D6: Reassessing Scientific and Social Determinants in Lowering Lead Risks

Many believe childhood lead poisoning to be an old risk that was largely eliminated in the US several decades ago with the banning of lead-based paint in 1978, and the conversion to unleaded gas in the 1980’s. In 2014, the events in Flint, Michigan placed lead poisoning in the forefront once again with a doubling of the rates of elevated blood lead levels (BLLs) within this environmental justice (EJ) community. Since then many states have examined the data and concluded that childhood lead poisoning remains a real risk that still affects many poor children mostly living in urban neighborhoods that are classified as EJ areas. Our session will examine the underpinnings of childhood lead poisoning, including the intransigence of governance to address documented risks of lead exposure. These risks include private homes and rental properties, often laced with lead-based paints from many decades ago, lead service lines (LSLs) that continue to deliver drinking water containing lead often above the Safe Drinking Water Act standards, and community redevelopment, which is associated with demolition of older homes generating lead dust, recirculating lead into the air and soil without proper safeguards during the gentrification process. Our session will bring together environmental scientists, environmental health researchers, physicians and public health professionals who work every day on challenges and barriers surrounding lead poisoning issues and recognize the importance of sound scientific discovery, which must be translated into effective public policy to improve health outcomes for children.

With the advent of the pioneering work of Dr. Herbert Needleman (1927-2017) in the 1970s, lead poisoning emerged as childhood pathology, rather than just an occupational hazard for adults that often were exposed to large quantities of lead from a variety of work environments. Dr. Needleman played a major role in securing some of the most significant environmental health protection directives achieved during the 20th century, which resulted in considerable reductions in the prevalence of lead poisoning among children. NCSE honored Dr. Needleman several years ago at the national meeting for his lifelong contributions in protecting children from the dangers of lead exposures.

For the past 40 years, environmental and medical science confirmed the irreversible serious health effects identified by Dr. Needleman from exposure to lead. Thousands of research articles on lead exposure document its health effects on children in the first few years of life. Young children who put their hands and other items in their mouth can easily be exposed to very large amounts of lead. Once in the body, lead kills nerves in the brain and leaves others with slowed signal conduction, thus interfering with thinking and behavior. Lead blocks the production of hemoglobin, leading to anemia, and an inability to carry oxygen throughout the body, leading to fatigue and lack of energy. Researchers at the University of Pennsylvania have found that early life exposure to lead results in lasting sleep disruption. Having sufficient quality sleep is essential to health, well-being, and learning. The researchers also found that lead injures certain types of cells in the brain that look for and remove harmful toxicants. When these cells are not working, lead-exposed children are at greater risk from other exposures. Researchers have also documented decreased IQ and behavioral problems in lead exposed children. Studies of school children in Chicago have shown that children with BLLs at the CDC reference level of 5µg/dL have lower test scores in reading and math when tested in the third grade. Every year in Philadelphia, about 2400 children are identified as having BLLs greater than 5µg/dL. These children have been robbed of their full academic potential. The consequences of decreased learning are lifelong. There is no effective treatment once a child has been exposed to lead, and damage is permanent. Primary prevention, by eliminating exposure to sources of lead, has been shown to be the most effective strategy for reducing BLLs and the harm caused to children. The most affected children are living in poor EJ neighborhoods, further extending the achievement gap of these children.

Though peeling lead paint has been found to be the most significant source contributing to lead exposure of children, research has revealed that a broader variety of sources is present, including lead-contaminated drinking water, air and soil, which leads to a cumulative impact on elevating BLLs in the affected population. The events of Flint introduced the country to the potential adverse effects of LSLs, which deliver lead through the drinking water. Many cities, including Philadelphia, have active gentrification policies in place, which promote demolition of old buildings with lead paint and other infrastructure, thus creating contaminated airborne dust, which settles on the streets and accumulates in soils. Some cities implemented aggressive real estate practices on renting only lead-safe properties and on replacing old LSLs. Other cities, however, do not have such policies or delay decisions on them, even though these practices have demonstrated significant reductions in the number of children with elevated BLLs.

