CLEVELAND, Ohio -- In the past five years, lead poisoning has set at least 10,000 Cleveland area children on a potential path to failure before they've even finished kindergarten.
It's a path that experts say helps to perpetuate two of Cleveland's most pressing and bedeviling problems: poor school performance and violence.
The problem isn't a new one. We've known about it for decades.
What we've failed to do is fix it. We've opted to save thousands of dollars now, and thereby committed to future costs that are likely in the billions.
We poison our children, and it's entirely preventable.
That point was made sharply on Aug. 3, 1990 by U.S. Rep. Louis Stokes as he stood on the floor of the House of Representatives, talking about the president's sick dog.
Millie the English springer spaniel had made headlines when she was diagnosed with lead poisoning, a casualty of renovations at the executive mansion that released flakes of toxin-laced paint.
The dog's ordeal was a "terrible thing," George H.W. Bush announced in the midst of a press briefing on the nation's defense systems.
President George H.W. Bush, his wife Barbara and English springer spaniel Millie after she recovered from the effects of lead poisoning.
Stokes was thinking about some less high-profile lead poisoning victims: more than 3 million American children, most of them poor and living in aging urban homes.
"It is appalling that the dangers of lead poisoning has to be brought to the nation's attention through the White House dog," Stokes told his colleagues that day.
Yet more than 25 years after Stokes' impassioned speech, Greater Cleveland's elected leaders, remain unable -- or unwilling - to act decisively on behalf of the city's children.
So what's stopping them?
The Plain Dealer spent months digging into the history of lead poisoning in our area, analyzed data to better measure the scope of the problem here, and questioned local political and public health leaders about the logic behind their strategies. Or the lack of them.
We also talked to cities that refused to accept more generations of lead poisoned children and instead began to clean up unhealthy homes.
"[I]t takes commitment, the resources and a coordinated effort to eliminate this devastating disease," Stokes said in 1990.
But our region's response has remained stubbornly reactionary rather than preventive, piecemeal rather than comprehensive, and almost wholly dependent on federal dollars.
Worse, Cleveland has, on several occasions, failed to use the funds it's been granted, severely limiting its ability to help even the most imperiled children.
City officials also fail to enforce the laws and rules put in place to hold property owners accountable for lead hazards, ones meant to protect babies or toddlers from being poisoned in their homes.
Other cities and states have stepped up, recognizing that cleaning up lead in homes would save millions in health, education and criminal justice costs down the line. Their smart, low-cost preventive solutions have left little excuse for inaction.
Lack of leadership
In Cleveland, doctors and public health officials have been working on lead poisoning in some form, whether haphazard or routine, since County Coroner Samuel Gerber first noticed dozens of children convulsing and dying of lead exposure in the 1950s.
In 1992, two years after Stokes' speech, federal lawmakers approved the Lead-Based Paint Hazard Reduction Act with the ambitious goal to implement "a broad program to evaluate and reduce lead-based paint hazards in the Nation's housing stock."
Since 1993, $2.3 billion in federal dollars have been spent to deal with lead hazards, mostly after children have become sick.
Cleveland and Cuyahoga County have spent $57 million of that -- $50 million of which has been used to slowly reduce lead hazards in homes after a child has received a positive lead test. Working on a few hundred homes per grant, the two entities have cleaned up roughly 4,300 homes since 1993. That's out of more than 187,000 the county estimates are hazards due to the year they were built and the likely presence of lead-based paint.
These efforts, combined with the work of environmental activists, health officials and housing advocates, have reduced by half the number of children who, when screened, have high lead levels.
"I would say that is pretty impressive impact," Cuyahoga County Board of Health Commissioner Terry Allan said in September. "We certainly have more work to do."
More work, indeed.
Roughly two-thirds of children at risk for poisoning are not being screened for the toxin, and in some parts of Cleveland and East Cleveland as many as a third to half are predicted to be poisoned, based on an analysis the Kirwan Institute for Race and Ethnicity at Ohio State completed for The Plain Dealer using Ohio Department of Health data.
The area's low screening rate, while a common problem across the country, is not inevitable.
Other cities have made changes and done better.
Since the county and city only inspect the homes of children who are already poisoned, they doom other children to new exposure every year.
"Over the last 15 years we've had 40,000 kids who have been poisoned in Cuyahoga County," said John Sobolewski, who supervises the county's lead poisoning program. "That's a lot of kids."
About 80 percent of the children who are poisoned each year within the county live in the city of Cleveland.
