The American Public Health Association,
Noting that in 1978 the Occupational Safety and Health Administration (OSHA) promulgated a comprehensive lead standard, based on the renal, neurologic, hematologic, and reproductive toxicity of lead to both male and female workers;1 and realizing that over 800,000 workers in over 100 different occupations are currently exposed to lead; and
Noting that several state health departments and occupational clinics have recently documented cases of acute and chronic occupational lead toxicity2 despite objectives of the US Public Health Service to eliminate occupational lead poisoning by 1990,3 while the full extent of occupational lead poisoning remains unknown, in part because only seven states require reporting of elevated blood lead levels,2 and most practitioners are inadequately trained about occupational disease;4 and
Recognizing that despite the passage of an OSHA standard, toxicity has been documented at blood lead levels well below current medical removal levels,5 and that the organic lead-using and construction industries are exempt from coverage,1 and required monitoring results are not centrally collected or used for preventive purposes, and employer compliance with the standard is incomplete especially in small-size businesses;6 and
Understanding that many lead-exposed workers are not protected or trained on safe techniques, resulting in poisoning of workers, household residents,7-13 family members,14,15 and environmental contamination; and
Noting that some employers have responded to the reproductive hazards of lead by adopting policies which remove female employees from hazardous areas or require sterilization, rather than eliminating the hazard, and that these exclusionary policies have largely affected women in male-dominated, higher-paying occupations,16 and noting that there have been inconsistent appellate court rulings on whether such policies are sex discriminatory;17,18 and
Noting that minority workers are at increased risk of lead poisoning and may face discrimination and other barriers in exercising their rights to protection;2 and
Noting that research has implicated lead as a cause of chronic neurologic, renal, cardiovascular, and reproductive damage,19,20 but that long-term, low level effects have been inadequately studied;21 therefore:
1. Urges the Federal Government to:
a) Expand the protective provisions of the Lead Standard to construction and organic-lead exposed workers, including specific requirements for abatement work, as has been done in Maryland;22,23
b) Increase emphasis on enforcement of the Lead Standard, and for employer/employee education on lead hazards, legal rights and responsibilities in the language and manner that will reach the target groups;
c) Ban all non-essential uses of lead and promote development and substitution of safe alternatives;
d) Consider revisions in the OSHA Lead Standard to reflect current scientific evidence of toxicity, and require thorough job analysis and control measures where levels are elevated.
2. Urges federal and state governments to provide incentives to small businesses in need of assistance to control lead;
3. Reaffirms its support of a mandatory, uniform, laboratory-based reporting system for occupational disease including lead poisoning,24 to include: reporting of all monitoring results, mandatory industrial hygiene and medical follow-up, and funding for such activities;
4. Reaffirms its support for education and safe lead abatement programs;25
5. Recommends that the National Institute for Occupational Safety and Health sponsor educational programs for health care practitioners to better recognize lead-related illness;
6. Encourages health practitioners to be trained to take occupational/environmental histories and to conduct a baseline blood lead if exposure is established;
7. Recommends funding for lead research on:
a) Techniques for assessing body lead burden;
b) Health effects of low-level exposure particularly on cardiovascular, reproductive, including effects on pregnant women and the fetus, neurologic and renal systems;
c) Control technologies and substitute materials.
8. Urges Congress to take steps to ensure that lead-using industries do not deny workers full employment rights and that no worker is required to submit to sterilization or fertility testing to forego procreation as a condition of employment.
1. Occupational Safety and Health Administration, US Department of Labor 29 CFR 1910.1025.
2. Rudolph L, Maizlish N, et al: Surveillance for Occupational Lead Exposure - United States, 1987. MMWR 1989; 38(37): 642-646.
3. US Department of Health and Human Services, Public Health Service: Promoting Health/Preventing Disease: Objectives for the Nation. Washington, DC: US Govt Printing Office, 1980.
4. Markowitz SB, Fischer E, Fahs MC, Shapiro J, Landrigan PJ: Occupational Disease in New York State: A Comprehensive Examination. Am J Ind Med 1989;16(4):417-443.
5. Landrigan PJ: Toxicity of lead at low dose. Br J Ind Med 1989;46:593-596.
6. Rudolph L, Sharp DS, et al: Environmental and biological monitoring for lead in California workplaces. Am J Public Health 1990;80(8):921-925.
7. Chisolm J: Changing sources of lead poisoning. In: Childhood Lead Poisoning: Current Perspectives. USDHHS co-sponsored conference proceedings, Indianapolis, IN, December 1-3, 1978.
8. Amitai Y, Graef JW, Brown MJ, Gerstle RS, Kahn N, Cochrane PE: Hazards of deleading homes of children with lead poisoning. Am J Dis Child 1987;141:758-760.
9. Feldman RG: Urban lead mining: lead intoxication among deleaders. N Engl J Med:1978;298:1143-1145.
10. Key-Alvarez, Menke-Hargrave T: Deleading dilemma: Pitfall in the management of childhood lead poisoning. Pediatrics 1987;79:214-217.
11. Marino PE, Franzblau A, Lilis R, Landrigan PJ: Acute lead poisoning in construction workers: The failure of current protective standards. Arch Environ Health 1989;44:140-145.
12. Landrigan PJ, Baker E, Himmelstein JS, Stein GF, Weddig JP, Straub WE: Exposure to lead from the Mystic River Bridge: The dilemma of deleading. N Engl J Med 1982;306:673-676.13.
13. Himmelstein JS, et al: Lead poisoning in bridge demolition workers - Massachusetts. MMWR 1989;38 (40):687-694.
14. Baker EL, Folland DS, Taylor, et al: Lead poisoning of children of lead workers: Home contamination with industrial dust. N Engl J Med 1977;296:260-261.
15. Giguere CG, Lowes AP, McBean M, et al: Increased lead absorption in the children of lead-exposed workers. Vermont MMWR 1977;26:61-62.
16. Paul M, Daniels C, Rosofsky R: Corporate response to reproductive hazards in the workplace: Results of the family, work and health survey. Am J Ind Med 1989;16:267-280.
17. Bertin JE: Reproduction, women and the workplace: Legal issues. In: Stein Z, Hatch MC (eds): Reproductive Problems in the Workplace. Occup Med State of the Art Rev 1986;1(3):497-508.
18. Auto Workers v. Johnson Controls, Inc., CA 7, No. 88-1308, 9/26/89.
19. Kristensen TS: Cardiovascular diseases and the work environment: A critical review of the epidemiologic literature on chemical factors. Scand J Work Environ Health 1989;15:245-264.
20. Pirkle JL, Schwartz J, Landis JR, Harlan WR: The relationship between blood lead levels and blood pressure and its cardiovascular risk implication. Am J Epidemiol 1985;121:246-258.
21. Landrigan PJ: Current issues in the epidemiology and toxicology of occupational exposure to lead. Environ Health Perspect 1990;(in press).
22. Maryland Occupational Safety and Health, Division of Labor and Industry: Occupational Exposure to Lead in Construction Work. Code of Maryland Regulations 09.12.32, 1988.
23. Maryland Department of the Environment: Procedures for Abating Lead-Containing Substances from Buildings. Code of Maryland Regulations 26.02.07, 1988.
24. American Public Health Association: Policy Statement #8807, Surveillance of Occupational Disease and Injury. Am J Public Health 1989;79(3):354-355.
25. American Public Health Association: Policy Statement #8909, Reducing health risks related to environmental lead exposure. Am J Public Health 1990;80(2):229-230.
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