United States children living in poorly maintained housing built before 1978 are at particular risk of lead poisoning, which harms their physical and cognitive development. Studies have shown that although refugee children may have been exposed to lead in their homelands, some experienced increased blood lead (BPb) levels after their resettlement in the United States. This study provides an insider's account of the resettlement process from the perspectives of case managers to explain why refugee children are at higher risk of being placed in substandard housing and of consequently being exposed to lead. We examine the productivity demands, financial pressures, and time constraints that case managers face and how the demands of their supervisors and resettlement agency funders may redirect their priorities away from protecting refugees' health. We conclude with recommendations to reduce the pressures on case managers and lessen the burden of lead poisoning among refugee children.

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