Mayor Frank Jackson, who has recently held news conferences decrying neighborhood gun violence, responded through a spokesman, via email, after repeated queries about his plans to combat lead poisoning.
The statement read:
"The City of Cleveland is committed to reducing high levels of lead contamination in homes and working towards eliminating lead poisoning in children. With assistance from agencies like Cuyahoga County and the U.S. Department of Housing and Urban Development, we will continue to identify resources to address this quality of life issue."
Cleveland has had a hard time, on more than one occasion, holding onto the federal resources Jackson's statement references, though.
In 2012, HUD stripped the health department of its federal grant because it wasn't fixing houses quickly enough. The federal agency later agreed to let the city keep a million dollars remaining on the grant if moved the money to a different department -- community development.
After that the city was denied a grant, and for nearly three years could help families only if their children had extremely high levels of lead in their blood--levels high enough to hospitalize them.
Cleveland relied on the county's lead program to assist those families in making their homes lead safe. Others received a packet of educational materials in the mail.
The city lost its funding, or nearly did, at least twice before that, too.
It recently heralded receiving its latest $3.7 million HUD grant for lead cleanup.
Cleveland Assistant Director of Community Development Michael Cosgrove, far left, accepts a check from HUD for lead hazard remediation along with other city and non-profit leaders last month.
Jonathon Brandt, who headed up the city's lead program until 2012, said recently that Cleveland is capable of taking care of the problem but lacks the leadership.
"It's just not a priority," he said. "We put more money into baiting for mosquitoes to curb West Nile virus and to prevent rabies in raccoons than we put into lead poisoning the entire time I worked in the city."
The high cost of the status quo
Researcher Dr. Bruce Lanphear often fumes about the lack of action when it comes to childhood lead poisoning nationwide. For decades, he's witnessed and studied the devastating impacts of the toxin on IQ and health.
Lanphear, a professor at Simon Fraser University in Vancouver, said the problem is the same now as it was then. Lead still isn't a priority. Unlike childhood diseases that have vaccines, he said, no one has figured out how to profit from preventing lead exposure.
"If someone could make a buck, or a lot of money to protect children from lead poisoning it would be done," he said.
Part of the problem may be that lead's effects are invisible. After children are exposed, the effects often don't show up until years later, when they struggle with reading, or problems crop up in behavior or health.
Others are less forgiving in identifying the reasons for a lack of action.
"The reason we don't respond is because of who is being poisoned," said Robert Cole, an attorney with Advocates for Basic Legal Equality Inc., a non-profit working to address lead poisoning in Toledo. "If this was a different group of children we wouldn't tolerate this as a society, community or a city."
Lead poisoning disproportionately affects poor black and Hispanic families who live in older, deteriorating homes closer to the city's core.
"They put the problems of society on things, like no fathers and other things but it is more than that -- it is lead," said Darrick Wade, who filed a lawsuit against the Cuyahoga Metropolitan Housing Authority in 1992 when his son Demetrius and other children who lived at Lakeview Terrace were lead poisoned.
Demetrius Wade died in 2007 at age 24.
Demetrius Wade's headstone was decorated by his mother, Deborah, at Cleveland Memorial Gardens. Lead poisoning caused chronic health problems for him.
Though it's impossible to directly link Demetrius's death to his lead exposure, he suffered from a number of diseases that have been linked to the toxin, including chronic kidney disease and heart disease.
"For him to die so young is just a shame," said Darrick Wade. "For nobody to care it is still happening is even worse."
Darrick Wade kneels by the grave site of his son, Demetrius. Wade feels leaders have ignored the impact of lead on the health and lives of poor children.
What Cleveland doesn't do
Cleveland mayors have called childhood lead poisoning a priority for decades, though none has enacted the local reforms the federal government has long said are needed.
In the early 1990s, Mayor Mike White stepped up the rhetoric after health department screening revealed that 86 percent of young children in the Glenville neighborhood and nearly 77 percent in the Kinsman neighborhood were poisoned by the toxin.
"Lead erodes the school performance of our children, it undermines housing values, it saps the vitality of our future workforce and ultimately threatens economic potential, which is central to our survival as a major metropolis," White said.
Mayor Mike White in the 1990s said lead poisoning threatened economic potential "central to our survival as a major metropolis."
White's public health department convened a meeting with more than 50 health experts to brainstorm ways to tackle lead poisoning. The group launched projects and set goals.
Very little changed.
Former Cleveland Mayor Jane Campbell had ambitious goals for reducing lead poisoning when she took office in 2002, expressing a desire to "become a national model" in handling the issue.
