FEDERAL ACTION PLAN TO REDUCE CHILDHOOD LEAD EXPOSURES AND ASSOCIATED HEALTH IMPACTS
3
Lead exposure to children can result from multiple sources and can cause irreversible and life-long health
eects. No safe blood lead level in children has been identied. Even low levels of lead in blood have been
shown to aect IQ, ability to pay attention and academic achievement.
The United States has made tremendous progress in lowering children’s blood lead levels. As a result of
multiple federal laws and regulations, including the 1973 phase out of lead in automobile gasoline, the 1978
federal regulation banning lead paint for residential and consumer use, and the 1995 ban on lead in solder
in food cans, the median concentration of lead in the blood of children aged 1 to 5 years dropped from 15
micrograms per deciliter in 1976–1980 to 0.7 micrograms per deciliter in 2013–2014, a decrease of 95%.
Although childhood blood lead levels have been substantially reduced as a result of these actions, some
children are still exposed to high levels of lead. For example, non-Hispanic black children, children living
in families below the federal poverty level and children living in older housing have statistically signicant
increased risk of higher blood lead levels (U.S. Environmental Protection Agency [EPA], 2017).
The Federal Action Plan to Reduce Childhood Lead Exposures and Associated Health Impacts (Action Plan)
is the product of the President’s Task Force on Environmental Health Risks and Safety Risks to Children
(Task Force). The Task Force is the focal point for federal collaboration to promote and protect children’s
environmental health. Established in 1997 by Executive Order 13045, the Task Force comprises 17 federal
departments and oces. The Secretary of the Department of Health and Human Services (HHS) and the
Administrator of the Environmental Protection Agency (EPA) co-chair the Task Force. The Senior Sta Steering
Committee (Steering Committee) is its operational arm.
The Action Plan is a blueprint for reducing lead exposure and associated harms through collaboration among
federal agencies with a range of stakeholders, including states, tribes and local communities, along with
businesses, property owners and parents. The Action Plan will help federal agencies work strategically and
collaboratively to reduce exposure to lead and improve children’s health. It builds upon previous work of the
Task Force to address lead exposure to children. In 2000, the Task Force published Eliminating Childhood
Lead Poisoning: A Federal Strategy Targeting Lead Paint Hazards (Task Force, 2000), which focused on the
largest lead source on average to children—lead paint in housing and adjacent soil. In 2016, the Task Force
released Key Federal Programs to Reduce Childhood Lead Exposures and Eliminate Associated Health
Impacts (Task Force, 2016), which describes the federal government’s diverse eorts to further decrease lead
exposure to children in the United States and mitigate adverse health impacts of lead.
This document promotes a vision that the United States will become a place where children, especially those
in vulnerable communities, live, learn and play protected from lead exposure and its harmful eects. With
a focus on populations disproportionately aected by lead exposure, the Action Plan strengthens federal
eorts to implement Executive Order 12898, Federal Actions to Address Environmental Justice in Minority
Populations and Low-Income Populations (EPA, 1994). This Executive Order calls upon each federal agency
“to make achieving environmental justice part of its mission by identifying and addressing, as appropriate,
disproportionately high and adverse human health or environmental eects of its programs, policies and
activities on minority populations and low-income populations.”
The Task Force obtained stakeholder input, including through presentations at public meetings, a listening
session with tribal partners, an online survey on the Task Force website, a request for input through a Federal
Register notice and focus groups with interested parties. Over 700 unique comments were received from a
broad spectrum of stakeholders. Commenters included state, tribal and local governments, child advocacy
organizations, environmental health advocates, medical providers, school and child care representatives,
community-based organizations, industry representatives, tribal leaders and other members of the general
public. The Task Force is committed to providing the public with updates regarding the progress of the federal
agencies in accomplishing the actions described in this document.
EXECUTIVE SUMMARY
FEDERAL ACTION PLAN TO REDUCE CHILDHOOD LEAD EXPOSURES AND ASSOCIATED HEALTH IMPACTS
4
The Action Plan has four goals with key priorities and objectives that seek to reduce harm to children from
exposure to lead. By identifying specic goals and actions, federal agencies can prioritize their eorts and
monitor progress.
The four goals are:
The Action Plan is not a budget document and does not imply approval for any specic action under
Executive Order 12866 or the Paperwork Reduction Act. It will inform future federal budget and regulatory
development processes within the context of the goals articulated in the President’s Budget. All activities
included in the Action Plan are subject to budgetary constraints, interagency processes, stakeholder input
and other approvals, including the weighing of priorities and available resources by the Administration in
formulating its annual budget and by Congress in legislating appropriations. In some cases, activities in the
Action Plan require a sustained, multi-year eort by federal, state, tribal and community partners.
GOAL 1: Reduce Children’s Exposure to Lead Sources
GOAL 2: Identify Lead-Exposed Children and Improve Their Health Outcomes
GOAL 3: Communicate More Effectively with Stakeholders
GOAL 4: Support and Conduct Critical Research to Inform Efforts to Reduce
Lead Exposures and Related Health Risks
VISION
The United States will become a place where children, especially
those in vulnerable communities, live, learn and play protected from the
harmful effects of lead exposure.
FEDERAL ACTION PLAN TO REDUCE CHILDHOOD LEAD EXPOSURES AND ASSOCIATED HEALTH IMPACTS
5
The Federal Action Plan to Reduce Childhood Lead
Exposures and Associated Health Impacts (Action
Plan) is a blueprint for reducing lead exposure
through collaboration among federal agencies and
with a range of stakeholders, including states, tribes
and local communities, along with businesses,
property owners and parents. The Action Plan
will help federal agencies work strategically and
collaboratively to reduce exposure to lead and
improve children’s health.
