I appreciate the
opportunity to provide the NGO perspective at this conference. Experience
has shown in country after country that achieving progress on lead poisoning
requires partnerships among government, the private sector, and NGOs.
The Alliance that I represent is a leading policy and advocacy public
interest organization dedicated to lead poisoning prevention. The Alliance
was formed in 1990, with an initial focus on dealing with lead-based
paint hazards in housing, the major cause of childhood lead poisoning
in the US. The compelling global nature of lead poisoning prompted an
early expansion of the Alliance's mission.
- In 1992, we surveyed
the Global Dimensions of lead poisoning in a report done jointly
with the Environmental Defense Fund.
- In 1994 we convened
the First International Lead Poisoning Prevention Conference.
- We have been
instrumental in gaining commitments to lead poisoning prevention in
several international fora: UN Commission on Sustainable Development;
Habitat II; and Summit of the Americas.
- We are now working
with NGO's in many countries and will soon have in place an electronic
network to link local advocates to share information on best practices
on policies and programs for prevention
I welcome Dr. George's
decision to focus the final day of this conference on developing an
Action Plan. I can personally testify to the power of action plans.
When the Clinton Administration first took office in 1992, the Alliance's
national action plan helped make lead poisoning an Administration priority.
Our International Action Plan provides a policy framework for prevention
strategies, identifies the roles and responsibilities of different disciplines
and sectors, and highlights the complementary efforts needed at the
international, regional, national, and community levels. Several other
countries have found this Action Plan helpful. Perhaps, this Plan can
provide ideas for India as well.
Where Is India
Now on Lead Poisoning Prevention?
This morning, I
want to provide an advocate's view on where India now stands and offer
a few thoughts for your consideration in developing India's Action Plan.
At the outset, I must tell you that I am surprised and encouraged at
how far India has come in the past 2-3 years. Project Lead-Free
has demonstrated forcefully that India has a serious lead poisoning
problem. Of course, the data are not complete or perfect -- they never
are. But the point is that you have already collected sufficient data
to demonstrate convincingly that India has a serious lead poisoning
problem.
I was also surprised
by the level of consensus and the clarity of understanding of the sources
of lead poisoning in India. The priorities, as I heard them in workshop
discussions are: leaded gas first and foremost, followed by (in some
order) battery recycling, jewelry production, surma and home remedies,
and glazes and paints. You now have a very good grasp of what the sources
are, and in each case, you have a clear understanding of what control
measures are needed. The challenge now facing India is to shift energy
and attention beyond blood lead screening and surveillance to primary
prevention by taking bold action to control significant sources of exposure.
In most of these
cases, the government has the power to correct the problem, but the
Government of India by all accounts places little urgency on lead poisoning
and is not responsive. The general population seems to know and care
little about lead poisoning. India also apparently has a limited tradition
of broad-based environmental or consumer movements.
Another important
factor is that India has many other public health and environmental
problems, -- each of which at some level competes for resources and
attention against the others. So what will it take to break this circle
of policy paralysis? First, a problem with achievable solutions. Second,
a problem whose solutions provide broader benefits. That's why I believe
that lead poisoning prevention offers a logical starting place for India
to make advances in environmental and public health.
What Is an Action
Plan?
Action Plans mean
different things to different people. I believe that an effective Action
Plan needs to provide both a long term vision of what success looks
like as well as identifying the strategic next steps for the near term.
The Action Plan's time horizon must be long enough not to disqualify
strategies that will take several years to implement. At the same time,
the Action Plan needs to identify the next steps that are needed now
to break the equilibrium.
The Action Plan
needs to be focused on the ultimate goal: primary prevention through
source control. The elements of the plan then need to serve - and must
be continually checked against - that primary prevention goal. Screening
and research may remain important strategies. But in the future, these
activities will need to be designed and executed to serve the larger
strategic objective of primary prevention.
Obviously, elements
of the Action Plan need to address each of the major sources of exposure.
You all know more than I do about the nuts and bolts that are specific
to India. I want to offer one general word of warning and suggest seven
generic strategies that I hope you will make part of your Action Plan.
First, I want to urge you to avoid falling into the trap of pitting
one source against others. In country after country, industry has paralyzed
prevention efforts by playing one source against another. The truth
is that all major exposure sources are important and all lead exposures
are additive. Of course you must set priorities, but you also need to
build in the flexibility to identify and respond to opportunities as
they are created to control lead exposures.
