Shining a light on the dangers of lead

Lead poisoning robs children of opportunity, and the impact is felt greatest in underserved communities. Faculty and students at Penn are bringing scientific and policy attention to the problem, while empowering young people to minimize their risk and be leaders for change.

students performing a lead test
(Pre-pandemic image) Tabeen Hossain, who recently completed a master’s in environmental studies at Penn, served as a TA in Rich Pepino’s Academically Based Community Service course and helped collect data on soil lead levels at various sites across Philadelphia. (Image: Alex Schein)

Richard Pepino “inherited” the Academically Based Community Service (ABCS) course, Urban Environments: Speaking Out About Lead in West Philadelphia, somewhat unwillingly from Earth and Environmental Science Department (EES) colleague Robert Giegengack

“He harassed me until I agreed to teach it for one year,” Pepino recalls with a chuckle. “Turns out the experience was like opening a Pandora’s Box that was filled with problems affecting mostly children of color, but like Pandora, I also found hope that my students could make things better within the West Philadelphia community.” Next month, he will begin teaching the course—one of the longest-running ABCS courses at Penn—for the thirteenth time. 

“It’s my favorite course of all time,” says Pepino, an environmental scientist and deputy director of the community engagement core at the Center of Excellence in Environmental Toxicology (CEET), “and it’s certainly the most influential course I’ve taught.”

Lead toxicity is a problem that is not unique to Philadelphia, but its impact is deeply felt in the city. Philadelphia’s children are twice as likely to have high blood lead levels as the national average. The issue is also one of environmental justice: In certain, typically impoverished areas of the city, as many as one in five children under six have elevated lead levels—the ages when lead can wreak its worst harm on their developing bodies and brains.

Pepino and Marilyn Howarth, an occupational and environmental medicine physician at the Perelman School of Medicine, are among several leaders at Penn and in the region in exposing, mitigating, and sharing education about the risks of lead. Their work has directed attention to the issue while also empowering Penn students and schoolchildren in Philadelphia to understand and act on lowering the risks that this often hidden but dangerous substance poses to public health.

“I’ve been at Penn since 1995 but in the last 7 years I’ve been working with CEET to design strategies about how to tackle a problem that is very based in socioeconomic and racial disparities in Philadelphia,” says Howarth, who is director of community engagement for CEET. She has been working on lead toxicity since beginning her career at the Centers for Disease Control and Prevention, where she investigated occupational exposure to lead paint. “What I’ve learned is important and what I have been trying to do is make substantive change in every way that vulnerable children are exposed to lead.”

This fall, as students in the ABCS course get an education on the heavy metal’s dangers, Philadelphia is set to enact an ordinance that will ensure every rental property in Philadelphia is certified lead-safe or lead-free, protecting the inhabitants from dangers of lead lurking in peeling paint. The policy will go into effect thanks in no small part to work by Pepino, Howarth, and many partners, offering a safer home environment to thousands of children.

Leading on lead

Born “in the shadow of Penn” in West Philly’s Misericordia Hospital and raised in the Overbrook neighborhood, Pepino says that heading up the ABCS course has taught him more than he could have imagined about the West Philadelphia community and the challenges it faces.

A partnership between the Netter Center for Community Partnerships, the Philadelphia Department of Public Health, and EES, the course involves teaching Penn students comprehensively about lead, then sending them into fourth to seventh grade classrooms in West Philadelphia to pass on their newfound knowledge.

“I always have students from EES, but also from health and societies, and usually about a third from Wharton,” Pepino says. “We discuss lead poisoning from the obvious—what is it medically, what is it scientifically—but also from a socioeconomic perspective. So, every student feels like they have a reason to be there, everyone brings a lot to the table.”

elementary school children learning about lead
(Pre-pandemic image) Penn students become the teachers during Pepino’s lead course, helping the younger students learn about the risks of lead, come up with strategies to mitigate their exposure, and then pass on their newfound knowledge. (Image: Courtesy of Anna Balfanz)

In addition to teaching lessons in the schools, such as Lea and Hamilton elementary schools, which also engage with other ABCS courses and activities through the Netter Center’s University-assisted community schools program, Penn students work with the younger students to test for lead in the environment, usually in or around their school buildings.

