Lead Poisoning

GAO's analysis of the Centers for Disease Control's (CDC) most recent blood lead level and screening survey data shows that children served by federal health care programs remain at significant risk for elevated blood lead levels. Three-fourths of the children aged one through five found to have an elevated blood lead level in CDC's 1991-94 survey were enrolled in Medicaid or the Special Supplemental Nutrition Program for Women, Infants, and Children or were within the target population for the Health Center Program. This equates to nearly 700,000 children nationwide. More than eight percent of the surveyed children who were served by federal health care programs had a harmful blood lead level--a rate nearly five times that for children not in these federal programs. Despite federal policies, most children in or targeted by federal health care programs have not been screened. Screening often does not occur because federal screening policies are largely not monitored at the federal and state levels. One underlying reason for low screening rates is the widespread belief among providers that lead exposure is no longer a problem in their communities. Another problem is that many children are not receiving adequate preventive health care services, visiting the doctor only when they are sick. Follow-up treatment for children with elevated blood lead levels is complex and potentially resources intensive. Little national data exists to reliability show the extent to which services are provided to children suffering from lead poisoning. At health centers and state and local health departments across the country, GAO found wide variations in the extent of timely follow-up. Providers sometimes miss opportunities to perform follow-up tests and children may not return for follow-up care. Another problem is that most state Medicaid programs do not reimburse for key treatment services.

GAO noted that: (1) the children served by federal health programs remain at significant risk for elevated blood lead levels; (2) three-fourths of all the children found to have an elevated blood lead level in the Centers for Disease Control and Prevention (CDC) 1991-94 survey were enrolled in Medicaid or the Special Supplemental Food Program for Women, Infants and Children (WIC) or were within the target population for the Health Center Program; (3) this equates to nearly 700,000 children nationwide; (4) more than 8 percent of the surveyed children aged 1 through 5 who were served by federal health care programs had a harmful blood lead level, a rate almost five times the rate for children who were not in these federal programs; (4) despite federal policies, most children in federal health care programs have not been screened; (5) for nearly two-thirds of the surveyed children aged 1 through 5 identified by CDC as having elevated lead levels, the blood lead test conducted as part of the CDC survey was the first such test they had received; (6) projecting these results nationally, more than 400,000 U.S. children in federal health care programs have undetected elevated blood lead levels; (7) other data that GAO analyzed for specific federal health programs tended to corroborate the overall low screening rates reported in CDC's survey and also showed that screening rates vary greatly from state to state and locality to locality; (8) screening is often not occurring because federal screening policies are largely not monitored at the federal and state levels; (9) one underlying reason for low screening rates is the widespread belief among providers that lead exposure is no longer a problem in their communities; (10) most state officials GAO contacted lacked reliable, representative data on the prevalence of elevated blood lead levels and the extent of screening in their states; (11) another problem is that many children are not receiving adequate preventive health care services, visiting the doctor only when they are sick; (12) follow-up treatment for children identified with elevated blood lead levels is complex and potentially resource intensive; and (13) at health centers and state and local health departments visited across the country, GAO found wide variation in the extent of timely follow up.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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