In 1991, the Public Health Service articulated a vision for primary prevention in Strategic Plan for the Elimination of Childhood Lead Poisoning, a departure from previous federal policy focused on finding and treating lead-poisoned children. This publication detailed a 15-year strategy for primary prevention and offered a cost-benefit analysis to demonstrate the monetized benefits of this approach. A strong national effort to follow this strategy developed but was eventually abandoned.
The organized campaign against universal screening began in California, where letters questioning the reported prevalence of elevated BLL began appearing in pediatric journals and newspapers. These letters acknowledged receiving editorial assistance from Kaiser Permanente Foundation Hospitals and argued that money spent on screening, treatment and abatement would be harmful to more worthy public health efforts. The AAP president took up this attack on universal screening as well, and efforts for universal screening were gradually eroded.
Needleman identifies racism and the belief that lead poisoning “is a product of poor mothering, not of environmental pollution” as a driving factor shaping lead detection and prevention efforts (or the lack thereof) … “this weighting of personal choice or behavior over environment is a tool used to shift responsibility away from health authorities or polluters and onto the victim” (1875).
