We have previously published considerable information about toxic
lead and its permanent detrimental effects on young children.
At low levels, lead impairs hearing, diminishes growth, and
reduces IQ. Children with low levels of lead in their blood may
have a hard time paying attention, controlling their impulses,
and learning. In some children, lead contributes to delinquency
In recent weeks we started asking, Why are governments refusing
to comply with a 1989 federal law that requires all infants and
toddlers in the Medicaid program to be tested for lead poisoning?
Medicaid is a federally-funded medical insurance program for poor
people. It is well-established that lead poisoning now occurs
mainly in poor neighborhoods. In 1998, 13.5 million children
(18.9% of all children in the U.S.) lived in poverty. The
General Accounting Office (an investigative branch of Congress)
reported during 1999 that "hundreds of thousands of children
exposed to dangerously high levels of lead are neither tested nor
treated," because state governments are refusing to comply with
the law, the NEW YORK TIMES said.
The current federal "acceptable" level of lead in children's
blood is 10 micrograms (mcg) of lead in each deciliter (tenth of
a liter) of blood, expressed as 10 mcg/dL. One way to get this
lead toxicity standard into perspective is to compare it to
naturally-occurring levels. Even before Europeans arrived in
North America, humans had some lead in their blood (and bones,
where it is still measurable today) because lead is a
naturally-occurring element and some of it is always blowing
around on the wind. We could argue about whether it is proper to
call this a "natural background level" because humans have been
mining lead out of the ground for perhaps 6000 years, so some
human-mobilized lead has been blowing on the wind for aeons,
adding to the levels that nature produces by itself.
In any case, according to the National Research Council, people
in the U.S. have average body burdens of lead approximately 300
to 500 times those found in our prehistoric ancestors.
So how does the "acceptable" limit of 10 mcg/dL compare to
pre-historic lead levels? The relationship between lead in
people's bones and lead in their blood is well-known. Careful
measurements of the bones of pre-Columbian inhabitants of North
America reveal that average blood lead levels were 0.016 mcg/dL
-- about 625 times lower than the 10 mcg/dL now established as
"acceptable" for our children. On the face of it, the current
10 mcg/dL standard seems imprudent because it assumes that a
potent nerve poison at levels 625 times as high as natural
background is "acceptable" for children.
Indeed, some of the nation's most prestigious medical
organizations acknowledge that children are being harmed at the
current federally-established "acceptable" level. The American
Academy of Pediatrics in 1993 reviewed 18 medical studies showing
that lead diminishes a child's mental abilities. "The
relationship between lead levels and IQ deficits was found to be
remarkably consistent," the Academy said. "A number of studies
have found that for every 10 mcg/dL increase in blood lead
levels, there was a lowering of mean [average] IQ in children by
4 to 7 points." Four to 7 IQ points may not sound like a major
loss, but an average loss of 5 IQ points puts 50% more children
into the IQ 80 category, which is borderline for normal
intelligence. It also reduces the number of high IQs; for
example, one group that should have had 5% children with IQs of
125 (or above) contained none. So 10 mcg/dL of lead -- the
federal government's current "acceptable" standard for lead
poisoning -- is sufficient to cause a general dumbing down of
children exposed at that level. As the federal Centers for
Disease Control (CDC) acknowledges, "Blood lead levels at least
as low as 10 mcg/dL can adversely affect the behavior and
development of children."2 Thus the federal government has set a
"acceptable" level of lead in blood that it acknowledges does not
protect children. Indeed, damage to children has been documented
at blood-lead levels considerably below 10 mcg/dL. The federal
Agency for Toxic Substances and Disease Registry (ATSDR, within
the CDC) cites studies showing that children's growth, hearing,
and IQ can be diminished by blood-lead levels as low as 5
In any case, federal law says that all children in the Medicaid
program should be tested for lead at age 12 months and again at 2
years. Many states have no idea what percentage of children they
have tested because they have failed to keep records. Among
states that have kept records, the worst is Washington state,
which has tested only 1% of eligible children; the state with the
best record, Alabama, has tested only 46% of those eligible.
