Milwaukee's Data-Driven Strategy to Eliminate Childhood Lead Poisoning

As the most populous city in Wisconsin, Milwaukee’s metropolitan area boasts over 1.5 million residents; however the 180 year-old city is plagued by one of the highest rates of childhood lead poisoning in the country and ranks fifth in the United States’ top ten cities with the most lead pipes. Between 2018 and 2021, nearly 6.25% of children younger than six who were tested for lead in Milwaukee were considered lead-poisoned, with some neighborhoods nearing 25% of children considered lead-poisoning according data to the Wisconsin Department of Health Services (DHS). 

Children before the age of six are especially vulnerable to lead exposure and poisoning – even low levels of lead in blood can cause irreversible brain and nervous system damage, resulting in reduced IQ; behavioral changes including a reduced attention span, antisocial behavior, or violent tendencies; reduced ability to learn; and premature death. Even in adults, lead exposure and poisoning can cause longstanding harm, including increased risk of high blood pressure, cardiovascular problems, and kidney damage.

These high rates of childhood lead exposures come from legacy lead in aging infrastructure – including disintegrating paint in homes, older plumbing, industrial waste, well water, soil, or playgrounds. Moreover, lead contamination is exacerbated in “majority non-White Milwaukee County neighborhoods with high poverty and low home ownership” with a history of redlining and lack of investment from the city.

“There's no safe level of lead for human beings, but especially for our kids,” said Milwaukee Mayor Cavalier Johnson in an interview. “It's important for us to tackle those issues where we're able to in Milwaukee, and we've been doing it over the course of the last number of years here.”

When he became mayor in 2022, Mayor Johnson wanted to find a way to increase the city’s ability to remove dangerous lead service laterals from the ground, and work with the public school system in order to ensure that there was no lead in the schools, in alignment with previous lead abatement work. 

“For lead poisoning specifically, it’s heavily data-driven,” said Tyler Weber, deputy commissioner of the Milwaukee Health Department’s environmental health division. “We have a targeted approach based on data of where we're seeing the worst lead poisoning in our city, which are the heavily red-lined areas with significant historical socio-economic segregation – a vast majority of our lead poison is coming from our Black and Brown neighborhoods.” Weber’s team is using that data to decide where to enact interventions, by following where high blood lead levels are occurring and servicing neighborhoods that need the most support.

With more than 2,000 children in Milwaukee testing positive for lead poisoning each year, Milwaukee’s municipal leaders and departments, including the mayor’s office, Milwaukee Health Department (MHD), Milwaukee Public Schools (MPS), and Milwaukee Water Works (MWW), are working aggressively to reduce by monitoring, testing, and providing resources in positive lead poisoning cases. This multi-pronged, multi-agency approach has helped Milwaukee become a national leader in lead abatement work and a model for other cities to follow.

Data-Driven Strategies and Actions

Replacing Lead Service Lines

A water service line is a pipe that connects a building or residential property to the water main in the street in order for those buildings to have running water and plumbing. In Milwaukee’s aging housing stock, many of those lines are made of lead. While Milwaukee’s water meets all federal and state quality standards when it departs the city’s treatment plants, lead can infiltrate drinking water when it comes into contact with lead pipes or plumbing. 

To protect public health, MWW has been working to replace the city’s aging infrastructure of around 65,000 residential lead service lines by 2037 with the city currently covering 100% of the costs for properties that qualify for the replacement program. Each year, MWW replaces thousands of lead service lines and determines where to replace them based on a Base Program (leaks/failures, licensed childcare centers, and certain planned construction projects), an owner request program which allows property owners to have their lead service lines with cost sharing between the owner and the city, and – most importantly – in neighborhoods where the need is highest and most socioeconomically vulnerable to lead exposure. 

Developing the Milwaukee Prioritization Program

Studies show that Milwaukee neighborhoods characterized by low home ownership, high poverty, and “majority non-White” populations were disproportionately affected by lead exposure and higher rates of childhood elevated blood lead levels (EBLL). Taking this into consideration, MWW is prioritizing their lead abatement efforts with equity-focused decision making by utilizing the Milwaukee Prioritization Program. 

The Milwaukee Prioritization Program looks at three factors when determining which neighborhoods should get lead service line replacements first: the number of children with EBLL, the number of lead service lines in the area, and the neighborhood’s score on the Area Deprivation Index (ADI). The ADI, developed by the UW School of Medicine and Public Health's Center for Health Disparities, combines 17 distinct criteria regarding income, employment, housing, education, and household circumstances, and was designed to inform health-related policy.  The ADI score is revised every two years based on the U.S. Census Bureau’s American Community Survey. 

Based on those three factors, each neighborhood, also known as a Census Block Group, in Milwaukee receives a priority score from zero to 1,000 which ranks them from highest to lowest. The program gives more significance to some factors than others (ADI score: 70%, EBLL incidence: 25%, lead service line quantity: 5%); and every two years, the scores are recalculated to reflect updated factors based on population changes, lead testing results, and completed service line replacements. 

Monitoring with Public Health Data

The EBLL numbers, used in the Prioritization Program, come from Milwaukee’s extensive strategy for monitoring blood lead levels, which focuses on regular blood testing for children, environmental assessment, and water quality testing. MHD recommends universal blood testing for all children in Milwaukee at 12, 18, and 24 months, and then annually through the age of five to provide earlier detection and monitoring. If a child tests positive for elevated EBLL, an investigation is triggered and MHD’s Home Environmental Health program inspects homes for lead-based paint, dust, and soil. Additionally, MWW’s water quality testing certifies that at least 90% of sampled, high-risk customer water taps remain below the U.S. Environmental Protection Agency’s (EPA) action level of 15 parts per billion (pbb).

