“Lead Wars” – The politics of prevention and responsibility

By Elizabeth Grossman

What constitutes a disease? If the symptoms are sub-clinical and the cause is an environmental contaminant, what is the appropriate public health response? Once an environmental hazard is identified, who is responsible for removing that hazard to protect people from ongoing exposure and to what extent – or is society’s responsibility limited to treating those individuals already harmed?

These are questions central to Lead Wars: The Politics of Science and Fate of America’s Children, Gerald Markowitz and David Rosner’s provocative new book that tells the disheartening story of our ongoing failure to fully protect American children from lead poisoning. While enormous progress has been made in reducing children’s exposure to high levels of lead, the latest science suggests that nearly half a million American children remain exposed to dangerous amounts of lead. In 2012, the US Centers for Disease Control and Prevention (CDC) lowered by 50% what it considers an elevated childhood blood lead level, dropping that level to 5 micrograms per deciliter (5µ/dl). (Between 1960 and 1990 that level was dropped from 60 µ/dl to 25µ/dl; in 1991 it was lowered to 15 µ/dl, and in 2003 to 10 µ/dl.) The CDC now says that no level of lead exposure appears to be without “deleterious effects.” There is also increasing evidence that early childhood exposure to very low concentrations of lead can create profound and lasting neurological damage. So while most American children are no longer exposed to lead levels that prompt acute symptoms, those who are exposed risk suffering lifelong and life-altering adverse effects.

“Industrial societies in the West may have significantly reduced the levels of new lead contamination, but the horror of lead poisoning here is hardly behind us, exposure coming from lead paint in hundreds of thousands of homes, in airborne particles from smelters and other sources and from contaminated soil, lead solder and pipes in city water systems, and some imported toys and trinkets,” write Markowitz and Rosner.

In many ways a sequel to Deceit and Denial, the authors’ landmark account of how companies that produced lead-containing products – notably paints, pigments and leaded gasoline – continued to do so long after their products were identified as health hazards, Lead Wars shows that we have yet to resolve key questions regarding this toxic legacy: Who can be held legally responsible for exposing children to the hazards of lead paint and for removing that hazard?  Given what’s known about lead’s toxicity, how thorough must abatement be, and how should that work be prioritized?

Paint manufacturers have yet to be held liable
Cases now underway, including in California, seek to hold lead paint and pigment manufacturers financially responsible for removing lead paint. In previous cases, notably one involving some 240,000 Rhode Island homes, juries have ruled against the manufacturers. But those verdicts were overturned on appeal. “So as of now,” explained Markowitz and Rosner via email, “no lead company has been held liable.”

Numerous state and federal laws restrict the use of lead, many with regulations designed to protect children’s health. Yet US policies make it extremely hard to hold a manufacturer responsible for a chemical product’s health hazards – especially when symptoms are not acute or are slow to manifest. In the case of lead, courts have ruled against landlords for violating lead-paint laws, as they have in Baltimore. The Environmental Protection Agency has fined companies for improper lead abatement. In the Rhode Island case, the court said landlords of the homes where leaded paint was used – rather than the paint manufacturers – should be responsible for preventing lead-poisoning “ignoring the fact that the industry had been aware of the harmfulness of its products when it sold lead paint to homeowners,” write Markowitz and Rosner.

While the details of proving this liability are legal and political, these cases’ arguments rely on the interpretation of science. Lead Wars shows persuasively how regulation has struggled to keep up with evolving science, even for a toxicant as well-characterized as lead. As recently as the mid-1980s, medical professionals were still debating whether “biological change resulting from lead exposure was itself a cause for concern,” recount Markowitz and Rosner. Some experts maintained that without observable effects there was no reason to lower “safe” exposure levels. Others argued that to wait for visible symptoms was medically irresponsible. At the same time, companies manufacturing lead products continued to call for more evidence that low levels of lead exposure were harmful and sought to prolong scientific determinations that might prompt further regulation of their products – arguments that extended to debate over regulation of leaded gasoline.

