Final statement from the CGD working group - A Call to Action to End Childhood Lead Poisoning Worldwide: A Neglected, Top-Tier Development Challenge

We're sharing here the final statement of the Center for Global Development's working group on global lead poisoning. We (Clare Donaldson and Lucia Coulter, Co-Executive Directors of LEEP) are participants of the working group and signatories of the statement. A full version of the statement, with detailed footnotes, explanations, and citations can be found here (recommended!).

Final Statement of the Working Group on Understanding and Mitigating the Global Burden of Lead Poisoning

This statement does not necessarily represent the views of all Working Group participants or the groups with which they are affiliated.

Lead exposure hurts human health and welfare

• Lead is a widely used and highly toxic metal, with neurological effects that are especially hazardous to children.
• Lead’s effects on the human body are extensive and profound, impacting almost every bodily system. There is no safe level of lead; neuro-cognitive effects in children and cardiovascular health effects in adults are apparent even at very low levels of exposure.
• A shared understanding of lead’s danger has already motivated dramatic global action to reduce the burden of lead exposure—specifically, the complete global phase-out of leaded petrol.
• Lead poisoning is preventable; most cases of lead exposure result from sources with safe and readily available alternatives. Eliminating ongoing lead exposure is needed to prevent brain damage in children and the loss of potential of entire generations.
• Nevertheless, lead remains a valuable and in-demand commercial commodity. Some industrial applications of lead are still considered “essential” by some stakeholders—most notably use within lead-acid batteries, which account for more than 85 percent of lead in current circulation.
• Most wealthy countries have dramatically reduced lead exposure since they took domestic actions to do so, including the phase out of leaded petrol and lead paint, though hot spots of lead exposure remain in some locations, particularly among vulnerable populations.

Lead poisoning remains widespread across low- and middle-income countries

• The danger of lead is well recognized, but the scale of ongoing global lead exposure is not.
• Though data is limited, current estimates suggest that the scale of lead poisoning today remains extraordinary, impacting an estimated 815 million children—one in three children worldwide.
• Most of these children live in LMICs; in low-income countries, it is estimated that more than half of children have lead exposure levels that can be considered lead poisoning, along with high proportions of adults.
• Within LMICs, significant sources of lead remain and continue to be introduced into the natural and home environments.
• The sources of ongoing lead exposure vary within and across LMICs, but include battery recycling, spice adulteration, ceramic and aluminum cookware, cosmetics, paint, environmental contamination, and traditional medicines, among others. The relative contribution of these different sources is not yet well characterized.

Ongoing lead exposure is a profound, preventable, and neglected threat to health, educational, and development prospects in countries around the world

• Through its impact on children’s cognitive development, lead exposure is estimated to be responsible for over a fifth of the learning gap between high-income countries and LMICs. Through this mechanism, a new analysis by the World Bank estimates that lead exposure drives a loss of income worth US$1.4 trillion, equivalent to 1.6 percent of global GDP.
• Lead exposure is recognized as a causal risk factor for cardiovascular disease by the American Heart Association. Through this mechanism, estimates suggest that chronic lead exposure is responsible for between 1.6 and 5.5 million deaths globally each year. Even at the low end of this range—e.g., the current figure put forth by Institute for Health Metrics and Evaluation (IHME)—the death toll from lead exposure far exceeds deaths from either HIV/AIDS or malaria. A recent World Bank estimate attributes 5.5 million deaths per year to lead exposure, roughly rivalling the death toll from particulate air pollution. The World Bank calculates the cost of this burden to be equivalent to $4.6 trillion, or 5.3 percent of global GDP.
• Childhood lead exposure has a likely though not conclusive role in increasing the prevalence of subsequent conduct disorders, with some evidence also suggesting a link with aggression and criminal behavior. We note that a causal link between lead exposure and these outcomes, if robustly established, could have major implications for many different global challenges, including intimate partner and domestic violence; crime and policing; and gang violence.
• Lead exposure is also a significant contributor to kidney disease, and ongoing scientific inquiries are exploring hypotheses that even low lead exposure may further contribute to amyotrophic lateral sclerosis, Alzheimer’s disease, and antimicrobial resistance, though such links are still unproven.
• Though not the focus of this Working Group, lead exposure is also a serious threat to the environment, ecosystems, and biodiversity, particularly among birds, mammals, and reptiles.
• Eliminating sources of future exposure, even among those previously exposed, has significant benefits at individual and population levels.
• Relative to its scale and impact, lead poisoning is extraordinarily neglected; many LMIC leaders are unaware of how widespread lead poisoning is in their own countries, most have no systems in place to detect and prevent lead exposure, and we were able to identify just $11 million in annual philanthropic funding for preventing and mitigating lead exposure in LMICs.