Despite her administration's optimism and best efforts the city didn't have enough money to tackle the problem systemically, she said.
"When I was there the city didn't have enough resources to pay the police and fire," Campbell said in a recent interview. That chronic lack of funding is compounded by a building and housing department that's historically been "very stressed," she said.
Those most familiar with the lead poisoning problem locally, including health officials, doctors and housing advocates say progress can only be made with the help and cooperation of this stressed department and one other--public health.
But if the city's public health and housing departments were stressed when Campbell was in office, they're in crisis now.
The public health department has lost almost 60 percent of its staff since 2005, according to city budget records.
Building and Housing has lost nearly a third of its code enforcement staff, which includes the inspectors whose job it is to routinely examine Cleveland homes for code violations, such as peeling paint.
Other cities making headway in prevention have used their code enforcers to help spot and cite peeling paint, vastly augmenting the efforts of lead inspectors. They also share information with residents, including databases to track rental properties and registries that show which properties are safe for children.
Cleveland doesn't do this and officials wouldn't say why.
Cleveland City Council President Kevin Kelley expressed little confidence that the city's Building & Housing department could do the same in Cleveland, calling the department "very challenging" to work with.
"We are fighting to go out and see whether properties are minimally compliant yet from the street view," he said in a recent interview with The Plain Dealer. "We're not to the point where the basics are being done yet."
"Building and housing used to have 100 inspectors," said Dr. Dorr Dearborn, professor emeritus at Case Western Reserve University and a lead poisoning expert who has been advocating for children in the area for decades. "We've been asking for years for them to be pulled into this and be trained to do this work, and no one above has ever responded."
Interim Building & Housing Department Director Ronald O'Leary did not respond to requests for comment.
What Cleveland could do
Ten years ago, Rochester, New York, like Cleveland, had among the worst lead poisoning rates in the country.
Today, about five percent of children there screened have lead in their blood at a level that the CDC says should trigger action roughly an 80 percent drop in the number of children poisoned. (To compare, Cleveland's was about 14 percent last year.)
Former city councilman Wade Norwood said it was a "tidal wave of facts" that led to the passage of that city's lead ordinance in 2005.
"There was a moral, scientific and community imperative that the ordinance pass," said Norwood, who helped write the legislation.
It took time to make the changes. It also took investment, though not nearly as much as some expected, Norwood said.
It wasn't simple, and Rochester's system isn't perfect. City code inspectors use shorter assessments that sometimes miss hazards and focus exclusively on rentals.
Periodic training has been necessary to keep the program on target, as has close communication with existing city and county lead assessment experts to hone the laws.
Rochester's program is just one example of a city creating and enforcing laws and building codes as a prevention strategy. In 2008, The District of Columbia stepped up inspections and enforcement while also requiring all children entering daycares or schools to be screened for the toxin.
Now, more than 50 to 60 percent of children are screened by age 2.
In Cleveland, a sustainable plan to proactively address lead poisoning--any coherent plan, for that matter--seems a long way off.
There are advocates for prevention in Cleveland, but their efforts have been hampered by lack of funding and leadership.
A tiny pilot program that showed promise in preventing lead poisoning in the homes of expectant mothers fizzled out when a grant ended.
Another small pilot in a neighborhood near MetroHealth Medical Center will use home inspections in hopes of preventing lead exposure and asthma in children, but is also subject to grant funding and city buy-in.
"I'm trying to get people to see that the housing is causing the illness, not to chase sick kids around," said Kim Foreman of Environmental Health Watch, who is heading the BUILD Health project.
Foreman has been working on lead poisoning in Cleveland for more than a decade. Her non-profit works closely with the county and city health departments, and she's careful in expressing her frustration."If we change the system to a prevention model, my belief is that the housing stock would get better," she said.
After months of public records requests, delayed meetings with city officials and repeated requests for information, a spokesman abruptly presented The Plain Dealer with an emailed city response to its lead problem.
The document, titled "City of Cleveland Lead Prevention Strategies Department Matrix," was familiar.
Inside was a list of 10 strategies for preventing lead poisoning, outlined by the Department of Housing and Urban Development in 2002.
The Plain Dealer had emailed the list to a city official days earlier. Cleveland's "matrix" was dated Sept. 25, 2015.
At the end, it read, "Our departments are committed to eliminating lead poisoning and building a healthy Cleveland."
Updated 4:43 p.m. An earlier version of this story incorrectly stated the severity of lead poisoning cases the city of Cleveland was able to respond to during a period when it had limited funding
.
The city responded to all hospital cases.