Making the Case for Use of Federal WIC Funds to Conduct Blood Lead Testing¹

Download this brief as a PDF

Childhood lead exposure remains a persistent environmental health threat, particularly for low-income minority children.^[2] Research has shown that children in families receiving public assistance such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are more likely to have elevated blood lead levels than children not enrolled in a public assistance program, and that targeted testing of WIC participants could help identify additional children with elevated blood lead levels.^[3] Testing participants for lead when they visit a WIC office for their required anemia test provides both an excellent and convenient opportunity to implement the Centers for Disease Control and Prevention’s (CDC) recommendation to target blood lead testing of children participating in federal programs, as well as address nationally persistent low testing rates.^[4] Importantly, there is no federal statutory language explicitly prohibiting WIC funds for blood lead testing, and use of WIC funds for this purpose has historical precedent.^[5] For these reasons, we recommend issuance of guidance/rules permitting federal WIC funds to be used to conduct blood lead testing, as well as for supplying lead-safe water filters and ready-to-feed formula.

Lead Poisoning: An Overview

Many children in the United States are falling through the cracks of early childhood lead testing requirements, leading to continued lead exposure and adverse health, learning, and behavioral consequences. Even small amounts of lead in the body can cause harm.^[7] Lead poisoning is entirely preventable, but remains a persistent public health problem in the United States.^[8] Young children are particularly vulnerable to lead poisoning because they absorb lead more easily than adults and their developing nervous systems are especially susceptible to the effects of lead exposure.^[9] Early detection of lead poisoning in children is important because “the harmful effects of childhood lead exposure can ripple out through adolescence and adulthood, imparting lifelong consequences on the social and learning abilities of a child.”^[10]

In adults, lead poisoning can cause high blood pressure, problems with memory and concentration, mood disorders; and miscarriage, stillbirth, or premature birth in pregnant women.^[11] In a pregnant woman, lead may cross “the placenta and can have a detrimental impact on a developing fetus.”^[12] Infants who have been exposed to lead prior to birth may be born prematurely, have a lower birth weight, and experience delayed growth.^[13] Mothers who have been exposed to very high levels of lead can pass lead to the infant through breast milk until their lead levels decrease,^[14] potentially impacting the infant’s health and development.

Despite the devastating effects of lead poisoning and the ability to prevent and mitigate exposure, the rates of testing children for lead are far from where they should be. All children enrolled in Medicaid are required to be blood lead tested at ages 12 and 24 months.^[15] However, in 2016 only 10.0% of children five years of age and younger were tested nationally.^[16] More than 60% of children were enrolled in Medicaid or the Children’s Health Insurance Program in 2017,^[17] indicating a substantial number of publicly insured children do not receive the required testing.

Overview of WIC

WIC’s mission is to safeguard the health of low-income women, infants, and children up to age 5 who are at nutritional risk.^[18] In federal fiscal year 2016, WIC served 7,696,439 participants.^[19] WIC provides federal grants to states to assist in meeting the nutrition needs of this population primarily through nutrition education and WIC food packages.^[20] The goals of WIC’s nutrition education are to 1) emphasize the relationship between nutrition, physical activity, and health and 2) assist the individual at nutritional risk in achieving a positive change in dietary and physical activity habits, including prevention of nutrition-related problems through use of WIC supplemental foods and other nutritious foods.^[21]

To qualify for WIC, an applicant must also “be determined to be at nutritional risk.”^[22] Lead poisoning is an example of a nutritionally-related medical condition which qualifies as a nutritional risk basis for certification of eligibility for the WIC program.^[23] To help prevent childhood lead poisoning, the CDC recommends targeting children in federal programs such as WIC for blood lead testing.^[24]

WIC’s Role in Preventing Lead Exposure

Although WIC agencies are not allowed to use WIC funds to test participants for lead, the program already aims to assist participants with lead exposure in a variety of ways. The U.S. Department of Agriculture (USDA) has noted that “the nutrition assistance programs administered by USDA’s Food and Nutrition Service (FNS) may help lessen the negative impacts of lead exposure by using nutrition as a tool which may mitigate lead absorption.”^[25] Indeed, “WIC foods contain good sources of calcium, iron and Vitamin C, nutrients that have been shown to help reduce the absorption of lead in children's bodies. Additionally, the WIC cash value voucher can be used to purchase fruits and vegetables that are good sources of vitamin C and calcium.”^[26] Furthermore, WIC agencies can assess the history of lead testing and administer risk assessment questionnaires for infants and children, refer for testing, provide nutrition counseling, and some even conduct capillary blood testing using non-WIC funds and non-WIC paid staff time.^{[27] [28]}

In 2016, the USDA temporarily granted Michigan permission to use WIC funds to conduct lead testing for WIC participants.[29] This was part of the Department’s efforts to support residents in Flint, Michigan by mitigating “the ill effects of the city’s water crisis on their health and wellbeing.”^[30] This temporary permission highlights the USDA’s recognition that targeted testing of WIC participants can help detect and prevent lead exposure. Ultimately, WIC has the potential to play an important role in combating lead poisoning through early testing, nutritional foods and education, and providing water filters and ready-to-feed formula (discussed below).

WIC and Blood Lead Testing

There is no federal statutory language explicitly prohibiting the use of WIC funds for blood lead testing. In fact, WIC funds’ use for lead testing has historical precedent.