Model National Lead Safety Policy Proposal Summary

Model National Lead Safety Policy Proposal – Towards a Lead-Safe World Summary

Lead is the most studied toxic substance because it is the most common pollutant of the industrial era.

Lead is the highest priority paediatric health problem in the United States because of the cost of dealing with the long-term effects and the massive return on investment of lead abatement and lead exposure prevention. Australian research by Arora et al established that “In ASD [Autism Spectrum Disorder] cases, higher [yet still relatively low] lead levels were observed over the prenatal period and first 5 months postnatally” in the lost baby teeth of Swedish children diagnosed with ASD compared to their non-ASD twin (Arora et al 2017).

“Persistent bioaccumulative toxic chemicals (PBTs) [such as lead] are of particular concern because they remain in the environment for significant periods of time and concentrate in the organisms exposed to them” (US EPA 2022).

Air lead pollution aside, the global elimination of leaded petrol (O’Brien 2021) does not on its own stop lead from petrol from reducing IQ and shortening longevity. Those two huge impacts on Global GDP and health will continue until petrol-lead contaminated dusts, soils, waters, sediments, and waste dumps are also cleaned up. Lead contaminated materials generated in cleaning up the world, could be disposed of as fill, in closed-down or mined out pits of heavy metal and fossil fuel mines.

The US National Toxicology Program (NTP) (2012) monograph, Health Effects of Low-Level Lead is a summary of recent research and is over 1000 pages long.

From the statistics that are emerging on health effects associated with lead exposure, everyone has been affected by lead to some degree even though most people are never tested or diagnosed. This silent global pandemic of lead poisoning stops virtually everyone from reaching their full cognitive and longevity potentials, and speeds brain ageing.

The World Health Organisation (WHO) reported in Childhood Lead Poisoning in 2010 that every dollar spent on preventing lead exposure returns between US$17-220 in benefits. “This cost-benefit ratio is better than for vaccines, which have long been described as the single most cost-beneficial medical or public health intervention” (WHO 2010).

Cost-benefit analyses demonstrate substantial returns on investment into lead abatement, and lead poisoning and contamination prevention and management. More recently, “participants of G7 members recognised that according to the World Bank’s most recent assessment, the global cost of the health effects of lead exposure is estimated to be 4.6% of global GDP” (German Federal Ministry for the Environment, Nature Conservation, Nuclear Safety and Consumer Protection November 2022).

By addressing historical lead contamination we will provide a lead-safe world for future generations of all living things. Without lead dampening IQ, our ability to prevent the climate crisis and other existential threats is much greater.

This is a Summary of a soon-to-be-published human health focused policy; significantly more environmental impacts apply than what has been included in the Model National Lead Safety Policy Proposal by The LEAD Group.

