Lead In Our Environment is a Major Cause of Global Health Inequity
I believe we need a global treaty, like the Framework Convention on Tobacco Control (FCTC), to ensure that basic health is a right that every citizen enjoys, no matter where they live and no matter how poor or rich their families might be. There are vast health inequities that separate various countries and various communities within countries. It is for this reason that several of us from around the globe have come together in a call for the governments around the world to agree to a Framework Convention on Global Health (FCGH).
Science and medicine is frustratingly known for its “good news, bad news” stories on a daily basis, as a recent Kristin Anderson Moore blog reveals. She referred to data in America that show a significant decline in teen birth rate from 55.6 births per 1,000 females ages 15-19 in 1975 to 24.2 in 2014. There was also a decline in overall youth violence (in spite of an upsurge in the 1990s). For example, rate of serious violent crime among juveniles ages 12-17 declined from almost 40 per 100,000 in the early 1980s to 7.6 in 2015 and the homicide rate among youth ages 18-24 fell substantially.
There are scientific studies that link these significant declines in teen pregnancies and in youth violence to the reduction of lead toxicity in American communities. This is the good news. The bad news? Lead continues to be a serious environmental risk factor for health. Indeed, lead exposure is another inequity that people face around the world. Children and women of reproductive age in certain parts of the world are more exposed to lead than their counterparts in other parts of the world.
Lead is a toxic, deadly chemical, causing serious illnesses and accounting for far too many deaths around the world. It is one of the major causes of cognitive deficits in children everywhere. We have known this for many decades and many countries have laws and regulations that restrict the use of lead. Yet after many decades since its deadly consequences became known, lead continues to be a persistent environmental hazard. One of the major sources of lead poisoning is our transport system. For example lead gasoline is still in use in many countries around the world.
There are many frightening reasons why the WHO lists lead as 1 of 10 chemicals of major public health concern, needing action by Member States to protect the health of workers, children and women of reproductive age. The Institute for Health Metrics and Evaluation (IHME) reported that, based on 2015 data, lead exposure accounted for 494,550 deaths and loss of 9.3 million disability-adjusted life years (DALYs) due to long-term effects on health. The highest burden is in low- and middle-income countries. IHME also estimated that lead exposure accounted for 12.4% of the global burden of idiopathic developmental intellectual disability, 2.5% of the global burden of ischaemic heart disease and 2.4% of the global burden of stroke.
In fact, the physical, chemical and biological environment, as this lead story reveals, plays a critical role in determining health of individuals and populations. An estimated 12.6M deaths each year are attributable to unhealthy environments – nearly one in four of total global deaths. Environmental risk factors, such as air, water and soil pollution, chemical exposures, climate change and ultraviolet radiation, contribute to more than 100 diseases and injuries. It is estimated that of the factors that affect the life expectancy and health quality of an individual, environmental factors contribute 10%, as much of an impact as our genes. It is not just the extent and the quality of healthcare and genetics that influence health – the environment, socio-economic and behavior are also potent health determinants.
Inequalities in health often reflect the differences in circumstances such as income, housing conditions, education levels and the overall deprivation of the area people live in. Similarly, improvement in these often interlinked factors can have a significant impact on health and well-being adding not only years to life but life to years. This lead story is a good example of how the environment is critical to how long and how well we live.
World leaders agreed when they signed on to the SDGs in 2015 and made the environment a major part of the agreement. Recently, the EU Commission launched the Exposome Project to look at how the totality of environmental exposures – including diet, lifestyle, occupational and environmental factors – from conception onwards, coalesce to contribute to the development of non-communicable diseases, such as type II diabetes, neurodegenerative diseases and cardiovascular disease.edi
By reducing lead in the environment, America shows us that the cognitive potential of children and youth is improved. This lead story demonstrates that we can change the dispensation. This lead story, together with the genome study, show us that genetics and genes are only part of the picture of complex diseases. Environmental components play a critical role and are important other layers in the onion of health disparity that people experience around the globe.
Health is a fundamental right and equally applies to each of us, no matter where we live. That it is a right that more than 2B people are denied is a major human right violation and every country is presently guilty to various extent and globally we are collectively guilty of not doing enough to create the minimum conditions to guarantee the Right to Health. For this reason I have joined a group of my colleagues from across the globe proposing that we need a Framework Convention on Global Health (FCGH), a convention that will establish obligations at national and global levels for various actors, principally governments to guarantee basic access to health care and actions that prevent and reduce ill-health impacts of physical, social and environmental factors.
Dr. Leslie Ramsammy
Vice-Chair, FCGH Alliance
January 19, 2018