Every positive blood lead level test is required to be reported to the state, explained Weber. The Wisconsin Department of Health Services' Childhood Lead Poisoning Prevention Program (CLPPP) collects data into the interactive Childhood Lead Poisoning Data Explorer, which MHD staff evaluate to identify trends and at-risk communities. 

MHD additionally utilizes the Healthy Homes and Lead Poisoning Surveillance System (HHLPSS), a web-based data management platform run by the Centers for Disease Control and Prevention (CDC). HLPPS is a national centralized blood lead level monitoring database used by state and local childhood lead poisoning prevention programs that helps MHD conduct daily monitoring of blood lead levels. The database includes identification and confirmation of children with EBLL; address validation and geo-coding; and environmental sampling results.

“We are required by state law to intervene when a child in our jurisdiction has [tested positive for an EBLL of] 15 micrograms per deciliter and above, which is pretty high,” said Weber. “We have our own internal policy that we intervene at 10 micrograms per deciliter and above at our maximum intervention, which is a full lead risk assessment with remediation, which can cost as much as $60,000 to $100,000.”

Funding Residential Lead Abatement Efforts

In May 2022, MHD launched the Lead Hazard Reduction Program, with federal funding provided by the American Rescue Plan Act (ARPA), which was signed into law in March 2021. Milwaukee received $394.2 million in assistance from ARPA, a $1.9 trillion stimulus package aimed at public health and economic recovery from the COVID-19 pandemic distributed to all state and local governments – about $21 million of which Milwaukee city leaders directed to MHD to support the program and a multitude of other lead abatement efforts.

The Lead Hazard Reduction Program services from MHD include: nurse case management and social worker support for families with children with EBLL, and lead safe home kits and lead water filters to all residents in the program. MHD is often working up to two years with families who have children with lead poisoning, providing nurse home visits, phone calls, and regularly monitoring blood lead level tests to make sure lead levels are going down, explained Weber.

The program also provides approximately $40,000 of lead hazard reduction work per housing unit in the program to ensure homes are lead-paint safe. MHD coordinates with community partners and nonprofits who work with local contractors such as Habitat for Humanity Milwaukee, Revitalize Milwaukee, and the Social Development Commission, to make sure houses are safeguarded against lead.

In 2024, an infusion of $30 million in federal funding from the Bipartisan Infrastructure Law allowed MWW to accelerate its lead replacement work from roughly 1,000 in 2023 to 5,000 replacements in 2026, and provide no-cost replacements for property owners. “We have worked very closely with the federal government during President Joe Biden and Vice President Kamala Harris's administration,” said Mayor Johnson. “I reminded [them] that if you want to see things get done, then put those dollars in the hands of cities and mayors, and we will put them to work. And that's exactly what we did in Milwaukee, using those federal resources to remove more lead service laterals out of the ground.”

As of January 2026, MWW has replaced 12,566 lead service lines according to the lead pipes dashboard on MWW’s website, where Milwaukee residents can also check if their home has a lead service line, see results from water sampling tests, and find information on resources. 

How Can My City Do This?

Even as a national leader in lead abatement and with all of the current lead monitoring, assessment, and abatement work in Milwaukee, there are still challenges: the current blood lead testing rate is roughly only 40-50% of the children in the city. As a result, the frequency of childhood lead poisoning remains a top public health priority for Milwaukee, and offers lessons for other cities.

Prioritize Partnerships

“The vast majority of the money is going into actually fixing the homes… but the health department can't do it alone,” said Weber. “We need more help fixing up houses, and ARPA allowed us to develop a very strong relationship with Habitat for Humanity locally. Now, we have them contracted to do lead abatement on an additional 50 homes this coming year.”

“We're one of the only municipalities in the country that, when making a prioritization schedule of what blocks and what neighborhoods to focus lead service line replacement on, we actually use lead poisoning data – that's the Health Department and state data,” said Weber. “We also have data sharing agreements with the utilities so that we can intervene together on lead poison cases and try and remove the lead service line and do more than give the family a water filter.”

Use Mayoral Leadership

When asked what advice he has for other city leaders who are facing public health issues such as widespread lead contamination, Mayor Johnson’s response addressed both the internal workings of local government and external communications to the public.

“At the mayoral level, you've got to have the political will in order to address a huge challenge like this,” stated Mayor Johnson. “It's also important to make sure that you have the right people in place with the right sort of mindset and aptitude – our Department of Public Works, our Water Works, our Department of Neighborhood Services, the Health Department too – all of those city agencies work in collaboration in one way or another in order to address the challenge. All of them understand the magnitude of it, all of them want to work, and they have been working diligently over years to address the issue.”

Build Trust with the Public

Finally, Mayor Johnson emphasized earning the goodwill of the public. “Another thing that's important too is for the mayor to showcase to the community why it's important to do this, to highlight the fact that this is about public safety, that this is about public health, and get the neighborhoods on your side,” Mayor Johnson explained, “because these construction efforts to remove lead service lines out of the ground can be intrusive and cause disruptions, so you need the public to be on your side in this as well. If you have that sort of cocktail of ingredients together, I think that mayors will be able to tackle the challenge.”