Lead exposure remains a serious concern worldwide. Lead exposure prevention and management is a priority across disciplines, yet a transparent, unified and sustained progress goal remains elusive.
Global work on reducing and elimination lead in the environment has been great. Collaboration between global health, environmental protection, international law and international advisory councils [1,2,3,4] is truly remarkable.
- It would be helpful to know who is responsible to guide goals, metrics and evaluation of lead exposure prevention worldwide.
- Metrics assigned to legal advice and consultation could support advancement.
- A plan to involve the trade industry would benefit lead prevention and mitigation efforts, worldwide.
- A plan to compare countries’ occupational surveillance for lead [5], as well as other occupational measures, could also assist.
- A comparison of country resources compared to country results should be undertaken without delay. This is an issue that effects all countries. Continued lead exposure, despite resources at disposal, should question lead programs and interventions.
US national efforts in lead exposure prevention, mitigation and management also continue.
- Consensus on data use and methodology or exposure surveillance should be sought [6].
- A unified goal to address racial and other disparities should be clear [7,8].
- Consensus on costs should also be clear. For decades, we continue to experience failures with lead exposure.
- Where are the national and state cost estimates on infrastructure replacement, new product requirements and waste management?
- Where are the cost estimates on lead surveillance for pediatric populations and adult occupational exposure, beyond physician referrals?
- What is the estimated cost for implementation and ongoing local and state HiAP efforts for lead prevention [9,10]
- Consensus on medical management, particularly when it is questioned in the public, should be available [11]. The question of what the medical community can do to improve consensus, thereby improving public trust, should see response.
- Clear and streamlined public health strategies should be clear.
- NACCHO and ASTHO have similar messaging for some lead programs [12,13]. How they work together to provide standard recommendations for public health administration should be clear. Annual evaluation plans for the recommendation and implementation should also be clear.
- Agencies including CDC, EPA, HUD have shared meetings. How they work with OSHA and other agencies to streamline lead exposure management [14,15, 16] should be known. How these agencies have streamlined household referrals to local and state public health resources, as well as streamlined referrals for medical consultation, should be mapped. Agencies should be tasked with household resource navigation supervision.
- Streamlined state processes should lessen the burden on the public. What state forms and processes can be better streamlined [17,18], so that public messaging is familiar regardless of state moves?
- A strategic gameplan for state improvement, evaluated nationally, could assist progress.
- Case examples and information sharing are available and could be cataloged [19].
- Local and state EHS public health action summaries are available and could also be cataloged [20].
- Long term plans, such as an Environmental Public Health Tracking (EPHT) portal, could detail goals for states and territories [21].
- Experienced public health program professionals could be tasked with consensus around recommending specific improvements for lead exposure prevention across public health agencies, medicine and other industries.
- Public health should improve a gameplan that shifts burden solely off of parents, households and individuals.
- When individual behavior change is asked of the public, [22,23] public health must reciprocate with accountability. Requirements of public administrations, employers and the medical community, should be transparent.
- Navigation of various state regulations, and failure to efficiently standardize regulation workflow, should also be a consideration that lessens household burden [24].
- Lead testing metrics should improve. The number of households requesting lead testing is not reported on. The CDC data refers to physician-determined testing [25], yet what about those who choose to test their homes? What has been the taxpayer cost to requests and delays? Once tests are completed, have the resource referrals been standard and equitable for high level results, regardless of geography? Better data can and should drive expectations [26].
- Occupational health and workplace safety around lead exposure could be better unified. Metrics to assess occupational health could be standardized alongside housing and environmental protection. Infrastructure pushes, such as lead in building materials, could be included as a workplace safety consideration. Military occupational health could be included in greater public health reporting, with lead exposure and management as a leading partnership.
- Legal consequences for private, employer, pediatrician and public administration officials who ignore lead safety should be clearer. Consequences for the US military, when lead prevention and management interventions are ignored [27,28], should also be clearer.
US military lead abatement and lead management efforts continue.
- Military interventions resulting from public relations investigations around lead exposure are a first step [29], as are government accountability audits [30,31]. How the need for an intervention at one military site or sector translates to intervention assessment across sites is unclear, however. It’s also not clear how lead issues are prevented across military systems once discovered in one area.
- Civilian infrastructure involvement could be clearer.
- State accounting for lead exposure in military households [32] is not known. It is not clear if base data is included in public health consistently.
- How the CDC and pediatrician community accounts for military families in data and tracking is also unknown [33].
- Occupational lead exposure leadership is an opportunity yet to be realized between civilian and military research [34,35]. It is also an opportunity to partner better with OSHA, EPA and public health. This opportunity should be taken.
- Data on lead exposure concerns from military members and from their medical professionals is unknown. What concerns from active duty and veteran hotlines have been documented, what resources were utilized and how many denials were there [36,37]? Given the serious, persistent and oft-accepted health damage from lead exposure, surveillance, oversight and urgency to interventions could be must stronger.
References
1. https://www.who.int/campaigns/international-lead-poisoning-prevention-week/2022
4. https://wedocs.unep.org/bitstream/handle/20.500.11822/37711/GPAAP21-23.pdf?sequence=3&isAllowed=y
5. https://academic.oup.com/milmed/article/181/9/1121/4159842
6. https://www.pnas.org/doi/10.1073/pnas.2118631119
7. https://pubmed.ncbi.nlm.nih.gov/33394180/
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6522252/
10. https://www.naccho.org/uploads/downloadable-resources/HiAP_LPP_Recommendations-FNL.pdf
12. https://www.naccho.org/uploads/downloadable-resources/HiAP_LPP_Recommendations-FNL.pdf
14. https://www.naccho.org/blog/articles/take-action-during-national-lead-poisoning-prevention-week
15. https://www.cdc.gov/nceh/lead/default.htm
17. https://www.dhs.wisconsin.gov/lead/ph-intervention.htm
18. https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/CLPPB/Pages/Lead-Poisoning.aspx
19. https://www.astho.org/communications/podcast/improving-care-to-address-maternal-child-lead-exposure/
21. https://www.astho.org/globalassets/pdf/epht-fellowship-presentation-tn-lead-poisoning-index.pdf
23. https://www.apha.org/Events-and-Meetings/Webinars/Lead-and-Public-Health
24. https://phc.amedd.army.mil/topics/workplacehealth/ih/Pages/leadproviders.aspx
25. https://www.cdc.gov/nceh/lead/data/index.htm
27. https://www.osc.state.ny.us/files/state-agencies/audits/pdf/sga-2020-19s50.pdf
28. https://www.reuters.com/investigates/special-report/usa-military-housing/
30. https://www.osc.state.ny.us/files/state-agencies/audits/pdf/sga-2020-19s50.pdf
31. https://www.reuters.com/investigates/special-report/usa-military-housing/
35. https://health.mil/News/Articles/2021/03/01/Blood-levels-MSMR-Mar-2021
36. https://www.publichealth.va.gov/exposures/lead/index.asp
37. https://phc.amedd.army.mil/topics/workplacehealth/ih/Pages/Lead.aspx
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