The Toxic Truth: Children’s Exposure to Lead Pollution Undermines a Generation of Future Potential The Toxic Truth: Children’s Exposure to Lead Pollution Undermines a Generation of Future Potential I Acknowledgements This report has been jointly produced by UNICEF and Pure Earth. Authors Nicholas Rees Richard Fuller Overall Guidance and Direction Gautam Narasimhan Angela Bernhardt Abheet Solomon Design and Visualization Shangning Wang Editor Debbie M. Price Research and/or Review Yoonie Choi Gordon Binkhorst Fiorella Polo Jack Caravanos Kam Sripada Bret Ericson Lilydahn Stewart Greg Ferraro Amy Wickham Andrew McCartor Fangqian Xu Elena Rahona Sarzah Yeasmin We are very thankful to Michael Brauer, Jeff Zhao and Jeff Stanaway at the Institute for Health Metrics and Evaluation (IHME) for global calculations on the number of children with elevated blood lead levels; Ernesto Sánchez-Triana and Santiago Enriquez at the World Bank for developing and contributing Chapter 4: Broader Economic Implications, including related analysis; David Heyman at Axis Maps for mapping support; and the NTNU Centre for Global Health Inequalities Research (CHAIN) for collaboration on this report. We are also very thankful for overall review and technical inputs from: Angela Bandemehr (US Environmental Protection Agency) Marie-Noël Bruné Drisse (World Health Organization) Dr. Howard Hu (University of Southern California) Dr. Philip Landrigan (Boston College) Dr. Bruce Lanphear (Simon Fraser University) Nicoline Lavanchy (United Nations Environment Programme) Desiree Raquel Narvaez (United Nations Environment Programme) Walker Smith (US Environmental Protection Agency) Joanna Tempowski (World Health Organization) Cover image: © Larry C. Price/Pulitzer Center on Crisis Reporting Disclaimer: The findings, interpretations and conclusions expressed in this paper are those of the authors and do not necessarily reflect the policies or views of UNICEF, the United Nations or Pure Earth. The designations in this publication do not imply an opinion on legal status of any country or territory or of its authorities, or the delimitation of frontiers. The Toxic Truth: Children’s Exposure to Lead Pollution Undermines a Generation of Future Potential CONTENTS EXECUTIVE SUMMARY.........................................................................................................................................................................................1 1. HOW LEAD HARMS CHILDREN..........................................................................................................................................................................5 Health Impacts...............................................................................................................................................................................................7 Years of Productive Life Lost.........................................................................................................................................................................8 Cognitive and Neurological Development..................................................................................................................................................9 Mental Health, Violence and Crime............................................................................................................................................................12 Signs and Symptoms of Lead Poisoning ...............................................................................................................................................14 Prevention and Treatment of Health Effects..............................................................................................................................................17 2. A DEVASTATING TOLL......................................................................................................................................................................................20 A New Understanding...................................................................................................................................................................................21 3. SOURCES OF LEAD EXPOSURE......................................................................................................................................................................25 Lead-acid Batteries.......................................................................................................................................................................................28 Spices, Cosmetics and Toys.......................................................................................................................................................................31 Ceramics and Cookware..............................................................................................................................................................................35 Lead-based Paint and Pigments.................................................................................................................................................................38 Leaded Gasoline...........................................................................................................................................................................................40 Lead in Soil...................................................................................................................................................................................................41 Lead in Water................................................................................................................................................................................................42 Electronic Waste...........................................................................................................................................................................................44 Occupational Exposure...............................................................................................................................................................................47 IV 4. BROADER ECONOMIC IMPLICATIONS............................................................................................................................................................49 Estimates of National/Subnational Economic Effects...............................................................................................................................50 Estimates of Global Health Economic Effects...........................................................................................................................................52 Benefits and Costs of Interventions to Reduce Lead Exposure................................................................................................................53 5. SOLUTIONS TO ADDRESS CHILDREN’S LEAD EXPOSURE...........................................................................................................................55 Monitoring and Reporting Systems...........................................................................................................................................................57 Prevention and Control Measures.............................................................................................................................................................58 Management, Treatment and Remediation...............................................................................................................................................59 Public Awareness and Behaviour Change................................................................................................................................................60 Legislation and Policy..................................................................................................................................................................................61 Global and Regional Action........................................................................................................................................................................62 ANNEX....................................................................................................................................................................................................................67 REFERENCES............................................................................................................................................................................................74 V EXECUTIVE SUMMARY Hundreds of millions of children are poisoned by lead. Some of these Childhood lead poisoning should command an urgent international children live in poor communities in rich countries, but the vast majority live in response. But because lead wreaks its havoc silently and insidiously, it often poor countries where they are exposed to lead through multiple routes. Often goes unrecognized. It irreversibly damages children's developing brains and unwittingly and with life-altering consequences, these children are growing up in nervous systems, the heart, lungs and kidneys and often does so whilst causing harm's way, inhaling dust and fumes from informal used lead-acid battery recycling no or only subtle symptoms in the early stages. Hence, the full magnitude of the operations and open-air smelters, eating food contaminated by lead-glazed pottery scale of global