Report 2019-105 Recommendation 5 Responses

Report 2019-105: Childhood Lead Levels: Millions of Children in Medi-Cal Have Not Received Required Testing for Lead Poisoning (Release Date: January 2020)

Recommendation #5 To: Public Health, Department of

To identify the highest priority areas for using resources to alleviate lead exposure among children, CDPH should immediately complete and publicize an analysis of high-risk areas throughout the State.

Annual Follow-Up Agency Response From October 2021

CDPH has completed the analysis of high-risk areas and published it on the CDPH website. https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/CLPPB/Pages/data.aspx

California State Auditor's Assessment of Annual Follow-Up Status: Fully Implemented

1-Year Agency Response

The geographic areas at high risk for childhood lead exposure identified in the biennial report are those zip codes with one or more geospatial risk factors which put children at increased risk of lead exposure. Additional maps to identify various levels of environmental risk areas have being developed at the census tract level and will be published on the CDPH website by January 2021.

California State Auditor's Assessment of 1-Year Status: Partially Implemented

The report CDPH published in its 2020 biennial report did not include sufficient information for its users to identify the highest priority areas for using resources to alleviate lead exposure among children. Its analysis of local health jurisdictions presented a number of blood lead related factors for certain jurisdictions, but did not describe how the rankings in the various categories relate to each other or what the overall risk determination is for each health jurisdiction. Further, its assessment of geographic areas and populations at risk for lead exposure identified essentially the entire State as a risk, making it unclear which geographic areas represented a higher risk than others.

The maps that CDPH submitted as examples of the information it intends to publish in January 2021 appear to better address our recommendation, and we look forward to reviewing the full report.

6-Month Agency Response

CDPH released the Biennial Report, "California's Progress in Preventing and Managing Childhood Lead Exposure" on June 9, 2020. The report is posted on the Childhood Lead Poisoning Prevention Branch website (https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/CLPPB/CDPH%20Document%20Library/CLPPBReport2020.pdf). The report provides statewide data and maps of the number of children with elevated blood lead levels, information about exposure sources and progress in lead exposure prevention and management, and identifies geographic areas at high risk for childhood lead exposure.

California State Auditor's Assessment of 6-Month Status: Partially Implemented

CDPH's report does not clearly indicate what areas present a high risk. Its analysis of local health jurisdictions presents a number of blood lead related factors for certain jurisdictions, but does not describe how the rankings in the various categories relate to each other or what the overall risk determination is for each health jurisdiction.

Further, its assessment of geographic areas and populations at risk for lead exposure is of limited value. It's analysis identified 99.3 percent of the State's zip codes as areas of risk for childhood lead poisoning. Because it identifies essentially the entire State as a risk, it is unclear which geographic areas represent a higher risk than others. As a result, this analysis is not useful for the purpose of identifying which parts of the State represent the highest priority for the limited resources available to address lead hazards.

60-Day Agency Response

CDPH prepared the Biennial Report, "California's Progress in Preventing and Managing Childhood Lead Exposure" and expects to release the report in Spring 2020. This report will be posted on the CDPH CLPPB website as well. The report identifies geographic areas at high risk for childhood lead exposure throughout the State. As of March 2, 2020, CDPH has posted the map outlining the high-risk areas on CDPH website. It is available here on the CDPH website: https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/CLPPB/CDPH%20Document%20Library/2018_BLL_Maps_Tables.pdf

California State Auditor's Assessment of 60-Day Status: Pending

We will review implementation of this recommendation after CDPH publicizes its biennial report.

All Recommendations in 2019-105

Agency responses received are posted verbatim.