Opinion Indu Bhushan and Soumya Swaminathan write: India’s hidden adversary, lead poisoning

The harmful effects of lead on health have been known for about a century. Initially, major sources of lead exposure were gasoline, water-pipes, and paints. Governments worldwide have taken robust actions to ensure that these are lead-free, resulting in positive outcomes. For instance, in the United States, the removal of lead from gasoline led to a reduction of more than 90 per cent in mean blood lead concentration from 1976 to 1995.

Despite being a recognised global concern, lead poisoning in India remains unaddressed. A lot of the country’s housing stock and public buildings are coated with paints containing dangerous levels of lead, which deteriorate with time and release toxic dust particles into the air. Old water-pipes are not lead-free. People are exposed to lead through lead solder in food cans, ayurvedic medicines, and toys.

Moreover, several occupations involve working with lead, and workers often bring contaminated dust home on their clothes and bodies, inadvertently exposing their families. One of the most concerning sources of lead exposure is the unsound recycling of used lead-acid batteries, found in millions of vehicles. Despite strict regulations, weak implementation results in over half of the used batteries ending up in the informal economy, where unregulated recycling operations further contaminate surrounding neighbourhoods. Other occupational sources of lead exposure include lead mining, smelting, welding, soldering, and automobile repairing. However, amid these challenges lies hope. Well-implemented interventions to reduce lead exposure have demonstrated their effectiveness.

For example, in Bangladesh, turmeric adulteration with lead chromate pigment was identified as a primary source of lead exposure. Multifaceted interventions, including strong regulations, rapid detection of lead contamination, and consumer education, were launched between 2017 and 2021 to reduce lead-tainted turmeric. A study found that the proportion of market turmeric samples containing detectable lead decreased from 47 per cent pre-intervention in 2019 to zero per cent in 2021. Blood lead levels dropped a median of 30 per cent in the affected population 16 months after the intervention. This is an exemplary intervention that can be replicated in our country.
To achieve success in combating lead poisoning, we need a systematic approach that encompasses the following pillars:

First, we need a robust legislative and policy framework that clearly defines health and safety standards for manufacturing and recycling of lead-acid batteries, e-waste and other consumer products that contain lead. We need to strictly enforce the legally binding standards on paints and water pipes. We should also have strong laws against informal recycling and use of lead containing waste, strictly prohibit child labour in e-waste picking or metals mining, and restrict access to toxic sites.

Second, we need to build a strong monitoring and reporting system for lead poisoning. We need to build capacity for blood lead level testing and introduce blood lead level monitoring in household surveys. A country-wide effort must be launched to identify lead-contaminated sites.

Third, a multi-pronged approach involving regulatory reforms and strict enforcement is essential. The government must prioritise the clean-up of contaminated sites, especially those located near schools and residential areas. Additionally, sustainable waste management practices and electronic waste recycling programmes must be established. As the responsibility for exposure prevention lies across several ministries and departments, an effective coordination mechanism will be required. Collaboration between government agencies, non-governmental organisations, and international technical partners is crucial.

Finally, we need well-targeted public awareness programmes. Campaigns should focus on the dangers and sources of lead exposure with direct appeals to parents and caregivers, schools, youth associations, community leaders and healthcare workers. Educating workers and owners of lead-related industries, particularly battery and electronic waste recyclers will be critical.

With strong government leadership, financial resources, innovation, and collaboration between private industry, the public sector, and non-governmental organisations, we can control lead contamination of daily-use products, eliminate unsafe lead recycling and smelting, clean up contaminated sites, and manage the safety of drinking water. The return on such investment is enormous: Improved health, increased productivity, higher IQs, reduced violence, and a brighter future for our children.

Children are the living messages we send to a time we will not see. Let us ensure they carry with them the strength, health, and hope to shape a better India.

Bhushan was the founding CEO of Ayushman Bharat and Swaminathan was the Chief Scientist at the World Health Organisation