Now let me turn
to the crosscutting strategies that will help to ensure the relevance
of your Action Plan as a lever for change.
1. Expanding
the Base
Historically, those
involved in the health and medical sectors have provided the leadership
in lead poisoning prevention - and the mix of people in this room reflects
that reality. You all have seen the tragedy of lead poisoning first
hand and each of you cares deeply about protecting children from exposure
to lead. At the same time, I think that each of you here today realizes
that you yourselves don't have the power to effect change. So, first
and foremost, your Action Plan needs to identify strategies for expanding
the constituency of support for lead poisoning prevention.
If you all don't
have the power to force source control, then you need to identify whom
you need to recruit as allies. Just consider what could happen if the
people in this room used your credibility, leverage, and contacts to
convince the computer industry in India to get behind lead poisoning
prevention. If the computer industry cared, think how much faster the
Government would be likely to respond. Imagine how much faster India
could achieve source control.
The allies you recruit
need to be strategically selected based on the control strategies that
are your priorities. You may not know it, but you have a powerful ally
in phasing out leaded gasoline, the auto industry. Auto manufacturers
seem to have difficulty finding the voice to forcefully express their
interest in leaded gas phase-out You can help them. Think of other groups
that have power and credibility: schoolteachers, university students,
labor organizations, religious groups.
2. Press Strategy
The Action Plan
also needs to have a press strategy, not simply to draw attention to
lead poisoning as a problem, but to engage the press in issues related
to source control. The George Foundation has done a tremendous job in
directing the media's attention to India's lead poisoning problem. But
I must prepare you: by the end of this week, the fact that India has
a lead poisoning problem will be "old news." Keeping lead poisoning
in the press will require focusing attention on control actions - and
building pressure for government policies and programs and private industry
responsibility. The press needs substantive stories related to source
control; they need controversy; they need villains; they need irony;
and all the rest. You already know the stories that need to be told.
You just need to make it easy for the press to provide them in depth
and in responsible coverage.
We have found in
the US that statistics on lead poisoned children and prevalence rates
grow stale quickly. In the US, framing lead poisoning in terms of children's
learning and success in school has proven the best way to reach key
audiences. You need to decide if this is the best context for India
- or if it should be the loss of human capital, or sustainability, or
national competitiveness in the 21st century. Whatever you decide, you
need to find ways to make the problem vivid: What percent of the children
starting school in each city have previously been lead poisoned? How
many million IQ points has lead poisoning cost India this year?
.
3. Education
Strategy
The Action Plan
also needs an education strategy. I would urge you to think of education
broadly. So often education is viewed narrowly in terms of trying to
change individual behavior. While clearly there is a need for that,
education can also be aimed at broadening the constituency for prevention
- educating policy makers to change their behavior - and building pressure
on government and private companies. So I would urge you to think about
education as a vehicle for policy change and constituency building,
not simply for changing individual behavior.
4. Leaded
Gasoline Phase-Out as a Strategy
Obviously, leaded
gasoline phase-out must be a top priority of the Action Plan, and a
variety of strategies are needed to ensure rapid phase-out. But your
Action Plan needs to make strategic use of leaded gasoline phase-out
to advance other longer-term prevention goals. Leaded gasoline provides
the opportunity for a clear and early victory, and movements need victories
to build momentum. Leaded gasoline phase-out also provides the opportunity
for building broader networks, recruiting new allies who will then continue
in the movement.
Leaded gasoline
phase-out is also the first step in much larger journey, because eliminating
lead in gasoline is a prerequisite to introducing catalytic converters
and improved engine technology - advances that can reduce auto emissions
by up to 90%. So I would urge you to think creatively about how to use
leaded gasoline phase-out strategically to serve these larger goals.
Start by framing the challenge not simply in terms of removing lead
but in terms of clean fuels that improve engine performance and fuel
economy while reducing aromatics and other emissions. India needs modern
automobile emissions controls just as much as you need to eliminate
tetraethyl lead.
5. Local Crisis
Strategy
While some lead
exposures in India, such as leaded gasoline, are countrywide, others
are intensely local. Your Action Plan therefore needs to have a strategy
for responding to lead poisoning "hot spots" caused by local sources.
The Action Plan should address not only the services that need to be
provided (by the Government or others) to respond to and treat children's
lead exposure, but also advocate strategies that will mobilize action
to control localized sources. In highly exposed communities, the Action
Plan could encompass community needs and resource assessments as a way
of engaging local leaders and building local constituencies for prevention.
