Health and Economic Consequences of Lead Exposure Associated with Products and Services Provided by the Informal Economy

Abstract

In low- and middle-income countries (LMICs), the presence of an informal economy can lead to human exposure to toxic metals such as lead (Pb). This paper demonstrates the local health and economic benefits of modifying practices within the informal economic sector in Madagascar. Specifically, leaded components in 504 locally manufactured household water pumps were replaced with unleaded components. Prior to the intervention, 32% of the household systems exhibited lead concentrations above the World Health Organization (WHO) provisional drinking water guideline of 10 μg/L, but after the intervention, fewer than 3% of the systems were in exceedance. The reduction of lead concentration is modeled to reduce the fraction of children with elevated BLLs (>5 μg/dL) from 34 to 13%. The reduction in BLLs is estimated to provide an average economic benefit of US$11 800 per child based on predicted increases in lifetime productivity. This corresponds to a total benefit of US$8.7 million for the 730 children aged 1–5 associated with the pumps, representing a return on investment of greater than 1000-to-1. Results demonstrate how the formation of partnerships between public, private, and civil society entities, as suggested by UN Sustainable Development Goal 17, can realize important local economic and health benefits in LMICs.

Advancing Knowledge to Reduce Lead Exposure of Children in Data-Poor Low- and Middle-Income Countries

“…35 On a local level, the health and economic consequences can run into the millions of dollars; however, targeted remediations to reduce exposure can have returns on investment of greater than 1000:1. 20 The need for sound management of chemicals and/or toxins, throughout their entire life cycle, 36 has been highlighted as "fundamental" to the advancement of all 17 Sustainable Development Goals (SDGs). 4,37 Achieving the SDGs will in large part help to reduce future lead exposures, though the projected growth of "green" technologies (e.g., electric vehicles and e-bikes) 38 provides an enduring source of complex mixtures of toxic metals 39 that often find their fate in LMICs.…”

“…Lead exposures in high-income countries have historically occurred through the use of leaded gasoline, lead-based paint, and contaminated drinking water, with indoor dust (from lead paint) a persistent “reservoir” for lead exposure. , With regulatory and educational efforts driving reductions in many of these sources in higher-income countries, exposure via drinking water has taken on greater importance. LMICs have similar routes of exposure; however, reducing lead exposures in these locations is a unique problem for multiple reasons, including the typically unregulated, informal economies (that may employ child labor) driving everyday lead emissions/exposures, more recent phase-out of leaded gasoline resulting in higher levels of lead in soil and dust, , cultural and behavioral differences resulting in increased ingestion, , impacts of malnutrition on lead poisoning, a lack of access to healthcare, limited autonomy in health care decision making, and a lack of health promotion and disease prevention activities . Informal and rural water systems in LMICs have been identified as important sources, aligning with issues of drinking water contamination in higher-income countries .…”

“…LMICs have similar routes of exposure; however, reducing lead exposures in these locations is a unique problem for multiple reasons, including the typically unregulated, informal economies (that may employ child labor) driving everyday lead emissions/exposures, more recent phase-out of leaded gasoline resulting in higher levels of lead in soil and dust, , cultural and behavioral differences resulting in increased ingestion, , impacts of malnutrition on lead poisoning, a lack of access to healthcare, limited autonomy in health care decision making, and a lack of health promotion and disease prevention activities . Informal and rural water systems in LMICs have been identified as important sources, aligning with issues of drinking water contamination in higher-income countries . Tremendous progress has been made to reduce global exposures through, for example, leaded gasoline use and household paint .…”

Systems Thinking for Effective Interventions in Global Environmental Health

“…This aligns with the definition given by the United States National Institute of Environmental Health Services . Some notable areas of global environmental health are inadequate water, sanitation, and hygiene (WASH) services and practices, household air pollution due to the burning of solid fuels, and chemical pollution resulting from industrial malpractice (often in the informal sector , ). These issues are relevant in development, humanitarian response, and environmental justice settings and across multiple scales, from individual behaviors to trans-national policies.…”

Midstream Players Determine Population-Level Behavior Change: Social Marketing Research to Increase Demand for Lead-Free Components in Pitcher Pumps in Madagascar

“…A study observed that 51% of field measurements of Pb concentrations in this community were above the World Health Organization (WHO) provisional guideline of 10 µg/L in drinking water [ 5 , 8 ]. A recent study modeling the BLLs of children in Toamasina estimates that approximately 34% of Malagasy children in Toamasina may be at risk for elevated BLLs [ 9 ].…”