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NEW YORK CITY — A third of the world’s children have so much lead in their blood they’re poisoned. These children experience cognitive and behavioral delays, reduced kidney function, anemia and more. They might drink water that passes through old pipes, play with toys decorated with lead paint, eat food served on contaminated dishes or walk past an informal lead-acid battery recycling facility on their way to school.
The sources of this mass-poisoning are widespread, with countless industries and products subtly introducing lead into people’s lives. The impacts of lead are felt most by those in low- and middle-income countries, which often lack the resources to identify and prevent lead-poisoning. The world took one major step forward by banning leaded gasoline in cars in all countries as of 2021. Yet, environmental health experts say lead poisoning remains an overlooked global health crisis. They’re working to bring the impacts of lead into the light and prevent exposure, one country and one source at a time.
Lead — an overlooked poison
No amount of lead exposure is safe, many health authorities agree. For children, lead exposure can be particularly devastating: it decreases IQ points, delays development and creates behavioral challenges, among other symptoms. Adults can experience problems with kidney function, anemia, the cardiovascular system and more. The severity of symptoms increases with higher exposure, but recent research shows that even a small exposure can impact health, according to the United Nations Children’s Fund (UNICEF).
Despite its severe impacts, it’s difficult for doctors in low- and middle-income countries to diagnose a lead poisoning case, Abheet Solomon, global program lead of healthy environments for healthy children at UNICEF, told Environmental Health News (EHN). He compares lead to the wildfire smoke that descended on UNICEF’s headquarters in New York this summer, “everybody saw the air pollution…you can’t say the same thing about lead because lead is invisible.”
The symptoms of lead poisoning are also subtle. While wildfire smoke might make someone cough the same day, lead operates on a longer timeline, and causes less obvious symptoms like IQ deficits or growth delays. “It’s hard to say this is a child that’s been poisoned by lead until you test,” Solomon explained.
In high-income countries blood lead tests are more common. In the U.S., most states require or recommend that children have blood lead tests between 12 and 24 months. Young children in the U.S. had a median blood lead level of 0.6 micrograms per decilitre from 2017-2018, according to the latest Environmental Protection Agency data. That’s well below the five micrograms per decilitre threshold for lead-poisoning, estimated in one in three children around the world (although pockets of significant lead exposure still occur in the U.S., such as in Flint, Michigan, where about 5% of children had lead poisoning due to lead water pipes in 2015.)
The barriers to sufficient testing in developing countries are numerous. First is a knowledge gap, “there’s little awareness in low- and middle-income countries about how pollution damages children’s health,” said Solomon. He explained that there’s better international awareness and resources for infectious and non-communicable diseases.
Then there are resource and technology limitations. Few low- and middle-income countries have the lab capacity needed to monitor blood lead levels. As of 2019, studies of blood lead levels had only occurred in 44 out of 137 low- and middle-income countries.
For the data that do exist, the global inequality is stark. One study found mean children’s blood lead levels well-above the five microgram per decilitre measure for lead-poisoning in low- and middle-income areas including Palestine, Pakistan, Cameroon and Egypt, among others.
UNICEF is gearing up to change this, Solomon said. Working with governments, they facilitate a survey of children’s health in developing countries about every 10 years, called a multiple indicator cluster survey (MICS). In 2018, Georgia became the first country to add blood lead testing to their MICS, after a small study of children’s blood lead levels indicated there could be a national problem. It was an important step for Georgia to get a national picture of lead-poisoning, Dr. Ziad Kazzi, a medical toxicologist and emergency medicine professor at Emory University who led the initial blood lead study, told EHN. “They don’t typically do environmental health assessments [on the MICS],” he explained. That year’s MICS revealed that 41% of children in the country had lead-poisoning, compared to 2% in the U.S., according to the Centers for Disease Control. Lead-contaminated spices were found to be a significant contributor to the poisonings.
That finding triggered better regulation, and there are some early signs that children’s blood lead levels could be dropping as a result. “I'm always hoping that other countries will pursue [blood lead testing] with their UNICEF office,” Kazzi said, and he’s eager to see more comprehensive follow-up data in Georgia.
Now, Solomon is working through UNICEF to get testing for lead and other harmful heavy metals on the MICS in more countries. “We have two countries lined up and we plan to do it in 10 countries over the next four years,” he reported, declining to name the two countries.
Finding a lead-poisoning culprit
In 2018, Georgia became the first country to add blood lead testing to their multiple indicator cluster survey (MICS).
Credit: Pure Earth
Once lead poisoning is identified in a child, it can be difficult to track down the source. In the U.S., some city and state programs take on this task. In New York City, the Department of Health and Mental Hygiene receives the blood lead levels of every New Yorker tested, and investigates each case of poisoning to find and remove the source.
Their consumer products database tracks years of investigations that identified lead-contaminated items like kohl eyeliner, metal amulets, painted dishes, cooking vessels, spices and medicines, typically purchased abroad.