Is it because the problem is too small to merit attention? Has
the problem of lead-poisoned children gone away, as some would
have us believe? Here is the most recent published information:
During the period 1991-1994, the federal Centers for Disease
Control (CDC) tested the blood of a representative sample of the
U.S. population, looking for lead poisoning. They found that 4.4%
of children ages 1 to 5 have at least 10 mcg/dL; CDC says 4.4%
represents just under a million children (890,000) ages 1 to
5. Of course each year roughly 200,000 of these children grow
to age 6 and leave the "high-risk" group (carrying their
intellectual deficit with them) and another 200,000 children join
the "high-risk group" and become brain-damaged. In some cities of
the northeastern U.S., 35% of pre-school children have 10 mcg/dL
or more of lead in their blood.
Who are these children? Although poverty itself is a good
predictor of childhood lead poisoning, there is a clear racial
disparity at work as well. One researcher who examined this
question reported that "the homes of Black children had higher
levels of lead-contaminated dust and their interior surfaces were
in poorer condition." Children living in low-income families
are 8 times as likely to be lead poisoned as children who are not
poor. Black children are 5 times as likely to be lead poisoned as
How can this problem be fixed? The source of the lead must be
eliminated without leaving a dangerous residue of toxic dust. The
American Academy of Pediatrics said in 1993, "Identification and
treatment of the child poisoned with lead continues to be
essential, but of greater importance is IDENTIFICATION OF THE
SOURCE and PREVENTION OF SUBSEQUENT EXPOSURES for that child and
other children in the future." [Emphasis in the original.] In
other words, the only real solution is primary prevention.
Testing children for lead poisoning is the current
federally-approved method for identifying lead-contaminated
homes. It is important to recognize that this approach is not
primary prevention. This approach uses children the way miners
formerly used canaries -- as a signal that trouble has already
occurred. In the mines, a dead canary meant that toxic gases had
built up to dangerous levels in the mine; similarly, finding 10
mcg/dL or more of lead in a child's blood is a sign that
excessive lead is present in the child's environment and
poisoning has already occurred.
Primary prevention -- preventing lead exposures -- is the only
permanent solution to this problem, and it will be expensive. It
has been estimated that the first-year cost of reducing lead
hazards in federally-owned and federally-assisted housing would
be $458 million. However, the calculated benefits from such lead
abatement would be $1.538 billion -- a net benefit of $1.08
billion, so it is certainly affordable.
Other public policies could help. A careful study of two
districts in Massachusetts and neighboring Rhode Island showed
that lead poisoning is much less common in Massachusetts.
For 20 years, Massachusetts has required lead abatement in all
homes built before 1978 that are inhabited by children younger
than 6. And Massachusetts law makes property owners legally
responsible for damage sustained by lead-exposed children. Rhode
Island has no such policies and it has a much higher incidence of
lead poisoned children. Most states have no laws like those in
When lead abatement occurs, it can be done well or it can be done
badly. Five to 10 percent of current childhood lead poisoning in
the U.S. is thought to have resulted from sloppy lead
abatement. Here again, public policies have gone awry. The
main source of lead in children is house dust. Both the federal
Department of Housing and Urban Development (HUD) and the U.S.
Environmental Protection Agency (EPA) have set standards for lead
in dust which, if met, essentially guarantee that childhood lead
poisoning at the level of 10 mcg/dL will continue.[10,14,15]
Even if the current government standard for lead in dust were
reduced to one-tenth its present level, it would still allow
children to be poisoned by lead in dust.[10,14,15]
In sum, we have a federally-mandated blood-lead standard (10
mcg/dL) that permanently dumbs down any children who meet it,
which is nearly a million children at any moment, and roughly
200,000 new dumbing-downs are occurring each year. Medical
authorities agree that the only real solution is primary
prevention -- keeping lead-contaminated dust away from children.
Credible estimates show that the federal government could make a
profit of $1.08 billion by undertaking primary prevention in
federally-owned or -assisted housing, but instead the government
requires the dead-canary approach, blood-lead testing, which the
states then refuse to carry out. We know from the Massachusetts
experience that public policies that put the onus on the private
sector can make a big difference -- but most states have failed
to adopt such policies.
