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Hillary Clinton's big, important promise to end lead poisoning in America, explained

Libby Nelson is Vox's policy editor, leading coverage of how government action and inaction shape American life. Libby has more than a decade of policy journalism experience, including at Inside Higher Ed and Politico. She joined Vox in 2014.

During the Democratic debate in February in Flint, Michigan, Hillary Clinton made a significant and mostly overlooked promise.

"I want us to have an absolute commitment to getting rid of lead," Clinton said in a city plagued by a lead crisis. "It's not only in water, but in soil and lead paint that is found mostly in older homes. … We will commit to a priority to change the water systems, and we will commit within five years to remove lead from everywhere."

Her response wasn't good enough for LeeAnne Walters, the Flint activist who asked Clinton for a promise to remove all lead service lines within her first 100 days in office.

But Clinton's response could quietly become one of the biggest commitments of the campaign. Ending lead poisoning has the potential to reduce crime, increase academic achievement, and even make the US more economically productive — and, technically speaking, it's not even particularly difficult.

Meeting the goal at all, let alone on Clinton's five-year timeline, will take a lot of money — and even more political will.

The total price of removing all lead paint from American homes is around $260 billion; removing lead service lines and treating lead-laced soil is more expensive still.

But the federal government wouldn't need to pay the whole tab, advocates argue, if it made stopping lead poisoning a top priority in everything from state grant programs to the tax code. And they see the wake of the Flint water crisis as an opportunity to keep the issue in the national spotlight.

"We have the capability, we have the knowledge, we have the science to have a strategy to declare war on lead poisoning," said Ruth Ann Norton, president of the Green and Healthy Homes Initiative, who has spoken with the Clinton campaign as well as other presidential candidates. "What you can achieve by doing that within five years is to eliminate lead poisoning as a major public health threat."

Half a million kids in the US still have lead poisoning

Doctor pricking girl's finger for lead blood test
A child in Flint has her blood drawn to test for lead poisoning.
Brett Carlsen/Getty Images

About 535,000 American children under age 5 have enough lead in their blood to put them over the Centers for Disease Control and Prevention's official "level of concern." Kids exposed to lead are more likely to struggle with self-control and with paying attention, to perform poorly on tests, and to have lower IQs. They're more likely to be aggressive and violent, and more likely to eventually be arrested.

The effects of lead are so toxic that the Environmental Protection Agency and CDC say there is no safe amount of lead exposure for children.

And lead exposure isn't distributed equally. Black children are more than two times as likely as white children to have too much lead in their blood. More than 4 percent of children in poverty are affected by high levels of lead, compared with 1.2 percent of children from wealthier backgrounds.

Until researchers from Virginia Tech revealed that Flint, Michigan, was exposing its children to lead with toxic water, lead poisoning struggled to get political attention and funding.

Lead exposure rates have declined dramatically since the 1980s, when the government began requiring it to be phased out from gasoline. But particularly in urban areas, pipes, soil, and house paint are still laced with lead. Kids are still exposed to it. And in the wake of the Flint crisis, the issue is getting more attention.

"We’ve never held anyone accountable for damage done to a century's worth of children, millions of children," said David Rosner, a professor at Columbia University and the author, with CUNY's Gerald Markowitz, of Lead Wars: The Politics of Science and the Fate of America's Children. "It was heartening to see that both candidates and so many people are paying attention to this issue at last."

It might not be possible to ensure that no one ever gets lead poisoning again, Norton said. But states and cities have been able to dramatically reduce the number of children with lead poisoning. The United States has, too, when it banned lead in gasoline.

Getting rid of lead paint could cost $260 billion

Child walking next to peeling lead wall
Peeling, flaking lead paint is a huge health hazard for children.
Spencer Platt/Getty Images

Flint is an outlier: Most lead poisoning among American kids doesn't come from water, but from walls. As lead-based paint, used until 1978, deteriorates and peels, it turns to lead dust that children can swallow or inhale.

There is a staggering amount of lead paint still coating the walls of American homes. A 2011 study estimated that 35 percent of all American homes still have lead-based paint, and 22 percent have paint deteriorating enough to be considered hazardous.

Safely removing all the lead paint in American homes built before 1978 would cost around $260 billion, or $7,000 per house.

The government has been trying to get paint out of homes for 25 years, when the Department of Housing and Urban Development first put forward a "comprehensive, workable plan" for lead abatement. It went nowhere.

In 2000, a Cabinet-level task force estimated it would cost $17 billion per year for 10 years — $22.8 billion per year in 2016 dollars — to remove lead paint from homes built before 1960. While it didn't recommend that the government pay the whole tab, the report suggested federal tax credits and grants would be necessary to help low- and moderate-income families afford lead abatement. (The report suggested public education and market forces could get richer families to go along too, perhaps out of the fear that homes with lead paint in them would be unsellable.)

Instead, since 2000, the federal government has spent just over $2 billion — across 16 years — on lead poisoning prevention and research.

"Lead is one of those things that we know how to solve," said David Jacobs, the former director of the HUD lead poisoning office and the principal author of the 2000 task force report. "The technologies to do so have been in place now for a number of decades. And it’s simply a matter of political will to appropriate the resources to make it happen."

But for decades, the political will has been absent, going back to efforts from lead and paint manufacturers to downplay lead poisoning risks in the '50s and '60s, said Rosner, the historian. Even then, the fact that black and Latino children were most affected helped drive public opinion.

