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    Ben Carson: Lead Goals Should Be ‘Working Toward Zero’

    6-27-2018 1-28-08 PM

    By Matt Smith

    How safe is your home?

    Ben Carson, MD, wants you to check around.

    Carson, a famous pediatric neurosurgeon at Baltimore’s Johns Hopkins University, is now the secretary of Housing and Urban Development. He’s spent much of June on familiar ground, talking up HUD’s “Healthy Homes” program, which highlights ways to reduce hazards like lead paint and mold. While the administration has sought steep cuts for the department, lead removal has gotten more money from the White House and Congress.

    He’s also promoting a network of “EnVision Centers,” a new pilot project aimed at helping people move away from public support — a program with a health component as well. WebMD spoke with Carson this week about what he wants to see come out of this focus.

    WebMD: What do you hope to achieve with the focus on health this month? 
    Carson: There are probably about 30 million homes in the United States that have some sort of indoor environmental hazard, be it lead paint, mold, pests, water leaks or obstacles that create dangerous conditions for elderly people falling, things of that nature. We want to raise awareness that our children are our most precious resource. We are calling this unlocking the potential of America’s children. Check your home, protect your family. It’s really just creating this awareness that things don’t take care of themselves – you have to be an active participant.

    WebMD: Can you give us an example of how your background as a doctor influences your thinking on this issue? 

    Ben Carson

    HUD Secretary Ben Carson, MD

    Carson: As a doctor, particularly working in a city like Baltimore, I spent a lot of time working very, very hard to give children a second chance at life, sometimes operating all night, just to be in a situation where it was time to send them home. And that created a great dilemma, because in many cases those homes were not healthy environments. There was lead and mold and rats and roaches and all kinds of physical dangers. Now there’s an actual opportunity to do something about it. That makes all the difference in the world.

    Then recognizing what the of course the tremendous impact of things like mold are on children — conditions that promote asthma, which is a multi-billion-dollar industry that could be much less if we concentrated more on prevention.

    With lead, everybody knows about the acute problems, but it’s the chronic ones that are devastating in terms of decreasing the intellectual potential, potentially creating seizures and other neurological disorders and greatly diminishing a person’s capacity. Understanding what the implications there are I think helps prepare you for this kind of position.

    WebMD: How do you plan to measure the success of these efforts? Are there specific targets or health outcomes you’ll be looking for as a result?

    Carson: We look at things like blood lead levels and set specific targets. We’re working with the CDC on that, and have actually made some pretty significant progress over the past few years. Also, Cuyahoga County, in Ohio, and King County, in Seattle, did longitudinal studies where we looked at areas that had significant concentration on mold remediation, and what the impact of that was school attendance various other parameters associated with asthma attacks. There was substantial improvement.

    We will continue to monitor those kind of things — blood levels, monitor the number of people reporting to emergency facilities for things like asthma, looking at the number of elderly people who fall. Most people don’t realize that in our country, we spent about $ 66 billion a year for treatments for elderly people who fall. It’s a huge problem, and making sure that they have appropriate kinds of rails in place for showering and for climbing and descending stairs — those kind of things make a huge difference.

    WebMD: The CDC says no level of lead is safe, and a CDC advisory panel has recommended reducing the blood lead level that is considered elevated by 30 percent, from 5 to 3.5 micrograms per deciliter. What would that mean for your efforts at HUD? Do you support that, and would you support reducing it to zero? 

    Carson: I would like to see everybody have a zero level, no question about that – but we obviously have to look at the science. We have to look at the data … We want to get to a much lower level, and working with the CDC, we’re suggesting over the next year, we could go from 1.6 to 1.5 [micrograms/dL] in the general population.

    I agree there’s no acceptable level, and we should be working toward zero. But we’re also realistic enough to know that we have a large number of dwellings, pre-1978, with deteriorating lead paint. You have other environmental sources of lead that we sometimes don’t talk about like soil, water, toys, candy that comes from overseas — all of these things are problematic and those are the kind of things we look for when we go in based on somebody having an elevated blood level.

    I would support reducing it to as low as we could possibly get. And if that’s zero, absolutely.

    WebMD: There have been a couple of recent reports critical of how HUD has followed up on lead hazards. How do you plan to improve things now that you’re in charge?

     Carson: This is an area that’s been one of great concern to me since I’ve been here. We’ve been particularly putting a lot of emphasis on educational material, disseminating it to tenants, to public housing authorities, to municipalities, to everyone who is involved. When there is a report of a child under 6 with elevated blood-lead levels, I’m making sure we respond in a timely fashion – within 15 days – and remediation within 30 days of that time.

    Within the last couple of weeks, we had an unprecedented settlement with the New York City Housing Authority, primarily instigated by the fact that they were giving inappropriate reports about lead remediation – false reports, quite frankly. Now the city has committed to $ 1.2 billion, the state to almost $ 600 million, in addition to an annual grant of about $ 1 billion that comes from HUD. And putting in a monitor who can help the assessments, along with the REAC [Real Estate Assessment Center, a branch of HUD] inspectors, with increased attention to the reporting that is done.

    That’s something that really is being done around the country – concentrating on the reports to see whether they’re consistent, working with local health facilities with data-sharing, because in many cases, they actually have information about children with elevated blood-lead levels, which they’re not sharing. Under HIPAA and federal regulations, they are allowed to share that info with HUD and with EPA and with other government agencies so we can target the response more effectively.

    WebMD: Lead gets most of the attention, but Healthy Homes covers a lot of other hazards, like mold or carbon monoxide. Which of those do you think could benefit the most from added attention? 

    Carson: They’re all very important, but I think the mold and the pest issues. Those are the things that stimulate the development of asthma. Asthma costs us as a society a tremendous amount not to mention fatal asthma attacks and severe injuries to individuals themselves. I’m happy that we’re developing web pages that have a lot of frequently asked questions and direct people to resources. I’m happy that the EnVision Center initiative will incorporate a health component …

    By having that health component right there in the neighborhood, we can disseminate very important information, particularly in terms of preventive care. That’s where the real bang for the buck is when it comes to mold and lead and radon and all of those things.

    WebMD: You’re touting the EnVision centers as a new way of reaching out to the public, but it’s a small program now. How do you plan to gauge its results and on what time frame? 

    Carson: We are putting together a beautiful dashboard that follows lots of different parameters as far as education, people getting GEDs, jobs and reducing lead exposure. But the real key for EnVision centers is giving people the tools that are necessary to become self-sufficient, and a lot of that has to do with your health. One of the examples I would give you is the HUD-VASH program, which has reduced homelessness among veterans by 47% recently [since 2010]. Why does that work? Because HUD provides housing, and the VA provides wrap-around services. Without the wrap-around services, it doesn’t work. It’s just like opioid addiction, which leads a lot of people to homelessness. Simply giving people a home doesn’t solve the problem. You have to also address the reasons for the addiction and provide the mechanism for them to obtain the cure.

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