“Clean Water for Carolina Kids” Program Wins Harvard’s Roy Award for Environmental Partnership

NC Child & partners’ work protects North Carolina’s children from dangerous lead exposure  

By: Fawn Pattison | September 2020

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CONTACTS:  Vikki Crouse, NC Child  vikki@ncchild.org
April Umminger, RTI International   news@rti.org

FOR IMMEDIATE RELEASE – September 9, 2020

CAMBRIDGE, MA –The Environment and Natural Resources Program at Harvard Kennedy School’s Belfer Center for Science and International Affairs announced today that Clean Water for Carolina Kids is the winner of the 2020 Roy Family Award for Environmental Partnership. The partnership of RTI International, NC Child, the Duke Environmental Law and Policy Clinic, and the North Carolina Division of Public Health protects children and infants from exposure to lead from drinking water at child care centers and schools.

The prestigious Roy Family Award is presented every two years to celebrate an outstanding cross-sector partnership project that enhances environmental quality through novel and creative approaches. This year’s winning project leveraged the combined strengths of each of the partners – a nonprofit research institute, a community advocacy group, a pro-bono public interest law school clinic and a state public health agency – to make a critical advancement in children’s health in North Carolina.

“For almost 20 years, the Roy Family Award has recognized partnerships that provide tangible benefits for people and the environment with the hope that the benefits could be transferred to millions,” said Henry Lee, Director of the Environment and Natural Resources Program, which coordinates the award. “The 2020 winner more than meets this high standard. The partnership will protect hundreds of thousands of children in North Carolina while providing a replicable model for other states and regions – and a shining example of how science-driven, highly-local approaches can effectively address environmental and public health challenges.”

It is estimated that 800 million children worldwide have dangerous levels of lead in their bodies. Lead causes damage to children’s developing brains and nervous systems even at very low concentrations, causing irreversible cognitive decline and behavioral difficulties. Standard public health practice is to test and treat children after exposure rather than proactively rooting out lead poisoning sources.

The Clean Water for Carolina Kids partnership was formed to address early childhood exposure to lead from drinking and cooking water. A 2017 RTI study piloted its novel testing approach at child care centers and elementary schools with pre-kindergarten Head Start programs. Lead was detected above 1 μg/L in 63% of centers, and 97% of centers had at least one tap with detectable Pb (0.1 part per billion, or ppb). One in six centers contained lead above 15 ppb in at least one tap. Variability of lead concentrations was high among individual taps within centers, suggesting every tap used for drinking or cooking should be tested (Redmon et al., 2020).

Given the study findings and the proven feasibility of the testing approach, the partnership evaluated legal and regulatory options for statewide testing with input from stakeholders. In fall 2019, a new statewide rule was adopted that requires all licensed child care centers to test for and remove lead in water used for drinking or food preparation. It is the first-of-its-kind lead in water testing program nationally to make large scale, yet scientifically robust testing feasible while empowering child care centers and schools to participate as citizen scientists.

“The teachers and administrators in North Carolina’s child care centers deserve enormous gratitude for the ways they go the extra mile for young children every day,” said Vikki Crouse, Policy Analyst/NC KIDS COUNT Project Director at NC Child. “They understood immediately that infants and young children are uniquely sensitive to the long-term, harmful impacts of lead exposure. Their willingness to show up for families and young kids – as teachers, as caregivers, and now as citizen scientists – inspires us all to work harder for kids each day.”

“Lead disproportionally impacts children and members of our most vulnerable communities,” notes Jennifer Hoponick Redmon, the Project Director and a Senior Environmental Health Scientist at RTI International. “Our partnership aims to proactively identify and remove lead in water sources so that all children, and especially those in disadvantaged and minority communities, may reach their full potential.”

The approach includes the use of mail-out test kits, an online enrollment and reporting portal, and most importantly, training and communication support. Coincidentally, the testing approach is also ideal during the COVID-19 pandemic. Using this community-based approach allows child care and school administrators to understand the problem, communicate with staff, parents, and children, and take collective action to make water quality improvements.

With federal grant funding since April 2020, the program is currently testing and providing communication support for needed mitigation in all open licensed North Carolina child care centers and elementary schools with Head Start programs. When lead is identified, there are often simple options for getting it out of taps, including the use of no-cost clean water habits along with low-cost solutions such as the replacement of lead-contaminated faucets or the installation and maintenance of filtration systems.

“The Clean Water for Carolina Kids collaboration has been critical to extending the reach of environmental health programs working against limited resources and diminished public trust,” said Ed Norman, the Program Manager for the NC Childhood Lead Poisoning Prevention Program. “We continue to improve the safety of drinking water throughout our state by eliminating faucets and plumbing that leach dangerous amounts of toxic lead into water. Our partnership has improved the health outcomes of thousands of North Carolinians beginning in childhood but lasting a lifetime.”

