NHMRC Public Consultations

Skip Navigation and go to Content
Visit NHMRC website

NHMRC Draft Information Paper: evidence on the effects of lead on human health submission

ID: 
6
This submission reflects the views of
Organisation Name: 
Public Health Association of Australia
Please identify the best term to describe the Organisation: 
Non-government organisation
Personal Details
Questions
Q1. Is the draft Information Paper presented and written in a manner that is easy to understand?: 

 

The NHMRC authors may feel they have been clear about the scope of the paper but from queries (particularly what it means for them) from residents and the media in endemic towns, such as Broken Hill, it has not been stated in a way that is clear to them. Some of the points below mirror the misunderstanding in these communities.

Perhaps the NHMRC has to either state that for communities where lead exposure is long term and ongoing, the issue of lead exposure and management and  will be addressed in a separate paper or (as NHMRC website previously stated that enHealth deals with the environmental aspects in communities with ongoing, long term lead exposure) that NHMRC make another recommendation that enHealth should now review and make recommendations on strategies for communities dealing with endemic lead exposure to, in part, address concerns raised by these communities.

Overall easy to understand, but there is some confusion around individuals as in lead endemic communities there are still the individuals with a high, above background, blood lead level. So while the scope of the paper discusses strategies to reduce or manage children’s and adults’ exposure the information paper also states the paper is not for information, policy or guidance on how health risks should be managed in communities living near lead smelters or mines…   

The Introduction is clear as is Part A of the review, though there is a typo in the caption to Fig 1.

On p13 there may be some confusion when NHMRC says that systematic reviews by the NTP and EPA were comprehensive and well conducted and then in the next paragraph assessed the reviews to be of moderate quality.  We found this unclear. We assumed NHMRC reviewers meant that the process of the systematic review in both cases was well done but the findings/ conclusions from the reviews were of moderate quality because of the quality of studies they included? Perhaps a bit more explanation is required.

On p20 last paragraph “Overall, the body of evidence may not be very relevant to Australian communities, because most studies were conducted with children or families from socioeconomically disadvantaged areas with blood lead levels greater than 10 micrograms per decilitre. “ This is relevant to Australian communities such as Broken Hill, Pt Pirie which are SES disadvantaged and the more disadvantaged, such as Aboriginal children, are more likely to have a blood lead level greater than 10, but these communities are not considered in this information paper. So if NHMRC means Australian communities without known lead contamination it should reiterate this to leave readers in no doubt.

When referring to individuals lead exposure eg Recommendation 11 Individuals with blood lead level between 5 and 10 should be investigated, so endemic communities are still composed of individuals. Does this recommendation apply to individuals in lead endemic communities as well? Though the source of lead might be thought to be known (from the ore body originally) finding a ‘point source/s’ of exposure for an individual is often unclear. Even if the source/s are determined the necessary response may be beyond the (financial and logistical) ability of both household and health service.

From reading the paper the NHMRC seem reluctant to say that an action should be to lower the “goal” downwards below 10 ug/dl though the committee kept suggesting that 5ug/dl is a ‘background’ above which blood lead levels should be investigated. Is this because NHMRC committee also suggest that there’s no definitive intervention/s for people below 10? Or what would that then mean for endemic places (and who’ll pay for any big changes required even if out of the scope of this paper). Would this also mean lead levels in air, soil etc need to be revised? PHAA is asking that the NHMRC are clear as to what their intent is as the evidence they presents suggests tightening is warranted.

 

Q2. Does the draft Information Paper clearly outline how the evidence was reviewed and interpreted by the Lead Working Committee?: 

In the Lead exposure in communities Recommendations sections 3 and 5… Though the NHMRC did not include evidence from lead endemic areas they perhaps miss information which may be applicable to low-risk communities. In particular information on average blood lead levels in those not exposed through occupation to lead.

Population Health Unit, Western NSW & far West Local health Districts lead health report – children less than 5 years old in Broken Hill, Broken Hill 2013http://www.wnswlhd.health.nsw.gov.au/UserFiles/files/FarWest/ANNUAL%20LEAD%20REPORT%202012%20Final.pdf 

From this Figure 1 cord blood screening, showing that average blood lead level since 2002 has been below 2 and since 2008 1.2 ug/dl, suggests that for non-occupationally exposed adults in an endemic community in newborn (babies mothers) blood lead levels can be almost as low as those found in USA adult NHANES studies adding to Australian studies on patterns of ‘background’ levels.  Even in endemic areas background among the non-occupationally exposed adults may be similar or the same as in low-risk areas.

d health report – children less than 5 years old in Broken Hill, Broken Hill 2013http://www.wnswlhd.health.nsw.gov.au/UserFiles/files/FarWest/ANNUAL%20LEAD%20REPORT%202012%20Final.pdf 

From this Figure 1 cord blood screening, showing that average blood lead level since 2002 has been below 2 and since 2008 1.2 ug/dl, suggests that for non occupationally exposed adults in an endemic community in newborn (babies mothers) blood lead levels can be almost as low as those found in USA adult NHANES studies adding to Australian studies on patterns of ‘background’ levels.  Even in endemic areas background among the non occupationally exposed adults may be similar or the same as in low-risk areas.

Page reviewed: 19 May, 2015