and cardiovascular health, making the reduc- tion of high BLLs in LMICs one of the most cost-effective interventions available. The recent recognition of the global bur- den of disease attributed to lead in LMICs has been amplified by some international orga- nizations and philanthropies. These groups have successfully highlighted LMIC dispari- ties for BLLs in children and placed these dis- parities in clear comparison with the prog- ress made in high-income countries over the past 70 years. Although BLLs have decreased significantly in high-income countries, it is estimated that 800 million children in LMICs have BLLs well above the minimum thresh- old (Olufemi et al., 2022). Furthermore, more than 90% of children with high BLLs reside in LMICs, with levels 10 times higher than reported in the U.S. (Crawfurd et al., 2023) and estimated costs due to decreases in IQ scores estimated at $977 billion USD (Schultz, 2014). One study found that higher observed lead levels in developing countries explain more than one half the gap in learning outcomes compared with developed countries and that the eradication of lead in these LMICs might be as effective as many other education policy actions (Crawfurd et al., 2025). Multisectoral mechanisms to better reduce environmental sources and health impacts do not exist in many LMICs. Government agencies and civil society organizations often work in isolation, so progress in one area does not necessarily result in comprehen- sive solutions. The combination of multiple sources of exposure, widespread informal labor, large numbers of vulnerable popula- tions, and the absence of robust testing and surveillance systems makes lead poisoning particularly challenging in these settings. Furthermore, limited advocacy, policies, and regulations have contributed to persistently high BLLs through exposure to paint, water, smelters, batteries, cosmetics, and cookware (Tong et al., 2000). Although lead poisoning has largely been eliminated in high-income countries, it remains overlooked in LMICs, often over- shadowed by other health priorities, finan- cial constraints, fragmented environmental health systems, limited maternal and child health capacity, and insufficient political will. Some of the more recent efforts under- taken to advance regulations on lead in
paint and used lead-acid batteries (ULAB) in LMICs deserve recognition. The Ethiopian Lead Poisoning Preven- tion Coalition, spearheaded by the German Corporation for International Cooperation (GIZ), Pesticide Action Nexus Association (PAN), and U.S. Agency for International Development (USAID), played an important role in increasing lead communication and mitigation in Ethiopia. Notable outcomes included a memorandum of understanding (MoU) between the Ethiopian Environmen- tal Protection Authority (EPA) and the Min- istry of Health in Ethiopia. Furthermore, the coalition successfully advocated for the Ethiopian government to become a found- ing member of the Partnership for a Lead- Free Future (PLF), a global private–public partnership launched by the United Nations Children’s Fund (UNICEF) and USAID to reduce lead exposure in Ethiopia. Lead in Africa It is known that 90% of children with ele- vated BLLs live in LMICs, and that most LMICs are in Africa (Schultz, 2014); many of these children have BLLs exceeding 5 µg/dl (Ericson et al., 2021). An assessment by the World Health Organization (WHO) estimated that one third of Africa’s disease burden was attributable to environmental health hazards (Prüss-Üstün & Corvalán, 2006). Furthermore, WHO recently rec- ognized lead as one of the top 10 areas of significant public health concern and noted the responsibility of individual nations to address this risk (Bhasin et al., 2023). The major sources of lead in Africa are paint, leaded gasoline, mining, water and food, ceramics and cookware, and acid battery manufacturing and disposal (Fisher et al., 2021; Nweke & Sanders, 2009). Most of Africa continues to report rela- tively elevated levels of lead compared with high-income countries. This discrepancy is primarily the result of a much-delayed phaseout of tetraethyl leaded gasoline and its persistence in the environment, as well as other sources of lead in informal workplaces (Renfrew, 2018). Although lead’s widespread nature and its risks to humans are well-doc- umented, only a small number of African countries have implemented substantial poli- cies and regulations to effectively address this problem (Tong et al., 2000).
Key Messages
Some mining regions (e.g., in Kabwe, Zambia, and in Zamfara, Nigeria) have communities where lead concentrations exceed 100 µg/dl (Nakata et al., 2022). The reality, however, is that most lead expo- sure across Africa stems from sources that demand coordinated and comprehensive public health strategies, programs, and pol- icies (World Health Organization, 2015). The evidence and advocacy efforts led by organizations—such as Pure Earth, the International Pollutants Elimination Net- work (IPEN), Global Development Incuba- tors (GDI), Vital Strategies, and the Center for Global Development (CGD)—under- score the urgent need to establish systems for surveillance, regulation, education, and worker protection. Lead in Ethiopia In Ethiopia, an estimated 30 million children have BLLs >5 µg/dl, a level that medical pro- fessionals consider detrimental to growth and development (Rees & Fuller, 2020). At least a dozen peer-reviewed studies have identi- fied elevated BLLs among vulnerable groups, creating guidelines, drafting regula- tions, and forming a lead-prevention coalition. • Ethiopia’s multisectoral lead preven- tion efforts provide key lessons in advocacy, resource mobilization, and joint planning. • Lead exposure has dropped in high- income countries, but many African countries still face widespread lead contamination and exposure. • Emerging economies can apply les- sons from high-income countries to prevent lead poisoning, especially for children and other vulnerable groups. • Despite high lead levels in Africa, there are not enough resources or healthcare professionals to address the problem. • Approximately 30 million people in Ethiopia have high lead exposure, but collaboration is difficult due to limited advocacy and urgent health needs. • Ethiopia has made progress in
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November 2026 • Journal of Environmental Health
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