March 7, 2019 — The traditional public health mantra is that there is no safe level of lead for kids. But a new report from the Harvard Prevention Research Center on Nutrition and Physical Activity finds that many kids in the U.S. could be exposed to lead through the water they drink at school.

The team from the Harvard Prevention Research Center analyzed data from 24 states that have lead testing programs in schools, plus Washington, D.C. Only 12 of the states had useable results. Among those, 12% of all water samples tested had higher-than-recommended lead levels, and 44% of schools tested had one or more samples with higher-than-recommended levels. In this week’s episode we’re talking about the report and its findings with Angie Cradock, who is the deputy director of the Prevention Research Center.

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Lead Testing of School Drinking Water Would Benefit from Improved Federal Guidance (U.S. Government Accountability Office)

3Ts for Reducing Lead in Drinking Water Toolkit (U.S. Environmental Protection Agency)

Lead and Copper Rule Revisions (U.S. Environmental Protection Agency)

Full Transcript

NOAH LEAVITT: I think most of our listeners probably broadly know that lead is harmful. But can you explain why we should be so concerned about lead in school drinking water? What are some of the potential health effects that we need to be concerned about there?

ANGIE CRADOCK: Well, I would say that federal officials suggest that there is no safe level of lead. And water is just one way that lead can get into the bodies of children. And it has lots of detrimental impacts on health and cognition, as well.

NOAH LEAVITT: And so I know on the flip side of that and looking at access to drinking water in schools, water, I think, is so crucial to health. We all know that. But particularly for kids, particularly for young kids, why is access to water such a particular big area of concern?

ANGIE CRADOCK: Well, I think kids spend a lot of time, most of their day, in school settings, especially kids of school age or of preschool age. And it’s important for them to have safe water to drink. And the water needs to be at a level that is important for health and helps them avoid consumption of other drinks that might not be as supportive of healthful outcomes.

NOAH LEAVITT: And I think we’ll probably talk a little bit more about that later on. And when it comes to lead in drinking water supplies, especially at schools, where is most of that lead coming from? Is it just from old pipes? Are there other factors at play?

ANGIE CRADOCK: Lead can enter the drinking water supply in many ways. It can come from the source, the community water system. It can also come from the pipes or other fixtures that are inside or outside of schools.

NOAH LEAVITT: This recent project that you completed, you were looking at state efforts to test drinking water for lead. So with this project, what states did you study, and, I guess, what were you particularly examining with regard to those states and those lead testing programs?

ANGIE CRADOCK: Sure. Well, we talked a little bit about the fact that kids spend most of their time in school. But there are no federal policies that require schools to test drinking water for lead. There are guidelines that the EPA has put together for schools that voluntarily choose to test the drinking water sources in the school for lead. It’s called the three Ts, testing, training, and telling. So it gives guidance.

And actually, there’s just new guidance that came out from the EPA that, I think it was in October of 2018. So brand new guidance with lots of different resources for schools that are interested in implementing those testing programs. But only schools that are considered what they call their community water system or their own water supplier are required to test drinking water for lead. So it’s kind of up to the states to initiate policies and programs that can help support the activities of individual schools to do that testing.

So we were interested in looking at how states are approaching programs or policies or implementing those programs and policies at the local level, so within schools, to test drinking water for lead, so that we could kind of understand where things were and the lay of the land, and help inform future actions to implement those programs and policies. As we talked about, not many states have these types of initiatives that are really working to protect kids from lead in school drinking water. So we wanted to identify strategies that might be useful to inform future efforts in that.
So we contacted states. Well, first we did a literature search to try to identify what state programs and policies were out there, using some academic databases and other resources that we had at our disposal. And then we contacted each state health agency, usually the Department of Environment would be another likely agency that would oversee such a program, or the Department of Education to identify other states that might not have formal legislative policies but might have programs that they were working on.
And then once we identified those– there are 24 states and the District of Columbia as of the end of our study, so February, 2018, so about one year ago– who had initiated a program or a policy to test school drinking water for lead, and they definitely had some variation in how they decided or guided schools in implementing the lead testing program. A wide variety and a variety of different things, I guess, what schools were asked to participate. So whether it was a voluntary program or a mandatory program. That was one key thing. How they collected the drinking water samples themselves. How they stored the data, the activities that they use to communicate the results of what they found. A wide variety of different things that impacted the information that came from that program.

NOAH LEAVITT: And what did you find with regards to, from those testing programs, the schools that actually did have positive test results for lead in their drinking water supplies?

ANGIE CRADOCK: So as I mentioned, schools used a variety of mechanisms for collecting the information on the lead content of drinking water, of storing those data, as well, and of pulling them together in different databases. So of the 24 states and the District of Columbia, there were 12 states that stored data in a central location that would identify the school name and source of the test results. And in 8 of those states, they actually reported also the concentrations, so the lead concentration level that was found in the test that was done.

