In a natural experiment profiled in an article being early released this month in Pediatrics, Danagoulian et al analyzed lead testing data of over 200,000 children enrolled in Medicaid in Michigan (born between 2013-2015) before and after the September 2015 lead health advisory was issued for Flint, Michigan (REF) . The authors’ primary outcome of interest was to determine if children were tested for lead earlier (prior to 12 months) and whether there was an increase in the total number of children tested statewide by 2 years of age. The analysis controlled for potential confounders including parental age and education, smoking during pregnancy, race, and child’s sex and birthweight.
While the authors noted an ephemeral increase in early lead testing (10 months as opposed to 12 months) in the city of Flint after the advisory was sent, the cumulative testing of all children by 24 months of life was unchanged in Flint and other jurisdictions throughout the state. These findings suggest that there is no clear association between the public health emergency declaration regarding contaminated water and if or when children are tested for lead.
The authors correctly point out that lead testing is, at best, secondary prevention and that the focus should prioritize primary preventative methods. However, authors note that lead testing continues to be important for early intervention and surveillance—particularly among children living in at-risk geographic areas. This article reminds us that a public health emergency declaration is not sufficient to induce needed change; we must take actions (e.g. pressing decision-makers for lead abatement in homes and drinking water sources) that result in primary prevention and incorporate such actions into our care for patients. This applies to topics ranging from immunizing our patients against COVID-19 to following guidelines outlined in Bright Futures.
