Lead paint abatement programs
Lead paint abatement programs eliminate lead-based paint and contaminated dust by removing or encapsulating lead paint or removing lead painted fixtures and surfaces1. Approximately 34.6 million housing units contain lead-based paint, with estimates showing dust lead hazards in 21.9 million homes and significantly deteriorating lead-based paint in 18.2 million homes2. In the U.S., lead-based paint and lead contaminated dust are some of the most widespread sources of lead exposure for young children3. Scientists indicate there is no safe blood lead level (BLL) for individuals of any age, including fetuses4, 5. The Centers for Disease Control and Prevention (CDC) blood lead reference level for initiating public health actions to prevent further exposure and mitigate health effects is 3.5 micrograms per deciliter (µg/dL); it is estimated that over 500,000 children have BLLs at or above this level4.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced lead exposure
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Reduced blood lead levels
Improved health outcomes
Improved child behavior
Improved youth behavior
Reduced health care costs
What does the research say about effectiveness?
There is strong evidence that lead paint abatement programs reduce lead dust exposure when removal of the lead source is confirmed6, 7, 8, 9, 10 ). Additional evidence is needed to confirm effects on blood lead levels11, 7, 6.
Lead abatement can improve physical and mental health outcomes for children and adults by reducing developmental disorders5, 12, 7, 13, 6. Newborn infants and fetuses are especially vulnerable to effects of lead exposure that disrupts brain development5, 14; a St. Louis-based study suggests prenatal screening and proactive lead hazard remediation can prevent exposure among some newborns1315, 12, 16. Higher prenatal and childhood blood lead levels have been associated with increased adult arrest rates and arrests for violent offenses17. Reduced lead exposure may be linked to reductions in violent crime levels roughly twenty years after exposure would have occurred18, 19.
Local lead laws are associated with reduced lead hazards for children20, 2122. A Philadelphia court that enforces lead hazard laws appears to increase property remediation rates232425151526.
Cost benefit analysis finds positive net benefits and a high rate of return for lead abatement programs overall27, 28. The Health Impact Project estimates that $84 billion in long-term benefits for each birth cohort could be generated by removing lead hazards and preventing childhood lead exposures4, 11. Economic modeling suggests that future earnings and decreased medical costs for children who benefit from these programs range from 2-20 times the estimated costs of lead abatement29///.
How could this strategy advance health equity? This strategy is rated potential to decrease disparities: suggested by expert opinion.
Lead paint abatement programs that direct resources to families who cannot undertake abatement without assistance have the potential to decrease disparities in lead exposure between children from families of color, with lower incomes, who do not own their homes, and children from white families, with higher incomes, who own their homes11, 12, 22, 24, 25, 41. Lead paint abatement programs that effectively remove lead hazards have the potential to reduce racial disparities in health, development, education, and socio-economic outcomes12. Experts suggest comprehensive lead poisoning prevention interventions are needed to identify lead exposure risks, offer environmental testing, and take action to abate or contain lead found in paint, soil, and pipes, especially for communities of color that are systematically disadvantaged42. Comprehensive policies should consider lead exposure pathways including dust, soil, water, and air43.
Lead hazards are a persistent environmental injustice that disproportionately affects children of color, from families that immigrated to the U.S., living in urban areas, living in areas with lower incomes, and living in older, deteriorating homes11, 22, 25, 42, 44, 45. Disparities in blood lead levels (BLLs) between Black children and white children ages 1-5 years old have decreased in recent decades; however, disparities persist, with Black children suffering from higher BLLs and higher lead exposures than white children, even at the highest income and highest education levels25, 42. Black children, especially younger children, also have the highest outlier BLLs; the data show potentially thousands of Black children with BLLs of 40 μg/dL or more and no children from any other racial or ethnic group with BLLs that high42.
