Around 1 in 3 children – up to 800 million globally – have blood lead levels at or above 5 micrograms per decilitre (µg/dL), a level that the World Health Organization and the United States Centers for Disease Control and Prevention have stated requires global and regional interventions. India accounts for 275,561,163 of these children.

Lead poisoning is affecting children on a massive and previously unknown scale

A joint report ‘The Toxic Truth: Children’s exposure to lead pollution undermines a generation of potential’ by United Nations Children’s Fund (UNICEF) and Pure Earth, a non-profit organisation notes that lead is a potent neurotoxin that causes irreparable harm to children’s brains. It is particularly destructive to babies and children under the age of 5 as it damages their brain before they have had the opportunity to fully develop, causing them lifelong neurological, cognitive, and physical impairment.

Lead levels in the blood of children show they score three to five points lower on intelligence tests, compared to their counterparts who did not have such elevated levels. A meta-analysis of lead levels in the blood of Indian children showed they could lose four intelligence quotient points each because of lead exposure, said the report.

The analysis of childhood lead exposure synthesized the results of 31 individual studies representing the blood lead levels of 5,472 people in nine states of India, finding a mean blood lead level of 6.86 ?g/dL for children and 7.52 ?g/dL for adults with no known occupational exposure.

Childhood lead exposure has also been linked to mental health and behavioural problems and an increase in crime and violence. Older children suffer severe consequences, including increased risk of kidney damage and cardiovascular diseases in later life, the report says.

“With few early symptoms, lead silently wreaks havoc on children’s health and development, with possibly fatal consequences. Knowing how widespread lead pollution is – and understanding the destruction it causes to individual lives and communities – must inspire urgent action to protect children once and for all,” said UNICEF Executive Director Henrietta Fore.

It is estimated to cost lower - and middle-income countries, $1 trillion in the lost economic potential of these children over their lifetimes.

It is clear from evidence compiled that lead poisoning is a much greater threat to the health of children than previously understood. Although much more research needs to be conducted, enough data has recently emerged for decisive action to begin – and it must begin now.

Sources of lead exposure

A leading contributor to lead exposure is informal and sub-standard recycling of lead-acid batteries, the report pointed out. Sources of childhood exposure include the lead in water from the use of leaded pipes, lead from active industry - such as mining - lead-based paint and pigments, and leaded gasoline.

Lead solder in food cans, as well as in spices, cosmetics, ayurvedic medicines, toys, and other consumer products, are also to blame. Parents whose occupations involve working with the lead often bring contaminated dust home on their clothes, hair, hands and shoes, inadvertently exposing their children to the toxic element.

The report also cited folk remedies and cosmetics used by households that contained lead. Ghasard, an Indian folk medicine in the form of a brown powder used as a tonic, contained lead. Sindoor (vermillion), a traditional red or orangish-red cosmetic powder worn by women on the Indian subcontinent, can contain lead.

Lead paint was yet another source of exposure, said the report, citing the lack of regulations in countries as a source of concern. Cameroon, China, Ethiopia, India, Israel, Kenya, the Philippines, Tanzania, and Thailand have laws against lead paint for industrial uses as of 2015, according to the report.

Lead in water

Lead in drinking water, most commonly from decaying or corroding pipes and fixtures or from the solder that connects pipes, continues to be a risk. Although lead was more expensive than iron, lead pipes had two significant advantages over iron ones: they lasted much longer than iron (about 35 years compared with 16) and, because lead is more malleable, the pipes could be more easily bent around existing structures. The degree to which lead dissolves into water depends on the temperature, pH, and time that water has been in touch with corroding lead pipes.

The report notes that countries should include strict parameters on lead in their drinking water quality standards. The World Health Organization provides a provisional guideline value of 10 ?g/L in drinking water for analytical purposes, but, in regard to health, the organization suggests lead levels should be as low as possible.

Canada has updated the drinking water guideline to reduce the maximum acceptable concentration as low as possible but to a maximum of 5 ?g/L. The US Environmental Protection Agency has a zero-exposure limit.

The long-term solution to eliminating the source of exposure is replacing pipes. However, replacing the pipes and mains of entire water systems is very expensive and in lower-income countries might be prohibitive. Hence, water providers can introduce additives (orthophosphate and pH) that reduce the corrosion of pipes and over time reduce the likelihood of lead getting into the water as it passes through the customer’s service line, indoor pipes, and plumbing to the faucet.

Drawbacks to using orthophosphate include the ripple effects of adding this nutrient into the larger water supply that, under the right conditions, can set off a chain of problematic events such as accelerating the growth of algae. Areas of intervention can include the regulation and the capacity of service providers to manage the lead-related risks of drinking water safety.

Recommendations

The report notes that governments in affected countries can address lead pollution and exposure among children using a coordinated and concerted approach across the following areas:

• Monitoring and reporting systems including building capacity for blood lead level testing.
• Prevention and control measures including preventing children’s exposure to high-risk sites and products that contain lead, such as certain ceramics, paints, toys, and spices.
• Management, treatment, and remediation including strengthening health systems so that they are equipped to detect, monitor and treat lead exposure among children; and providing children with enhanced educational interventions and cognitive behavioural therapy to better manage the negative effects of lead exposure.
• Public awareness and behaviour change including creating continual public education campaigns about the dangers and sources of lead exposure with direct appeals to parents, schools, community leaders, and healthcare workers.
• Legislation and policy including developing, implementing, and enforcing environmental, health and safety standards for manufacturing and recycling of lead acid batteries and e-waste, and enforcing environmental and air-quality regulations for smelting operations.
• Global and regional action including creating global standard units of measure to verify the results of pollution intervention on public health, the environment, and local economies; building an international registry of anonymized results of blood lead level studies; and creating international standards and norms around recycling and transportation of used lead acid batteries.

The report is available here