Lead poisoning may be among the most pressing public health challenges faced by low and middle-income countries (LMICs) and is certainly one of the least recognized and most neglected. Lead exposure is estimated by the Institute of Health and Metrics to be responsible for 900,000 deaths per year (more than malaria), primarily as a risk factor for heart disease,^[1] and both chronic and acute exposure can have debilitating effects on almost every body system. On a population level, much of its harm comes through its effects in impeding child neurological development: even low-level, subclinical lead exposure during pregnancy and early childhood has been shown to cause substantial and lifelong deficits in cognitive ability, as well as issues with attention and behavior control.

In high-income countries (HICs), the phaseout of leaded gasoline since the 1970s has led to dramatic decreases in levels of lead exposure. While levels have also fallen in many LMICs, they remain extremely high. There is a severe scarcity of data, but what does exist suggests that up to a half of children in LMICs have levels of lead exposure at which the WHO recommends public health intervention, and even levels below the WHO benchmark have been shown to carry significant risks. The effects of lead poisoning on cognition and behavior, combined with its high prevalence, suggest that lead exposure is likely to have a substantial impact on overall educational attainment, crime, violence, and potentially economic growth in LMICs.

Sources of lead exposure and potential solutions

Since the phaseout of leaded gasoline, no single source of exposure has dominated globally, and the key sources responsible for lead poisoning vary widely between and within countries. While our understanding of the primary contributors has improved, there is still limited research on the relative importance of sources at the global and local levels. Nevertheless, the following sources have been identified as a cause or potential cause of significant levels of lead poisoning in many LMICs: lead-acid battery recycling, mining and ore smelting, contaminated spices, lead paint, cookware, cosmetics, and toys and consumer goods. Other potentially important sources include lead pipes, residual pollution from leaded gasoline, light aviation fuel, e-waste recycling, traditional medicines and ceremonial powders, and folkloric traditions involving lead.

Important steps governments and agencies within LMICs can take against lead poisoning include developing capacity for the measurement and monitoring of levels of lead exposure; assessments of exposed populations to identify key sources; strengthening health systems to diagnose and treat lead poisoning; improving nutrition to limit lead absorption; and informing key stakeholders and the public generally about the threat of lead exposure, and how to recognize and prevent it. Other key actions are source-specific and may depend upon the sources identified to be the most central within a country. These are detailed in parts 2 and 4, but include roles for increased regulation, improved enforcement capacity, land remediation, and engagement with industry stakeholders and manufacturers of affected consumer products. Interventions against some sources are at an early stage of development, and there is a shortage of research on their effectiveness.

Current initiatives and actions by the G7 and international organizations against lead poisoning

While most action against lead poisoning within LMICs must be taken by LMIC governments themselves, G7 countries and international organizations also have an important role to play in efforts to end lead poisoning globally. Overall, our stocktaking of current actions and initiatives detailed in part 3, while not exhaustive given the rapid timeframe in which it was conducted, shows that current actions are fragmented, ad hoc, and relatively small in scale compared to the importance of lead poisoning as a global health, education, environment, and development issue.

In 1996 and 1997, OECD and G8 declarations (respectively) included commitments to reduce lead poisoning; however, the content of these declarations is no longer in line with up-to-date recommendations based on current scientific consensus. The Convention on Long-Range Transboundary Air Pollution contains a protocol limiting emissions of heavy metals, including lead. The Rotterdam convention requires that importing countries give prior informed consent to imports of certain lead compounds historically used as gasoline additives. The Basel convention also requires prior informed consent from countries importing certain types of waste containing lead.

A few G7 countries fund and/or implement programs aimed at building capacity for chemical and waste management in various low and middle-income countries, although few of these are directed specifically at lead poisoning. Besides this, many countries provide financial and technical support to the international organizations discussed below in their efforts against lead poisoning.

