'It May Be Too Late': How Oakland Addresses Lead Contamination Puts Children at Risk, Medical Experts Say

L

ead has been a part of 41-year-old Silvia Guzman’s life since she was a child. She immigrated with her parents and two siblings to San Francisco in 1991. Though the details are fuzzy for her, she said she remembers her mother enrolling her and her siblings in school and telling administrators that her younger brother tested positive for lead when they lived in Mexico. Their response scarred her.

“What I recall from that experience is that feeling of everybody shaming us, my parents, the family,” she said. They told her parents, “‘You’re not doing a good job, you brought children in sick. They need to go to treatment. You need to be responsible.’ … When I look back in time, I really don’t think any of us needed to go through that.”

The administrators’ reactions, she added, shaped her perception that lead exposure had to do with the fact that she was an immigrant from Mexico — not knowing, yet, that lead is pervasive throughout the Bay Area, and in particular Oakland, where Guzman later relocated and started her own family.

“The notion has always been for me internally that people who migrate bring it with us,” she said. “Being of Mexican descent, all my candy was just poisonous … my culture was poisonous.”

Now, Guzman works to dispel that myth as a promotora for La Clinica’s Healthy Housing Champion’s project, an initiative by the health center to inform Oakland’s Spanish-speaking population about the threat of lead in much of the city’s older housing stock, encourage childhood testing and connect them to treatment. According to a city report, all of Oakland’s predominately Latino census tracts are in the top percentile of lead risk in the state of California.

But despite the data, and evidence that no amount of lead is safe to have in the body, Alameda County-run lead abatement efforts typically begin only after a child has tested positive for exposure to the dangerous toxin. Abatement measures — treating the child and the home for lead — mostly range from virtual consultations to home visits to test for the source of the lead contamination and take steps to remove it from the home.

Because a medical test usually triggers the process of abatement, doctors and nurses have become the de facto frontline for abatement efforts throughout Alameda County. Children first test positive for lead, then the source of their contamination is investigated — a system that relies on kids being poisoned before action takes place. Many in the local health care industry have said they resent being placed in this position and have called for change.

It’s a flawed system, according to some lead researchers, and culture plays a complicated role in how treatment does and doesn’t work. Parents, like Guzman’s mother, face shame and stigma for having sick kids. Moreover, because many of Oakland’s children testing positive for lead come from Latino households with mixed-status family members, Alameda County nurses dedicated to lead treatment say they sometimes struggle to convince parents to utilize their services.

“I think it reflects racial segregation and disadvantage and great income inequality … within California,” said Jessica Wolpaw Reyes, a professor of economics at Amherst College whose research focuses on economic disparities and public and environmental health. “For white kids, California would rank really good on things they do for kids, right? But for Black and Latino kids, no.”

Triggering the system

California children with Medi-Cal coverage, the state’s program for people with low income, are required to be tested for lead at one and two years of age. But according to Oakland’s 2021 Racial Equity Impact Analysis, across Alameda County, the percentage of children enrolled in Medi-Cal who missed their mandatory testing ranged between 37% to 81% per census tract.

According to the most recent data from the California Department of Public Health (PDF), more than 14,000 children under the age of six tested positive for low amounts of lead in their blood in 2022. An additional 458 children under six tested positive for amounts of lead higher than 3.5 micrograms per deciliter, a measurement that requires a response from the county.

“Families, I can only imagine, are just feeling like, ‘What do I do? I don’t know what I’m supposed to do. I didn’t even know it’s a thing. What do I do now?’” said Marilen Biding, a public health nurse with Alameda County Healthy Homes Department, the office that oversees lead abatement efforts and treatment. “That’s exactly where we come in. We’re on their team and we’re here to support them as much as possible.”

But the amount of resources a family receives will vary depending on the severity of the child’s blood lead levels. In cases of blood lead levels above 14.5%, the family “gets the full nine,” Biding says. That involves regular check-ins with a public health nurse like herself, meetings and advice by video calls and in person, a nutrition plan, lab testing of the home to determine the source of the contamination and further blood lead level testing over time to check that the level of contamination is going down.

“We don’t have the bandwidth to be able to give all of the cases the same type of service,” Biding said. “We would love to, right, but it’s just not possible frankly.”

Cases of children who test lower than 14.5 will be referred to a Community Health Outreach Worker within the department. As of September 2024, the Healthy Homes Department was responding to about 1,200 active cases that fell between 3.5 and 9.4 micrograms per deciliter. Those cases will receive support from an outreach worker for a year who can advise parents about the steps they should take to treat their children and provide referrals for additional testing if necessary. Children whose blood lead levels fall between 9.5 and 14.4 receive additional at-home support.

While public health responses might vary per jurisdiction, across the nation most systems are “reactive” to lead poisoning, rather than actively working on prevention, Wolpaw Reyes said. “A kind of reactive, medically centered [process] that burdens pediatricians, I would say is kind of common,” she said.

