We are excited to announce the launch of Lead Exposure Elimination Project (LEEP), a new EA organisation incubated by Charity Entrepreneurship. Our mission is to reduce lead poisoning, which causes significant disease burden worldwide. We aim to achieve this by advocating for lead paint regulation in countries with large and growing burdens of lead poisoning from paint.

In this post, we make the case for lead exposure reduction as a priority, and outline our plan to address this problem.

The Problem

Others in the effective altruism community have already identified that working on lead poisoning could be a high-impact opportunity (see here, here, and here). Through the Importance, Tractability, Neglectedness framework, we unpack the reasoning for prioritising lead exposure interventions, and for our approach of advocating for the introduction of lead paint laws.

Importance

Lead poisoning has substantial health and economic costs, and lead paint is a primary contributor [1]. In terms of individual impacts, lead exposure has a number of effects. Even a low level of lead exposure can lead to mental disability and IQ loss, as well as increased rates of mental illness and psychopathology and significantly reduced lifetime earnings capacity [2, 3, 4]. Lead also has effects on behaviour and criminal tendencies; in particular having a large impact on the prevalence of violent crime [5]. In adults, lifetime lead exposure is an important risk factor for renal disease and cardiovascular disease, including hypertension and coronary artery disease [6, 7]. Higher levels of exposure can affect all organ systems, and even result in respiratory difficulties, seizure, coma, and death [5].

Lead poisoning primarily affects children, and does so at a massive scale. UNICEF reports that 815 million children have blood lead levels above 5 µg/dL - a sufficient level for neurodevelopmental effects and reduced IQ [8]. The vast majority live in low and middle-income countries. Put another way, one in three children are currently affected by lead poisoning to some degree.

In addition to disability, it also causes 1 million deaths per year. In total, lead poisoning accounts for 22 million DALYs every year, which means that lead poisoning is responsible for approximately 1% of the global disease burden [9].

In terms of lost earnings, lead poisoning impacts the world economy to the level of approximately $1 trillion per year [4]. This amounts to a loss of 1.2% of world GDP. These losses are concentrated in low and middle-income countries, where they can amount to as much as 5-8% of GDP, suggesting that lead exposure can be a significant barrier to economic development and poverty reduction.

In short, the problem of lead poisoning is a significant one.

Neglectedness

At present, while all countries except for one have banned leaded petrol, 61% of countries have no lead paint regulations whatsoever [1]. In many of these primarily low and middle-income countries the burden of disease from lead poisoning is still significant. In high-income countries, this is a less severely neglected area, as most countries have introduced regulations banning leaded petrol and lead paint.

While there are some organisations working to address this issue in low and middle-income countries, including IPEN, ToxicsLink, and Pure Earth, many countries with significant lead burdens remain neglected by other actors. LEEP aims to fill this gap, and target these neglected countries.

Tractability

This is the most uncertain aspect of working on lead poisoning, given the uncertainty around the success of policy change interventions. However, there are several reasons in favour of the tractability of policy change to ban the production and import of lead paint.

• Experts suggest that lead paint may be the most tractable source of exposure to address and the easiest to regulate. Lead paint is a major source of exposure to lead, but other sources include batteries, mining, foodstuffs, pipes, and cookware [1].
• There is broad agreement that the introduction of legislation is the most effective way to reduce exposure to lead paint [10].
• Switching to unleaded paints is technically and economically viable for manufacturers [10].
• NGOs have so far been successful in introducing new lead paint laws in 21 low and middle-income countries, demonstrating a precedent for feasibility [11].
• The presence of opposition can often make policies harder to pass [12]. One of the strengths of lead paint regulation as an intervention is that it exists in a virtually unopposed political environment. There is no significant lead paint lobby that might oppose regulation, and in some cases the paint industry has even supported the introduction of regulation.
• Lead paint regulation would have obvious benefits to political decision-makers due to its very low costs and significant long-term benefits for our target countries. It has been estimated that every dollar spent in lead paint hazard control results in a return of $17-$221 [5].
• Lead paint is typically a non-partisan issue, making political opposition less likely.

