A team of researchers from Johns Hopkins University is partnering with Baltimore City officials and community members to tackle a longtime local health problem: old lead pipes that threaten the health of residents, especially children.
Participation rates are up tenfold in the Baltimore Service Line Partnership survey after teams of city officials and Hopkins researchers and caregivers went door-to-door to help renters and homeowners identify water pipes at risk of leaching lead, which can irreparably damage the brain and nervous system.
Their work comes after years of slow progress and at a crucial time, as the U.S. Environmental Protection Agency updated its Lead and Copper Rule in late 2024, giving cities 10 years to identify and replace all lead service lines. In Baltimore, more than 200,000 homes need to be surveyed.
Launched by the Baltimore City Department of Public Works, the survey asks residents to identify their water pipes using a simple scratch test and smartphone photos to report the results online. But 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," says 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 says.
Video credit: WBAL-TV 11 Baltimore
To boost awareness and participation, Exum partnered with community groups and city leadership in October 2024, launching a pilot outreach campaign 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," says Exum. 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 says. "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.
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 says. "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.
