Milwaukee’s “Growing Healthy Soil for Healthy Communities” (GHSHC) project started in 2014 as a five-year Healthier Wisconsin Partnership Program grant led by the Medical College of Wisconsin and Sixteenth Street Community Health Center, along with Walnut Way Conservation Corp., University of Wisconsin-Madison, and City of Milwaukee Health Department Laboratory (MHDL). The primary focus of the partnership, originally set to end December 2018 and subsequently extended through June 2019, was to address the public health issue of lead exposure through soil, particularly urban or backyard gardening. The aim was to demonstrate the effectiveness of soil and landscape interventions, enhance environmental health literacy education, expand access to soil testing – partly through the creation and pilot of a community soil screening program at MHDL, and create awareness of environmental policy necessary to sustain real change in soil health and environmental lead exposure mitigation practices. The project was first piloted in Lindsay Heights and Kinnickinnic River neighborhoods located in the City of Milwaukee, which has an estimated population of 588,265 people. The City of Milwaukee is located within Milwaukee County, which comprises an estimated 944,483 people, based on 2020 census estimates. MHDL (www.milwaukee.gov/healthlab) sought to understand the total and bioavailable fraction of lead (and other toxic heavy metals) to help determine potential toxicity of soil upon exposure or intake through vegetables. MHDL validated the accuracy of Mehlich 3 method o extract the fraction of lead, potassium, and phosphorus from urban backyard soil samples that “might be” available for plants’ uptake. Flame Atomic Absorption Spectroscopy (FAAS) was utilized for the analysis of lead and potassium in urban backyard soil samples. This was critical for providing soil testing to residents served by the grant at the project's outset, eventually expanding to a public soil screening program, now serving Milwaukee County and beyond.

At its outset, GHSHC identified four objectives to be achieved by December 2018, including:

1.      Best Practices in safe urban gardening informed by results from community-engaged research which tests the effectiveness of soil and landscape interventions implemented at 70-90 properties in Lindsay Heights and Kinnickinnic River neighborhoods.

2.      Participating adults and youth (425 total) to complete environmental health literacy workshop/s to increase knowledge and intentions to practice safe gardening and engage in lead poisoning prevention action, including soil testing.

3.      Stakeholders (Policy Professionals, Urban Gardening Institutions, and Urban Gardeners) to have increased understanding of implications of existing policies and institutional procedures surrounding urban residential gardening and to commit to engage in further policy formation and advancement to mitigate health risks associated with backyard gardening.

4.      GHSHC partnership to expand to include Milwaukee Health Department by end of 2014, and Milwaukee County Extension by end of 2018, to increase public health capacity to reduce soil lead concentration and bioavailability in Milwaukee neighborhoods.

All objectives were met by the end of the grant, with measurable success achieved in conducting environmental health literacy workshops and performing soil screening and landscape interventions. Throughout the grant, 33 workshops were conducted with 534 individuals (295 adults and 239 children), exceeding target goals of reaching 425 adults and youth through 24 workshops. During the same time, 117 households consented to soil testing and landscape intervention, with 112 households receiving initial testing (37 from Lindsay Heights, 68 from Kinnickinnic, 7 from other neighborhoods), which again met and exceeded goals for Lindsay Heights and Kinnickinnic, respectively. During the grant-funded study period, MHDL analyzed 215 samples from the target neighborhoods. Further, a policy boot camp was conducted for community partners and residents, facilitating progress toward supporting policy formation associated with backyard gardening; engaging neighbors, policymakers, governmental organizations in discussions about relevant policies; and increasing understanding of implications of existing policies and practices by documenting how soil screening/testing decisions are made, what barriers exist to testing services, and what actions are taken based on knowledge gained. Other noteworthy community education included an Association of Public Health Laboratories (APHL) 2015 Annual Meeting poster (https://city.milwaukee.gov/ImageLibrary/Groups/healthAuthors/LAB/PDFs/Posters/APHLHealthySoilposterV2web1.pdf), an overview presentation by grant partners to the Wisconsin DNR Brownfield Study Group in May 2016 (https://dnr.wi.gov/topic/Brownfields/documents/bsg/LeadStudyPresentation.pdf), and a Weston Roundtable lecture at UW-Madison Nelson Institute presented by MHD Public Health Laboratory Director Sanjib Bhattacharyya in October 2017 (https://nelson.wisc.edu/sage/weston-roundtable/weston-archives.php?year=2017). Milwaukee County Extension was engaged to provide expertise for environmental health literacy curriculum, assisting with planning a lead education dissemination event, and supporting safe gardening workshops conducted in 2018. The project culminated in June 2019 with a dissemination event, including a panel discussion with local and state leaders and elected officials in soil science, lead remediation, public health policy and lead poisoning prevention, and a community story-telling session about lead in the community.

