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In 1991, the Public Health Service published the Strategic Plan for the Elimination of Childhood Lead Poisoning. This document marked a fundamental shift in federal policy from finding and treating lead-poisoned children to authentic primary prevention. It spelled out a 15-year strategy to achieve this goal and provided a cost-benefit analysis showing that the monetized benefits far exceeded the costs of abatement. A strong national effort to eliminate the disease developed. Now, 7 years after publication of the plan, primary prevention of lead exposure has Been abandoned. This article examines the role of some prevailing attitudes and institutions in derailing the effort. Some institutions-the lead industry, real estate interests, and insurance interests-behaved as anticipated. Others, including private pediatricians, the American Academy of Pediatrics, some federal agencies, and a public interest group ostensibly dedicated to eliminating lead poisoning, also played an unexpected part in derailing the plan. [ABSTRACT FROM AUTHOR]

Several letters to the editor are presented in response to the article "Childhood Poisoning: The Promise and Abandonment of Primary Prevention," by Herbert Needleman in the 1998 issue.

The article reflects on the issues regarding childhood lead poisoning. It mentions that the amount of lead in the portion of bread wrappers ranges from zero to 84 milligrams per bag. It believes that a more serious issue about lead poisoning is its insertion to the ecosystem through the use of the said source.

Recent data have demonstrated health effects of lead in children at doses previously believed to be harmless. Data from epidemiological studies in many countries, and from experimental studies of animals given lead, demonstrate psychological impairment at blood lead concentrations of 0.5-0.7 µmol/L. Current estimates are that 17 per cent of American children (3-4 million) exceed the level of 0.7 µmol/L. Lead exposure is not a problem for urban poor children alone, but inner-city minorities have a higher rate of exposure. The overabundance of lead coexists in the same area with two serious shortages: affordable housing and jobs. It is argued that a program to train unemployed inner-city residents in safe de-leading, while expensive, makes hygienic, economic, and common sense. (Am J Public Health 1989; 79:643-645.) [ABSTRACT FROM AUTHOR]