The International Lead Poisoning Prevention Week: a Progress Report on Achievement of the Business Plan Indicator, 2013–2017

The International Lead Poisoning Prevention Week:

A progress report on achievement of the Business Plan indicator, 2013–2017

1. Introduction

The Global Alliance to Eliminate Lead Paint (Lead Paint Alliance) is a voluntary collaborative partnership working to focus and catalyse the efforts of a diverse range of stakeholders to achieve international goals to prevent children’s exposure to lead from paint and to minimize occupational exposures to lead paint. It was established in response to resolution II/4/B adopted by the second session of the International Conference on Chemicals Management in 2009. The Alliance is a joint undertaking of United Nations Environment Programme (UN Environment) and the World Health Organization (WHO).

In 2012 the Lead Paint Alliance finalized its business plan1, which provides a road map describing the strategies, milestones and means of achieving the goals and overall objective of the Alliance. Section VII of the plan identifies a number of performance indicators for evaluating the achievements of the business plan. One of these indicators relates to awareness-raising about the risks of lead paint:

• Performance indicator: Number of countries with national awareness activities about the risks of lead paint

▪ Milestone targets: o 2013 – 5 countries with national awareness days for prevention of lead poisoning with an emphasis on the risks of lead paint. o 2015 – 10 countries with national awareness days for prevention of lead poisoning with an emphasis on the risks of lead paint. o 2020 – 40 countries with national awareness days for prevention of lead poisoning with an emphasis on the risks of lead paint.

1.1 Establishing International Lead Poisoning Prevention Week

Recognising the practical difficulty of synchronising national awareness-raising campaigns on a single day, the Lead Paint Alliance decided to establish an annual International Lead Poisoning Prevention Week (ILPPW), with the expectation that national days and activities would take place during this

1 Available at: http://www.unep.org/chemicalsandwaste/sites/unep.org.chemicalsandwaste/files/publications/GAELP_BusinessPlan.pdf

period. The purpose of ILPPW would be to raise awareness worldwide about lead poisoning and to strengthen actions to eliminate the use of lead additives in paint, in particular by:

1) highlighting the efforts of all countries and Alliance partners to prevent childhood lead poisoning; and 2) urging further action to eliminate lead paint.

To facilitate the organization of local campaigns and the harmonization of campaign messages internationally, it was decided that customizable outreach materials should be provided each year and a register of events maintained by WHO. The already well-established annual Lead Poisoning Prevention Week in the USA provided a model for awareness-raising materials and activities.

Each year a working group comprising representatives from WHO, UN Environment, the US Environmental Protection Agency (US EPA) and IPEN2 develop a range of hand-outs, posters, fact- sheets and other outreach materials on lead poisoning, and plan a social media communications strategy. Many of these materials are provided in the six UN official languages (Arabic, Chinese, English, French, Russian and Spanish) and can be downloaded from the WHO website, from dedicated webpages for each language3. Since 2016, a campaign resource pack has also been provided, which gives guidance on organizing campaigns, suggestions for key messages, as well as links to the campaign materials. In 2017, campaign materials were also made available from a Trello board4. WHO has set up an event registration page and organizations interested in arranging an event during the week are urged to register their plans on this page5.

The campaign materials developed by Lead Paint Alliance partners can be customized with the logos and contact information of event organizers and translated into local languages. The purpose of developing campaign icons, key messages and customisable materials for adaptation by campaign organizers is to amplify the campaign at the global level. The success of this strategy is shown by the number of campaign posters, websites and events using the customisable ILPPW posters, the “Lead- Free Kids for a Healthy Future” icon and standardized messages in multiple languages, including in Albanian, Dutch, Georgian, Hindi, Nepali, Serbian, Sinhala and Thai. Many event organizers have created additional flyers and hand-outs to further raise awareness of lead exposure in their countries, sometimes drawing attention to other sources of exposure.

The first International Lead Poisoning Prevention Week was held on 20–26 October 2013 and there has been an ILPPW in each subsequent year, in the last full week in October. The overarching theme for the ILPPW has been “Lead-Free Kids for a Healthy Future”, and the sub-theme has, thus far, been the elimination of lead paint.

This report reviews the worldwide activities that have taken place during ILPPW over the past five years (2013–2017), and how these relate to the performance indicator and milestone targets established in the Alliance business plan of 2012.

2 An international network of environmental civil society organizations 3 http://www.who.int/ipcs/lead_campaign/en/ 4 https://trello.com/b/AmFq8zWK/international-lead-poisoning-prevention-week 5 http://www.who.int/ipcs/lead_campaign/event_registration/en/

2. Analysis of participation in the ILPPW, 2013–2017

This analysis is based on events during ILPPW that were registered on the WHO website. It is recognised that there are an unknown number of events that were not registered and, therefore, not included in this analysis.

2.1 Number of awareness-raising events, by WHO region

The number of events registered with WHO increased over the first four years, but decreased in 2017 (Table 1). The smaller number of events in 2017 was, to a large extent, because 33 fewer events were registered from the USA compared with 2016. This does not necessarily mean that fewer events took place but that fewer were registered from that country.

