Minnesota Public Health Association Resolution:

Protecting Children from Harmful Effects of Lead in the Environment

WHEREAS, the toxic effects of excessive lead exposure on the brain and nervous system have been recognized for centuries,¹ and,

WHEREAS, during the second half of the 20^th century, it became increasingly evident that lower exposures to lead can also cause lasting intellectual and behavioral impairments, even when the dose is not immediately life-threatening,^1-3 and,

WHEREAS, over the past 40 years, science has repeatedly shown that blood lead concentrations once believed to be safe are actually toxic to children’s developing brains and nervous systems,⁴ and,

WHEREAS, since the 1960s, the Centers for Disease Control and Prevention (CDC) has reduced its blood lead “level of concern” four times, due to scientific evidence of harm: In 1971, from 60 µg/dL to  40 µg/dL; in 1978, to 30 µg/dL; in 1985, to 25 µg/dL; and, in 1991, to the current limit of 10 µg/dL,⁴ and, 

WHEREAS, a large and growing body of scientific evidence published since 1991 demonstrates adverse effects among children whose blood lead concentrations do not exceed the current CDC exposure limit (“level of concern”; “elevated blood lead level”) of 10 µg/dL,^5-16 and,

WHEREAS, studies have found that intellectual impairment, quantified as significant loss of points on IQ tests, is associated with blood lead concentrations under 10 µg/dL,^5-7 and,

WHEREAS, researchers have evaluated effects of lead on brain function through the use of a variety of other tests of cognitive ability, academic aptitude, and neurodevelopment, and have reported adverse effects at blood lead concentrations below 10 µg/dL,^8-10 and, 

WHEREAS, a recent study of the impacts of lead on children’s academic performance found that blood lead concentrations below 10 µg/dL were correlated with lower reading and math scores on standardized tests that school systems administer to assess children’s academic achievement,¹¹ and,

WHEREAS, lead exposure has been identified as a risk factor for attention deficit/hyperactivity disorder (ADHD)^12-15 and conduct disorder (CD)¹⁶ even when blood concentrations do not exceed 10 µg/dL, and,

WHEREAS, a no-effects threshold for blood lead concentration has not been found,² yet studies have reported more serious neurocognitive effects of lead among children whose blood concentrations are between 5 µg/dL and 10 µg/dL, compared to children with levels below 5 µg/dL, ,^6,8,11 and,

WHEREAS, the majority of children exposed to lead paint today are already disadvantaged, mainly living in poverty-stricken areas of our cities, and,

WHEREAS, African-American children as a group and children from lower-income families (of any racial or ethnic background) are subject to disproportionately high exposures,¹⁷ and,

WHEREAS, in 2005, the American Public Health Association (APHA) published a resolution urging the CDC to “substantially lower its current ‘blood lead level of concern’ because the current action level is set too high and does not adequately protect children from the toxic effects of lead,”¹⁸ and,

WHEREAS, the CDC acknowledges that “research conducted since 1991 has strengthened the evidence that children’s physical and mental development can be affected at [blood lead levels] < 10 µg/dL”,¹⁹ and,

WHEREAS, investment in lead exposure prevention can yield great economic returns: Decades after the phaseout of lead from gasoline, children’s lead exposure from other sources still costs the U.S. economy over $40 billion per year in lost productivity when children become adults of working age,²⁰ and,

WHEREAS, the State of Vermont,²¹ the City of Chicago,²² the City of Cincinnati,²³ and the City of Cleveland²⁴ have each successfully established a blood lead exposure limit of 5 µg/dL, demonstrating that this standard is both cost-effective and achievable, and,

WHEREAS, policy requiring thorough family education and follow-up venous blood testing at an exposure limit of 5 µg/dL would not change or supersede higher regulatory thresholds already in place (e.g., 15 µg/dL, 45 µg/dL, 60 µg/dL) that trigger more intensive interventions,^25,26

THEREFORE, BE IT RESOLVED, that the Minnesota Public Health Association urges Minnesota state and local government agencies to promulgate policy, as resources become available, adjusting the children’s blood lead exposure limit (“level of concern”; “elevated blood lead level”) from 10 µg/dL to    5 µg/dL, and,

THEREFORE, BE IT RESOLVED, that when a child’s blood lead level exceeds 5 µg/dL, the Minnesota Public Health Association recommends: 1) thorough family education on potential sources of lead and on ways to avoid exposure, and, 2) at least one follow-up (venous) blood test after 3 months for the exposed child and for all other children ≤ 5 years of age living in the residence.

References

1. U.S. Department of Health and Human Services, Agency for Toxic Substances and Disease Registry. Toxicological Profile for Lead. Atlanta, GA; August 2007.

2. Etzel RA, Balk SJ, Eds. Pediatric Environmental Health, 2^nd Edition. American Academy of Pediatrics, Elk Grove Village, IL; 2003.

3. Bellinger DC. Lead. Pediatrics. 113(4): 1016-22. April 2004.

4. Centers for Disease Control and Prevention. Preventing Lead Poisoning in Young Children: A Statement by the Centers for Disease Control and Prevention. Atlanta, GA; October 1991.

5. Canfield RL, Henderson CR Jr, Cory-Slechta DA, Cox C, Jusko TA, Lanphear BP. Intellectual impairment in children with blood lead concentrations below 10 µg/dL. New England Journal of Medicine. 348(16): 1517-26. April 17, 2003.

