How many Mississippi kids are poisoned by lead? Massive undercounts, inconsistent testing provides officials few answers.
More than 16,000 children with dangerous levels of lead in their blood have fallen through the cracks in Mississippi due to a nuance in the type of blood test a child gets.
This is the first story in a series about lead exposure risk.
By Erica Hensley | July 24, 2020
GREENWOOD — Mayor Carolyn McAdams has no way of knowing how big a problem lead exposure among children in her city is.
The devastating effects of lead exposure in children are as bad here in Greenwood, according to limited data available, as anywhere in the state: Three percent of children tested in Leflore County from 2012 to 2017 showed high lead levels — well above the state average and one of the highest in the state.
“Nobody’s ever said, ‘Leflore County is high in lead-based paint poisoning,’ and to me that’s everything,” McAdams said. “(State officials) know these statistics and they know these problems, but they’re not getting the information to the people that need the information.”
For McAdams and leaders across the state, knowing exactly how many children are affected by lead poisoning has been rendered impossible after years of massive undercounts in data, decreased and inconsistent testing and dwindling focus on the issue by officials at the resource-strapped Mississippi State Department of Health.
But lead lurks in Mississippi homes, hiding silently below the surface in paint, plumbing and soil. It chips off the walls, leaks from old pipes into drinking water, tracks home on work boot dust and lands in small children’s mouths, where it quickly works into their bloodstream.
Once in a child’s bloodstream, lead’s damage is irreversible. Labeled a dangerous neurotoxin for developing bodies, it causes health and behavioral problems through brain damage and neurological misfires, often delaying cognitive development. Research shows even low lead levels in small children can cause lifelong effects — lower test scores, a 3-to-7-point IQ reduction and increased chances of learning disabilities. Though families can remove the source to reduce future exposure, the initial damage upon exposure cannot be undone.
The Delta’s aging homes and businesses, high rate of poverty and vast farmland create a perfect storm for paint and soil lead exposure. The old pipes that sit unused in schools for long periods of time and that serve water to neighborhoods risk leaching lead into drinking water.
The realities of underchecked lead exposure in Delta towns like Greenwood are heavy: Lead poisoning disproportionately affects Black children living in poverty. Across the state, Black children are almost twice as likely to be poisoned by lead than white children.
Mississippi Today launched a year-long investigation into lead exposure across the state, combing and analyzing water quality reports, census records and blood lead levels to assess lead exposure risk.
Our analysis ultimately narrowed on two counties based on percentages of older homes, lead plumbing and children showing high lead levels over time. Leflore County, home to Greenwood, was one of them.
And officials like McAdams have been provided few resources to protect her constituents.
“To be honest with you, I did not know (lead exposure was high in Greenwood) until today,” McAdams told Mississippi Today. “… The education component has always been extremely low on how we educate our people on what they need to know about, and that is the truth. We have to do a better job.”
Mississippi has undercounted lead exposure among its young children for a decade, by nearly seven times the actual number.
Publicly available reports show 3,000 Mississippi children had worrisome levels of lead in their blood from 2009 to 2015. From 2012 to 2016, that number was even lower at 1,500. Looking at these reports, the number and rate of children poisoned by lead is sharply declining and well below the national average.
But data published for physicians across the state in 2019 paints a different picture that is more representative of the problem. It showed 19,794 children in the same time period with high lead levels — nearly 16,900 more than the publicly available reports.
The discrepancy in the reports, according to officials at the Mississippi Department of Health, is because of the method of testing. The 2019 report for physicians showed all blood tests with high lead levels, both those collected by a finger-stick test or a vein blood draw. The publicly available reports show only the latter. Mississippi is one of just five states to only report and help children with venous-confirmed blood tests of 5 micrograms of lead per deciliter or higher. Most other states, following the Centers for Disease Control’s guidance, allow finger-sticks to confirm lead poisoning or report “unconfirmed” results publicly. Mississippi does neither, and those 16,000 children remain uncounted and their lead risks uncorrected.
While the latest report still shows a decline over the years, it’s not nearly as assuring as the surveillance reports regularly released. Most of those children who fell through the cracks and never received lead-prevention services were young Black boys who use Medicaid as their insurance.
This illustrates one of the main problems with tracking lead exposure in Mississippi: inconsistency in testing and data reporting. Large pieces of the data are often seemingly lost in translation either between doctor to lab, lab to doctor, doctor to health department or at the analysis stage.
There is no safe level of lead. Over the last few decades, the threshold to trigger action by state, parents and doctors has lowered and the medical consensus is clear: No matter the lead source, find it quickly and get rid of it.
