How many Montanans have lead in their blood? Health officials don’t know
Lead contamination and exposure in Montana go back several decades. But the data do not. Without more information, state and local health departments have no way of knowing how many people have been affected and the extent of the impact.
The city of Helena, Montana is well-acquainted with lead. The state capital is home to two Superfund sites.
“Pretty much everything except that slag pile is what remains,” says Valerie Stacey, an environmental health specialist with Lewis and Clark Public Health.
Stacey is sitting in the driver's seat of her Chevy pickup, pointing to a 16-million-ton pile of slag. It’s the byproduct of the former ASARCO lead smelter in East Helena. It opened in 1888 and ran until 2001.
“So that's basically all of the discarded byproducts of the lead smelting operation,” Stacey says.
Superfund designation matters
Helena’s smelter was one of the world’s largest lead processors in its day. In 1984 the federal government declared East Helena a Superfund site. That’s why this city is ahead of some others when it comes to testing for lead exposure.
“If that Superfund site didn't exist, we wouldn't have a lead program,” she says.
The next stop is East Helena’s City Hall. On the second floor is the former office of the original Lead Education and Abatement Program (LEAP), which was created in 1992. The room overflows with binders, maps, photographs and case investigations related to lead exposure in East Helena.
“Yeah, I don't know if you've heard about the ‘81 flood, but probably one of the biggest floods that we've ever had here in this area,” Stacey says. “And so this is the interstate. This is the lead smelter site.”
Stacey is looking at a black and white aerial photograph.
“They intentionally put those places adjacent to creeks because they powered their operations,” Stacey says.
East Helena experienced widespread contamination when the creek flooded.
“1981 was a very large event that transported a lot of contaminated soil throughout that entire floodplain,” Stacey says. “Which as you can see, ran through a large part of town and far north.”
Kathy Moore is the environmental division administrator for Lewis and Clark Public Health. She’s been with the department for 28 years and oversees the LEAP program.
“The CDC came to East Helena,” Moore says. “They did blood lead screening in the community and what they found was that children in East Helena were elevated above the national average.”
Blood lead levels are the detectable levels of lead in blood. The Centers for Disease Control and Prevention’s value for children, which has been adjusted over the years, is now 3.5 micrograms per deciliter.
“And those levels of blood lead were significantly higher than the CDC’s health standards,” Moore says.
Funding for the LEAP program is provided through a cooperative agreement with the EPA and can only be used within the Superfund area.
“So if we're working outside of that area, the health department out of their budget has to pay for the rest of it,” she says. “So we don't have a budget, we literally don't have a program outside of East Helena.”
Despite these limitations, East Helena is in a better position than other communities in the state. Most local governments don’t have a good way to pay for the remediation of lead even if they know people are getting exposed.
“What my understanding is of other programs in the state that are dealing with lead is that there really aren't any,” Moore says. “Local government, county health departments typically reach out to DPHHS for some assistance.”
The last time they did a large-scale blood lead draw, “All of our East Helena kids were below that national standard,” she says.
Lack of data complicates things
“So we did pretty well at that point. But what we were finding is that we were getting elevated levels from the rest of the county.”
Moore’s team started recognizing that lead exposure was not just coming from the smelter. It was also coming from homes built before 1978, from plumbing, paint, dust, leaded glass, beloved clawfoot tubs, toys, and mine tailings.
“Now we're saying, wait a minute, you know, East Helena was a real serious issue,” Moore says. “But have we overlooked everyone else? And to some extent we did.”
In the last five years, Moore’s team started to address residential cases of elevated blood lead levels outside of the Superfund area and in nearby counties.
“So we said if you have an elevated blood lead, you can give us a call,” she says. “We will come down, we'll do a residential home assessment and we'll try to determine what that source might be. And then we'll provide education to the family about how to protect their kiddos.”
Montana requires health care providers, labs and school administrators to report elevated blood lead levels to the local county health department or to the Department of Health and Human Services. But that information doesn’t always flow in both directions.
“The state a few years ago changed the way they shared information with local government,” Moore says. “We used to get a copy of every blood lead test that happened in our county, and the state decided that, well, we're not going to do that anymore. We're only sending you the elevated ones. Now, if you're trying to figure out a percentage of how many of your kids are elevated and you don't have that denominator. Well, forget it, you can’t.”
Unlike East Helena, with its lead smelter, other cities and towns in Montana have lacked funding and data to understand the full scope of lead exposure in the state.
“We can't really track our progress or the scope of the problem, because we don't look at the problem,” Moore says. “We, being our medical community, and the state of Montana, and local health departments.”
In a written response to an interview request, Jon Ebelt, public information officer for Montana’s Department of Public Health and Human Services says, “DPHHS had a lead poisoning prevention program about a decade ago — in 2011-2012 — that was funded through a cooperative agreement with the CDC. With this funding, DPHHS conducted a field study, the results of which demonstrated that many children were not being screened during that time. Overall, we lack relevant data about the true landscape of lead exposure in MT."
Sarah Harmon, an environmental health specialist at DPHHS says, “It is really staggering to see that there is a lack of testing that has been going on looking at the data from previous years.”
Harmon is part of their new Childhood Lead Poisoning Prevention Program team.
In September of 2021, the state health department received a five-year grant from the CDC to evaluate the landscape of childhood lead exposure in Montana.
“And prior to this grant, we have really had no program established within the state that's been designated solely for lead prevention work,” Harmon says. “So really, that's what our goal is with our program is to bring back that public attention, provide the support for local public health departments, pediatricians doctors, and just to handle this, for lack of a better word, crisis”
Too expensive to fix?
David Rosner is an author and professor of public health and history at Columbia University in New York City. One of his books is titled Lead Wars.
“There's been a war going on about what the nature of lead poisoning is,” Rosner says. “Who has a right to try to control it, what the industry's interests in maintaining its power is, and how to basically deal with a problem that this industry created by polluting this world by basically putting it everywhere.”
“That's the situation we're in. And we're constantly trying to figure out ways of ameliorating local outbreaks,” Rosner says.
Across the United States in rural and urban environments the issue persists.
“It's not just Montana,” Rosner says. “It's not just for Chicago, or Flint, or New York or anywhere else. We all have this common problem, which is that we don't have the resources to really take care of it.”
A national report found that keeping blood lead levels of children born in 2018 at zero would generate $84 billion in societal benefits by reducing special education, health care and criminal justice costs and increasing productivity.
“And we still claim that's too expensive to do anything about it,” Rosner says. “That's nuts after a century.”
At Lewis and Clark Public Health, Moore and Stacey know this all too well.
“So it's part of a societal issue, in my mind,” Moore says. “It’s why we don't take this one issue out of many seriously, it's just kids. In the view of public health, every child's life is important to protect and to ensure that they don't get those nasty side effects from blood lead poisoning.”
Moore and Stacey hope lead exposure in Montana isn’t as big of a problem as it seems.
But as Stacey says, "We really don't know until we have that widespread testing effort.”