The Action Plan is the product of the President’s
Task Force on Environmental Health Risks and
Safety Risks to Children (Task Force), the focal point
for federal collaboration to promote and protect
children’s environmental health. Established in 1997
by Executive Order 13045, the Task Force comprises
17 federal departments and oces and is chaired by
the Department of Health and Human Services (HHS)
and the Environmental Protection Agency (EPA).
The United States has made tremendous progress
in lowering children’s blood lead levels. As a result
of multiple federal laws and regulations (EPA, 2017)
including the 1973 phase out of lead in automobile
gasoline, the 1978 federal regulation banning lead
paint for residential and consumer use and the
1995 ban on lead in solder in food cans, the median
concentration of lead in the blood of children aged 1
to 5 years dropped from 15 micrograms per deciliter
(μg/dL) in 1976–1980 to 0.7 μg/dL in 2013–2014, a
decrease of 95%. The 95th percentile for blood lead
among children aged 1 to 5 dropped from 29 μg/
dL in 1976–1980 to 2.2 μg/dL during 2013–2014,
a decrease of 92% (Task Force, 2016). Figure 1
depicts the timeline for major actions to prevent
lead poisoning and the impact of these actions
on reductions in mean blood lead levels (μg/dL)
among children aged 1 to 5 years from 1972 to 2012
(Centers for Disease Control and Prevention [CDC],
n.d.).
Despite the overall decline of blood lead levels
over time, lead exposure remains a signicant
public health concern for some children because of
persistent lead hazards in the environment. Sources
of lead include lead-based paint (Dewalt et al., 2015),
lead service lines, lead in plumbing material and soil
contaminated by historical sources (EPA, 2018a;
EPA, 2018b). Children may also be exposed to lead
through ingestion of contaminated food; use of folk-
remedies, cultural products, and consumer products;
recreational activities; and take-home exposures from
workplaces (Lin et al., 2010; Shah et al., 2017; Task
Force, 2016).
Lead exposure in children is measured by the
concentration of lead in their blood. Between 1991
and 2012, children were identied as having a blood
lead “level of concern” if the test result was 10
micrograms per deciliter (µg/dL) of lead in blood.
However, the Centers for Disease Control and
Prevention (CDC) no longer uses the term “level of
concern” to describe children with elevated blood
lead levels (CDC, 2017). Instead, based on the lack
of scientic evidence for a safe blood lead level in
children, CDC uses a population-based reference
value to identify children with blood lead levels
greater than 97.5% of the children aged 1 to 5
years (CDC, 2017). The blood lead reference value
(BLRV) is not a clinical reference level dening an
acceptable range of blood lead levels in children
nor is it a health-based toxicity threshold; rather it
is a policy tool that helps identify the children in the
upper end of the population blood lead distribution
in order to target prevention eorts and evaluate their
eectiveness.
The current CDC BLRV is 5 μg/dL based on the
97.5th percentile of the distribution of blood lead
levels (BLLs) for children aged 1 to 5 years that was
collected in the ongoing National Health and Nutrition
Examination Survey (NHANES) during the 2007–2008
and 2009–2010 cycles (CDC, 2017). NHANES data
from 2011–2014 show that in children aged 1 to 5
years, the estimated 97.5th percentile of blood lead
INTRODUCTION
SCOPE
Lead exposure to children can result from
multiple sources and can cause irreversible
and life-long health effects. The Action Plan
focuses on reducing exposures from lead
sources and associated health impacts that
present a serious and urgent threat to children,
especially in high-risk communities.
FEDERAL ACTION PLAN TO REDUCE CHILDHOOD LEAD EXPOSURES AND ASSOCIATED HEALTH IMPACTS
6
level is 3.5 μg/dL (Caldwell et al., 2017). Accordingly,
CDC is now evaluating whether to update its BLRV
from 5 to 3.5 μg/dL.*
The risk for lead exposure is not the same for all
children—data show disparities in exposure by
sociodemographic characteristics and geographic
location (Roberts et al., 2017; Hanna-Attisha et al.,
2016; CDC, 2013; CDC, 2016). Furthermore, the
relative contribution of various exposure media
(e.g., house dust, soil, drinking water, food, air)
to BLLs can vary by childhood age and between
those children with elevated BLLs versus lower
BLLs (Zartarian et al., 2017). Analysis of NHANES
data identied important risk factors for elevated
BLLs in U.S. children including: race/ethnicity (non-
Hispanic Black), housing age (pre-1946 and pre-
1973), and poverty level (family income at or below
poverty income ratio) (Caldwell et al., 2017; CDC,
n.d.). The U.S. Department of Housing and Urban
Development’s (HUD’s) American Healthy Homes
Survey data established important housing risk
factors that are associated with a higher prevalence
of lead-based paint hazards, including lower income
households and children living in homes that do not
receive government rental support (Dewalt et al.,
2015).
Average blood lead levels remain increased among
non-Hispanic black children when compared to
Mexican-American and non-Hispanic white children
“Protecting children from exposure to lead is important
to lifelong good health. No safe blood lead level in
children has been identied. Even low levels of lead
in blood have been shown to affect IQ, ability to pay
attention, and academic achievement. And effects of
lead exposure cannot be corrected.”
Centers for Disease Control and Prevention
Source: https://www.cdc.gov/nceh/lead/acclpp/blood_lead_levels.htm
Figure 1: Source - Adapted from https://ptfceh.niehs.nih.gov/features/assets/files/key_federal_programs_to_reduce_childhood_lead_exposures_ and_
eliminate_associated_health_impactspresidents_508.pdf and Brown MJ and Falk H. Toolkit for establishing laws to control the use of lead paint. Module C.iii.
Conducting blood lead prevalence studies. Global Alliance to Eliminate Lead Paint (2017)
______________________
* On January 18, 2017, the CDC’s National Center for Environmental Health/Agency for Toxic Substances and Disease Registry (NCEH/ATSDR) Board of Scientic Counselors voted
to recommend that NCEH/ATSDR lower the current BLRV of 5 μg/dL to 3.5 μg/dL.
