For more than two years, students in the Environmental Law and Policy Clinic have worked on a series of legislative and policy initiatives aimed at reducing incidents of childhood lead poisoning in North Carolina. Their efforts are combatting a disturbing statewide rise in lead levels in children’s blood over the past decade, even as levels in other states have fallen.

Students first supported the clinic’s client, nonprofit policy advocate NC Child, in its work with the General Assembly and the Department of Health and Human Services to pass legislation to strengthen the state’s early childhood lead surveillance system. The law, enacted in 2017, cuts in half the blood-lead level at which it takes action to address the health of an individual child, bringing the state standards into alignment with current guidelines from the Centers for Disease Control.

Over several semesters, students have also created educational materials for NC Child that relate to preventing childhood lead exposure. They have mapped the location of childcare centers while coding them by year of construction to indicate the likely risk of lead contamination in drinking water and crafted recommendations for testing in those facilities. Additionally, they have analyzed other states’ approaches to abatement of lead pain exposure in older housing and assessed the costs and practicability of similar testing and mitigation in North Carolina, developing policy arguments on economic benefits of reducing lead contamination. Clinic teams continue to help NC Child identify additional policy and regulatory approaches to preventing childhood lead exposure.

Students presented their work relating to NC Child’s legislative advocacy to North Carolina health researchers and policymakers at the 2017 Environmental Health Scholars Forum.

Tackling issues relating to childhood lead exposure offers students an exceptionally well-rounded learning experience, said Clinical Professor Michelle Nowlin JD/MA ’92, the clinic’s supervising attorney.

“Our work for NC Child marries scientific expertise with legal and policy strategies,” she said. “Students approach the problem using GIS mapping, legal research and policy analysis, outreach and education, economic analysis, and a range of other skills. They also have the opportunity to observe the legislative and regulatory processes our client engages in, to gain a better understanding of how their skills can be applied to address client’s interests and tackle complex problems facing our community.”

And they have been highly effective in doing so, said Tom Vitaglione, NC Child’s senior fellow for health and safety. “It’s just unbelievable work that the clinic has done for us,” he said. “It’s not hyperbole to say we’ve been blessed to have this relationship.”

Helping a client advance long-term public-health goals

Vitaglione, a former head of the children and youth branch of the Women’s and Children’s Health Section within the North Carolina Division of Public Health, explained that elevated lead levels harm a child’s brain development and can have a host of negative effects, including learning disabilities, impaired kidney function, anemia, hearing loss, IQ loss, developmental delay, and behavioral problems. Because common sources of exposure are lead in water pipes in older buildings and lead in paint in older housing, blood-lead levels are often found to be elevated among low-income and minority women and children, raising questions of environmental justice.

NC Child was already a clinic client in 2017 when the governor’s budget offered an opportunity to advance the organization’s long-term goals of improving the surveillance system for monitoring and preventing children’s lead exposure; the budget proposed to substantially reduce the blood-lead level for an individual child that would trigger the deployment of public services to investigate and mitigate the source of lead exposure. But given North Carolina’s contentious political climate, the proposal’s adoption was less than assured, Vitaglione said.

“We needed to develop some advocacy with legislators, and the clinic started producing those kinds of advocacy documents showing why it’s important to mitigate lead in children, how lead affects children’s development — all of that,” he said.

Based on her scientific research, clinic student Jordan Kozal, who is pursuing her PhD at the Nicholas School of the Environment, proposed including maternal transmission of lead among the issues NC Child raised with legislators, as lead stored over a lifetime can leach from a mother’s bones and be passed to her fetus. High lead levels during pregnancy can cause high blood pressure, miscarriage, premature birth and low birth weight, and harm to the fetus’s brain, nervous system and kidneys, and babies can later be exposed to through breastmilk or contaminated water used to make formula. Kozal developed infographics and policy recommendations for NC Child’s legislative advocacy, as well as public education materials on avoiding prenatal and postnatal lead exposure.

“The state government had little information on maternal exposure, so we relied on the clinic to come up with all of the background documents on why it was important to include pregnant women as well as children,” said Vitaglione. “We were very fortunate that with that good background material the clinic had done for us, we were able to get some key legislators to agree.”  As a result, North Carolina’s new standards relating to testing and follow up of blood-lead levels now apply to pregnant women as well as children.

Client service advances students’ professional skills

Kozal said that in translating research into accessible infographics and public presentations she honed skills that are directly applicable to her work as a scientific consultant engaged with litigation support and regulatory comment. “Coming from a niche applied toxicology PhD background, it was interesting to see how the research that gets done ends up being useful in developing laws, but how you really need to communicate it in ways that legislators think is important or the general public can understand.”

Emma Wellbaum, JD/MEM ’21 also found it helpful to apply concepts learned in her legal coursework directly in service to a client. “I got to work on a lot of legal writing and hone the skills that I learned in my first-year legal writing course,” she said. “There was a lot of interaction with the clients, which I think was really valuable because it meant that I was also creating work products that needed to be accessible to a non-legal reader. And I’ve really appreciated learning about some of the bigger, broader concepts of administrative law and seeing how they’re applied.”