Detroit has a rich history, expanding in the mid-20th century to one of the largest cities in the US with roughly 1.8 million people, spread out over 139 square miles. The city was constructed with multiple highways, large single-family homes and no true public transportation infrastructure—predicated on the booming automobile industry and the premise everyone would own cars. The decline of the automobile industry and racist federal urban policies such as redlining created an accelerated decline in the population (now 673,104 with 79.1% African-American), leaving extreme pockets of low density, blight, concentrated poverty (37.9%), and a vastly spread out population without transportation modalities needed to sufficiently access services and employment. Taken altogether, these factors indicate a population with high levels of isolation, entrenched barriers to opportunity, and significant health inequalities. As a health department, this creates significant challenges to reaching people and improving health outcomes, and has required innovative and neighborhood-based approaches to service provision.
In the summer of 2018, the Detroit Health Department launched the Lead Primary Prevention Pilot Project (Pilot”) as a proactive measure to end childhood lead poisoning in Detroit through education, blood lead level testing, testing for lead paint, and by providing lead-safe cleaning kits. The scope of the project is focused on door-to-door outreach performed by Community Health Workers in the five zip codes with the highest rates of childhood lead poisoning: 48202, 48204, 48206, 48213, and 48214. We also have a field liaison to oversee the on the ground work, and a social worker and nurse manager that assists with follow up for case management. The goal of the Pilot is to reduce lead poisoning in children, who are developmentally the most vulnerable to the harmful effects of lead exposure, before they are exposed. This goal will be achieved by increased testing of children for lead, education, and lastly, getting families with young children into the pipeline for having their homes abated for lead hazards.
The Detroit Health Department (DHD) started the pilot by collecting addresses for every parcel in each of our target five zip codes, a total of over 37,000 parcels provided by post office records. We dispatched our Community Health Workers to knock on every door starting out in zip code 48202, and later moving into 48204 and 48213. Through our partnership with Wayne State University, who replicates our efforts in 48206 and 48214, we have created a referral pathway directly to DHD for any in-home child lead testing that is requested.
We are close to completing a door knock in each single family home in our target zip codes, and successfully completed outreach to over 17,000 occupied homes. Of those homes, we were able to provide education to over 1,000 families, and completed full home assessments to almost 50 homes, and lead testing for 35 children ( 4 of which were not previously tested and were found to have elevated levels). 80 lead-safe cleaning kits were distributed to families in our target demographic and target zip codes. The Pilot tested a total of three pregnant women and detected zero with elevated blood lead levels.
We were able to meet our objectives of providing resources and education to the community, increasing knowledge and education, testing children who previously had not received a test, and increasing the number of homes placed in the housing abatement pipeline. We were able to meet these objectives by being proactive, flexible, and creative and bringing our services and resources into neighborhoods.
The public health impact from this pilot is that more children are prevented from being exposed to lead hazards, testing increased, and long-term fewer children will be impacted by the negative impacts of lead exposure.
Our website is located at: https://detroitmi.gov/departments/detroit-health-department/programs-and-services/lead-program