Collaboration to achieve health policy change: PHN and the NC Rural Communities Assistance Project

Lead has long been recognized as a dangerous and potentially lethal source of children's environmental poisoning. Increasingly sensitive biomonitoring, psycho-educational evaluation, and social epidemiological analysis have revealed the potential lifelong consequences of low level lead exposure in children,(defined as BLL<10 µg/dL). The 2010 Social Policy Report: Protecting Children from Exposure to Lead, Old Problem, New Data, and New Policy Needs, summarizes the “robust” evidence for the correlation between low BLL in children and negative impacts on cognitive development and behavior. It goes on to say that current federal and state-level child screening and lead level reporting practices are inadequate. Children's lead screening policy is under scrutiny by the CDC Childhood Lead Poisoning Prevention Branch. In North Carolina, two counties have successfully lowered the “action level”. In another NC county, the NC Rural Communities Assistance Project, (NCRCAP), partnered with a PHN faculty, the county health department, and medical providers to promote a similar policy change. NCRCAP successfully utilized a lay health advisor model to conduct in-home outreach visits to parents and caregivers. Through culturally competent health education programs in targeted highest risk areas, NCRCAP gathered data critical to implementing the health policy change. In 2008, the NCDEH sent “Report Cards” to all medical providers detailing their blood lead screening rates for Medicaid-eligible one and two year olds. These reports provided a catalyst for medical provider intervention described in this session. We describe the key steps used to promote environmental health policy change in an economically challenged rural NC county.