The voices of Urban Institute's researchers and staff
April 8, 2016

Poor nutrition leaves kids vulnerable to lead poisoning—and not just in Flint

We are all now sadly familiar with the story of lead-contaminated water threatening the health of children and their families in Flint, Michigan. Good nutrition can lessen the harmful effects of lead exposure, but one in four children in Flint is food insecure.

What’s more, Flint isn’t the only place with high levels of lead exposure and high rates of child food insecurity—two problems that can create profound and lifelong health disadvantages. Among 26 states that report lead exposure data to the Centers for Disease Control and Prevention (CDC), we identified 47 counties where children are at risk for the same issues that children in Flint face now.

Although it is not possible to fully reverse the potentially devastating impact of lead exposure on child development, the crisis in Flint has led to a robust discussion about addressing lead exposure’s negative effects. 

One strategy is better nutrition, which can lessen the absorption of lead in the bloodstream or mitigate its toxicity, while maximizing the prospects for healthy physical and mental development. Poor nutrition—particularly diets lacking in vitamin C, iron, and calcium—may make children more susceptible to the damaging effects of lead on the central nervous system.

Unfortunately, the news for Flint has not been good on the nutrition front either. According to Feeding America’s Map the Meal Gap project, Genesee County, where Flint is located, has a childhood food insecurity rate of 23.2 percent. Since the problems in Flint have come to light, food and nutrition resources have mobilized in the community. 

Local health care providers like pediatrician Mona Hanna-Attisha have elevated the urgency of good nutrition for at-risk families, promoting community nutrition resources—such as cooking classes focused on diets rich in vitamin C, iron, and calcium—that can help address lead poisoning.

The US Department of Agriculture and local institutions have collaborated to leverage federal nutrition programs to support Flint families, including the distribution of 10,000 booklets on nutrition and lead, temporary approval to use funds at WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children) clinics to test for lead, and identification of and outreach to schools that can adopt new “community eligibility” provisions to offer free breakfast and school lunch to all students.

Lead poisoning and high rates of poor child nutrition found in 47 counties

It is difficult to fully assess lead exposure at the county level across the United States: only 26 states report these statistics to the CDC, and not all counties test enough kids to be confident in the results. 

Working with available data for 2014, we focused on counties that tested at least 1,000 children, had poverty rates at or above the national average of 14.8 percent, and reported that 5 percent or more of their child population had elevated blood lead levels of 5 micrograms per deciliter (mcg/dl) or higher, the threshold that public health officials believe is cause for greatest concern (although there is wide consensus that no amount of lead exposure is acceptable).  

County 2013 child food insecurity rate Number of children tested Percent of children with lead levels higher than 5 mcg/dl
Bernalillo County, NM 25.1% 1949 95.7%
Forrest County, MS 28.0% 1197 54.9%
Cuyahoga County, OH 23.6% 21398 14.4%
Cambria County, PA 23.9% 1212 13.0%
Peoria County, IL 23.2% 4000 11.3%
Genesee County*, MI 23.2% 6717 2.5%
*This is the last reported data from Genesee County, which includes the city of Flint, to the CDC. The CDC does not collect city specific lead data in this dataset. Recent estimates from state of Michigan data report that in Genesee County 3.5% of kids 17 and under tested at levels of lead higher than 5mcg/dl in 2014 and 5.6% in 2015. The state of Michigan data also reports that in Flint 2.4% of kids 17 and under tested at levels of lead higher than 5mcg/dl in 2014 and 3% in 2015.

Forty-seven counties in the 26 states met those criteria. Among the top five for lead exposure rates, Bernalillo County, New Mexico, reports that an astonishing 95.7 percent of children have elevated blood lead levels. The lowest rate among the top five is 11.3 percent, which is well above Genesee County​'s preliminary 2015 estimates of 5.6 percent.  

And the top five all have child food insecurity rates that exceed the already abysmal national average of 21.4 percent (based on 2013 data, the most recent year available at the county level). Indeed, most of the remaining counties in our sample also experience higher-than-average child food insecurity rates. Clearly, there are many communities beyond Flint that need to tackle lead exposure. And these efforts will be undermined without a concentrated effort to address the significant nutritional risks of food insecurity.

Lessons from Flint for all cities

The crisis in Flint will undoubtedly be discussed for years as a case study in policy failure. But Flint’s experience also offers lessons for today. Every community should have a robust lead monitoring program that reports data to the CDC so that we can better evaluate and mobilize the response of both public and private infrastructure at the earliest warning signs.

A vigorous response should also harness everything we know that may help improve lifetime outcomes, including ensuring a food-secure community with high-quality nutrition available and affordable to all families.

Of course, that should be the minimum standard for all children, something that should be a priority in the coming months as Congress belatedly considers the reauthorization of the child nutrition programs, which technically expired last September, and debates proposed cuts to the SNAP program, which research demonstrates alleviates food insecurity and can improve health outcomes for children later in their lives

In the final analysis, the conversation about what to do about lead exposure doesn’t end with strategies for testing water fountains or replacing pipes; it has to include all the ways we may be underinvesting in the health of vulnerable children. Without that long view, we will not have learned the lessons from Flint.

Five-month-old Dakota Erler of Flint, MI gets blood drawn from her heel in order to have her blood lead levels tested at Carriage Town Ministries in Flint on Thursday, February 4, 2016. Photo by Brittany Greeson for The Washington Post via Getty Images

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