Public Health Association of Australia: Policy-at-a-glance Environmental Lead Exposure Policy

Transcription

1 Public Health Association of Australia: Policy-at-a-glance Environmental Lead Exposure Policy Key message: PHAA will: 1. Provide input to NHMRC Lead Working Committee ( ) 2. Advocate review of the adequacy of the current blood lead guidelines for all Australians 3. Advocate to government for a National Plan for Lead Prevention and Management, with strategies and funding to research, prevent and manage individual and population level exposures of lead, as part of the National Environmental Health Strategy Summary: Exposure to lead in Australia continues to be a preventable public health problem. Developing children are most at risk, and some communities are disproportionately affected. Recent research suggests there may be adverse health effects from lead exposure at blood lead levels even lower than previously recognised. Some countries have moved to reduce guideline levels below those current for all Australians. The NHMRC is reviewing evidence for current recommendations. A nationally coordinated approach is required for improved research, prevention and management of lead exposure in Australia. Audience: Federal, State and Territory Governments, NHMRC, enhealth, and policy makers. Responsibility: PHAA s Ecology and Environment Special Interest Group. Date policy adopted: September 2014 Contacts: Peter Tait, Ecology and Environment SIG Convenor: aspetert@bigpond.com 1

2 ENVIRONMENTAL LEAD EXPOSURE Policy Please note existing PHAA policies on Child Health, Environmental Chemicals and Toxins, and Health Justice. The Public Health Association of Australia notes that: 1. Lead is a cumulative environmental toxin, with no known benefits of exposure. It is can affect multiple body systems, including the neurological, haematological, gastrointestinal, cardiovascular and renal systems. There is no established blood lead (BLL) threshold below which adverse health effects do not occur. Exposure to lead comes from multiple sources, such as industry and occupational exposure, lead contaminated paint, dust, soil, water, food, traditional medicines, home renovation and hobbies. 2. Children and the developing foetus are particularly susceptible to the adverse effects of lead exposure. Exposure may impair neurodevelopment, placing them at increased risk for developmental delay, reduced IQ and behavioural problems. Older age groups may also experience health impacts, with a reported association between low BLLs and increased cancer and cardiovascular mortality. (1,3,6,8,9,14). 3. Lead toxicity is a potentially preventable disease, with prevention and management of lead toxicity a public health priority. (14) 4. Currently there is still an health issue with environmental, industrially generated community lead exposure in towns with long history of mining and smelting; e.g. Broken Hill, Mt Isa, and Port Pirie. (Esperance in Western Australia also has exposure related to transport of lead through the town.) Lead is in dust in footpaths, housing, yards, play areas, where people living and playing (children particularly) can be [2,5,8,9,10, 11,15] exposed. 5. In other cases exposure may be a legacy issue from lead in petrol being spread by air and being deposited near major roads and other areas, and in other areas from lead in paint, with aging housing stock exposed due to weathering, poor maintenance or renovation. [2,3,5,12,15] 6. Management of lead exposure is a state and territory government responsibility. However in communities where excessive lead exposure is long-term and ongoing, (eg mined or smelted), environmental aspects of lead are considered by the Environmental Health Committee (enhealth), a subcommittee of the Australian Health Protection Committee, which reports to the Australian Health Ministers Advisory Council. [8] 2

3 7. While household dust remediation may not be effective in lowering BLLs, where there is an extensive legacy of lead exposure through industrial emissions, contaminated land remediation may be effective. However this is expensive and must be adequately funded and supported at state and federal levels and, where appropriate by the mining industry. [3,9,12,14].Lead levels may be higher in children from lower SES background, and appropriate assistance for these families should be provided. [2,3,5,12,14] 8. The most recent research now suggests that there may be adverse health effects from lead exposure at BLLs even lower than previously recognised- including levels below the threshold currently set by Australian NHMRC guideline of 10ug/dl (0.483 umol/l). In some countries, such as the USA, the blood lead threshold at which action is required to investigate and reduce exposure in children and pregnant women has been lowered to 5 ug/dl (0.242umol/L) or lower. [3,10,12,14] 9. The NHMRC is commissioning an independent evaluation of the evidence relating to individual lead exposure in Australia to inform a revision of the 2009 Public Statement and Information Paper (if required) and the development of a guideline on the management of individual exposure to lead in Australia for health practitioners. [8,10]. 10. The NHMRC Lead Working Committee ( ) has been established to consider and provide comment on the evaluation of the evidence, and advice on the development/revision of the three documents. Public consultation on the draft documents is anticipated to occur in the first half of The Public Health Association of Australia affirms the following principles: 11. The impact of the social determinants of health is applicable to the issue of environmental lead exposure in that socio-economically disadvantaged groups may experience poorer health outcomes without adequate intervention. 12. For communities where lead exposure is widespread and long-term, preventive strategies at the community/ population level are the most effective way to reduce lead exposure. 13. Lead toxicity is a potentially preventable disease, and prevention and management of lead toxicity is a public health priority 14. Australian governments- federal, state and territory -need to adequately support public health programs, and research and surveillance activities, that aim to reduce individual and population health exposures to lead 3