Initial Steps to Prevent Lead Exposure and Lead Poisoning

• Set up a National Blood Lead Surveillance System to collect ALL blood lead testing results (not just those results which exceed the target blood lead limit at any one time). This Surveillance System will include active blood lead screening of individuals (and communities) identified through a lead risk questionnaire, not just passive reporting of those cases identified by health care professionals.
• Establish national blood lead action levels for sub-populations and targets that reduce over time. On health grounds alone, there is no threshold of safety in lead exposure, but less lead means less damage. The LEAD Group advocates an action level of 1µg/dL, thus any result above this will be followed-up by actions/interventions which aim to bring the blood lead level to below 1µg/dL.
• Promote blood lead testing of individuals and inclusion in blood lead surveys of categories of people at risk of historical, current or future lead exposure.
• Use pathology reports to re-educate lead-workers, employers, trade unions and health professionals as to current blood lead target and blood lead action levels. Unlike other pathology parameters, a range should not be provided as there is no healthy range for blood lead levels. This is also an important medium for passing on information about accurate and reliable testing of environmental lead sources that may have resulted in elevated blood lead levels.
• National governments will budget for the provision of affordable laboratory testing and guidance on lead results in potential environmental, food, and other sources of lead to individuals (of all ages). This includes means-tested assistance in environmental testing and lead abatement.
• Determine and allocate responsibility for prevention of lead exposure and lead poisoning within the following delineations:
  • Primary Prevention is concerned with preventing public/individual lead exposure and/or poisoning. It is the responsibility of intergovernmental organisations and national governments.
  • Secondary Prevention is concerned with preventing further lead exposure in individuals by environmental testing and removing the individual from the source of lead exposure or removing the source from the individual. The state or local health authorities have a significant role to play.
  • Tertiary Prevention is concerned with preventing the lead already in a person’s body from doing further harm, including causing early morbidity and mortality. The responsibility for Tertiary Lead Poisoning Prevention is diversified.
• Carry out a National Blood Lead Survey of All Ages within 6 months of endorsing the National Lead Safety Policy. The collation of this data can be modelled on the US CDC’s NHANES. Participants will need to complete a lead risk factor questionnaire and a general health questionnaire that specifically includes incidence of lead-related health outcomes in the person.
• Data from the National Blood Lead Surveillance System enables research into pathways of exposure, including historical via isotopic fingerprinting to prevent lead exposure and inform clean-up strategies; and provide information on trends on effective methods of reducing blood lead levels. As well, this information will be used for campaigns to increase public awareness, inform relevant professionals, and inform manufacturers and consumers.
• Examine and utilise research on the effects of lead on human health as well as fauna, flora, microbes and the environment to create environmental protection legislation and to justify budgetary allocations to National Lead Safety Policy.
• Ensure that the recycling of the biggest use of lead complies with the requirements of a circular economy by legislating for the lead in used lead-acid batteries (ULABs) to be 100% recyclable and recycled.
• Contribute to a global database of research of world’s best practice on Lead Exposure and Lead Poisoning Prevention possibly to be developed by the World Bank, WHO or the UN, and promoted during International Lead Poisoning Prevention Week of Action (ILPPWA) 

1.0    Steps in Primary Prevention of Lead Exposure

• Provide environmental lead testing to every young child in public housing or living in poverty or in an inner-city area or leaded community.
• The results of the National Blood Lead Survey of All Ages and all lead interventions research can be used to identify persons/groups at risk of future elevated blood lead levels; provide pre-emptive environmental testing for those identified as being at-risk; and introduce regulations to prevent such exposures from occurring in others, so that each target can be met.
• To achieve blood lead target levels, introduce legislated maximum limits for lead in various media.
• Legislate for the certification of professionals and tradespeople involved in the inspection, assessment, removal/abatement, and clearance of lead hazards to establish a gold standard.
• Incorporate changes informed by Primary Lead Exposure and Poisoning Prevention into educational materials and media campaigns to reduce blood lead levels and create awareness.
• Ensure ongoing blood lead monitoring of at-risk groups.
• Ensure ongoing blood lead monitoring of at-risk groups.

2.0 Steps in Secondary Prevention of Lead Exposure

• This can highlight the efficacy of interventions which may decrease lead absorption or increase lead elimination.
• Further funds diverted from fossil fuel subsidies could be used to fund environmental laboratory testing for lead to ensure social equity.
• Isotopic fingerprinting will be used to identify exposure pathways for those who have no identified lead sources. This information can prevent Primary Lead Exposure of other individuals/communities.
• Ongoing blood lead monitoring is required to achieve Secondary Lead Exposure Prevention and to adjust medical protocols to order blood lead testing for anyone presenting with  any of the signs or symptoms associated with lead exposure.
• All learnings from steps taken to this point in Secondary Lead Exposure Prevention will be incorporated into lead education and media campaigns.

3.0 Steps in Tertiary Prevention of Lead Poisoning

• Fund further research to discover if there are links between elevated blood lead levels at any age and the development of certain adverse health effects in later life. Discovery of such links would be a step in reducing or eliminating a source of significant morbidity.
• Fund or conduct research to ascertain whether certain intervention protocols succeed in reducing the risk of development of associated adverse health effects.
• Require independent research of detoxification claims and inform health professionals and the public of research findings so that the lead already in patients is managed without further harm.
• Promote the utilisation of all known and proven ways of overcoming lead-associated health and behavioural problems.
• All learnings from steps taken to this point in Tertiary Lead Poisoning Prevention will be incorporated into lead education and media campaigns. Public awareness campaigns will be evaluated to ensure return on investment, including by repeat blood lead surveys after education/awareness campaigns in targeted sub-populations and, where relevant, the provision of lead testing kits with instructions for environmental sampling, comments and interpretation of the results.