GREENWOOD — Mayor Carolyn McAdams doesn’t know how serious the problem of lead exposure in Greenwood is. According to limited data, the devastating effects of lead exposure on children in Greenwood are just as severe as elsewhere in the state. From 2012 to 2017, three percent of Greenwood children were tested for high levels of lead — far more than the state average, and one of the highest in the entire state. McAdams stated that no one has ever claimed that Leflore County was high in lead-based poisoning. To me, this is everything. “State officials know these statistics, they know these problems but they aren’t getting the information to people that need it.” McAdams said. McAdams, along with other leaders in the state, has struggled to determine how many children are at risk from lead poisoning. This is due to years of undercounts, inconsistent testing, and a fading focus by the resource-strapped Mississippi State Department of Health. Lead lurks below the surface of Mississippi homes in soil, paint, and plumbing. Lead can cause damage to walls and pipes, as well as leakage into drinking water. It also tracks back on work boots dust, landing in the mouths of small children, where it rapidly enters their bloodstream. Lead’s irreversible damage can be done once it has entered a child’s body. It is a neurotoxin that can cause serious health and behavioral problems in developing bodies. Even low levels of lead in children can have long-lasting effects, including lower test scores and a reduction of 3-7 points in IQ. Although families can reduce the amount of lead in their homes to prevent future exposure, it is impossible to reverse the damage caused by the initial exposure. Due to the Delta’s high poverty rate, aging homes, and large farmland, there is a lot of paint and soil lead exposure. Old pipes that have been left unattended in schools and provide water to residents for long periods of times could leach lead into their drinking water. In Delta towns like Greenwood, the reality of lead poisoning is severe. Black children in Mississippi are twice as likely to become poisoned from lead than white children. Mississippi Today began a year-long investigation into lead exposure in the state. We analyzed water quality reports, census records, and blood lead levels to determine lead exposure risk. Based on the percentage of lead-plumbing children and older homes, our analysis narrowed down to two counties. Leflore County, which is home to Greenwood was one of them. McAdams and other officials have not been given the resources they need to protect their constituents. McAdams said that she did not know that lead exposure was high in Greenwood until today. “… Our education component has been very low in terms of how we educate our citizens about the issues they face. This is the truth. “We have to do better.” Mississippi has nearly seven-fold undercounted the amount of lead exposure among its young children over the past decade. According to public reports, 3000 Mississippi children tested positive for lead from 2009 to 2015. This number dropped to 1,500 between 2012 and 2016. These reports show that the rate and number of children poisoned with lead is steadily decreasing and is well below the national average. However, data that was published in 2019 for state physicians shows a more accurate picture of the problem. The data showed that 19,794 children had high levels of lead in the same period — almost 16,900 more than what is publicly available. According to the Mississippi Department of Health officials, the reason for the discrepancy between the reports is the way the testing was done. All blood tests that had high lead levels were included in the 2019 report for doctors. These could have been taken by either a fingerstick test or vein blood draw. Only the public reports reveal that this is true. Mississippi is one the five states that only reports and helps children with blood tests that have been confirmed by veins at 5 micrograms or more. Most states allow finger-sticks to confirm or report lead poisoning, as per the Centers for Disease Control guidelines. Mississippi doesn’t allow finger-sticks to confirm lead poisoning. Mississippi has 16,000 children who are still uncounted, with their lead risk uncorrected. Although the latest report shows a decrease over the years it is not as encouraging as the regular surveillance reports. Many of the children who didn’t receive lead-prevention services and fell through the cracks were young Black boys who had Medicaid. This highlights one of the major problems in Mississippi lead monitoring: inconsistent testing and reporting. Many large pieces of data can be lost in translation between doctors, labs, doctors, and health departments. There is no safe level for lead. The threshold for parents, doctors, and state to take action has decreased over the past few decades. Medical consensus is that no matter what lead source you have, it should be found quickly and eliminated. Quest Diagnostics, one the nation’s largest scientific labs, has found that 5 percent of Mississippi’s children who were tested for lead had “high” levels. This is the same level as Flint, Michigan at the heights of its high-profile lead-in water crisis. Quest Diagnostics’ research also revealed Mississippi had the tenth highest