Goodman A K, Shultz H, Klitzman S, Kimmelblatt M, Spadaro W
Department of Health, New York City.
Bull N Y Acad Med. 1993 Winter;70(3):236-50.
The major challenge for lead poisoning prevention programs is to increase the availability of lead-safe housing as quickly as possible. The approach proposed by the City of New York maximizes the impact of the limited resources available to address this problem. The approach, however, is based on an assumption that in the short-term, modest lead hazard reduction measures such as restoring surfaces to an intact condition is adequate for most units and that more extensive abatement should be reserved for the relatively fewer units in which there is a high risk of exposure of lead-poisoned children reside. Ideally, this plan would be implemented with voluntary efforts to abate lead hazards when other renovation or remodeling occurs or when dwellings are vacant and more extensive abatement work can be performed at lower cost and without the attendant difficulty of abating occupied units. Approaches ranking hazards and implementing varying levels of hazard reduction must be fully evaluated and modified as new information becomes available. The specific criteria used to rank hazards should be evaluated to determine what measures best differentiate risk. Given the magnitude of the problem and the numerous obstacle--lack of funding, limited trained workers, and limited technical knowledge--it will probably take years, if not decades, to abate lead hazards in all the dwellings in which they exist. We must not be deterred, however, from beginning this effort in the communities and dwellings that need intervention the most: deteriorated, older housing units in which young children reside. In major urban centers such as New York City the greatest lead hazards will generally be found in areas where poverty is greatest. Thus, every effort must be made to ensure that adequate resources are available to improve housing in the communities in greatest need.
预防铅中毒项目面临的主要挑战是尽快增加安全无铅住房的供应量。纽约市提出的方法最大限度地利用了有限资源来解决这一问题。然而,该方法基于这样一种假设:短期内,对于大多数住房单元而言,诸如将表面恢复到完好状态等适度的铅危害降低措施就足够了,而更广泛的消除铅危害措施应保留给相对较少的那些有铅中毒儿童居住且接触风险高的单元。理想情况下,当进行其他翻新或改造工程时,或者当住宅空置且可以以较低成本进行更广泛的消除铅危害工作且不存在消除有人居住单元铅危害带来的相关困难时,该计划应通过自愿努力来消除铅危害得以实施。对危害进行排名并实施不同程度的危害降低措施的方法必须在有新信息可用时进行全面评估和修改。用于对危害进行排名的具体标准应予以评估,以确定哪些措施能最好地区分风险。鉴于问题的严重性以及众多障碍——资金短缺、训练有素的工人有限和技术知识有限——消除所有存在铅危害的住宅中的铅危害可能需要数年时间,甚至数十年。然而,我们绝不能因此而退缩,不在最需要干预的社区和住宅中展开这项工作:有年幼儿童居住的破旧老房子。在纽约市这样的主要城市中心,最大的铅危害通常会出现在贫困程度最高的地区。因此,必须尽一切努力确保有足够的资源来改善最需要帮助的社区的住房条件。