Very good article that compares, contrasts, and analyzes the effectiveness of housing-based primary prevention policies—laws that aim to identify and fix lead hazards before children become poisoned—including a look at the context surrounding their implementation:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3967847/

Korfmacher KS, Hanley ML. Are local laws the key to ending childhood lead poisoning?. J Health Polit Policy Law. 2013;38(4):757–813. doi:10.1215/03616878-2208603

Quoting from the conclusion ;)

Lead-poisoning prevention may be one of the most complex issue areas in which municipalities—particularly smaller cities—are innovating new policies. Because lead is a “health problem with a housing solution,” it often requires new partnerships between health and housing agencies. Local lead laws operate in a complex legal environment of case, state, and federal law—understanding this setting and the roles of agencies at multiple levels of government can be daunting. Additionally, technical knowledge about cost-effective ways to inspect for, address, and monitor lead hazards is constantly evolving as the result of ongoing research and practical experience. Thus designing and implementing a cost-effective, up-to-date, technically sound lead law presents many challenges to local policy makers.

As one member of Rochester’s city council said, “Lead was the first policy in which we recognized that our staff did not hold the needed expertise, and we had to partner with outside agencies, community groups, and academic institutions to design a smart policy. After that, we used that approach with many new policies.”

What did the authors of this paper do?

The authors conducted a process to first identify laws passed since the year 2000, then chose 19 to analyze, and 8 to do case studies on. Here are my favorite excerpts:

Their framework for comparing the structure of the laws is:

• What is the target housing? (what is the category of housing affected by the law, typically by age or tenure)
• What is the timing for proactive inspections?
• What is the trigger for inspections? (what situations lead to an inspection)
• What is the inspection type? (visual, dust wipe, full risk assessment, etc. and type of instrument used)

Some of the key resources needed to effectively implement a local law are:

• inspection resources (trained staff and adequate funding)
• enforcement tools
• evaluation systems

7 points to analyze when crafting a new law

Quoting the authors directly for this entire section:

Our analysis suggests that prior to passing a new law it is critical to assess the local environment to inform policy choices, including:

1. Physical environment (geographic targeting): To what extent are lead hazards dispersed throughout the city versus clustered in neighborhoods that can be geographically targeted for implementation? What is the appropriate target housing? Example: If EBL or housing data show that most lead poisoning occurs in one section of a city, the lead law could target that area. If EBL cases are more dispersed, it might be more appropriate to target all rental housing, or all units occupied by children.

2. Health status and systems: What percentage of high-risk children receive blood lead tests? What percentage of these have EBL? Example: If EBL testing rates are low, it may not be prudent to rely on past EBL data for geographic targeting.

3. Public awareness (by residents, landlords, and community leaders) of the connection between lead poisoning and health, educational, and social outcomes. Example: In communities with high lead awareness, relying on provisions like self-referral (complaint by tenant) or voluntary certification by landlords is more likely to succeed.

4. Economy/housing market (rental revenues, vacancy rates, foreclosures, etc.): Are there any financial assistance programs available to subsidize needed repairs? Example: If the housing market is strong or financial resources are widely available, a local law might require full abatement requirements. If not, the more economical approach of interim controls plus ongoing monitoring of maintenance practices may be more realistic.

5. State legal environment: Does the locality have the authority to implement a local lead law? Does state law have provisions (such as the power to enact stronger provisions in designated high-risk areas) that can serve as a framework for local action? Example: Depending on the jurisdiction, authority for local actions varies from being specifically authorized, to being preempted or limited, and in some cases is permitted but may require approval. This may limit the targeting options available to local policy makers.

6. Case law: What are the relevant court rulings and settlements related to lead hazards, duty to maintain properties, inspections, and landlord liability? Example: Recent local cases in which damages are assessed against landlords may affect landlords’ perceptions of their legal liability for lead poisoning (and thus their economic incentive to maintain lead safety, independent of a local leadlaw). In such situations, voluntary certification or compliance is more likely to be effective than when liability is limited.

7. Implementation resources: What is the public (city inspectors) and private (number of certified risk assessors and sampling technicians) capacity for conducting proactive inspections? Are property owners and maintenance staff trained and certified renovators? What enforcement tools currently exist that the city could access for this policy (fines, lead court, etc.)? Is there adequate funding for enforcement? Example: We identified several cases in which implementation was limited by insufficient city resources to inspect and enforce the law. If a law relies on private inspectors, sufficient time and resources must be allocated to develop technical capacity to conduct required inspections.8. Political climate: Are there supporters inside and outside government to champion the law? Who will be against the law (e.g., landlord groups) and how powerful are they? Is it possible to address the opposition’s key concerns while still enacting a viable law? Example: Strong political and community support for lead-poisoning prevention makes it more likely that a local law will be passed and effectively implemented.