number of children tested for high levels of lead. This was the same percentage as Flint, Michigan, during the height of its notorious lead-in-water crisis. However, state records show a more positive picture than the Quest results. Only 1% of Mississippi children were found to have “high” levels in the same time period. The state medical association published a further analysis of the health department in 2019. It shows that the percentage of children who tested “high” for lead dropped from 12 percent to 3 percent in 2015. This is closer to Quest’s findings. Additional research by the American Academy of Pediatrics revealed that Mississippi may have detected less than 30% of children who had elevated levels of lead between 1999 and 2010. Dr. Harvey Kaufman is the lead author of Quest. He referred to the CDC’s aggregate state report on lead. “But their (state department of health) numbers aren’t quite right, except for 2013, which seems real.” He said: “And frankly,” he added. “There is no reason in 2020 that we expose infants to lead, regardless of whether one’s 9th or 49th. “We’ve known this for a while and we know how we can remediate homes and how to test it, but it’s a public health issue that continues to plague Mississippi.” Last year, 21 Mississippi families received in-home interventions. In-home assessments are only available to Mississippi State Department of Health families whose child has a lead level of 15 or more. Nearly 400 children were eligible for the services from 2009 to 2016. However, only one-third of them received them. Only 5 percent of children with “high” blood lead levels (defined as a blood test that shows 5 or more micrograms per deciliter) were able to receive in-home assessments to identify and reduce lead sources. The thousands of undercounted children were not even considered for in-home visits. Officials from the health department claim they are investigating the possibility of lowering the threshold in order to capture more children who were previously not counted. Beryl Polk, director for health services, said in an email that it is their policy to ensure children with elevated blood lead levels (depending on the level) get an environmental investigation and/or education about lead poisoning prevention strategies. Although the program only had one inspector who visited homes in the state and no epidemiologist to follow cases, she said they could enroll more children. However, families and pediatricians would have to pay for the necessary follow-ups. Stephanie Showalter-Otts is the director of the National Sea Grant Law Center at The University of Mississippi. She conducted research about lead-in water problems in the Mississippi Delta. This led to a new partnership between the state health department and Stephanie Showalter-Otts. She believes that part of the problem is low lead testing which prevents targeted lead prevention from being addressed. She stated that families don’t get the information they need from the beginning. “There’s also a lot misinformation about risk factors and how many Mississippi children are affected.” “Our testing rates are so low that we don’t know how many children might have elevated blood lead levels. This is my biggest concern. Families don’t hear much about it, they don’t get it very often, and it isn’t an issue. It’s not a big problem anymore. Experts consider lead poisoning to be one of the greatest public health issues of the past century. Previously a topic of national safety campaigns, lead poisoning has been largely ignored. Major lead sources have been largely eliminated from infrastructure through policy and advocacy interventions. This has dramatically reduced childhood exposure. It was banned from paint, phased out in gasoline and most plumbing in 1986. National research has shown that the lead content in children’s blood has dropped by approximately 90% since 1980. It persists in areas with older homes, however. It is particularly prevalent in areas of Mississippi where there are many Black children, especially in the Delta. Although lead exposure isn’t discriminatory, it can be caused by poverty and requires money to fix. Lead is most likely to be present in older homes if pipes or paint aren’t replaced. A family renting their home is not required to remove lead hazards. Research from both the national and state levels has shown that lead poisoning affects children in poverty more than other groups. According to a 2019 state health department analysis, 7 percent of small Black children tested for lead had “high” levels between 2009 and 2015. This compares to 6 percent for white children. Overall, more than twice as many Black children had high levels. However, most state interventions are not targeted at communities that have specific needs and risk. Showalter-Otts stated that a neighborhood with an abandoned gas station is more likely to be exposed to soil and dust than a rural community that draws its water from wells. She said that one thing that struck her as she worked on the project was the lack of universally applicable information about lead. It’s not the best way to help families understand their lead risk and reduce it. It all depends on where you live and where your housing environment is. I believe we need to do more targeted outreach and