Lead poisoning has, historically, been a major blind spot in the world of global health. The scope of the problem is huge: a Landmark studies It has been found that almost half of children in poor countries are exposed to very high levels of lead. at least 1.5 million people died Annual cardiovascular disease (such as heart disease) caused by lead poisoning imposes an almost global cost. 6 trillion dollars a year.
But resources devoted to poisoning prevention were minimal. one Estimated in 2021 It found that charities and non-governmental organizations were spending $6-10 million a year on the problem. That’s less than two cents per child poisoned by lead.
Fortunately, this number has increased dramatically. Amid the UN General Assembly meeting in New York last week, the US Agency for International Development (USAID) and UNICEF launched an initiative they are calling. Partnering for a lead-free future. The effort is supported by $150 million in seed funding from USAID, the Gates Foundation, Open Philanthropy and other sources.
$104 million in funding, from all philanthropic sources, will be channeled through a Lead Exposure Action Fund (LEAF) led by Open Philanthropy, which Says it wants to spread the money By the end of 2027. James Snowden, who leads the grantmaker’s main work, explained that the money would be allocated over four years, at a cost of about $26 million a year. This alone nearly doubles the current global philanthropic expenditure on lead poisoning.
“It’s a simple fundraising effort that I’ve been involved with,” Samantha Power, USAID’s administrator and one of the partnership’s lead organizers, told me. The gap, it seems, was mostly knowledge: once funders realized how bad the lead problem was and how cheaply it could be mitigated by addressing it. Cause of poisoning Like lead paint, contaminated spices and industrial recycling, they got on board.
Power was similarly induced. When his USAID advisor Garrett Lamm brought him data on the extent of the global lead problem, “my first reaction was ‘this can’t be true,’ something that causes so much harm isn’t being addressed.”
It was true; This is less true now. Funding in the global lead world is now close to the level needed to address the problem. Now the question is how to spend it.
lead, explanation
Lead – atomic number 82 in the periodic table – is soft, abundant, and easy to mine and handle, which is why humans have been using it for thousands of years for a variety of purposes. But it is also toxic to many parts of the human body, including the brain, especially the developing brain of children. it is Especially harmful What psychologists call “executive functioning”: the ability to choose behavior to achieve conscious goals rather than acting on impulse.
A particularly rigorous study in New Zealand found this Children with high blood lead levels had an IQ of 5.8 points lower Those with low blood lead levels. Lead is also associated with higher levels ADHDless Consent and conscienceand high levels of neuroticism. There is strong evidence of this Lead exposure increases crime rates. Pollution in childhood can permanently change the course of a person’s life.
Later in life, lead can be a major contributor to cardiovascular disease such as heart disease. The best evidence here comes from some one Recent research examines NASCAR’s decision to ban leaded gasoline From its car in 2007. Overall, counties with NASCAR races saw a 1.7 percent drop in the death rate for older people when the races stopped using leaded gas. The authors estimate that gas races in NASCAR and elsewhere cause an average of about 4,000 premature deaths a year in the United States.
Leaded gasoline, which in the U.S Phases started in 1975The world is no longer a major source of lead poisoning; Algeria, the last country to phase out lead from gasoline, did so in 2021 But there are other significant sources of lead Stanford researchers Jenna Forsyth and Stephen Luby found it In Bangladesh turmeric masala is often cut with lead chromateWhich is vibrant yellow, making the spice look brighter and more appealing. The problem probably extends beyond Bangladesh. Consumer Reports found that even US grocery stores had Turmeric sold with heavy metals.
informal Recycling of lead-acid car batteries Another major contributor. In many developing countries, this type of recycling is done in mom-and-pop operations in backyards, with no protection from the resulting fumes for recycling workers or neighboring residents. Cookware, both ceramic And metalScrap metal thrown into piles or used for glazing can be contaminated with lead, which can then leach into cooked food. Lead paint It is still present in many homes in the United States and is still sold in many parts of the world, as it provides a more vibrant white color. It can chip and contaminate small children when eaten or when it decays into dust in the air; Sometimes it is used to paint toys that children put in their mouths.
Addressing the global lead problem means addressing all of these sources, and potentially others as well.
