LEAD IN THE AMERICAS

A call for action



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LEAD IN THE AMERICAS: A call for action LEAD IN THE AMERICAS A call for action

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LEAD IN THE AMERICAS: A call for action This page in the original is blank.

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LEAD IN THE AMERICAS: A call for action LEAD IN THE AMERICAS A call for action CHRISTOPHER P. HOWSON, MAURICIO HERNÁNDEZ-AVILA, AND DAVID P. RALL Editors COMMITTEE TO REDUCE LEAD EXPOSURE IN THE AMERICAS BOARD ON INTERNATIONAL HEALTH INSTITUTE OF MEDICINE Washington, DC, USA in collaboration with THE NATIONAL INSTITUTE OF PUBLIC HEALTH Cuernavaca, Morelos, Mexico

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LEAD IN THE AMERICAS: A call for action Support for this study was provided by AETNA; the U.S. Centers for Disease Control and Prevention; Environmental Defense Fund; U.S. Environmental Protection Agency; U.S. Food and Drug Administration; International Lead Zinc Research Organization, Inc.; Johnson & Johnson Family of Companies; W. K. Kellogg Foundation Endowment Fund; Charles Stewart Mott Foundation; U.S. National Institute of Environmental Health Sciences; U.S. National Research Council/National Academy of Sciences, and the World Bank. Lead in the Americas: A Call for Action First edition, 1996 ©Copyright 1995 by the U.S. National Academy of Sciences and by the National Institute of Public Health of Mexico. All rights reserved. Additional copies of this report are available from: National Institute of Public Health Center for Population Health Research Av. Universidad 655 Col. Sta. María Ahuacatitlán 62508 Cuernavaca, Morelos, Mexico ISBN 968-6502-25-4 Library of Congress Cataloging-in-Publication Data 95-073273

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LEAD IN THE AMERICAS: A call for action Notice: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance. The English-language version of this report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Spanish-language version has been reviewed and approved by staff of the National Institute of Public Health of Mexico. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Institute of Public Health (NIPH) (Instituto Nacional de Salud Pública) was founded in 1987, through the merger of three academic organizations that were moving in similar directions: the School of Public Health of Mexico, the Center for Research on Infectious Diseases, and the Center for Public Health Research (now Populational Health). The legal status of the NIPH is that of a semi-autonomous public organization located within the Health Sector, although the Institute has its own legal status and exercises its own budget. The headquarters of the NIPH are located in Cuernavaca, 70 km south of Mexico City, in the state of Morelos. The Center for Populational Health Research (CISP) is in charge of developing epidemiologic and health systems research which provides rational foundations for policy and decision-making. Its priorities include studies on epidemiologic transition, the health of women and children, quality of care, organization and financing of primary health care, the problem of medical employment and allocation of health resources. The Center for Research on Infectious Diseases (CISEI) is devoted to the study of bacterial, viral, fungal and parasitic ailments, including many of the so-called “neglected diseases”. In a developing country such as Mexico, these diseases continue to be of great public health importance. The Center for Malaria Research (CIP), located in the southern state of Chiapas, is linked to the CISEI. A new center also exists within the NIPH, the Center for Health Systems Research, which studies macro and micro aspects of health systems and their social context, analyzing health policies, organization and services, and their interaction with communities. The Academic Secretariat coordinates the School of Public Health of Mexico, an institution which is over 70 years old and which offers a range of Master's and Doctoral programs, as well as certification programs, to both national and international students. With these components, the NIPH combines bio-medical, populational and health systems research and human resource development. The Institute has focused its efforts on vigorously stimulating research, because the development of a better health care system requires a firm scientific basis. Thus, planning can be based on an understanding of the complex epidemiologic reality of the capabilities of different organizational arrangements for health care. Also, the formulation of health care standards can be updated incorporating new procedures whose effectiveness has been demonstrated by sound research.