6. Jusko TA, Henderson CR, Lanphear BP, Cory-Slechta DA, Parsons PJ, Canfield RL. Blood lead concentrations <10 µg/dL and child intelligence at 6 years of age. Environmental Health Perspectives. 116(2): 243-8. February 2008.

7. Lanphear BP, Hornung R, Khoury J, Yolton K, Baghurst P, Bellinger DC, Canfield RL, Dietrich KN,   Bornschein R, Greene T, Rothenberg SJ, Needleman HL, Schnaas L, Wasserman G, Graziano J, Roberts R. Low-level environmental lead exposure and children's intellectual function: an international pooled analysis. Environmental Health Perspectives. 113(7): 894-9. July 2005.

8. Surkan PJ, Zhang A, Trachtenberg F, Daniel DB, McKinlay S, Bellinger DC. Neuropsychological function in children with blood lead levels <10 µg/dL. Neurotoxicology. 28(6): 1170-7. November 2007.

9. Téllez-Rojo MM, Bellinger DC, Arroyo-Quiroz C, Lamadrid-Figueroa H, Mercado-García A, Schnaas-Arrieta L, Wright RO, Hernández-Avila M, Hu H. Longitudinal associations between blood lead concentrations lower than 10 µg/dL and neurobehavioral development in environmentally exposed children in Mexico City. Pediatrics. 118(2): e323-30. August 2006.

10. Lanphear BP, Dietrich K, Auinger P, Cox C. Cognitive deficits associated with blood lead concentrations <10 µg/dL  in US children and adolescents. Public Health Reports. 115(6): 521-9. November-December 2000.

11. Miranda ML, Kim D, Galeano MA, Paul CJ, Hull AP, Morgan SP. The relationship between early childhood blood lead levels and performance on end-of-grade tests. Environmental Health Perspectives. 115(8): 1242-7. August 2007.

12. Braun JM, Kahn RS, Froehlich T, Auinger P, Lanphear BP. Exposures to environmental toxicants and attention deficit hyperactivity disorder in U.S. children. Environmental Health Perspectives. 114(12): 1904-9. December 2006.

13. Chiodo LM, Covington C, Sokol RJ, Hannigan JH, Jannise J, Ager J, Greenwald M, Delaney-Black V. Blood lead levels and specific attention effects in young children. Neurotoxicology and Teratology. 29(5): 538-46. September-October 2007.

14. Nigg JT, Knottnerus GM, Martel MM, Nikolas M, Cavanagh K, Karmaus W, Rappley MD. Low blood lead levels associated with clinically diagnosed attention-deficit/hyperactivity disorder and mediated by weak cognitive control. Biological Psychiatry. 63(3): 325-31. February 1, 2008.

15. Wang HL, Chen XT, Yang B, Ma FL, Wang S, Tang ML, Hao MG, Ruan DY. Case-control study of blood lead levels and attention deficit hyperactivity disorder in Chinese children. Environmental Health Perspectives. 116(10): 1401-6. October 2008.

16. Braun JM, Froehlich TE, Daniels JL, Dietrich KN, Hornung R, Auinger P, Lanphear BP. Association of environmental toxicants and conduct disorder in U.S. children: NHANES 2001-2004. Environmental Health Perspectives. 116(7): 956-62. July 2008.

17. U.S. Environmental Protection Agency, Office of Children’s Health Protection. America’s Children and the Environment: Measures of Contaminants, Body Burdens, and Illnesses, 2^nd Edition. EPA Pub. No. 240-R-03-001. Washington, DC, February 2003.

18. American Public Health Association. Protecting Children from Overexposure to Lead in Candy and Protecting Children by Lowering the Blood Lead “Level of Concern” Standard. APHA Policy Statement Number 2005-7. Washington, DC; December 14, 2005.

19. Centers for Disease Control and Prevention, Advisory Committee on Childhood Lead Poisoning Prevention. Interpreting and Managing Blood Lead Levels <10 µg/dL in Children and Reducing Childhood Exposures to Lead. Morbidity and Mortality Weekly Report. 56(RR08): 1-14,16. November 2, 2007.

20. Landrigan PJ, Schechter CB, Lipton JM, Fahs MC, Schwartz J. Environmental pollutants and disease in American children: estimates of morbidity, mortality, and costs for lead poisoning, asthma, cancer, and developmental disabilities. Environmental Health Perspectives. 110(7): 721-8. July 2002.

21. State of Vermont, Office of the Attorney General. Lead. www.atg.state.vt.us/display.php?smod=218. Accessed June 20, 2008.

22. City of Chicago, Department of Public Health. Control and Mitigation of Lead-Bearing Substances. http://egov.cityofchicago.org/webportal/COCWebPortal/COC_ATTACH/LeadReg_1may08.html. Accessed May 22, 2009.

23. City of Cincinnati. Ordinance dated September 12, 2006. Cincinnati, OH.

24. Cleveland Department of Public Health. Childhood Lead Poisoning Prevention. www.clevelandhealth. org/Enviroment/LeadSafeLiving/Prevention.html. Accessed June 20, 2008.

25. Minnesota Department of Health. Childhood Blood Lead Clinical Treatment Guidelines for Minnesota. St. Paul, MN; February 2006.

26. Minnesota Department of Health. Childhood Blood Lead Case Management Guidelines for Minnesota. St. Paul, MN; July 2006.