4 15. Current guidelines and recommendations about diagnosis, prevention and management of lead exposure should be supported by the most up-to-date and credible scientific evidence The Public Health Association of Australia believes that the following steps should be undertaken: 16. Australia requires a national framework approach to environmental lead management which includes management of legacy issues, good longitudinal population health survey data, a national strategy that encompasses prevention as well as management and incorporates revised action consequent to a reduction of the blood lead reference levels on communities. [3,10,13] 17. That the Resources for Regions funds in relevant states be available for lead affected LGAs to bolster community remediation where this is recommended. 18. That the NHMRC take note of the latest scientific evidence, and the actions of other governments in lowering blood lead level guideline values, to ensure current lead guidelines and protections for all Australians are adequate. The Public Health Association of Australia resolves to undertake the following actions: National Office, Board, and the Ecology and Environment Special Interest Group, will: 19. Provide comment to NHMRC Lead Working Committee, consistent with this policy 20. Advocate for a National Plan for Lead Prevention and Management, with enhealth to include strategies and funding to monitor for, research, prevent and manage existing individual and population level exposures of lead in its next National Environmental Health Strategy ( ), 21. Advocate for State government resources to deal with lead exposures for families in long-standing legacy areas. 22. Advocate for a review of the adequacy of the current BLL guidelines for all Australians, especially for children and pregnant women, and that guidelines for occupationally exposed workers be consistent with national recommendations. ADOPTED 2014, 4

5 ADOPTED by the Board as an Position Statement in March 2014, adopted as policy at the 2014 Annual General Meeting of the Public Health Association of Australia. References: 1. Bellinger DC, Bellinger AM. Childhood lead poisoning: the torturous path from science to policy. The Journal of Clinical Investigation 2006; 116(4): Berg DR, Eckstein ET, Steiner MS, Gavard JA, Gross GA. Childhood lead poisoning prevention through prenatal housing inspection and remediation in St. Louis, MO. American Journal of Obstetrics and Gynecology 2012; 206(3):199.e Centers for Disease Control and Prevention. CDC Response to Advisory Committee on Childhood Lead Poisoning Prevention Recommendations in Low Level Lead Exposure Harms Children: A Renewed Call of Primary Prevention Available from 4. Cecil KM, Brubaker CJ, Adler CM, Dietrich KN, Altaye M, Egelhoff JC, et al. Decreased brain volume in adults with childhood lead exposure. PLoS Medicine 2008; 5(5): e Korfmacher KS, Ayoob M, Morley R. Rochester's lead law: evaluation of a local environmental health policy innovation. Environmental Health Perspectives 2012; 120(2): Lanphear BP, Hornung R, Khoury J, Yolton K, Baghurst P, Bellinger DC, et al. Low-level environmental lead exposure and children s intellectual function: An international pooled analysis. Environmental Health Perspectives 2005; 113(7): Mazumdar M, Bellinger DC, Gregas M, Abanilla K, Bacic J, Needleman HL. Low-level environmental lead exposure in childhood and adult intellectual function: a follow-up study. Environmental Health 2011; 10: National Health and Medical Research Council. Lead Exposure and Health effects in Australia - NHMRC position. [13th February 2013]; Available from: 9. Schober SE, Mirel LB, Graubard BI, Brody DJ, Flegal KM. Blood lead levels and death from all causes, cardiovascular disease, and cancer: results from the NHANES III mortality study. Environ Health Perspect. 2006;114(10): Taylor MP, Winder C, Lanphear BP. Eliminating childhood lead toxicity in Australia: a call to lower the intervention level. Medical Journal of Australia 2012; 197 (9): Taylor MP Camenzuli D, Kristensen LJ, Forbes M, Zahran S Environmental lead exposure risks associated with children s outdoor playgrounds. Environmental Pollution 2013; 178: 447e Wheeler W, Brown MJ Blood lead levels in children aged 1-5 years, United States, Morbidity & Mortality Weekly 2013 ; 62: Wilhelm M, Heinzowb B, Angererd J, C. S. Reassessment of critical lead effects by the German Human Biomonitoring Commission results in suspension of the human biomonitoring values (HBM I and HBM II) for lead in blood of children and adults. International Journal of Hygiene and Environmental Health 2010; 213: World Health Organisation. Childhood lead poisoning. Geneva, Switzerland: WHO Document Production Services Yeoh, B., et al., Household interventions for preventing domestic lead exposure in children. Cochrane Database of Systematic Reviews. 2012,