would continue to plague policy makers and advocates alike for decades.
Lin-Fu’s pamphlet and her subsequent work on lead poisoning became the basis for the first statement on the subject by the surgeon general of the Public Health Service, Jesse L. Steinfeld. Lin-Fu remembers, “When we finally finished the draft of the guidelines [in the fall of 1970 for childhood lead-poisoning programs] and sent them downtown [to the Department of Health, Education and Welfare secretary’s office], the surgeon general was on duty that weekend, responsible for signing important papers for the DHEW secretary’s office. He signed the paper and saw the significance of the draft, and it became the [basis for the] surgeon general’s policy statement.”11 In November 1970, Steinfeld announced “guidelines for a nationwide campaign against lead poisoning” because “as many as 400,000 children” were estimated to have blood lead levels above 40 micrograms per deciliter—in 1970, a shocking number of children.12 At the time, children were considered poisoned if their blood lead levels were over 60 µg/dl. This was the level at which many children, though not all, showed classic acute symptoms of lead poisoning—convulsions, coma, permanent neurological damage, and even death. According to the New York Times, Steinfeld recommended screening programs for “all children under six years of age living in old and poorly maintained houses.”13
The surgeon general’s policy statement was important, Lin-Fu recalls, “because a new concept of lead poisoning was contained in the document—that of ‘undue lead absorption,’ which was [seen as] an intermediate problem that preceded clinical symptoms. The document challenged the old concept and definition of lead poisoning—those with overt symptoms of profound neurological damage—and introduced the concept of finding children at the phase of undue lead absorption, defined at blood lead levels of 40 µg/dl and over.”14
The federal government’s acknowledgment that “undue” lead absorption was a danger to children was an important breakthrough. But it was not achieved without a struggle. The ad hoc committee that drew up the DHEW guidelines for lead poisoning, in case impending legislation became a reality, had included Jane Lin-Fu and other DHEW staff along with outside experts, including Julian Chisolm. “Chisolm opposed me [Lin-Fu] on this, as did the chairman of the committee. . . . He and Chisolm thought that I was being too aggressive and impractical to implement screening and follow-up, as New York City was finding 45 percent of its sampling above 40 micrograms.” The chair challenged Lin-Fu: “How are you going to tell local public health officials that they have a lead problem in half of their kids?” And she answered: “That’s their problem. Our job in the government is to tell them the scientific facts, the truth.”15 It was Chisolm who had originally written a paper stating that the upper limit of “normal” blood lead should be 40 µg/dl, she pointed out.16 “When he refused to back up his own statement at the meeting, she recalls, “I knew that DHEW’s committee would not let me say [in the draft guidelines] that the upper level of normal should be 40.”17
As a compromise, Lin-Fu drafted a statement proposing that in cities with overwhelming lead-poisoning problems priority should be given to children whose blood lead levels were more than 60 µg/dl, followed by those with levels between 40 and 60, and then those with levels less than 40. Children of one to three years should be given priority over those of three to six years, and so forth. At the next meeting, Lin-Fu spread copies of the document around the table and said, “This is what I propose.” Chisolm said, “If we include this statement on priority, then dropping to 40 µg/dl in the statement is OK.” But the chair angrily said it was too radical: “I am leaving the government in three months and I don’t really care what happens with this document. If you insist on the 40 µg criteria, after that statement is released, and when all the letters start coming in to the secretary’s office, you will have to deal with this and answer those letters.” “I will,” Lin-Fu said without hesitation. “Deal,” the chairman said, and the final draft included Lin-Fu’s triage concept of dealing with lead poisoning and dropped the upper limit of what was considered the “normal” blood lead level from 60 to 40 µg/dl, with children having levels above 40 considered at risk from undue lead absorption.18
While Lin-Fu was fighting within the federal bureaucracy to convey a better understanding of and more action on low-level lead poisoning, a few senators and representatives were also trying to address the emerging lead-poisoning epidemic. Responding to pressure from community organizations in New York, Boston, and around the country and from local public health officials, Congressman William Ryan (D-NY) and Senator Ted Kennedy (D-MA) cosponsored bills in 1969 and 1970 to authorize $30 million in federal grants to combat lead poisoning. The Ryan-Kennedy Bill was passed on December 31, 1970, and signed into law as the Lead-Based Paint Poisoning Prevention Act by President Nixon in mid-January 1971. The act was composed of three parts: the first “empowered HEW [the Department of Health, Education and Welfare] to prohibit the use of ‘lead-based paint’ [paint with more than 1 percent lead pigment] in federally constructed or rehabilitated housing” but left unregulated the private housing stock; the second authorized the Department of Health, Education and Welfare “to make grants to cities establishing lead-abatement programs and . . . to establish screening and treatment programs”; and the third authorized the Department of Housing and Urban Development “to survey the scope of the lead-paint hazard and establish methods for abatement.”19 More broadly, the law set in motion surveillance of the lead problem nationally.20 Thus, as early as 1970, lead paint abatement was considered essential to any attempt to deal with the lead problem. But it quickly became clear that the funds to address true removal would not be forthcoming anytime soon, fulfilling the prophesy of the Lead Industries Association that lead pollution would plague the country for the indeterminate future.
The administration and Congress initially refused to appropriate or even request the funds to implement lead-abatement or poisoning-prevention programs that were authorized by the Ryan-Kennedy Bill. As reporter Jack Newfield wrote in June 1971, six months after the law was passed, even though the appropriations bill for that fiscal year “included funds for every special interest: $3.5 million for dairy and beekeeper indemnity; . . . [and] $15 million for highway beautification . . . [there was] not one cent for lead poisoning.21 The New York Times reported that as the cities “waited . . . the politics of embarrassment began. . . . The Administration asked for $2 million, which was raised to $5 million in the House and $15 million in the Senate, before the $7.5 million was agreed on in conference.” Later that year, on August 14, 1971, Congress finally appropriated the agreed-upon amount.22
In its account of the politics of appropriations for lead poisoning, the Times identified a fundamental conflict embodied in the act and in lead-poisoning prevention programs in general: Should “prevention” measures apply only to children who were already poisoned? Or should abatement of lead-infested houses take place before children were damaged? This raised a fundamental question that would plague lead specialists and, the public health profession and society more broadly: Were children in effect their own “canaries in the mine”? As the Times put it, “what constitutes prevention . . . remains unsolved among public health practitioners. The few lead poisoning programs currently in operation around the country all look for children with high levels of lead in their blood and then clean up the environment that poisoned them.” The newspaper noted that many in public health wanted a true prevention program, “a systematic clean-up of housing known to contain lead before children can ingest the paint.” In the end, such a systematic program of detoxifying the housing stock might be slow, but it would be “more useful and less costly.” The New York City Health Department had found that “93 percent of 2600 reported cases [of lead poisoning] last year could be traced to housing”; but in New York, as in Chicago, Baltimore, and other cities, “repair is only authorized in the dwelling unit in which the child has been poisoned even though other apartments in the same building may be equally hazardous.”23
Meanwhile, the magnitude of the problem was becoming increasingly apparent as damage was found to be occurring to children at lesser levels of contamination