Several departments within the United Nations Environment Program (UNEP) publish guidelines supporting policymakers to address lead poisoning. They have also initiated a few programs supporting countries directly in introducing regulation, and more recently the United Nations Environment Assembly agreed on the foundation of a science policy panel on pollution prevention. The World Health Organization (WHO) also provides technical advice for clinicians as well as policymakers to address lead poisoning. Together, UNEP, WHO, and the United States Environmental Protection Agency lead the Global Alliance to Eliminate Lead Paint, which promotes lead paint regulation globally. The World Bank has begun to incorporate action against lead poisoning within its lending operations and its analytical work, and is seeking funding for a multi-donor trust fund to improve chemical and waste management. UNICEF has also taken actions against lead poisoning through survey work in Georgia, and a global awareness-raising campaign. There is a relatively high appetite among international institutions to sustain and expand these initiatives.

Recommendations for the G7 and its member countries

The report identifies a number of highly impactful actions that can be taken by G7 partners now to reduce the burden of lead poisoning. The recommendations are briefly summarized here, and detailed in full in section 6; while informed by our engagement with various stakeholders, they remain solely our own.

Reaffirm and elevate a collective G7 political commitment to a shared vision for a world free of lead poisoning. A strong, clear, and high-level statement is needed, referencing up-to-date international standards and evidence, and endorsed by the political leadership of G7 members, to elevate lead poisoning as a priority issue with independent standing as a pressing global challenge.

Support strengthened international cooperation–among G7 members and the broader global community–to progressively reduce the burden of lead poisoning worldwide. Specific actions for consideration include:

• Exploring the potential for expanded and more structured standards, potentially under the auspices of a voluntary or binding international agreement;
• Regular coordination and strategic alignment between G7 members and potentially the broader international community to address sources of lead poisoning;
• International standard-setting, monitoring, and reporting of lead poisoning via relevant technical agencies;
• Developing a Global Environment Facility proposal to address sources of lead poisoning;
• Expanding investments in reducing lead poisoning via other multilateral mechanisms and international organizations; and
• Expanding involvement by G7 members in international cooperation to reduce lead poisoning.

Expand use of Overseas Development Assistance (ODA) to invest in global and LMIC country-level capacity to monitor, prevent, and treat lead poisoning. G7 members, via their respective aid agencies, should elevate lead poisoning as a priority issue, and consider initiating or expanding the following activities:

• Supporting LMICs to conduct initial diagnostic exercises on the prevalence of lead poisoning and key sources of contamination;
• Strengthening in-country capacity for the routine monitoring of lead exposure;
• Increasing awareness among field-based staff on the problem of lead poisoning;
• Supporting civil society organizations advocating for action against lead poisoning;
• Assisting LMICs to establish and enforce limits on lead in consumer products;
• Through G7 development finance institutions (DFIs), support private sector efforts to increase lead safety;
• Funding research by local partners on the burden of lead poisoning, exposure sources, and interventions against it;
• Considering investments in R&D designed to address lead poisoning in low-resource settings.

Strengthen G7 leadership at home to protect G7 citizens from lead while contributing to a world free of lead poisoning. G7 members should consider the following actions to support the broader vision for a lead-free world:

• Ensure domestic regulatory standards on products and the environment are aligned with the most stringent, evidence-based levels recommended by the WHO and other technical bodies;
• Develop inter-agency working groups on lead within G7 governments to coordinate efforts across relevant governmental bodies;
• Ensure compliance with the Basel convention and other existing international agreements on the cross-border movement of hazardous waste containing lead;
• Integrate lead poisoning awareness and prevention into health and safety protocols for government staff travelling to areas with high levels of lead poisoning;
• Consider expanded domestic surveillance systems, including source analysis, full data publication, and follow-up actions to remove lead-contaminated products from supply chains;
• Conduct preliminary review of exports and imports of lead, products containing lead, and lead waste to inform potential measures to address lead poisoning through trade levers;
• Consider responsible sourcing regulations for G7-based importers of lead; and
• Consider regulations on the export of products containing lead, for example requiring that exporters guarantee a functioning end-use system.