FEDERAL ACTION PLAN TO REDUCE CHILDHOOD LEAD EXPOSURES AND ASSOCIATED HEALTH IMPACTS
7
(EPA, 2017; Advisory Committee on Childhood Lead
Poisoning Prevention [ACCLPP], 2012). Non-Hispanic
black children, children living in families below the
poverty level and children living in older housing
have a statistically signicant increased risk of higher
BLLs (EPA, 2017). For 2011–2014, the 95th percentile
for lead in blood in families with incomes below the
poverty level was 3.4 μg/dL, and among those in
families at or above the poverty level it was 2.0 μg/dL
(Caldwell et al., 2017; EPA, 2017).
Reducing exposure to lead and associated health
impacts begins by identifying risk factors at the local
level, improving the identication and monitoring of
lead exposed children, and targeting services and
resources to localities at greatest risk. In collaboration
with partners (e.g., all levels of state, tribal and local
government, the private sector, non-governmental
organizations, philanthropies and community
organizations), federal agencies, as part of their
commitment to this Action Plan, will focus on tribal,
environmental justice, and other communities where
BLL disparities are most pronounced. In the context
of the CDC’s conclusion that even low levels of lead
exposure present a concern for young children and
no safe level exists, the federal government has
identied actions to further reduce exposures to lead
and associated health impacts, especially for those
localities at greatest risk.
Actions to reduce exposures to lead fall under the
following four interconnected goals. These goals are:
• Goal 1: Reduce Children’s Exposure to Lead
Sources
• Goal 2: Identify Lead-Exposed Children and
Improve Their Health Outcomes
• Goal 3: Communicate More Eectively with
Stakeholders
• Goal 4: Support and Conduct Critical Research
to Inform Eorts to Reduce Lead Exposures and
Related Health Risks
Most actions are integrated from the federal level to
regional oces, state, tribal and local governments,
and community stakeholder groups so that the
intended benets reach target populations such as
pre-school and low-income children and providers
serving them, health educators, school ocials,
industrial workers and renovation contractors.
FEDERAL ACTION PLAN TO REDUCE CHILDHOOD LEAD EXPOSURES AND ASSOCIATED HEALTH IMPACTS
8
Goal 1: Reduce Children’s
Exposure to Lead Sources
KEY PRIORITIES: Reduce children’s exposure
to lead-based paint, lead-contaminated drinking
water and lead-contaminated soil.
Objective 1.1. Reduce Children’s Exposure in
Homes and Child-Occupied Facilities with Lead-
Based Paint Hazards
Reducing exposure to lead paint in old housing
continues to oer the potential to signicantly
decrease blood lead levels in the largest number of
children. It is important that a focus on structures
include homes and locations outside the home where
young children spend signicant amounts of time,
such as child care settings and schools (EPA, 2008).
Actions:
• Consider revisions, as appropriate, to the dust-lead
hazard standards to address childhood exposures
to lead-contaminated dust generated from lead-
based paint. (EPA)
• Continue to implement regulations and other
relevant authorities that require individuals and
rms conducting lead-based paint abatement, risk
assessment or inspection to be properly trained
and certied, training programs to be accredited,
and these activities to be conducted according to
reliable, eective and safe work practice standards.
(EPA)
• Increase HUD review of federally assisted projects
to assure individuals and rms conducting lead-
based paint inspections and risk assessments,
abatement and interim controls, are properly
trained and certied to conduct such actions in
federally assisted properties. (HUD)
• Increase the number (or percentage) of certied
renovation rms capable of providing lead-safe
renovation, repair and painting services through
targeted outreach campaigns to contractors;
continue to provide a nationwide list of certied
renovation rms on the EPA’s website. (EPA)
• Reduce lead exposure in rural housing by
promoting the Lead Based Paint Compliance Key
(https://leadpaint.sc.egov.usda.gov/LBPWeb/
lbpQuestionaire), an interactive internet program, to
identify lead mitigation actions and by continuing
to leverage loans for lead abatement activities.
(USDA)
• Expand the targeting of residential lead hazard
reduction programs to the highest risk homes and
communities. (HUD)
• Expand direct collaboration with state, tribal and
local governments on their development of lead
paint hazard reduction strategies under their
Consolidated Plans for community planning and
development, program assistance and their lead
hazard control grants. (HUD)
• Reduce post-disaster lead exposure from
response- and recovery-phase renovations
and repair for structures that are destroyed or
signicantly damaged. (HUD)
Objective 1.2. Reduce Exposure to Lead from
Drinking Water
In 1991, the EPA promulgated the Lead and Copper
Rule (LCR) under the Safe Drinking Water Act, to
minimize lead and copper levels in drinking water.
Recognizing that no safe level of lead in drinking
water had been identied, the LCR set a non-
enforceable health-based maximum contaminant
GOALS
IMPACT:
Federal efforts can further reduce childhood
lead exposures by employing multiple
coordinated approaches that include
strengthening standards, enhancing prevention
and control measures, and implementing long-
lasting infrastructure improvements.
Public lead outreach and education event.
FEDERAL ACTION PLAN TO REDUCE CHILDHOOD LEAD EXPOSURES AND ASSOCIATED HEALTH IMPACTS
9
level goal of zero for lead and requires a treatment
technique to reduce lead levels to the extent feasible.
Under the LCR, water systems must work with their
customers to collect tap samples from locations with
lead service lines and/or leaded plumbing materials.
The LCR requires water systems that are not able to
limit lead levels below EPA’s action level for lead in
water of 15 µg/liter by optimizing corrosion treatment
to replace service lines that are made of lead and
conduct public education. Progress in reducing
lead exposures has resulted, in part, from improving
implementation of and compliance with the current
LCR (EPA, 2018c).