make it easier for families to identify the risk. July 8, 2020. Mississippi and other states don’t test enough children to determine the risk level or scale. A third of all states, including Mississippi are able to reach fewer than 1 in 5 children each year to test for lead poisoning. Nearly half of those states with low lead testing have seen their rates increase over the past decade. According to the CDC records, Mississippi’s testing rate has declined from a peak level of 20 percent in 2014, to just 16 percent in 2016. The state saw an increase in the number of positive tests during that time. Medicaid, which is an insurance program for low-income families requires universal blood lead testing for all its enrollees. American Academy of Pediatrics recommends that all children below 6 years old are screened for risk assessment. They also recommend testing any children who may be at higher risk such as those living in older homes. However, only 25% of Mississippi Medicaid beneficiaries under 6 had blood tests in the last two years, although it has increased over recent years. According to a 2019 study by the state health department, Medicaid recipients in Mississippi are 93% more likely to have blood lead levels. The Mississippi State Department of Health’s lead prevention office focuses on high blood lead levels, poverty rates, and older homes to reduce risk. The agency narrowed 26 counties at high risk for lead exposure based on these metrics. Nearly half of them are located in the Delta. Mississippi is unique in that it does not use zip codes. This allows for the identification of targeted areas of risk based upon neighborhood exposure. It can also narrow intervention efforts and get community support to fix hazards. A field of soybeans near U.S. Highway 49, Greenwood, Miss. July 8, 2020. Kaufman, the Quest national researcher, stated that “I don’t have any sense” and added, “I just don’t have a sense. “Children don’t have a voice… but it does impact these children in terms of their behavior and in terms of their IQ. It has consequences, and it’s an issue.” He said: “We are concerned about who’s missing in terms who’s not getting tested. That takes into account children who are homeless and children who have limited access to medical care. Yes, we are under-counting the most vulnerable populations.” Lead has been difficult to remove in Greenwood County and Leflore County. Despite the fact that it is difficult to determine the source of lead without extensive testing, the Delta community has the highest rate of childhood exposure in the state. Only one family received state-provided in-home lead treatment last year. Jamie Stowers (Greenwood water utility vice president) said, “Oh, it’s everywhere,” referring to the widespread use of lead and its stubborn persistence since around 2000. Greenwood was identified by state health officials as a high-risk community for lead exposure. The state health department received a federal grant of $1.5 million in 2018 to reduce lead paint exposure in 75 homes throughout the state. Greenwood was one of the recipients. Greenwood’s welcome sign at U.S. Highway 49, Greenwood, Miss. July 8, 2020 McAdams, who is the mayor, spent months working with the state health department to figure out how her city could use the funds for lead abatement. McAdams received little clarity from federal and state officials. She decided to withdraw from grant program because there were too many unanswered questions and undetermined factors. Although her experience with the local housing authority suggested the problem, she has never seen the data to determine if it is worse in Leflore. “Nobody can s.”
Aid, “Well, we’re giving (you this) grant because Leflore County’s high.” In response, Crystal Veazey, spokesperson for the lead program, stated: “This was our very first time receiving HUD funds… It has been and will continue being a difficult year.” Additionally, the department has not had a dedicated epidemiologist for over a year, which has limited its ability to track lead more effectively and led to data reporting discrepancies. Mississippi Today took samples from 25 taps in Greenwood and Leflore County, using the same methods – first pull after tap was seated – and had the results analyzed at an EPA-certified laboratory. The lead content in water from 12 homes was on the rise, with an average of 2 parts per million and 6 parts per trillion. This is more than three times higher than the average county level in 2018, and 25 percent above the city’s average. However, the numbers are not large. The results did not exceed the 15 parts per million action level, however, the results in Greenwood and Leflore County showed that lead was present in the water. Officials at the county water utility did not respond to a request for comment about Mississippi Today’s findings. However, they previously stated that they are doing their part in ensuring the federal testing regulations are met. Our analysis covered the equivalent of half of a reporting period of testing in the city as well as the county utility. Stowers’ water records, which he submits to the state every three year in order to comply with the Environmental Protection Agency’s Lead and Copper Rule, are in compliance. However, this doesn’t necessarily mean that lead isn’t