One thing I guess I should maybe back up and say, that one of the other key areas that states varied in the implementation of their program was the lead concentration that they defined as an action level. So that’s the concentration of lead in the sample of water that’s taken from the tap that triggers an action. So whatever that action was defined as was specific to the state. But it could be shutting off the tap or doing some short-term remediation efforts that could lower the concentration of lead in the drinking water for students.

So some places used, say, 5 parts per billion, which is what is used for bottled drinking water here in the United States. And others used other levels, like 15 parts per billion or 20 parts per billion. It really depended on the state. So we were able to look at the exceedance, I guess, of those action levels that were defined by the state, and in 12 states.

NOAH LEAVITT: So it’s interesting. Because I mean, an elevated lead level is concerning its own right. But what it seems like it’s almost more concerning is that there is no kind of agreement on measurement. It seems like you can’t even accurately measure what the problem might be.

ANGIE CRADOCK: That is true. There is no current health based standard for lead in drinking water. So the FDA has a standard for bottled water. But there is no health based standard for lead in drinking water. Although the EPA is working on deriving one and is doing research on that, and hopefully that information will be available soon. I have heard that it’s supposed to be sometime this spring.

NOAH LEAVITT: And so when it comes to– because you just talked about how there’s all this variability between states– when it comes to, I guess kind of the whole picture of the system is in place, retaining data, are there states that are performing particularly well that you think could be models for other states to learn from and hopefully create some sort of standardization?

ANGIE CRADOCK: Well, I will say that states were doing things very differently. And we didn’t look, in this study, we were just characterizing what they were doing. We did not look to see the outcomes or the impact of those state programs in the lead content level that was in the water over time. So there’s no evaluation component of the success or lack of success of different programs. So I can’t really speak to that.

But I think it is interesting to learn from what states are doing, because the context of states is very different. Even the agency that was kind of in charge of overseeing and implementing the program was different across the states. And you know, that really can make a difference within the state government context, as well. So it kind of gives states somewhat of a level of flexibility or learning from other programs about how they’re doing things in a way that might work for them.

NOAH LEAVITT: Is one of the goals, from your perspective, would be to create kind of a broad federal testing standard for schools? And how realistic is that to actually implement?

ANGIE CRADOCK: Well, I think the goal of our work was to identify what states were doing to inform future state action. I think that with the revised three Ts, that guidance that’s given to individual schools to conduct their testing was expanded and the resources and technical guidance that were given to them was also expanded with that. At the same time, the EPA, which I think is a great thing to know, is that the EPA also initiated a grant program that would support states in conducting that testing. Because not all states were able to provide funding for collecting the water and the labs for conducting the testing and for training the school personnel or other people that needed to go about doing those activities, or to figure out funding, in the case that exceedance, like elevated levels of lead were found in the water, to pay for any remediation or things that would need to be done to remove the lead from the drinking water in schools.

NOAH LEAVITT: Yeah. And I actually wanted to ask that about some of the barriers you meet. Is funding really the biggest barrier here, or are there other kind of barriers at the state level to improving these testing programs?

ANGIE CRADOCK: Unless a state has a policy or a program that gives guidance and helps to organize a program, it’s completely voluntary that schools would conduct any testing. And there was also a recent GAO report that might be of interest to listeners that was done looking nationally at some of those barriers and some of the costs that schools reported and school districts reported that they incurred in doing that testing, as well.
Schools are strapped for money. Their primary goal is to educate students. And they don’t often have set aside resources for doing things that might be optional for them, such as testing school drinking water. So it’s nice to have the overarching policy that gives them the guidance, helps them with resources, and makes that just an easier process.

NOAH LEAVITT: I’m guessing at the school level, they recognize that lead is something that everyone should be concerned about. I mean, that’s not an issue. It’s not that schools are saying this isn’t an issue. It’s more, this an issue but we have all of these other priorities and we only have limited resources. Is that kind of what’s going on there? That it’s not a lack of recognition of the problem of lead in water, it’s more just the ability to actually address the problem.

ANGIE CRADOCK: I would say it might differ by place. Because I think there are some districts and some states that are really tackling this issue. And they have a set program, they have technical assistance in place, they have funding. They are really set up and structured to, I guess, help schools along with this issue. And then there are other states where it might be a little bit less consistent, or I guess there are many states that it’s very much less consistent. And in those states, we don’t really know what’s happening or what the lay of the land is at the school level.

NOAH LEAVITT: So we were talking before the interview about some of your other related work on just generally promoting, for example, water consumption instead of sugar sweetened beverage consumption. So how does this work you’re doing on the safety of school drinking water kind of fit into that broader public health goal of getting students to choose to go to the bubbler in the school instead of getting a soda from the vending machine? So how does all of that, how does this work fit into that larger public health goal?

ANGIE CRADOCK: Well, sugary drinks are the largest source of sugar in our American diet. And this is true for kids, as well. So one of the goals for us to make sure that kids grow up at a healthy weight is to limit sugar consumption, especially that through sugary drink consumption. And the obvious alternative to that is to promote water as a healthy hydration source. And so in order to do that, we want to make sure that water is safe to drink and that it’s appealing and available to students, and children in other settings as well. And then we also want to promote consumption and intake among kids.