Actions:
• Revise the LCR based on input EPA recently
received from state, tribal and local partners, as
well as the best available peer reviewed science,
to ensure the rule reects the best ways to improve
public health protection and reduce levels of lead in
drinking water. (EPA)
• Enhance implementation of the LCR by engaging
with state, tribal, local and other stakeholders to
identify implementation challenges, best practices
and tools to address these challenges. (EPA)
• Assist schools and child care centers with the 3Ts
approach (Training, Testing and Taking Action) to
reduce lead in drinking water and increase the
number of schools and child care centers that test
and provide parents with information on how to
minimize children’s exposure to lead in drinking
water. (EPA)
• Finalize regulatory changes to the denition of lead-
free plumbing products and make other conforming
changes to implement the Reduction of Lead in
Drinking Water Act and the Community Fire Safety
Act enacted by Congress. The nal regulation
is expected to result in fewer sources of lead in
drinking water by implementing new standards for
lead content in plumbing materials used in new
installations and repairs. (EPA)
• Collaborate with states and tribes to provide
opportunities for low-interest loans and grants
through the Drinking Water State Revolving
Fund and the Water Infrastructure Finance and
Innovation Act loan program for updating and
replacing drinking water infrastructure. (EPA)
• Implement three newly authorized grant programs
under the Water Infrastructure Improvements for
the Nation Act, for which Congress appropriated
$50 million in FY2018, to fund grants to small
and disadvantaged communities for developing
and maintaining infrastructure, for lead reduction
projects, and to support the voluntary testing of
drinking water in schools and child care centers.
These programs decrease exposure to lead in
drinking water by providing nancial incentives to
test, educate and replace infrastructure. (EPA)
• Provide low-interest loans and grants to rural
communities for drinking water infrastructure.
(USDA)
Objective 1.3. Reduce Exposure to Lead in Soil
Lead can be a relatively common soil contaminant
as a result of past and current human activity or
uses (i.e., lead paint deposited in surface soil),
and natural occurrence (ATSDR, 2017; EPA, 2017).
Young children often have higher rates of soil and
dust ingestion because of their unique behaviors
such as crawling and hand/object-to-mouth contact
(Task Force, 2016). As such, children who play
in areas near former mining and smelting sites,
Soil cleanup on a residential property.
FEDERAL ACTION PLAN TO REDUCE CHILDHOOD LEAD EXPOSURES AND ASSOCIATED HEALTH IMPACTS
10
manufacturing facilities, processing plants, landlls,
and buildings with exterior lead-based paint may
be exposed through incidental ingestion of small
amounts of soil or soil-derived indoor dust (ATSDR,
2017). Soil near roadways (Mielke et al., 2013) and
in yards, playgrounds, gardens and elsewhere in
the community may also be a source of exposure.
Contaminated soil can also be tracked into the home.
Progress has been made to ensure community
residents are better protected, informed and
involved in site cleanup decisions. EPA actions
to reduce childhood exposure from lead in soil
include: managing lead contamination at Superfund,
Resource Conservation and Recovery Act (RCRA)
Corrective Action and other sites through removal,
remedial and corrective actions; sponsoring lead
education events in communities that include oering
free testing of soil from residential yards and gardens
and blood lead testing for children; updating the
Superfund Lead-Contaminated Residential Sites
Handbook; and oering technical assistance to
browneld communities to identify best management
practices and potential funding opportunities.
Actions:
• Manage lead contamination at Superfund, RCRA
Corrective Action and other sites to reduce
exposure to community residents. (EPA; HHS/
ATSDR)
• Continue to reduce childhood exposures to lead
in soils through removal, remedial and corrective
actions at contaminated sites and reduce lead
soil exposures to the most sensitive community
residents. (EPA)
• Expand the use of Soil Screening, Health, Outreach
and Partnership (SoilSHOP) health education
events to inform community members about
the lead content of the soil in their immediate
environments and best practices for safer
gardening and prevention of childhood lead
exposure. (HHS/ATSDR)
• Continue to support the evaluation of lead
exposure at contaminated sites and identify ways
to protect the public’s health. (HHS/ATSDR; EPA)
Other Objectives: Addressing other sources of lead
and enforcing and providing compliance assistance
with the laws aimed at reducing lead exposures will
further reduce exposures.
Objective 1.4. Reduce Exposure to Lead
Associated with Emissions to Ambient Air
As a result of several regulatory actions over the past
two decades, lead emissions in air have substantially
declined (EPA, 2014a; EPA, 2014b; Task Force,
2016; EPA, 2018d). However, lead is still emitted
into ambient air from a variety of sources, including
metals processing facilities and combustion of leaded
aviation fuel (avgas) by aircraft with piston engines
(EPA, 2014a; Task Force, 2016). Currently, the source
category with the greatest contribution to total U.S.
air emissions is piston-engine aircraft operating on
leaded fuel (EPA, 2018d; Task Force, 2016). The
highest air concentrations in individual locations
are currently found near secondary lead smelting
operations, such as battery recycling facilities and
other metal processing facilities (EPA, 2014a; Task
Force, 2016). As detailed below, federal agencies
are taking several steps to assess and manage lead
emissions from these sources.
Actions:
• Continue to work with state and tribal air agencies
to implement the National Ambient Air Quality
Standard (NAAQS) for lead and aim to reduce the
number of areas violating the lead NAAQS. (EPA;
HHS)
• Evaluate the impacts of lead emissions from aircraft
using leaded aviation fuel under the Clean Air Act.
