This is part two 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. In part one, Allan described how his health department built a successful collaboration that has reduced childhood lead poisoning rates by 74 percent in Cuyahoga County from 2002 to 2011. Below, he discusses how other local health departments (LHDs) can replicate his program’s success.

Last year, Congress cut the Centers for Disease Control and Prevention (CDC) lead program budget from $29 million to $2 million. How have you overcome funding challenges?

The Cuyahoga County Board of Health (CCBH) has not received any funding from the Centers for Disease Control and Prevention (CDC) since 2008–2009. These reductions will impact CCBH due to the reduction in funds the Ohio Department of Health will receive from CDC. This has impacted the ability of the state to conduct surveillance and provide direct referrals of children with elevated blood lead levels. These cuts will also affect the City of Cleveland, which was in part supported by these CDC funds.

Our health department does not have an alternative other than the state for receiving referrals on a consistent basis. We maintain our environmental response capacity based upon the commitment of the CCBH Board, local foundation funding, and grants from the Housing and Urban Development (HUD) Office of Healthy Homes and Lead Hazard Control.

What would you encourage other LHDs to do as a result of your experiences with Healthy Homes?

I would encourage other LHD leaders and staff to do the following:

• Advocate for Community Development Block Grant funds to support lead poisoning prevention activities in your community
• Describe the impact of lead poisoning on educational attainment and advocate for funding from the Department of Energy to support the Home Weatherization Assistance Program, which can reduce lead hazards
• Support the continuation of HUD Healthy Homes funding
• Support the restoration of funding for the CDC’s Childhood Lead Poisoning Prevention branch

As has been said many times by many people, these cuts represent an abandonment of children, particularly children from low-income families who typically need the most help.

Legislative support has also been helpful for our program. Former Member of Congress Louis Stokes has been a stalwart supporter of the lead poisoning prevention initiative in greater Cleveland. He was a Congressional leader who shepherded the initial proposal from HUD to establish the national Healthy Homes initiative in 1999. Rep. Stokes grew up in a HUD housing estate in Cleveland and was a passionate supporter of efforts to reduce childhood lead poisoning and indoor environmental triggers of asthma, particularly among low-income minority children disproportionately impacted by these environmental insults.

Identifying elected officials to champion this work is very important to providing a local and national voice to this important public health issue, which increases opportunities for funding from public and private agencies. These champions can also rally other local officials in support of healthy homes initiatives, which broaden the range of community agencies willing to participate in the work. This type of visible support also provides a platform for families impacted by lead poisoning to share their story and educate the public.

What else is important to know about your work on the Healthy Homes?

We are proud that much of what has taken place in Cuyahoga County has informed many of the models used in programs around the country. Our local success is due to the collaborative spirit and involvement of local foundations, community partners (including Environmental Health Watch), housing-industry partners, medical partners, and overwhelming support from the HUD Office of Healthy Homes and Lead Hazard Control. Without these active partnerships and the tremendous support we have received from the nationwide Healthy Homes community, we would not have been able to make the significant progress we have experienced in Cuyahoga County.