Pure Earth is pleased to announce the launch of a new program, Mitigating Lead Exposure in Low- and Middle-Income Countries (LMICs), operating in seven countries across Asia, Africa, and Latin America, including Ghana, Peru, Colombia, India, Indonesia, the Philippines, and Egypt.
The program, begun in Q4 of 2024, includes establishing long-term, effective lead mitigation strategies through health surveillance, supply chain mapping, regulatory guidance, and collaboration with governments and other stakeholders.
The scope includes the identification and reduction of lead in cookware and cosmetics in Ghana, Peru, and Colombia; reduction of lead contamination in spices and cookware in India; reforming unsafe ULAB recycling practices in Indonesia; and integrating lead exposure detection and treatment into national health systems through blood lead level (BLL) surveillance and source assessments in the Philippines and Egypt.
Support for this effort comes from a major grant by the recently formed Lead Exposure Action Fund (LEAF). LEAF is a collaborative fund managed by Open Philanthropy which was developed to address the issue of lead poisoning by distributing grants to support measurement, mitigation, and mainstreaming awareness of the problem.
See further country details below:
Colombia and Peru: Addressing Lead Contamination in Cookware
In Peru and Colombia, project efforts will focus on reducing lead exposure from lead-contaminated cookware.
Pure Earth’s global screening of more than 5,000 samples of consumer products sold in markets in 25 countries documented that 45% of ceramic cookware samples and 52% of metallic cookware samples were contaminated with high levels of lead. The Andean Region contains the highest estimated mean BLLs in Latin America (6 μg/dL in Peru) and some of the highest prevalence of lead-contaminated metallic cookware in the RMS (Peru 69% of samples tested, Colombia 40%). For ceramics, the prevalence of lead-contaminated items was Colombia (50% of samples tested), and Peru (42%).
In Latin America, ceramic cookware is used for cooking, food preparation, and service, presenting a high risk that lead will leach into food. Regulatory frameworks in the region are inadequate or, in many cases, ignored. Furthermore, governments do not have the capacity to assess and monitor manufacturers, supply chains, and distributors, critical for adequate enforcement of any new or existing regulations and policies.
What:
- Assess how much metal and ceramic cookware in Peru and Colombia exceeds national safety limits (if any).
- Identify cookware that surpasses a reasonable safety threshold and recommend regulatory limits.
How:
-Map key stakeholders and cookware producers in Peru and Colombia.
-Test the lead (Pb) levels of ceramic and metal cookware.-
-Report findings and recommendations.
Egypt: Health Surveillance and Source Analysis
According to IHME, Egypt has one of highest estimated average childhood blood lead levels (BLLs), between 6.92 and 8.42 μg/dL. In Egypt, Pure Earth is working with CEOSS on reducing lead exposure through health surveillance and exposure source analysis.
Data will be generated through BLL screening and home-based assessments, which will provide the government of Egypt and key stakeholders an understanding of the prevalence, severity, and sources of lead exposure. This will guide the mitigation strategy and next steps for the government and other involved parties.
What:
-Plan and conduct a BLL survey
-Analyze BLL data to understand the prevalence, severity, and distribution of high BLLs
-Offer counseling to families of children with high BLLs
-Advise the government on effective strategies to reduce exposure
-Publish a research paper on the BLL survey and home-based assessment findings
How:
-Train relevant government authorities and academic institutions on source-assessment methods
-Assess products and environmental media in households with a focus on children with high BLLs identified through testing
-Assist government authorities in analyzing results and developing policies, programs, or communications campaigns to address key exposure sources
Ghana: Regulating Lead-Contaminated Cookware and Cosmetics
In Ghana, the project will reduce lead exposure from lead-contaminated cookware and cosmetics through regulatory changes.
Pure Earth has increased its work in Ghana on lead exposure issues since establishing a national Toxic Sites Identification Program in 2010. In 2020, Pure Earth established a physical office in Ghana and expanded its activities significantly. Since 2020, Pure Earth, UNICEF, the Ghana Health Service, and Ghana EPA have collaborated on activities that include a large-scale blood lead level (BLL) survey (3227 participants, but not nationally representative).
In a recent nationwide BLL survey Pure Earth and Ghana Health Service conducted in 3 regions of Ghana, the region of Northern Ghana had the highest prevalence of lead poisoning. Lead-contaminated eyeliner, locally known as “chilo,” was identified through follow-up home-based assessments as a potentially important contributor to exposure. In Northern Ghana, chilo use was nearly universal and highly correlated with elevated BLLs. Among the most contaminated cosmetics sampled in Ghana, we found many were eyeliner products imported from and manufactured in South Asia.
What:
-Increase understanding of the link between lead-contaminated cookware and cosmetics and lead poisoning through home-based source assessments
-Research supply chains, regulatory landscape, and market dynamics of cookware and cosmetics in Ghana
How:
-Conduct a market screening, supply chain analysis, and regulatory assessment for cookware and cosmetics
-Design a research protocol for a randomized control trial
-Establish a research program for cookware and cosmetics that addresses Northern Ghana
Results from these activities will inform subsequent regulatory and policy reforms.
India (Bihar, Uttar Pradesh, Jharkhand, Tamil Nadu): Addressing Lead in Spices and Cookware
In India, the program aims to reduce lead exposure from lead-contaminated cookware and spices.
Reduce Lead in Spices in Bihar, Uttar Pradesh, and Jharkhand
According to IHME estimates, Bihar is the Indian State with the highest average blood lead level (10.42 ug/dL), followed by Uttar Pradesh (8.67 ug/dL), and Jharkhand (8.15 ug/dL).
