tional exposures to lead do not exist. National policymakers are thus seriously disadvantaged in their ability to make adequate assessments and appropriate decisions about public health investments and allocations of human and financial resources. As a result, opportunities to incorporate primary prevention of environmental diseases into economic and social development programs may be missed. Assistance organizations at all levels, including international development and technical assistance agencies, local nongovernmental organizations (NGOs), and community-based environmental action groups have similar, corresponding difficulties. Recognizing this, in 1993 the Board on International Health of the Institute of Medicine proposed an international symposium and associated workshops on the topic of lead and health. The objectives of the activity were twofold: to provide a forum for the exchange of current information on major sources and toxic effects of lead exposure and to offer a neutral venue for North and Latin American and Caribbean policymakers, private sector representatives, research scientists, community representatives, and health professionals to identify cost-effective strategies for reducing lead exposures in the hemisphere. The symposium was to: (1) review and assess what is known about the magnitude of lead toxicity as a public health problem in selected countries of the Americas; (2) review and assess what is known about the sources of lead in the Americas, levels in various environmental media, and the uses of lead that increase human exposure; (3) evaluate transnational impacts of lead, including environmental fate and transport, and transboundary movements of lead in commerce, including recycling and waste disposal; and (4) develop a framework for the identification, analysis, and articulation of integrated control strategies to reduce environmental and occupational exposures to lead and consequent human disease. The conference was designed to build on the solid evidentiary base provided, in part, by past efforts of the National Academy of Sciences (NRC, 1980, 1993) and other influential bodies (Alliance to End Childhood Lead Poisoning and EDF, 1994; ATSDR, 1988; CDC, 1991; National Center for Lead-Safe Housing, 1995; OECD, 1994).

The Board decided to focus on lead exposure reduction in the Americas for four general reasons:

One, many countries in North and Latin America and the Caribbean are beginning to respond to environmental concerns and are looking for guidance in the allocation of funds for environmental research and intervention. The region has already seen agreements between the public and private sectors with respect to reducing environmental lead.



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