A Minneapolis health inspector takes a lead dust sample from a window sill. Credit: Courtesy of Minneapolis Health Department

It’s an unusual display: a collection of items including clay bean pots, a figurine of Cookie Monster, a lion, and a red and green rattle.

The items are for education purposes only, because they contain lead. The Minneapolis City Health Department found them in homes and now uses them as part of the city’s initiative to lower lead levels in kids. 

The effort is part of a broader, largely successful, public health story: Lead levels among children peaked in the 1970s, when people pumped leaded gas into their cars and painted their walls with lead-laced paint. The substance can produce brilliantly colored, moisture-resistant walls, but research has shown that it is toxic to humans. Lead can cause everything from gastrointestinal issues to memory problems. 

After legislation banned leaded paint in the late ’70s and leaded gas in the ’90s, lead levels started dropping. In 2008, Minneapolis recorded 505 cases of lead-poisoned children. That dipped to 66 in 2020, when testing during the pandemic dropped, and climbed to 112 in 2022.* 

But the story isn’t a complete success: The children who test positive today are more likely to be children of color from lower-income neighborhoods. Almost three-fourths of kids with elevated lead levels in Minneapolis are kids of color. 

Fardowza Omar is on a mission to change that. She leads the city health department’s Healthy Homes team that inspects houses and apartments deemed to be at risk of lead exposure. The team also does extensive outreach (participating in 33 events last year) in the five neighborhoods with the highest numbers of elevated lead levels in Minneapolis: Central, Powderhorn Park, Phillips, Jordan, and Hawthorne. 

When Fardowza joined the Healthy Homes team, she was one of six inspectors. Now, she leads a team of 14 who speak multiple languages and understand the specific concerns of the communities at risk. That’s important because people tend to trust the information they receive from someone who is a member of their own community, or who is very knowledgeable about the community, said Laura Breeher, an occupational and environmental medicine physician at the Mayo Clinic in Rochester, Minnesota.

“There are a lot of resources available, but it can be overwhelming,” she said. “Knowledgeable community health workers can quickly connect people to community resources.”

That’s exactly what Adylene Ocotoxtle, one of the Healthy Homes inspectors, was doing at a recent Cinco de Mayo event on Lake Street. She grew up in the neighborhood, and knew that many of the attendees would be nervous to get testing because of deportation fears, she said. Ocotoxtle offered reassurance and explained what lead poisoning is and how to apply for grants in Spanish. Parents are often surprised to learn about the dangers of lead, but many agree to have their children tested with a finger prick in the mobile lab. 

As one mother and her children waited for results, Ocotoxtle explained what resources were available should the results come back positive. Of the 15 kids the workers had tested that afternoon, a few had come back with levels higher than five micrograms per deciliter, the level that triggers high levels of concern in Minnesota. 

Usually the immediate intervention that follows from health departments brings relief for the family. 

“You can get involved, and change the trajectory of a child’s life,” Fardowza said.

How lead impacts kids

Lead harms both adults and kids, but prevention efforts focus on children for a few reasons: Most kids have a higher risk of exposure because they tend to touch more contaminated items such as floors, walls and windowsills — and then put their fingers in their mouths. Children also absorb more of the lead that they ingest. While adults take in up to one-fifth of ingested lead on a full stomach and up to four-fifths on an empty stomach, children absorb about half of ingested lead on a full stomach and up to 100 percent on an empty stomach. Also, lead is stored in the bones, and the bones of growing children pull in both more nutrients and more unwanted toxins.

“It’s going to be taken up in bones very readily,” Breeher said. “That can result in elevated lead levels for quite some time.”

Lead toxicity takes two forms, Breeher said. Acute toxicity often results in symptoms such as headaches, upset stomachs, muscle aches, and cognitive effects. Chronic lead toxicity, on the other hand, usually doesn’t produce many noticeable symptoms, or symptoms so mild most people wouldn’t think of lead as a cause, Breeher said. 

But it can still affect many of the same systems for many years. “In children, one of the primary concerns is cognitive effects,” she said. “We want to make sure children aren’t having long-term negative cognitive effects of memory and learning. 

“That’s a big reason why we have screening programs. Knowledge is power. It’s much better to identify the risk and know and be able to eliminate the risk and help that child avoid those long-term impacts.”

When Fardowza started inspecting homes, the city would get involved only when a test showed a level of at least 20 micrograms per deciliter, she said, in order to use their limited resources to address the needs of children with the highest exposure and health risks. As research has progressed and continues to show negative consequences of high lead levels, and as intervention has been shown to work, the number that flags a level of concern has dropped, from 40 micrograms per deciliter in 1971 to 10 in the ‘80s to Minnesota’s present level of five micrograms per deciliter.

