New York City and Rome have both experienced dramatic reductions in population blood lead levels over the past two decades. , These declines conform with national trends in the United States and Italy, respectively, which have largely been attributed to the reduction of lead in gasoline in both countries and also, in the United States, to regulatory bans on the use of lead in paint, solder in food and beverage cans and plumbing.
Despite overall declines in both the magnitude and severity of lead poisoning, the impact on certain population subgroups remains significant, and so, underscores the need for continued public health interventions. For example, in New York City, of the more than 1000 new cases of lead poisoning diagnosed in 1998, a disproportionate number occurred among toddlers, aged 1 - 2.5; African-American and Latino children; children living in neighborhoods where there is a high percentage of pre-1950 distressed housing that contains lead-based paint; and construction workers.1
The banning of lead in gasoline has been hailed as a major public health triumph. Yet similar broad-based policies and regulations to further control lead poisoning – such as through universal blood lead testing of children under age 6 and universal abatement of lead-based paint – have been the subject of much recent debate and controversy. In the last few years, real estate, insurance, and lead industry interests in the United States have played a significant role in replacing ‘universal’, far-reaching public health policies with more proscribed, targeted approaches. – both in the area of lead screening and abatement. These developments raise a number of important policy issues which will be explored in the presentation, including: To what extent have these shifts been driven by empirical data vs. political and economic interests? What value does our society places on true prevention and its associated costs? What parallels exist between the ‘lead debate’ and other environmental and public health policy issues?