Lead poisoning is a cumulative risk. As such, all exposures become important to a vulnerable child that already faces a myriad of environmental, social and medical challenges. No consistent funding base seems on the horizon at any level of governance to rid the environment of lead paint. This session examines Plan B, i.e., which interventions can be done when the best and most effective solution seems unattainable. Who are the stakeholders that can help solve these problems? Instead of looking at the role of governance to identify small pots of inadequate funding to tackle an enormous task, how can governance promote, or even coerce, prime stakeholders to recognize their responsibility in lowering risks to the most vulnerable parts of the population. Research estimates that there are substantial returns to investing in lead hazard control, particularly if it is targeted at early intervention in communities most at risk. Given the high societal costs of inaction, lead hazard control appears to be well worth the price (https://doi.org/10.1289/ehp.0800408).

Our session is designed to comprehensively address the widespread occurrence and the severity of lead poisoning, and to bring to light that there are a variety of exposures that need to be assessed if we are to mitigate the damage done to children from these exposures or, better, to hopefully eliminate the problem. This engagement, which is urgently needed to protect children from ongoing lead exposure, must be proactive and include identification of lead hazards in homes and the environment. It will further require governance to make difficult choices with both economic and social consequences that will not always be popular with important stakeholders.

The session will be organized and moderated by experts from a broad variety of backgrounds who will alert peers to current risks that continue to exacerbate childhood lead poisoning. We will present and discuss recent scenarios that have introduced significant exposures of lead with the potential to elevate BLLs in children. The four main topics will be: 1) consideration of rental practices, recognizing that substandard housing too often becomes the only available choice for the most vulnerable in our urban centers; 2) the occurrence of lead service lines, “the Flint problem”, in older cities with crumbling water infrastructure, which requires repair and a consistent funding base to ensure safe drinking water; 3) gentrification in our aging cities, which is designed to invigorate tired neighborhoods and bring new capital and commercial investments to these communities, but along the way recirculates decades-old lead paint into air, soil and streets due to the hundreds of demolitions using inadequate safety and health practices; and 4) global efforts to eliminate lead paint from the world marketplace, which include the promotion and implementation of laws that will prohibit the sale and use of lead-based paint in all countries. Currently, only 72 countries have enforceable laws as documented by the work of the Lead Paint Alliance, aka Global Alliance to Prohibit the Commercial Use of Lead Paint. Most of these existing laws follow the United Nations Environment Programme (UNEP) standard, which stipulates a maximum of 90 ppm lead in liquid paint.

Our session will examine a series of new ideas that look at alternative strategies in communication, funding, and community engagement, and eventually strong policies and laws to tackle a very old but pervasive problem. These new strategies are needed, not just in the US but also globally, to build the momentum required to continue work on lead exposure rather than remembering lead poisoning only when a tragedy like in Flint, MI becomes the headline story for a short time. We need funding, but we also need better science, collaboration between universities, governments, and international institutions (e.g., UNEP, WHO, World Bank) as well as industry, sound policy, and accountable decision-making by governance at ALL levels, if we are to finally end childhood lead poisoning, a target that should be both a national and an international priority. The session is aimed at starting a dialog between NCSE and EPA in order to find the most efficient strategies.

Presenters

  • Reto Giere, Ph.D., UPenn Representative, Professor and Department Chair, University of Pennsylvania
  • Richard Pepino, Deputy Director, Community Engagement Core, Center of Excellence in Environmental Toxicology, University of Pennsylvania
  • Marilyn Howarth, MD, Adjunct Associate Professor, Perelman School of Medicine, University of Pennsylvania
  • Walker Smith, Director, Office of Global Affairs and Policy, Office of International and Tribal Affairs, EPA
  • Angela Bandemehr, International Lead Paint Team Manager, Office of Global Affairs and Policy, EPA