“There’s been increased awareness of impacts of elevated lead levels, especially with children,” Breeher said. “There can be small impacts on cognitive function with even low levels of chronic lead toxicity, so there’s an increased interest in making sure we’re reducing lead exposures as much as possible.”

Why lead exposure remains a problem in parts of Minneapolis

Most Minneapolis residents face potential lead exposure simply from living in older homes constructed when lead paint was the preferred wall covering and drinking water flowed through lead pipes. People of color and immigrant communities tend to live in poorer neighborhoods that are at even higher risk of lead exposure because they are closer to freeways and houses are more likely to contain old paint. Lead lingers in soil and dust, so the effects of years of pollution can build up. 

In addition to neighborhood exposure, immigrants may face additional risk of exposure from items and cultural practices from countries that don’t have stringent regulations around lead. Adults in lower-income neighborhoods are also more likely to work in factories where lead is present.

The Healthy Homes team uses an X-ray fluorescence device to test everything from spices to medicines at community events. For example, the team has tested beans cooked in a traditional clay pot often used by Latino families and found a high level of lead in the beans.

“We tell families to bring their bean pot, and if it tests positive, we take it and give them a crock pot,” Fardowza said. “The minute they find out it’s positive, they start feeling guilty.” 

In addition to bean pots, outreach workers look for coal used as makeup in Somali and Southeast Asian homes, spices in Indian homes, and medicines, candy, and toys that come directly from other countries. 

Often, people are surprised by the results. Immigrants who moved to the U.S. more recently are also less likely to know that lead is a risk.

Outreach events target neighborhoods where kids are least likely to have been tested for lead. The Minneapolis Health Department recommends children who live in homes built before 1978 get tested annually until age 6. Tests above 5 micrograms per deciliter get sent to the Minnesota Department of Health (MDH), and the state shares that information with the Minneapolis Health Department. That’s when a family would get a call from the Healthy Homes team.

“Usually we call the family faster than their doctor, so people can be a bit skeptical,” Fardowza said. 

Although there is a state mandate that health workers must be allowed into a home where a child has a raised level, most families welcome the team in, she said. “There’s often some initial apprehension, especially if they’re undocumented, but we put them at ease with someone who speaks Spanish,” she said—explaining, for example, that the inspection process won’t reveal their immigration status to other authorities.

In teams of three, inspectors look at everything painted in a home, inside and out. Assessment and abatement can be an intimate process. There are so many potential sources of lead exposure that you have to test all the possibilities, Breeher said. Home inspectors look at every wall and window sill, and test belongings including toys, medicines, even makeup.

“We test the garage, fences, soil, the basement, all the rooms on the first floor and second floor,” Fardowza said. “If it has paint, we have access and will test it.”

Within two hours of sampling, the team can report their findings to the family and offer recommendations. That could mean temporary solutions as simple as blocking window sills with furniture, Fardowza said. Longer-term fixes may involve applying for grants to remediate paint or replace windows and doors. They can send people to trainings on how to cover bare soil with mulch, and they can educate people on cleaning window sills and even getting lead off of hands. (Tip: Use a bucket with a separate towel and wash the towel apart from other laundry.)

Once the exposure is eliminated, lead levels usually drop quickly — and many children who tested high initially don’t experience any long-term effects, Breeher said.

One parent Fardowza remembers wanted to restore the natural woodwork in the family’s home. When the eight-month-old tested high at their annual check, the dad was also tested and also had high levels. After the team pinpointed the cause, the child’s blood level dropped to under an acceptable level. 

CLARIFICATION: This story has been updated with information from the city health department. An earlier version said that the city paused in-person outreach during the pandemic. While community events were paused, health inspectors continued visiting homes.

What you can do

Gov. Tim Walz recently signed a bill providing $240 million to replace lead pipes across the state. Legislation such as this has helped create positive system change, Breeher said. But individuals can also take steps to protect themselves and their families. 

The city health department advises people to take care of a common cause of lead exposure in homes: dust from lead paint often ends up in window sills. Watch the department’s video on how to properly clean windows here.

Check common items imported from other countries, such as in the photo above. Talk to the city health department about any items you’re concerned about. Test your soil and water. And if anything tests high, apply for funding.

Sheila Mulrooney Eldred writes stories about health equity for Sahan Journal. As a freelance journalist, she has written for The New York Times, the Washington Post, FiveThirtyEight, NPR, STAT News and...