Introducing LEEP: Lead Exposure Elimination Project

post by Jack · 2020-10-06T07:25:26.829Z · score: 128 (71 votes) · EA · GW · 26 comments

Contents

  The Problem
    Importance
    Neglectedness 
    Tractability
  Our Plan
  How You Can Help
    Advisors
    Hires
    Funding
    Follow our work
    Feedback
  References
None
24 comments

We are excited to announce the launch of Lead Exposure Elimination Project (LEEP), a new EA organisation incubated by Charity Entrepreneurship. Our mission is to reduce lead poisoning, which causes significant disease burden worldwide. We aim to achieve this by advocating for lead paint regulation in countries with large and growing burdens of lead poisoning from paint.

In this post, we make the case for lead exposure reduction as a priority, and outline our plan to address this problem.

The Problem

Others in the effective altruism community have already identified that working on lead poisoning could be a high-impact opportunity (see here, here, and here). Through the Importance, Tractability, Neglectedness framework, we unpack the reasoning for prioritising lead exposure interventions, and for our approach of advocating for the introduction of lead paint laws.

Importance

Lead poisoning has substantial health and economic costs, and lead paint is a primary contributor [1]. In terms of individual impacts, lead exposure has a number of effects. Even a low level of lead exposure can lead to mental disability and IQ loss, as well as increased rates of mental illness and psychopathology and significantly reduced lifetime earnings capacity [2, 3, 4]. Lead also has effects on behaviour and criminal tendencies; in particular having a large impact on the prevalence of violent crime [5]. In adults, lifetime lead exposure is an important risk factor for renal disease and cardiovascular disease, including hypertension and coronary artery disease [6, 7]. Higher levels of exposure can affect all organ systems, and even result in respiratory difficulties, seizure, coma, and death [5].

Lead poisoning primarily affects children, and does so at a massive scale. UNICEF reports that 815 million children have blood lead levels above 5 µg/dL - a sufficient level for neurodevelopmental effects and reduced IQ [8]. The vast majority live in low and middle-income countries. Put another way, one in three children are currently affected by lead poisoning to some degree.

In addition to disability, it also causes 1 million deaths per year. In total, lead poisoning accounts for 22 million DALYs every year, which means that lead poisoning is responsible for approximately 1% of the global disease burden [9].

In terms of lost earnings, lead poisoning impacts the world economy to the level of approximately $1 trillion per year [4]. This amounts to a loss of 1.2% of world GDP. These losses are concentrated in low and middle-income countries, where they can amount to as much as 5-8% of GDP, suggesting that lead exposure can be a significant barrier to economic development and poverty reduction.

In short, the problem of lead poisoning is a significant one.

Neglectedness

At present, while all countries except for one have banned leaded petrol, 61% of countries have no lead paint regulations whatsoever [1]. In many of these primarily low and middle-income countries the burden of disease from lead poisoning is still significant. In high-income countries, this is a less severely neglected area, as most countries have introduced regulations banning leaded petrol and lead paint.

While there are some organisations working to address this issue in low and middle-income countries, including IPEN, ToxicsLink, and Pure Earth, many countries with significant lead burdens remain neglected by other actors. LEEP aims to fill this gap, and target these neglected countries.

Tractability

This is the most uncertain aspect of working on lead poisoning, given the uncertainty around the success of policy change interventions. However, there are several reasons in favour of the tractability of policy change to ban the production and import of lead paint.

In addition to the direct impacts of our work, we hope that our intervention will provide further evidence to the tractability of policy interventions.

Our Plan

Our first priority is country selection to ensure we target tractable, high-burden, and neglected countries. We have identified Malawi as the most promising country on this basis. Over the next two months, we will be testing the levels of lead in new paints on the market in Malawi and building relationships with stakeholders and decision-makers. Depending on findings and progress from this stage, we will either pilot our advocacy campaign in Malawi to introduce lead paint regulation, or pivot to another promising country.

We plan to advocate for evidence-based policy change while rigorously tracking our counterfactual impact, in alignment with the principles of the EA movement. In this process, we will publish our full findings on our website so that they can be used by other organizations or individuals working on lead poisoning (or policy change more broadly).

In our preliminary cost-effectiveness analysis, we found that this intervention has the potential to be highly cost-effective, currently comparable to GiveWell’s top charities. Ultimately, lead policy seems to be an area that has the potential to be more cost-effective than the most effective existing charities in global health and development.

Though we will initially focus all of our efforts on one target country, our long-term goal is to introduce lead regulation in a number of high-burden countries, and reduce lead poisoning at an international scale.