When patterns emerge, the department issues warnings to communities. They also go incognito in stores to purchase and test items that might contain lead. “If we have identified a certain type of product that keeps showing up amongst our cases, we want to find out if it's available in New York City stores,” Paromita Hore, director of environmental exposure assessment and education at the New York City Department of Health and Mental Hygiene, told EHN.
If they find stores selling the products they can take enforcement actions. But most often, the products causing lead poisoning are carried by individuals back to New York from countries with weaker regulation and enforcement.
“If one country has a problem, the impact of that problem is not constrained to their borders,” Andrew McCartor, executive director of Pure Earth, a non-profit dedicated to reducing global lead and arsenic exposure, told EHN.
Hore’s department often reaches out to other countries’ consulates to alert them of an issue with a product, and she thinks those efforts could be expanded. “We could have a national repository…you can essentially scale up what we’re doing in New York City,” she said. Other areas, like North Carolina, conduct similar lead investigations. Coordinating those efforts could build a better picture of lead poisoning sources and inform action.
The kind of investigations needed to find the cause of a lead-poisoning case occur rarely around the world. McCartor’s organization, Pure Earth, is hoping to change that with a program to test blood lead levels in seven low- and middle-income countries and test consumer products that might contain lead in 25 countries. They’re building the data that can show governments where to act to reduce lead-poisoning. And there’s precedent for global action on lead — just two years ago leaded gasoline was phased out from cars in every country on Earth.
The world gets lead out of gasoline
In August 2021, the last tank of leaded gas going into a commercial vehicle was pumped in Algeria. This exhausted their supply, and made it the final country in the world to phase out the toxic fuel from cars. Leaded gasoline came on the market a century earlier promising to help engines run smoother, but emitting dangerous fumes in the process. Public health experts raised concerns as early as the 1920s, but the gasoline remained on the market for a century, emitting nearly 10 million tons of lead into the Earth’s environment, a portion of it ending up in people’s bodies.
Japan became the first country to completely phase out leaded gasoline in 1986, with the U.S. following in 1995, finishing a process started by the Environmental Protection Agency two decades earlier. Between 1976 and 1991 the average blood lead level of a person in the U.S. dropped from 12.8 micrograms per decilitre – well above the 5 microgram per decilitre measure for lead poisoning – to 2.8 micrograms per decilitre. Leaded gasoline is still used in other vehicles like planes, farm equipment and race cars around the world. (In 2022, researchers found that students living near a race track in Florida scored 4.4% lower on a state standardized test until NASCAR voluntarily phased out leaded gasoline in 2007.)
Throughout the 2000s, countries around the world followed, spurred by a United Nations campaign to phase out leaded gasoline globally. When they started, 117 countries still used leaded gasoline, including nearly all countries in sub-Saharan Africa. Attention and resources from the UN campaign helped phase out the toxic gas in most African countries within just a few years, said Jane Akumu of the UN Sustainable Mobility Unit in a webinar. She explained that collecting data on lead pollution and blood lead levels before and after the phase out in some countries helped convince others to act. Many of the countries that took longer to phase out the gasoline had political conflicts that made policy changes difficult to implement, she said.
When Algeria used the last of its supply in August 2021, they ended a century of toxic pollution. This achievement represents “a testament to the power of multilateralism to move the world towards sustainability and a cleaner, greener future,” Inger Anderson, executive director of the UN Environment Program, said at the time.
Two of the largest causes of global lead-poisoning today are lead-based paints and informal lead-acid battery recycling centers. Lead can be added to paint for color or corrosion control in homes or products and ingested by young children when it chips. The UN is currently working to help all countries regulate and enforce bans on lead in paint, which 48% of countries have done, according to the World Health Organization.
Use of affordable lead-acid batteries is increasing as the world electrifies, exposing many to lead. The batteries can be effectively recycled, but informal recycling centers without sufficient health and safety precautions create health risks for workers and surrounding communities. The UN and other NGOs working on this issue aim to build knowledge, regulations and enforcement capacity to promote safe lead-acid battery recycling.
Beyond paints and batteries, countless products create less obvious lead exposures. These are the sources that require more investigative resources to track down.
Who’s left behind when it comes to lead exposure?
“It’s kind of a backwards approach. We’re basically using kids as canaries in the coal mine."
Credit: Pure Earth
Removing a source of lead poisoning can stop symptoms from progressing, but the neurological and developmental delays it causes can’t be undone. “You’ll find sometimes the environmental toxicology side doesn’t connect to the clinical side,” said Kazzi, of Emory University. “What about the people that have the lead in their body? Who’s going to take care of them?”
As a medical toxicologist, he emphasizes providing care to those affected by lead poisoning concurrently with finding and removing exposure sources. That means improving nutrition, which can help reduce absorption of lead still present in blood, and providing support for children with learning and development disabilities. Not all children with lead-poisoning will experience a learning disability, but its negative impacts on IQ and development can push more kids into that category.
