The American Public Health Association,
Recognizing that exposure to lead is universal as a result of human-caused disturbances in the natural distribution of lead, and that elevation in the body burden of lead is one of the most prevalent causes of preventable disease;1,2 and
Accepting that current lead levels in Americans are between 100 and 1,000 times those occurring in humans prior to the current technological era,3 and that new biomedical data demonstrate that lead is toxic to fetuses, children, and adults at levels of exposure which are endemic,4,5 and that existing sources of lead affect millions of Americans through contamination of air, water, food, dusts, and soils; and
Noting that toxicity has been described by the US Environmental Protection Agency and the Agency for Toxic Substances and Disease Registry at levels that are experienced by more than 16 percent of all children in the United States, and 55 percent of Black children in poverty; and
Noting that the sequelae of lead toxicity are persistent and associated with chronic diseases of the cardiovascular system6,7 and kidney,8 as well as impaired growth,9 hearing,10 learning and social development of children;11-13 and
Noting that various agencies of the federal government, including the Environmental Protection Agency, Occupational Safety and Health Administration,14 Consumer Product Safety Commission,15 Department of Housing and Urban Development,16 and Food and Drug Administration17 have taken actions to identify and reduce certain sources of lead exposure in the environment and workplace, but that these actions are uncoordinated and incomplete; and
Recognizing that the current uncoordinated approach to preventing lead toxicity has resulted in inconsistent public policy and lack of effective actions by responsible government agencies and inadequate funding for abatement programs, particularly those related to removing leaded paint from old housing; and
Recognizing that environmental lead exposure results from both historic uses of lead, and ongoing uses of lead in industry and in consumer products, many of which are replaceable or reducible; and
Recognizing that the areas of highest lead exposure are also the areas of the nation with highest unemployment and greatest need for low-cost housing; and
Recognizing that the social costs of unidentified lead exposure exceed $1.5 billion18 per year for remedial education, and that lead exposure is related to school dropout, attention deficit, and reading disability; and
Considering the enormous costs exerted by lead on public health and the inequitable distribution of these costs on American society; therefore
- Reaffirms the recommendations provided by APHA policy statement #8508;19 and further
- Recommends the establishment, periodic review, and modification by the Centers for Disease Control of health-based guidelines for prevention of lead poisoning in both adults and children. These guidelines must recognize the newest health and environmental data, and will be more stringent than current standards;
- Urges that the eradication of lead toxicity be a major public health goal in the US and that appropriate federal, state, and local funding be provided for this purpose;
- Encourages actions by the World Health Organization to achieve similar ends world-wide;
- Recommends coordination of the actions of federal agencies to reduce ongoing sources of lead in the environment and to facilitate the rapid abatement of lead sources associated with past uses such as lead in gasoline, lead smelters, and lead-based paint in housing;
- Encourages research on the potential carcinogenicity, neurotoxicity, reproductive toxicity, and potential effects of lead on aging populations;
- Recommends the development of training and certification programs in safe lead abatement and housing rehabilitation and requires that all workers and contractors who undertake lead abatement be properly certified; and that all lead abatement work adhere, at a minimum, to the OSHA lead standard for industry;
- Recommends that abatement programs where possible be designed to offer employment opportunities to residents of leaded neighborhoods; and
- Urges that adequate funds be appropriated to enable low and moderate income residents and property owners to undertake residential lead abatement efforts.
- Mushak P, Crocetti A: The nature and extent of lead poisoning in children in the United States: A report to Congress. Atlanta, GA: US DHHS, Centers for Disease Control/Agency for Toxic Substances and Disease Registry (CDC/ATSDR), 1986.
- EPA: Air Quality Criteria for Lead. Research Triangle Park, NC: US Environmental Protection Agency, 1986.
- Patterson CC: An alternative perspective — lead pollution in the human environment origin, extent, and significance. In: Lead in the Human Environment. A report prepared by the Committee on Lead in the Human Environment, National Academy of Sciences. Washington, DC: NAS, 1980;265-349.
- Needleman HL, Landrigan P: The health effects of low level exposure to lead. Annu Rev Public Health 1981;2:277-298.
- Needleman HL: The persistent threat of lead: Medical and sociological issues. Current Problems in Pediatrics; Yearbook Medical Publishers, 1988;18:704-744.
- Freeman R: Reversible myocarditis due to chronic lead poisoning in childhood. Arch Dis Child 1965;40:389-393.
- Silver W, Rodriguez-Torres R: Electrocardiographic studies in children with lead poisoning. Pediatrics 1968;41:1124-1127.
- Emmerson BT: Chronic lead nephropathy. Kidney International 1973;4:1-5.
- Schwartz J, Angle C, Pitcher H: Relationship between childhood blood lead levels and stature. Pediatrics 1986;77:281-288.
- Schwartz J, Otto D: Blood lead levels, hearing thresholds, and neurobehavioral developmental in NHANES II children and youth. Health Effects Research Laboratory, USEPA, 1986.
- Needleman HL, Gunnoe C, Leviton A, Reed R, Peresie H, Maher C, Barrett P: Deficits in psychologic and classroom performance of children with elevated dentine lead levels. N Engl J Med 1979;300:689-695.
- Bellinger D, Leviton A, Waternaux C, Needleman HL, Rabinowitz M: Longitudinal analyses of prenatal and postnatal lead exposure and early cognitive development. N Engl J Med 1987;316:1037-1043.
- Fulton M, Raab G, Thomson G, Laxen D, Hunter R, Hepburn W: Influence of blood lead on the ability and attainment of children in Edinburgh. Lancet 1987;1:1221-1226.
- Occupational Safety and Health Administration: Occupational exposure to lead. Federal Register 1975;40:45934.
- Consumer Product Safety Commission: Regulation of products subject to other acts under the Consumer Product Safety Act, 16CFR 1500. Federal Register Sept. 1, 1977 44192-44202.
- US Department of Housing and Urban Development: Lead-based paint poisoning prevention in federally owned and federally assisted housing. Federal Register June 25, 1975;, 40:26974.
- US Food and Drug Administration: Hazardous substances. Definitions and procedural interpretive regulations, classification of certain lead-containing paints and other similar substances. 21 CFR 191.9. Federal Register March 11, 1972;37:5229-5231.
- Provenzano G: The social costs of excessive lead exposure during childhood. In: Needleman HL (ed): Low Level Lead Exposure: The Clinical Implications of Current Research. New York: Raven Press 1980;299-315.
- American Public Health Association, Policy Statement #8508: Health Risks Related to Lead Exposure. APHA Public Policy Statements 1948-present, cumulative. Washington, DC: APHA, current volume.
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