How You Can Help

What can you do if you want to contribute to our mission?

Advisors

We are currently being mentored and advised by the Charity Entrepreneurship team, as well as by the founders of Fortify Health, but are also seeking further advisors. Specifically, we are looking to connect with experts involved in lead regulation or other forms of political advocacy. If you have experience in any of these fields we would love to connect with you.

We are also seeking advisors who have connections or in-country experience in our top few target countries. If you have connections in Malawi, Madagascar, Sierra Leone, Burkina Faso, or Guatemala, we would love for you to get in touch.

Hires

We plan to hire in-country staff during our first year in our target location. In future years, we may seek interns or employees for operations, research, and communications roles.

Funding

Charity Entrepreneurship has awarded us a seed grant of $60,000, which will enable our organisation to operate for most of our first year.

We will be seeking further funding, and would love to be in contact with risk-tolerant donors looking to support early stage organisations

Follow our work

If you would like to be kept updated by our work then please sign up to our newsletter, and follow us on Facebook, Twitter and Linkedin.

Feedback

We greatly value your feedback and suggestions, particularly at this early stage. Please feel free to post your questions or comments below or reach out to us directly through our contact form.

LEEP was incubated under Charity Entrepreneurship, an effective altruism organization, which provided our initial funding with a $60,000 seed grant. Our current team members are co-founders Jack Rafferty and Lucia Coulter.

References

  1. UNEP 2019: Update on the global status of legal limits on lead in paint. September 2019
  2. Lamphear et al. 2oo5: Low-level environmental lead exposure and children’s intellectual function: an international pooled analysis
  3. Reuben et al. 2019: Association of childhood lead exposure with adult personality traits and lifelong mental health
  4. Attina & Trasande 2013: Economic costs of childhood lead exposure in low-and middle-income countries
  5. Gould 2009: Childhood lead poisoning: Conservative estimates of the social and economic benefits of lead hazard control
  6. Chowdhury et al. 2018: Environmental toxic metal contaminants and risk of cardiovascular disease: systematic review and meta-analysis
  7. Lanphear et al. 2018: Low-level lead exposure and mortality in US adults: a population-based cohort study
  8. UNICEF 2020: The Toxic Truth
  9. IHME 2017: Global Burden of Disease Study
  10. WHO ‎2020: Global elimination of lead paint: why and how countries should take action: technical brief
  11. Charity Entrepreneurship 2020: Lead Paint Regulation
  12. Baumgartner et al. 2009: Lobbying and Policy Change: Who wins, who loses, and why?

26 comments

Comments sorted by top scores.

comment by Linch · 2020-10-07T01:58:51.207Z · score: 13 (9 votes) · EA(p) · GW(p)

This sounds like an awesome project and I'm very excited for your plans! I've been interested for quite a while in things in the general category of cognitive/disease burden costs of pollution, and excited to see an EA project working on them!

Over the next two months, we will be testing the levels of lead in new paints on the market in Malawi and building relationships with stakeholders and decision-makers. Depending on findings and progress from this stage, we will either pilot our advocacy campaign in Malawi to introduce lead paint regulation, or pivot to another promising country.

Definitely don't spend a lot of time on it, but I'm interested if you have thoughts on the probabilities of your next steps here? Specifically

  • What probability will you assign to having enough internal validity to know of next plans in 2 months?
  • What's your probability of piloting your advocacy campaign in Malawi to introduce lead paint regulation (as opposed to another promising country)?
  • (Again, feel free to not answer) what probability will you put on being a Givewell Top or Standout charity by the end of 2025?
comment by Jack · 2020-10-07T09:36:53.370Z · score: 9 (6 votes) · EA(p) · GW(p)

Hi Linch, Great question. Probability estimates about the future are always difficult - we can give you some loose indications of what we expect, though these should be taken with a grain of salt.

1. A two month timeline may be hard to estimate, as things can often run more slowly when starting in a new country. However, we can give more confident estimates on a three month timeline (which offers some buffer room).

We’d attach a reasonably high probability to having enough information to make these decisions within the next 3 months (~80%). Our decision-relevant data gaps at the moment are a) about the level of lead paint use in Malawi, and b) about the tractability of meeting with Malawian politicians. However, we have ways to test both of these things, and identify whether they should be a disqualifying factor, and have strong leads on the connections required to get this information.

