Lead in the Americas A Call for Action (1996) / Chapter Skim
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1 Executive Summary: Action Plan to Reduce Lead in the Americas
1 Executive Summary: Action Plan to Reduce Lead in the Americas
Pages 21-38
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CHAPTER 1 Executive Summary . Action Plan to Reduce Lead in the Americas
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Clearly, lead exposure is widespread, albeit heterogeneous. Hence, conference participants recognized that the optimal approach to prevention will vary from country to country, as willl the political and economic strategies needed to achieve success.
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Critical steps of the Action Plan include: Assemble and share the necessary information; Build capacity and train the necessary personnel; Build political will; Involve the target community; Make the needed technical changes; Determine and communicate the benefits, and costs, of eliminating lead from industrial processes and uses; Identify cases, prevent further exposures, and provide clinical care; Evaluate the results; Follow-up There was universal agreement that primary prevention through technical change is necessary and appropriate, and consistent with proven principles of public health. Specifically, conference participants agreed on a wide-ranging set of recommendations: .
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First, there is clear evidence that human exposure to lead from gasoline is widespread, and that eliminating lead from gasoline lowers population blood lead levels by reducing lead in air, foods, and dusts and soils. Second, there is a readily available alternative: unleaded gasoline.
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Fourth, the substitution of welded joints for lead-containing solder has been shown to derive the following commercial benefits: a 3-5 percent reduction in raw materials, resulting from the smaller welded joint; no net additional costs from retooling because material costs most often offset equipment costs; and a smaller welded joint provides a larger surface area for advertising, and a potential for increased market share. Conference members recommended that each country, through collaboration among its public health authorities, canning industry, and other interested parties, move rapidly toward eliminating the use of lead-containing solder in food cans.
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The hazards of occupational lead exposure have been well recognized for centuries, and international guidelines on limiting exposure have been available for decades. Members of the working group on occupational and industrial health endorsed the need for enforceable limits on lead levels in workplace air and for medical removal with full pay and job security for workers whose blood lead levels exceed a threshold, and they recommended that the acceptable threshold levels used as a basis for enforcement be standardized to the extent possible across the countries of the region.
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All countries should strive to implement such programs, with the active involvement of labor organizations, industries, government agencies, and health care providers. The conference participants call on the countries of the Americas to implement appropriate public health initiatives such as surveillance of high-risk populations, environmental monitoring, and education of the public and workers.
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There was widespread agreement among conference participants that steps to control lead exposures need not, and indeed should not, awaitfurther physiologic or toxicologic data. Further infonnation for decisionmaking is needed, but only in limited and specific ways.
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One example of this type of analysis endorsed by conference participants would be an extension of the 1994 Pan American Health Organization survey conducted by Drs. Tsabelle Romeo and Marina Lacasana, whose initial results appear in this volume.
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Addressing these deficits should, therefore, be an important part of any hemispheric plan to reduce lead exposure. Workshop participants urged North-South and South-South collaboration to offer assistance in technical training and equipping in countries that lack the infrastructure to develop lead surveillance programs.
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Conference participants also agreed on the importance of presenting data, where available, on the cost-effectiveness of reducing lead in the environment. Communicating the economic advantages of strategies to reduce lead exposure can be an important instrument for building political will.
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Accordingly, there was broad consensus among conference participants that active community involvement is a necessary prerequisite for effective prevention and control of lead poisoning across the hemisphere. Participants agreed that the growing movement to involve community members and other local "stakeholders" in health promotion and disease prevention and control programs has demonstrated clearly that such individuals can be vital to the development of innovative and sustainable solutions at the local level.
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The preliminary list of federal and private organizations involved in lead poisoning prevention provided in Appendix D of this report provides a means of obtaining preliminary information toward this end. But there also are costs associated with not reducing or eliminating lead exposure.
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Nevertheless, two other approaches currently not used in most countries of the Americas deserve attention: medical treatment of lead toxicity and rehabilitation. Medical treatment of lead toxicity rests primarily on chelation therapy, using calcium disodium edetate (EDTA)
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Fo~ow-UP Even the best-designed public health prevention and control programs will yield little benefit if their implementation and maintenance are given insufficient care and attention. Acknowledging this point, conference participants concurred strongly on the need for continued, active follow-up of programs deriving from the Action Plan described in this summary.
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The Action Plan described in this summary provides generic guidelines for national efforts to prevent lead poisoning that allow for adaptation in each country. Finally, the conference participants emphasized the importance of collaboration among constituencies such as industry, labor, environmentalists, communities, and government, as well as among countries facing comparable challenges.
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