Although the described approach does not solve the United States’ aging infrastructure crisis – which is complex and requires significant financial investment to resolve – it prevents childhood exposure to lead in drinking and cooking water in a timely manner, before today’s children are tomorrow’s adults. By focusing on prevention, the partnership will protect the 230,000 children ages six and under in child care centers and schools in North Carolina. A net economic benefit of $6.4 million in the first six years of the program’s implementation is expected from avoided health care costs and increased lifetime earnings.

An expansion of the program is planned in 2021 for voluntary testing of family child care homes and elementary schools, with enrollment prioritized based on financial need, racial equity and building age. While North Carolina is the first state in the U.S. to use this novel approach to identify lead in child care water and schools, the program is scalable as a national model to advance efforts to eliminate childhood lead exposure in other states, child care centers, schools, and homes.

The partnership was selected from a pool of high-potential nominees from around the world that strive to address seemingly intractable environmental problems ranging from coastal and marine plastics pollution, using urban forestry projects to offset emissions from university travel, to structuring a multi-state carbon trading scheme for the transportation sector.

The Roy Award will be presented to the partners during a virtual celebration hosted by the Harvard Kennedy School later this fall.

Comments from Additional Partners

“Under the previous regulatory approach, a child had to be poisoned with lead before the source of contamination was identified and mitigated. This regulatory gap may have resulted in the exposure of thousands of children to lead, albeit at levels lower than the outdated statutory threshold for “poisoning.’ Our partnership highlighted a distinct need for focused regulatory attention on health standards rather than corrosion control. The new statewide testing rule helps close that gap. We can protect children from lead hazards, as this partnership demonstrates, and can do so without breaking the bank. We hope this effort will be replicated in other states.” Michelle B. Nowlin, Clinical Professor of Law and Co-Director, Duke Environmental Law and Policy Clinic

­­­­­­­­­­­­­­About the Clean Water for Carolina Kids Program

This partnership was formed to end the de facto use of children as lead detectors and address problems associated with early childhood exposure to lead from water.  Children consume a significant portion of their drinking water, infant formula, and prepared foods while in school or in child care.  Nevertheless, state-licensed child care centers were not previously required to test their water for the presence of lead.  In fact, the only time testing occurred is when a child in its care was found to have lead poisoning based on infrequent pediatric blood testing. Prior efforts to address requirements for lead testing in child care water were unsuccessful because of a lack of data on whether lead was prevalent and uncertainty regarding costs.

Our multi-sectoral partnership meshed sectors and disciplines. RTI’s Clean Water for Carolina Kids pilot study showed that 1) lead is present in drinking and cooking water at child care centers in North Carolina, and 2) a citizen-science based testing protocol is feasible. The Duke Environmental Law and Policy Clinic used the scientific findings to devise a regulatory and fiscal basis for a proposed rule. NC Child advocated for the state to address the problem on behalf of children, child care centers, and citizens. With support from the child care community, the North Carolina Division of Public Health used the scientific, legal, and economic analysis to successfully propose an update to North Carolina’s statewide child care sanitation rules. The resulting Clean Water for Carolina Kids program is managed by RTI International and administered by the North Carolina Division of Public Health. Overall, our partnership allowed for effective innovation to solve a significant environmental health challenge that can be expanded and transferred to different geographical areas and settings.


NC Child is a non-profit organization that builds a strong North Carolina by advancing public policies to ensure all children – regardless of race, ethnicity, or place of birth – have the opportunity to achieve their full potential. NC Child is a trusted community partner for both parents and child care facilities in the state. Equipped with scientific, legal, and regulatory information on lead in child care water from our partnership, NC Child successfully advocated for a statewide testing requirement and is helping to ensure statewide implementation is inclusive of various child care centers and children. NC Child has also helped to create how-to videos with RTI staff to make it easier than ever to become a citizen scientist and protect children from lead in water.

­­­­­­About the Roy Family Award

The Roy Family has been a long-time supporter of the development of cross-sector partnerships to meet social and environmental goals. The Roy Family Award for Environmental Partnership provides positive incentives for governments, companies and organizations worldwide to push the boundaries of creativity and take risks that result in significant changes that benefit the environment.

This year marks the ninth time that the Harvard Kennedy School has bestowed the award. The 2018 winning project, the Advancing Green Infrastructure Program in New Haven, CT, was selected for its inclusive, replicable approach to dealing with the negative impacts of more frequent and intense rainfall events due to climate change.

The California Healthy Nail Salon Program, a partnership between the California Healthy Nail Salon Collaborative, Asian Health Services (AHS), and five city and county government departments won in 2016. The Program addresses the environmental health and justice issues faced by workers in the salon industry and works to standardize safe, pollution prevention salon practices that can be implemented nationwide and globally.