Table 1. Number of ILPPW events and number of countries where events took place, 2013–2017

2013 2014 2015 2016 2017 No. events 57 74 95 106 67 No. countries 40 37 37 47 44

Figure 1 shows the number of events organized in each WHO region. The regions with the largest number of events are the Americas and Europe, while the smallest number of registered events has been in the Eastern Mediterranean and Western Pacific Regions.

Figure 1. Number of registered events organized in each WHO region in the years 2013–2017

40 2013 30 2014 2015 No ofevents No 20 2016 10 2017

0 AFR AMR SEAR EUR EMR WPR WHO region

Key. AFR: African Region; AMR: Region of the Americas; SEAR: South-East Asia Region; EUR: European Region; EMR: Eastern Mediterranean Region; WPR: Western Pacific Region.

2.2 Number of countries with awareness-raising events, by WHO region

As shown in Table 1, the target of 40 countries having events was already achieved in the first ILPPW and this figure was exceeded in 2016 and 2017.

Figure 2 shows the number of countries in each WHO region where an event was organized. There has been an increase in the number of countries in the regions for Africa and Western Pacific. In the region for the Americas there seems to be a downward trend, in South-East Asia and Europe the trend is more variable, while in the Eastern Mediterranean Region there has been little change.

Figure 2. Number of countries in each WHO region where an event took place in 2013–2017

18 16 14 12 2013 10 2014 8 2015 6 2016 4 2017 No ofcountries No with eventan 2 0 AFR AMR SEAR EUR EMR WPR WHO Region

Key. AFR: African Region; AMR: Region of the Americas; SEAR: South-East Asia Region; EUR: European Region; EMR: Eastern Mediterranean Region; WPR: Western Pacific Region.

As the regions differ in the number of member countries, it is also helpful to look at the proportion of countries in each region where ILPPW events were held (Figure 3). This shows that there is again a consistent upward trend in the African region and a downward trend in the American region. The region with the highest proportion of countries having ILPPW events is South-East Asia where, in three of the five years that ILPPW has taken place, more than 50% of countries have had an event. In the other WHO regions, events were organized in at least 10% of countries, peaking at 30% in the European Region in 2016.

Figure 3. Proportion of countries in each WHO region where an event took place in 2013–2017

70%

60%

50% 2013 40% 2104 30% 2015 20% 2016

10% 2017

Percentage ofcountries witheventan 0% AFR AMR SEAR EUR EMR WPR WHO Region

Key. AFR: African Region; AMR: Region of the Americas; SEAR: South-East Asia Region; EUR: European Region; EMR: Eastern Mediterranean Region; WPR: Western Pacific Region.

2.3 Types of organizations arranging awareness-raising events

ILPPW events are organized by a range of organizations and institutions, with the most active being non-governmental organizations (NGOs), national governmental and local governmental authorities (Figure 4). Others include academic institutions, industry and poisons centres. NGOs are particularly active during ILPPW, organizing over 60% of the registered events in 2016 and 2017. While the number of events registered by the paint industry is small their engagement is important and is actively encouraged by the International Paint and Printing Ink Council (IPPIC). Industry activities include issuing statements of support for the goals of the Lead Paint Alliance and organizing workshops for manufacturers on the technical requirements for restricting lead use in paint.

Note that the figures for intergovernmental organizations (IGOs) do not include WHO Headquarters and UN Environment, which are, of course, involved every year.

Figure 4. Number of events organized by type of organization or institution

70 60 50

40 2013 30 2014 20 2015

10 2016 Numberofevents organized 0 2017

Type of organization or institution

Key. Nat gov: national government authority; Loc gov: local government authority; NGO: non-governmental organization; Acad ins: academic institutions; PC: poisons centre; IGO: intergovernmental organization; Multi: multi- sectoral organizers.

2.4 Number of countries and organizations with events in multiple years

Now that ILPPW has taken place for five years it is interesting to see how well-established it has become as an annual event. This can be looked at from two perspectives: the number of countries where an event was organized in multiple years and the number of organizations that arranged events in multiple years. For example, in Albania there were events in four years but two organizations were involved: the Institute of Public Health organized events in 2013–2015, and in 2016 an event was organized by the Environmental Center for Development, Education and Networking. As another example, in Bangladesh there were events in five years, each time organized by the Environment and Social Development Organization (ESDO).

Table 2 shows the number of events from these two perspectives. In the case of organizations, this table probably underrepresents US organizations that had national activities in multiple years as not all were registered.

Table 2. Number of countries and number of organizations with registered events in multiple years

Perspective In 5 years In 4 years In 3 years In 2 years Only in 1 year Countries 13 11 15 15 20 Organization 8 12 16 42 84

An ILPPW event was registered each year in 13 countries and these are shown in Table 3. This table also shows the organizations in each country that had an event in at least one year. The countries were in each of the WHO regions: four each in the regions for Africa and South-East Asia, two in the Western Pacific region, and one each in the regions for the Eastern Mediterranean, Europe and the Americas.