Available data suggest that children living in households with higher education levels have lower rates of lead exposure than children living in households with less formal education, and as income levels increase, BLLs among children decrease42. Children from families with lower income levels living in areas with higher risk of lead exposure experience negative brain development and cognitive outcomes more than children from families with higher income levels living in the same higher risk areas46. Children from families with lower incomes also have higher risks of nutritional problems, especially iron deficiency, which can increase lead absorption and elevate BLLs47.
Lead abatement laws have the potential to increase housing discrimination against and evictions of families with young children from landlords trying to avoid the costs of lead abatement15. Evictions are disproportionately experienced by families living in urban areas with low incomes, often neighborhoods of color15. Evictions harm families and reduce economic and social stability, employment opportunities, education outcomes, and mental health, and increase experiences of homelessness15.
What is the relevant historical background?
By the late 19th century, lead’s toxic and harmful effects were known, yet the lead industry and many businesses profited from selling lead for use in paint, pipes, and gasoline. Lead was also part of many consumer goods, including toys and household appliances. By the 1950s, millions of children had been poisoned by lead, either chronically or acutely, and public health officials had documented the irreversible effects of childhood lead poisoning from lead exposures in paint and contaminated water11, 48. Powerful leaders of the lead industry avoided responsibility for knowingly selling products containing toxic lead and claimed lead poisoning was only a problem among individuals and families of color and those living in poverty, falsely suggesting that education about the risks of lead paint was all that was needed48.
Formerly redlined neighborhoods are more likely to be communities of color with lower incomes and fewer resources, affected by polluting industries and waste dumping sites, comprised of older and deteriorating houses with lead-based paint, located near lead-polluting industries, and surrounded by heavy traffic with residual effects from leaded gasoline pollution42, 44. Children of color experience disproportionate adverse exposures, including to lead, living in racially segregated, formerly redlined neighborhoods. Government disinvestment and the systematic concentration of poverty has increased and exacerbated lead hazards as housing stock deteriorates, lead water service lines degrade, and industry and waste dumping sites further contaminate the air and soil11, 47, 49, 50.
The Lead-Based Paint Poisoning Prevention Act in 1971 banned lead paint as of 1978 and identified paint chips as the primary lead hazard in homes. The Residential Lead-Based Paint Hazard Reduction Act of 1992 included lead-contaminated dust and soil in the definition of lead hazards and moved towards prevention of poisoning rather than reaction to poisoning as the national strategy for addressing lead hazards47, 51. This legislation mandates removal of lead hazards and the adoption of lead safety requirements for federally assisted housing and requires landlords and sellers for private housing to disclose information about potential lead-based paint and other lead hazards26. The U.S. Environmental Protection Agency also adopted the Lead-Based Paint Renovation, Repair and Painting (RRP) Rule in 2010 to establish training and certification requirements for all contractors encountering and disturbing lead paint in homes26.
Legislation and lead hazard removal has reduced childhood lead exposure, with population level decreases in BLLs since the 1970s51. As of 2010, 23 states have adopted comprehensive lead prevention laws47. Several local and state governments have adopted legislation that requires lead testing for children at age 1 or 2, including Philadelphia and Pittsburgh, as well as Connecticut, Delaware, Maryland, New Jersey, and New York49. However, roughly half a million children age 1 to 5 still have BLLs at or above 5 μg/dL, when it is known that there is no safe blood lead level and significant disparities in lead exposure by race, ethnicity, and income remain47, 51. Although a federal program to provide nationwide lead abatement would require allocating significant funds, cost benefit analysis suggests benefits of $17-$221 for every dollar invested in lead paint hazard control due to reduced health care, special education, and crime costs as well as increased lifetime earnings and tax revenue28. Government decisions about what it is worth to save communities and people suffering from lead hazard exposure are value judgments that have been influenced by explicit and implicit bias with disastrous effects for many communities of color48. The World Health Organization estimates that lead exposure worldwide accounts for over 1 million deaths annually and over 24 million years of healthy life lost45, and as of January 2024, only 48% of countries have banned lead paint52.