Lead paint was taken off the US market in 1978, but lead paint remains in more than 30 million homes across the country. (The 25-year US phase-out of leaded gasoline concluded in 1996 although some uses are still allowed)  Some states have laws that require homeowners and landlords to inform prospective buyers and tenants about lead-paint hazards before selling or leasing homes with lead paint. The costs of lead-paint removal and medical expenses associated with childhood lead poisoning are tax-deductible in some states. This sounds helpful but Markowitz and Rosner point out that most residents endangered by lead poisoning can’t afford to do the necessary renovations. This is but one of the many elements of environmental injustice that plague lead-contamination issues.

Meanwhile, manufacturers of leaded paint and pigment are not required to contribute directly to the costs of removing lead paint or to lead-poisoning treatment programs. This leaves these costs thoroughly externalized with individual households and taxpayers shouldering the expense. And while the problem is very far from solved, in 2012 funding for the CDC’s “Healthy Homes/Lead Poisoning Prevention Program” was cut from $29 million to $2 million.

Because renovation of lead-painted buildings can produce large amounts of lead dust, workers and residents both need protection. Without proper precautions lead abatement can endanger workers removing the lead paint and create new hazards from lead dust and paint chips for residents, particularly young children. In addition the cost of thoroughly removing lead paint has repeatedly been cited as an obstacle to full abatement. Rosner and Markowitz write that the cost for removing all the lead paint thought to be in US homes in 1976 was estimated to be between $28 and $25 billion – or $111 to $139 in 2012 dollars.

Ongoing impacts
That lead largely (but far from exclusively) has affected low-income and minority children living in poorly maintained housing has complicated the social response to lead exposure. That lead is a neurotoxicant that depresses IQ and can prompt behavior problems and primarily affects the country’s  poorest children, has contributed to learning problems and reinforced cycles of poverty. It also allowed some opponents of lead regulation to suggest that confounding social factors – rather than lead exposure – might be causing the observed neurological problems. The history Lead Wars tells is often not only appalling but also shocking to those who did not live through it.

Also central to Lead Wars is a discussion of what Markowitz and Rosner see as a shift in public health programs that aim to improve public health by eliminating environmental hazards to those that emphasize individual treatment. The latter, they argue, has not helped the lead elimination cause.

While the story of lead contamination is in many ways unique, Markowitz and Rosner point out that lead is but one of numerous near ubiquitous environmental pollutants now affecting public health. “Presently,” they write, “the public health profession faces a conundrum: as the threats from industrial and environmental pollutants multiply, will the profession of public health remain true to its traditional mission of working to prevent disease or will it accommodate itself time and again to the politics of “economic feasibility”? And what will we as a society insist upon?”

Lead Wars is not a happy story or a story with a happy ending. It is a sobering, cautionary and ongoing tale. “For more than a hundred years, we have knowingly poisoned our children and destroyed the futures of millions of our citizens,” write Markowitz and Rosner. “Lead poisoning, we remind ourselves, is a completely preventable disease that we have had foisted on us by rapacious industries that have knowingly profited from our human suffering.” The lessons of this history, they write, “should not be forgotten, for in future years we will again and again face the Faustian bargain in which today’s technological “progress” will be paid for with the health and well-being of future generations.”

Meanwhile outside the US and Europe, leaded paint and gasoline continues to be sold. And if abatement is problematic and has been deemed too costly to complete thoroughly in Baltimore and Oakland, what are the prospects for properly protective abatement in Mumbai and Manila?

Elizabeth Grossman is the author of Chasing Molecules: Poisonous Products, Human Health, and the Promise of Green Chemistry, High Tech Trash: Digital Devices, Hidden Toxics, and Human Health, and other books. Her work has appeared in a variety of publications including Scientific American, Salon, The Washington Post, The Nation, Mother Jones, Grist, and the Huffington Post. Chasing Molecules was chosen by Booklist as one of the Top 10 Science & Technology Books of 2009 and won a 2010 Gold Nautilus Award for investigative journalism.