Americans everywhere on the political spectrum agree: Today, equality of opportunity is more a dream than a reality. Almost two-thirds of Americans believe only a small minority of privileged people have a chance to excel in today’s economy. Examples of inequality of opportunity are often painfully present, from crumbling schools to the school-to-prison pipeline. But these stark manifestations of inequality tend to obfuscate the identity of their more hidden cousins, ones so transparent they are tough to spot in a glass of water.
Rocketed into news coverage by the Flint water crisis but then quickly forgotten, lead exposure is an issue that often slips from the public consciousness. Yet it is a pernicious cause, and symptom of inequality. Across the country, at least 4 million households—10 percent of all households with children—are exposed to high levels of lead. The Center for Disease Control recommends intervention at blood lead levels (BLLs) above five micrograms per deciliter (mcg/dl). Over half a million American children exceed that threshold during their first five years of life, exposing them to serious problems at a time when the human body is most susceptible to the long-term effects of lead. At very high levels, lead exposure in children causes immediate consequences. The metal attacks multiple body systems, disrupting impulse control, attention span, and even overall mental functioning.
Across American households, inequality of exposure is the central injustice of this epidemic: It is a matter of opportunity, not just one of health.
In Rhode Island, the problem of lead exposure is dire: The state has three times the average number of children with BLLs over 10 mcg/dl. More than 1,000 Rhode Island children are poisoned annually. Almost 1 in 5 rental homes in Providence are serviced by utility-owned pipes made of lead, owing to the fact that the city, like many of its ilk, has a particularly old housing stock. Although lead pipes are common, the burden of this epidemic is not shared equally. Across American households, the inequality of exposure is the central injustice of this epidemic: It is a matter of opportunity, not just one of health.
In her May 2017 National Bureau of Economic Research study, Anna Aizer, an economist at Brown University, published data on lead and juvenile delinquency among Rhode Island youth. The paper, coauthored by Janet Currie of Princeton University, is crucial in advancing the understanding of lead exposure as an issue of social justice and inequality of opportunity.
Aizer’s study capitalizes on a dataset of blood lead levels from the state’s robust screening program. Between 1990 and 2004, 120,000 children born in Rhode Island were tested at various stages of childhood development. Aizer and Currie first note that low-income and minority children in the state are more likely to live in urban neighborhoods. Inhabitants of urban areas are more susceptible to lead exposure due to the greater likelihood of high traffic congestion and older housing, two major sources of lead pollution. The study further confirms that the burden of lead exposure is disproportionately placed upon the shoulders of low-income people and people of color in Rhode Island, as is the case in many communities across the nation. While the average BLL of white children in the dataset was 3.4 mcg/dl, African-American and Hispanic children had levels 65 percent and 53 percent higher, respectively—both above the level recommended for intervention. This burden was also disproportionately borne by low-income families: The average BLL of children who qualified for free school lunch was 50 percent higher than that of those who did not.
Lead exposure is profoundly disruptive for children. For every unit increase in BLL, the probability of school suspension increased from 6.4 to 9.3 percent. These disruptions correspond to academic deficits: An August 2016 study from Professors Aizer and Currie found that for every one unit increase in BLL, the probability of a student scoring substantially below proficiency in reading rose by 3.1 percentage points. Outside of the classroom, the effects are even worse: The researchers found the same increase in BLL augmented the likelihood of incarceration by up to 74 percent.
Elizabeth Tobin-Tyler, a lawyer and professor at Brown’s Alpert Medical School, emphasizes a central absurdity in how we approach lead poisoning: “Most of our systems are about what happens after a kid gets poisoned as opposed to creating systems and structures that ensure we are addressing the problem before the exposure happens.” Indeed, the current way of dealing with lead is reactive, with action usually beginning after exposure in a child has been reported. Furthermore, systems generally place the burden on tenants to report possible lead hazards, intimidating would-be reporters by allowing the possibility of retributive eviction. The status quo thus forces low-income tenants to choose between adequate living standards and having a place to stay, often silencing the victims of lead exposure.
Current regulations in the Ocean State have simply not gone far enough to address the problem. Providence Water, a department of the city, will replace lead lines from the water main to the curbs, but it is not allowed to use ratepayer funds to address lead pipes on private property, a system known as “partial pipe replacement.” This leaves the onus of replacing lead pipes on property owners themselves. Particularly for those lacking the finances to personally pay for removal or renting from an unwilling landlord, this burden is often too high. Worse, as the neighborhood of Mount Hope in Providence discovered in 2010, this “partial pipe replacement” can exacerbate the problem: By disrupting the pipes and inadvertently exposing water to increased levels of lead, partial pipe replacement is often accompanied by spikes in lead levels in the short term.
Despite these challenges, Rhode Island has made some recent strides in advancing preventative measures. In 2002, the state passed the Lead Hazard Mitigation Act, giving landlords an affirmative duty to assess and fix lead hazards, perform ongoing lead maintenance, and obtain a lead hazard conformance certificate. While the law was a substantial step forward, weak enforcement has hindered its effectiveness: Between 2005 and 2009, 4 out of 5 of properties subject to the law did not comply with the regulations.
Summoning the will to address these regulatory inadequacies has proven easier said than done. The first hurdle, unsurprisingly, is a financial one. Replacing a large service line containing lead costs between $2,000 and $3,000—meaning it would take about $95 million to replace the nearly 38,000 lead service lines owned by Providence Water, Rhode Island’s largest supplier. As of August 2017, Providence Water began offering a three-year, zero percent interest loan to homeowners in need of replacing lead service lines. However, even at such terms, the program remains inaccessible to thousands of low-income Rhode Islanders.
To motivate action, then, politicians should look to the social benefits of removing lead. Research suggests that although the initial investment would be expensive, the ultimate social rewards—in the form of less crime, higher productivity, and lower medical costs—would be worth the price. Research from PEW Charitable Trusts explains that, across the country, removing lead service lines and eliminating lead paint from low-income homes with young children would see returns over time of about $1.33 per dollar invested.
The lead exposure debate here in Rhode Island and across the country requires elected officials to embrace short term investment for a long-term reward—a difficult campaign platform for officials who might no longer be in office by the time society reaps the benefits. There is good reason for optimism, however, even in the face of this daunting task: The Aizer and Currie studies strongly suggest that reducing lead exposure would offer children greater impulse control, decreased rates of juvenile delinquency, and improved school performance. While acknowledging that it comes with real costs, fixing the problems of lead should be seen as a safe investment in improving social outcomes for those whom our society most often fails. Eradicating lead exposure is an imperative task for a society intent on pursuing justice, and Providence might just be the place to start.