Lead poisoning should be elevated as a top-tier global development challenge

• Lead exposure is a top-tier impediment to global health, education, and economic development; it robs children of their ability to learn and thrive, and deprives adults of years of healthy life.
• Lead exposure is a significant barrier to achieving almost all of the Sustainable Development Goals; it threatens efforts to make progress on poverty, inequality, early childhood development, health, education, growth, clean energy, sustainability, responsible consumption, and the health of oceanic and land-based ecosystems. It also endangers countries’ potential to benefit from the demographic dividend.
• Addressing the global crisis of lead poisoning deserves urgent prioritization as such from national governments, development partners, philanthropists, and multilateral organizations. It should be considered a priority not just for public health and the environment, but also for the education sector and overall child welfare.
• The scale of the crisis demands a multipronged, multiscale approach—one that integrates international, national, and local actions, and which pairs short-term interventions with development of long-term national regulatory, enforcement, and surveillance capabilities in LMICs.
• While the elimination of lead poisoning is a long-term project, there are important tractable steps that can be taken in the short term. There are notable recent success stories from LMICs in removing lead-contaminated products from the market, and there are affordable, highly cost-effective, and immediately actionable measures to do so. There is some evidence such interventions have resulted in significant decreases in population blood lead levels. In the short-term, broad-based public health and regulatory measures (including regulations and enforcement) to eliminate lead in spices, paint, and consumer goods, and to reduce lead exposure from battery recycling, have the highest potential to cost-effectively reduce lead exposure at scale.
• LMIC governments are in the driver’s seat to address this issue—but development partners and philanthropists have an essential catalytic and ongoing role to play in mobilizing advocacy and high-level attention, building capacity for regulation and enforcement, and providing proof of concept for interventions to reduce lead exposure. In particular, generation of local evidence on the prevalence, severity, sources, and/or impact of lead exposure can be very helpful in motivating national action.
• We estimate that $350 million in development assistance through 2030—just $50 million per year—would be sufficient to transform the landscape and mobilize scaled action in LMICs. A small and sustained percentage of total global philanthropic giving or official development assistance would be transformative.
• Effective advocacy, stakeholder engagement, and grassroots mobilization are essential to raise awareness of lead poisoning at the international, national, and local levels; to increase the urgency and accountability of action by governments, international bodies, and industry to reduce lead exposures and contamination, including via effective legislation, regulation, and enforcement; and to empower families and communities to protect themselves from lead exposure to the extent possible. Advocacy should be broad-based and multisectoral, helping motivate public health, medical, environment, education, and industrial constituencies to take action.
• Opportunities for effective intervention remain constrained by serious data and evidence deficits. There is an urgent need for further research and data collection, including vis-à-vis the local and global prevalence, severity, and impact of lead poisoning; the relative contribution of different sources of lead exposure at the global, regional, and local levels; and the effectiveness and cost-effectiveness of interventions to reduce lead exposure and blood lead levels.
• There is also a need for research and development for further solutions, including improved and lower-cost technologies for exposure detection, source evaluation, and remediation. More research is needed to evaluate and compare the efficacy and cost-effectiveness of environmental, policy, and medical interventions.

The Working Group calls for dramatic action 

• We call on global leaders to take bold and urgent action that will end this slow-moving crisis; protect children’s potential to learn and thrive; and dramatically reduce unnecessary, preventable deaths from cardiovascular disease.
• As a global community, we must pledge to end lead poisoning for the next generation of children—no matter where they live.
  • Every country should begin working today to end childhood lead poisoning by 2040; in concrete terms, this means ensuring that to the extent possible every child has a blood lead level below 5 µg/dl, and progressively reducing levels “closer to zero” below that point.
• Since children in LMICs are disproportionately affected, LMIC governments must work urgently with support from development agencies, the UN system, and multilateral development banks to take national action to reduce and prevent additional lead contamination of homes, workplaces, supply chains, and the environment, including through strict regulations (and their enforcement) on all sources of lead, extended producer responsibility where it is required, and bans on non-essential uses in consumer products.
• To support immediate mitigation efforts, as well as longer-term progressive reductions in blood lead levels, countries should urgently build surveillance systems for nationally representative blood lead measurement combined with source assessment where necessary, calling on the assistance of WHO and UNICEF as needed and appropriate, with a goal of reporting initial results by end-2026. Development agencies, multilateral development banks, and international organizations should provide financial and technical support for these efforts, also as needed and appropriate, including to help build laboratory and field sampling capacity.
• In parallel, countries should work to evaluate and integrate lead exposure prevention and lead poisoning diagnosis and treatment into universal health coverage systems, as appropriate for their respective levels of development and resource availability. This should include adaptation and implementation of WHO guidelines on managing lead exposure, and ensuring the availability of diagnosis and indicated treatment (chelation therapy) for severe lead poisoning.

See PDF for full endnotes, explanations, and citations.