Regulating Health

Posted on | January 6, 2009 | Comments Off on Regulating Health

The story of lead poisoningThe recent financial crisis in the U.S. unleashed a passionate debate on the absence of sufficient regulation to protect the interests of Americans. But as regulations associated with health in America well illustrate, it’s not enough to have regulation. You must have the right type of regulation at the right time, and it must be enforced. Case in point? Lead poisoning.

An Australian scientist first recognized an epidemic of lead poisoning in children in 1908. It took European nations just one year to make a connection with lead-based paints and ban their use. But in the United States, it would take nearly 70 more years to ban lead in paints, due mostly to the effective lobbying action of the Lead Industries Association.

Once the weight of the facts and the actions of other nations drove regulatory bodies to action, those actions were still painfully slow and agonizingly incremental. Here in the United States, a blood lead level of greater than 60 micrograms per deciliter made the diagnosis of lead poisoning in 1970. It wasn’t until 1991, 21 years later, that we reached the current level of 10 micrograms per deciliter as the definition of lead poisoning.

In 1970, 88 percent of all U.S. children under age 6 had blood lead levels above 10 micrograms per deciliter. By 1991, that figure had dropped to only 5 percent. Even so, significant numbers of children are still affected. A study from 1999 to 2001 found that 430,000 kids, or 2.2 percent of under-age-6 population, had lead poisoning. The numbers were higher among poor kids with rates topping 6 percent in one Medicaid study. Also, a lack of proper follow-up post-diagnosis was extremely common. A study published in 2005 found that out of about 3,600 Medicaid-enrolled children in Michigan with lead poisoning, 46 percent did not receive appropriate follow-up testing.

It is not that we are disinterested, but rather disintegrated and conflicted. The story of lead poisoning illustrates that failed leadership in health can carry extraordinarily high long-term costs. Lead poisoning in children has a well-established association with reading delays, school failure, delinquency and criminal behavior, independent of other associated risk factors. And as the affected kids turn into adults, the picture worsens. We now know that lead-poisoned children become chronically ill adults with high rates of cardiovascular disease, kidney disease, cognitive decline, spontaneous abortion, tooth decay, and cataracts.

What are the lessons learned? First, we are too slow. Second, we are too risk-averse. Third, we too often stick our heads in the sand. And whether it’s our financial sector or our health care sector, we are now painfully aware that when you behave this way, disaster is always just around the corner.

I’m interested in your thoughts on lead poisoning. Do you know anyone who has experienced it first-hand? Please leave a comment here. For more information, be sure to read the full transcript or watch the video embedded with this page.