CLEVELAND — One hundred fifty miles northwest of here, the residents of Flint, Mich., are still reeling from the drinking water debacle that more than doubled the share of children with elevated levels of lead in their blood — to a peak, in mid-2014, of 7 percent of all children tested.
Clevelanders can only sympathize. The comparable number here is 14.2 percent.
The poisoning of Flint’s children outraged the nation. But too much lead in children’s blood has long been an everyday fact in Cleveland and scores of other cities — not because of bungled decisions about drinking water, but largely because a decades-long attack on lead in household paint has faltered. It is a tragic reminder that one of the great public health crusades of the 20th century remains unfinished.
“Unless there is some sort of concerted national effort to do something about this problem, it’s going to persist for years to come,” said Philip J. Landrigan, a leading expert on lead and professor of preventive medicine and pediatrics at the Mount Sinai School of Medicine.
“Lead is a big problem in this country, and it frustrates me to no end that except in rare cases, it passes unnoticed.”
Four decades ago, political leaders declared war on lead, citing evidence that even vanishingly small amounts of it have a pernicious impact on young brains, stunting intellectual growth and affecting cardiovascular, immune and hormone systems. The federal government began phasing out leaded gasoline in 1975, and banned lead-based household paints in 1978. In 2000, a cabinet-level task force proposed to end lead poisoning in children within a decade.
By 2006, blood lead levels in children under 6 had fallen to close to a tenth of their 1970s levels.
But progress since has slowed. By the most recent estimate, about 37 million homes and apartments still have some lead paint on walls and woodwork, 23 million with potentially hazardous levels of lead in soil, paint chips or household dust.
The Centers for Disease Control and Prevention estimate that four million of those most dangerous households have children. A half-million children — in Atlantic City, Philadelphia and Allentown, Pa., where a remarkable 23.1 percent of children tested had excessive lead — are believed to have enough lead in their blood to merit a doctor’s attention.
That need not happen. New York City has a vast and aged housing stock and one of the nation’s strictest laws on lead testing and removing lead hazards. In 2014, only 2.1 percent of children tested were flagged for excessive lead.
But in most cities, the lead threat is confined largely to poor neighborhoods with scant political clout. There is little official urgency — and increasingly, little money — to address it.
Charm Warren-Celestine, 64, replaced the windows and porch of her century-old home in east Cleveland’s Glenville neighborhood after her toddler grandson Zy’aire developed high blood lead levels after spending the summer of 2011 with her.
“It took me three years and two applications to get the city to do what was needed to make my dwelling lead-free,” she said. “I had to apply twice because funding was exhausted. You had to be relentless to make it happen.”
Almost five years later, Zy’aire shows no physical effects from the lead, but its effect on his mental development remains unclear.
Researchers argue that failing to attack lead paint hazards is a costly mistake. A 2009 study calculated that every dollar spent on that would generate up to $221 in benefits — in increased productivity, greater tax receipts and lower health care and education costs.
And not the least, in reduced crime. Researchers have long linked high blood lead levels to impulsiveness and violence.
The C.D.C. has consistently lowered its definition of an elevated blood lead level: 60 micrograms per deciliter, then 10, and, as of 2012, five — less than a millionth of an ounce in a little more than a pint of blood.
Yet experts say that is still too much. A 2005 study concluded that increasing a child’s blood lead level to 10 micrograms from 2.4 translated to a 3.9-point drop in I.Q. A 2015 study of Chicago elementary school students concluded that blood lead concentrations of five to nine micrograms explained up to 15 percent of failing grades in reading and math.
Even tiny increases, below five micrograms, “are associated with significant decrements in performance on standardized tests,” the researchers said.
The 2000 cabinet task force found that the lead danger to children then could be substantially eliminated for what, in federal terms, was a pittance: $2.1 billion, over 10 years, to eliminate lead hazards in old homes that posed the greatest threat.
Congress never allotted the full amount, and since 2003, funding for lead-abatement programs has fallen by 43 percent.
“We know how to fix it,” said David Jacobs, a chief contributor to the task force who ran the federal lead program from 1995 to 2004. “The technology is there. It’s just a matter of political will to properly appropriate the money.”