Most of the victims of all this are babies born into poverty. We
can only conclude that current government policies must reflect
the values of those who hold power. Those who make public
policies must feel a need to maintain a permanent pool of people
disadvantaged from birth. Governments throughout the U.S. must
be doing what powerful elites want them to do -- refusing to
confront the lead industry, the paint industry, the housing
industry, the real estate industry and the campaign contribution
industry, refusing to apply the primary prevention approach to
this public health menace, and, instead, continuing to poison
hundreds of thousands of poor black and hispanic children each
If you are skeptical of (or offended by) the suggestion that this
problem is allowed to endure because it mainly affects poor
children and minority children, ask yourself this: how long would
this problem persist if those being poisoned were mainly white
children who spent their summers at the country club?
--Peter Montague (National Writers Union, UAW Local 1981/AFL-CIO)
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#490, #501, #508, #526, #529, #539, #540, #551, #561, #590, #591,
#633, #687, #688 available at www.rachel.org.
 Anonymous, "Update: Blood Lead levels -- United States,
1991-1994," MORBIDITY AND MORTALITY WEEKLY REPORT Vol. 46, No. 7
(February 21, 1997), pgs. 141-146. A correction was published in
"Erratum: Vol. 46, No. 7," Morbidity and Mortality Weekly Report
Vol. 46, No. 26 (July 4, 1997) pg. 607.
 Children's Defense Fund, "Poverty Status of Persons Younger
Than 18: 1959-1998," available at http://www.-
 Robert Pear, "States Called Lax on Tests for Lead in Poor
Children," NEW YORK TIMES August 22, 1999, pg. A1.
 Jerome O. Nriagu, "Tales Told in Lead," SCIENCE Vol. 281
(September 11, 1998), pgs. 1622-1623.
 National Research Council, MEASURING LEAD EXPOSURE IN
INFANTS, CHILDREN, AND OTHER SENSITIVE POPULATIONS (Washington,
D.C.: National Academy Press, 1993), pg. xii.
 A. Russell Flegal and Donald R. Smith, "Lead Levels in
Preindustrial Humans," NEW ENGLAND JOURNAL OF MEDICINE Vol. 326,
No. 19 (May 7, 1992), pgs. 1293-1294.
 Committee on Environmental Health, American Academy of
Pediatrics, "Lead Poisoning: From Screening to Primary
Prevention," PEDIATRICS Vol. 92, No. 1 (July 1993), pgs. 176-183.
 ATSDR, TOXICOLOGICAL PROFILE FOR LEAD (Atlanta, Ga.: Agency
for Toxic Substances and Disease Registry, July 1999). Available
from ATSDR, 1600 Clifton Rd., NE, E-29, Atlanta, Ga. 30333, pgs.
 Bruce P. Lanphear, "The Paradox of Lead Poisoning
Prevention," SCIENCE Vol. 281 (September 11, 1998), pgs.
 Bruce P. Lanphear, "Racial Differences in Urban Children's
Environmental Exposures to Lead," AMERICAN JOURNAL OF PUBLIC
HEALTH Vol. 86, No. 10 (October 1996), pgs. 1460-1463.
 Don Ryan and others, "Protecting Children From Lead
Poisoning and Building Healthy Communities," AMERICAN JOURNAL OF
PUBLIC HEALTH Vol. 89, No. 6 (June 1999), pgs. 822-824.
 James D. Sargent and others, "The Association Between State
Housing Policy and Lead Poisoning in Children," AMERICAN JOURNAL
OF PUBLIC HEALTH Vol. 89, No. 11 (November 1999), pgs. 1690-1695.
 Bruce P. Lanphear and others, "Lead-Contaminated House Dust
and Urban Children's Blood Lead Levels," AMERICAN JOURNAL OF
PUBLIC HEALTH Vol. 86, No. 10 (October 1996), pgs. 1416-1421.
 Bruce P. Lanphear and others, "The Contribution of
Lead-Contaminated House Dust and Residential Soil to Children's
Blood Lead Levels," ENVIRONMENTAL RESEARCH, SECTION A Vol. 79
(1998), pgs. 51-68.
Descriptor terms: lead; paint; children's health; housing;
public health policy;