Table 3. Countries where events were held each year in 2013–2017 and organizations holding events in at least one year

Country Organization Australia Lead group

Bangladesh Environment and Social Development Organization (ESDO)

Cameroon Centre de Recherche et d’Education Pour le Développement (CREPD)

Georgia National Center for Disease Control and Public Health (NCDC)

India All India Institute of Medical Science, Jodhpur Consumers India Era University Father Muller Medical College Foundation of Health Care Technologies Indira Gandhi Government Medical College King George's Medical University, Department of Biochemistry Lata Medical Research Foundation Maulana Azad Medical College National Referral Centre for Lead Poisoning in India Society for Advancement of Occupational and Environmental Health SRM Medical College Toxics Link WHO Regional Office for South East Asia

Indonesia Balifokus Gita Pertiwi and KAKAK Foundation

Jordan Jordan Environment Society Land and Human to Advocate Progress Ministry of Environment Ministry of Health

Kenya Eco Ethics Kenya Centre for Environment Justice and Development (CEJAD) Kenya Industrial Research & Development Institute (KIRDI) Mombasa Lead Alliance University of Nairobi

Nepal Center for Public Health and Environmental Development (CEPHED) Leaders Nepal Ministry of Health Ministry of Science

Nigeria DoTheDream Youth Development Initiative SRADev Nigeria West African Academy of Public Health Young Volunteers for the Environment

Country Organization Philippines EcoWaste Coalition Philippine Society of Clinical and Occupational Toxicology Saint Louis University Laboratory elementary school

Uganda National Association of Professional Environmentalists National Environment Management Authority Uganda Network on Toxic Free Malaria Control

USA 84 organizations, including: Centers for Disease Control and Prevention Pan American Health Organization US Environmental Protection Agency (US EPA) US EPA regions 4, 8 and 10 Multiple State health departments, healthy child programmes and civil society initiatives

Table 4 gives more detailed information about the eight organizations that registered an event for five years consecutively. Again, this does not include WHO and UN Environment. There were two governmental organizations and six NGOs. Of the eight countries, four have legally binding controls on lead paint as of October 2017: Cameroon, Nepal, the Philippines and the USA6. Except for the USA, the introduction of legal controls on lead paint was recent.

Table 4. Organizations that registered an event for five consecutive years

Name of the Country Type of Type of activity organization where organization activity took place Balifokus Indonesia NGO Organizing events for the public – mostly children, distribution of materials (including national report), social media campaigns, press conferences. CEPHED Nepal NGO Media campaigns, distribution of materials, organization of a national stakeholder seminar, information for school children. CREPD Cameroon NGO Organizing workshop with government ministries, social media campaign, press releases, organizing meeting with other health sector stakeholders. EcoWaste Philippines NGO Press release with results of study on lead content Coalition in paint sold at local markets, awareness-raising events for the public and students, children’s zombie run. ESDO Bangladesh NGO Organizing events for the public, media campaigns, workshops, human chains. LEAD Group Australia NGO Art competition, use of social media, production of a themed calendar.

6 Countries with legally binding controls on lead paint, http://www.who.int/gho/phe/chemical_safety/lead_paint_regulations/en/

Name of the Country Type of Type of activity organization where organization activity took place NCDC Georgia Government National workshop with key decision makers (organized each year), social media campaigns. US EPA United Government Various activities, including social media States of campaigns, infographics, outreach to consumers & America contractors, information booths. Key: CEPHED: Center for Public Health and Environmental Development; CREPD: Centre de Recherche et d’Education Pour le Développement; ESDO: Environment and Social Development Organization; NCDC: National Centre for Disease Control and Public Health; US EPA: US Environmental Protection Agency;

3. Conclusion and discussion

This 2018 analysis of country-level participation in the International Lead Poisoning Prevention Week shows that the Alliance has exceeded its milestone targets for 2013 and 2015 regarding the number of countries where lead awareness activities took place. This momentum continued in both 2016 and 2017, with the Alliance exceeding even its future 2020 milestone of 40 countries with awareness activities on the risks of lead paint. This can, therefore, be considered a great success in terms of the performance expectations specified in the Alliance’s 2012 business plan.

However, the success of the annual International Lead Poisoning Prevention Week should also be evaluated in the context of its larger purpose, which is to help prompt actions by national governments to adopt laws and regulations to stop the production and sale of lead paints. The Alliance has another key milestone target: that all countries will have adopted legally binding lead paint laws, regulations or standards by the end of 2020. For this performance measure on lead paint laws, there is still a large gap between the current number of countries with legally binding controls on lead paint (i.e. 68 countries in October 2017) and the 2020 target.

Achievement of the 2020 target for legal controls on lead paint requires increased engagement by governments in those countries that do not yet have the necessary control measures in place. Awareness-raising on the serious health consequences of lead exposure, and the benefits of preventive measures such as regulating lead paint, is one important means to obtain this government engagement. Continued efforts are therefore needed during the annual International Lead Poisoning Prevention Week, and at other opportunities, to ensure that governments are informed about lead and the legal action that they should take to protect the health of their populations.

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