Improving Health in the Community A Role for Performance Monitoring (1997) / Chapter Skim
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A.4 Environmental and Occupational Lead Poisoning
A.4 Environmental and Occupational Lead Poisoning
Pages 242-261
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From page 242... ...
The problems of childhood and occupational lead poisoning and strategies to address these problems are discussed below. Child Lead Intoxication Elevated blood lead level is one of the most prevalent environmental threats to the health of children in the United States (CDC, 1988)
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Current strategies to reduce the exposure of children to lead include abatement of lead hazards in homes and further reduction of lead levels in soil and drinking water. Abatement of lead in homes requires substantial resources, since the cost of abatement of a single residential structure can range from $3,000 to $15,000 (CDC, 1991)
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Adult Lead Intoxication Lead intoxication is a less prevalent problem among adults than among children. Among adults, lead exposure is associated most commonly with work at battery manufacturing plants, smelting operations, construction sites, radiator repair shops, ceramics production shops, firing ranges, and foundries (Pirkle et al., 1985; CDC, 1988)
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As mentioned earlier, lead intoxication in children can lead to serious conditions with lifelong impacts such as coma, potentially irreversible mental retardation, delayed cognitive development, reduced IQ scores, impaired hearing, and growth deficits. In adults, lead intoxication can lead to cardiovascular, reproductive, renal, neurological, hematological, and musculoskeletal system problems.
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. Occupational lead exposures are associated most commonly with work at battery manufacturing plants, smelting operations, construction sites, radiator repair shops, ceramics production shops, firing ranges, and foundries (Pirkle et al., 1985; CDC, 1988)
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. At levels of 10–19 µg/dL, CDC suggests that health agencies provide educational information to parents about lead poisoning prevention.
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Clinicians are likely to test blood lead levels of children living in high-risk environments, adults working in high-risk environments, and patients with symptoms of lead poisoning. The additional tests are important for disease surveillance.
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However, CDC recommends the following: • At levels of 10–19 µg/dL, CDC suggests that health agencies provide educational information to parents and caretakers about lead poisoning prevention. • At levels of 20–39 µg/dL, CDC recommends environmental and medical management.
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Eliminating lead exposures at the work site and using personal protective measures (e.g., respirator, goggles, protective work clothes, boots) may decrease the occurrence of occupational lead poisoning.
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Communities that embark on lead poisoning prevention projects will be faced with many issues such as inadequate lead hazard identification and remediation, liability insurance, rental property issues, financial incentives for lead abatement or control, inadequate public information, poor coordination of public agencies, and potential for exposure at public schools and child care facilities. Communities may want to consider indicators such as the following: 1.
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Abatement of lead hazards in homes eliminates an important source of childhood lead poisoning. This indicator also measures the performance and coordination of federal agencies (e.g., HUD and EPA)
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5. Environmental lead exposure as measured by sources such as the Toxic Release Inventory, Air Quality Management Districts, public water supply sources, contaminated food, and consumer product listings.
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Social Environment Many sectors of the community, in addition to the medical, public health, and environmental sectors, can influence and be influenced by lead poisoning prevention activities. For example, social service agencies play a potentially important liaison role between community members who need lead prevention services and service providers.
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SAMPLE SET OF INDICATORS Although all of the indicators discussed above are relevant to monitoring lead poisoning prevention efforts in communities, the nine measures listed below represent a minimal proposed set of indicators. Communities can supplement this list according to their interests and circumstances.
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8. Environmental lead exposure as measured by sources such as the Toxic Release Inventory, Air Quality Management Districts, public water supply sources, and contaminated food and consumer product listings.
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OLPPP/HESIS Medical Guidelines. Berkeley: California Department of Health Services, Occupational Lead Poisoning Prevention Program and Hazard Evalu ation System and Information Service.
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1984. Blood Lead Levels for Persons Ages 6 Months to 74 Years: United States, 1976–1980.
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agencies Local health agencies continued on next page 259
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proportion that are in the Employees process of remediation; General public proportion that have been referred for legal enforcement Improve coordination Proportion of local housing State agencies, of community programs programs, weatherization survey of programs to address lead hazards programs, rehabilitation programs, and local building codes that include provisions for lead hazard control Proportion of lead State agencies, inspectors, risk survey of programs assessors, supervisors, project designers, and abatement workers certified through accredited training courses IMPROVING HEALTH IN THE COMMUNITY
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