"We're not to trying to take anything away from Flint," said Elyse Pivnick, director of environmental health for Isles Inc., a community development organization based in Trenton. "But, whoa, we have to tell the story of lead in Pennsylvania and New Jersey, too."
Regional health officials on Thursday, while expressing concern for children exposed to lead, insisted that the advocates were mismatching data and failing to recognize the progress that has been made.
Though the focus in Flint is on water, the biggest source of lead remains chipping and flaking paint in old and poorly maintained houses. Despite improvements in recent years, blood lead levels remain high, especially among poorer children.
The controversy also shows that lead numbers are tough to interpret, and that lead's impact on individuals can vary dramatically.
Tom Vernon, a Philadelphia physician and former director of Colorado's Department of Health, agreed that lead is less of a problem these days due to measures such as removing it from gasoline and paint.
"But that good news is offset by what we're learning about the effects on school achievement and executive function at lower and lower levels of lead exposure," Vernon said.
There is no safe level of lead exposure for children, according to the Centers for Disease Control and Prevention. But a blood lead level of 5 micrograms per deciliter is the threshold that should trigger public health action, according to the federal agency.
That's a relatively new threshold; a few years ago, 10 micrograms was the federal standard, as it still is in New Jersey, according to its health department.
The debacle in Flint was created when the city opted for a cheaper municipal water supply. In 2015, 112 children of the 3,340 tested - or 3.3 percent - had a blood lead level of at least 5 micrograms, according to data collected by Michigan health authorities.
Comparisons between Flint and other cities are not perfect because of how the data are collected and the differing test periods. But the numbers are striking.
Philadelphia, which has 15 times Flint's population, tested 35,863 children under the age of 7 during the 2014 calendar year. Of those, 3,655 - or 10.2 percent - had blood lead levels of 5 or greater.
Some states, including New Jersey, mandate lead testing, a position supported by the American Academy of Pediatrics. But in others, such as Pennsylvania, physicians determine which of their patients should be tested. Lower-income children in older houses are considered at highest risk.
"It only takes a couple of paint chips to substantially increase the blood lead level," said Marilyn Howarth, a physician at the Center of Excellence in Environmental Toxicology at the University of Pennsylvania.
"Although the CDC has established the reference level at 5 [micrograms], they're not saying that 5 is safe," Howarth said. "At 5, there is evidence that nerves are affected, and there can be impact on IQ, development, and behavior."
Lead poisoning often is not noticed, because it can be subtle, Howarth said. Initial symptoms may include fatigue, lack of motivation, poor coordination, and problems with speech and language.
"People rarely bring their child to a doctor because of those symptoms," Howarth said. "They are easily overlooked."
Long term, the damage can mean a lifetime of intellectual limitations and other neurological damage. Freddie Gray, whose death from injuries sustained while in police custody last year sparked riots in Baltimore, was tested for lead as a child six times, the Baltimore Sun reported. Gray and his two sisters had lead levels between 11 and 19 micrograms, according to legal documents, leading "to multiple educational, behavior, and medical problems."
In Pennsylvania, 13,000 children under age 7 were known to have blood lead levels over 5, according to the 2014 Childhood Lead Surveillance Report. That marked a decrease of nearly 7 percent from the previous year. In the New Jersey report for that year, more than 5,400 children were similarly affected.
Philadelphia data, collected by the Division of Disease Control in 2012, showed children with the highest lead levels concentrated in Center City, Roxborough/Manayunk, and a sizable swath of West Philadelphia.
"Unfortunately, in a city where 39 percent of children are living in poverty, you then put them in a home or a day-care center where there is lead, and it's a double whammy for that child," said Daniel Taylor, director of community pediatrics and child advocacy at St. Christopher's Hospital for Children.
"However, I'm a bit skeptical of the Philadelphia numbers," the pediatrician said. "We're in the epicenter of old homes, poverty, immigrants, and refugees, but I don't see lead poisoning in one of every 10 kids."
Pennsylvania health officials on Thursday signaled their concern over the situation without mentioning Flint. "The Department of Health is very concerned about elevated lead levels in children wherever they may occur," Health Secretary Karen Murphy said in a statement.
Jeff Moran, a spokesman for the Philadelphia Health Department, said comparing the city to Flint would be "inappropriate." In New Jersey, Health Department spokeswoman Donna Leusner said her state has been a national leader on the issue.
"Our cases have steadily declined, making comparisons with the acute crisis in Flint misleading and unfair," Leusner said.
"Of course it's not exact," she said. "But we're trying to make the point that while there's attention being paid to Flint, we have a chronic problem of children being poisoned, and it's not getting enough attention."
It costs about $8,000 per dwelling to remove lead. But the costs of lead poisoning are potentially far greater, said Jay Schneider, who researches lead's effects on children at Thomas Jefferson University.
In addition to the burden on the health-care system, there are costs for special education for children with neurological damage. Down the line, courts and prisons bear the load for behavior that has been linked to lead poisoning.
Lead poisoning is a danger even before birth, he explained. Lead is stored in the bones, and can be released during the stress of pregnancy.
"And now that lead has access to the fetus," he said.
Recent research also suggests lead poisoning can alter human DNA, Schneider said, leading to damage that can be passed to subsequent generations.
"If you can't get kids out of the lead environment, you'll have to find a way to deal with the kids after they've been poisoned," Schneider said.
Pa., N.J. Children and High Lead Levels
The table below shows the proportion of children under 7 (under 6 in New Jersey) whose tests showed elevated blood lead levels in selected Pennsylvania and New Jersey cities in 2014. Cities were selected for analysis because of their risk factors for lead poisoning: high proportions of children under 7, families with low income, and older housing.
In Flint, Mich., 3,340 children under the age of 6 were tested in 2015. Of those children, 112, or 3.3 percent, had elevated levels of lead.
Under-7 Child Children Children With Tested With
City Population* Tested High Lead Levels High Levels**
Allentown 12,747 2,484 574 23.1
Altoona 4,190 792 162 20.4
Bethlehem 5,757 908 130 14.3
Chester 3,852 852 117 13.7
Easton 2,463 778 123 15.8
Erie 10,269 2,937 355 12.1
Harrisburg 5,829 2,467 300 12.2
Johnstown 1,975 690 126 18.3
Lancaster 6,356 1,904 210 11.0
Lebanon 2,767 608 79 13.0
Norristown 4,113 1,509 178 11.8
Philadelphia 138,163 35,863 3,655 10.2
Pittsburgh 20,390 7,935 660 8.3
Reading 11,537 3,234 522 16.1
Scranton 6,225 1,018 198 19.4
Wilkes-Barre 3,304 638 84 13.2
Williamsport 2,676 566 68 12.0
York 5,460 1,612 200 12.4
Atlantic City 3,677 1,738 177 10.2
East Orange 5,534 1,896 147 7.7
Elizabeth 11,792 4,921 195 3.9
Irvington 4,993 2,705 229 8.4
Jersey City 20,393 8,605 347 4.0
New Brunswick 4,753 1,747 64 3.6
Newark 24,831 14,030 800 5.7
Passaic 8,226 4,433 163 3.7
Paterson 13,987 6,407 310 4.8
Plainfield 4,961 2,892 127 4.4
Trenton 7,998 3,421 214 6.3
* 2010 census (under 6 in New Jersey)
** An elevated blood lead level is 5 micrograms per deciliter or greater
SOURCES: Pennsylvania and New Jersey Departments of Health