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Lead pipe & plumbing material replacement

Health Factors: Air & Water Quality
Decision Makers: Community Development Professionals Community Members Employers & Businesses Local Government State Government Nonprofit Leaders Public Health Professionals & Advocates
Evidence Rating: Expert Opinion
Population Reach: 50-99% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

Lead leaches into drinking water through corroded plumbing material that contains lead (CDC MMWR-Brown 2012). Lead pipes, plumbing material, and fixtures can be replaced by individual property owners or by public water systems. As of 2014, the federal Safe Drinking Water Act (SDWA) prohibits use of plumbing material that is not lead-free, defined as 0.25% lead for pipes, fittings, and fixtures, and 0.20% for solder and flux, decreased from the 1986 SDWA’s 8% lead allowance (US EPA-SDWA Sec 1417). The 1991 Lead and Copper Rule (LCR) requires water utilities to monitor water quality and to take action if more than 10% of monitored taps exceed 15 parts per billion (ppb), the EPA’s lead action level for drinking water (US EPA-LCR). However, in 2015, the National Resources Defense Council’s analysis of the EPA violations list estimated at least 18 million Americans were served by water systems with lead contamination violations; this figure did not include some locations with known violations such as Flint, Michigan (NRDC-Olson 2016). Violations exist in all 50 states (NRDC-Lead violations map). As of 2012, scientists indicate no safe blood lead level (BLL). The Centers for Disease Control and Prevention (CDC) blood lead reference level for initiating public health actions to prevent further exposure and mitigate health effects is 5 micrograms per deciliter (µg/dL); it is estimated that over 500,000 children have BLLs at or above this level (White 2015, NCHH-Lead 2014, CDC-Lead facts). 

Expected Beneficial Outcomes

Reduced lead exposure
Improved health outcomes

Evidence of Effectiveness

Replacing lead pipes, plumbing material, and fixtures is a suggested strategy to reduce lead exposure and blood lead levels (BLLs), especially in children (CDC MMWR-Brown 2012, US EPA-Lead). Available evidence associates full service lead pipe and plumbing material replacement with reduced lead levels in drinking water (Pfadenhauer 2016). Partial lead service line replacement can also reduce lead levels in the long-term, but has been shown to increase lead release in the short-term, especially if metal connections couple lead pipes to copper pipes (CDC MMWR-Brown 2012, Cartier 2012, Cartier 2013, Edwards 2013). Additional evidence is needed to confirm the effects of full and partial lead pipe and plumbing material replacement on BLLs.

Full lead service line replacement removes the source of corrosion and lead leaching, reducing the likelihood of lead exposure. Lead pipe and plumbing material replacement appears to be most effective when combined with educational interventions. Filtering systems, water treatment measures, and other engineering interventions may also reduce lead in drinking water (Pfadenhauer 2016).

Using plastic pipe connections or incorporating an insulating spacer between the pipes in partial lead pipe replacement can avoid the corrosion that increases lead release (Wang 2012, St. Clair 2012). Education efforts and system monitoring can help prevent lead exposure and lead poisoning during initial increases in lead release (CDC MMWR-Brown 2012). When lead remains in the water service system, contamination can be increased by corrosive water, water sitting in pipes, warm water temperatures (Laidlaw 2016, WCLPP-Report 2014), and high flow rates (Cartier 2012).

Lead abatement can improve health outcomes for children and adults by reducing developmental disorders, attention deficit hyperactivity disorder-related behaviors (ADHD), anemia, hypertension, and kidney and brain damage (Armstrong 2014, Berg 2012, NCHH-Jacobs 2009). Newborn infants are especially vulnerable to effects of lead exposure (Vigeh 2014); a St. Louis-based study suggests prenatal screening and proactive lead hazard remediation can prevent exposure among some newborns (Berg 2012). Reduced lead exposure may be linked to reductions in violent crime roughly twenty years after exposure would have occurred (Wolpaw Reyes 2015, NBER-Wolpaw Reyes 2007, Feigenbaum 2015). 

