them into the marketplace or the environment, that we as a society should err on the side of safety rather than await possible harm. By adopting this approach, public health would reestablish prevention as its primary creed. Others insist that a renewed focus on corporate power, economic inequality, low-income housing options, racism, and other social forces that shape health outcomes is most needed to counter the antiregulatory regime of early twenty-first-century America. These ideas, or a more unified alternative, however, have yet to galvanize the field or the broader public, at least in the United States.
In this book we look at the shifting politics of lead over the past half century and the implications for the future of public health and emerging controversies over the effects of other toxins. The developing science of lead’s effects, the attempts of industry to belittle that science, the struggles over lead regulation, and the court battles of lead’s victims have taken place against the backdrop of a changing disease environment and, in more recent decades, an emerging conservative political culture, both in the broader society and in the public health profession.
Researchers have shown over the last five decades that the effects of lead, at ever-lower exposures tested, represent a continuing threat to children, a tragedy of huge dimensions. In the coming decades, without substantial political and social change, we will be placing millions more children at risk of life-altering damage. This research, combined with declining public will and resources to remove lead from children’s environment, has left the public health community and society at large with a difficult dilemma, not unlike that which Julian Chisolm and his young colleague Mark Farfel faced: Should we insist on the complete removal of lead from the nation’s walls, through some combination of full abatement and new housing, and therefore a permanent solution to this century-old scourge? Or should we search for a “practical” way to reduce the exposure of children to “an acceptable” level?
If we choose the former, the danger is that, without strong popular and political advocacy and a public health profession rededicated to the effort, nothing will be done—complete abatement may well be judged too costly, and we may encounter an ugly unwillingness to address a problem that primarily affects poor children, many of them from ethnic and racial minority groups. If we choose the latter, and if the dominant political forces give at best only grudging support to this ameliorative effort, the danger is that the children of entire communities will continue to be exposed, albeit at gradually declining levels, to the subtle and life-altering effects of lead. Public health as an institution, in trying to define what an “acceptable” level is, could lose in the process its moral authority and its century-long commitment to prevention, yet with no viable coherent intellectual alternative. This is a conundrum that affects us all, for we console ourselves with partial victories, often framed as progress in the form of harm reduction rather than prevention. We have become willing to settle for half measures, especially when what is at issue is the health of others, not of oneself. Isn’t this, so to speak, the plague on all our houses? In this sense, we are all complicit in the “experiment” that allows certain classes of people to be subjected to possible harm in the expectation of avoiding it ourselves.
2From Personal Tragedy to Public Health Crisis
All scientific work is liable to be upset or modified by advancing knowledge. That does not confer upon us a freedom to ignore the knowledge we already have, or to postpone the action that it appears to demand at a given time.
BRADFORD HILL, 1965
By the mid-1950s the cat was out of the bag. Any doubt that lead exposure could permanently damage children was put to rest as researchers at Harvard documented continuing mental and neurological disorders among those ostensibly “cured” of acute lead poisoning, which was most often diagnosed after children showed a variety of symptoms, such as convulsions, muscle paralysis, “mental lethargy,” vomiting on eating solid food, and dizziness. For generations it was well recognized that workers in lead-based industries suffered severe neurological damage from lead poisoning, and by early in the twentieth century women and children were often barred from working in the areas of pigment and paint factories where lead was used. Beginning in the early twentieth century recognition grew that children outside the factory were also at risk because of contact with lead paint in their homes. As the nation’s cities grew exponentially following the Civil War, so too did the danger from lead paint that was used in and on the new houses.
By the 1920s physicians were remarking on the fact that children “lived in a lead world,” and by the 1940s a huge literature had emerged that detailed the horrifying effects of this metal on children. But for both children and adults prior to the 1940s, the assumption had been that if the overt symptoms of lead poisoning passed, there would be no residual effects. During World War II, the two Harvard researchers—Randolph Byers and Elizabeth Lord, a pediatrician and psychologist, respectively, at Boston’s Children’s Hospital—documented the long-term effects of acute lead poisoning even after a child had ostensibly “recovered.” From a group of 128 patients ranging in age from about ten months to four years who had been admitted with acute symptoms of lead poisoning over the span of a decade, the researchers followed twenty children who still lived in the Boston area. All but one of the children who had returned home with no clinical symptoms of cerebral damage still suffered in “both the intellectual and emotional spheres” in school over the course of the study. These children’s motor coordination was abnormal and their general intelligence appeared to have been permanently affected. A few of the children suffered “recurrent convulsions.” One child at the end of first grade had “not learned to write or print his name or recognize any figure.” Another six-year-old was described as “cruel, unreliable [with] impulsive behavior; runaway; unable to get on with other children or adults; excluded from school because of behavior.”1 In the decades since, researchers and clinicians have documented the huge numbers of children at risk, now with the understanding that lead causes permanent damage.
As the seriousness of this epidemic became increasingly apparent in the 1950s, public health officials in Baltimore, New York, Chicago, Cincinnati, Boston, and other large cities began to follow the scientific and medical literature on the effects of lead paint poisoning. Many cities passed ordinances that required warnings on containers and restrictions on the sale of lead paints for use on walls, woodwork, and other surfaces accessible to children. But their actions were piecemeal and uncoordinated.
Historically, health departments in the United States were local operations whose administrators rarely harmonized responses with each other, even in the face of the most dire public health threats. In the case of childhood lead poisoning, very few city administrators as late as the 1950s were even aware of the national scope of the problem, much less how colleagues in other communities were coping with it. While some of the larger cities began to establish registers to document the extent of the problem within their jurisdiction, there was no central source for information outside of the Lead Industries Association (LIA), the trade association of the lead industry. Nor did public health officials generally remember the controversy that arose about the potential hazards from lead when it was introduced into gasoline in the 1920s.
Since its creation in 1928, the LIA had downplayed health concerns for fear that they might undermine business, but that had not stopped the organization from tracking reported cases in the medical literature of death and disease among children exposed to lead paint. In the 1950s the LIA bragged that it possessed the most extensive archive of newspaper articles, reports, and general information on this toxic metal.2 Though the U.S. Public Health Service (PHS) was nominally responsible for addressing the health effects of toxic metals, at the time this agency was largely focused on the problems of infectious epidemic diseases and their threat to the nation as a whole. The modern federal institutions that potentially might coordinate a national effort to inform local agencies of toxic threats and to coordinate remedial action were just being born. The U.S. Department of Health Education and Welfare, the predecessor to the current U.S. Department of Health and Human Services, which today oversees the PHS and the National Institutes of Health, was only established by Congress in 1954.
In
