|LEAD Action News vol
11 no 1, September 2010, ISSN 1324-6011
Incorporating Lead Aware Times (ISSN 1440-4966) & Lead Advisory Service News (ISSN 1440-0561)
The journal of The LEAD (Lead Education and Abatement Design) Group Inc.
Editor: Anne Roberts
From Susy Retnowati, to the Editor, 5th August 2010.
(Susy Retnowati was born and raised in Indonesia and then worked for The LEAD Group in the late 1990s. Susy was asked to make pre-publication comments on Suherni’s Lead Poisoning in Indonesia in English and Indonesian Keracunan Timbal di Indonesia.
It's an honour to have my name mentioned in Suherni’s report. Thank you.
It would be interesting to know what categories of schools were chosen to have blood lead levels tested. Indonesia has 4 different categories of school: government schools, national schools, national plus and international schools.
National plus and international schools are more for those in a higher socio-economic class. The children are not exposed to contact with sources of lead at home. They have everything done for them, in clean conditions. They have a better and higher standard of living.
If the surveys were done at this higher socio-economic level, then generally, the results should have been lower blood lead levels.
About the recycled plastics industry
I have observed many syringes and other hospital wastes not being recycled or disposed of safely. It is common practice in Indonesia and has been shown on TV - where kids grow up on waste land, playing and working at the same, collecting plastics or other materials that are re-sellable for money. It is sold to a "middle man", who then sells all the plastic (which contains blood and other biological chemicals) to be made into plastic recycled materials. The recycling industry can be anything from a home-based industry up to an industrial level.
The same is true of shoe-making - it could be home-based up to industrial level.
Other possible sources of lead contamination are Batik - Indonesia traditional clothes and arts.
These use a colouring agent, and the expensive ones, gold colour. All are sewn or woven and dyed by hand. Batik Prada - it would be interesting to research this area. The colouring tools are made of bronze, heated with fire / candle-light.
The following link will show you the process of making batik: www.youtube.com/watch?v=2XdjebgIL5k
The crematorium / morgues don't have proper chimneys or waste dump facilities. The ashes just got thrown into the local river or the sea. This happens even next to fishing villages where dry salted fish is produced. It's unbelievable, but that’s the reality.
So far, I’ve been talking mainly about the island of East Java. The highest lead contamination would probably be in Papua, Irian Jaya - where the gold mines are, and Kalimantan Island - where other mining industries are.
Fairly recently – in 2006 - a mud eruption began (Lumpur Sidoarjo - Lusi) on East Java. It's still erupting today. Several villages have been destroyed and all the trees died. See http://en.wikipedia.org/wiki/Sidoarjo_mud_flow – this mud flow along with volcanic ash may be a possible source of lead poisoning.
That's all for now... I hope this adds more value to Suherni’s research.
All the best,
From Professor A.J. McMichael, to Elizabeth O’Brien, September 2010, in response to an e-mail from Elizabeth O’Brien, following a Sydney Morning Herald story on Professor McMichael and climate change (The man with our future in his hands, September 11-12, 2010). Date: September 16, 2010.
A.J. McMichael is at the National Centre for Epidemiology & Population
It's good to see the important work you are continuing to do, which I am aware dates back several decades…
You will be aware of the lead that has accumulated in the polar ice sheets over the past two, industrialising, centuries. That lead will be mostly in the superficial ice layers. Will it be re-mobilised into sea-water as ice sheets slowly melt? Your association might like to follow that question up.
(Ed’s note: Elizabeth O’Brien of The LEAD Group, and other members of the National Health and Medical Research Council (NHMRC) Lead Working Committee, had been asked for information on any work being done internationally to revise the positions on acceptable blood lead levels in other countries, in order to update the NHMRC Information Paper and Public Statement on blood lead levels.)
From: Elizabeth O’Brien
To: other Members of the former Lead Working Committee of the National Health and Medical Research Council (NHMRC)
Date Sent: August 30, 2010
Dear Members of the NHMRC Lead Working Committee,
I believe Canada is looking at a very low blood lead goal for children but for me what's most important that I do have more detail on, is that I was advised that the most enlightened and useful approach has been happening in Germany for some years, when I attended the World Health Organisation meeting on lead in Geneva in May of this year.
Also, a 2009 US cost benefit analysis "The Social Costs of Childhood Lead Exposure in the Post-Lead Regulation Era" by Peter Muennig [abstract at http://archpedi.ama-assn.org/cgi/content/abstract/163/9/844] had the following results:
"Reducing blood lead levels to less than 1 µg/dL among all US children between birth and age 6 years would reduce crime and increase on-time high school graduation rates later in life. The net societal benefits arising from these improvements in high school graduation rates and reductions in crime would amount to $50000 (SD, $14000) per child annually at a discount rate of 3%. This would result in overall savings of approximately $1.2 trillion (SD, $341 billion) and produce an additional 4.8 million QALYs (SD, 2 million QALYs) for US society as a whole." These results would seem to justify a large investment in reduction of blood lead levels at least among children in Australia too, and previous cost benefit analyses, certainly justify expenditure on bringing down the blood lead levels of adults and older children as well. See for instance: "The Benefits and Costs of the Clean Air Act, 1970 to 1990" at www.epa.gov/oar/sect812/1970-1990/contsetc.pdf and "Economic Analysis for the Renovation, Repair, and Painting Program Proposed Rule" at www.epa.gov/oppt/economics/pubs/lrrpnprmea.pdf - both by US EPA.
In Germany, they have a continuous improvement towards zero blood lead level policy approach. Every so often, a national blood lead survey is done to determine the current blood lead levels in the particular sub-populations of men and women (18 to 69 years) and children (3 to14 years of age). When the results are analysed, the 95th percentile (that is, the blood lead level that 95% of the population is already below) is then set as the new goal for the entire sub-population. As of 2009 for instance, the new goals were set at:
Each of these levels is world’s best policy national goal blood lead level for that sub-population as far as I am aware.