The success of this project was built upon its innovative multi-level and multi-agency approach that creates action at the individual, community and societal levels to minimize lead exposure pathways from the environment. Community involvement, both from the residents in target neighborhoods and grant partners serving them, was critical to maintaining project momentum and achieving milestones throughout the duration of the project. Further, utilization of research gathered through soil screening, landscape intervention and follow-up in order to better inform and influence individual household members, institutional and regulatory policy at the societal level helped take the project to the next level, allowing the greater Milwaukee community to benefit.

Access to cost-effective soil screening services for nutrients and heavy metals (e.g. lead) in garden soil is limited in Milwaukee, due to minimal funding to maintain such public testing services for homeowners and urban gardeners. MHDL officially launched its community soil screening program in May 2018 and has continued to sustain it since grant funding ended, offering affordable soil screening at a per sample cost of $10 for lead screening, $15 for nutrient analysis (pH, soil conductivity, organic matter, phosphorus, potassium), or $25 for both. The program is available to the general public and has been utilized by residents in the greater Milwaukee area and beyond. Through December 2020, MHDL’s community soil screening program has analyzed nearly 250 soil samples – 37 for lead only, 118 for nutrient analysis, and 93 for both.

Exposure to lead remains a serious problem in large metropolitan areas like Milwaukee, WI, particularly in low-income, African American and immigrant communities according to national data. Wisconsin Lead Program data continues to show a disproportionate burden of lead poisoning for children in Milwaukee, with the percentage of children in Milwaukee with blood lead levels greater than 5 µg/dL nearly twice as high as the statewide percentage. Research documents that lead in soil is a major source of exposure for children because it creates a fine dust that is easily tracked into the home and ingested by very young children. Meanwhile, urban agriculture is increasingly used as a means to transform and empower communities that have been historically marginalized due to race, social class, economic stability, and gender; however, increased health risks from backyard gardening via exposure to lead-impacted soil and plants may result.

The GHSHC project aimed to address that issue by first focusing on residents in two Milwaukee neighborhoods (Lindsay Heights and Kinnickinnic River) facing higher foreclosure and poverty rates. At the outset of the project, there were 10,136 residents in the Lindsay Heights neighborhood, and 18,280 residents in the Kinnickinnic River neighborhood, with 534 individuals (295 adults and 239 children) in 117 different households ultimately participating in soil testing and intervention. The innovation and responsiveness of the project was unique in that it was built upon the extensive, longstanding experience that grant partners Walnut Way Conservation Corp. and Sixteenth Street Community Health Center already had working with local residents on neighborhood planning around environmental education and urban ecology-based initiatives, and thus addressed priorities and concerns identified directly by neighborhood residents, resulting in greater investment and commitment from participants. As that extended to the development of the community soil screening program at MHDL for all Milwaukee area residents, the historical lead screening and prevention knowledge and efforts of the Milwaukee Health Department (MHD) Childhood Lead Poisoning Prevention Program (CLPPP), along with MHD Laboratory testing support, was critical. Despite the MHD’s progress in reducing exposure risks through abatement programs (supported by the US HUD funding), there was much more to be done, with more broadly available soil screening being just one critical piece of that.

Further, the project was also innovative in its adoption of a multi-level and multi-agency approach that translated existing knowledge regarding urban backyard/garden  soil contamination into strategies to minimize lead exposure pathways from the environment and improve public health at the individual, community and societal levels. Thus, it was uniquely positioned to address environmental toxin exposures and improving soil health that may otherwise be an unintended, negative consequence of increased interest in backyard and community gardening. Pre-pilot and pilot research for the GHSHC project allowed grant partners to engage neighborhood residents on the research team, document gardening practices that may impact lead exposure, gather pilot data regarding soil lead concentrations and utilize the data to inform efforts going forward. The group also benefitted from industry knowledge related to soil testing and WI DNR reporting requirements through its work with a private environmental engineering firm. And, through existing relationships between CBO leaders and academia, GHSHC project leadership was also able to identify the soil science expertise necessary to continue project work. Importantly, ongoing community feedback sessions revealed that neighborhood residents were interested not only in being aware of soil lead hazards, but also in identifying and testing strategies to reduce soil lead contamination, so that people could continue backyard gardening. The investment in the project by neighbors in the community has remained critical in helping carry project advancements beyond simply educating residents about the risks of lead exposure from backyard gardening, to fostering actual behavioral change outcomes related to soil testing. 