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LEAD IN THE AMERICAS: A call for action COMMITTEE TO REDUCE LEAD EXPOSURE IN THE AMERICAS David P. Rall, * Chair, Retired Director, U.S. National Institute of Environmental Health Sciences, Washington, D.C. J. Peter Figueroa, Principal Medical Officer Epidemiology, Jamaican Ministry of Health, Kingston, Jamaica Howard Frumkin, Chair, Department of Environmental & Occupational Health, Rollins School of Public Health of the Emory School, Atlanta, Georgia Mauricio Hernández-Avila, Director, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico Joan Cook Luckhardt, Director, Lead Poisoning Prevention Program, University of Medicine and Dentistry of New Jersey-SOM, Stratford, New Jersey René Méndes, Professor, Department of Preventive Medicine, Federal University of Minas Gerais School of Medicine, Belo Horizonte, Brazil Terry Oke, Administrator, Trail Lead Program, Trail, Canada Eduardo Palazuelos-Rendón, Mexico City, Mexico Ellen K. Silbergeld, Professor, Department of Epidemiology and Preventive Medicine, University of Maryland Medical School, Baltimore, Maryland Tania M. Tavares, Professor, Institute of Chemistry, Federal University of Bahia, Bahia, Brazil Institute of Medicine Project Staff Christopher P. Howson, Director, Board on International Health Kimberly A. Brewer, Research Assistant Delores H. Sutton, Senior Administrative Assistant Jamaine Tinker, Financial Associate National Institute of Public Health Conference Staff Mauricio Hernández-Avila, Director, Center for Population Health Research Kelly Scoggins, Subdirector, Academic Extensions Teresa Téllez, Logistic Assistant Carmen Alvarez, Logistic Assistant * Member, Institute of Medicine

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LEAD IN THE AMERICAS: A call for action BOARD ON INTERNATIONAL HEALTH 1995 Barry R. Bloom (Cochair), * Howard Hughes Medical Institute, Albert Einstein College of Medicine, Hastings-on-Hudson, New York Harvey V. Fineberg (Cochair), * Harvard School of Public Health, Boston, Massachusetts John H. Bryant, * Moscow, Vermont Jacqueline Campbell, The Johns Hopkins University School of Nursing, Baltimore, Maryland Richard G. A. Feachem, London School of Hygiene and Tropical Medicine, University of London, England Julio Frenk, * Mexican Health Foundation, Mexico City, Mexico Dean Jamison, * University of California, Los Angeles, California Eileen T. Kennedy, Center for Nutrition Policy and Promotion, Washington, DC Arthur Kleinman, * Harvard Medical School, Boston, Massachusetts William E. Paul, * National Institute of Allergy and Infectious Diseases and Office of AIDS Research, National Institutes of Health, Rockville, Maryland Patricia Rosenfield, The Carnegie Corporation of New York, New York, New York Thomas J. Ryan, Boston University School of Medicine and Boston University Medical Center, Boston, Massachusetts Susan C. M. Scrimshaw, * University of Illinois School of Public Health, Chicago, Illinois June E. Osborn (Institute of Medicine Liaison), * The University of Michigan School of Public Health, Ann Arbor, Michigan William H. Foege (Ex Officio), * Carter Center, Emory University, Atlanta, Georgia David P. Rall (Institute of Medicine Foreign Secretary), * Washington, DC Staff Christopher P. Howson, Director Kimberly A. Brewer, Research Assistant Delores H. Sutton, Project Assistant Jamaine L. Tinker, Financial Associate * Member, Institute of Medicine

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LEAD IN THE AMERICAS: A call for action NATIONAL INSTITUTE OF PUBLIC HEALTH (Cuernavaca, Morelos, Mexico) Jaime Sepúlveda-Amor, General Director Mauricio Hernández-Avila, Executive Director Center for Population's Health Research Malaquías López-Cervantes, Executive Director Center for Health Systems Research Mario H. Rodríguez-López, Executive Director Center for Research on Infectious Diseases Jose Luis Valdespino-Gómez, Academic Secretary Jose Luis Alamaraz Segovia, Administrative Director Augusto García-Besné, Internal Comptroller