits to implement these activities, including Habitat for Humanity Milwaukee (over $3 million), Revitalize Milwaukee, and the Social Development Commission, with each of the latter two receiving over $7 million in ARPA funds from the department. Weber notes this includes investing in them and building their staff capacity. Weber explains: “we wanted to not just take this money and hold it close within the city, we wanted to get it out the door to really create a new cross-sector referral system for lead paint abatement with the theory that it would be better for local contractors, it’d be better for communities because these community groups should have a better grasp on what's going on at the ground level in these neighborhoods.”
Inside the home, where the majority of the lead abatement services occur, the project begins with conducting interim controls: stopping blood lead levels from rising by using HEPA vacuums, disposing of items that might have lead dust on them, and wrapping windows to seal up lead hazards. This is followed by an in-depth lead inspection risk assessment (LIRA) consisting of dust wipe, paint chip, and soil samples from the unit. Using ARPA funds, the City purchased new XRF (X-ray fluorescence) analyzers without radioactive isotopes in them to take 200-300 readings around each unit.
The data from the household is analyzed and compiled into a report that details the LIRA and XRF findings which helps the health department create a course of action for the state-approved contractor. Since houses are typically not safe for families to stay in, the health department works with the community partners and nonprofits to get the families relocated for one to two weeks while the house is being treated. Once the work on the property is cleared, the nurses continue to work with the family depending on the child’s blood level.
Centering equity in the program
Due to the history of redlining in Milwaukee, a majority of the houses with dangerous lead levels are located in neighborhoods largely made up of communities of color, 50 percent of program participants are Black/African American and 15 percent are Hispanic/Latino. Weber notes that “just by focusing on the children that we already knew were lead poisoned, we knew that…it took a natural racial equity approach. Those were the communities that were being touched by this and the most impacted.”
80 percent of families the project is serving are renters located in low-income neighborhoods. Working with the Department of Neighborhood Services who have building code authority, the health department occasionally has them inspect the home for other hazards. A few times a year after completing an inspection, the department has had to condemn a house and relocate a family to a safer residence.
The most significant challenge has been onboarding and reporting for community partners and nonprofits involved in the project. Working on a smaller scale, it has been difficult for them to pay contractors fast enough to get the work done swiftly. Additionally, translating the LIRA report for contractors to work with requires significant staff support and training for the community partners and nonprofits which the health department hopes can be remedied with additional funding.
Outcomes to date
The health department and community partners are early in the allocation process for the project. This ARPA project launched around May 2022 and Milwaukee’s health department expects to complete everything by August 2026. As of March 2024, the Lead Hazard Reduction Project has served 80 out of the 400 unit goal.
Toward transformative change
Milwaukee’s health department hopes that this APRA funded initiative will serve as an initial investment to prompt more philanthropy, hospital system support, and private donations to continue the work of the department as well as the community partners and nonprofits.
For jurisdictions in similar positions, Weber suggests developing a strong cross-sector team to fund development and find a champion for the initiative. For Milwaukee, the mayor, Cavalier Johnson, and the president of the Common Council, José Pérez, have been important champions for the project. Additionally, Weber describes “finding ways to articulate [the project] and bring people close, whether its [through] media, elected officials, nonprofit partners” as key when advocating for safe and quality housing for Milwaukee residents.