Evidence gathered throughout the duration of the grant-funded portion of the project effectively demonstrates the impact of soil and landscape interventions in lowering lead levels in soil as well as education to communities, implementing policy and practice for improving backyard/garden soil health in local communities. For the homes completing landscape interventions in this project, the median change in lead concentration from baseline to 12-month samples was -83.09 ppm or a decrease of 41 percent. Additionally, the impact of community education programs in increasing residents’ knowledge of lead risks and safe gardening practices was clearly demonstrated, with lead knowledge increasing from 76.4 percent correct answers on pre-workshop surveys to 80.1 percent correct answers on 3 month post-workshop surveys; knowledge was gained specifically in the areas of lead risks and understanding of behaviors to help minimize risk. Gardening practices such as raised beds, soil amendments (with compost, phosphate-bearing products), and safe product handling was shown to educate, instruct and best practices to reduce lead contamination risk, and community-based educational workshops documented improved knowledge of the impact of diet and home hygiene on lead poisoning. The implementation and utilization of the City of Milwaukee Health Department Laboratory’s soil screening program (250 community samples screened to date), serves as evidence of successfully providing community access to low cost soil screening for lead and nutrients.

The City of Milwaukee Health Department (MHD), including both the Laboratory and Childhood Lead Poisoning Prevention Program, supported the project primarily by providing soil lead screening services. MHDL worked with UW Soil Science faculty and staff to learn and implement the Mehlich-3 soil screening method. Much of the work required to establish soil testing methods at MHDL was funded with in-kind support. From 2015 through 2018, MHDL worked in collaboration with fellow grant partners, particularly Walnut Way and Sixteenth Street Community Health Center, to analyze the 215 soil samples collected in the neighborhoods participating in the grant, which was reimbursed with grant funding. MHDL also played an active role in fulfilling overarching project objectives related to this, including, for example: helping develop a protocol for collecting and delivering samples for x-ray fluorescence (XRF) analysis to MHD and performing both baseline and follow-up XRF soil testing, which informed soil and landscape interventions; conducting confirmatory analysis on up to 20 samples at UW-Madison; participating in environmental health literacy workshops to help increase residents’ knowledge and intentions to practice safe gardening and engage in lead poisoning prevention action, including soil testing, as well as developing procedures for accessing MHD Laboratory soil testing; working with Milwaukee County Extension to support safe gardening workshops and provide expertise for environmental health literacy programming; and increasing public health capacity to reduce soil lead concentration and bioavailability in Milwaukee neighborhoods, including exploration of potential funding sources, such as Medicaid, to address lead hazards in homes.

MHDL’s central role in this important community collaboration was exemplified in April 2017, as MHDL was named the recipient of the Community Partner Award for the Medical College of Wisconsin (MCW) President’s 2017 Community Engagement Awards (https://www.youtube.com/watch?v=vGGKjC4rcBM&feature=youtu.be). “The Milwaukee Health Department Laboratory has been instrumental in developing a new community resource for analysis of soils for urban gardening, going above and beyond standard practices,” said Dr. Sheri Johnson of the MCW Department of Pediatrics, who formerly served as principal investigator for the Growing Healthy Soil grant. MHDL subsequently began piloting its public soil screening program in June 2017, with the formal launch in May 2018, and since then has analyzed approximately 250 additional samples for lead and/or nutrients through December 2020. Since 2019 the program has been funded exclusively with MHD operating funds and also supported with the minimal revenue generated by the program. MHD is also in the process of developing other resources for sharing information on soil screening services with the public, including via its website (www.milwaukee.gov/health/testing-Fees/Soil-Screening-Information.htm) and an updated soil screening brochure that is in the final stages of production (See MHDL soil screening brochure: https://drive.google.com/file/d/1Wn4TrmucNU6rLl3aMOe1Bhz2DXBuFJWN/view?usp=sharing).

