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Running head: LEGISLATIVE IMPACT 1

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LEGISLATIVE IMPACT

Legislative Impact to Mitigate Lead Content in Drinking Water

National University

Legislative Impact to Mitigate Lead Content in Drinking Water

Recent controversies regarding toxic levels of lead in drinking water have emerged out of Flint, Michigan and hit the national airways; however, this is not a new topic. Lead has been dubbed as a “’close-to-home’ contaminant” (Renner, 2010) as well as a “pervasive environmental contaminant” (Brown & Margolis, 2012). Although drinking water goes through a treatment system, lead can perfuse through the drinking water system, ironically, through altered “water chemistry, destabilizing lead-bearing mineral scales that coat service lines and corroding lead solder, pipes, faucets, and fixtures” (Renner, 2010). Lead is an extremely poisonous toxin and can remain in the body for long periods of time (National Institute of Health [NIH], 2015). The Centers for Disease Control and Prevention (CDC, 2016) has emphasized that there are no safe blood lead levels (BLLs) in children and its mission is to meet the goals of Healthy People 2020 to eradicate, not only BLLs of 10mcg/dL or greater, but also disproportion of BLLs stemming from racial and socioeconomic status (SES) (CDC, 2016).

History

Lead exposure and poisoning are not new issues. The Romans acknowledged its harmful effects. The Romans associated lead poisoning to one of their deities, Saturn, “’the ghoulish titan’ who devoured his own young” and regarded the affected individuals with lead poisoning as “saturnine” (Lewis, 1985). The word “saturnine” described the health outcome of lead poisoning: gloomy, cynical, and taciturn (Lewis, 1985). The danger of lead in drinking water system was also taken notice in 1793 by the Duke of Würrtemberg, Germany and by 1878, due to negative health effects of lead, he outlawed the use of lead pipes in the water system (Brown & Margolis, 2012). In the United States, the harmful effects of lead pipes in drinking water systems were recognized in 1845 (Brown & Margolis, 2012).

In 1978, there were 13.5 million children ages 1 through 5 who had BLLs of greater than or equal to 10mcg/dL (Brown & Margolis, 2012). With regards to racial disparity of BLLs, between 1970-1980, approximately 12% of black children had BLLs of 30mcg/dL or greater comparing to 2% of white children (Brown & Margolis, 2012). Additionally, children of lower socioeconomic status were at an increased risk of having BLLs of 30mcg/dL or greater (Brown & Margolis, 2012). In 2007-2008, 36% of children of non-Hispanic black heritage from low-income families were found to have higher BLLs at 1.9mcg/dL comparing to their white counterparts at 1.4mcg/dL (Brown & Margolis, 2012). Moreover, Brown & Margolis (2012) found that, although prevalence of BLLs of 10mcg/dL or greater may not be as significant in children age six years or younger, the risk exposure disparity continues and remains as a public health concern.

The NIH (2015) reported lead to have significant effects on behavior or attention, absenteeism, kidney damage, reduced IQ, comprised physical development, headaches, irritability, reduced sensations, and more. The CDC tracks the prevalence of lead poisoning in children six years of age or less. In a 2014 data, there were a total of 3,557 children six years old or younger in the state of California alone who have confirmed blood lead levels (BLLs) of at least 10mcg/dL; however, the data acquired from California has a limitation; incomplete report due to funding issues, therefore, the total of children affect in 2014 could be higher than reported (CDC, 2016). Nationally, in 2014, there were 105,966 children age six years or younger who have at least BLLs of 10mcg/dL (CDC, 2016).

Hicken, Gragg & Hu (2011), found there are greater number of black Americans with blood lead levels than their white counterparts; 23% with BLLs of greater than 20mcg/dL comparing to 14% of whites with the same BLLs, respectively. Prevalence of lead exposure have also been found to be higher in the environment where racial minorities occupy (Hicken, Gragg & Hu, 2011). Research indicated that lead in the body are associated with increased blood pressure in minorities, specifically in black communities (Hicken, Gragg & Hu, 2011). Blacks with hypertension have an increase in their systolic blood pressure by one millimeter of mercury (mmHg) when BLLs double regardless of age, tobacco dependence, and body mass index (Hicken, Gragg & Hu, 2011). Emerging data have shown causal relationship between lead exposure and increase in blood pressure and hypertension, which is a noteworthy finding due to the fact that hypertension has a direct relationship with a high mortality disease, the cardiovascular disease (Hicken, Gragg & Hu, 2011). The harmful effects and burden of lead on health of black Americans may be exacerbated by sociocultural influence and is also reflected in annual healthcare cost of $2.8 billion (Hicken, Gragg & Hu, 2011). The CDC (2012) also found that prevalence of lead exposure was especially higher in newly immigrated, pregnant women in 1999-2002. The CDC stated that in 2003 pregnant women who were born outside of the United States were found to have BoLLs of 5mcg/dL or greater (Brown & Margolis, 2012).

Financial Burden of Lead Poisoning

According to the CDC (2016), children who sustain from serious level of lead poisoning will require an annual cost of $5,600 in medical and special education. Brown & Margolis (2012) estimated that $110-$300 million in earnings would be saved when children born after 1976 were not exposed to lead and approximately $17-$220 is saved when $1 is spent in lead-reduction methods. In another study of causal effect of cognitive impairment and BLLs of 10mcg/dL or greater in boys and girls at age 5, Attina and Trasande (2013) found that the approximately $1,413,313 for a boy and $1,156,157 lifetime earning for a girl would be lost due to lead poisoning. An estimated global economic earning of $2.45 trillion per year would be saved if BLLs decrease around the world (Attina & Trasande, 2013). The U.S. have estimated that $50.9 billion have been lost to lead-related health outcomes (Attina & Trasande, 2013).

