Lead: background information
Published 8 October 2024
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The need for guidance
Lead is a common toxic metal with no safe level. It has had widespread and extensive uses in the UK both currently and historically, as well as occurring naturally in mineralised parts of the country. It is a totally preventable poison.
Lead exposure can have serious consequences for the health of both adults and children. At high levels of exposure lead affects the brain and central nervous system, causing coma, convulsions and even death. At lower concentrations with no obvious symptoms, children may be left with intellectual disability and behavioural disorders. In particular, lead can affect children’s brain development, resulting in reduced intelligence quotient (IQ), behavioural changes such as reduced attention span and increased antisocial behaviour, and reduced educational attainment.
Global effects
The World Health Organization (WHO) (1) identifies that lead causes 901,716 deaths per year worldwide (based on 2019 data) with 21,676,385 total disability-adjusted life years (DALYs), based on cardiovascular diseases (CVD) (4.6%); chronic kidney diseases (CKD) (3.0%); and idiopathic intellectual disability (IID) (30%).
Work done by the World Bank in 2023 (2) based on a study of 84 countries, concluded that for high-income countries that 6% of children had blood lead levels above 5µg/dL, and for every 1µg/dL there was a drop in 2 IQ points, equating to a lifetime drop in earnings of 2% per IQ point. In exposed children who became adults, CVD deaths cost high-income countries 3.8% GDP and cases were 44.8 people per 100,000 per year.
Lead exposure
When lead and items containing lead are processed, worked, used or scrapped, they can create lead dust, fume or vapour. The lead is absorbed via:
- inhalation as lead dust, fume or vapour
- ingestion from dust if you eat, drink, smoke, or bite your nails without washing your hands and face
Flaking paint, paint chips and powdered paint are major sources of lead exposure in young children. Other domestic sources of exposure include food, drinking water, traditional medicines and cooking pots and utensils brought back from other countries outside the EU.
More detailed information on sources of exposure can be found in Lead: information for the public.
Detection and intervention
In 2021, 121 cases of lead exposure in children in England were notified to the UK Health Security Agency (UKHSA) (3), with an average detection rate for England between 2015 and 2021 of 7 cases per million children aged 0 to 15 years, although there was large regional variation. In 2022, the number of cases rose to 191 (4). Cases were typically 1 to 4 years of age, male, and resident in more deprived areas, although the regional variation may be due to clinical awareness.
As lead exposure commonly causes few visible or non-specific symptoms the surveillance of clinically reported cases is unlikely to identify all affected children. International population surveys, which more accurately estimate the number of children exposed to lead, suggest an expected incidence of cases of paediatric lead exposure higher than detected through the Lead Exposure in Children Surveillance System (LEICSS).
References
1. World Health Organization (WHO). The public health impact of chemicals: knowns and unknowns: data addendum for 2019 2021
2. Larsen B, Sanchez-Triana E. Global health burden and cost of lead exposure in children and adults: a health impact and economic modelling analysis. Lancet Planet Health 2023: volume 7, e831-40