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#827 -- Pediatricians Urge a Precautionary Approach to Toxic Lead, 29-Sep-2005

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#827 – Pediatricians Urge a Precautionary Approach to Toxic Lead, September 29, 2005
  
By Peter Montague

PEDIATRICIANS URGE A PRECAUTIONARY APPROACH TO TOXIC LEAD

The American Academy of Pediatrics (AAP) has just issued a new "policy statement" urging the U.S. to eliminate toxic lead from all housing, to stop poisoning the nation's children.[1]

The Academy says 25% of children in the U.S. still "live in housing with deteriorating lead-based paint and are at risk of lead exposure with resulting cognitive impairment and other sequelae [consequences]."

This means there are more children labeled "at risk" today than there were 20 years ago. During the 20 years, the median level of lead in children's blood has dropped nearly 8-fold (from 15 ug/dL to 1.9 mg/dL) because lead was banned from gasoline, from water pipes, and from food containers. However, during the same period, bad news about lead's harmful effects at low levels has accumulated year after year.

According to the latest estimate from the Academy, about 20 million children (ages 0-18) live in homes where lead-based paint is still a hazard, 5 million of them age 5 or younger. The youngest three million of these -- kids up to age 3 -- are in greatest danger because they are most likely to lick or chew window sills or other sources of lead- based paint, or to put their hands or household objects or toys in their mouths. Lead-based paint tastes like lemon drops.

This is the first time the Academy has urged the elimination of toxic lead-based paint at its source as the best way to stop the poisoning of children. In the past the Academy has relied on pediatricians to educate parents about ways to prevent their children from being poisoned.[2]

Notice the difference: The old approach assumed that attentive parents could manage to raise healthy children in a toxic environment. When they failed, a "case manager" from the health department stepped in locate the source of exposure and fix the problem. At least that was the theory. This cumbersome and expensive one-on-one approach did not protect the nation's children. In contrast, the Academy's new policy assumes that persistent toxicants like lead cannot be managed but must be eliminated -- signaling a clear shift to a precautionary approach. As the Academy's new policy says, "The focus in childhood lead-poisoning policy... should shift from case identification and management to primary prevention, with a goal of safe housing for all children." We salute the American Academy of Pediatrics for this important step forward.

The Academy's new policy statement contains considerable new information about the dangers of exposing young children to lead:

** The current "level of concern" for lead in a child's blood is still set by the federal government at 10 micrograms of lead in a deciliter (1/10th of a liter) of blood, expressed as ug/dL. The federal government recommends taking no action on lead below 10 ug/dL. >From 10 to 15, monitoring is recommended but no action. Unless a child has 15 ug/dL lead in their blood for longer than 3 months, or if a child has 20 ug/dL in their blood at any time, then the government recommends investigating the child's environment to find the source of the lead exposure and reduce or eliminate it.

However the Academy's new policy statement confirms that no one any longer believes that 10 ug/dL protects lead-exposed children from harm, or that there is any "safe" level of lead exposure for children. The federal government itself came to this conclusion in 2002: "there is no apparent threshold below which adverse effects of lead do not occur," said the Centers for Disease Control and Prevention (CDC). The Academy, too, acknowledges that, "Evidence continues to accrue that commonly encountered blood lead concentrations, even those less than 10 micrograms/deciliter, may impair cognition [brain function], and there is no threshold yet identified for this effect." In other words, any amount of lead in a child causes some brain damage -- there is no "safe" level of lead except zero. Yet the federal government continues to recommend that children poisoned by lead be ignored if their blood lead level is lower than 10 ug/dL.

The main effect of lead is to impair cognition, which is usually measured (after age 5) by an IQ test. Any amount of lead reduces a child's IQ to some degree.

The Academy's new policy statement says, "The best-studied effect is cognitive impairment, measured by IQ tests. The strength of this association [between increased lead and decreased IQ] and its time course have been observed to be similar in multiple studies in several countries. In most countries, including the United States, blood lead concentrations peak at approximately 2 years of age and then decrease without intervention." This decrease occurs because children older than 2 don't put hands and objects in their mouths as often as babies and toddlers do, plus the child is gaining weight, so lead is being diluted.

