After years of slow progress identifying old pipes at risk of leaching lead into Baltimore homes, Hopkins researchers and their community partners have formulated an approach that is finally moving the needle—boosting participation rates in critical surveys 10-fold. This progress comes at a crucial time, as a federal mandate issued last fall gives cities 10 years to identify and replace all lead service lines.
Their approach combines door-knocking campaigns and student training to tackle a huge problem: More than 200,000 Baltimore City homes have service lines that need to be identified and may contain lead, threatening residents’ health, especially that of children, who show elevated blood lead levels compared to the rest of Maryland.
What is the issue?
Lead exposure—whether from paint, dust, or drinking water—can irreparably damage the brain and nervous system, especially in children. Symptoms range from learning difficulties to behavioral problems and delayed growth.
To address risks from lead pipes, the U.S. Environmental Protection Agency updated its Lead and Copper Rule in late 2024, requiring all cities to locate and replace their lead service lines. The Baltimore City Department of Public Works responded by launching the Baltimore Service Line Partnership, asking residents to identify their water pipes using a simple scratch test and smartphone photos to report the results online.
But public participation has been alarmingly low. As of July 2024, only 2.4% of residents had completed the survey—most of them homeowners. In a city where 65% of households are rentals, that leaves a critical gap in the neighborhoods most likely to have lead pipes.
“There are many, many barriers,” said Natalie Exum, assistant professor in Johns Hopkins’ Department of Environmental Health and Engineering. “Can a resident even access the pipe in the basement? Do they have a smartphone to take photos? Can they tell which pipe is the water line?”
In some cases, basic awareness is also a hurdle. “Most people we spoke to during door knocking in Pen Lucy—a community on the York Road corridor of North Baltimore—hadn’t even heard about the need to identify their pipes for lead,” she said.
Grassroots engagement strategy
To boost awareness and participation, Exum partnered with community groups and city leadership to meet residents where they are: in their own homes.
In October 2024, a pilot outreach campaign was launched in Pen Lucy, led by District 4 Councilmember Mark Conway. Volunteers canvassed the area with flyers and offered one-on-one support to help residents test their pipes.
The response was immediate. Survey submissions to the city’s lead pipe inventory portal increased tenfold in the two weeks following the door-knocking event.
At the same time, new educational initiatives are underway in Baltimore City schools through a partnership with the Johns Hopkins Health Education Training Corps. Exum is teaching students how water quality, environmental justice, and systemic health disparities are interconnected. Students, in turn, act as ambassadors for the program, helping their fellow students take the message of lead testing into their homes.
Exum recently toured one of the city’s water treatment plants with 60 MERIT scholars – local high school sophomores interested in pursuing health careers. She taught them drinking water safety. The students will also complete a group project focused on lead service line identification with various community groups in Baltimore.
“We want to empower kids to become change-makers and messengers in their own communities,” said Exum.
Blending research and practice to get results
While public health experts are often focused on gathering data, the immediate priority in Baltimore is outreach about the dangers of lead and the importance of testing, according to Exum.
“There’s no shortage of research showing the health harms of lead. What we need now is community engagement,” Exum said. “That’s the work that enables future research—by building trust, forming advisory boards, and ensuring the questions we ask later truly reflect community concerns.”
She says the program is a textbook example of community-based participatory research: embedding science within grassroots action and developing solutions with residents rather than prescribing them.
Real impact
Exum says that even small actions have shown measurable results. For example, the Pen Lucy campaign demonstrated that a modest investment—400 flyers and one afternoon of door-knocking—can dramatically boost participation. Going forward, local city health departments that have long focused on hazards like lead paint should implement more drinking water testing for lead in their programs, she says.
“This issue has flown under the radar for too long,” Exum said. “Replacing lead pipes isn’t just infrastructure work—it’s public health work. And it could make a real difference for Baltimore’s children.”
The work was funded by the National Institute of Environmental Health Sciences through a pilot grant from CHARMED center. The effort has continuing support from the Green and Healthy Homes Initiative. Community partners are Young, Gifted and Green, MERIT Health Leadership Academy, and the Baltimore Department of Public Works.