present. Stowers responded to our testing and said that he was pleased that another lab had found similar results. It’s also a reminder to homeowners to pay attention to their pipes. Stowers stated that people should be aware of their plumbing inventory. During the night water can sit in pipes and fixtures, which can lead to a small amount of lead. He said that a simple flush would make a huge difference in the level of lead in the water. In the 1990s, the federal Lead and Copper Rule was established by the EPA to combat lead corrosion in water distribution systems and establish action levels. The program is largely administered by states, in Mississippi the state health department. LCR as it is known is complex and subject to its own problems. It has been criticised for its inability to enforce and its poor methodology. The LCR is currently being reviewed for the first-time in many decades. The water system will be in compliance if 90 percent of the homes that have been tested for lead exposure (out of 50 total homes tested every three years by the county and Leflore city utilities) stay below 15 parts/ billion. The state can work with utilities to improve corrosion control in the water system to balance its corrosivity, and prevent lead pipes from leaching. The EPA may also order utilities to replace lead service lines. However, this has not been done in Mississippi despite Jackson’s well-documented history of lead overages. The Lead and Copper Rule is not intended to be a health standard. It allows water utilities to know if they have to take any action such as adding corrosion protection to pipes. Health experts insist that there is no safe level for lead. Officials call it the “90th percentile rule” and they are not required to report publicly the top 10 percent of lead results. The Delta’s water systems are fragmented and small. Most counties have 18 public water systems. Research showed that at least 20 of these systems had lead spikes over the past decade. However, only seven were found to be in violation the EPA rule. Humphreys, Brooklyn showed the highest reading at 228 parts/billion — more than 15-times the legal limit. Stowers in Greenwood claims that all lead pipes used in Greenwood to supply water have been removed and replaced. This is a practice that has been common over the past few decades to reduce the risk to the entire system. According to records from the city, some lead pipes still exist, but they are being excavated and replaced as soon as possible. Stowers states that the Lead and Copper Rule is not working well enough to identify true risk. He said, “It’sn’t looking in the right places.” He added, “And it makes them responsible for what is in their homes.” However, the problem of lead exposure in the area remains. Three percent of children tested in Leflore County between 2012 and 2017 had high levels of lead, which is well above the state’s average and one of its highest. In 2009, individual lead levels were measured at county level. The highest concentrations of Leflore’s lead were found in the area around Greenwood and east Leflore. Mississippi Today reviewed the county’s testing history and found that the East Leflore Water District, which is the second-largest water utility in the county, tested its own homes and those of their families for lead between 2009 and 2018. Although the water utility reports having lead service lines in their state records, Shemeka Collins, the district operator, says that they are not on the side of property owners. However, the water utility did not test all of the homes with lead service lines or pipes within their system. Federal law requires utilities to test at most half of their sample from homes that have lead service lines. At least 12 other state utilities with higher lead risk counties have also tested the homes of their residents. Although testing their homes is allowed under federal law and has been reported in states other than California, it excludes other homes at risk of lead poisoning from the pool of tests. This increases the difficulty of identifying areas of high exposure for children. All of it comes down to the balance between LCR compliance, not burdening small water utilities, according to Bill Moody, the head of the Bureau of Public Water Supply, and LCR enforcer for the state. Although it is not common practice to test utility workers’ homes, it is allowed. He said that COVID is now available, but some systems still have difficulties getting customers to take part in the sampling process. LCR is the only requirement for this type of participation. Some systems are not able to get customers involved. Operators and officials may have little choice but to follow this path. You can see individual Lead and Copper Rule results in your local area. Click on your county and your system to view individual results. It can be hard to interpret results. Learn how here and here. Find out more about the yearly reporting of your water system and if you have lead service lines. University of Mississippi has resources to help communities test their water for lead, reach out at leadinwater@olemiss.edu or (662) 915-7101. This project was funded by the Doris O’Donnell Innovations in Investigative Journalism Fellowship at Point Park University’s Center for Media Innovation.