Independent research from Quest Diagnostics, one of the largest scientific labs in the country, found 5 percent of Mississippi’s small children tested for lead showed “high” levels from their pool of 10,000 results — the same levels as Flint, Michigan, at the height of that city’s high-profile lead-in-water crisis.
Mississippi also showed the tenth-highest number of children with high lead levels, according to Quest Diagnostics’ research, and the single largest jump from 2009 to 2015, from 3 to 6 percent of children testing “high.”
But state health department records paint a different, rosier picture than the Quest results, showing just 1 percent of children with “high” levels during that same time frame. However, further analysis from the health department published by the state medical association in 2019 shows the percentage of small children testing “high” for lead — using the same metric as both of the above reports — dropped from 12 percent in 2009 to 3 percent in 2015, closer to Quest’s results.
Further, additional national research from the American Academy of Pediatrics showed that Mississippi likely detected less than 30 percent of children with elevated levels of lead in their blood from 1999 to 2010.
“You just wonder what’s being reported and what’s not being reported,” said Dr. Harvey Kaufman, lead author of the Quest study, referencing the CDC’s aggregate state lead reporting. “But their (state health department) numbers aren’t quite right, other than 2013, which looks real.”
He added: “And frankly, whether one’s 9th or 49th, there is no reason that in the year 2020 that we’re exposing infants to lead. We’ve known about this and we know how to remediate homes and we know how to test, but it’s one of these public health issues that persists.”
Despite the prevalence of lead in the blood of Mississippi children, just 21 families in Mississippi received in-home interventions from the state last year.
The Mississippi State Department of Health only offers in-home assessments to families whose child tested at a blood lead level of 15 or higher. From 2009 to 2016, almost 400 children qualified, but only about one-third received the services.
Still, only 5 percent of kids with confirmed “high” blood lead levels — a measurement of 5 or more micrograms per deciliter by a vein blood test — received in-home assessments to locate and mitigate lead sources. And the thousands of children who were undercounted were never even considered for the in-home visits.
Officials at the health department say they are “investigating the feasibility” of lowering the threshold to catch more children that previously went uncounted. “It is our policy to ensure that children identified with an EBLL (elevated blood lead level) (depending on level) receive an environmental investigation and/or counseling and education about lead poisoning prevention strategies,” Beryl Polk, director of health services, wrote in an email.
Despite the program having only one inspector to visit homes across the state and no epidemiologist to track cases, she added they did have the capacity to enroll more children but that families and pediatricians would be on the hook for ensuring children get follow-ups necessary for enrollment.
Stephanie Showalter-Otts, director of National Sea Grant Law Center at the University of Mississippi, conducted research on lead-in-water problems in the Mississippi Delta, which ultimately led to a new partnership with the state health department to test families’ water for lead. She says part of the problem is the cycle of low testing, which keeps the issue of targeted lead prevention off the table.
“From the very beginning, families aren’t getting information they need … and there’s a lot of misinformation about actual risk factors and how many kids in Mississippi are impacted,” she said. “My biggest concern is that because our testing rates are so low, we really just don’t know how many kids might have elevated blood lead levels, and therefore we don’t know the full extent of the problem.”
She continued: “If you have low testing, you don’t catch a lot of cases, you don’t hear about it very much, families don’t know about it at all. I think that contributes to it just being seen as not that big of a problem anymore, that it’s just in the Northeast and old industrial cities where you have that problem.”
Experts call lead poisoning one of the most preventable public health problems of the last century.
Once the subject of nationwide safety campaigns, the conversation about the dangers of lead exposure has dramatically tapered off in recent years. Through policy and advocacy interventions, major lead sources have largely been stripped from infrastructure, dramatically reducing childhood exposure. It was banned in paint and phased out of commercial gasoline in the 1970s and in most plumbing in 1986.
Because of these efforts, national research suggests the amount of lead in children’s blood has decreased by about 90 percent since 1980. But still it persists, particularly in neighborhoods with old homes. For this reason, it disproportionately affects Black children living in poverty in parts of Mississippi, particularly clustered in the Delta.
Though lead exposure doesn’t discriminate, its sources are problems of poverty, and its fixes require money. If pipes and paint haven’t been replaced in older homes, lead is likely present. If a family rents their home, like more than one-third of Mississippians do, the landlord has no legal responsibility to mitigate lead risks, unlike other states that require lead hazards be removed.
National and state research shows that lead poisoning disproportionately affects Black children living in poverty. From 2009 to 2015, 7 percent of small Black children tested showed “high” levels of lead compared to 6 percent of white children tested, according to a 2019 analysis by the state health department. And overall, more than double the number of Black children showed high levels.