Legislation

Several legislations have been created to mitigate lead levels in water supply. The Safe Drinking Water Act (SDWA) was developed in 1974 and the U.S. Environmental Protection Agency (EPA) initial determination of safe maximum contaminant level goals (MCLGs) of lead was zero, which was an evidence-based value at the time and continues to be as there is no safe level of lead exposure (EPA, 2016). In 1991, the Lead and Copper Rule (LCR) was water treatment technique then created under the cognizance of the SDWA to bolster regulation of treatment and control corrosion of lead in water systems (EPA, 2016). The LCR is a requirement that samples of tap water be collected and assessed for lead content, which no more than 10% of collected samples should have 15 parts per billion of lead content (EPA, 2016). If the samples collected were to exceed the maximum allowed, then more steps, such as supplemented corrosion control treatment, public education, and water system service lines replacement are required (EPA, 2016). The EPA had also mandated community water systems to provide an annual report of water quality to the consumers: the Consumer Confidence Report or CCR (EPA, 2016). Additionally, the EPA created the Public Notification Rule, which require all public water supplier to notify their consumers when issues arise regarding their drinking water (EPA, 2016). In 2010, legislation H.R. 5289, the Get the Lead Out Act, authored by Representative Anna Eshoo (D-Palo Alto), was passed and reduced the SDWA maximum allowable lead content of 8% down to an average of 0.25% on wetted surface that make contact with drinking water (California's 18th Congressional District, 2010).

Impact

The CDC (2012) reported BLLs have significantly decreased in 1999-2004 by 10mcg/dL or greater specifically in children ages one to five regardless of race and SES due to federal, state, and local policies. The CDC and their state level programs have aided in significantly reducing the number of children with BLLs of 1mcg/dL or greater by 3 million in 2008-2010, which translates to $26-57 billion in lifetime productivity earnings saved; however, figures do not reflect cost of lifetime productivity lost for children affected by behavioral effects, attention-deficit/hyperactivity disorder, criminal behavior, and need for special education (CDC, 2013). In 2009, the CDC became the technical support to state and local government as they developed lead screening tools and abatement laws, which increased the number of states from 3 to 27 with active lead abatement laws (CDC, 2013). Since the implementation of the LCR in 1991, lead content in drinking water has significantly reduced; however, many water system service lines are not fortified with optimized corrosion control, which remain as a harmful health cause for children and pregnant women (Brown & Margolis, 2012).

Conclusion

As the CDC have pointed out, lead is a pervasive contaminant in our lives. Lead poisoning has been shown to affect children in not only the United States, but the lead-attributed health outcomes is at a global level. The cost of financial burden is $43 billion per year, but cost savings of $17-$220 can also be achieved for every $1 spent on lead mitigation measures (World Health Organization, 2010). The creation of legislations, laws, and regulations at all governmental levels have reduced the maximum allowable lead levels in drinking water to an average of 0.25% of wetted surfaces that make contact with drinking water where the maximum allowable level was at 8% (California's 18th Congressional District, 2010). Children, especially those who are six years old or younger, pregnant women, and minorities and low-income populations are at greater risk of lead exposure and have higher lifetime BLLs (Brown & Margolis, 2012). The CDC still maintains and emphasizes that there is no safe amount of BLLs for children (Brown & Margolis, 2012). Current efforts are reducing the BLLs and, although, many remain at high risk for lead exposure and contamination, there is data suggesting that prevalence is diminishing. The goal of the CDC and Healthy People 2020 is to completely eradicate lead exposure and contamination from the entire population, thus continued efforts by federal, state, and local government must continue.

Reference

Attina, T. M., & Trasande, L. (2013). Economic costs of childhood lead exposure in low-and middle-income countries. Environmental Health Perspectives, 121(9), 1-6.

Brown, M. J., & Margolis, S. (2012, August 10). Lead in drinking water and human blood lead levels in the United States. Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/mmwr/preview/mmwrhtml/su6104a1.htm

California's 18th Congressional District. (2010, May 19). Legislation eliminates lead in drinking waer. Washington, D.C.: House Subcommittee on Energy and Environment.

Centers for Disease Control and Prevention. (2013, February 4). CDC's healthy homes/lead poisoning prevention program. Retrieved from National Center for Environmental Health: http://www.cdc.gov/nceh/information/healthy_homes_lead.htm

Centers for Disease Control and Prevention. (2016, January 29). Lead. Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/nceh/lead/default.htm

Hicken, M., Gragg, R., & Hu, H. (2011). How cumulative risks warrant a shift in our approach to racial health disparities: The case of lead, stress, and hypertension. Health Affairs, 30(10), 1895-1900.

Lewis, J. (1985, May 1). Lead poisoning: A historical perspective. Retrieved from United States Environmental Protection Agency: https://www.epa.gov/aboutepa/lead-poisoning-historical-perspective

National Institute of Health. (2015, January 13). MedlinePlus. Retrieved from U.S. National Library of Medicine: https://www.nlm.nih.gov/medlineplus/ency/article/002473.htm

Renner, R. (2010). Exposure on tap: Drinking water as an overlooked source of lead. Environmental Health Perspectives, 118(2), A68-A74. Retrieved from U.S. Environmental Protection Agency.

United States Environmental Protection Agency. (2016, March 17). Basic information about lead in drinking water. Retrieved from EPA United Staes Environmental Protection Agency: https://www.epa.gov/your-drinking-water/basic-information-about-lead-drinking-water