Pure Earth and Stanford University have been conducting supply chain analyses and spice adulteration testing since 2020, revealing high concentrations of lead in spices throughout Northern India, including commercial hubs in the states of Bihar, Jharkhand, and Uttar Pradesh. In May 2023, Pure Earth carried out a Rapid Market Screening project in three cities of Uttar Pradesh, showing that 70% of spice samples had elevated levels of lead. Compelling evidence suggests that lead chromate is introduced to turmeric roots by wholesale traders at central markets, and subsequently distributed.
What:
-Reduce spice adulteration in northern India in Bihar, Uttar Pradesh and Jharkhand
– Assist governments in setting safety standards for spices, assess and monitor supply chains, and build monitoring and enforcement capacities to reduce spice adulteration.
How:
-Establish intergovernmental panels in each state
-Conduct research on the regulatory landscape and a spice supply chain analysis
-Create trainings for authorities, inspectors, producers, and sellers, plus consumer education and national and state-level advocacy
Addressing Lead-Contaminated Cookware in Tamil Nadu
As a result of this project, the state government and key stakeholders will have the information needed to launch an initiative to reduce lead levels in cookware, which could include a research program, monitoring, or policy development, even if not a formal regulation.
Pure Earth began working in Tamil Nadu in 2018, to pilot the state’s first cleanup of a lead-contaminated site – a community located next to a licensed, sub-standard, polluting ULAB operation. In 2023, Pure Earth India and local partners assessed 30 lead-contaminated hotspots and selected two cities to conduct home-based assessments as a research activity supported by local entrepreneurs, not a State-owned initiative. Of the 120 children surveyed 85% had BLLs above 5µg/dl. Unlike Bihar, the soil and spice lead levels were not measuring high. However, 57% of cookware and 47% of lead dust samples had high lead levels.
What:
-Reduce lead exposure from metal cookware in India by assessing how, when, where, and why lead enters cookware
-Work with regulators and producers to develop lead-free solutions.
How:
-Share findings from the recent lead-contaminated cookware study with key stakeholders in Tamil Nadu
-Analyze the supply chain and sharing study results at the state level
-Conduct home-based assessments across 7 districts in Tamil Nadu
-Share results from blood lead surveillance and home assessments with stakeholders statewide
Indonesia: Improve Used Lead-Acid Battery Recycling Practices
In Indonesia, the project is focused on reducing lead exposure by reducing the number of used lead-acid batteries (ULABs) that are recycled in environmentally unsound facilities. Informal recycling operations can release lead into the environment, endangering workers and surrounding communities.
Pure Earth began working in Indonesia in 2004, identifying more than 170 toxic sites, with lead being the most prevalent pollutant followed by mercury. According to IHME, 45 million Indonesian children (63%) under the age of 14 had BLLs above 5 ug/dl, and the average BLL is 6.4 ug/dl.
While most low- and middle-income countries have some form of regulation that dictates acceptable practices in such operations, these laws and policies are often insufficient and loosely enforced. However, best practices for national ULAB management systems do exist. Pure Earth has authored or contributed to many manuals and guidance documents, including UNEP’s A Guidance Manual for Policymakers and Regulators for the Environmentally Sound Management of Waste or Used Lead Acid Batteries in Africa, the World Economic Forum white paper Consequences of a Mobile Future: Creating an Environmentally Conscious Life Cycle for Lead-Acid Batteries, the soon-to-be-released updated version of the Basel Convention Technical Guidelines on the Environmentally-Sound Recycling of Waste Lead Acid batteries.
What:
– Reduce the number of used lead-acid batteries (ULABs) that are recycled in environmentally unsound facilities
-Develop regulatory guidance for sub-national government agencies and battery producers/recyclers
How:
-Conduct ULAB ecosystem stakeholders mapping and supply chain analysis
-Review hazardous waste management regulations and requirements for the ULAB sector
-Produce recommendations and policy briefs for key stakeholders
-Raise awareness in affected communities
Philippines: Integrating Lead Detection Into National and Local Health Systems
In the Philippines, the project is focused on reducing lead exposure through institutionalizing lead detection, referral, and management into the national and/or local health system.
Pure Earth Philippines has been working alongside the government to implement blood lead level surveys in the country since 2021, when Pure Earth worked with the government to include testing for lead in their National Nutrition Survey, which takes place every three years. Based on the results of the 2021 lead poisoning survey, which tested 3000 children and pregnant women across 25 areas of the Philippines, it is estimated that around one million children ages 6-9 years have elevated blood lead levels. In September 2024, in partnership with Pure Earth Philippines, Valenzuela City launched its first Blood Lead Level (BLL) screening program, focusing on children with disabilities. This was the first city-led BLL screening and first screening for a particular sector, children with disabilities, in the Philippines. Policies developed, training conducted, protocols established and implemented, data gathered and lessons learned from pilots like Valenzuela City are hoped to strengthen Pure Earth Philippines’ continuing efforts in institutionalizing lead monitoring and surveillance in the country.
What:
Kickstart lead monitoring and management within national and local health systems.
How:
-Make blood lead level (BLL) testing a standard part of national food and nutrition surveys
-Set up routine screening for lead poisoning in high-risk areas and vulnerable groups, like children with disabilities
-Create clear referral and treatment protocols for lead poisoning in specialized centers
-Build a national database to track sources of lead exposure