But most interventions in the state aren’t targeted to communities based on specific risk and needs. If a neighborhood has an abandoned gas station, soil and dust exposure risks are likely highest, whereas a rural neighborhood that pulls their water from wells should be looking closely at the water, Showalter-Otts said.
“One thing that has struck me as we’ve worked on this project is this one-size-fits-all public information about lead,” she said. “I don’t think it’s the most effective way to help families understand and mitigate their risk from lead. It really does depend on where you live and your housing environment where that risk comes from, and I think we need more targeted outreach on that and resources available to help families identify that risk.”
Mississippi and other states aren’t testing enough children to pinpoint the scale or spot of risk. One-third of states across the nation, including Mississippi, reach fewer than one in five children per year to test their blood for lead poisoning.
Of those low-testing states, nearly half have increased their testing rate over the past decade. Mississippi’s rate, meanwhile, declined from a peak of 20 percent of young children tested in 2014 to 16 percent tested in 2016, according to records from the CDC. During that same time, the state’s proportion of positive tests increased.
Medicaid, the insurance program for low-income families, requires universal blood lead tests for its children enrollees. The American Academy of Pediatrics recommends screening all children under the age of 6 for risk assessment and testing all kids with any elevated risk, like living in an older home. But from 2012 to 2016, the most recent data available, just one-quarter of Mississippi Medicaid enrollees under 6 received blood tests on average each year, though it’s increased in recent years. In Mississippi, Medicaid recipients are 93 percent more likely to have lead in their blood, according to the 2019 state health department study.
The lead prevention office at the Mississippi State Department of Health works to narrow pools of risk by looking at elevated blood lead levels, poverty rates and old homes. Based on those metrics, the agency has narrowed 26 high-risk counties for lead exposure, almost half of which are in the Delta. Unlike most states, Mississippi does not use zip codes, which can identify targeted pockets of risk based on neighborhood exposure to narrow intervention efforts and harness community buy-in to fix hazards, outside of Jackson.
“I just don’t have a sense, other than a few champions here and there, this is received as a major public health issue,” said Kaufman, the physician leading Quest’s national research. “Children don’t have a voice … but it does affect these kids in terms of their behavior, in terms of IQ. It does have consequences and it’s an important issue.”
He added: “We’re concerned about who’s missing in terms of who’s not getting tested and that takes into consideration children who are homeless, children who have limited or no real access to medical care. Yes, we’re under-counting the most vulnerable population.”
In Greenwood and Leflore County, lead has proven hard to scrub out. Though it’s impossible to identify its source without widespread testing, the Delta community has one of the highest rates of childhood lead exposure in the state. Just one family received in-home lead intervention from the state last year.
“Oh, it’s everywhere,” said Greenwood water utility vice president Jamie Stowers, referring to its widespread use and stubborn persistence since the mid-1900s.
State health officials identified Greenwood as a particularly at risk community for lead exposure. In 2018, the state health department was awarded a $1.5 million federal grant to mitigate lead paint exposure in 75 homes across the state. Greenwood was among the targeted recipients of a grant.
McAdams, the mayor, worked with the state health department for months to determine how, exactly, her town could use those lead abatement funds. She received little clarity from state and federal officials and ultimately decided to withdraw from the grant program, writing that there were too many “undetermined factors and unanswered questions” and “honestly not enough affirmative information to clearly instruct the city’s team to follow.”
Though she said she hated to give up the grant because she knows the danger of lead poisoning, she still doesn’t know why her city was offered the grant. Her background with the local housing authority hinted to the problem, but she’s never seen the data to know where it might be worse in Leflore or the source. “Nobody said, ‘Well we’re giving you this (grant) because Leflore County is high.’”
In response, lead program spokesperson Crystal Veazey said: “This was our first time receiving HUD funding … There has been and will continue to be a lot of trial and error.” Further, the department has lacked a dedicated epidemiologist for a year now, knee-capping its ability to track lead in a more meaningful way and adding to data reporting discrepancies.
With the inconsistent blood testing data in hand, Mississippi Today sampled 25 water taps across Greenwood and Leflore County using the same methods — first pull sample after tap had been sitting – and had the results analyzed by an EPA-certified lab.
Our analysis of water in 12 homes showed lead averaging 2 parts per billion and as high as 6 parts per billion — more than three times the average level the county reported in 2018 and 25 percent higher than the city’s reported average, though the numbers are small. No results were over the action level of 15 parts per billion, but results across Greenwood and Leflore County, in the same parts of town that the utilities test, showed lead in the water.