Childhood lead poisoning occurs at higher rates among families with lower incomes and those living in older homes than their counterparts (White 2015, Korfmacher 2014, Reed 2011a, NCHH-Lead 2014). On average, black children from low income families have higher blood lead levels than white or Hispanic children from low income families (White 2015).

Although lead pipe and plumbing material replacement is costly, cost benefit analysis finds positive net benefits and a high rate of return for lead abatement programs overall (Cochrane-Nussbaumer-Streit 2016, Gould 2009). Economic modeling suggests that future earnings and decreased medical costs for children who benefit from these programs range from 2-20 times the estimated costs of lead abatement (Jones 2012). 

Implementation

United States

The Madison Water Utility in Madison, Wisconsin was the first major water utility in the nation to fully replace all of the city’s lead pipes. The effort began in 2001, took over a decade, and cost approximately $19.4 million (WCIJ-Schmidt 2016). The Lansing Board of Water & Light (BWL) in Lansing, Michigan also removed all lead service lines; the project began in 2004, removed 12,150 active lead service lines, and cost $44.5 million (BWL-Replaced lead pipes 2016).

The 10 regional offices of the US Environmental Protection Agency (EPA) each have a designated Regional Lead Coordinator who oversees lead-poisoning prevention efforts, including lead pipe and plumbing material replacement (US EPA-Lead contacts). Individuals can have their drinking water tested for lead contamination through certified laboratories; lists of certified laboratories are available through state or local drinking water authorities or by calling the EPA's Safe Drinking Water Hotline (US EPA-Protect your family). 

Wisconsin

The Wisconsin Department of Natural Resources has an $11.8 million program to replace lead pipes in low income areas across the state (WCIJ-Hall 2016). The Wisconsin Childhood Lead Poisoning Prevention Program (WCLPP) tracks state trends in childhood lead poisoning and provides abatement information and resources for lead paint and plumbing hazards (WCLPP-Report 2014).

Implementation Resources

CDC-Lead facts - Centers for Disease Control and Prevention (CDC). Lead: Facts, tips, tools, training, and resources for childhood lead poisoning prevention. Accessed on April 18, 2017
Flint Water Study-Guide and resources - Flint Water Study. FlintWaterStudy.org guide and resources. Accessed on March 23, 2017
NMC PHC-Guidance and tools - Navy and Marine Corps Public Health Center (NMC PHC). Guidance and tools. Accessed on January 5, 2017
NRDC-Lead violations map - National Resources Defense Council (NRDC). What’s in your water? Flint and beyond: Explore lead problems across America. Accessed on January 5, 2017
NSF-Lead in drinking water - NSF International. Lead in drinking water and a consumer guide to NSF certified lead filtration devices for reduction of lead in drinking water. Accessed on January 5, 2017
US EPA-Lead - US Environmental Protection Agency (US EPA). Lead: Lead poisoning is preventable. Accessed on April 18, 2017
US EPA-Lead in drinking water - US Environmental Protection Agency (US EPA). Ground water and drinking water: Basic information about lead in drinking water. Accessed on February 28, 2017
US EPA-Protect your family - US Environmental Protection Agency (US EPA), US Consumer Product Safety Commission, US Department of Housing and Urban Development (US HUD). Protect your family from lead in your home. Washington, DC: US Environmental Protection Agency (EPA); 2012. Accessed on February 28, 2017