"What we’re essentially saying is that those lives do not matter and those children do not matter," he said. "It’s too expensive because it’s those lives that are being affected."

This isn't just about money. Norton reeled off a list of preexisting federal programs that could be used to encourage getting lead out of housing.

"If you take a federal dollar or a state dollar or a city dollar anywhere in the country around housing intervention, for example, it should meet a very high lead safe standard," Norton said.

But she also mentioned strategies that seem less obvious at first — such as changing the rules for health savings accounts to allow families to use the funds for lead abatement due to the health consequences of lead poisoning. Together, those commitments would add up to the statement that reducing the harm of lead poisoning is a top priority for the federal government.

Norton argues this has been done before at the state level: A tough lead exposure law in Maryland, passed in 1994, required landlords of properties built before 1950 to register their buildings with the state, submit to inspections, and reduce lead hazards when they were found. Since 1994, lead exposure rates have declined 98 percent in the state.

It's hard to estimate how much replacing lead pipes and soil would cost

Construction zone in Flint
Flint has started to replace its lead service lines.
Bill Pugliano/Getty Images

Clinton didn't just promise to get lead out of houses. She promised paint and soil and water — and soil and water are both lesser contributors to childhood lead poisoning, and a much bigger mystery to fix.

A 2006 study of covering lead-laced soil in Boston found that abatement cost about $2,800 per yard.

The problem is that states and cities don't track soil quality on a house-to-house basis. Studies of lead in yard and parks where children play in Washington, DC, New Orleans, and New York have revealed dangerously high levels throughout most major cities. Any effort to get lead out of soil would have to start with finding the source of contamination.

And when experts have tried to estimate the cost of replacing every lead pipe in the US, they've essentially shrugged. Many cities simply have no idea how many lead service lines they have or where they might be. In 1984, when the Environmental Protection Agency conducted a survey of more than 150 cities about their lead service lines, 30 percent of respondents couldn't identify or locate them.

Replacing 6 million lead services lines, a ballpark estimate at best, could cost as little as $33 billion (the estimate from the American Water Works Association) or as much as $275 billion (the estimate from Fitch Ratings, which analyzes municipal finance and bond markets).

Jacobs says tackling paint, water, and soil together is the right approach. But only partially replacing lead pipes can be worse than doing nothing, and fully removing them means that homeowners, who are considered responsible for the lead pipes on their property, would probably have to pay part of the bill.

One first step, according to Norton, is to get officials' "hair on fire" at the EPA about disclosing lead contamination in water to the public. Another is to deal with the threat of lead leaking into the water, not from pipes, but from faucets and fixtures in people's homes.

Getting lead out of American life could save trillions of dollars in the long run

Unleaded gas sign
Removing lead from gasoline was a public health triumph.
David McNew/Getty Images

Lead abatement has struggled to get attention in part because of bad timing. Low-level lead exposure from paint and soil, rather than gasoline, became the major lead poisoning concern just as politicians began emphasizing shrinking the size of government. The result was that public health became less ambitious, focusing on managing hazards rather than eliminating them.

That approach made some sense for issues like smoking or AIDS, which couldn't be eliminated through large-scale government action, Rosner said. But it meant that ambitious plans like the 1990 and 2000 reports on lead paint removal were also abandoned in favor of a less aggressive approach.

The problem is that the only way to manage lead poisoning is to get rid of lead: Low-level lead exposure can't be reversed. And the last ambitious attack on lead — removing it from gasoline — was phenomenally successful.

In the late 1970s, before lead was banned in paint, toys, and gasoline, 88 percent of children ages 1 to 5 had at least 10 micrograms of lead per deciliter of blood, double the CDC's current threshold of concern. By the early 1990s, just 4 percent did.

And as lead levels declined, so did other societal problems.

Kids who were exposed to less lead as children were less likely to get pregnant as teenagers, less likely to commit crimes, and less likely to use drugs. Scores for 9- and 13-year-olds on reading and math tests have gone up. Researchers argue that at least some of those gains were the direct result of reducing lead exposure — children exposed to lead and living in poverty have more trouble paying attention than children who are poor but not exposed to lead, for example — although some of those findings are disputed.

In 2002, researchers at Harvard and the CDC estimated that getting lead out of gasoline added $213 billion per year to the economy because children not exposed to lead had higher IQs.

Because lead can do damage even at very low levels, some estimate that getting rid of lead entirely could deliver major benefits, even though lead levels have already declined dramatically.

An estimate in 2009 by Elise Gould, now the director of health policy research at the Economic Policy Institute, found that every dollar spent on lead hazard reduction could lead to $17 to $221 in benefits later on, mostly in the form of increased tax revenue (because kids not exposed to lead would earn more later in life) and decreased spending on health care.

Jacobs argues that paint companies should shoulder some of the costs of lead paint abatement, since they knew lead was toxic for decades before they removed it from their products. Aside from a recent $1.1 billion ruling in California, though, paint companies have often successfully defended themselves against lawsuits meant to force them to pay.

But he also argues that society pays for the consequences of lead poisoning — through special education, medical care, and complicated construction renovating rules — even if it doesn't pay for lead removal.

"You get what you pay for in this world," Jacobs said. "And if the resources are not appropriated, then we pay for this problem anyway."