Equity Considerations
- What neighborhoods in your community have higher lead paint exposure risks? Who has the decision-making power to prioritize reducing disproportionate lead exposure risks in your community? How could local lead laws support new maintenance requirements and lead abatement? How could local laws be designed to prevent landlords from increasing evictions to avoid new lead abatement requirements?
- Is your community abating lead hazards before children are exposed, as is recommended to prevent irreversible serious harm, or reacting to blood lead level tests after lead exposures have occurred?
- What lead poisoning prevention interventions exist in your community? Are these interventions comprehensive, with additional funding available for households that need help to remove lead hazards? What funding could be made available to prevent lead poisoning through abatement or removal of lead hazards?
- Are all pathways to lead exposure considered and addressed through preventative lead poisoning efforts in your community? What partnerships or collaborations could support addressing lead hazards in contaminated dust, soil, water, and air? How can your community gather support and coordinate efforts from public agencies, community organizations, grant funders, property owners, the public, and others for comprehensive lead poisoning prevention?
Implementation Examples
As of 2021, 45 states have legislation to address lead hazards, primarily lead paint and lead dust30. In some states, such as Maryland, Massachusetts, and Rhode Island laws focus on identifying and fixing lead paint hazards before children are exposed22, 26. Maryland laws require inspection and remediation of lead hazards in older, rental properties and have established strong state and local enforcement measures, including heavy fines for noncompliance26. Many states have universal lead screening and reporting for all children ages 1 and 2, as in Maine and Maryland26. Some state laws, as in Ohio and Massachusetts, require investigations into potential sources of exposure after lead exposure has been documented, and mandate addressing lead hazards in rental units before they can be re-rented11, 26. Many state agencies also support lead hazard reduction. The New York State Department of Health, for example, supports regional lead resource centers in New York City, Syracuse, and Buffalo that work to improve lead testing, education, and prevention activities through partnerships with local medical providers and departments of health31. The U.S. Environmental Protection Agency (EPA) also administers lead-based paint programs in affiliated territories and on most tribal lands32. Four tribes developed and run their own EPA-authorized programs: Bois Forte Band of Chippewa; Cherokee Nation; Lower Sioux Indian Community; and Upper Sioux Community33.
Some cities have lead hazard reduction laws. Rochester, NY, for example, adopted a Lead-Based Paint Poisoning Prevention Ordinance in 2006 that requires lead paint inspections for rental units within the city limits34 and uses neighborhood-level BLL data to prioritize enforcement of local lead abatement laws11. Burlington, VT35; New York City36; Philadelphia, PA37; and Washington, D.C.38 are additional examples of cities with ordinances regarding assessment of lead hazards in rental units. In some cities, as in Washington, D.C., prohibitions against lead paint hazards include rental homes, child care and pre-kindergarten facilities, common areas of multi-family properties, and other areas where children spend time11.
The Centers for Disease Control and Prevention (CDC) Childhood lead poisoning prevention program provides funding for blood lead level surveillance in 29 states, Washington, D.C. and five other cities39. The 10 regional offices of the U.S. EPA each have a designated Regional Lead Coordinator who oversees lead-poisoning prevention, training, and enforcement efforts in the region40.
Implementation Resources
‡ Resources with a focus on equity.
US EPA-Lead - U.S. Environmental Protection Agency (U.S. EPA). Lead: Lead poisoning is preventable.
US EPA-EJScreen - U.S. Environmental Protection Agency (U.S. EPA). EJScreen: Environmental justice screening and mapping tool.
US EPA-Protect your family - U.S. Environmental Protection Agency (U.S. EPA), U.S. Consumer Product Safety Commission, U.S. Department of Housing and Urban Development (U.S. HUD). Protect your family from lead in your home. Washington, D.C.: U.S. Environmental Protection Agency (EPA); 2012.