In addition to the direct impacts of our work, we hope that our intervention will provide further evidence to the tractability of policy interventions.

Our Plan

Our first priority is country selection to ensure we target tractable, high-burden, and neglected countries. We have identified Malawi as the most promising country on this basis. Over the next two months, we will be testing the levels of lead in new paints on the market in Malawi and building relationships with stakeholders and decision-makers. Depending on findings and progress from this stage, we will either pilot our advocacy campaign in Malawi to introduce lead paint regulation, or pivot to another promising country.

We plan to advocate for evidence-based policy change while rigorously tracking our counterfactual impact, in alignment with the principles of the EA movement. In this process, we will publish our full findings on our website so that they can be used by other organizations or individuals working on lead poisoning (or policy change more broadly).

In our preliminary cost-effectiveness analysis, we found that this intervention has the potential to be highly cost-effective, currently comparable to GiveWell’s top charities. Ultimately, lead policy seems to be an area that has the potential to be more cost-effective than the most effective existing charities in global health and development.

Though we will initially focus all of our efforts on one target country, our long-term goal is to introduce lead regulation in a number of high-burden countries, and reduce lead poisoning at an international scale.

How You Can Help

What can you do if you want to contribute to our mission?

Advisors

We are currently being mentored and advised by the Charity Entrepreneurship team, as well as by the founders of Fortify Health, but are also seeking further advisors. Specifically, we are looking to connect with experts involved in lead regulation or other forms of political advocacy. If you have experience in any of these fields we would love to connect with you.

We are also seeking advisors who have connections or in-country experience in our top few target countries. If you have connections in Malawi, Madagascar, Sierra Leone, Burkina Faso, or Guatemala, we would love for you to get in touch.

Hires

We plan to hire in-country staff during our first year in our target location. In future years, we may seek interns or employees for operations, research, and communications roles.

Funding

Charity Entrepreneurship has awarded us a seed grant of $60,000, which will enable our organisation to operate for most of our first year.

We will be seeking further funding, and would love to be in contact with risk-tolerant donors looking to support early stage organisations

Follow our work

If you would like to be kept updated by our work then please sign up to our newsletter, and follow us on Facebook, Twitter and Linkedin.

Feedback

We greatly value your feedback and suggestions, particularly at this early stage. Please feel free to post your questions or comments below or reach out to us directly through our contact form.

LEEP was incubated under Charity Entrepreneurship, an effective altruism organization, which provided our initial funding with a $60,000 seed grant. Our current team members are co-founders Jack Rafferty and Lucia Coulter.

References

1. UNEP 2019: Update on the global status of legal limits on lead in paint. September 2019
2. Lamphear et al. 2oo5: Low-level environmental lead exposure and children’s intellectual function: an international pooled analysis
3. Reuben et al. 2019: Association of childhood lead exposure with adult personality traits and lifelong mental health
4. Attina & Trasande 2013: Economic costs of childhood lead exposure in low-and middle-income countries
5. Gould 2009: Childhood lead poisoning: Conservative estimates of the social and economic benefits of lead hazard control
6. Chowdhury et al. 2018: Environmental toxic metal contaminants and risk of cardiovascular disease: systematic review and meta-analysis
7. Lanphear et al. 2018: Low-level lead exposure and mortality in US adults: a population-based cohort study
8. UNICEF 2020: The Toxic Truth
9. IHME 2017: Global Burden of Disease Study
10. WHO ‎2020: Global elimination of lead paint: why and how countries should take action: technical brief
11. Charity Entrepreneurship 2020: Lead Paint Regulation
12. Baumgartner et al. 2009: Lobbying and Policy Change: Who wins, who loses, and why?

This work is licensed under a Creative Commons Attribution 4.0 International License.