2. Our probability of piloting in Malawi is also quite high, as the early indicators of burden and tractability seem quite strong. We’ve managed to find a 2017 study on the level of lead in paint in Malawi which indicates that this country would be highly promising to target. The study found that 56% of paint tested in Malawi had more than 90ppm, and 37.5% had more than 600ppm - this makes us think that it is quite likely that lead is a significant contributor to the overall burden of lead poisoning in Malawi. On the tractability side, making contacts within Malawi has also been much easier than expected. This makes us think that our probability of piloting in Malawi is better than even, around 60%.

3. Good question. This intervention has the potential to have very large-scale benefits, and very high cost-effectiveness, but I don’t think I could attach a reasonable probability estimate that I’d trust this far out.

comment by ElliotJDavies · 2020-10-09T19:47:19.975Z · score: 1 (1 votes) · EA(p) · GW(p)

In super simple terms, how does lobbying work for one of these countries? Is it as simple as getting the phone with a local politician and going from there?

comment by Misha_Yagudin · 2020-10-06T17:40:48.711Z · score: 12 (7 votes) · EA(p) · GW(p)

I am curious about which other countries you identified as promising?

Listing them might be beneficial, as I can imagine that finding an experienced and well-connected candidate for a target location can change the outcome of cost-effectiveness calculation by increasing tractability. On other hand, good candidates might not be hard to find or be especially likely discovered via the EA network.

comment by Jack · 2020-10-07T09:48:01.497Z · score: 9 (4 votes) · EA(p) · GW(p)

Hi Misha! I totally agree. Tractability could make a significant difference on the expected cost-effectiveness of a particular country. In the coming weeks we’ll be having a full blog post on our site unpacking our country selection in detail, but I can give you a quick summary here.

To identify the most viable target countries we’ve assessed every country worldwide (with more than 300,000 births in the last 5 years), and ranked them on a number of factors. These factors included size of lead burden, absence of lead paint regulation, stability (which works as a loose indicator of tractability - or at least of intractability in extreme cases), and neglectedness by other actors.

Based on this, our other top tier countries included Madagascar, Angola, Sierra Leone, Liberia, Burkina Faso, Niger, Zimbabwe, Lesotho, Haiti, Guatemala, El Salvador, and Honduras.

comment by Ula · 2020-10-06T10:55:01.646Z · score: 12 (8 votes) · EA(p) · GW(p)

Congratulation on your launch! Very impressed so far on how much progress you're making in a short amount of time. Good luck in Malawi!

comment by Jack · 2020-10-07T09:34:46.920Z · score: 4 (3 votes) · EA(p) · GW(p)

Thanks so much Ula!

comment by Julia_Wise · 2020-10-09T13:58:29.048Z · score: 11 (7 votes) · EA(p) · GW(p)

I've been surprised that this topic hasn't gotten more attention in EA before, and I'm happy to see this work launch!

comment by LuciaC · 2020-10-09T15:15:54.595Z · score: 4 (3 votes) · EA(p) · GW(p)

Thanks so much Julia!

comment by dwebb · 2020-10-07T20:48:47.236Z · score: 10 (6 votes) · EA(p) · GW(p)

Thanks for this Jack! Sounds like an interesting area to look into.

I am curious about the literature suggesting that lead paint causes negative health / psychological effects. After an admittedly cursory glance, many of the studies you cite seem to indicate an association between lead exposure and some negative outcome, but don't necessarily imply a causal link from lead exposure to these negative outcomes. This is important: if the correlation is actually due to some other factor (e.g. living in worse conditions more generally), then we may overestimate how bad lead exposure is, and end up misdirecting funds.

Can you point us towards the best causal studies on lead exposure? E.g. ones that evaluate an RCT reducing lead exposure, or some other kind of "natural experiment"? (Apologies if you've referred to it and I just missed something)

comment by LuciaC · 2020-10-09T07:19:31.478Z · score: 10 (7 votes) · EA(p) · GW(p)

Hi, thanks for the comment! Yes, most of the studies are longitudinal cohort studies. I think this is one of the best examples of a well-designed interventional study: https://www.aeaweb.org/articles?id=10.1257/app.20160056

comment by BrianTan · 2020-10-07T03:53:36.244Z · score: 9 (5 votes) · EA(p) · GW(p)

Thanks for writing this! Do you know a resource or link that lists which countries still do not have lead paint regulation? And is there a ranking of which countries is it most promising to work on lead poisoning reduction? I am from the Philippines and I think we have lead paint regulation, but I have heard it's not yet well-implemented. I'd like to know where we fare if there is a ranking of which countries is it most promising to work on this problem on.

comment by Jack · 2020-10-07T09:35:41.222Z · score: 10 (5 votes) · EA(p) · GW(p)

Hi Brian! Thanks for commenting. Here is a link which lists countries which do not currently have lead paint regulation. We didn’t come across any ranking of most promising countries to target, but we have collated this information ourselves. We’ll be publicly releasing our country selection spreadsheet in the coming weeks and this will likely provide you with the information that you need.