(EPA)
• Conduct a research and development program
for evaluating unleaded aviation fuels through
the Piston Aviation Fuel Initiative. (Department
of Transportation (DOT)/Federal Aviation
Administration (FAA))
FEDERAL ACTION PLAN TO REDUCE CHILDHOOD LEAD EXPOSURES AND ASSOCIATED HEALTH IMPACTS
11
Objective 1.5. Reduce Lead Exposure from
Occupational Sources
The Occupational Safety and Health Administration
(OSHA) enforces workplace standards for lead that
include a permissible exposure limit for workers’
exposure to airborne lead and temporary medical
removal protection provisions for workers with
elevated blood lead levels, in addition to other
requirements. OSHA is exploring regulatory options
to lower blood lead levels in aected workers.
Actions:
• Publish an Advanced Notice of Proposed
Rulemaking to seek input from the public on
possible areas of the lead standards for revision
to improve protection of workers in industries and
occupations where preventable exposure to lead
continues to occur. Children may be exposed to
lead if their parents or other adults in the household
transfer lead from the workplace to their home or
vehicle. (Department of Labor (DOL)/OSHA)
• Reduce occupational exposure to lead, including
take-home exposure to children, by incorporating
information on such hazards and how to avoid
them into training courses/materials developed and
conducted by the National Institutes of Health’s
(NIH) National Institute of Environmental Health
Sciences (NIEHS) Worker Training Program. (HHS/
NIEHS)
Objective 1.6. Reduce Exposure to Lead in Food
To assess the risk of lead in food, the FDA currently
uses an interim reference level of 3 micrograms per
day to assess the risk of lead in food for children.
Following good agricultural and manufacturing
practices can minimize lead contamination of foods.
Actions:
• Reevaluate the provisional tolerable total dietary
intake level as a tool for assessing risk linked to
exposure to lead in any particular food. (HHS/FDA)
• Consider increased monitoring of domestic and
imported foods for lead. (HHS/FDA)
• Consider whether to establish maximum lead levels
in foods by regulation or by guidance. (HHS/ FDA)
• Participate in decreasing the Codex Alimentarius
General Standard for Contaminants and Toxins in
Food and Feed’s maximum levels for lead in food
worldwide. (HHS/FDA)
Objective 1.7. Reduce Exposure to Lead in
Cosmetics and Personal Care Products
Because of its background presence in the
environment, lead may occur as an impurity in
ingredients used in some cosmetic products.
Actions:
• Continue to monitor domestic and imported
cosmetics for lead impurities. (HHS/FDA)
• Participate in international lead reduction eorts.
(HHS/FDA)
• Monitor and post results of lead levels in cosmetic
products, including tattoo inks, through FDA’s
survey activities. (HHS/FDA)
• Issue nal guidance for a maximum lead level in
cosmetic products. (HHS/FDA)
Objective 1.8. Reduce Exposure to Lead in
Consumer Products
The Consumer Product Safety Commission (CPSC)
limits total lead content of children’s products and
bans paints intended for consumer use, certain
Soil cleanup of a Superfund site.
FEDERAL ACTION PLAN TO REDUCE CHILDHOOD LEAD EXPOSURES AND ASSOCIATED HEALTH IMPACTS
12
furniture articles, children’s toys and other articles
intended for use by children that bear lead-containing
paint. CPSC requires that certain paints that are not
banned must have cautionary labeling.
Actions:
• Continue to enforce regulations regarding lead
content and lead paint limits for consumer
products. (CPSC)
• Continue to enforce labeling requirements to
prevent consumer product-related lead exposure.
(CPSC)
• Work internationally to improve foreign suppliers’
compliance with U.S. lead-based paint and total
lead content requirements. (CPSC)
Objective 1.9. Reduce Lead Exposure Through
Enforcement and Compliance Assistance
Congress has given federal regulatory agencies and
the Department of Justice (DOJ) authority to employ
a wide range of options to assure compliance with
and enforce the laws that help reduce the sources
of lead in children’s environments. Options may
include formal or informal administrative actions by
the regulatory agency or judicial enforcement through
a referral to DOJ for a civil enforcement action or
criminal prosecution. EPA and HUD are the regulatory
agencies that conduct administrative enforcement
and provide compliance assistance for homes and
child-occupied facilities with lead-based paint, lead-
contaminated drinking water, and lead-contaminated
soil.
DOJ supports the regulatory agencies’ focus on
addressing lead exposures. DOJ is committed to
the vigorous enforcement of the law and seeks to
prioritize action on agency referrals of cases involving
actual or potential childhood exposure to lead,
particularly when these cases are time sensitive and
require rapid action to protect human health.
The goals of DOJ’s civil enforcement actions are
generally to require violators to come into compliance
and take measures to stop ongoing violations,
remedy harm to public health or the environment,
remove the economic benets of noncompliance, and
punish and deter violations through civil penalties.
Although less common, criminal enforcement is
also a key component of the overall enforcement
scheme. It deters subsequent violations through
criminal penalties, including nes, imprisonment and
probation, and provides restitution for crime victims.
DOJ will coordinate and collaborate with federal
agencies, U.S. Attorneys’ oces and states and
tribes to share information and develop enforcement
cases. DOJ will also seek opportunities to provide
training to attorneys bringing enforcement cases
intended to reduce the sources of lead exposure to
children.
Goal 2. Identify Lead-Exposed
Children and Improve Their Health
Outcomes
KEY PRIORITIES: Improve identication of
children exposed to lead through surveillance
of BLL data and foster access to services and
support designed to improve children’s physical,
developmental and mental health. Ideally, these
services would be provided through a patient-
centered medical home in a coordinated system
of care.
Objective 2.1. Improve Surveillance of Blood Lead
Levels (BLLs) to Identify Children Exposed to Lead
Children can be given a blood test to measure the
level of lead in their blood. These tests are covered
by Medicaid, if the children are covered by Medicaid,
and most private health insurance plans.
Actions:
• Evaluate updating the blood lead reference value.
