The problem began in the early twentieth century when a spate of lead-poisoning cases in children occurred across the United States. The symptoms—vomiting, convulsions, bleeding gums, palsied limbs, and muscle pain so severe “as not to permit of the weight of bed-clothing,” as one doctor described it—were recognizable at once because they resembled the symptoms of factory workers poisoned in the course of enameling bathtubs or preparing paint and gasoline additives. One Dupont factory was even nicknamed “the House of the Butterflies” because so many workers had hallucinations of insects flying around. Many victims had to be taken away in straitjackets; some died.
By the 1920s, it was known that one common cause of childhood lead poisoning was the consumption of lead paint chips. Lead paint was popular in American homes because its brightness appealed to the national passion for hygiene and modernism, but the chips taste sweet, and it could be difficult to keep small children away from them. Because of its well-known dangers, many other countries banned interior lead paint during the 1920s and 1930s, including Belgium, France, Austria, Tunisia, Greece, Czechoslovakia, Poland, Sweden, Spain, and Yugoslavia.
In 1922, the League of Nations proposed a worldwide lead paint ban, but at the time, the US was the largest lead producer in the world, and consumed 170,000 tons of white lead paint each year. The Lead Industries Association had grown into a powerful political force, and the pro-business, America-first Harding administration vetoed the ban. Products containing lead continued to be marketed to American families well into the 1970s, and by midcentury lead was everywhere: in plumbing and lighting fixtures, painted toys and cribs, the foil on candy wrappers, and even cake decorations. Because most cars ran on leaded gasoline, its concentration in the air was also increasing, especially in cities.
Lead paint was the most insidious danger of all because it can cause brain damage even if it isn’t peeling. Lead dust drifts off walls, year after year, even if you paint over it. It’s also almost impossible to get rid of. Removal of lead paint with electric sanders and torches creates clouds of dust that may rain down on the floor for months afterward, and many children have been poisoned during the process of lead paint removal itself. Even cleaning lead-painted walls with a rag can create enough dust to poison a child. Gut renovating the entire house solves the problem, but this too may contaminate the air around the house for months.
Only in the early 1950s did companies start removing lead from most domestic products. But lead house paint remained in use until the congressional ban in the late 1970s, and it’s still on the walls of some 30 million American homes today.
Minuscule amounts of lead can poison a child. The signs of severe lead poisoning—convulsions, pain, coma, etc.—are typically seen when the concentration of blood lead exceeds sixty micrograms per deciliter (a tenth of a liter) of blood. This corresponds to the ingestion of a total amount of lead weighing about the same as six grains of table salt. According to the Centers for Disease Control, parents should be concerned if their children’s blood lead concentration exceeds five micrograms per deciliter, but studies have found that even infinitesimally low levels—down to one or two micrograms per deciliter—can reduce a child’s IQ and impair her self-control and ability to organize thoughts.
There is no way of knowing how many children were harmed over the past century by America’s decision not to ban lead from consumer products early on, but the number is somewhere in the millions. The most accurate national survey of lead poisoning was probably the 1976–1980 National Health and Nutrition Examination Survey, which found that 4 percent of all children under six—roughly 780,000—had blood lead concentrations exceeding thirty micrograms per deciliter, which was then thought to be the limit of safety.
Black children, the survey found, were six times more likely to have elevated lead than whites. The number of children with lead levels over five micrograms per deciliter—or for that matter over one or two—was obviously much higher, but there’s no way of knowing how high it was. The 1985 leaded gasoline ban and the gradual renovation of slum housing have since reduced the number of poisoned children, so that today, the CDC estimates that some 500,000 children who are between one and five years old have lead levels over five micrograms per deciliter.
As the scale and horror of the lead paint problem came to light, the lead companies played down the bad news. When popular magazines like Ladies’ Home Journal began publicizing the dangers of lead poisoning in the 1930s and 1940s, lead and paint manufacturers placed cartoons in National Geographic and The Saturday Evening Post celebrating the joy that lead paint brought into children’s lives. Advertisements for Dutch Boy paint—which contained enough lead in one coat of a two-by-two-inch square to kill a child—depicted their tow-headed mascot painting toys with Father Christmas smiling over his shoulder.
Rather than banning lead from consumer products, government-sponsored public health campaigns characterized lead poisoning as a behavioral problem of the poor that they called “Pica”—a disorder in which people consume inedible substances—and advised parents to control their children. The lead companies also paid scientists who produced flawed studies casting doubt on the link between lead exposure and child health problems. When University of Pittsburgh professor Herbert Needleman first showed that even children with relatively modest lead levels tended to have lower intelligence and more behavioral problems than their lead-free peers, some of these industry-backed researchers claimed that his methods were sloppy and accused him of scientific misconduct (he has since been exonerated).
The companies also hired a public relations firm to influence stories in The Wall Street Journal and other conservative news outlets, which characterized Needleman as part of a leftist plot to increase government spending on housing and other social programs. So, just as the tobacco industry deliberately obfuscated the dangers of cigarettes until skyrocketing smoking-related Medicaid costs finally led state governments to sue the companies,12 and just as oil company–backed scientists now downplay the dangers of greenhouse gases, the lead industry also lied to Americans for decades, and the government did nothing to stop it.