Anna Balfanz’s experience in Pepino’s ABCS course, in the fall of 2017, was formative, directly shaping the direction of her next few years. She took the course as a junior, enrolled at the same time in Howarth’s ABCS course that focused on the health impact of air pollution. The following year she served as a teaching assistant for Pepino. And now, as an Emerson Fellow with the Netter Center, she’s working with Pepino and others to deliver the contact and enhance the interaction with the grade school students, even in a virtual setting.

“Those were definitely some of the best courses I took at Penn,” Balfanz says. “They were very focused on real-world problem-solving, on youth-to-youth learning, and learning by doing—all priorities we operate under here at the Netter Center.”

A memorable lesson with the younger students, Balfanz says, had students engaged in hands-on learning to drive home the destructive nature of lead to the body. 

“The kids will get in a line and all hold hands and we’ll time them as they go one to the next, tapping each other’s hands,” she says. “Then we’ll describe how lead blocks neurons firing and have them go down the line again, timing them as select students wait two seconds between each tap to show how lead affects the neuron activity.”

Toward the end of the semester, the Penn students not only conduct lead testing with the elementary students, but also discuss what to do about the results, or “what it means to be an activist,” Balfanz says. “We ask them who they can share this prevention knowledge with and have them practice speaking up about it.” 

Simple actions

Continuing to spread awareness about the threat of lead has become a priority for many Penn students who have the opportunity to learn from Pepino and Howarth. Yoni Gottlieb, who graduated from Penn in 2019, took Pepino’s ABCS course in the fall of 2018. “Rich is so passionate about what he does, he makes you fall in love with it,” says Gottlieb. “All of a sudden I found myself becoming a lead advocate.”

Rather than a traditional final paper, Gottlieb asked Pepino if he could create a video that would teach the public how to recognize lead risks—and then act upon them.

Children are being exposed in a variety of ways and settings. The body doesn’t know where the lead comes from, it’s all cumulative exposure. Marilyn Howarth, an occupational and environmental medicine physician at the Perelman School of Medicine

Working with the Overbrook Environmental Education Center, Gottlieb logged days filming in the community and interviewing stakeholders, including the Center’s executive director, Jerome Shabazz, who had guest lectured in Pepino’s course, about lead toxicity. 

“The thing that inspired me most about Jerome’s talk was when he said that whenever you try to explain an issue to somebody, you want to say: what’s the issue, why you should care, and what can you do about it,” Gottlieb says. “I was really drawn to that idea of making things simple to engage more people in your activism.”

Gottlieb edited a two-minute video for his course requirement, but continued working on it afterward, and just released a full six-and-a-half minute video, promoting it through the Overbrook Center and other channels. “With COVID happening, people are stuck at home and may be at a higher risk of lead exposure,” Gottlieb says, “so the segment that covers how to avoid lead exposure in your home is particularly relevant now.”

Partnerships to mitigate harm

With Philadelphia’s older housing stock and lead contamination coming from multiple sources—soil, paint, water service lines, and more—confronting the issue requires a multipronged attack. Pepino and Howarth have worked together with multiple partners, from local entities like the Overbrook Environmental Education Center to federal agencies like the CDC and the Environmental Protection Agency (EPA), to take it on. 

Howarth and Pepino’s background in federal service has enhanced these collaborations, says Lora Werner, a regional director with the Agency for Toxic Substances and Disease Registry, a federal agency that is a sister organization to the CDC. “We understand the strengths we can offer the community and our limitations,” she says. “This helps enhance the work we do in our different roles. We often refer students and community members to each other when we know the other might be able to serve a need better.”

Shabazz of Overbrook has been a key point of contact in reaching impacted communities as well. 

“Overbrook Center was created to embody the best practices and solutions—for environmental issues, particularly around the intersection of environmental health and community,” he says. “Very often work on environmental issues is done in an academic setting where people are researching issues that impact people who may not know they’re being affected. We don’t have the luxury of working in that disconnect. Our goal is to empower the community with useful information.”

performing a lead test
Faculty and students have engaged with community members for years on the issue of lead. Soil lead levels around the city, among other data, have informed efforts to establish meaningful regulations to prevent lead poisoning. (Image: Alex Schein)

Shabazz regularly provides guidance to Penn students, such as Gottlieb and others, on projects related to lead exposure and many other environmental health issues. Pepino and Howarth, in turn, have provided their own expertise in workshops and education at the Overbrook Center. Shabazz is now a member of CEET’s Stakeholder Advisory Board. 