US EPA-LAF - U.S. Environmental Protection Agency (U.S. EPA). Lead abatement, inspection and risk assessment: Locate an accredited training provider or find a risk assessment, inspection or lead abatement firm (LAF).
US EPA-Lead hotline - U.S. Environmental Protection Agency (U.S. EPA). Lead hotline: The national lead information center.
NCHH-Lead 2014 - National Center for Healthy Housing (NCHH). Preventing lead exposure in U.S. children: A blueprint for action. 2014.
US HUD-Lead 2012 - U.S. Department of Housing and Urban Development (U.S. HUD), Office of Healthy Homes and Lead Hazard Control. Guidelines for the evaluation and control of lead based paint hazards in housing. 2012.
CDC-Lead CLPP - Centers for Disease Control and Prevention (CDC), National Center for Environmental Health. Childhood Lead Poisoning Prevention (CLPP) program.
NYS DOH-Lead paint - New York State Department of Health (NYS DOH). What you need to know about working with lead-based paint.
EPHDT-WI Lead - Environmental Public Health Data Tracker (EPHDT): Wisconsin Environmental Public Health Tracking Program. Childhood lead poisoning: filterable map of lead poisoning in Wisconsin.
ME DEH-Lead - Maine Center for Disease Control and Prevention Division of Environmental Health (ME DEH). Childhood lead poisoning: Prevention resources and information.
Footnotes
* Journal subscription may be required for access.
1 US HUD-Lead 2012 - U.S. Department of Housing and Urban Development (U.S. HUD), Office of Healthy Homes and Lead Hazard Control. Guidelines for the evaluation and control of lead based paint hazards in housing. 2012.
2 US HUD-AHHS 2021 - U.S. Department of Housing and Urban Development (U.S. HUD). American Healthy Homes Survey II: Lead findings. Final Report. October 29, 2021.
3 CDC-Lead paint - U.S. Centers for Disease Control and Prevention (CDC). Childhood lead poisoning prevention: About lead in paint.
4 CDC-Lead CLPP - Centers for Disease Control and Prevention (CDC), National Center for Environmental Health. Childhood Lead Poisoning Prevention (CLPP) program.
5 Arora 2024 - Arora J, Singal A, Jacob J, Garg S, Aeri R. Chapter 4: A systematic review of lead exposure on mental health. In: Kumar N, Jha AK. Lead toxicity mitigation: Sustainable nexus approaches. Cham: Springer International Publishing; 2024:51-71.
6 NCHH-Jacobs 2009 - Jacobs DE, Baeder A. Housing interventions and health: A review of the evidence. Columbia: National Center for Healthy Housing (NCHH); 2009.
7 Armstrong 2014 - Armstrong R, Anderson L, Synnot A, et al. Evaluation of evidence related to exposure to lead. Canberra: National Health and Medical Research Council; 2014.
8 Levin 2008 - Levin R, Brown MJ, Kashtock ME, et al. Lead exposures in U.S. children, 2008: Implications for prevention. Environmental Health Perspectives. 2008;116(10):1285-1293.
9 Dixon 2012 - Dixon SL, Jacobs DE, Wilson JW, et al. Window replacement and residential lead paint hazard control 12 years later. Environmental Research. 2012;113:14-20.
10 Wilson 2015 - Wilson J, Dixon SL, Jacobs DE, et al. An investigation into porch dust lead levels. Environmental Research. 2015;137:129-135.
11 HIP-Lead 2017 - Health Impact Project (HIP), Robert Wood Johnson Foundation, PEW Charitable Trusts. 10 policies to prevent and respond to childhood lead exposure: An assessment of the risks communities face and key federal, state, and local solutions. A report from the Health Impact Project. 2017.
12 Coulton 2023 - Coulton C, Richter FGC, Cho Y, et al. Making the case for lead safe housing: Downstream effects of lead exposure on outcomes for children and youth. Health and Place. 2023;84.
