Control of Lead Sources in the United States, 1970-2017: Public Health Progress and Current Challenges to Eliminating Lead Exposure

Abstract

Context: During the past 45 years, exposure to lead has declined dramatically in the United States. This sustained decline is measured by blood and environmental lead levels and achieved through control of lead sources, emission reductions, federal regulations, and applied public health efforts. Objective: Explore regulatory factors that contributed to the decrease in exposure to lead among the US population since 1970. Design/Setting: We present historical information about the control of lead sources and the reduction of emissions through regulatory and selected applied public health efforts, which have contributed to decreases in lead exposure in the United States. Sources of lead exposure, exposure pathways, blood lead measurements, and special populations at risk are described. Results: From 1976-1980 to 2015-2016, the geometric mean blood lead level (BLL) of the US population aged 1 to 74 years dropped from 12.8 to 0.82 μg/dL, a decline of 93.6%. Yet, an estimated 500 000 children aged 1 to 5 years have BLLs at or above the blood lead reference value of 5 μg/dL established by the Centers for Disease Control and Prevention. Low levels of exposure can lead to adverse health effects. There is no safe level of lead exposure, and child BLLs less than 10 μg/dL are known to adversely affect IQ and behavior. When the exposure source is known, approximately 95% of BLLs of 25 μg/dL or higher are work-related among US adults. Despite

Blood Lead Levels in children 2 through 59 months old in Bhutan

“…The only significant risk factor was regularly eating with fingers/ hands (p<0.001). comparison, in developed countries where lead prevention programs have been active for decades, the prevalence of EBLLs is as low as 1.3% 14 . This study found significantly more boys had EBLLs compared to girls.…”

“…In addition, demographic data and thirty questions related to lead exposure risks, such as the presence of peeling paint in the dwelling, proximity to construction or busy roads, and the use of traditional medicines were asked. These questions were developed based on other studies as well as local context [12][13][14] .…”

The State of Public Health Lead Policies: Implications for Urban Health Inequities and Recommendations for Health Equity

“…The banning of leaded gasoline dramatically improved blood lead levels among people of all ages and has significantly reduced lead in the air [85]. Yet, the CAA falls short in protecting communities from lead exposure.…”

“…The Standards continue to focus on lead-based paint, as they are only applicable to homes built pre-1978, the year during which lead-based paint was outlawed. In doing so, the Standards overlook other historical sources of lead, such as lead from gasoline emissions, which was not completely phased out until the mid-1990s [85]; and lead in soil and dust that may be influenced by leaded paint.…”

“…California’s permissible lead exposure level for adults (25 µg/dL), is less stringent than the 5 µg/dL established by the National Institute of Occupational Safety and Health (NIOSH) [85]. This is notable provided lead exposure in adulthood has been found to be associated with hypertension, renal problems, cognitive deterioration, and an elevated risk for all-cause mortality [51,52,53,55].…”