(HHS/CDC)
• Rene national health objectives (e.g., Healthy
People objectives) for BLLs in children to focus
on populations at highest risk for exposure. (HHS/
Oce of the Assistant Secretary for Health)
• Explore ways to improve the utility of required
blood testing of children enrolled in Medicaid and
receiving services from the Supplemental Nutrition
Program for Women, Infants, and Children (WIC).
(HHS/Centers for Medicare & Medicaid Services
(CMS)/CDC; USDA)
IMPACT:
Expanding the federal government’s efforts to
identify children in high-risk communities will
target resources for interventions and services
and improve health outcomes.
FEDERAL ACTION PLAN TO REDUCE CHILDHOOD LEAD EXPOSURES AND ASSOCIATED HEALTH IMPACTS
13
• Conduct targeted screening surveys and/or small-
area prevalence studies to identify localities with
high lead exposure risk. (HHS/CDC)
• Better understand childhood lead exposures
through collaboration with tribal partners and
identifying exposure scenarios; identify appropriate
data, improve federal programs, services, and
blood lead testing opportunities for Native
American children. (HHS/Indian Health Service/
CDC; EPA; HUD; USDA)
Objective 2.2: Facilitate Follow-up Blood Lead
Testing and Monitoring of Children Identied as
Lead-Exposed
A primary purpose of blood lead testing is to identify
children with lead exposure before they show signs
and symptoms and ensure that they promptly receive
services to identify exposure pathways, reduce
exposures, and reduce the potential impacts of lead
exposure. State, tribal and local health agencies use
blood lead test results above a designated public
health action level to initiate lead investigations in
the child’s home, once a child is identied as lead-
exposed. Case management activities are initiated
at varying blood lead “action” levels based on
applicable jurisdictional laws and regulations, as well
as available local resources.
Pediatric Environmental Health Specialty Units
(PEHSUs), jointly funded by EPA and HHS/ATSDR,
work with healthcare professionals, parents, schools
and community groups, and with federal, state,
tribal and local agencies to address children’s
environmental health issues in homes, schools and
communities. PEHSUs can facilitate training of health
providers who serve lead-exposed children and their
families.
Actions:
• Explore creative ways to work with state, tribal and
local communities to match children identied as
lead-exposed with local environmental assessment
services and enhanced health services. (HUD;
HHS/CDC/CMS)
• Support the eorts of the PEHSUs to increase the
number of obstetricians, pediatricians and nurses
with continuing education on prevention, diagnosis,
management and treatment of lead exposure. (EPA;
HHS/ATSDR)
Objective 2.3. Facilitate Screening for
Developmental Delays in Children Identied as
Lead-Exposed
Once a child is identied as at-risk for developmental
delays because of lead exposure by state, tribal and
local ocials based on their criteria, assessment
of the child’s developmental progress over time by
healthcare providers facilitates early identication of
any developmental delays.
Early identication of developmental delays allows
providers and communities to intervene earlier
to improve outcomes. Guidance co-sponsored
by EPA and ATSDR through PEHSUs and the
American Academy of Pediatrics (AAP) states that
lead exposure should be viewed as a lifelong issue,
rather than an acute exposure (Newman et al., 2013).
Because children with elevated BLLs are at high
risk for developmental problems, the AAP further
recommends continued screening for developmental
delays and mental, emotional and behavioral
disorders in those children as they age (Newman et
al., 2013).
Actions:
• Work across government and non-government
agencies in communities where surveillance has
identied children with higher BLLs. Encourage
primary care and other providers to promote
developmental monitoring by providing CDC’s
“Learn the Signs. Act Early.” (LTSAE) materials
(https://www.cdc.gov/ncbddd/actearly/milestones/
index.html) to parents and other caregivers when a
child under ve years of age has documented lead
exposure. (HHS/CDC/NIH Eunice Kennedy Shriver
National Institute of Child Health and Human
Development)
• Link CDC’s LTSAE web materials, “Birth to Five:
Watch Me Thrive!” and other child developmental
monitoring information with CDC’s lead webpages
and with at least two technical assistance and
support webpages serving HHS early childhood
grantees. (HHS/CDC)
FEDERAL ACTION PLAN TO REDUCE CHILDHOOD LEAD EXPOSURES AND ASSOCIATED HEALTH IMPACTS
14
Objective 2.4. Facilitate Referrals and Receipt of
Appropriate Services for Children Identied as
At-Risk for Developmental Delays Due to Lead
Exposure
Children with developmental delays or at high risk for
developmental delays benet most from interventions
that start at an early age (HHS, 2015). Thus, timely
identication and referral to services are critical.
Increasing referrals to appropriate services could
improve child and family outcomes beyond the
cognitive and behavioral sequelae of lead exposure.
Family-to-Family Health Information Centers (F2F
HICs) provide information, education, technical
assistance and peer support to families of children
and youth with special healthcare needs and the
professionals who serve such families. F2F HICs
are staed by families with children and youth with
special health needs.
The Maternal and Child Environmental Health
Collaborative Improvement and Innovation Network
supports coordinated systems of care in 10 states
that will use a quality improvement framework and
collaborative learning to improve coordination of the
many services needed by lead-exposed children.
Participating states will also develop or update a
state action plan to decrease children’s exposure to
lead.
Actions:
• Facilitate the development of state action plans and
improve access to coordinated systems of care for
children exposed to lead in all states participating
in the Maternal and Child Environmental Health
Collaborative Improvement and Innovation
Network. (HHS/Health Resources and Services
Administration (HRSA))
• Provide one-on-one risk assessments and
counseling to individuals concerning lead
exposures and developmental milestones and
provide resources related to lead exposures
for families through the Maternal and Child
Environmental Health Network. (HHS/HRSA)
• Provide training to F2F HICs on the implications of
lead exposures and resources to support families
who are exposed to lead. (HHS/HRSA)
• Provide PEHSUs and public health agencies in
at least 25 states with information and resources
about eective treatments for mental, emotional,
behavioral and developmental disorders and
developmental monitoring related to lead exposure.
