Important Context:

• The primary source of lead identified in Brown County lead hazard investigations and lead poisoning investigations is exposure from the home. 
• As of October 28, 2021 the CDC uses a blood lead reference value (BLRV) of 3.5 micrograms per deciliter (µg/dL) to identify children with blood lead levels that are higher than most children’s levels. Before October 28, 2021, the CDC had used a BLRV of 5.0 µg/dL.
  • We must consider how the modified standards will affect the number of reported cases.

Supporting Factors:

• Aging housing stock and access to affordable safe housing has been prioritized by Brown County community organizations such as: Community Housing Initiative (ggbcf.org)
• Leadsafe Renovation courses have been offered. 
• WI Department of Health Services (WI DHS) requires children enrolled in Medicaid or WIC to be tested for lead levels at ages 1 and 2. Reimbursement expansion for lead mitigation activities provides a fiscal incentive to allocate resources to this initiative.
• Brown County Public Health was awarded the DHS Environmental Health Tracking Grant and programming is focused on increasing testing at primary care providers.
• The Brown County Lead Coalition holds quarterly meetings to first discuss outreach and education needed, and then develops and executes these plans. 
• Brown County Public Health sanitarians provide home lead inspections when a case is reported.

Limiting Factors:

• Lack of affordable and/or lead mitigated housing stock. Housing costs have trended upward and many younger and first time homeowners are facing challenges purchasing homes. These buyers may be "priced out" of purchasing newer homes, which are less likely to have lead paint. 
• During the height of the COVID pandemic, there were decreased in person visits for routine care including blood lead screenings. See CDC report linked here.
• Children, especially those from lower income households, are more likely to live in older homes. 

Anticipated Factors:

• Fewer children were tested during the height of the COVID-19 Pandemic in 2020 and 2021. We can expect to see higher rates of poisoning due to caregivers "catching up" on routine medical office visits. 
• The COVID-19 pandemic led many children to spend more time within their households while lead mitigated or lead free schools and childcare centers were closed. If these children reside in homes with lead contamination, there may be an increased risk of lead exposure.
• The rate of poisoning may be expected to increase due to the decreased threshold for poisoning to 3.5 micrograms per deciliter (µg/dL).

Organizations currently engaging in this important work in Brown County include: 

• Brown County Lead Coalition (Brown County Public Health, City of De Pere Public Health, Oneida Community Health Services, Brown County WIC, UWGB Environmental Management and Business Institute, Brown County Planning Commission, NeighborWorks Green Bay, Green Bay Water Utility, Wisconsin Department of Health Services) 
• WIC
• NEW Community Clinic
• Advocate Aurora
• Prevea Health
• Hospital Sisters Health System (HSHS)
• Bellin Health
• Greater Green Bay Community Foundation (Blueprint)
• NeighborWorks Green Bay
• WI DHS
• Contractors and renovators

Opportunities for further partnership:

• The Oneida Nation
• Brown County schools
• Rental companies and landords
• Housing authorities 
• Casa ALBA
• Municipal building inspectors

Research/Evidence-Based Practices:

• Expansion of home lead testing
• Lead Safe Home Program
• Testing of children enrolled in WIC or Medicaid programs
• Testing in early years (ages 1, 2, and 3-5 if not tested)
• Testing of childcare facilities during inspection/licensing process 

Low Cost/No Cost Solutions:

• Education through partnerships, social media, etc.
• Brown County Lead Coalition 
• Educational materials distributed to clinics, food banks, daycares...

Innovation Solutions:

• Require lead safety inspections and mitigation in the homes of every newborn in Brown County. 
  • Universal environmental-hazard-free housing for those who are found to have lead in primary residence until lead can be mitigated.
• Free testing of all homes built before lead paint was removed from the market and provide funding for lead mitigation.

Additional Research: 

• Sources of lead poisoning specific to Brown County children to determine most effective upstream solutions.
• Communication and education best practices as they evolve.

In 2023 and beyond, Brown County Public Health will lead this strategy work by bringing together a multitude of cross-sectional environmental health leaders in the community to:

• Facilitiate discussions around environmental risk factors that increase childhood lead posioning. 
• Engage in enhanced data collection and alignment discussions to reflect timely, local, and accurate childhood lead posioning prevalence in Brown County.
• Provide education and resources to the impacted communities in Brown County.
• Address, assess, and form plans on how to maintain and create safe, high quality physical environments.