Plan for partnership
Spending $150 million on new lead partnerships is a major asset, but arguably its biggest asset is the attention that such a high-profile team-up is able to bring to a neglected issue. Lead poisoning has long been on the sidelines of global health and has garnered less interest than malaria or HIV/AIDS. A Unveil event partnershipsA-list speakers included First Lady Jill Biden, World Bank President Ajay Banga and President Lazarus Chakwera of Malawi, whose country has made significant progress in remediating lead paint.
This type of advocacy is important because progress against lead depends heavily on new regulations and governments willing to pass and implement them. At the launch event, Power highlighted Stanford’s Forsyth, whose discovery of lead in yellow Under the leadership of the Bangladesh government Banning lead chromate in spices and increasing monitoring of spice production process. A Follow-up study in 2023 by Forsyth and colleagues It was observed that the proportion of yellow samples containing lead decreased from 47 percent to 0 percent. The regulation worked.
Lead paint exhibits similar dynamics. As with spices, the problem arises in the production process, and large advances can be made by targeting a relatively small number of producers. D Lead Exposure Elimination ProjectA small non-profit focused on paint, managed a Study in Malawi That found lead in common paints, leading to a national ban. “This measure alone has reduced the market share of brands including lead paint by 50 percent within two years,” said Malawian President Chakwera. Launch event.
Part of the partnership’s job is to pass and enforce similar laws. USAID is there On-the-ground presence Can be a big help in more than 80 countries. “Fifty states have no laws on the books regulating lead,” says Power. “It gives you a sense of a clear place to start our mission.”
Other sources may be difficult to eliminate. For example, much battery recycling occurs in small backyard workshops rather than large centralized facilities that regulators can easily influence. And the green energy transition is making battery recycling more popular and profitable, encouraging more families in the developing world to try their hand at the business.
“With the proliferation of these off-grid solar systems, actually a lot more disassembled batteries can be repaired and recycled,” Rachel Bonifield, a senior fellow at the Center for Global Development who has been very influential in making leadership a major global health issue, told me. Pure Earth researcher Christopher Kinally, who Studied practice in MalawiIt found that the batteries were “openly refurbished on busy market streets, often within 100 meters of food markets, community water wells and nursery schools.”
“We know the playbook now where it’s coming from the paint. We know the playbook where it’s coming from spices,” Atul Gawande, a distinguished author-physician who is now assistant administrator for global health at USAID, told me. With batteries, by contrast, “we’re still in the learning process.” He points to Brazil as a possible model; there, Informal recycling has decreased Due to a law battery manufacturers are responsible for recycling them at the end of their life cycle.
Even more important than the remedy may be simple information-seeking. Most countries do not conduct regular, nationally representative surveys of blood lead levels in children, and almost none have good data indicating the proportion of lead poisoning attributable to specific sources of lead.
When Bonifield and colleagues combined A fairly standard budget for a global leadership strategyThe single largest category of costs involved developing systems in each affected country to measure blood lead levels, lead sourcing, product testing, and other basic data collection and analysis.
Already the partnership has received commitments from several countries for regular blood tests. “We have 12 countries that are tracking blood lead levels, totaling over 1 billion people,” Gawande said. Those countries include Bangladesh, Nepal, Malawi and the Dominican Republic.
Open Philanthropy’s Snowden notes that the LEAF partnership It divides its work into three categories: Measurement, Mitigation, and Mainstreaming. Although mitigation is arguably the most attractive, all three are important. Without measurement, effective mitigation is difficult to get off the ground. And without mainstreaming, it’s hard for countries to even know that they have this opportunity to save the lives and futures of so many of their citizens at such a low cost.
“Lead, this experience for us as an agency, has changed us,” reflected Power It gave the opportunity to look at global health in a new way, for America’s foreign aid agencies to ask themselves, “If you’re starting from scratch and you don’t know the taste of money coming to you, how do you prioritize? doing in the world? A lot of agencies $45 billion Budgets, and more broadly those of global health organizations, are earmarked for specific diseases or problems.
Being able to look outside these silos and work with other funders allowed USAID to find a huge neglected problem in lead. Perhaps the greatest promise of this project is that it suggests that the lead may be just the beginning, that there may be many neglected areas of global health that U.S. foreign aid agencies can begin to address.