(EPA; HHS/ATSDR/CDC)
Goal 3: Communicate More
Eectively with Stakeholders
KEY PRIORITIES: Improve public awareness of
the dangers associated with lead exposure by
consolidating and streamlining federal messaging
on reducing exposures to lead.
IMPACT:
Communicating early and often with all
stakeholders will assist state, tribal and
local governments in their on-the-ground
community-based efforts to reduce lead
exposures in their communities and
provide information for community
members including parents.
Community health fair.
FEDERAL ACTION PLAN TO REDUCE CHILDHOOD LEAD EXPOSURES AND ASSOCIATED HEALTH IMPACTS
15
Objective 3.1. Consolidate and Streamline Federal
Lead-Related Communication and Messaging
To ensure that stakeholders receive consistent
and accurate messages on lead, the Task Force
will work collaboratively to expand federal
communication eorts by leveraging existing
partnerships and stakeholder relationships and
develop a comprehensive and eective federal-wide
communications and outreach plan for reducing
exposures to lead.
Actions:
• Create an online portal to enhance, consolidate
and streamline federal-wide communication to
the public. Links will direct the public to agency-
specic information. (Not everyone aected by
lead exposures has access to the internet, and
therefore, agencies will continue to provide access
to printed materials.) (Steering Committee)
• Provide periodic updates on the progress of
implementing the Action Plan on the online portal.
(Steering Committee)
• Enhance local partnerships with community
organizations, local health agencies, faith-based
organizations and private philanthropies to raise
awareness of the dangers of exposure to lead-
based paint hazards, and to promote data sharing.
(Steering Committee)
Objective 3.2. Improve Awareness of Lead
Hazards, Prevention, and Remediation among
Diverse Populations, Especially Those Most at
Risk
As each community is diverse and deals with a
variety of challenges, a one-size-ts-all approach
is not eective at increasing prevention awareness.
Therefore, it is imperative that outreach activities
be designed specically for diverse populations—
especially racial and ethnic minorities, recent
immigrants and limited English prociency
populations who are at highest risk of being exposed
to lead—taking into account factors such as income,
education, internet access, healthcare access,
cultural and other considerations.
When developing outreach and education materials
for various communities, the NIEHS/EPA Children’s
Environmental Health and Disease Prevention
Research Centers (“Children’s Centers”) and PEHSUs
can serve as important resources. In addition to
conducting scientic studies on environmental
health issues, each Children’s Center collaborates
with various community partners and organizations
to inform, advance and disseminate information for
public health protection.
Actions:
• Utilize the Children’s Centers and PEHSUs
to develop appropriate, evidence-based
lead exposure prevention and intervention
communication materials and disseminate them
through the Centers’ established community
partnerships. (Steering Committee)
• Enhance partnerships with state, tribal and local
governments, and key stakeholders (e.g., media,
community groups, faith-based groups, advocacy
groups, departments of health, departments
of environmental quality, medical providers,
philanthropies, federal grantees and others)
that represent or serve communities at risk for
childhood lead exposure. (Steering Committee)
• Increase outreach events and engagement
processes in collaboration with at-risk communities
and lead-safe coalitions to provide education
on the dangers of lead exposures, strategies
for reducing exposures in children, and actions
to support exposed children and their families.
(Steering Committee)
Exhibit at a health fair.
FEDERAL ACTION PLAN TO REDUCE CHILDHOOD LEAD EXPOSURES AND ASSOCIATED HEALTH IMPACTS
16
Goal 4: Support and Conduct
Critical Research to Inform Eorts
to Reduce Lead Exposures and
Related Health Risks
Building on past and current lead research, this
goal focuses on addressing critical information
gaps, identifying and eliminating duplication of
eorts and maximizing leveraging and coordination
opportunities. Because of disparities in BLLs and
because lead sources vary by location (CDC,
2016) and relative exposure pathway, approaches
are needed to evaluate the contributions of
multimedia lead exposures and identify risk factors
at the local level (Zartarian et al., 2017). Childhood
lead exposure is a multifaceted, multimedia
issue with critical information and data gaps
remaining. Research eorts through cross-agency
collaborations are needed to address key information
gaps for identifying children at highest risk, and
understanding, preventing, and mitigating lead
exposure and related health eects.
KEY PRIORITIES: Prioritize and address the
critical research and data needs to inform lead
policies and guide decisions.
Objective 4.1. The majority of the research to
address the actions identied under this goal is
expected to be implemented by EPA, HHS and
HUD; other agencies will also conduct lead-focused
research, as needed, to support their missions.
Actions:
• Enhance and apply data and tools (e.g., models or
approaches) and determine the key drivers of blood
lead levels from multimedia exposures to inform
lead regulatory decisions and site assessments.
(Informs Goals 1, 2)
• Generate data, maps and mapping tools to
identify high exposure communities or locations
and disparities for prioritization eorts to reduce
children’s blood lead levels. (Informs Goals 1, 2, 3)
• Generate data to address critical gaps for reducing
uncertainty in lead modeling and mapping
for exposure/risk analyses and for estimating
population-wide health benets of actions to
reduce lead exposures. (Informs Goals 1, 2, 3)
• Identify approaches to prevent, mitigate, and
communicate about lead exposures and risks in
exposed communities. (Informs Goals 1, 2, 3)
• Evaluate the eectiveness of actions (e.g.,
interventions, programs, policies, enforcement) to
prevent lead exposure, mitigate health eects and
communicate on lead exposures/risks. (Informs
Goals 1, 2, 3)
Implementing the actions in Objective 4.1 will require
eective collaboration among the federal agencies.
