Promoting Health Preventing Disease

178 Promoting Health, Preventing Disease
eliminating lead from petrol, before turning to ex ante analyses of proposed
policies for eliminating lead contamination in homes.
The phase- out of lead in petrol remains to this day one of the major watershed
moments in childhood disease prevention in the twenty- first century. The
story behind this landmark policy intervention, however, is more parochial
than it appears today. A major driver for the initial phase- out in the United
States during the 1970s was that lead impeded the function of catalytic
converters, which were being introduced into cars at the time. Approximately
five years later, a technological work- around was identified, permitting the
reincorporation of lead into petrol. Policy debate about the reintroduction of
lead into petrol only ceased when data from serial surveys of the US National
Health and Nutrition Examination Survey documented a lock- step decrease of
BLLs with the average concentration of lead in petrol.
Retrospectively, this decision proved tremendously smart from an economic
perspective. Scott Grosse and colleagues at the Centers for Disease Control
and Prevention compared BLLs of children born in the 1970s with children
born in the 2000s, and identified approximately a 12–15 µg/dL difference in the
average blood lead between these two cohorts of children. Utilizing available
literature on decrements of IQ per increment in blood lead, estimates of
increased percent lifetime earnings per IQ point, and lifetime earnings estimates,
he estimated that the cohort of children born in 2000 would be $263 billion ($213
billion in 2000 prices) more economically productive than the cohort of children
born 30 years earlier. Accounting for uncertainty in lead- IQ and IQ- earnings
associations, they estimated a possible range of economic benefits between
$136 to $393 billion ($110 to $318 billion in 2000 prices) (Grosse et al. 2002).
These benefits compare to an ex ante $6.25 billion ($6 billion in 2007 prices)
cost estimate of the regulations, published by the US Department of Energy
(Nichols 1997). 3
Only six countries have currently failed to eliminate lead from gasoline. Tsai
and Hatfield (2011) have quantified the economic benefit of removing lead from
gasoline globally, extending the findings of Grosse et al. and accounting for
other benefits such as reduced health care costs and criminality. They estimate
that the benefits of removing lead in gasoline are $2.86 trillion/year ($2.45
trillion in 2003 prices), or 4 per cent of global gross domestic product. Using
the most conservative inputs to their estimates, they suggest that the economic
benefits can be no lower than $1.17 trillion/year ($1 trillion in 2003 prices), and
might be as much as sixfold higher. Even if the costs of these regulations are
only orders of magnitude within the estimated United States phase out costs
(adjusting of course for demographic, economic, and geographic differences),
then these phase outs have enjoyed unambiguously favourable ROIs.
The dominant intervention for reducing lead exposure in the home is the
removal of lead paint and plumbing. Other possible measures include the
control of dust and educational interventions with households, but none of
these have been shown to be effective (Yeoh et al. 2012). Table 8.3 presents the
burden of disease for childhood lead poisoning alongside the costs and benefits
of lead abatement in homes. This can be a tricky and costly operation, and
it is important that safe work practices are used during the removal process
(Jacobs et al. 2003). Assuming safe practices are followed, the average cost