This is part one of a two-part interview with Terry Allan, RS, MPH, Health Commissioner, Cuyahoga County Board of Health, and current NACCHO president. Cuyahoga County Board of Health serves a population of approximately 855,000 in the greater Cleveland area. Below, Allan discusses how his health department has created a nationally replicated childhood lead poisoning prevention program.

Please provide us with a brief overview of Cuyahoga County Board of Health’s lead poisoning prevention program.

The Cuyahoga County Board of Health (CCBH) operates a comprehensive childhood lead poisoning prevention program as one of 16 delegated authorities of the Ohio Department of Health. CCBH has ten Licensed Lead Risk Assessors on staff. We receive approximately 100 referrals per year of children with elevated blood lead levels from the state and provide environmental testing, office-based case management services, and blood lead screening through our office clinic. The program is supported by a series of large competitive grants we have received from the Department of Housing and Urban Development (HUD) Office of Healthy Homes and Lead Hazard Control for home assessment and remediation since 2000.

The program began with the incorporation of the City of East Cleveland into our health district in 1990. East Cleveland historically has had the highest rates of childhood lead poisoning in Cuyahoga County, reaching as high as 25 percent in the 1980s. The State of Ohio passed the first lead poisoning law in 1995 establishing the requirements for surveillance and response. The latest state law passed in 2004 established the modern, aggressive framework for responding to children with elevated blood lead levels. Grounded by a comprehensive program and broad community collaboration in place in Cuyahoga County since 2002, the rates were slightly above eight percent in 2011.

How have collaborations strengthened your program?

The Greater Cleveland Lead Advisory Council was initially formed in 2002. The group’s name was changed in 2012 to the Healthy Homes Advisory Council of Greater Cleveland. This reflected a change in the strategic priorities towards a comprehensive whole-house approach to incorporate asthma and chronic obstructive pulmonary disease in addition to lead. The main reason this collaborative continues to exist lies in the fact that we have seen a 74 percent reduction in childhood lead poisoning rates in Cuyahoga County from 2002 to 2011.

How did you make the Healthy Homes collaborative sustainable?

Funding sustainability is a major priority for our program and for programs across the country. The program is funded through limited general revenue support from CCBH, local foundation funding from the Saint Luke’s Foundation and Mt. Sinai, limited Medicaid reimbursement provided through the Ohio Department of Health, and support from the HUD Office of Healthy Homes and Lead Hazard Control grants. We have maintained the program by having CCBH staff work as generalists among many programs and by including lead poisoning prevention as an integrated service rather than a stand-alone program.

While CCBH serves greater Cleveland, the City of Cleveland has its own health department. Please describe the cross-jurisdictional issues that have arisen as a result of this work.

A majority of the cross-jurisdictional work has taken place through the Healthy Homes Advisory Council, where both the Director of the Cleveland Department of Public Health and the CCBH Health Commissioner are co-chairs. This collaboration, in concert with the 75 agencies participating on the Healthy Homes Advisory Council, has made for a very impactful program.

Additionally, the Cleveland Department of Public Health has been a sub-recipient on our current HUD Lead Hazard Reduction grant. To ensure the sustainability of our partnership, we have incorporated new opportunities to share resources to maximize community dollars into our new business plan development process. We are also exploring opportunities to gain reimbursement for a range of prevention and intervention services from Medicaid and private payers.

Has your work with Healthy Homes produced the outcomes you first had in mind?

Our work in Healthy Homes first began as a response to cases of idiopathic pulmonary hemosiderosis (lung bleeding) in greater Cleveland in the mid-1990s, which were associated with the home environment of the children afflicted with these cases. This led to the award of our first HUD Lead Poisoning Prevention grant in 1998 and the first HUD Healthy Homes grant in 2000. These opportunities fostered collaborative initiatives with Case Western Reserve University and the Cleveland Department of Public Health to work on issues that have profound public health and future workforce readiness implications.

The HUD Healthy Homes grants have demonstrated that a positive change in the home environment has a direct impact on health outcomes and healthcare utilization. The next step is to provide environmental assessments and interventions for patients suffering from chronic respiratory disease so that we can improve health outcomes while simultaneously reducing healthcare costs.