For children with more than 10 ug/dL of lead in their blood, each additional 10 ug/dL of lead reduces IQ another 2 to 3 points. However, two recent studies have shown that the first 10 ug/dL increase is the most damaging, reducing a child's IQ by "more than 7 points," the Academy reports. In other words, the "dose response curve" is steepest at the lowest doses; the greatest harm from lead begins to occur when a children has the least lead.

Obviously, this means it is important to prevent that first 10 ug/dL rise in a child's blood lead levels.

The Academy acknowledges these studies but says that its new policy statement does not reflect this new information. The Academy is waiting for additional confirmation before acting more aggressively to protect young children from that first 10 ug/dL "hit" to their systems.

** The new policy statement acknowledges that toxic lead is associated with aggressive behavior and delinquency in children. Past policy statements by the Academy have ignored the body of literature, going back to 1943, linking lead exposure with aggressive and violent behavior and delinquency. The Academy now says:

"Other aspects of brain or nerve function [besides IQ], especially behavior, also may be affected. Teachers reported that students with elevated tooth lead concentrations were more inattentive, hyperactive, disorganized, and less able to follow directions. Additional follow-up of some of those children showed higher rates of failure to graduate from high school, reading disabilities, and greater absenteeism in the final year of high school. Elevated bone lead concentrations are associated with increased attentional dysfunction, aggression, and delinquency. In children followed from infancy with blood lead measurements, self-reported delinquent behavior at 15 to 17 years of age increased with both prenatal and postnatal lead exposure, and bone lead, thought to represent cumulative dose, is higher in adjudicated delinquents. These data imply that the effects of lead exposure are long lasting and perhaps permanent."

** Effects of lead are irreversible

This is another important point in the Academy's most recent policy statement: it reviews evidence showing that harm from lead is irreversible. Physicians used to think (or at least hope) that ending toxic exposure would allow a child to recover lost brain function. That possibility now seems very unlikely.

** Damage to hearing, impaired sense of balance

The Academy's policy statement says that, "Subclinical effects on both hearing and balance may occur at commonly encountered blood lead concentrations." In other words, at levels of toxic lead routinely found in many children today, we can expect hearing loss from lead. Does this contribute to poor performance in school, with reduced life- possibilities?

** Lastly, the Academy now recommends that all children should be tested for lead in the blood at least once during their first 2 years of life. In the past the Academy has said universal testing is not worth the money. Now that levels of lead as low at 1 or 2 ug/dL are known to cause some damage to a child's brain, the Academy has reversed its position on universal testing.

* * *

The Academy did not rush precipitously to adopt a precautionary approach to lead poisoning, urging removal of lead-based paint from all housing. The paint industry openly acknowledged in the 1890s that lead-based paint was dangerous; in 1897 at least one company was advertising that its paint "is NOT made with lead and is not poisonous." The poisoning of children by dust from lead-based paint was first reported in medical literature just over 100 years ago, in 1904. Lead-based paint was banned for interior uses in Australia and most of Europe during the 1920s.[3] The U.S. waited 50 more years before banning it in 1978.

The problem of children poisoned by lead-based paint was widely recognized by public health physicians in the U.S. in the 1930s. The City of Baltimore began routine surveillance of lead poisoning in children in 1931. Reports of large numbers of children poisoned by lead-based paint appeared in medical literature in the 1950s. (See Rachel's #294.) Unfortunately, those early reports emphasized that lead was mainly a danger to poor, African-American children living in urban slums. Public health specialists subsequently recognized that even well-to-do children in the suburbs were being poisoned by lead, but the original understanding of lead as a problem of poor blacks proved hard to reverse. In a society oriented by 350 years of law and custom to white supremacy,[4] a silent epidemic of poisoning thought to affect only poor blacks had no political meaning.

Nevertheless, public-interest scientists (Barry Commoner, Rene Dubos and others) pressed for controls on lead-based paint[5] and, in 1971, Congress passed The Lead-Based Paint Poisoning Prevention Act declaring lead-based paint a health hazard to children and ordering that it be stripped from the nation's stock of federally subsidized housing. However, President Nixon was then developing his "southern strategy" to woo voters away from George Wallace, the avowedly white supremacist candidate for president. In 1971, President Nixon "rejected a recommendation of Government health specialists for a national push this year against childhood lead poisoning."[6] That set the tone for the federal response to the dangers of lead-based paint. Twenty years later the New York Times would report that the federal lead-paint-removal program had "produced a legacy of frustration and failure." "The Government's record in dealing with this problem is one of absolute dereliction," said Dr. Herbert Needleman in 1990, according to the Times.[7]

Now, 100 years after the first medical reports of children poisoned by lead-based paint in their homes, lead-based paint flaking off the walls of homes is still the main cause of childhood lead poisoning.[1] The victims are still generally, though by no means exclusively, poor and they are still far more likely to be black or Latino than white.