The Growing Healthy Soil for Healthy Communities (GHSHC) project’s primary aim was to demonstrate the effectiveness of soil and landscape interventions, expand environmental health literacy education and access to soil testing, and create awareness of environmental policy necessary to sustain real change. MHDL’s has most directly supported the objective of expanding access to soil testing, through providing the necessary operations to sustain its community soil screening program. So far MHDL’s community soil screening program has been evaluated by the number of people utilizing the program. Through December 2020, MHDL’s community soil screening program has analyzed nearly 250 soil samples – including 37 for lead only, 118 for nutrient analysis, and 93 for both. The program has served residents in the greater Milwaukee area and beyond, extending as far as Hudson in the northwest portion of Wisconsin and Mount Pleasant in the southeastern corner of the state (See GIS mapping figures - 1: All communities served by ZIP code: https://drive.google.com/file/d/1EtW4hyFxRBYtKbrcuDYroDBXp6li30S1/view; 2: Milwaukee County communities served by ZIP code: https://drive.google.com/file/d/11S4n0B1mYfh_KaJqgOQy5434T7MQcEHh/view?usp=sharing). Within about 10 days of submitting samples, residents receive an electronic and/or mailed report containing their soil screening numerical results, where those fall within acceptable ranges for urban gardening, and recommendations on how to address soil that has high or low values for a particular nutrient or element (See soil screening report template: https://drive.google.com/file/d/1Yut4_JEraNGT2n5QD3G2BZ8-Hk7DbeE1/view?usp=sharing). Of the samples it screened for lead (130 total), MHDL identified 18 samples or 13.8 percent with high or very high lead levels, and an additional 65 samples, or 50 percent, with moderate lead levels – alerting residents to the need for soil interventions prior to utilizing those areas for urban gardening purposes. Of those analyzed for nutrients, 205 samples, or nearly 83 percent, had values outside of (either above or below) optimal ranges in one or more areas, suggesting the need for other interventions that could help improve the quality of the soil for gardening. Specifically, 193 samples tested outside of recommended ranges for phosphorus, which can be corrected by either adding or removing phosphorus-containing fertilizer depending on whether values are too high. A total of 143 samples tested outside of recommended ranges for potassium, which can be resolved through the addition or removal of potash fertilizer. About 34 samples contained less than 5 percent organic matter, which suggests a need to add compost or manure to soil. MHDL is also able to provide additional information and/or refer residents to other urban gardening resources for specific questions or concerns about soil screening results. MHDL has yet to gather data on post-screening soil interventions implemented by residents, or perform any follow-up testing to assess effectiveness of interventions. However, MHDL is considering the design of a follow-up survey that could be shared with residents who have requested soil screening to help better gather and track this type of information.

Since its inception, the Growing Healthy Soil for Healthy Communities (GHSHC) project has created a vested interest from grant partners, community based organizations, urban gardeners and residents involved to minimize lead exposure through the environment, improve accessibility to soil screening, and ensure safe urban gardening practices. Concurrently, the development of environmental health literacy and educational materials also serves as a successful strategy to inform and foster behavioral changes among residents, ultimately helping to sustain healthy urban gardening practices. MHDL provides information on its website related to its community soil screening program and other urban gardening resources, and is in the process of developing an informational brochure on the program, including the instructions and form for submitting soil samples for screening. This is in addition to the availability of educational publications produced in collaboration with community partners during the grant funding period, such as UW Extension guidance on soil hazards and mitigation and updated publications on soil analysis and potential community gardening soil hazards, published in both English and Spanish. MHDL will continue to advocate for the program in order to ensure that funding remains available to support the program and its ability to offer low-cost soil screening for lead and nutrients in the future. Additionally, MHDL is also in the process of exploring opportunities to collaborate with other City of Milwaukee departments, such as the Environmental Collaboration Office (ECO) and Department of Neighborhood Services (DNS), on related community initiatives and services moving forward, including the potential for City revenue generation and self-supporting of the soil screening program for sustainability

Another key lesson learned through this project and partner collaboration has been that the relationships between community based organization (CBO) staff and neighborhood residents are key to expanding neighborhood capacity to address concerns. For example, at one property enrolled in the study, the soil lead concentration increased between its baseline soil test and 12-month follow-up test. Upon discovering the increase, the CBO staff involved spoke with the homeowner and learned that the family had the front porch scraped and repainted. There were visible paint chips still in the soil surrounding the home. The family had used a neighborhood home repair/remodeling person who was not a lead-safe certified renovation contractor. CBO staff gave the homeowner information about lead-certification renovation classes to pass on to the contractor, and the contractor actually went and completed the certification process, according to later conversations with the homeowner. This example highlights how the relationships and conversations that community and public health organizations have with the residents they serve can play a role in identifying a need and advocating for policy change. Ultimately, policy change stands to play a significant role in ensuring and funding sustainable practices moving forward, and establishing the groundwork for policy recommendations is one of the desired long-term effects of the program. Previous educational outreach efforts by the Sixteenth Street Community Health Center (SSCHC) Lead Outreach Program and project partners during the grant funding period contributed to increased funding and resources for remediation, including the Wisconsin Department of Health Services’ inclusion of a federal waiver proposal in the 2019-2021 biennial budget request to enhance funding for comprehensive lead abatement. MHD and fellow public health partners can continue to advocate for this type of lobbying for policy change in the future, as funding and resources remains one of the most critical pieces to ensure long-term sustainability and success of this practice. However, additional local or regional resources will be critically needed to support the next steps of soil and landscape intervention, education and other follow-up, and pursuing additional future grant funding opportunities will likely be a part of sustainability plans moving forward.