By comparison, Port Pirie already has a target of 95% of children under 5 yrs being below 10 µg/dL by the end of 2010 but this target was chosen on the basis of health effects, not on the basis of the 95th percentile found in this sub-population. The Port Pirie target-setting process differs significantly from the German approach in that, in Port Pirie, the Health Department appears to not be particularly looking after the interests of the 5% of the child population with the highest blood lead levels (although these should come down with lowered emissions from the smelter), whereas the Germans are, specifically, focussing on the 5% of all ages (except, strangely, 15-17 year olds and under 3 yr olds and over 70 yr olds) who have the highest blood lead levels.
If Australia were to move to continuous lowering of blood lead targets for all ages, based on regular surveys, and action plans to achieve the new targets, we would be complying with the Donovan (1996) recommendation [Ref: page 71 of "Lead in Australian Children"] that:
"Targets should be set only where public health action is planned or under consideration. Also, when there is no threshold or 'safe' level, it is not enough to set a target that everyone should have blood lead concentration below a specified level. If Australia requires targets in future, then because all lead exposure should be minimised, there should be targets for those with low exposure as well as high."
We would also be complying with the World Health Organisation (WHO) (circa 2003 or 2004 undated factsheet) "Issue Brief Series: Lead" at www.who.int/heca/infomaterials/lead.pdf recommendation: "Setting and reducing targets (e.g., below 10 µg/dL) for child blood lead levels, as well as recording and tracking these levels provides an excellent means of assessing progress on reducing child lead exposure and helping countries to identify key sources of lead pollution."
My proposal to this group and to the NHMRC is that Australia could have the world's best policy on blood lead by combining these ideas of targets and goals for the 95th percentile of a sub-group or a geographically located sub-group, and could improve on the German method by increasing the frequency of resetting the target (ie the frequency of blood lead surveys), as appropriate to the sub-group or the geographic location eg 6-monthly or annually as currently occurs in Broken Hill and Port Pirie. The German approach could be further improved by adding in the kind of recommended action for communities and individuals that was recommended by the NHMRC in 1993, but at lower blood lead levels, again relating to the 95th percentile.
Also, the same goal-setting, target-setting and action-level setting methodology should apply to each of the different lead-exposure jobs, because the body lead stores of lead workers eventually become a public health problem (when they retire from working or move to non-lead work), and because Donovan (1996, page 71) recommended:
"The existing [1993 NHMRC blood lead] targets recognise the particular problems of occupational exposure, and allow them as an exception to the general target. At least in respect of children, there could be benefit from setting additional targets in relation to individual occupational and hobby sources of lead where exposure can be modified."
Thus my proposal to the NHMRC consists of the following points:
3. blood lead surveys should involve over-sampling of the most at-risk sub-populations (including lead workers): children living in older housing, people under-going renovations on housing built pre 1970, people dependent on rainwater for drinking water, lead mining and smelting community residents, smokers, passive smokers, alcoholics, people taking Ayurvedic medicines or Chinese herbal medicines; people suffering from hypertension, Alzheimers disease, osteoporosis, learning difficulties, pica, criminal or aggressive behaviour; hobbyists such as backyard automotive-repairers, panel-beaters, renovators, jewellery-makers, fishing sinker or ammunition casters, ceramicists, artist painters, etc, and indigenous populations within all these sub-populations.
4. once the 95th percentile blood lead level has been determined for each sub-population, any obvious regulatory changes or free-food programs to improve nutrition in certain sub-populations should be immediately introduced but also, the new targets for all these sub-populations, along with information on lead health risks and how to prevent further exposure, should be widely advertised especially to medical and public health professionals (especially those working in indigenous health or aged-care) and anti-smoking campaigners, as well as to members of the public who are applying for work in lead industries or lead mining or smelting communities, people considering purchasing or renting or renovating pre-1970 housing or housing in lead mining or smelting communities, people importing their own Ayurvedic medicines, smokers etc - the priority being all the sub-populations with the highest blood lead targets.
5.all blood lead test results should become notifiable (not just those above 10 µg/dL or 15 µg/dL) and target-setting needs to be followed with blood lead action levels for secondary prevention of lead poisoning eg, if an individual exceeds the target blood lead level for their sub-population, they are given a free home-lead assessment and/or advice on how to lower their blood lead level or their child's blood lead level;
That's as far as I'd like to go without getting some feedback on this line of thinking from other members of the Lead Working Committee, but I would also like to propose that Professor Mark Taylor be invited by the NHMRC to join the Lead Working Committee because he has recently done an enormous amount of collation of information on lead in Australia and his research could better-inform the Committee's work. A recent publication [Ref: www.ncbi.nlm.nih.gov/pubmed/20598069] co-authored by Professor Taylor and another member of our Lead Working Committee, Professor Alison Jones, stated that "Gould (2009) demonstrated that for every (US) dollar spent on controlling lead hazards, some $17–$221 is returned to society."
It should be kept in mind that my proposal has the huge advantage not only of following recommendations from Donovan and WHO, but also of completely eradicating the need to have endless arguments and counter-arguments about the health impacts of low blood lead levels. Further, it would place Australia at the forefront of lead poisoning prevention policy globally, a position we should never have allowed ourselves to slide from, since we were the first nation to publish in a medical journal, detailed information on childhood lead poisoning, on 20th October 1897. Wouldn't it be great if on the 113th anniversary of that publication (International Lead Poisoning Awareness Day 20th October 2010), the NHMRC were to announce a blood lead survey for all ages n Australia?
I look forward to all your comments.
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