Most political systems respond faster to local pressure.
6. Transnational
Strategy
I would hope that
your Action Plan would also take advantage of outside forces and opportunities
to move India to prevention. For example, you may be able to pressure
the Government of India to live up to international agreements related
to lead poisoning prevention. The Alliance is now pursuing regional
strategies for lead poisoning prevention. Initially, we have been concentrating
on Latin America. The multiple opportunities presented by this conference
allowed us to convene a meeting in Bangkok last week of NGO, government,
and private sector representatives from nine countries to focus on source
control policies. I would also hope that advocates in India will participate
in the Alliance's international electronic network focused on best practices
for advancing source control.
7. Boldness
Strategy
Finally, I want
to urge you to think boldly in this Action Plan and in your advocacy.
This Action Plan provides the chance for some of you to use the other
side of your brains - to be wildly creative - to think outside the box.
In the brainstorming mode last night, a few of us came up with three
ideas:
- What is the primary
reason that 50% of children in India's cities are lead poisoned? You
all have told me again and again: leaded gasoline. And who makes leaded
gasoline? The sole remaining major manufacturer of tetraethyl lead
is a British company named Octel. Your Action Plan could call for
a lawsuit on behalf of these victims, not only to seek damages for
their injuries but also to provide remedies and resources for prevention.
That would help to focus national and world attention on fuel additives,
air quality, and human health.
- For three days,
I have heard about how difficult it will be to educate India's population
about the dangers of surma, which has been in use for 1,500 years.
Instead of relying on convention health education strategies, your
Action Plan could demand that the Government of India simply ban surma.
"Impossible!" you say. "Too controversial?" Keep in mind that sometimes,
controversy can be constructive. I dare say that the media's coverage
of the controversy over "300 elite scientists demand that the Government
of India ban on surma" would be more effective in getting out the
word about surma's dangers than 10 million brochures and family education
home visits.
- Here's another
wild idea: your Action Plan might promise some grand prize to the
first oil company to phase out leaded gas and replace it with a clean
fuel that improves fuel economy and performance without adding other
metals or increasing aromatics. Remember, advocacy doesn't always
mean throwing punches. Applause can sometimes be a powerful tool.
In closing, I want
to note that the Action Plan needs to address resource and organization
issues related to its own implementation. If you really want to make
these things happen, then you need to assess the resources required
realistically. Implementing this kind of Action Plan aimed at primary
prevention through source control will require several full-time staff,
at a minimum. These staff should not be doctors or scientists, but they
need to know how to use your doctors and scientists for maximum impact.
Based on your Action Plan's strategies and objectives, you will have
to decide on needs of the staff. But you might begin by considering
an environmental lawyer, a community organizer, and a media advocacy
expert as a starting point.
The Action Plan
also needs to deal with issues of organization, structure and
accountability.
The George Foundation has put lead poisoning on the map in India,
but
Dr. George
cannot do this alone. To implement an Action Plan for preventing
lead
poisoning across
India, an organization is needed that reflects a central focus on
primary
prevention
through source control and the broader base of support needed to
achieve this
goal. I urge
you to be ruthless in skeptically examining any and all activities
that might
distract from
primary prevention: you must not allow screening or surveillance
or even
the treatment
of lead-poisoned children to stand in the way of primary prevention.
Those
activities
are also important, of course, but the Action Plan must be focused
on
success of source
control.. All of the Plan's strategies need to serve this goal.
That is my vision
of an Action Plan for Preventing Lead Poisoning in India. As a group,
you will need to decide together how your Action Plan will advance advocacy
and action to achieve prevention through source control. In any event,
the Action Plan needs to be explicit about its focus and objectives.
If your Action Plan tries to be all things to all people, it is doomed
to disappoint everyone.
And then each of
you individually needs to decide whether or not this is your "cup of
tea." For many of you, the answer will be "No," which is fine. In addition
to advocates for prevention, lead poisoning needs good clinicians and
scientists and researchers. But from listening and talking to many of
you over the past two days, I know that many of you do have the desire
and the passion to reach beyond your clinics and your laboratories and
step beyond your "day jobs" to become powerful advocates for prevention.
In this room today
are the seeds of a movement broad enough and powerful enough to place
lead poisoning on India's national agenda and to hold the government
and private industry accountable for source control. Dr. George has
created a tremendous opportunity with this conference. The stage is
now set for lead poisoning prevention to begin in India. I urge
you to step forward and join in taking responsibility to achieve this
goal.