During the 1980s, government officials finally agreed that the lead paint crisis was real, but they were conflicted about how to deal with it. In 1990, the Department of Health and Human Services developed a plan to remove lead from the nation’s homes over fifteen years at a cost of $33 billion—a large sum, but half the estimated cost of doing nothing, which would incur a greater need for special education programs, Medicaid and welfare payments for brain-damaged and disabled lead-poisoning victims, and other expenses. But the plan was opposed by the lead industry, realtors, landlords, insurance companies, and even some private pediatricians who objected to the extra bother of screening children. The plan was soon shelved, and instead, the EPA, looking for a cheaper way around the problem, commissioned the Baltimore toddler study.
Since then, the US government has spent less than $2 billion on lead abatement. This money has supported a number of exemplary state and nonprofit programs that work in inner cities, but it’s a tiny fraction of what’s needed, and about twenty times less than US spending on the global AIDS crisis since 2004 alone. It’s worth asking why both Republican and Democratic administrations appear to have cared so little about this threat to America’s children.
Many people think the administration of public health programs is a bureaucratic business, like running a railroad or corporation. Researchers are supposed to identify programs to reduce hazards and governments are supposed to spend money on them. But as Markowitz and Rosner remind us, public health is inseparable from politics, and as history shows, governments are often reluctant to protect their populations without either activist pressure or the threat of social unrest.
It’s hard to imagine the squalor of eighteenth-century European cities. Just walking through certain Parisian neigh-borhoods in the 1780s could cause throat ulcers. By then, according to public health historian George Rosen, advances in science, medicine, and sta- tistics had created the basic under- standings and methods of public health, but they were being implemented only on a private, desultory basis. National programs, run by states, would have to await the political impulses of the French Revolution and the early nineteenth century. After the Revolution, Napoleon made public health a priority. He commissioned sewers, attempted to clean up the water supply, created more sanitary slaughterhouses and markets, and implemented the first government-funded, universal smallpox inoculation campaign.
Across the Channel, this lesson was not lost on the English. The sanitary reforms that commenced in London during the 1830s and 1840s were similarly motivated by fears that cholera epidemics and other diseases were not only reducing the productivity of workers, but also fostering revolutionary ideas. In the US, both activist pressure and fears of incipient unrest have accelerated some of our most important government public health programs, from the Progressive era when reformers pressured the government to ban child labor, improve working conditions in factories, reduce infant mortality, and create legal standards for food safety, sanitation, and housing; to the 1960s when the Sierra Club and other environmental groups put pressure on the government to impose regulations on pesticides and reduce air pollution, and underground networks of doctors and lawyers joined with the women’s movement to pressure the government to legalize abortion. In the 1980s gay groups like Act Up pressured the otherwise indifferent Reagan administration to invest in AIDS treatment programs.
Lead-poisoning prevention once had its partisans too, but they were marginal and rapidly stifled. During the 1960s, the Black Panthers and the Puerto Rican activist group the Young Lords set up community health clinics and carried out screening programs for tuberculosis and sickle cell anemia as well as lead poisoning. The historian Alondra Nelson’s excellent Body and Soul: The Black Panther Party and the Fight Against Medical Discrimination (2011) describes how these groups maintained that new civil rights laws and Great Society programs alone would never meet the needs of the poor unless the poor themselves had a voice in shaping them.13 The Panthers espoused violence and called for a separate black country. They certainly weren’t right about everything, but when it came to lead poisoning, they probably were.
By the early 1980s, the movements to achieve social justice led by Martin Luther King Jr., Malcolm X, and the Black Panthers had largely subsided, and with them, grassroots advocacy for the health of poor black children. Some scientists continued to raise the alarm about lead poisoning, including Herbert Needleman, Jane Lin-Fu of the US Children’s Bureau, Philip Landrigan of Mount Sinai Hospital in New York, and Ellen Silbergeld, the editor of the journal Environmental Research, but they lacked a strong social movement to take up their findings and fight for children at risk. Although there were some desultory campaigns against lead poisoning, neither the powerful women’s health movement nor environmental groups took up the issue in a sustained manner. The Obama administration has invested no more in this problem than George W. Bush’s did. Lead poisoning isn’t even on the CDC’s priority list of “winnable public health battles.”
Faced with a government aiming to spend as little as possible on a public health catastrophe, Chisolm and Farfel may well have felt they had no choice but to try to figure out how many corners they could cut. However, it’s also possible to imagine that these researchers might have worked with poor communities to use their research findings more creatively. They might have tried to mobilize public opinion in support of the original fifteen-year $33 billion lead removal plan. They could have tried to work with black politicians, religious leaders, civil rights groups, and parents’ organizations. If lead poisoning had been seen as a problem affecting middle-class children, this might well have happened. Instead, as Markowitz and Rosner put it, Chisolm and Farfel’s response was to “do another study.”
The Lead Menace April 4, 2013