Lucia Coulter, Expert on preventing lead poisoning, speaks about the successful Lead Exposure Elimination Project (LEEP) reducing childhood lead exposure in poor countries and the devastating effects of lead poisoning on health and cognitive development. They discuss the cost-effectiveness of LEEP's work, the sources of lead exposure, and efforts to remove leaded paint. The chapter also explores challenges in lead testing methods, intervention strategies, funding, and industry support for regulation.
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Quick takeaways
Lead paint is a significant and neglected source of lead exposure in low and middle-income countries.
Lead exposure has severe health impacts on children, including cognitive impairments, reduced IQ, cardiovascular problems, kidney disease, and behavioral disorders.
Eliminating lead from paint is a cost-effective intervention with a high return on investment.
Lead exposure comes from various sources, including lead-acid batteries, ceramics, spices, cosmetics, and water systems.
Efforts are underway to eliminate lead paint in 50 more countries, covering 90% of children in low-income nations.
Close collaboration between organizations, governments, and industry stakeholders is essential in addressing lead exposure and implementing regulations.
Deep dives
Lead Paint: A Widespread and Neglected Source of Lead Exposure
Lead paint is a significant and neglected source of lead exposure in low and middle-income countries. Paints with high levels of lead have been found in many countries, including Malawi. Through a study conducted in Malawi, Leap and the Malawi Bureau of Standards discovered that 57% of paint samples tested had very high levels of lead. This led to immediate action by the government, with commitments to implement regulations and enforce lead paint standards. Similar successes have been seen in other countries Leap works in. The role of lead paint is particularly important because it is a widespread and tractable source of lead exposure.
The Devastating Health Impacts of Lead Exposure
Lead exposure has severe health impacts, especially on children. Even at low levels, lead can cause cognitive impairments, reduced IQ, cardiovascular problems, kidney disease, and behavioral disorders. Children are more vulnerable to lead's toxic effects as they absorb it more readily and their developing brains are more susceptible to damage. Additionally, lead can be stored in bones, gradually releasing over time. Low and middle-income countries bear a significant burden of lead exposure, with 95% of global cases found in these regions. The economic and health costs of lead exposure are substantial, making efforts to eliminate lead from various sources crucial.
Lead Paint: A Cost-Effective Target for Intervention
Eliminating lead from paint is a cost-effective intervention. Studies have shown that the expenses incurred by LEAP in addressing lead paint in Malawi had a high return on investment. The cost-effectiveness was estimated at $14 per disability-adjusted life year (DALY) averted. By intervening and accelerating the implementation of lead paint regulations, LEAP was able to bring forward the removal of lead paint by eight years, potentially preventing widespread lead exposure in children. The cost-effectiveness of lead paint interventions highlights the urgent need to prioritize action in low and middle-income countries where this issue is prevalent.
Other Sources of Lead Exposure
In addition to lead paint, other significant sources of lead exposure include lead-acid batteries, lead-glaze ceramics, cosmetics (such as black eyeliners in some cultures), lead-adulterated spices, and water systems. Each of these sources poses its own unique challenges and risks, contributing to the overall burden of lead exposure in different regions. While lead paint is a top priority for intervention due to its widespread and tractable nature, addressing the broader range of lead sources is essential to comprehensively combat lead exposure and its detrimental effects on health.
Extent of lead exposure
Lead exposure can come from sources such as lead-based makeup and lead-a-gasoline in soil, with children most at risk.
Challenges in identifying lead sources
It is difficult to determine the exact sources of lead exposure and attribute it to specific sources due to various factors, including low-level and widespread exposures.
Lead in water
While lead piping in high-income countries is less of a contributor, it remains a concern in low-income countries where water systems may contain lead.
Exploring other sources of lead
Alternative sources worth considering include lead in spices, cosmetics like black eyeliner, and aluminum cookware, with each having their own advantages and challenges.
Scaling up lead paint elimination
Efforts are underway to eliminate lead paint in 50 more countries, covering 90% of children in low-income nations, with the aim to secure funding and hire more personnel.