13 Berg 2012 - Berg DR, Eckstein ET, Steiner MS, Gavard JA, Gross GA. Childhood lead poisoning prevention through prenatal housing inspection and remediation in St. Louis, MO. American Journal of Obstetrics and Gynecology. 2012;206(3):199.e1-199.e4.
14 Vigeh 2014 - Vigeh M, Yokoyama K, Matsukawa T, Shinohara A, Ohtani K. Low level prenatal blood lead adversely affects early childhood mental development. Journal of Child Neurology. 2014;29(10):1305-1311.
15 Fesko 2023 - Fesko L. First lead, now no bed? The unintended impacts of lead abatement laws on eviction. Journal of Environmental Economics and Management. 2023;117:1-38.
16 Wolpaw Reyes 2015 - Wolpaw Reyes J. Lead exposure and behavior: Effects on antisocial and risky behavior among children and adolescents. Economic Inquiry. 2015;53(3):1580-1605.
17 Wright 2008 - Wright JP, Dietrich KN, Ris MD, et al. Association of prenatal and childhood blood lead concentrations with criminal arrests in early adulthood. PLoS Medicine. 2008;5(5):e101.
18 NBER-Wolpaw Reyes 2007 - Wolpaw Reyes J. Environmental policy as social policy? The impact of childhood lead exposure on crime. National Bureau of Economic Research (NBER). 2007. Working Paper 13097.
19 Feigenbaum 2015 - Feigenbaum JJ, Muller C. Lead exposure and violent crime in the early twentieth city. Cambridge: Harvard University; 2015.
20 Korfmacher 2013 - Korfmacher KS, Hanley ML. Are local laws the key to ending childhood lead poisoning? Journal of Health Politics, Policy and Law. 2013;38(4):757-813.
21 Korfmacher 2012 - Korfmacher KS, Ayoob M, Morley R. Rochester’s lead law: Evaluation of a local environmental health policy innovation. Environmental Health Perspectives. 2012;120(2):309-315.
22 Korfmacher 2014 - Korfmacher KS, Malone J, Jacobs D. Local housing policy approaches to preventing childhood lead poisoning. Public Health Law Research: Making the Case for Laws that Improve Health. 2014.
23 Campbell 2013a - Campbell C, Gracely E, Pan S, et al. Public health and law collaboration: The Philadelphia Lead Court study. American Journal of Public Health. 2013;103(7):1271-1277.
24 NCHH-Lead 2014 - National Center for Healthy Housing (NCHH). Preventing lead exposure in U.S. children: A blueprint for action. 2014.
25 White 2015 - White BM, Bonilha HS, Ellis C. Racial/ethnic differences in childhood blood lead levels among children <72 months of age in the United States: A systematic review of the literature. Journal of Racial and Ethnic Health Disparities. 2015:1-9.
26 NCSL-Healthy housing - National Conference of State Legislatures (NCSL). Healthy housing report. February 26, 2021.
27 Cochrane-Nussbaumer-Streit 2020 - Nussbaumer-Streit B, Mayr V, Dobrescu AI, et al. Household interventions for preventing domestic lead exposure in children. Cochrane Database of Systematic Reviews. 2020;(10):CD006047.
28 Gould 2009 - Gould E. Childhood lead poisoning: Conservative estimates of the social and economic benefits of lead hazard control. Environmental Health Perspectives. 2009;117(7):1162-1167.
29 Jones 2012 - Jones DJ. Primary prevention and health outcomes: Treatment of residential lead-based paint hazards and the prevalence of childhood lead poisoning. Journal of Urban Economics. 2012;71(1):151-164.
30 NCSL-Lead statutes 2021 - National Conference of State Legislatures (NCSL). State lead statutes. February 26, 2021.
31 NYS DOH-RLRCs - New York State Department of Health (NYS DOH). Regional Lead Resource Centers (RLRCs).
32 US EPA-LPAEP - U.S. Environmental Protection Agency (U.S. EPA). Lead-based paint abatement and evaluation program (LPAEP): Overview.
