Household lead control education interventions

By the late 19^th century, lead’s toxic and harmful effects were known, yet the lead industry and many businesses profited from selling lead for use in paint, pipes, and gasoline. Lead was also part of many consumer goods, including toys and household appliances. By the 1950s, millions of children had been poisoned by lead, either chronically or acutely, and public health officials had documented the irreversible effects of childhood lead poisoning from lead exposures in paint and contaminated water¹⁰. Powerful leaders of the lead industry avoided responsibility for knowingly selling products containing toxic lead, claiming that lead poisoning was only a problem among individuals and families of color and those living in poverty and falsely suggesting that education about the risks of lead paint was all that was needed¹⁰.

Formerly redlined neighborhoods are more likely to be communities of color with lower incomes and fewer resources, affected by polluting industries and waste dumping sites, comprised of older and deteriorating houses with lead-based paint, located near lead-polluting industries, and surrounded by heavy traffic with residual effects from leaded gasoline pollution^{9, 11}. Children of color experience disproportionate adverse exposures, including to lead, living in racially segregated, formerly redlined neighborhoods. Government disinvestment and the systematic concentration of poverty has increased and exacerbated lead hazards as housing stock deteriorates, lead water service lines degrade, and industry and waste dumping sites further contaminate the air and soil^{14, 15, 16}.

During the 1970s and 1980s, federal regulation began to address lead air pollution after lead’s toxic effects were evident among children from families with higher incomes, not just among children from families of color with lower incomes^{10, 14, 17}. Legislation reduced the amount of lead in gasoline, and the Clean Air Act Amendments of 1990 banned leaded gasoline for most motor vehicles¹⁷. Lead emissions still come from other sources, including industrial processing and leaded gasoline for some aircraft, racing cars, boats, and trucks¹⁷. As of 2001, roughly 2.7 million people lived in counties that fail to meet U.S. EPA air quality standards for lead emissions, and all of these locations are near industrial sources¹⁷.

The Lead-Based Paint Poisoning Prevention Act in 1971 banned lead paint as of 1978 and identified paint chips as the primary lead hazard in homes. The Residential Lead-Based Paint Hazard Reduction Act of 1992 included lead-contaminated dust and soil in the definition of lead hazards and moved towards prevention of poisoning rather than reaction to poisoning as the national strategy for addressing lead hazards^{14, 17}. Additional federal legislation addressing lead hazards has removed lead from consumer products, foods, pesticides, pottery and glassware, and food packaging¹⁷.

The Safe Drinking Water Act of 1974 established limits for lead levels in drinking water, but it wasn’t until the 1986 amendment that requirements for lead-free plumbing were included, and those did not take effect until 1988^{14, 17}. The Lead and Copper Rule of 1991 identified corrosion of lead pipes and service lines as a major source of lead-contaminated drinking water and encouraged corrosion control and line replacement. Replacement efforts that only partially replace lead pipes can dislodge lead-containing minerals and contaminate drinking water. After serious water contamination events as in Flint, Michigan and Washington, D.C. many cities are attempting to fully replace their lead water service lines; however, private connections to public service lines are typically paid for by homeowners, which may increase disparities in who has access to clean water from lead-free pipes¹⁷.

Legislation and lead hazard removal has reduced childhood lead exposure, with population level decreases in BLLs since the 1970s¹⁷. As of 2010, 23 states have adopted comprehensive lead prevention laws¹⁴. Several local and state governments have adopted legislation that requires lead testing for children at age 1 or 2, including Philadelphia and Pittsburgh, as well as Connecticut, Delaware, Maryland, New Jersey, and New York¹⁵. However, roughly half a million children age 1 to 5 still have BLLs at or above 5 μg/dL, when it is known that there is no safe blood lead level and significant disparities in lead exposure by race, ethnicity, and income remain^{14, 17}. Although a federal program to provide nationwide lead abatement would require allocating significant funds, cost benefit analysis suggests benefits of $17-$221 for every dollar invested in lead paint hazard control due to reduced health care, special education, and crime costs as well as increased lifetime earnings and tax revenue¹⁸. Government decisions about what it is worth to save communities and people suffering from lead hazard exposure are value judgments that have been influenced by explicit and implicit bias with disastrous effects for many communities of color¹⁰. The World Health Organization estimates that lead exposure worldwide accounts for over 1 million deaths annually and over 24 million years of healthy life lost¹, and as of January 2024, only 48% of countries have banned lead paint¹⁹.

• What lead poisoning prevention interventions exist in your community? Are these interventions comprehensive, with funding to remove lead hazards, or are they providing education only? If only education is being provided, why is that? What funding could be made available to prevent lead poisoning through abatement or removal of lead hazards?
• Are all pathways to lead exposure considered and addressed through preventative lead poisoning efforts in your community? What partnerships or collaborations could support addressing lead hazards in contaminated dust, soil, water, and air? How can your community gather support and coordinate efforts from public agencies, community organizations, grant funders, property owners, the public, and others for comprehensive lead poisoning prevention?
• What neighborhoods in your community have higher lead exposure risks? Who has the decision-making power to prioritize reducing disproportionate lead exposure risks?