Obviously the nation has dragged its feet on this problem. This seems odd because it is widely acknowledged that huge sums of money could be saved by cleaning up lead in housing. The new policy statement from the Academy of Pediatrics discusses several cost-benefit analyses showing that eliminating the lead hazard from housing would save billions of dollars each year because lead diminishes a child's IQ and IQ translates into earning power (which, in turn, translates into tax revenues).

Here are some numbers from the Academy's new policy statement.[1] There are 4 million homes in the U.S. needing lead removal. The cost would be a one-time investment of $28 billion. The savings each year thereafter would be $43 billion. So lead removal would pay for itself the first year and then save billions each year thereafter. An investment of $28 billion is less than the U.S. spends every six months in Iraq.

The Academy cites other studies that make the same point, but you get the idea -- there's a huge amount of money to be saved by ending the poisoning of our children.

To state it in the reverse: we are foregoing billions of dollars in income and taxes each year in order to keep our urban children poisoned. This is an astonishing use of scarce resources, to put it mildly. How can we possibly explain such a bizarre national policy?

All I can figure is that some things are more important than money.

Here is a hypothesis based on U.S. history: Perhaps both Republican and Democratic administrations of the past 35 years have found it advantageous to keep inner-city kids behind the 8-ball by diminishing their IQs early in life, making them less successful in school, plus making them more aggressive and violent. I know this is an outrageous hypothesis, but hear me out.

For forty years, 1940-1980, the nation was ruled by a "bottom up" New Deal coalition of liberal middle-class whites plus minorities plus the organized working class. During this period, inequalities of income and wealth were held in check chiefly by the power of labor unions, by tax policies, and to a lesser extent by welfare programs. Recall that the income tax rate on the top tax-bracket was 91% from 1949 to 1964 (including during the Eisenhower administration) -- compared to 35% today.[8]

But "conservative" politicians (of both parties) began to undermine the "bottom up" New Deal coalition in the early 1960s, using race as the wedge issue to split the coalition.

This historical reality -- using race to divide and conquer the New Deal coalition -- has been well-documented in four excellent books:

** Dan T. Carter, From George Wallace to Newt Gingrich: Race in the Conservative Counterrevolution, 1963-1994 (1996; ISBN 0-8071-2366-8);

** Thomas and Mary Edsall, Chain Reaction; The Impact of Race, Rights and Taxes on American Politics (1992; ISBN 0-393-30903-7);

** Sara Diamond, Roads to Dominion; Right Wing Movements and Political Power in the United States (N.Y.: The Guilford Press, 1995); ISBN 0-89862-864-4,

** Jean Hardisty, Mobilizing Resentment (Boston: Beacon Press, 1999); ISBN 0-8070-4316-8).

In 1964, Barry Goldwater ran for president on an anti-civil rights platform. He lost, and two more civil rights laws were enacted in 1965 and 1968. These laws -- plus the civil disorder of the period 1965-1968 ("Burn, baby, burn!") -- fueled a backlash. (Many people conveniently forget that this phase of 1960s civil disorder was a response to 5 years of white supremacist riots, bombings, murders, and assassinations, 1960-1965.)[9]

White supremacist "conservative" politicians fanned the backlash. George Wallace discovered that a white supremacy message resonated not only in the south but also in the mid-west. In 1963, Wallace had an epiphany: "They all hate black people, all of them. They're all afraid, all of them. Great God! That's it! They're all Southern. The whole United States is Southern!"[10] In the 1964 Democratic primary, Wallace took 34% of the vote in Wisconsin, 30% in Indiana, and 43% in Maryland. In the 1972 presidential campaign, Wallace won 51% of the vote in Michigan.

