By Michael Wines

New York Times

CLEVELAND >> One hundred fifty miles northwest of here, the residents of Flint, Michigan, are still reeling from the drinking water debacle that more than doubled the share of children with elevated levels of lead in their blood — to a peak, in mid-2014, of 7 percent of all children tested.

Clevelanders can only sympathize. The comparable number here is 14.2 percent.

The poisoning of Flint’s children outraged the nation. But too much lead in children’s blood has long been an everyday fact in Cleveland and scores of other cities — not because of bungled decisions about drinking water, but largely because a decadeslong attack on lead in household paint has faltered. It is a tragic reminder that one of the great public health crusades of the 20th century remains unfinished.

“Unless there is some sort of concerted national effort to do something about this problem, it’s going to persist for years to come,” said Philip J. Landrigan, a leading expert on lead and professor of preventive medicine and pediatrics at the Mount Sinai School of Medicine. “Lead is a big problem in this country, and it frustrates me to no end that except in rare cases, it passes unnoticed.”

Four decades ago, political leaders declared war on lead, citing evidence that even vanishingly small amounts of it have a pernicious effect on young brains, stunting intellectual growth and affecting cardiovascular, immune and hormone systems. Congress began phasing out leaded gasoline in 1975, and banned lead-based household paints in 1978. In 2000, a Cabinet-level task force proposed to end lead poisoning in children within a decade.

By 2006, blood lead levels in children under 6 had fallen to close to a tenth of their 1970s levels.

But progress since has slowed. By the most recent estimate, about 37 million homes and apartments still have some lead paint on walls and woodwork, 23 million with potentially hazardous levels of lead in soil, paint chips or household dust.

The Centers for Disease Control and Prevention estimate that 4 million of those most dangerous households have children. A half-million children — in Atlantic City, New Jersey; Philadelphia; Milwaukee; and Allentown, Pennsylvania, where a remarkable 23.1 percent of children tested had excessive lead — are believed to have enough lead in their blood to merit a doctor’s attention.

That need not happen. New York City has both a vast and aged housing stock and one of the nation’s strictest laws on lead testing and removing lead hazards. In 2014, only 2.1 percent of children tested were flagged for excessive lead.

But in most cities, the lead threat is confined largely to poor neighborhoods with scant political clout. There is little official urgency — and increasingly, little money — to address it.

Charm Warren-Celestine, 64, replaced the windows and porch of her century-old home in east Cleveland’s Glenville neighborhood after her toddler grandson Zy’aire developed high blood lead levels after spending the summer of 2011 with her.

“It took me three years and two applications to get the city to do what was needed to make my dwelling lead-free,” she said. “I had to apply twice because funding was exhausted. You had to be relentless to make it happen.”

The CDC has consistently lowered its definition of an elevated blood lead level: 60 micrograms per deciliter, then 10, and, as of 2012, 5 — less than a millionth of an ounce in just over a pint of blood.

Yet experts say that is still too much. A 2005 study concluded that increasing a child’s blood lead level to 10 micrograms from 2.4 translated to a 6.9-point drop in IQ. A 2015 study of Chicago elementary school students concluded that blood lead concentrations of 5 to 9 micrograms explained up to 15 percent of failing grades in reading and math.

Even tiny increases, below 5 micrograms, “are associated with significant decrements in performance on standardized tests,” the researchers said.

In 2010, researchers estimated that 7.7 percent of the nation’s black children under age 6 had blood lead levels above 5 micrograms per deciliter. But in Glenville, 26.5 percent of children tested in 2014 — 286 children in all — exceeded that standard. Two registered more than 45 micrograms, the threshold for hospitalization to remove lead from the body.

Cleveland tested less than half its under-6 population. How many other children are at risk is unknown, but an Ohio State University analysis suggests that in some census tracts, it could be more than 4 in 10.

Dr. Dorr Dearborn, a retired pediatrician and chairman emeritus of Case Western Reserve University’s department of environmental health sciences, said widely elevated lead levels “give these children an abnormal base to which all the other determinants of school failure and aggressive behavior are added.”

Dearborn has long campaigned for Cleveland to erase lead-based paint from its homes — nearly 9 in 10 of the city’s houses were built before the 1978 ban — but Clevelanders were oblivious.

That changed last October, after a series of articles in The Plain Dealer reported that the city’s Department of Public Health had failed to investigate more than 2,100 cases of lead poisoning during the previous five years. Until 2015, the city had but one employee to inspect homes where lead poisoning occurred.

City officials contest some of those numbers, but in an interview they conceded that the city’s lead safety efforts were a mess. The main reason, they said, was a lack of money.

When the CDC began cutting lead poisoning prevention grants in 2010, the officials said, the Health Department had to curtail lead tests and lay off inspectors. In 2012, federal officials withdrew Cleveland’s multimillion-dollar grant for addressing lead in homes because the city’s track record was so poor.

Some critics are less sympathetic, noting that the city has found money for other projects — including $30 million for a 2013 renovation of its NFL stadium — while lead abatement languished.

“A lot of folks failed,” said Kim Foreman, director of Environmental Health Watch, a local group that works to ease lead and other health threats in homes. “The layperson, they thought we dealt with lead. But you also have a lot of folks affected who are people of color or low-income people. And honestly, people are not as concerned about them.”

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