Childhood lead poisoning: The promise and abandonment of primary prevention

In 1991, the Public Health Service published the Strategic Plan for the Eli mination of Childhood Lead Poisoning. This document marked a fundamental sh ift in federal policy from finding and treating lead-poisoned children to a uthentic primary prevention. It spelled out a 15-year strategy to achieve t his goal and provided a cost benefit analysis showing that the monetized be nefits far exceeded the costs of abatement. A strong national effort to eli minate the disease developed. Now, 7 years after publication of the plan, p rimary prevention of lead exposure has been abandoned. This article examines the role of some prevailing attitudes and institution s in derailing the effort. Some institutions-the lead industry, real estate interests, and insurance interests-behaved as anticipated. Others, includi ng private pediatricians, the American Academy of Pediatrics, some federal agencies, and a public interest group ostensibly dedicated to eliminating l ead poisoning, also played an unexpected part in derailing the plan.