Newark’s success shows how infrastructure — homes, schools, office buildings, roads, parks and, yes, pipes — impacts health. I saw this firsthand over 20 years working for and eventually leading Chicago’s public health department. And the country will see it thanks to major new funding from the federal Infrastructure Investment and Jobs Act (IIJA) to replace lead service lines nationwide. Ensuring that communities with the most lead service lines are prioritized for replacement funding is a health, economic and moral imperative.
My career has taught me just how much community conditions affect health. As a pediatrician, I treated children for asthma exacerbated by poor air quality in their homes and neighborhoods. As health department commissioner, I located clinics near public transportation so all Chicagoans could access life-saving vaccines.
I’ve also seen the benefits of prioritizing marginalized communities when improving infrastructure. Chicago’s Connected Communities Ordinance, for instance, provides financial incentives for affordable-housing development and job creation near public transit to benefit residents of neighborhoods typically cut off from such opportunities.
That’s the approach needed for lead service lines. The Environmental Protection Agency (EPA) estimates that there are 9.2 million such lines nationwide. There is no “safe” level of lead; even low levels in children’s blood can damage their brains. Children exposed to lead — half of U.S. children under age 6 have lead in their blood — can suffer lifelong repercussions, from learning and behavior problems to hearing and speech deficiencies.
While every state is affected by lead service lines, some neighborhoods are harmed far more than others. Residential segregation, structural racism and chronic disinvestment in water infrastructure have contributed to higher risk of exposure to lead in drinking water in low-income communities and communities of color, and subsequently to higher blood lead levels among children — Black children in particular — living in those places. Households at risk for lead exposure from water must take extraordinary measures, such as regularly buying bottled water, using filters for faucets or never drinking or cooking with water from their hot water taps.
Achieving the Biden administration’s goal of replacing all lead service lines over the next decade is critical. To ensure an equitable approach, policymakers in charge of funding distribution must start with the most affected communities. Last month, EPA allocated $3 billion from the IIJA for lead service line replacement. The funding distribution formula correctly emphasized the estimated number of lead service lines in each state.
States must follow suit; it is imperative that communities with acute needs but limited capacity to apply for funds are helped, not forgotten. Under the law, 49 percent of lead service line replacement funding to disadvantaged communities must be in the form of grants or principal-forgiveness loans; states should meet or even exceed that threshold. EPA’s Lead Service Line Replacement Accelerators Program, which currently provides technical assistance to localities in four states, should be expanded.
Philanthropy also has important responsibilities. My organization, the Robert Wood Johnson Foundation, recently provided more than $15 million in clean-water grants and investments for places like Little Village in Chicago, where families with low incomes can get lead service lines replaced for free, and Jackson, Miss., where researchers and high school students have teamed up to test home water samples for lead. We’ve also provided $5 million in predevelopment loans to help communities in the Deep South apply for federal water funds.
I’m confident that all lead service lines will eventually be replaced. But how we get there matters. Put health at the forefront. Pair funding with fairness. Prioritize people and places that policymakers have historically overlooked. All families — like those in Newark — will then have peace of mind, not fear, when they turn on the tap. And we’ll be closer to ensuring that all infrastructure projects safeguard and promote — rather than harm — the public’s health.
Julie Morita, a pediatrician, is executive vice president of the Robert Wood Johnson Foundation and former commissioner of the Chicago Department of Public Health. She can be reached on Twitter at @DrJulieMorita.
Governing's opinion columns reflect the views of their authors and not necessarily those of Governing's editors or management.
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