33 US EPA-TAS - U.S. Environmental Protection Agency (U.S. EPA). Environmental protection in Indian Country: Tribes approved for treatment as a state (TAS).
34 Rochester-Lead paint - City of Rochester, NY. Lead paint - Get prepared.
35 Burlington-Lead paint - Burlington, Vermont. Code of Ordinances Chapter 18, Housing Article III, Minimum standards section 18-112: Lead-based paint.
36 NYC-Lead paint - New York City, NYC.gov. Housing preservation & development: Lead-based paint.
37 Philadelphia-Lead paint - City of Philadelphia, Public Health. Lead paint laws and regulations.
38 DC-Lead paint - Washington, D.C., DC.gov, Department of Energy & Environment. Lead in the District.
39 CDC-CLPP Data - Centers for Disease Control and Prevention (CDC). Childhood Lead Poisoning Prevention (CLPP): Data and statistics.
40 US EPA-Lead contacts - U.S. Environmental Protection Agency (U.S. EPA). Lead: Contacts in EPA regional offices for lead-based paint exposure prevention efforts.
41 Reed 2011a - Reed W. Preventing childhood lead poisoning. In: Lemelle AJ, Reed W, Taylor S, eds. Handbook of African American Health: Social and Behavioral Interventions. New York: Springer; 2011:103-11.
42 Teye 2021 - Teye SO, Yanosky JD, Cuffee Y, et al. Exploring persistent racial/ethnic disparities in lead exposure among American children aged 1–5 years: Results from NHANES 1999–2016. International Archives of Occupational and Environmental Health. 2021;94:723-730.
43 Zartarian 2017 - Zartarian V, Xue J, Tornero-Velez R, Brown J. Children’s lead exposure: A multimedia modeling analysis to guide public health decision-making. Environmental Health Perspectives. 2017;125(9):097009.
44 Lynch 2020 - Lynch EE, Meier HCS. The intersectional effect of poverty, home ownership, and racial/ethnic composition on mean childhood blood lead levels in Milwaukee County neighborhoods. PLoS ONE. 2020;15(6):e0234995.
45 Balza 2024 - Balza J, Bikomeye JC, Flynn KE. Effectiveness of educational interventions for the prevention of lead poisoning in children: A systematic review. Reviews on Environmental Health. 2024.
46 Marshall 2020a - Marshall AT, Betts S, Kan EC, et al. Association of lead-exposure risk and family income with childhood brain outcomes. Nature Medicine. 2020;26:91-97.
47 Hauptman 2023 - Hauptman M, Rogers ML, Scarpaci M, Morin B, Vivier PM. Neighborhood disparities and the burden of lead poisoning. Pediatric Research. 2023;94:826-836.
48 Bloomberg-Bliss 2016 - Bliss L. The long, ugly history of the politics of lead poisoning. Bloomberg. February 9, 2016.
49 Howarth 2023 - Howarth MV, Eiser AR. Environmentally mediated health disparities. American Journal of Medicine. 2023;136(6):518-522.
50 Bravo 2022 - Bravo MA, Zephyr D, Kowal D, Ensor K, Miranda ML. Racial residential segregation shapes the relationship between early childhood lead exposure and fourth-grade standardized test scores. Proceedings of the National Academy of Sciences. 2022;119(34):e2117868119.
51 Dignam 2019 - Dignam T, Kaufmann RB, LeStourgeon L, Brown MJ. Control of lead sources in the United States, 1970-2017: Public health progress and current challenges to eliminating lead exposure. Journal of Public Health Management and Practice. 2019;25:S13-S22.
52 WHO-Lead paint - World Health Organization (WHO). Legally-binding controls on lead paint.
Related What Works for Health Strategies
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