Citations - Description

CDC MMWR-Brown 2012 - Brown MJ, Margolis S. Lead in drinking water and human blood lead levels in the United States. Morbidity and Mortality Weekly Report (MMWR). 2012;61(Suppl):1-9. Accessed on January 5, 2017
CDC-Lead facts - Centers for Disease Control and Prevention (CDC). Lead: Facts, tips, tools, training, and resources for childhood lead poisoning prevention. Accessed on April 18, 2017
NCHH-Lead 2014 - National Center for Healthy Housing (NCHH). Preventing lead exposure in US children: A blueprint for action. 2014. Accessed on April 18, 2017
NRDC-Lead violations map - National Resources Defense Council (NRDC). What’s in your water? Flint and beyond: Explore lead problems across America. Accessed on January 5, 2017
NRDC-Olson 2016 - Olson E, Fedinick KP. What’s in your water? Flint and beyond. New York City: National Resources Defense Council (NRDC); 2016. Accessed on January 5, 2017
US EPA-LCR - US Environmental Protection Agency (US EPA). Drinking water requirements for states and public water systems: Lead and Copper Rule (LCR). Accessed on February 28, 2017
US EPA-SDWA Sec 1417 - US Environmental Protection Agency (US EPA). Section 1417 of the Safe Drinking Water Act (SDWA): Prohibition on use of lead pipes, solder, and flux. Accessed on March 16, 2017
White 2015 - White BM, Bonilha HS, Ellis C. Racial/ethnic differences in childhood blood lead levels among children <72 months of age in the United States: A systematic review of the literature. Journal of Racial and Ethnic Health Disparities. 2015:1-9. Accessed on April 18, 2017

Citations - Evidence

Armstrong 2014 - Armstrong R, Anderson L, Synnot A, et al. Evaluation of evidence related to exposure to lead. Canberra: National Health and Medical Research Council; 2014. Accessed on April 18, 2017
Berg 2012* - Berg DR, Eckstein ET, Steiner MS, Gavard JA, Gross GA. Childhood lead poisoning prevention through prenatal housing inspection and remediation in St. Louis, MO. American Journal of Obstetrics and Gynecology. 2012;206(3):199.e1-199.e4. Accessed on April 26, 2017
Cartier 2012* - Cartier C, Arnold RB, Triantafyllidou S, Prévost M, Edwards M. Effect of flow rate and lead/copper pipe sequence on lead release from service lines. Water Research. 2012;46(13):4142-4152. Accessed on January 5, 2017
Cartier 2013* - Cartier C, Doré E, Laroche L, et al. Impact of treatment on Pb release from full and partially replaced harvested lead service lines (LSLs). Water Research. 2013;47(2):661-671. Accessed on January 5, 2017
CDC MMWR-Brown 2012 - Brown MJ, Margolis S. Lead in drinking water and human blood lead levels in the United States. Morbidity and Mortality Weekly Report (MMWR). 2012;61(Suppl):1-9. Accessed on January 5, 2017
Cochrane-Nussbaumer-Streit 2016* - Nussbaumer-Streit B, Yeoh B, Griebler U, et al. Household interventions for preventing domestic lead exposure in children. Cochrane Database of Systematic Reviews. 2016;(12):CD006047. Accessed on April 18, 2017
Edwards 2013* - Edwards MB, Bocarro JN, Kanters MA. Place disparities in supportive environments for extracurricular physical activity in North Carolina middle schools. Youth & Society. 2013;45(2):265–85. Accessed on December 15, 2015
Feigenbaum 2015 - Feigenbaum JJ, Muller C. Lead exposure and violent crime in the early twentieth city. Cambridge: Harvard University; 2015. Accessed on April 26, 2017
Gould 2009 - Gould E. Childhood lead poisoning: Conservative estimates of the social and economic benefits of lead hazard control. Environmental Health Perspectives. 2009;117(7):1162-7. Accessed on April 26, 2017
Jones 2012* - Jones DJ. Primary prevention and health outcomes: Treatment of residential lead-based paint hazards and the prevalence of childhood lead poisoning. Journal of Urban Economics. 2012;71(1):151-164. Accessed on April 26, 2017
Korfmacher 2014 - Korfmacher KS, Malone J, Jacobs D. Local housing policy approaches to preventing childhood lead poisoning. Public Health Law Research: Making the Case for Laws that Improve Health. 2014. Accessed on April 18, 2017
Laidlaw 2016 - Laidlaw M, Filippelli G, Sadler R, Gonzales C, Ball A, Mielke H. Children’s blood lead seasonality in Flint, Michigan (USA), and soil-sourced lead hazard risks. International Journal of Environmental Research and Public Health. 2016;13(4):358. Accessed on January 5, 2017
NBER-Wolpaw Reyes 2007 - Wolpaw Reyes J. Environmental policy as social policy? The impact of childhood lead exposure on crime. National Bureau of Economic Research (NBER). 2007. Working Paper 13097. Accessed on April 26, 2017
NCHH-Jacobs 2009 - Jacobs DE, Baeder A. Housing interventions and health: A review of the evidence. Columbia: National Center for Healthy Housing (NCHH); 2009. Accessed on April 26, 2017
NCHH-Lead 2014 - National Center for Healthy Housing (NCHH). Preventing lead exposure in US children: A blueprint for action. 2014. Accessed on April 18, 2017
Pfadenhauer 2016* - Pfadenhauer LM, Burns J, Rohwer A, Annette E. Effectiveness of interventions to reduce exposure to lead through consumer products and drinking water : A systematic review. Environmental Research. 2016;147:525-536. Accessed on January 5, 2017
Reed 2011a* - Reed W. Preventing childhood lead poisoning. In: Lemelle AJ, Reed W, Taylor S, eds. Handbook of African American Health: Social and Behavioral Interventions. New York: Springer; 2011:103-11. Accessed on April 18, 2017
St. Clair 2012 - St. Clair J, Stamopoulos C, Edwards M. Technical note: Increased distance between galvanic lead: Copper pipe connections decreases lead release. Corrosion. 2012;68(9):779-783. Accessed on January 5, 2017
US EPA-Lead - US Environmental Protection Agency (US EPA). Lead: Lead poisoning is preventable. Accessed on April 18, 2017
Vigeh 2014* - Vigeh M, Yokoyama K, Matsukawa T, Shinohara A, Ohtani K. Low level prenatal blood lead adversely affects early childhood mental development. Journal of Child Neurology. 2014;29(10):1305-1311. Accessed on April 26, 2017
Wang 2012* - Wang Y, Jing H, Mehta V, Welter GJ, Giammar DE. Impact of galvanic corrosion on lead release from aged lead service lines. Water Research. 2012;46(16):5049-5060. Accessed on January 5, 2017
WCLPP-Report 2014 - Wisconsin Childhood Lead Poisoning Prevention Program (WCLPP), Wisconsin Department of Health Services (WI DHS). 2014 Report on childhood lead poisoning in Wisconsin. 2016. Accessed on January 5, 2017
White 2015 - White BM, Bonilha HS, Ellis C. Racial/ethnic differences in childhood blood lead levels among children <72 months of age in the United States: A systematic review of the literature. Journal of Racial and Ethnic Health Disparities. 2015:1-9. Accessed on April 18, 2017
Wolpaw Reyes 2015* - Wolpaw Reyes J. Lead exposure and behavior: Effects on antisocial and risky behavior among children and adolescents. Economic Inquiry. 2015;53(3):1580-1605. Accessed on April 26, 2017

