The Board of Supervisors finds that:
(a) The Centers for Disease Control ("CDC") have determined that childhood lead poisoning is one of the most common pediatric health problems in the United States today, and it is entirely preventable. ("Preventing Lead Poisoning in Young Children," CDC, Oct. 1991.) Children in San Francisco up to 72 months of age are particularly at risk due to the multiple sources of lead in the City's housing stock and in the background environment. The Board of Supervisors believes that childhood lead poisoning is the most significant environmentally caused health threat to young children living in San Francisco.
From March 1991 through November 1994, initial blood lead tests were received by the Department of Public Health for 7,143 children aged six to 72 months. Of these 7,143 children, 587 (8.2 percent) had elevated blood lead (EBL) levels greater than or equal to 10 µg/dL, the level at which some action must be taken to prevent further exposures according to CDC guidance. Children requiring case management included 186 children (2.6 percent of the total) with blood lead levels between 15 and 19 µg/dL and 123 children (1.7 percent of total) with blood levels greater than or equal to 20 µg/dL. The highest prevalence of EBL was 10.1 percent for one-year-olds, closely followed by a prevalence of 9.6 percent among two-year-olds. ("San Francisco Epidemiologic Bulletin," Vol. 11, Nos. 1/2, Jan/Feb. 1995.)
There are approximately 42,000 children in San Francisco in the age group of concern, but this number is likely to grow. At the current rate of 9,000 births per year, thousands more children will enter the age group of concern in the coming years. Census data from 1990 show significant numbers of these children living in poverty, and in properties built prior to 1950. Based on these proven risk factors, a significant proportion of San Francisco's children are at risk for lead poisoning.
(b) Childhood lead poisoning is dangerous to public health, safety and general welfare. It requires large, but avoidable expenditures of public funds for health care and special education, causing a substantial, unnecessary drain on public revenues, and it reduces the ability of lead-poisoned children to become productive members of the City's work force. Recent studies show a need for remedial education for lead-poisoned children. Studies by the federal government show that the benefits of protecting children from lead poisoning are far greater than the costs needed to prevent lead poisoning and reduce lead hazards.
(c) The Agency for Toxic Substances And Disease Registry has reported the following toxicological effects of lead to the U.S. Congress: "Exposure to lead continues to be a serious public health problem - particularly for the young child and the fetus. The primary target organ for lead toxicity is the brain or central nervous system, especially during early child development. In children and adults, very severe exposure can cause coma, convulsions and even death. Less severe exposure of children can produce delayed cognitive development, reduced IQ scores, and impaired hearing - even at exposure levels once thought to cause no harmful effects. Depending on the amount of lead absorbed, exposure can also cause toxic effects on the kidney, impaired regulation of vitamin D, and diminished synthesis of heme in red blood cells. All of these effects are significant. Toxicity can be persistent, and effects on the central nervous system may be irreversible." ("The Nature and Extent of Lead Poisoning in Children in the U.S.: A Report to Congress," ATSDR, July 1988.)
Furthermore, the ATSDR reported that in recent years, a growing number of investigators have examined the effects of exposure to low levels of lead on young children. The history of research in this field shows a progressive decline in the lowest exposure levels at which adverse health effects can be reliably detected. Thus, despite some progress in reducing the average level of lead exposure in this country, it is increasingly apparent that the scope of the childhood lead poisoning problem has been, and continues to be, much greater than was previously realized. The National Health and Nutrition Examination Survey ("NHANES III") has shown that the remaining issues are in the nation's housing stock, particularly in urban areas and communities of color or low income status.
(d) The most significant sources of environmental lead are deteriorated and disturbed lead-based paint in housing, lead-contaminated dust, water and soil. In San Francisco, approximately 75 percent or 260,000 out of some 330,000, housing units have been painted with leaded paint prior to 1978, the highest percentage of housing units in a county in California, and one of the highest number of housing units in an urban city in the entire country. The Board of Supervisors finds that these types of lead hazards are under the control of building owners and landlords who have ultimate authority over and responsibility for the condition of San Francisco's housing stock. The Board intends to require that owners of residential property built prior to 1978 warn tenants of the potential for lead paint hazards.
(e) Other sources of lead in San Francisco contribute to lead poisoning of children, including lead in drinking water, some food cans, some ceramics and dishware, artists' paints, automotive and marine paints, adult occupations and hobbies, old factory sites and auto wrecking yards, soil and reentrained dust along busy roads and highways, and some traditional medicines. In addition, where lead hazards do not exist they are often created by painting and home remodeling. The Board intends to address this last hazard through requirements for signs warning of lead hazards in home improvement stores where painting and remodeling equipment is sold.
