A Heavy Metal Crisis In India: Lead Exposure In Children Is A Silent Epidemic, Though Preventable

Lead toxicity poses a significant public health crisis in India, especially among children under 18. India bears a disproportionate burden with millions of children having elevated blood lead levels.

WHO considers a blood lead level of 5 µg/dL to be the actionable threshold where preventive action is required.

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Ambrish Kumar Chandan & Yatin Pimple

Lead toxicity is a pressing public health crisis with profound, long-lasting effects on children’s physical and cognitive development. Young children, due to their biological vulnerability and frequent exposure, bear a disproportionate share of this burden. India, a young country having nearly a quarter of the population under the age of 18, is at heightened risk. The scale of the problem is overwhelming, with millions of children displaying elevated blood lead levels, which correlates directly with challenges in learning capacity, behavioral health, and overall productivity. 

While there is no “safe” blood lead level, the World Health Organization considers 5 µg/dL to be the actionable threshold where preventive action is required. The Institute of Health Metrics and Evaluation estimates that over 275 million children in India have blood lead levels exceeding 5 µg/dL, necessitating action to prevent further exposure. Alarmingly, 64.3 million children have blood lead levels exceeding 10 µg/dL, which is deeply concerning. 

The 2022 report by NITI Aayog and the Council of Scientific and Industrial Research analysed data from 36 Indian studies conducted between 1970 and 2014. It highlighted that in 23 states, the average blood lead levels (BLL) exceeded 5 μg/dL. Additionally, the average BLL for children under 2 years old in India was 4.9 μg/dL, more than 8 times that of the average level of 0.6 μg/dL in the United States. 

In Bihar, a state-representative study in 2023 tested children under five years of age and found that 90 percent of the children had blood lead levels above 5 µg/dL. This statistic represents a public health crisis with irreversible consequences for millions of children across India. There is a pressing need to build on policy actions to mitigate childhood lead exposure. However, it's promising to see the growing commitment within governments at the national and state levels to prevent lead exposure in India. 

Lead Toxicity Is A Silent But Pervasive Threat

Understanding the sources and effects of lead exposure is essential to grasp the gravity of this public health crisis. This toxic metal is prevalent in various household items like paint, toys, cookware, jewellery, packaged food, spices, traditional medicines, and cosmetics. Exposure can also occur during industrial activities like recycling lead-acid batteries, mining, and manufacturing lead-containing products. Contamination can permeate the environment, entering the human body through ingestion of contaminated soil, water, or food, or through the inhalation of lead-laden air or dust.

Young children exhibit increased susceptibility to lead poisoning due to their increased gastrointestinal absorption rates compared to adults, combined with the ongoing development of their central nervous systems. This vulnerability is aggravated due to their oral exploratory behaviors, such as frequently placing hands, toys, or other objects in their mouths, significantly increase their risk of ingesting lead-contaminated dust or paint particles. Additionally, lead exposure also poses serious risks for pregnant women, as lead readily crosses the placental barrier, potentially impairing fetal organ development and leading to adverse neurodevelopmental outcomes. 

Even at low levels, lead can cause irreversible damage to a child's brain, resulting in a reduced intelligence quotient (IQ), learning disabilities, attention disorders, hyperactivity, and aggressive behaviour. A study published in The Lancet noted that in 2019 alone, children under five in low- and middle-income countries lost 729 million IQ points due to lead exposure. In India, IQ loss due to childhood lead poisoning resulted in an annual economic loss of nearly 3.3 percent of its 2019 GDP, or 94 million USD. The impact extends beyond individual children, affecting entire communities with long-term socioeconomic consequences as a generation is unable to reach its full potential. 

Policy Imperative To Mitigate Childhood Lead Exposure

While awareness of the harms of lead exposure is increasing among government officials, health systems, and parents, more action is needed. To build on current efforts and protect our children from lead exposure, it is essential to implement data-driven and targeted policy interventions through a multi-stakeholder approach. Such an approach should include government agencies, the health system, specific at-risk communities, and the general public. 

An important first step towards creating evidence-based policy interventions is strengthening surveillance systems that help understand the local burden of lead exposure and identify major sources and pathways of exposure in India. Globally, countries like the United States have made significant progress in reducing lead exposure through biomonitoring and screening, which led to data-driven interventions. The US Centre for Disease Control's Lead Poisoning Prevention Program is a notable example, which uses geographic information systems to map lead exposure hotspots and direct preventive actions where they are most needed.

Countries like Georgia and Mexico have also implemented successful national surveys to collect local data on blood lead concentrations that help understand the severity of the problem. Governments in countries like Colombia, Peru, Indonesia, Kyrgyzstan, and, India also partners with NGOs and Not for profits to strengthen health systems that can measure childhood lead exposure. 

Health systems need to be strengthened through periodic capacity-building and training exercises, and they must be equipped with resources to disseminate crucial information on preventive measures against lead exposure. Clinicians and health professionals should be trained so that they can identify, manage, and treat lead poisoning cases, particularly among vulnerable populations like children and pregnant women.

Additionally, it is vital to build awareness among government agencies, businesses, and NGOs to create comprehensive actionable frameworks to reduce childhood lead poisoning. To effectively combat lead exposure, awareness campaigns targeting at-risk communities, such as low-income households, pregnant women, and families with young children, must be prioritized. Public awareness campaigns supported by government agencies can play a pivotal role in preventing childhood lead poisoning and safeguarding the future of India's children.

In this regard, it is heartening to see the Government of India make significant strides in public health initiatives to prevent heavy metal toxicity. These include convening stakeholders in March 2024, mapping laboratories that can support heavy metal testing in bio-specimens and forming a Technical Working Group to develop and finalize a National Biomonitoring Programme on Chemical Toxicants to address heavy metal toxicity, particularly lead poisoning, under the leadership of the National Centre for Disease Control. As data describing the scale and scope of lead exposures, use, and sources improves, it will be important to integrate these findings into a common platform to highlight areas in the country that require the most rapid and intensive attention. 

Ambrish Kumar Chandan and Yatin Pimple are Technical Advisors, Environmental Health Surveillance, Environmental Health, at Vital Strategies.

[Disclaimer: The information provided in the article, including treatment suggestions shared by doctors, is intended for general informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.]