Officials from the county water utility have not responded to request for comment on Mississippi Today’s findings, but previously said they’re doing their part to ensure the federal testing regulation is met. On average, our analysis tested the equivalent of half a reporting period’s worth of testing in both the city and county utility.
Stowers’ water reports — part of the records he sends the state every three years to comply with the Environmental Protection Agency’s Lead and Copper Rule — are in compliance. But that doesn’t mean lead isn’t there.
In response to our testing, Stowers said he was glad another lab found similar results, and that it’s a reminder that homeowners should pay attention to their pipes.
“People do need to be aware of the plumbing inventory on their property … As water sits in the pipes and fixtures during the night, a small amount of lead does come from the customers’ fixtures. A simple flush would do wonders for the amount of lead in the water,” he said.
The EPA instituted the federal Lead and Copper Rule in the 1990s to address lead corrosion in water distribution systems and set action levels. But the program relies mostly on states — in Mississippi, the state health department — to regulate compliance. The LCR, as it’s known, is ripe with its own issues and has been criticized for its lack of enforcement and methodology. It is currently under revision for the first time in decades.
If 90 percent of homes tested for lead exposure — out of 50 homes total every three years from the county and city utilities in Leflore — stay below 15 parts per billion, the water system is in compliance. If not, the state is supposed to work with utilities to add corrosion control to the system to balance the water’s corrosivity and help prevent lead pipes from leaching.
As a last resort, the EPA can mandate utilities start replacing lead service lines, but this has never happened in Mississippi, despite the city of Jackson’s well-documented lead overages in 2016.
The Lead and Copper Rule was never meant as a health standard; instead, it lets water utilities know if they need to take action, such as adding corrosion control to protect pipes. Still, health experts reiterate there is no safe level of lead. And under what officials call “the 90th percentile rule,” they don’t have to publicly report the highest 10 percent of lead results, no matter how high.
Water systems across the Delta are small and fragmented — most counties averaging 18 public water systems. Of those, research showed at least 20 systems had lead spikes in their water over the last decade, but only seven were in violation of the EPA rule. The Brooklyn community in Humphreys showed the highest reading during that time at 228 parts per billion — more than 15 times the legal limit.
Stowers in Greenwood says all the lead pipes previously used to deliver water in Greenwood have been dug up and replaced — a common practice over the last few decades to reduce risk across the system. But some lead piping still exists, per the city’s records sent to the state, though it’s excavated and replaced when found.
As for the Lead and Copper Rule, Stowers says it’s not quite working to truly identify risk. “It’s not looking in the right place,” he said. “And it makes us responsible for what’s in our customers’ homes.”
Still, lead exposure is a problem in the area as three percent of kids tested from 2012 to 2017 showed high lead levels in Leflore County, well above the state average and one of the highest in the state. The last time individual lead results were mapped beyond county level, 2009, showed Leflore’s high levels concentrated around Greenwood and just outside, in east Leflore.
Upon review of the county’s testing history, Mississippi Today learned that officials at the county utility — East Leflore Water District, the second largest water utility in the county serving 5,200 residents — tested their own homes and their families’ homes for lead from at least 2009 to 2018. The water utility does report having lead service lines on their state records, but district operator Shemeka Collins says they are on the property owners’ side.
Still, despite listing at least five homes that have lead service lines or lead pipes in their system across two different neighborhoods, only some of those were tested in their every-three-year testing sample. The federal rule does require utilities to test at least half of its sample from homes with lead service lines when present in the system.
Officials in at least 12 other utilities in the state’s higher risk counties for lead tested their own or families’ homes. Testing their homes is not prohibited under the federal rule and has been reported in other states, but it leaves other potential leaded homes out of the pool of tests, snowballing the problem of failure to identify pockets of risk where there is known high childhood lead exposure.
It all goes back to a balance between LCR compliance and not over-burdening small water utilities, says Bill Moody, head of the Bureau of Public Water Supply and LCR-enforcer for the state. As for testing utility operators’ own homes: “It isn’t common, but nothing prevents it from being allowable. With now COVID, but even prior to it, some systems have great difficulty in getting the customers to participate in the sampling process,” he said. “LCR is the only rule that requires this kind of customer participation. Some systems cannot get the customers to be involved. Officials and operator may be left with little recourse but to head this direction.”
See individual Lead and Copper Rule results for your area here. (Pick your county, your system, then click “Chem/Rad Samples/Results by Analyte” on the Left, choose “Lead”, then you can click through individual results.) Results can be difficult to interpret, learn how here and here. Read more about your water system’s yearly reporting here and see if your system has lead service lines here.
This project was supported by the Doris O’Donnell Innovations in Investigative Reporting Fellowship from Point Park University’s Center for Media Innovation.