ADVANCEMENT OF THE PRACTICE
Open Access
INTERNATIONAL PERSPECTIVES
Building a Multisectoral Coalition to Prevent Lead Exposure in Ethiopia
Researchers additionally reported the dispro- portionate impact on marginalized commu- nities, who were most vulnerable to elevated lead levels (Markowitz & Rosner, 2014). In the U.S., it took more than 50 years of advocacy to effectively reduce levels of lead in the environment, leading to major reduc- tions in blood lead levels (BLLs). This move- ment took considerable time and required major advocacy in lead prevention, commu- nication of scientific research to the public, and gradual influence of public opinion and policy (Markowitz & Rosner, 2014). In 2023, the U.S. government made lead exposure prevention a global health prior- ity based on findings from various sources reporting on its negative effects in low- and middle-income countries (LMICs) (Craw- furd et al., 2023; Ericson et al., 2021; Larsen & Sánchez-Triana, 2023). These estimates included a substantial global burden of dis- ease associated with lead exposure and mil- lions of disability-adjusted life years (DALYs) lost due to exposure across the lifespan, with a particular burden on children. One study estimated that children younger than 5 years of age lost 765 million IQ points and that approximately 5.5 million adults died from cardiovascular disease related to lead exposure in 2019 alone. Additionally, the authors report that the global cost of lead exposure was estimated at $6 trillion USD in 2019 (Larsen & Sánchez-Triana, 2023). A systematic review of more than 500 studies found that BLLs likely remain ele- vated in LMICs despite efforts to eliminate leaded fuel (Ericson et al., 2021). Strong sci- entific evidence exists on the harmful effects of lead poisoning on cognitive development Jonathan Drewry, MPH, DrPH, REHS Mary Heersink Institute for Global Health, University of Alabama School of Medicine Bereket Tesfaye Belihu, MBA Pure Earth Ethiopia Argaw Ambelu, PhD Center for Water Research, Addis Ababa University Tadesse Amera, PhD Pesticide Action Nexus Association Ethiopia (PAN-Ethiopia)
Abstract Lead poisoning remains a major global threat to human health, despite substantial progress over the last century by high- income countries. Many low- and middle-income countries (LMICs) continue to have major sources of lead exposure, which particularly affect vulnerable populations of mothers and children. Despite clear evidence of lead’s health risks in Ethiopia, high exposure persists due to insufficient prevention and mitigation efforts. The creation of a multisectoral coalition in Ethiopia supported advocacy efforts that were furthered through the Partnership for a Lead-Free Future (PLF). The Ethiopian Lead Poisoning Prevention Coalition advocated for a formal memorandum of understanding signed in 2025 between the Ethiopian Environmental Protection Authority and the Ministry of Health in Ethiopia. This article outlines the strategies, activities, and future steps to enhance collaboration among agencies and increase public awareness. Such initiatives and actions are meaningful milestones and could be of interest to other LMICs, particularly in the Global South. Keywords: lead exposure, lead poisoning prevention, multisectoral collaboration, coalition building, Ethiopia, environmental health, public health policy
Introduction The impact on human health from the intro- duction of lead into our environment has been recognized as early as 5,000 years ago (Needleman, 2004). Due to rapid industri- alization that began in the 17th century, the use of lead increased rapidly and accelerated toxicity in humans (Wani et al., 2015). More than three decades ago, the scientific com- munity established that there was no safe minimum level of lead exposure, and any level caused negative effects, particularly in children (Needleman, 2004). For example, the estimates of lead expo- sure on cognitive development and neu- robehavioral abnormalities are a 2.6-point decrease in IQ for every 10 μg/dl, but even
lower levels of exposure have been associated with behavioral problems in youth (Schultz, 2014). Lead in the environment has a nega- tive effect on human health across one’s lifes- pan, with women and children being par- ticularly vulnerable to lead’s harmful effects. The toxicity of lead negatively affects human physiology, including our neurological and cardiovascular systems. Over time, lead exposure prevention advocates in the U.S. formed coalitions and brought scientific research to the public, thereby gradually influencing public opinion and policy. This shift was driven by grow- ing evidence of lead’s neurological harm to children, with lead exposure linked to paints and gasoline (Markowitz & Rosner, 2014).
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Volume 89 • Number 4
https://doi.org/10.70387/001c.173647
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