(f) The impact on children from lead poisoning is immediate at high levels of exposure. At chronic low-level exposure, epidemiological studies have shown lifelong impact. The causes of childhood lead poisoning are well understood. This terribly debilitating disease is preventable and can be eliminated with concerted community action.
(g) The CDC has recommended that primary prevention efforts (that is, elimination of lead hazards before children are poisoned) receive more emphasis as the blood lead levels of concern are lowered. The CDC further determined that the goal of all lead poisoning prevention activities should be to reduce children's blood lead levels below 10 µg/dL. If many children in the community have blood lead levels greater than or equal to 10 µg/dL, community-wide interventions (primary prevention activities) should be considered by appropriate agencies. Medical interventions for individual children should begin at blood lead levels of 15 µg/dL. ("Preventing Lead Poisoning in Young Children," CDC, Oct. 1991.)
(h) San Francisco has begun to implement a comprehensive plan for preventing childhood lead poisoning and reducing exposure to lead. Medical case management currently begins when a child has a blood lead level of 15 µg/dL or greater. Environmental investigation of the child's housing unit begins when blood lead levels are 20 µg/dL or greater, or 15 to 19 µg/dL in consecutive tests three to four months apart. These interventions were provided for in the Comprehensive Lead Poisoning Prevention Program added to the San Francisco Health Code in 1992.
(i) The 1992 ordinance did not provide specific authority for the Department of Public Health to order control or elimination of the lead hazards in dwelling units. The Board of Supervisors was aware that protecting the public health from lead poisoning problems involves complex issues, including technological questions, that required discussion and resolution. To that end, in 1992 the Board appointed, in Section 1608 of the 1992 Ordinance, the Lead Hazard Reduction Citizens Advisory Committee. The Committee was mandated to recommend legislation to the Board on the technical and policy issues needing resolution. The Board of Supervisors concurs with the recommendations submitted by the Citizens Advisory Committee, including the recommendation that the Department of Public Health must have authority to order the removal of lead hazards, and that such authority is a necessary component of a program designed to control lead hazards that would adversely affect a child with elevated blood levels. It is the intent of the Board of Supervisors that the Director of Public Health have broad discretionary authority to enforce the mandates of this ordinance by ordering the control or elimination of lead hazards. The provisions of this law shall be liberally construed to implement and effectuate its purposes.
(j) The intent of the Board is that lead hazards be controlled or eliminated in a cost-effective manner. The Board of Supervisors finds that the "Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing" produced by the Department of Housing and Urban Development, provide a useful guide for the Department of Public Health to use in sampling, testing, and approving the control and elimination of lead hazards. The preface to the "Guidelines" notes that the overall framework is designed to "tailor sensible and effective hazard control programs to fit the financial and environmental conditions of specific properties." The Director of Public Health should, to the extent feasible, utilize these Guidelines and other guidance issued by federal and State agencies, to maintain the high standard of public health protection that is scientifically based and cost-effective.
(k) This legislation is directed primarily at those dwelling units where a lead-poisoned child resides, has resided in the recent past, or spends a considerable amount of time. This ordinance is an integral step toward primary prevention of lead poisoning through remediation of the City's overall housing stock, and the Board intends that the Director of Public Health make diligent efforts to see that building owners and landlords and tenants receive prompt, actual notice of any identified lead hazards. The Board intends that those lead hazards that are within the control of owners or managers of buildings should be considered nuisances and subject to elimination or control whenever a lead-poisoned child is present. The Board expects that future legislation will address these issues for all properties, regardless of the age or health of the occupants. The Lead Hazard Reduction Committee's mandate includes future legislative proposals for the Board to consider towards the goal of prevention of childhood lead poisoning.
(l) On May 222, 2000, the California Department of Health Services issued Childhood Lead Poisoning Prevention Branch (CLPPB) Program Letter #00-06 creating new policy which directed local Childhood Lead Poisoning Prevention (CLPP) Case Management Contractors to modify the case definition eligible for case management services, to include children from birth to 21 years of age. Because CLPP contractors are providing services to children in publicly funded programs (such as EPSDT, a Medicaid service), we must make our eligibility criteria consistent with other federal and state agencies that regulate and fund blood lead testing and case management services. EPSDT services are provided to eligible children from birth to 21 years of age.
(m) Based on scientific evidence, such as the age of concern established by the CDC, the Director of Health is focused on reducing lead hazards to children up to 72 months of age in order to prevent lead poisoning in this vulnerable population. However, due to a contractual agreement with the State Department of Health Services for the City and County of San Francisco to provide case management services to lead-poisoned children, the Director's authority to respond to reports of lead poisoning is extended to children up to 21 years of age.
(Added by Ord. 376-92, App. 12/23/92; amended by Ord. 409-96, App. 10/21/96; Ord. 36-03, File No. 021857, App. 3/28/2003)