So we have done several studies in school settings, in out-of-school time settings, and other places to think about interventions or activities that we can do to support that. So that kind of dual goal of reducing sugary drink consumption and using water as the first for thirst for hydration for kids.
And so over time, I guess we’ve looked at the impact of policy initiatives at the district level, say, in Boston, to limit the sale of sugary drinks in schools, which was I think implemented in 2004 and 2005. So prior to the Healthy Hunger for Kids Act that also– and the smart snacks rules that were federal– Boston initiated some, I think, quite innovative policies to help promote healthier hydration. So limiting access to sugary drinks in school settings. And we looked at the impact of that. And it was successful in reducing sugary drink consumption among– we measured it among high school students over time.

So obviously, when they’re not drinking sugary drinks, what are they drinking? So we’ve also done studies that looked at access to water in cafeteria settings and other school areas across the state of Massachusetts. And we’ve also looked at initiatives that can promote water when it’s available. So when there’s water in the cafeteria or in other settings, what can we do to promote that? And researchers, such as Erica Kenney and others on the team, have published studies looking at grab a cup, fill it up. So how you can provide cups and promotion around water sources and it will increase consumption of water and actually, at the same time, limit the amount of sugary drinks that kids are bringing in to consume during meal times, as well.

NOAH LEAVITT: I imagine at the end of the day, you’re promoting, you should drink, you should choose water. But you also, then you have to ensure that the water they’re drinking is isn’t another source of health harm.

ANGIE CRADOCK: Right, yeah, and safe for them. Another study that we’ve done that has been conducted in out-of-school time programs, which often operate in school buildings during the hours before or after school. And as one of the strategies that we are focusing on, again, was this kind of switching away from sugary beverages to ensuring that water is provided as an option for snacks and the after school time.

And in that intervention we had to be pretty flexible because not all schools had plumbed drinking water sources that were safe in the schools that we are working in. They had been turned off because they had been found to exceed the action level of lead. So they were using other sources, such as bottled water drinking sources and other ways of accessing drinking water.

So sometimes we have to be flexible that I think those initiatives that the states are undertaking to test drinking water for lead, and then also to provide funding to schools to be able to remediate and address those exceedances and ensure that the water is safe and available to kids, in during the school day and in the times after school as well. These are all really important activities. And I hope that our work here looking at the state programs will encourage other states to take this on. Because it is a big issue. It’s an issue for kids in school, in programs after school, in the use of schools as community settings in the hours outside of the regular school day, as well, for everyone, and for staff, too.

NOAH LEAVITT: Yeah. Well, as you’re talking, that idea of the school beyond school hours, I mean, especially in a low income area, students might be in school early for breakfast. So is that also a factor here, that there’s potentially this double hit for– you might be a school in a lower income area, so you have less funding, less resources for lead testing? At the same time, those are the students who might actually be spending the most time in the school buildings. Is that a concern at all? Kind of disparities in terms of potential– or disparities in testing programs?
ANGIE CRADOCK: So we’re looking into that with some of our data. I don’t have specific findings to discuss. But I think there are big differences in the amount of time that some students spend in the school building and the amount of meals and other nutritional sources that they consume while they’re there. So that’s definitely, I think that’s a valid question and issue to address. And we hope to look into that a little bit more.

NOAH LEAVITT: If there are parents listening to this who are kind of wondering about their own schools, aside from reading the report, which we’ll have a link to, which is really, really detailed and definitely worth reading. But are there any other things that you would recommend that parents do? I mean, should they talk to school administrators? If parents are concerned about this, is there anything they could do to get involved?

ANGIE CRADOCK: I think the first thing would be to talk to your principal. It may be that your school has conducted water quality testing and maybe just the information hasn’t gotten out there to everyone or hasn’t been presented in a way that reaches all parents, for example. So that would be the first question.

Another source of helping to address both water access and water quality within schools is through participation in school wellness councils. So parents can choose to join– most schools, I hope all schools, have what they call a school wellness council, which is a body that sometimes is comprised of people within the administration of the school, parents and other folks that might be interested in supporting the health of students. And that’s another way that parents can get involved.
Often, all districts are required to have what’s called a district wellness policy. Parents can encourage school districts, as part of that work within the school wellness council, to institute policies that address school water quality and water access. Those are all easy– not necessarily always easy ways, but they are ways that parents can get involved and become more informed about that.

NOAH LEAVITT: You’ve said that this study was really kind of about reporting on what states are currently doing, almost like a state of the states in this regard. So what would be some of the next steps? What are you looking at next from a research perspective? What are your next projects on the horizon to take this work a step further?

ANGIE CRADOCK: You talked about a couple of them already. So one, since we did the report, three additional states have initiated programs. And we’re really excited about that. But it also means that the field and the work that’s happening at the local level is changing all the time. So it’s somewhat of a moving target. So we’re hoping to continue to do this work to understand what states are doing and what they’re finding, and then use that information to identify, as you were talking about, maybe some best practices or ideas about how water quality might vary by the demographic characteristics of schools or locales and how that might inform future testing initiatives.