Lead poisoning: An invisible public health emergency

Recognising lead poisoning as a global health hazard, the international community led by USAID and UNICEF is launching Partnership for Lead Free Future on September 23, 2024 on the side-lines of the UN General Assembly.

One of the most alarming examples of its dangers is represented by what is known as the Flint Water Crisis. In 2014, Flint city in Michigan switched its water supply from Lake Huron to the Flint River to save costs. This seemingly small decision led to a public health catastrophe. What started as a routine conversation between a paediatrician and a concerned mother revealed the horrifying truth—Flint's new water supply was contaminated with lead, putting the entire city at risk. Over time, this discovery led to a community-driven campaign to reverse the decision and mitigate the damage. What began as an effort to save $200,000 a year ended up costing the government nearly a billion dollars, including a $600 million settlement for Flint’s residents.

The Flint crisis is not a distant memory for a developing nation; it occurred in one of the world’s most advanced countries, just a decade ago. If such a disaster can happen in the United States (US), the risk in developing nations, including India, becomes even more pressing.

This crisis has been documented in several books including What Eyes Don’t See by the paediatrician Mona Hanna Attisha, who started the movement. The title of the book captures the essence of the problem. Lead is a silent, invisible killer—it cannot be seen, tasted, or smelt, but its effects, especially on children, are devastating. Lead exposure leads to cognitive deficits, developmental delays, and numerous long-term health problems. Sadly, more than half of Indian children have unacceptably high levels of lead in their blood, and the lack of awareness around the issue only exacerbates the crisis.

Not surprisingly, in India, the dangers of lead exposure have been largely overlooked. Government programmes and policies do not focus on mitigating the danger of lead exposure and addressing its impact. A recent survey in Jharkhand found that more than 80% of health care professionals are not even aware of the issue of lead poisoning. Government health facilities are not equipped to test lead levels in blood. Without awareness and action, lead poisoning will continue to harm the most vulnerable, especially children. To address this crisis, a multi-faceted approach is needed, with government leadership, health care reforms, and public awareness campaigns playing a central role.

The first step in addressing lead poisoning is understanding the scale of the problem. The country needs a robust national surveillance programme that monitors blood lead levels, especially among children, pregnant women, and industrial workers. Establishing a national lead registry could be a critical first step. This would allow policymakers to gain a comprehensive view of where lead poisoning is most prevalent, helping to direct resources and interventions where they are needed most. Collecting data at this scale is crucial for informing policy and public health measures.

Identifying the sources of lead exposure is the next priority. In India, lead enters the body through many channels, including contaminated water, lead-based paints, certain spices, cosmetics, and even air pollution. Mapping out the regions where lead exposure is most likely to occur, such as industrial areas, urban slums, and informal recycling sites, will allow for targeted interventions. For example, informal recycling of lead-acid batteries is a major contributor to lead exposure. In such cases, informal recycling practices must be discouraged, while formal recycling processes should be incentivised through tax reductions and better regulatory frameworks.

Strengthening the regulatory framework is essential to controlling the sources of lead exposure. India already has some regulations governing lead content in products like food, cosmetics, paints, and water. However, the enforcement of these regulations is often inadequate. Enforcement agencies need to ensure that standards are followed strictly, especially in sectors where informal practices dominate. Expanding extended producer responsibility could be one way to hold manufacturers accountable for the safe disposal of lead-containing products, ensuring that lead is handled properly from production through to disposal.

Alongside regulatory efforts, the health care system must be strengthened to deal with lead poisoning more effectively. Doctors and health workers should be trained to recognise the symptoms of lead poisoning, and lead screening should become a routine part of health check-ups, especially for children and pregnant women. Ayushman Bharat Arogya Mandirs and schools could play a critical role in screening, and positive cases must be followed up with investigations to eliminate the sources of exposure. Moreover, investing in cost-effective technologies for testing blood lead levels and detecting environmental contamination is vital to long-term success. Integrating this issue into medical and public health education would ensure that future health care workers are equipped to tackle lead poisoning.

Public awareness is the backbone of any successful health intervention. Lead poisoning remains largely invisible to the general public in India, meaning many do not know how they or their children might be at risk. National awareness campaigns should focus on educating people about the dangers of lead exposure and how to prevent it. This can involve partnerships with NGOs, schools, and community groups to spread the message, while advocacy aimed at policymakers and industries highlights the economic and social costs of inaction.

Addressing lead poisoning is not a challenge that any one organisation or sector can take on alone. It requires a multi-sectoral effort, involving various ministries, government departments, private industries, and community organisations. Ministries focused on health, environment, and industry all need to work together to reduce the sources of exposure and protect public health. Collaboration between the public and private sectors will be key, especially in regulating industries that contribute to lead contamination.

The Flint crisis serves as a reminder of what can happen when invisible health threats are ignored. India cannot afford to let lead poisoning continue unchecked, nor can it wait for a disaster to take action. This is not just an environmental issue—it is a public health emergency that affects millions of children across the country. India must take this warning seriously, for the future health of its children, and by extension, the future of the country, rests on it.

This article is authored by Dr Indu Bhushan, distinguished fellow, Pahle India Foundation and founder-CEO, Ayushman Bharat.