President Nixon went on to develop what is still today euphemistically called the "southern strategy," a polite phrase for "white supremacy." As we have seen, in 1971 Mr. Nixon rejected the advice of public health specialists and refused to tackle the problem of toxic lead poisoning among urban children. It wouldn't pay to be seen as investing tax dollars in the health of those inner city troublemakers. Ronald Reagan built on the Nixon legacy, openly hostile to civil rights and affirmative action (at least affirmative action for blacks; affirmative action for whites was OK with the Gipper[11]). Reagan even tried to reverse the federal policy of withholding subsidies to segregated schools, until the Supreme Court tripped him up. Despite this setback, Reagan's white supremacist policies attracted fundamentalist religious conservatives and thus helped cobble together the current conservative coalition that slowly took power starting about 1972.[12]

The genius of the white supremacist strategy (later to be combined with other diversionary "social" issues -- anti-intellectual, anti-gay, anti-abortion, pro-school prayer) is that it provided a focus for the fears, hatreds and frustrations of lower middle-class and working class whites -- deflecting attention away from the real political action of those decades, which was to cut taxes for the rich and the super-rich and redesign the world order to make it easy to move money overseas (where it was easier to hide from the U.S. tax man) -- a byproduct of "globalization" which had the effect of making the super-rich richer.[13]

So that, in a nutshell, is the political usefulness of a permanent underclass of blacks and Latinos trapped in poisoned housing -- they provide endless targets for white supremacist frustrations and fantasies, while they deflect attention away from the real political action of the last 20 years, which is the funneling of hundreds of billions of dollars from the middle class and the working poor into the pockets of the super rich. During the Reagan-Bush years, 1980-1992, the super rich (the wealthiest 1%) saw their incomes rise by 78% while the median wage-earner saw his or her income decline 5%.[14] Those with declining incomes have been seething with frustration as the American dream has passed them by. They have tried to tread water by putting more family members to work, working longer hours, driving longer distances in worsening traffic to second and even third jobs, but for low- and middle-income groups, keeping up with the Jones gets harder each passing year. To deflect attention away from this massive upward redistribution of economic rewards, "conservative" politicians have developed a ready explanation, expressed in the shorthand of white supremacy: "welfare queens" and "Willie Hortons" have been stealing from hard-working, law-abiding Americans.

To this day, white supremacy remains the central issue -- almost never discussed openly -- that divides U.S. society.[15] The environmental movement tried for a time to overcome this history, but the "environmental justice" movement has, so far, been unable to claim its fair share of the available funds. Wealthy white groups, and many of their funders -- while adopting the rhetoric of environmental justice -- have not offered equal space at the table for non-whites,[16] and so the cycle of frustration and anger is perpetuated even among liberal environmentalists.

It seems safe to say that until liberals figure out how to rebuild a durable interracial political coalition (including a democratically-run, all-inclusive labor movement), the "conservatives" will retain political control of the U.S., wealth will continue to float upward, destroying the middle class, and democracy will continue to fade into empty rhetoric.

This then is the importance of the new policy statement by the American Academy of Pediatrics. By advocating a precautionary policy of removing lead from housing, it affirms that everyone has a basic right to a non-toxic environment and a decent start in life. Making such a policy real will not be easy -- the silent forces of white supremacy remain arrayed against it -- but it nevertheless does keep alive the hope that we may one day create a society "with liberty and justice for all."

==============

[1] Committee on Environmental Health, American Academy of Pediatrics, "Lead Exposure in Children: Prevention, Detection, and Management," Pediatrics (October 2005), pgs. 1036-1046. Available here.

[2] Committee on Environmental Health, American Academy of pediatrics, "Screening for Elevated Blood Lead Levels," Pediatrics Vil. 101, No. 6 (June 1998), pgs. 1072-1078. Available here.

[3] Sven Hernberg, "Lead Poisoning in Historical Perspective," American Journal of Industrial Medicine Vol. 38 (2000), pgs. 244-254. Available here.

[4] Francis D. Adams and Barry Sanders, Alienable Rights; The Exclusion of African Americans in a White Man's Land, 1619-2000 (New York: HarperCollins, 2003). Betita Martinez points out that the phrase "white supremacy" is more accurate than "racism" because it conveys the inherent power relationship in racism; Elizabeth (Betita) Martinez, "Racism: The U.S. Creation Myth and Its Premise Keepers," in David Solnit, editor, Globalize Liberation (San Francisco: City Lights, 2004; ISBN 0-87286-420-0).