An interagency workgroup is working to further
dene, prioritize and address the critical research
needs. The outcomes are expected to inform lead
policies and guide decisions through the application
of tools, data, information, and approaches, and
identication of the most eective public health
practices to reduce children’s lead exposures
and its health impact. Prioritizing, leveraging and
coordinating lead research among agencies will
identify opportunities to increase the value of
individual agency eorts, while remaining cognizant
of the dierent missions, capabilities and resources
of the various federal agencies.
IMPACT:
Advance scientic understanding of
multimedia lead exposures and their
relationship to BLLs, and improve/provide
data, tools, methods, and technologies for
targeting effective prevention
and mitigation solutions.
FEDERAL ACTION PLAN TO REDUCE CHILDHOOD LEAD EXPOSURES AND ASSOCIATED HEALTH IMPACTS
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Objective 4.2. Establish the Lead Exposure and
Prevention Advisory Committee (LEPAC). The
Water Infrastructure Improvements for the Nation
Act requires HHS to establish LEPAC as a federal
advisory committee. It will review research and
federal programs and services and identify eective
services and best practices for addressing and
preventing lead exposure and its impacts in aected
communities.
Action:
• Establish, convene and support the work of the
LEPAC. (HHS/CDC/ATSDR)
FEDERAL ACTION PLAN TO REDUCE CHILDHOOD LEAD EXPOSURES AND ASSOCIATED HEALTH IMPACTS
18
APPENDIX I: ACKNOWLEDGEMENTS
The Task Force Senior Steering Committee Co-Chairs Sandra Howard (HHS) and Michael
Firestone (EPA) thank all of the federal partners for their eorts and contributions in developing
the Federal Action Plan to Reduce Childhood Lead Exposures and Associated Health Impacts.
In particular, we acknowledge the work of the Lead Subcommittee, co-chaired by Michael
Firestone (EPA/Managing Co-Chair), Adrienne Ettinger (HHS) and Warren Friedman (HUD);
Manthan Shah (EPA) and Kimberly Thigpen Tart (HHS) for their assistance in preparing this
document; Linda Birnbaum (HHS) for her support for community engagement activities; and
Amanda Hau (EPA) for the tribal outreach eort.
The following individuals served as goal team leads:
• Goal 1: Michael Firestone (EPA); Warren Friedman (HUD)
• Goal 2: Adrienne Ettinger (HHS); Sharunda Buchanan (HHS); Jennifer Kaminski (HHS); Ann
Ferrero (HHS); and Joan Scott (HHS)
• Goal 3: Angela Hackel (EPA) and Sharon Ricks (HHS)
• Goal 4: Valerie Zartarian (EPA); Suril Mehta (HHS) and Peter Ashley (HUD)
Many other individuals across 17 federal agencies contributed and collaborated to identify the
objectives most important to reduce exposures to lead and protect the health of children. We
thank them for their contributions.
FEDERAL ACTION PLAN TO REDUCE CHILDHOOD LEAD EXPOSURES AND ASSOCIATED HEALTH IMPACTS
19
APPENDIX II: LIST OF ACRONYMS
AAP American Academy of Pediatrics
ATSDR Agency for Toxic Substances and Disease Registry
BLL Blood Lead Levels
BLRV Blood Lead Reference Value
CDC Centers for Disease Control and Prevention
CMS Centers for Medicare & Medicaid Services
CPSC U.S. Consumer Product Safety Commission
DOJ U.S. Department of Justice
DOL U.S. Department of Labor
DOT U.S. Department of Transportation
EPA U.S. Environmental Protection Agency
FAA Federal Aviation Administration
FDA U.S. Food and Drug Administration
F2F HIC Family-to-Family Health Information Center
HHS U.S. Department of Health and Human Services
HRSA U.S. Health Resources and Services Administration
HUD U.S. Department of Housing and Urban Development
LCR Lead and Copper Rule
LEPAC Lead Exposure and Prevention Advisory Committee
LTSAE CDC’s “Learn the Signs. Act Early.” Program
NAAQS National Ambient Air Quality Standard
NCEH National Center for Environmental Health
NHANES National Health and Nutrition Examination Survey
NIEHS National Institute of Environmental Health Sciences
OSHA Occupational Safety and Health Administration
PEHSU Pediatric Environmental Health Specialty Unit
RCRA Resource Conservation and Recovery Act
SoilSHOP Soil Screening, Health, Outreach and Partnership
USDA U.S. Department of Agriculture
FEDERAL ACTION PLAN TO REDUCE CHILDHOOD LEAD EXPOSURES AND ASSOCIATED HEALTH IMPACTS
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PRESIDENT’S TASK FORCE ON ENVIRONMENTAL
HEALTH RISKS AND SAFETY RISKS TO CHILDREN
U.S. Consumer Product Safety Commission www.cpsc.gov
U.S. Department of Agriculture www.usda.gov
U.S. Department of Education www.ed.gov
U.S. Department of Energy www.energy.gov
U.S. Department of Health and Human Services www.hhs.gov
U.S. Department of Homeland Security www.dhs.gov
U.S. Department of Housing and Urban Development www.hud.gov
U.S. Department of Justice www.justice.gov
U.S. Department of Labor www.dol.gov
U.S. Department of Transportation www.transportation.gov
U.S. Environmental Protection Agency www.epa.gov
Council of Economic Advisers www.whitehouse.gov/administration/eop/cea
Council on Environmental Quality www.whitehouse.gov/administration/eop/ceq
Domestic Policy Council www.whitehouse.gov
National Economic Policy Council www.whitehouse.gov
Oce of Management and Budget www.whitehouse.gov/omb
Oce of Science and Technology Policy www.whitehouse.gov/administration/eop/ostp
