BACKGROUND AND GENERAL FINDINGS:
(From Ruth Ann Norton's Preliminary Recommendations to Mayor Slay dated October 27, 2003.

Ms. Norton is the Executive Director of the Coalition to End Childhood Lead Poisoning.) St. Louis, like many other urban centers struggling with the issue of childhood lead poisoning, has operated for decades under reactive rather than proactive prevention policies. The Mayor of St. Louis has expressed a commitment to change this approach and asked us to review the City's program with an eye to making positive changes. We have investigated the landscape in St. Louis and now offer these initial recommendations for a Mayor's Initiative from the point of view of practitioners who have assisted in the design and implementation of successful lead efforts in other jurisdictions. Here are our
preliminary findings and recommendations.

The three City agencies currently sharing responsibilities for lead poisoning prevention are the Department of Health (DOH), the Department of Public Safety's Building Division, and the Community Development Administration (CDA). In our work, we found that the multi-agency staff dedicated to lead hazard control and lead poisoning prevention is instructed by old policies and operating procedures dating back decades, and works in a reactive manner. In addition, each agency essentially has operated like a silo - standing alone. Thus, key information to improve interagency cooperation and efficiencies lack daily protocols. The three responsible agencies often operate with differing accountability and differing communication structures, and thus lack a shared vision with defined benchmarks and goals for accomplishment.

Beyond adjusting operational issues that can be readily fixed, the City has a strong need to structure programs that encourage private sector and nonprofit cooperation in primary prevention - such as targeting cleanup of units housing pregnant women and/or providing property owners with incentives such as tax credits or easily accessible grants. In addition, enforcement mechanisms - the lynchpins of any successful lead poisoning prevention program - need to be updated so as to move owners into compliance without bankrupting them or degrading investment in City properties.

As the City proceeds with the consolidation of property for new development in various agreed-upon parts of the City’s geography, a number of properties that are now lead hazards will be replaced with new development. Although this report and the plan it advocates does not deal directly with these broader city planning matters, strategic demolition of condemned property should be considered now in those areas identified as high-hazard areas where new development is ultimately planned.

These recommendations are based on an initial assessment only. To complete the implementation of a meaningful program, we recommend that the City continue this planning and review process with the Coalition to allow the Coalition the opportunity to more clearly designate responsible parties for each task, to complete an implementation timeline, and to assist the City with program implementation.

The City already has many of the core assets needed for a successful and comprehensive action plan - a Mayor who is committed to addressing this problem, funding from both federal and local sources available to begin implementation, and staff who care deeply about the children affected by this problem. These core assets can be used to move the City’s strategy from a reactive approach to a proactive prevention model by implementing simple but meaningful programmatic initiatives. As outlined in the body of this plan, these simple but effective initiatives include an accountability structure that clearly outlines responsibilities and expected accomplishments for every member of the program team, a clear set of program priorities, a schedule of expected deliverables and timeframes for each service component, long-term strategies to leverage public funding with non-profit, faith-based and private sector investment, and the design and use of effective enforcement mechanisms.

While other cities across the country have experienced significant reductions in lead poisoning, St. Louis’ children remain at high risk. According to the Department of Health’s 2001 Surveillance Report, the average time frame between initial inspection and the start of lead hazard control activities is 223 days. It is imperative that the delivery of lead hazard control activities be accelerated. In addition, enforcement must be improved so as to support the gains made by education and inspection staff. In 2001, 513 lead violation cases were prosecuted in the City’s Housing Court, with only 74 of these cases resulting in abatements or hazard reductions. This represents a positive resolution in less than 15% of the cases. In addition, the time frames for the meager resolutions achieved, if any, run from 7 months to 2 years.

Given the fact that children can be seriously poisoned in a matter of days, it is imperative that this time frame be dramatically reduced through efficient management, clarification of roles, responsibilities and accountability structures. The “Action Plan” section of this document is intended to shorten response and completion of intervention time frames to a maximum of 90 days.

The Coalition believes that the City has the assets and abilities to become a national leader in lead poisoning prevention - and, with Mayor Slay’s leadership, now has the will to achieve this leadership status.

Download the entire Lead Safe St. Louis Action Plan - November 21, 2003 (PDF)