[5] Sandra Blakeslee, "Experts Recommend Measures to Cut Lead Poisoning in Young," New York Times Mar. 27, 1969, pg. 25.

[6] "Funds for Victims of Lead Poisoning Asked of Senators," New York Times July 14, 1971, pg. 71.

[7] William E. Schmidt, "Lead Paint Poisons Children Despite 1971 Law on Removal," New York Times August 26, 1990, pg. 1.

[8] Gar Alperovitz, "Tax the Plutocrats," The Nation Jan. 27, 2003.

[9] Hugh Davis Graham, "On Riots and Riot Commissions: Civil Disorders in the 1960s," The Public Historian Vol. 2, No. 4 (Summer 1980), pgs. 7-27.

[10] Dan T. Carter, From George Wallace to Newt Gingrich: Race in the Conservative Counterrevolution, 1963-1994 (Baton Rouge: Louisiana State University Press, 1996; ISBN 0-8071-2366-8), pg. 6.

[11] Ira Katznelson, When Affirmative Action Was White: An Untold History of Racial Inequality in Twentieth-Century America (N.Y.: W.W. Norton, 2005); ISBN 0-393-05213-3.

[12] On Reagan's white supremacist policies, see, for example, Francis D. Adams and Barry Sanders, Alienable Rights (NY: HarperCollins, 2003; ISBN 0-06-019975-X), pgs. 308-313; see also Thomas and Mary Edsall, Chain Reaction; The Impact of Race, Rights and Taxes on American Politics (1992; ISBN 0-393-30903-7), especially chapter 9.

[13] See these three books: Donald Barlett and James B. Steele, America: Who Really Pays the Taxes? New York: Touchstone, 1994. ISBN 0-671-87157-9; and Donald Barlett and James B. Steele, The Great American Tax Dodge; How Spiraling Fraud and Avoidance Are Killing Fairness, Destroying the Income Tax, and Costing You. Berkeley, Calif: University of California Press, 2002. ISBN 0520236106; and Charles Lewis, Bill Allison, and the Center for Public Integrity. The Cheating of America; How Tax Avoidance and Evasion by the Super Rich are Costing the Country Billions -- and What You Can Do About It. New York: William Morrow, 2001. ISBN 0-380-97682-X.

[14] Dan T. Carter, From George Wallace to Newt Gingrich: Race in the Conservative Counterrevolution, 1963-1994 (Baton Rouge: Louisiana State University, 1996; ISBN 0-8071-2366-8), pg. 6

[15] Robert Jensen, The Heart of Whiteness; Confronting Race, Racism and White Privilege (San Francisco: City Lights, 2005); ISBN 0-87286-449-9.

[16] In their report, Green of Another Color (Boston: Northeastern University, 2001) Daniel Faber and Deborah McCarthy show that, of all funds available for environmental work during the period 1996 to 1999, some 96% went to the lawyers and scientists of the traditional environmental movement, and only 4% went to all the thousands of groups working to build the "environmental justice" movement.




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Rachel's Democracy & Health News (formerly Rachel's Environment & Health News) highlights the connections between issues that are often considered separately or not at all. The natural world is deteriorating and human health is declining because those who make the important decisions aren't the ones who bear the brunt. Our purpose is to connect the dots between human health, the destruction of nature, the decline of community, the rise of economic insecurity and inequalities, growing stress among workers and families, and the crippling legacies of patriarchy, intolerance, and racial injustice that allow us to be divided and therefore ruled by the few. In a democracy, there are no more fundamental questions than, "Who gets to decide?" And, "How do the few control the many, and what might be done about it?" As you come across stories that might help people connect the dots, please Email them to us at dhn@rachel.org. Rachel's Democracy & Health News is published as often as necessary to provide readers with up-to-date coverage of the subject. Editors: Peter Montague - peter@rachel.org Tim Montague - tim@rachel.org ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::: To start your own free Email subscription to Rachel's Democracy & Health News send a blank Email to: rachel-subscribe@pplist.net. In response, you will receive an Email asking you to confirm that you want to subscribe. ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::: Environmental Research Foundation P.O. Box 160, New Brunswick, N.J. 08903 dhn@rachel.org