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September 10, 2019

Lead is Still a Public Health Culprit

By Amish Dave, MD, MPH

At a recent meeting of the Somali Health Board in Seattle, concerned parents raised questions about the prevalence of lead in their communities. They wondered if their children's low birth weights and hyperactive behavior might be associated with the age of their apartments, paint on the walls, or what they were eating.

Even though lead-based paint was banned by 1978, lead remains an issue today. Lead is everywhere, from older plumbing fixtures, soil, imported medicines, and ceramics. It is found adjacent to highways and via occupational exposures. Even more concerning, the attorney general's office in Washington recently found lead in children's school products. Further, many of Washington's counties have a high percentage of homes with lead paint, lead piping, and environmental lead exposures.

There is no safe level of lead in the human body. Even low blood lead levels (<5 micrograms/deciliter) can harm a child’s ability to learn and increase behavior problems. Research shows an association of childhood lead exposure and later risk of poorer educational attainment and incarceration.

Lead has also been causally linked with attentiondeficit hyperactivity disorder diagnosis. Most children exposed to lead remain asymptomatic, as longterm effects of lead exposure manifest later in life. Importantly, pregnant mothers with elevated lead levels can transfer lead from their blood to the fetus.

Massachusetts and New York are leading the way in screening for lead and conducting blood testing in 50 percent of their children. By comparison, in Washington, we test fewer than 5 percent of our children, making this state one of the five worst in the country for that metric. In King County, we estimate more than 6,000 children are likely lead poisoned, are not tested, and don’t receive services that could support their development.

Besides the personal toll on affected children, there are hard costs as well. One study estimates that for children born in 2014, with lead exposure, they would experience a total loss of $195 million in lifetime earnings and 393,000 healthy years lived. When long-term lead-exposure effects (hypertension, organ damage, reproductive problems, behavioral impacts) are factored over a five-year period, the costs expand to $1 billion in financial loss and 2 million healthy years lost.

We have a responsibility to advocate for the health and well-being of vulnerable children. For the past two years, Public Health – Seattle & King County and the King County Medical Society Board of Trustees partnered with the Washington Chapter of the American Academy of Pediatrics, the Washington State Department of Health, the Washington Poison Center, and the Northwest Pediatric Environmental Health Specialty Unit to highlight the seriousness of lead poisoning. We introduced a comprehensive resolution at the 2018 WSMA Annual Meeting to increase awareness about lead poisoning, which was adopted by delegates and is now association policy (bit.ly/wsma-lead).

But we need to do more. To get involved, contact Salem Adisu at sadisu@kcmsociety.org.

Amish Dave, MD, MPH, is a rheumatologist with Virginia Mason Medical Center in Seattle, in addition to being chair of the Public Health Committee for King County Medical Society and a delegate to the WSMA House of Delegates.

This article was featured in the September/October 2019 issue of WSMA Reports, WSMA's print newsletter. WSMA Reports is a benefit of membership. Non-members may purchase a subscription.

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