After listening to an NPR story this weekend about Dr. Herbert Needleman, a pioneer in the fight against child lead poisoning, we wanted to share this excerpt from our most recent issue of Voices in Urban Education (VUE). Dr. Peter Simon has been on the front lines of the fight against lead poisoning here in Rhode Island for over twenty years, and in his piece he connects this public health problem to larger issues of poverty and toxic stress, and calls on officials from public health and early education to work together to solve the systemic problem of child lead poisoning.

Excerpted and adapted fromThe Effects of Early Toxic Stress and Lead Poisoning on Learning and Development: Systemic Problems Require Systemic Solutions

(published in VUE 43: Promoting Seamless Transitions from Preschool to Kindergarten and Beyond)

by Peter Simon

I was working at the Rhode Island Department of Health in 1977, when the Centers for Disease Control (CDC) issued the first request for proposals [RFP] on prevention of childhood blood poisoning. My boss asked me to present it to [then head of the department] Dr. Joseph Cannon. I told Dr. Cannon, “It appears from limited surveillance that there’s a real problem here. We have a lot of poor kids. We have a lot of old housing with lead in it. And a little bit of screening that’s going on just is yielding quite a significant load.” He said, “Where’s the lead coming from?” I said, “Most likely it’s coming from housing.” So he thought for about two seconds, and he said, “It sounds like it’s a real problem for kids in Rhode Island, for the state. It’s a real public health challenge. And I’m going to tell you to go ahead. But I’ve got to tell you right now, it’s a loser. You’re going to be barking up a housing tree that is loaded with politics and the worst kinds of human behavior. But go ahead.”

We got funded to increase screening and include screening as a routine part of a child’s medical care. We had to build up a lab capacity and an outreach. Those were some of the things that I learned the most from – the need to do cross-cultural, cross-linguistic health education outreach to families and screen their kids right on their doorsteps. We had a door-to-door summer campaign every summer, and I’d hire twenty-five college kids – representative of all the different ethnic, linguistic, minority communities in Rhode Island – train them about lead, teach them how to get a good finger stick sample, fill out the form correctly. We used to do 10,000 kids a summer. It was an outstanding model program of childhood lead poisoning control.

Since we started the lead program twenty-three years ago, the percentages affected and new cases have been falling. Back then, in South Elmwood, along Elmwood Avenue in South Providence, one out of two kids was poisoned – fifty percent of kids! And if you ask early childhood educators, “How can you see the effects of lead in your preschool kids?” they’ll tell you: “They’re distractible. They’re easily agitated. Their working memory is poor. Their behavior and developmental profiles are immature in terms of their emotional volatility.”

Rhode Island KIDS COUNT uses as an indicator kids entering kindergarten with a lead level over 5 – that indicator is a great a way of bringing attention from the preschool part of kids’ lives through the kindergarten doorway. And from what I understand from talking to the people in charge of early learning in the Department of Education is that now the entire curriculum in K–3 is essentially an ongoing effort to actually work with struggling students. So they don’t wait for the kids to fail. They’re constantly providing additional resources inside the classroom. And I think that’s fantastic.

But we need to harmonize some of what we’re doing across public health and education. We can’t keep operating in silos, we just can’t afford to do that. I hope we can get people to understand the importance of collaboration rather than competition. We need more of an ecological approach, building on the assets we already have.

Dr. Peter Simon is a pediatrician and public health expert who has worked at the Rhode Island Department of Health for over forty years, most recently as the medical director of the Division of Community, Family Health, and Equity, a position from which he retired in 2013.