When countries add blood lead tests to their MICS, equipping governments to address the problem is key, said Solomon of UNICEF. Each country’s government has control over the MICS and they choose what data to share. An action plan to address lead poisoning encourages data transparency, he explained.
“We need to be building the response plan with the survey itself,” said Solomon, “[countries] need to be seen to be taking action to actually address these issues.” They took this approach in Georgia, so that when high lead-poisoning was found the government quickly rolled out treatment and exposure prevention plans.
Many working in the field worry about the ongoing exposures people face as they race to develop the data and resources they need to take action.
“It’s kind of a backwards approach. We’re basically using kids as canaries in the coal mine,” Ed Norman, program manager of childhood lead-poisoning prevention at the North Carolina Department of Health and Human Services, told EHN. His program often identifies homes with lead paint as a source of childhood lead poisoning, along with products like ceramics, spices, toys and bullets. “We’re testing the kids to see if there’s an exposure we should be preventing…in that sense it’s kind of sad, but we are able to prevent exposures for future generations of kids.”
That’s not good. But many of these fast-food and fast-casual restaurants have announced plans to ban the “forever chemicals” and for some — Taco Bell, Wendy’s, Sweetgreen and others — it seems to be working. In total 35% of 81 pieces of fast-food packaging showed detectable levels of organic fluorine, an indicator of the group of chemicals known as PFAS, according to a new report from Mamavation.
Partnering with EHN.org, the environmental wellness blog and community had the packaging tested by a U.S. Environmental Protection Agency-certified lab and found levels of organic fluorine ranging from 10 parts per million (ppm) to 469 ppm.
Organic fluorine is a strong indicator of per- and polyfluoroalkyl substances, also known as PFAS or “forever chemicals”— which have been linked to everything from cancer to birth defects to lower vaccine effectiveness.
EHN.org partially funded the testing and Pete Myers, chief scientist of Environmental Health Sciences, which publishes Environmental Health News, reviewed the findings. The report builds on previous fast-food packaging testing and EHN.org and Mamavation’s growing library of consumer products tested for evidence of PFAS, including products such as contact lenses, pasta and tomato sauces, sports bras, tampons, dental floss, electrolytes and butter wrappers.
It also comes on the heels of an EHN.org investigation, What we know about PFAS in our food, that found due to inadequate testing and a lack of regulation, we’re all eating PFAS.
Linda S. Birnbaum, scientist emeritus and former director of the National Institute of Environmental Health Sciences and National Toxicology Program and scholar at residence at Duke University, told Mamavation that fast-food packaging remains one of the main ways people are exposed to PFAS. She pointed to the patchwork of PFAS legislation happening at the state level as inadequate to fully protect consumers.
“We support states that pass legislation to curtail these problems, but we worry that brands may have just moved their more toxic packaging to other states that allow it,” Birnbaum said. “So the next step here to protect consumers would be federal legislation banning PFAS in food packaging so that all states comply. This is essential to protect the public.”
PFAS: from packaging into our food
PFAS have previously been found in food packaging such as pizza boxes, sandwich wrappers, French fry containers and popcorn bags. The chemicals are excellent at resisting grease and stains. They are either added intentionally into food packaging — or can contaminate the packaging unintentionally.
But they can migrate from packaging into food. People who eat more takeout, fast-food and pizza often have higher levels of PFAS in their bodies than people who regularly cook at home, according to a 2019 study.
“When we buy food for our families—our spouse, our children, and our grandchildren—we should not have to worry about forever PFAS chemicals. This is especially true of little ones,” Terrence Collins, Teresa Heinz professor of green chemistry & director of the Institute for Green Sciences at Carnegie Mellon University, told Mamavation.
Fast-food PFAS bans
Many fast-food restaurants — including Burger King, Tim Horton’s, Popeyes, Chick-fil-A, Starbucks, McDonald’s, Panera, Sweetgreen, Taco Bell and Wendy’s — have committed to phasing out PFAS in their packaging.
Mamavation tested some packaging from all of these restaurants and did not detect evidence of PFAS in Taco Bell or Wendy’s wrappers.
In addition, Sweetgreen announced in March 2020 they would get rid of PFAS in their molded fiber bowls, however, Mamavation found PFAS in the bowls in late 2022. A few months after Mamavation let them know of the concerning results, they announced nationwide changes to the bowls. And this testing round? No detected organic fluorine.
What fast-food restaurants have PFAS-free packaging?
Mamavation did not detect evidence of PFAS in packaging from 18 fast-food restaurants, including some popular companies like Arby’s, In-n-Out Burger, Subway, Little Caesars, Dunkin Donuts and others.
To see the full list of brands test — and which ones were contaminated — please see the new report at Mamavation.
The testing is part of an ongoing effort by Mamavation and EHN.org to identify PFAS in common consumer products. Follow our PFAS testing project with Mamavation at the series landing page.
Want to know more about PFAS? Check out our comprehensive guide.