Oakland, now, is considering whether the city should adopt a new model that prioritizes proactive inspections of rental units to test for lead and other hazards without involving tenants or relying on blood lead level tests — a model supported by many of the city’s pediatricians.

‘It may be too late to effectively intervene.’

While resources for those children with the highest levels of lead in their system exist at the county level, there has long been a debate between city and county officials about how to do better for all children with lead exposure.

A legal settlement against paint manufacturers that were allegedly selling lead-based paint resulted in the city of Oakland and Alameda County receiving $24 million to address lead hazards. In December 2021, after two years of negotiation, county and city officials agreed that Oakland would receive $4.8 million of the settlement dollars immediately. An El Tímpano investigation found that as of August 2024, that money had not been spent. An additional $9.6 million of the settlement fund will go toward the benefit of Oakland residents at a later date, after a plan for how to spend the money is negotiated between the two jurisdictions.

Pediatricians and community health care centers in Alameda County have tried to put pressure on Oakland city officials to move faster on plans to utilize the money already in their accounts. In September 2024, 60 pediatricians in Oakland signed a letter addressed to then-Mayor Sheng Thao urging the city to design a Proactive Rental Inspection Program, which would aim to ease the onus on health care providers and renters to address lead hazards that harm children.

A PRIP, the doctors argue, would create a code compliance model that, in theory, would keep children from being exposed to lead hazards in the first place by requiring regular inspections of rental units. At the moment, a landlord isn’t required to test a home for lead unless a tenant complains.

“Municipalities typically utilize rental code enforcement to address these problems, which is complaint-based. However, the most vulnerable tenants often do not feel safe lodging complaints against landlords out of fear of eviction, or they may have language barriers or disabilities that make navigating the code enforcement system difficult,” the pediatricians said in their letter. “Heartbreakingly, because of this policy, when we pediatricians identify lead-exposed children it may be too late to effectively intervene.”

The city of Oakland announced in the fall of 2024 that it had hired a consultant to evaluate whether a lead hazard abatement program could work alongside a PRIP. The consultant has until mid-2025 to complete their report.

“I owe it to my patients to not only know about the risks, but to advocate for change to prevent lead poisoning in the first place,” said Brianna Doherty, a resident physician at UCSF Benioff Children’s Hospital who helped organize the pediatrician’s petition. “It feels incredibly frustrating to wait for change.”

Building trust

Without an alternative, Healthy Home’s community outreach coordinator Eloisa Ramos says her team has to spend time building trust with immigrant families who, in some cases, fear getting involved with government programs.

“They have to go to the owners for the owners to address these hazards,” Ramos said. “And that’s when we do get a little bit of a hesitation from those renters because they are afraid of retaliation, and that really just breaks my heart because, obviously, it’s illegal for an owner to retaliate against a tenant for wanting to address these hazards. It’s owners’ responsibility to provide a healthy environment for these tenants.”

Ramos said she leans on her language skills to build trust with Spanish-speaking families. “I let them know that I’m only here to help you,” she said. “I’m not here to, you know, gain this information to have it be worked against you. This is just for me to help you and your family.”

What should parents do to advocate for their children?

Guzman said she understands how advocating for children in the doctor’s office can be a challenge — she herself was denied a blood lead level test by a pediatrician when she requested one for her kids.

She had found out through a neighbor that she and her children had been living in an apartment complex that contained lead when they were young. She and her family had already moved out of the apartment when she learned the news, so she asked that her children, 12-year-old twins, be tested. The pediatrician, she said, told her that her kids were too old to receive a test and that their risk was now low because they no longer lived in the apartment.

“Fue como una burla,” she said in Spanish, “you know, it was like a joke.”

She said she spends significant time providing educational information about lead to members of the Latino immigrant community.

The rules guiding who is tested for lead and when the results are shared are perplexing, as Guzman’s experience suggests.

Parents should insist on a blood lead level test for their children, and ask the medical provider to record when they deny a test, according to La Clinica de la Raza, which provided advice to attendees of a lead testing workshop hosted by El Tímpano in July.

Parents should also request to see the results of the test regardless of the results — in many cases parents won’t receive the results of the test unless the child has a blood lead level of 3.5 or higher.

“I think one of the most constant stories that I hear repeat itself over and over is people telling me, grown adults telling me, ‘I thought we would not have these kinds of problems here,’” Guzman said. “A lot of people tell me that they thought lead lived only outside of this country, that this country couldn’t possibly have lead because it is the number one country. I guess with all the money going around, how could this country have lead, or the state?”

Former senior housing reporter Cassandra Garibay contributed to this article. This story was produced as part of the Pulitzer Center’s StoryReach U.S. Fellowship.