Addressing Childhood Lead Poisoning with Health in All Policies Strategies

In October 2018, NACCHO, along with the National Environmental Health Association (NEHA), the Association of State and Territorial Health Officials (ASTHO), and the National Center for Healthy Housing (NCHH) began a collaborative project to address lead poisoning using a Health in All Policies (HiAP) approach, informally referred to as the HiAP + Lead Collaborative.

NACCHO defines HiAP as a change in the systems that determine how decisions are made and implemented by local, state, and federal governments to ensure that policy decisions have neutral or beneficial impacts on health determinants. HiAP emphasizes the need to collaborate across sectors and break down “silos” to achieve common health goals. It is an innovative approach to the processes through which policies, plans, and programs are created and implemented but does not require that health be at the center of every policy, plan, or program.

Local health departments possess the legal authority, responsibility, and mission to protect and promote the public’s health, so they are natural leaders to implement HiAP at the local level by acting as facilitators to convene partners and stakeholders—such as city or county officials, planning or transportation departments, community-based organizations, local businesses, developers, and advocates—to address the policy and structural factors affecting health within communities. HiAP often fits within local health departments’ ongoing efforts to improve population health through policy, systems, and environmental change strategies.

Meeting of the project partners and grantees in Washington, DC in July 2019

The HiAP + Lead Collaborative involves working with three local health departments to address at least one of several childhood lead related activities or outcomes (e.g., lead testing awareness, case management coordination, surveillance, implementation of BLRV). The communities were identified through a rigorous application process and represent diverse high-need communities. The 2018-2019 health department grantees were the Allegheny County Health Department (PA), Louisville Metro Public Health and Wellness (KY), and the Houston Health Department (TX).

Each health department received a $20,000 grant, technical assistance from all four national partners, HiAP translation tools specific to addressing childhood lead, opportunities for HiAP capacity building, and support in developing draft cross-sectoral lead prevention implementation plans.

Allegheny County

The Allegheny County Health Department subcontracted with the community organization Women for a Healthy Environment to cement the establishment of the Lead-Safe Allegheny Coalition. The focus of the funding is to twofold: 1) begin developing workgroups, goals, and overarching policies/procedures; and 2) facilitate exploratory conversations among diverse stakeholders to assess opportunities to bring additional resources to the region for lead poisoning prevention. Highlighting the work in Allegheny County, NACCHO, ASTHO, NEHA and NCHH will be presenting with Women for a Healthy Environment at the American Public Health Association Annual Conference on Tuesday, Nov. 5 in Philadelphia.


Louisville Metro Public Health & Wellness hired and onboarded a program coordinator to 1) update their internal case management database to obtain more user-friendly, relevant, high quality data; 2) begin a series of community outreach events and use lessons learned to inform development of additional events; and 3) work with local partners to evaluate and assess overarching data needs and sharing opportunities. To learn more about the work of Louisville Metro Public Health and Wellness view their presentation on NACCHO’s July 2019 HiAP webinar or view the new Louisville HiAP success story.


Houston Health Department’s work primarily focused on enhancing workforce capacity and integrating data and evaluation systems. The health department completed lead paint housing/lead-risk/historical screening data overlay maps, hired and onboarded a community outreach representative to complete seven training workshops, trained ten residents to deploy as block captains/community ambassadors throughout the Fifth Ward, and developed new cross-sector partnerships. For more information of the Houston Health Department’s HiAP + Lead work, view this webinar coordinated by NEHA in July 2019.

The HiAP + Lead Collaborative partners were impressed with the progress of the three grantees, and they plan to find additional mechanisms for promoting their work. Additionally, the HiAP + Lead Collaborative partners focused on creating resources for a broad health department audience, such as the 2019 fact sheet, Health Department Strategies for Implementing Health in All Policies to Reduce Lead Exposure. This fact sheet is an updated version of NACCHO’s 2014 HiAP factsheet detailing state and local examples of health departments using one of the seven HiAP strategies to address lead poisoning prevention.

In the upcoming 2019-2020 project year, the HiAP + Lead Collaborative will continue working to support health departments to address childhood lead poising prevention and reduction. However, the structure of the collaboration will expand, with NCHH continuing to fund and support the three health departments from year one of the collaboration. The expansion will involve NACCHO awarding up to five local health departments funding and technical assistance, ASTHO awarding up to two state or territorial health departments, and NEHA working with the Green and Healthy Homes Initiative (GHHI) to develop work products examining the connection between populations that require lead-related assistance and other social services at the local level.

For more information on NACCHO’s HiAP + Lead work please visit our HiAP webpage. If you would like to receive regular HiAP email updates, please contact Bridget Kerner at


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