Dear Commissioner Thomas Frieden:
You have gotten off to a promising start in one of the City's toughest jobs, Commissioner of the Department of Health and Mental Hygiene.
Just look at your list of accomplishments so far.
You aggressively took on the battle to get New Yorkers to stop smoking -- advancing landmark prohibitions on smoking in restaurants and bars, boosting cigarette taxes and even distributing nicotine patches to help New Yorker's kick the habit.
You have been systematically building up New York City's disease surveillance system -- to insure that the city gets the earliest possible warning of infectious disease outbreaks and unthinkable medical emergencies.
And you have been quick to respond to any report suggesting that Severe Acute Respiratory Disease, or SARS, might be trying to secure a toehold in our city.
You have done all this while absorbing tough budget cuts at your agency, and as you work to complete a smooth merger of two former departments that now fall within your portfolio.
So it's understandable that you may just have been too busy to take on the important battle of protecting New York City children from lead poisoning.
But this issue too deserves your attention. And the time is now, I respectfully suggest, for you to make room on your overloaded priority list to come to the rescue of thousands of city youngsters who are unnecessarily suffering from the preventable health impacts of exposure to toxic lead in paint.
THE CHALLENGE OF TOXIC LEAD
As you know, more than 6,200 children with elevated lead levels were newly identified and reported to your department in 2000. Independent estimates suggest that the total number of city children with blood-levels about the 10 micrograms per deciliter threshold is probably double that amount. As has been well-established by the medical community for more than four decades, and as your department has long-acknowledged, elevated blood lead levels can "result in long-lasting neurological damages that may be associated with learning and behavioral problems and with lowered intelligence."
The problems of lead poisoning are not equally distributed across the city. Neighborhoods like Bedford Stuyvesant/Crown Heights, East New York, Williamsburg/Bushwick and East Flatbush/Flatbush (in Brooklyn) and Jamaica and Southwest Queens (in Queens) have for years been disproportionately affected. About 95 percent of the lead-poisoned children identified in the department's 2001 annual report, Preventing Lead Poisoning In New York City, were Black, Hispanic or Asian.
No wonder then that a 1993 Mayor's Advisory Committee Report concluded that "[c]hildhood lead-paint poisoning may be the most significant environmental disease in New York City, in terms of the numbers of cases, the severity of the medical damage created, and the personal, social and economics costs it imposes."
In a recent profile of you, Richard Perez-Pena of the New York Times noted that, like Mayor Bloomberg, you "live on the data... [and] believe in the numbers." So please take a look at the data and numbers concerning elevated lead levels in New York City, and tell us what you think.
Thankfully, the number of reported cases of lead poisoning has declined in recent years.
But isn't it a disgrace in 2003, in the greatest city in the nation, that thousands of children will suffer the intellectual and behavioral burdens from new exposures to long-lasting leaded paint in their apartments and homes?
And what about the latest data, just published in the medical journals?
Have you seen the April 17, 2003 issue of the New England Journal of Medicine, which reports on a study of children in Rochester, New York -- finding that children suffer intellectual impairment even at blood-lead levels below 10 micrograms per deciliter? Another study, completed at Children's Hospital Medical Center in Cincinnati, also released last month, reached similar conclusions. An author of that study, Bruce Lanphear, concluded: 'There is no magic number for lead poisoning; the science shows that any lead exposure hurts fetuses and young children."
I'm sure your excellent staff can pull together all of the latest research data for you. They make a compelling case for further action by New York City to do everything that it can to end exposures to toxic lead in paint without further delay.
NEW YORK CITY'S ANEMIC LEAD LAW
Unfortunately, existing City law -- Local Law 38 --does not do what is necessary to reduce the lead threat to New York City youngsters.
In 1999, a divided City Council enacted a new lead law, weakening an earlier city statute. The 1999 law limited lead "hazards" to peeling paint, placed no duty on landlords to prevent poisoning from lead dust, contained week training and certification provisions, shifted the burden from landlords to tenants to know about lead hazards in the dwelling and set out extended time frames for enforcement of lead paint violations -- among numerous other gaps.
It was no surprise then that the U.S. Environmental Protection Agency told city officials in 2000 that the new law will probably result in additional cases of lead poisoning. "I believe that Local Law 38, as currently written, falls short of the protection that children deserve and need," said then EPA Regional Administrator Jeanne Fox. The law, she wrote, contained critical loopholes, such as the failure to require trained workers for lead abatement activities and the failure to mandate follow-up testing to insure that the lead abatement work was properly completed.
With such concerns in mind, a diverse coalition of health groups, children's' organizations and environmental activists got together with the new City Council to reform the weakened statute. Leading the charge have been the N.Y. Coalition to End Lead Poisoning, NYPIRG and West Harlem Environmental Action. The city's medical community, spearheaded by long-time lead clinician Dr. John Rosen and others, has also made its voice heard in support of a strengthened lead paint law.
The result is Intro. 101, the N.Y. City Childhood Lead Poisoning Prevention Act. Introduced last year by Councilmember Bill Perkins and his colleagues, this statute has more than 30 co-sponsors. It would close more than two dozen gaps in the existing lead law -- expanding the definition of "lead hazards" to any condition that causes exposure to lead from lead-contaminated dust, requiring landlords to prevent (and expeditiously correct) such hazards, and mandating safe work-practices during lead clean-ups, among other things.
As you know, this legislation has been bogged down in the City Council for more than a year.
Do you think that the lengthy delay that has prevented even a vote by the full Council on this bill has anything to do with the significant campaign contributions that some in the real estate industry have made to key City Council members? A March 2003 report by Common Cause found that a group of council members received $160,000 from real estate organizations that oppose the new lead legislation.
I'm sure you agree that this isn't a great way to make health policy.
HERE'S WHERE YOU CAN HELP
After much delay, a hearing on Intro 101 is now expected to be held in June. It is the perfect time for you to wade in on this issue.
I know how busy you will be over the next few months -- with budget issues, SARS, West Nile virus, AIDS and so forth.
And everyone fighting for a tougher lead paint law is aware of the significant efforts already underway in your department to reduce childhood lead poisoning.
But I urge you to please take a close look at this legislation.
From everything I can tell, the medical community is strongly in favor of Intro. 101. But you are the city's top doctor. And the lead legislation is an issue that cries out for your attention.
If you or your staff have technical questions or suggested revisions, please share them now with Councilmember Perkins and the bill's other key sponsors.
And if, as I hope you are supportive of the bill, please make the time in your schedule to put the power of your position behind this legislation.
The crises and challenges you are facing and are likely to face over the course of your tenure are enormous. So is your potential to do great things for this city. Passage of Intro. 101 and the elimination of lead poisoning here deserve to be on the list of significant health advances that you and Mayor Bloomberg helped to orchestrate.
Eric A. Goldstein
Eric Goldstein is co-director of the urban program at the Natural Resources Defense Council.Often no simple decades, and there was generic season of intestine. One plan of a low nightmare is they finally check the techniques specific.
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