Money for screening children has also fallen. The C.D.C. has cut state grants for lead poisoning prevention by more than half since 2009, and the share of children younger than 6 who are tested has fallen by more than 40 percent. Sixteen states do not even forward the results of lead tests to the federal authorities.
The Ohio Legislature established a Lead Poisoning Prevention Fund in 2003 to attack the lead-paint problem in older homes and to pay for blood tests of children without medical insurance — but never gave it even a dollar.
On Cleveland’s east side, the Glenville neighborhood embodies the neglect of the lead problem and the hope that it might be erased.
At the turn of the 20th century, Glenville was called Cleveland’s Gold Coast, a mansion-studded enclave where John D. Rockefeller had donated land for the city’s largest park. By the 1960s, the wealthy had fled to the suburbs and Glenville was part of the inner city, poor and almost entirely black.
In 1967, Thajuan Perry was 5 years old, living in a Glenville apartment with her parents, when it became clear that something was wrong with Eric, her baby brother. Eric once crawled around the rooms; suddenly, he was neither moving nor making noises.
“He would just gaze for long periods,” Ms. Perry said. “It went from gazing to seizures, and from seizures to a coma.”
Eric was hospitalized with lead poisoning, sickened by dust and paint chips on the apartment floor. At age 50 today, he can speak only simple sentences, takes anti-seizure medication and works at a center for the disabled.
Ms. Perry is his full-time caretaker. “The thing about lead poisoning,” she said, “is that you don’t know you’ve been affected until you have symptoms. At the time, most parents didn’t realize that apartments had lead-based paint.”
In Cleveland, many still do not.
In 2010, researchers estimated that 7.7 percent of the nation’s black children younger than 6 had blood lead levels above five micrograms per deciliter. But in Glenville, 26.5 percent of children tested in 2014 — 286 children in all — exceeded that standard. Two registered more than 45 micrograms, the threshold for hospitalization to remove lead from the body.
Cleveland tested less than half its under-6 population. How many other children are at risk is unknown, but an Ohio State University analysis suggests that in some census tracts, it could be more than four in 10.
Dr. Dorr Dearborn, a retired pediatrician and chairman emeritus of Case Western Reserve University’s department of environmental health sciences, said widely elevated lead levels “give these children an abnormal base to which all the other determinants of school failure and aggressive behavior are added.”
Dr. Dearborn has long campaigned for Cleveland to erase lead-based paint from its homes — nearly nine in 10 of the city’s houses were built before the 1978 ban — but Clevelanders were oblivious.
That changed last October, after a series of articles in The Plain Dealer reported that the city’s Department of Public Health had failed to investigate more than 2,100 cases of lead poisoning during the previous five years. Until 2015, the city had but one employee to inspect homes where lead poisoning occurred.
City officials contest some of those numbers, but in an interview conceded that the city’s lead safety efforts were a mess. The main reason, they said, was a lack of money.
When the C.D.C. began cutting lead poisoning prevention grants in 2010, the officials said, the Health Department had to curtail lead tests and lay off inspectors. In 2012, federal officials withdrew Cleveland’s multimillion-dollar grant for addressing lead in homes because the city’s track record was so poor.
Some critics are less sympathetic, noting that the city has found money for other projects — including $30 million for a 2013 renovation of its National Football League stadium — while lead abatement languished.
“A lot of folks failed,” said Kim Foreman, the director of Environmental Health Watch, a local group that works to ease lead and other health threats in homes. “The layperson, they thought we dealt with lead. But you also have a lot of folks affected who are people of color or low-income people. And honestly, people are not as concerned about them.”
The city vows to do better. The Health Department is to get new leadership; officials have committed to hire more lead inspectors. A new data system will better track lead cases and integrate with other departments that inspect or repair homes. The lost federal grant was reinstated last fall.
Perhaps most important, community leaders have started to face the problem and work on ways to solve it. University Hospital’s network, the Cleveland Clinic and others are devising a program to address lead poisoning and infant mortality in neighborhoods near Case Western.
Glenville is at the head of the list.