Citations - Implementation

BWL-Replaced lead pipes 2016 - Lansing Board of Water and Light (BWL). Lansing Board of Water & Light replaces last lead service line. 2016. Accessed on January 5, 2017
US EPA-Lead contacts - US Environmental Protection Agency (US EPA). Lead: EPA regional lead contacts. Accessed on March 16, 2017
US EPA-Protect your family - US Environmental Protection Agency (US EPA), US Consumer Product Safety Commission, US Department of Housing and Urban Development (US HUD). Protect your family from lead in your home. Washington, DC: US Environmental Protection Agency (EPA); 2012. Accessed on February 28, 2017
WCIJ-Hall 2016 - Hall DJ. Wisconsin launches effort to replace aging lead pipes to safeguard water. WisconsinWatch.org; Wisconsin Center for Investigative Journalism (WCIJ). April 27, 2016. Accessed on January 5, 2017
WCIJ-Schmidt 2016 - Schmidt S. First in the nation: City of Madison replaced all lead pipes. WisconsinWatch.org; Wisconsin Center for Investigative Journalism (WCIJ). February 1, 2016. Accessed on January 5, 2017
WCLPP-Report 2014 - Wisconsin Childhood Lead Poisoning Prevention Program (WCLPP), Wisconsin Department of Health Services (WI DHS). 2014 Report on childhood lead poisoning in Wisconsin. 2016. Accessed on January 5, 2017

Page Last Updated

April 25, 2017

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