77th World Health Assembly

May 29, 2024

Geneva, Switzerland

Thank you, Anshu. Thank you for your partnership at WHO and leadership. The UN system has been a vital component of bringing to awareness the concern about this work and taking action and that’s through WHO, UNICEF, and the UN Environment Programme. Grateful to Anshu also for chairing this session.

On behalf of the United States’ delegation to the World Health Assembly, on behalf of USAID, and and also our esteemed co-partner, UNICEF, on this session represented by Ted Chaiban, let me thank the Honorable Minister Pate for joining in this panel, also the additional Director General of Health Services of Bangladesh, and the Vice Minister of Health of Vietnam for their leadership in showing the way in this important line of work. Many thanks also to the other speakers and panelists we have from Africa. CDC, Dr. Mohammed Abdulaziz, a partner on multiple lines of work for us as the Head of Division of the Disease Control and Prevention of Africa CDC. We'll be joined virtually by Dr. Howard Hu, a globally recognized lead expert from the University of Southern California, and also note his dedication in taking this in the very early hours of the day and late night in California, and then also Larah Ibanez, Pure Earth's Country Director for the Philippines, and an ardent advocate of efforts to prevent lead exposure who's at the other end of the spectrum joining us virtually from a time zone 12 hours in the other direction. Welcome to all of you here in this audience, but also online, where we have hundreds of people who have joined as well.

This is an important topic, and I want to emphasize it because it's a rare example of a massive impact problem, a problem that has been neglected and a problem that is also highly tractable.

This is an issue for which I had little awareness until a couple of years ago, when we really began looking at USAID and where, in a flat funded environment, we could have the potentially largest impact on health outcomes and lead rapidly rose to the top of the list for reasons I will discuss. The wakeup call in the United States was when children in the city of Flint, Michigan were found one out of 20 to have elevated lead levels when we thought you know, we had addressed lead in paint. We addressed unleaded gasoline. This is a problem that had been solved, but it had turned out it wasn't, and President Biden made it a major initiative to address the issues. As I began diving into the information that people in the environmental health community have known for some time, the level of impacts and the level of prevalence are shocking. If it was one in 20 children that was the wakeup call for the United States, in Flint, Michigan, as you heard, it's one in three children in the world. It is one in two children in low-income countries. 90% of the problem of lead exposure around the world is in children in low- and middle-income countries.

Second, the impacts are extraordinary. The educational and cognitive impact on children is that currently in low- and middle-income countries, the lead level of the average child is high enough to reduce IQ by six percentage points. That is sufficient that if you're moving the entire intelligence curve to the left for your population – that means you have a 60% increase in the number of intellectually disabled children, and you reduce the percentage of gifted children by 60%. That alone is a damage to the future of our world. Second, however, was what Anshu mentioned, was the evidence now that there are multiple pregnancy complications from the accumulation of lead in your body later in your life, including increased levels of preterm birth, low birth weight, and stillbirths and causing harm in the development of the fetus in utero.

Add to that, the newer data over the last decade, demonstrating that lead is a major driver of atherosclerosis. Last week, the global burden of disease estimates from the Institute of Health Metrics and Evaluation came out, and they have upgraded because of this recent evidence, the estimate, their estimates of the number of deaths associated with lead. They estimated 1.5 million increased deaths around the world from lead. This is on par, in fact, larger than TB, larger than malaria, and yet, we have not exerted the same level of focus in the health community as we have in these other spaces. It's also going to be impossible to take on our burden of noncommunicable diseases, given that the major way in which lead kills. Lead can kill because high lead levels can be directly poisonous to children, and you can have children die, but the massive numbers are premature cardiovascular disease, and that is a huge opportunity.

Let me then just say that the goals here today are to bring awareness and to hear from our country ministers about the activities they've taken so we can understand the pathway for taking action. We we have done it before. Samantha Power, the USAID Administrator, at the World Economic Forum in Davos, outlined a vision of a world that has a future free from lead exposure. It starts from the demonstration that with very low amounts of investment, we were able to remove lead from gasoline around the world. Now, in the high-income countries, 90% of high-income countries have signed on to remove lead from paint and other consumer sources. But that has not happened at the middle-income and low-income levels, and it's leading to a major inequity in survival and in educational attainment and other outcomes. And so, we have joined the Global Alliance to eliminate lead paint at USAID, becoming the first development agency to join the Global Alliance. We've joined along with the U.S. Environmental Protection Agency and CDC, and we encourage those in the development community and in the health world to join that effort and to participate in work that you'll be hearing about on major sources of lead exposure, which include household items like spices, paint, cosmetics, and cookware.

So with that, I'm going to turn this back to or onward to our next colleague. I want to introduce Howard Hu, whom I mentioned is a globally recognized expert on the relationship between environmental factors such as lead and the impact on disease and development in the population. He's the Flora L. Thornton chair and professor at the Department of Population and Public Health Sciences at the Keck School of Medicine at the University of Southern California. And thank you again, Dr Hu for joining us in the middle of the night. We're so grateful for your dedication, all that you are discovering and teaching the world about these connections and what you will present today. Thank you.

Atul Gawande