Opportunity is uneven across metropolitan areas, and this unevenness is deeply rooted in how cities developed, writes First Year contributor Richard Schragger in his essay, “City power.” To create opportunity, he argues, we ought to invest in public goods in the places where people live. I agree. Environmental health, particularly the eradication of child lead poisoning, is one of these public goods. The next president should attack child lead poisoning by creating institutions that will keep the problem visible and by finding funding sources that are adequate to the large task of massively reducing lead hazards.

Disparities in exposure to environmental pollutants are one of the key mechanisms by which uneven opportunity, and thus inequality, is reproduced. Pollutants cause acute and chronic health problems, and health problems are expensive to treat. They can affect the kind of jobs people get and keep, how much work they can do, and how productive they are. Some pollutants affect development and learning in children, which limits opportunities for education and income in the long term.

No environmental health problem smothers opportunity so unremittingly as child lead poisoning. Lead toxicity can disrupt every organ system, but the nervous system is the most vulnerable. The developing brains of children are at the highest risk. Lead levels in children have dropped dramatically in the last few decades as a result of bans on lead paint, leaded gasoline, and lead in water pipes. But lead remains in the environment from the past use of these products. And unfortunately we have learned that even very low levels of lead exposure can cause intellectual impairments, learning disabilities, hyperactivity, and attention deficit disorder. Research has shown lead to be so potent that the Centers for Disease Control (CDC) no longer recognizes any safe lower limit for lead in children’s blood.

No environmental health problem smothers opportunity so unremittingly as child lead poisoning.

In addition to limiting individual opportunity, child lead poisoning disproportionately affects the poor and some racial minorities, especially African Americans. While lead poisoning knows no spatial boundaries, it is particularly common among minorities and the poor living in old, inner city housing. Disparities in child lead poisoning reinforce inequalities across class, racial, and spatial lines.

These disparities are rooted in part in the way cities in the United States developed. National housing insurance, provided through the Federal Housing Authority and the Veteran’s Administration, favored single-family housing in the suburbs from the 1930s to the 1960s. But these policies often discriminated against African Americans, and government programs often worked with lenders, developers, and realtors who were racially discriminatory.

These white suburbs that emerged in this period were more environmentally healthy places. Among other things, they were further away from industrial pollutants, including lead, and the housing in these suburbs had fewer lead paint hazards since it was newer and built at a time that lead paint use was ebbing.

Back in the inner city, conditions were different. Suburban white flight and constricted lending (due to the policies that favored the suburbs) provided fertile ground for slumlords. Slumlords neglected maintenance on housing for short-term gain. In addition, racial discrimination in housing drove up the price of housing for African Americans. That meant they had less money to spend on housing maintenance. Deteriorating lead paint in housing was extremely hazardous. The feedback loop of disinvestment leading to deterioration and then to more disinvestment produced durable disparities in lead paint hazards.

Suburban white flight and constricted lending (due to the policies that favored the suburbs) provided fertile ground for slumlords.

At the same time, suburban commuting produced its own unequal and durable environmental health problems. Automobiles allowed rapid suburbanization in the mid-twentieth century, but the leaded gasoline they depended on was highly hazardous. Automobile pollution was most heavily concentrated in the inner city where commuters converged on a daily basis. That pollution disproportionately harmed inner-city children. But even after the ban of leaded gasoline, contaminated soils in those areas remain a source of exposure.  

We know less about disparities in exposure to lead in drinking water, but research on the recent lead-contaminated drinking water crisis in Flint, Michigan, suggest that social inequality within and between cities makes the poor and African Americans more vulnerable.

As Flint shows, lead poisoning continues to be a problem. In fact, many cities have worse child lead poisoning rates than Flint, mostly as a result of paint hazards. What happened in Flint was outrageous—it deserves its own relief policies—but it has also put child lead poisoning into the public conversation. For the first time, lead poisoning has featured prominently in a presidential race, even being mentioned in Hillary Clinton’s nominee acceptance speech.

Now is the time to make good on so many past pronouncements about the eradication of lead poisoning. Child lead poisoning will not be snuffed out over night, but does it need to go on for decades more?

One of the most important things the new administration can do is to keep it on the agenda. Child lead poisoning has been a pervasive problem for at least a century, but it has often been marginalized. Cities only recorded few problems with lead poisoning for the simple reason that they never looked for it. In other cases, child lead poisoning was presented as only a problem of the ghetto. But disparities, while real, were not, and are not, absolute. Children from all backgrounds can be poisoned.

Child lead poisoning will not be snuffed out over night, but does it need to go on for decades more?

One way to try to keep a spotlight on the lurking threat of child lead poisoning is to monitor it better and more publicly. The federal government should require all states to report elevated child lead poisoning cases to the CDC. Only about half of the states currently do so. The CDC should investigate the housing, soils, and water in places where there are many children with high blood lead levels.

Other agencies concerned with lead, especially the Environmental Protection Agency and the Department of Housing and Urban Development, need to adopt the CDC’s threshold of elevated blood lead (5 micrograms/deciliter) for determining actions, exposure, and technology. The EPA ought to require more rigorous and transparent water testing for lead from utilities. Finally, these biomonitoring and hazards data should be linked together and, when possible, made publicly available. These reforms will help to identify and prioritize programs for those communities that face the highest risks. And a more integrated and public base of knowledge will help keep the problem of child lead poisoning from slipping back into the shadows. 

Better monitoring will be expensive, as will programs to reduce lead hazards themselves. Although many aspects of lead-related programs need to be reformed, the biggest challenge is funding these programs. Whether they are regulations that must be enforced in millions of homes or programs that provide funds for reduction, money is, and has been, a key issue.

While dealing with lead will be expensive, the benefits will exceed the costs many times over. By one estimate, for every dollar spent on lead paint abatement would yield up to $221 in benefits. Despite the enormous benefits, funding for lead monitoring and reduction has fallen in the last ten years and has been well below what is necessary to vigorously reduce hazards. One problem is that politicians have little incentive to spend on issues whose benefits will not accrue until much later.

By one estimate, for every dollar spent on lead paint abatement would yield up to $221 in benefits.

One route the new administration can take is to create programs that ease the cost of lead hazards reduction without requiring the federal government to spend a lot of money. Tax credits for lead hazards reductions are one way to do that. Another is to support programs that allow property owners to get loans for hazards reductions and then have payments attached to the property tax bill. This spreads costs out over time and keeps them attached to the property, rather than an individual. Although these are local programs, they will be limited unless the Federal Housing Authority agrees to incorporate them into its mortgage program.

However, if we are going accelerate the reduction of lead hazards in housing, soil, and pipes, we will need more than tax credits and loans; the costs of monitoring and enforcement will require money from the federal government. Especially in low-income households and neighborhoods, we will need subsidies to off-set the cost of lead removal. One source of money could be the elimination, or at least reform, of the mortgage-interest tax deduction, which annually withholds about $71 billion dollars from the federal coffers. This deduction has long primarily benefited affluent homeowners in the suburbs. It is time to direct these benefits elsewhere, to improve the environmental health conditions, and thus opportunities, in poor, inner city neighborhoods and other neglected places.