The importance of cost-effective testing methods
Developing low-cost and portable devices for lead testing in both paint and blood could facilitate more efficient and accessible monitoring and lead mitigation initiatives.
Collaborative efforts and government engagement
LEAP collaborates closely with governments to establish relationships, conduct paint studies, and support the formulation and implementation of lead paint regulations.
Budget constraints and capacity building
LEAP provides financial support, technical expertise, and resources to assist regulatory authorities in overcoming budget limitations and enhancing testing capabilities.
Industry cooperation and resistance
Many paint manufacturers are supportive of lead paint regulations to ensure a level playing field, while a lack of industry resistance has been observed.
Ongoing challenges and future opportunities
Addressing lead exposure requires continued efforts to raise awareness, expand testing capabilities, and develop cost-effective solutions to eliminate lead from various sources.
The Impact of Regulation on Industry and Government
Regulation can be beneficial for both industry and government when it is enforced uniformly across the entire industry. It creates a level playing field and allows industry to maintain their size and revenue. The government is more inclined to support regulation when industry is on board, making it easier to enforce and feasible. This bidirectional relationship between regulation and industry helps ensure a smooth implementation.
The Importance of Messaging to Policymakers
When communicating with policymakers, it is crucial to provide local data and offer solutions that are feasible for industry. Policymakers value information that is relevant to their role and appreciate the international precedent set by other countries. Credibility from organizations like the World Health Organization (WHO) and the UN Environment Program enhances the messaging and increases the likelihood of support for the regulations.
Charity Entrepreneurship Program and its Impact
The Charity Entrepreneurship Program supports individuals in starting high-impact nonprofits. By researching and presenting intervention ideas to participants, the program helps them prioritize certain causes. It offers comprehensive training on various aspects of starting a nonprofit and helps participants find co-founders. The program also provides ongoing support and mentorship, fostering a community of like-minded individuals. Overall, it enables individuals to create impactful organizations that address neglected areas and have the potential for significant change.
Lead is one of the most poisonous things going. A single sugar sachet of lead, spread over a park the size of an American football field, is enough to give a child that regularly plays there lead poisoning. For life they’ll be condemned to a ~3-point-lower IQ; a 50% higher risk of heart attacks; and elevated risk of kidney disease, anaemia, and ADHD, among other effects.
We’ve known lead is a health nightmare for at least 50 years, and that got lead out of car fuel everywhere. So is the situation under control? Not even close.
Around half the kids in poor and middle-income countries have blood lead levels above 5 micrograms per decilitre; the US declared a national emergency when just 5% of the children in Flint, Michigan exceeded that level. The collective damage this is doing to children’s intellectual potential, health, and life expectancy is vast — the health damage involved is around that caused by malaria, tuberculosis, and HIV combined.
This week’s guest, Lucia Coulter — cofounder of the incredibly successful Lead Exposure Elimination Project (LEEP) — speaks about how LEEP has been reducing childhood lead exposure in poor countries by getting bans on lead in paint enforced.
Which raises the question: why hasn’t this happened already? How is lead still in paint in most poor countries, even when that’s oftentimes already illegal? And how is LEEP able to get bans on leaded paint enforced in a country while spending barely tens of thousands of dollars? When leaded paint is gone, what should they target next?
With host Robert Wiblin, Lucia answers all those questions and more:
Why LEEP isn’t fully funded, and what it would do with extra money (you can donate here).
How bad lead poisoning is in rich countries.
Why lead is still in aeroplane fuel.
How lead got put straight in food in Bangladesh, and a handful of people got it removed.
Why the enormous damage done by lead mostly goes unnoticed.
The other major sources of lead exposure aside from paint.
Generalisable lessons LEEP has learned from coordinating with governments in poor countries.
And plenty more.
Producer and editor: Keiran Harris Audio Engineering Lead: Ben Cordell Technical editing: Milo McGuire and Dominic Armstrong Transcriptions: Katy Moore
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