“I do think that Rich and Marilyn are working hard to make their work meaningful and I’m pleased to be a colleague and to offer my support,” he says.

In recent years Penn has thrown additional support behind this outreach. With a Making a Difference in Diverse Communities grant from the School of Arts & Sciences, awarded in 2017, Pepino and Reto Gieré of EES created opportunities for students to work on projects to collect data on lead around the city and share that information with members of the community at greatest risk of high levels of exposure.

Part of that work has involved collecting data on soil lead throughout the city. While the crisis in Flint, Michigan, turned the public’s attention to the dangers of lead in water, lead in soil is an underappreciated concern. Pepino and Howarth contributed to attention of this issue in the Fishtown neighborhood, where gentrification in recent years has led to a construction boom that disturbed lead-containing soil. 

“Children are being exposed in a variety of ways and settings,” Howarth notes. “The body doesn’t know where the lead comes from, it’s all cumulative exposure.” 

In addition to the legislation set to come online this fall, last year lead advocates including those at Penn helped get legislation passed that requires universal blood lead testing in children. “We recognized that health department funding through HUD [the U.S. Department of Housing and Urban Development, to pay for lead paint remediation] was not sufficient,” says Howarth. “We’d be remediating houses for the next two centuries. It’s just not tackling the problem in a meaningful, timely way, and we’d be giving up on generations of children. It was important to identify more of the children who have been exposed so that intervention programs can target them.”

Through COVID and beyond 

At the current time, it’s unclear what the ABCS course will look like this year, but Balfanz is already planning for Penn students to “Zoom” in to virtual classrooms at University-assisted community schools as part of it. 

That’s crucial, Balfanz says, not only so Penn students can get the most out of the course, but also for the elementary and middle school students to get an unforgettable learning opportunity. 

“When I was first in the class, there was one student who just blew me away,” recalls Balfanz. “We would ask them, ‘How do you think you measure the lead in the soil,’ and she asked, ‘is it some kind of X-ray?’ and we were like, ‘yes it is.’ And she asked, ‘did the paint companies know that lead in the paint was poisoning people?’ And we were like, ‘that’s such a good question, some of them did, so why do you think they didn’t stop?’ She was so smart, she would talk to me about how she wanted to be a scientist when she grew up.”

Balfanz is looking for ways to deepen the connection between Penn and neighborhood schools by continuing programs into the spring semester or offering after-school opportunities to continue learning. 

“Those classes absolutely subscribed me to the belief,” she says, “that the action-based participatory way of learning, and involving yourself intricately with the community, is the only way to truly learn how to do something.”

Editor’s note: For the Penn community on campus, the Office of Environmental Health and Radiation Safety’s Lead Management Program provides consultation, advice, and oversight to minimize the risks of lead exposure.  

Anna Balfanz is an Emerson Fellow of the Netter Center for Community Partnerships and Penn graduate of the class of 2019.

Marilyn Howarth is an adjunct associate professor of emergency medicine and systems pharmacology and translational therapeutics and is director of community engagement at the Center of Excellence in Environmental Toxicology (CEET) in the Perelman School of Medicine.

Richard Pepino is deputy director of the community engagement core of CEET and coordinator of the Academically Based Community Service course in the Schools of Arts and Sciences’ Department of Earth and Environmental Science.

Reto Gieré is a professor in the School of Arts & Sciences’ Department of Earth and Environmental Science.

Yoni Gottlieb is a music producer and communications specialist from the Penn class of 2019.

Lora Werner is regional director of the Agency for Toxic Substances and Disease Registry.

Jerome Shabazz is executive director of the Overbrook Environmental Education Center.

For the Penn community on campus, the Office of Environmental Health and Radiation Safety’s Lead Management Program provides consultation, advice, and oversight to minimize the risks of lead exposure.  

Editor’s note: The ABCS course on air pollution will be taught this year by Maria-Antonia Andrews, associate director of undergraduate programs in the School of Arts & Sciences’ Department of  Earth and Environmental Science, who is a member of CEET’s Stakeholder Advisory Board.

Homepage photo: Peeling paint in Philadelphia’s older homes is a major source of lead exposure for children in the city, but it’s not the only one. “Children are being exposed in a variety of ways and settings,” says Marilynn Howarth, a physician and faculty member at Penn Medicine. “The body doesn’t know where the lead comes from, it’s all cumulative exposure.”