to just under 400. Despite the increasing evidence of lead’s destructive environmental effects, during the 1960s and the 1970s lead production increased substantially. In 1964, the United States consumed 1,202 short tons of lead. By 1974, this had grown by about 25 percent, to 1,550 short tons.67
Patterson was not alone in taking on Kehoe’s paradigm. In 1966 Harriet Hardy, one of the nation’s preeminent occupational health physicians, condemned the lead industry’s threshold idea of harm based on adult lead workers; she argued it was inadequate as a means of protecting high-risk populations outside of the workplace. As coauthor, with Alice Hamilton, of the main textbook in occupational medicine, she argued that certain vulnerable populations—particularly children and pregnant women—might suffer the effects of lead at much lower levels of exposure than male workers did. Hardy also delineated the inadequacies in earlier definitions of lead poisoning, arguing that lead poisoning produced a host of subtle and difficult-to-define symptoms (such as fevers, lethargy, and joint pain), but no less damaging for that, which could easily escape the notice of physicians. “It is necessary to emphasize,” she wrote, “that no harmful effect of lead is unique [to that poison] except perhaps the motor palsy of the most-used muscle group, as in the wrist drop.”68
Hardy believed that the developing child was most at risk. Randolph Byers and Elizabeth Lord’s research in Boston on long-term effects of acute lead poisoning, along with clinical observations by doctors such as L. Emmett Holt, John Ruddock, Charles McKhann, and Edward Vogt, supported Hardy’s opinion that lead was more toxic to the young than to the adult population.69 In contrast to Kehoe, who used adult males in his studies and in his model of classic lead poisoning, Hardy recognized that a much wider net had to be cast to understand the full range of lead’s effects: “Prevention of diagnosable Pb poisoning in healthy male workers is important but not enough in our society.” Lead was a known toxin, and there was “no available evidence that lead is useful to the body,” particularly for women and children.70
In the coming years, the policy model that Patterson first proposed—that lead, a known toxin, should not be widely introduced into the human environment, and that Hardy expanded to specifically include women and children—would be embraced by those who pushed for the removal of lead from gasoline, and, hence, from the atmosphere.71 This was an early statement of what, generalized, would become known as the “precautionary principle”—the basic idea behind public health, that, when considering the use of new or suspect chemicals, it is prudent to prove them safe rather than waiting to see if they are harmful to people or the environment. Hardy quoted Bradford Hill, the eminent English epidemiologist who, with Sir Richard Doll, demonstrated the relationship between cigarette smoking and lung cancer: “All scientific work is incomplete. . . . 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.”72
SOCIAL ACTION AND LEAD POISONING
Until the mid-1960s, lead poisoning—whether from lead paint, lead in gasoline, or lead in the factory—had remained, beyond the victims themselves, largely an issue for clinicians and researchers in a few major medical centers around the country, a small group of public health professionals, and an industry intent on protecting its market. But this changed as the civil rights movement galvanized the African American community and forced middle-class white Americans to acknowledge the extent of endemic poverty and racism. Michael Harrington’s 1962 book, The Other America, and the civil rights–era sit-ins, Freedom Rides, voter-registration campaigns, and school-desegregation drives all made poverty and racial discrimination headlines in daily newspapers across the country.
As the War on Poverty took shape in the years following John F. Kennedy’s assassination, the links between poverty, housing, and racism in the nation’s cities became increasingly apparent to many Americans. Lead poisoning—particularly from peeling paint in slum housing—became a signature disease of poverty. In New York City, the number of children identified as lead poisoned, now defined as 60 or more micrograms of lead per deciliter of blood shot up from 20 in 1952 to 509 by 1965; in Philadelphia, from 2 in 1952 to 163 in 1965; in Chicago, from 33 in 1953 to 304 by 1966. This was not because more children were affected but because more public health authorities and doctors were now conscious of lead poisoning’s existence and its array of symptoms.73
FIGURES 3A.Children at risk, 1960s. During the War on Poverty, peeling and chipping paint became a symbol of urban blight and social inequality. Community activists and housing reformers were critical in pressing for improved conditions. Source: (a) Chicago Tribune, February 3, 1966, reprinted with permission;
FIGURES 3B.Continued_(b) New York City Housing Authority, Wagner Archives, reprinted with permission.
Community groups such as the Young Lords in New York (a largely Latino organization), the Citizen’s Committee to End Lead Poisoning in Chicago, the Black Panthers in Boston and Oakland, and the Harlem Park Neighborhood Council in West Baltimore, as well as others around the country, seized on this devastating disease, seeing it as a representation of the ills of a culture rather than as a product of nature. These groups began agitating for more testing of children, better enforcement of existing housing laws, poisoning surveillance and prevention programs by departments of health, and new laws to hold landlords accountable for lead hazards.74 Sometimes, the lead tragedy actually led to civil disobedience, as it did in New York City in 1970 when the Young Lords seized unused mobile testing vans and began door-to-door screening for lead poisoning while others staged sit-ins at the Department of Health.75 In 1969, Jack Newfield, an influential writer for the Village Voice, picked up the story and wrote a series of articles about lead poisoned children who had suffered irreversible brain damage, thereby putting enormous pressure on the city to strengthen housing codes against flaking and peeling paint.76
Community activism played an important role in bringing attention to lead poisoning and reducing its impact on poor communities, as Mark Farfel wrote in 1985, a few years before he would codirect the Kennedy Krieger Institute study: the “Great Society programs, including Medicaid, urban renewal projects, and food stamp and food supplement programs,” led to the identification and amelioration of lead poisoning in subtle ways that were “difficult to quantify.” Building on the public health model of an earlier time, in which social reform was viewed as essential to effective public health efforts, Farfel noted that “improved nutrition, access to medical care and new housing” were critically important in reducing risk to children. “Even the civil rights movement may have reduced risk for toxicity among blacks by opening some doors to better housing.”77
Indeed, public health activists embraced numerous social causes in the mid-1960s and mid-1970s, building on the older tradition of allying with community organizations and consumer groups to effect changes in the delivery of services and health care. In New York City, the Health Policy Advisory Committee (Health PAC) gave young professionals both in and out of government a means of linking movements to combat poverty, poor housing, lead poisoning, racism, and other social ills to health and their professional identities. For at least a decade, Health PAC and other health professional organizations and other groups in the American Public Health Association—such as the Medical Committee for Human Rights, Physicians Forum, and Physicians for Social Responsibility—helped to build community health centers in poor neighborhoods in northern cities and southern rural communities, achieved a partial atomic test ban to reduce strontium 90 and other radioactive exposures, developed programs to improve housing condition in poor communities around the country, and pressured governments to organize services for the poor on Indian reservations
