Role of Government

An initial estimate can be drawn from secondary sources of information, including from the Institute for Health Metrics and Evaluation’s global burden of disease study. A literature review of existing in-country studies may also help identify high-risk areas where children are most affected, the socio-economic profile of these communities and potential sources of exposure. The next step is to include monitoring of blood lead levels of children in a national household survey, such as a Multiple Indicator Cluster Survey (MICS) or a Demographic and Health Survey or through routine screening programmes. Testing of blood samples requires the engagement of accredited in-country, regional or international laboratories that utilize sensitive analytical methods in line with the relevant standards approved by the International Organization for Standardization (ISO). These laboratories can also help to identify potential sources of exposure and determine their contribution to the levels of lead poisoning.

Ending childhood lead poisoning requires a whole-of-government approach. This entails coordination with relevant ministries – health, environment, trade and industry, education, finance and land management, among others – and agreeing on sectorial responses. These responses should be included in a budgeted national action plan that considers key international treaties, conventions and voluntary agreements that exist to prevent lead poisoning. The national plan should consider the role of the private sector and civil society in addressing childhood lead poisoning.

The health system must be equipped to protect children from lead exposure. Trained health care workers play a critical role in the prevention of lead poisoning, specifically in the recognition of the symptoms of lead exposure, the testing of blood lead levels and the management of lead poisoning. Equally important are facilities to measure blood lead levels; availability of essential medicines and the development of structures for referral; and testing and management of exposure, including nutrition, education and supplements.

An important starting point to ensure early screening of children and pregnant women is the development and maintenance of a childhood blood lead surveillance system. Undernourished children are more susceptible to lead poisoning because they absorb more lead if they are lacking nutrients such as calcium and iron. Children aged 10 years and younger should be given calcium and iron supplementation if they have a blood lead concentration level of ≥ 5 μg/dL, have, or are likely to have, inadequate calcium intake or iron deficiency.

The institutionalization of Children’s Environmental Health Units within ministries of health and ministries of the environment is key to the implementation of a childhood lead poisoning prevention programme. These units should lead the development of strategies for improving health system capacity; the provision of consultative medical services; and the implementation of public education about the impact of lead exposure on children’s health.

Adopting appropriate laws, standards and regulations to eliminate or limit the use of lead in all consumer products is a key step to reducing lead levels in the environment. Though many still lack such policies and legislation, a growing number of countries have laws and regulatory measures in place to eliminate the use of lead compounds in consumer products such as paint, ceramics and pottery, children’s toys, cosmetics, spices, cookware and traditional medicines. National environmental standards for lead in air, water and soil are equally critical. The use of lead may be unavoidable in certain industrial applications. Therefore, it is important to develop and implement national strategies for the environmentally sound management of lead in these applications, including recycling of ULAB, e-waste and other products. If national legislation, policies and good practices to protect children from lead exposure are not already in place, international standards, norms, guidelines and guidance around the recycling and transportation of ULAB can be used as building blocks for their development.

Informal recycling of ULAB can be a major source of lead poisoning in certain conditions. In such situations, the recommended strategy is to develop and implement policy and economic measures that address unregulated recyclers operating in the informal sector with due concern for their livelihoods. The prevalence of informal recycling practices and insufficient industrial hygiene may have resulted in widespread lead-contaminated sites in communities. Each toxic site will have unique clean-up requirements, which may involve: the removal of waste and contaminated soil; planting grass and vegetation; the installation of barrier cloths; and paving and covering areas with clean fill.