Until then, I can pass on some relevant information about our findings. From our research, we found that the Philippines does currently have legislation (as you mentioned), and is not currently neglected by other actors (EcoWaste Coalition and IPEN are active there).

We found that there are still significant levels of lead poisoning in the Philippines (see annex), but we are not confident that this necessarily indicates that the current legislation is not well enforced. It could be an indicator that there is significant exposure to lead from other sources, or it could just be that the effects have been delayed because legislation takes time to have impact. Paint bans need to be in effect for a few years before health impacts can be noticed.

On the other hand, it could well be an enforcement issue. Controls were introduced in 2015 to ensure that paint has lead levels below 90ppm, but in 2017 it was found that the Philippines still had 23% of their paint with lead levels exceeding 90ppm, 16% of their paint with lead levels exceeding 600ppm, and 12% of their paint with lead levels exceeding 10,000ppm. That might imply that the controls aren't being followed perfectly. However, it’s also been three years since that study was done, so things may have changed.

Hope this was useful!

comment by BrianTan · 2020-10-09T08:25:44.013Z · score: 1 (1 votes) · EA(p) · GW(p)

Yup, this was useful Jack! We are wondering though if EcoWaste Coalition would still be a cost-effective and/or evidence-based charity that we should recommend donors who want to give to local Philippine charities.

I am assuming that we can still recommend them, but we are finding it hard to model their cost-effectiveness given that it's a policy charity, so we may have to rely on other types of rationale or argumentation. I'd love to hear any thoughts you may have on how we might be able to still assess whether or not it's still cost-effective (or effective in general) for local donors to donate to the EcoWaste Coalition. Thanks!

comment by Peterslattery · 2020-10-14T22:16:23.146Z · score: 6 (3 votes) · EA(p) · GW(p)

Great work Jack! Really excited to see this!

comment by Jack · 2020-10-15T00:38:16.087Z · score: 3 (2 votes) · EA(p) · GW(p)

Thanks very much Pete!

comment by thecommexokid · 2020-10-12T05:35:53.467Z · score: 5 (4 votes) · EA(p) · GW(p)

Very cool, and if you eventually reach a scale where you are seeking dedicated operations staff, you’ll probably be getting a résumé from me!

In your FAQ on the website, I would suggest clarifying the language of the claim you make that “the relationship between lead exposure and neurotoxic effects is greater at lower blood lead levels.” It is correct as written, but I had to follow the link and find the graph in the original paper to understand it. My initial reading was that you were claiming some sort of J-shaped dose–response curve, which fortunately struck me as nonsensical enough to click through and verify. I might suggest “stronger”or “more pronounced” rather than “greater,” or some other way to make it clearer that you are talking about the slope rather than the value.

comment by Jack · 2020-10-13T06:56:28.947Z · score: 1 (1 votes) · EA(p) · GW(p)

Ah! I can definitely see how that might have been confusing, thanks for letting us know. I'll make sure that this is reworded to be as clear as possible. Good catch!

And that sounds fantastic. It's likely we'll seek to hire a dedicated operations staff member as we scale, perhaps in our second or third year. In case you'd like to keep an eye out for when such positions crop up, all future job postings for LEEP will be announced on our website, in our newsletter, and on the 80,000 Hours Jobs board.

comment by sky · 2020-10-07T22:20:23.166Z · score: 5 (3 votes) · EA(p) · GW(p)

Congrats on the launch! This may be a stretch, but if you'd find it helpful to connect with any of these folks: https://youtu.be/DbplLXRQquI or the Data Science for Social Good team at U of Chicago to see if they have additional contacts, let me know and I can connect you.

comment by LuciaC · 2020-10-09T15:26:02.228Z · score: 4 (3 votes) · EA(p) · GW(p)

Hi Sky, thank you for directing us to this and offerening to connect! We'll take a closer look a what they're working on and let you know if/when a connection would be helpful.

comment by Matt_Lerner (mattlerner) · 2020-10-06T19:35:01.313Z · score: 5 (4 votes) · EA(p) · GW(p)

I'm really excited to see this!

I understand that, lead abatement itself aside, the alkalinity of the water supply seems to have an impact on lead absorption in the human body and its attendant health effects. I'm curious whether (1) this impact is significant (2) whether interventions to change the pH of water are competitive in terms of cost-effectiveness with other types of interventions and (3) whether this has been tried.

comment by Jack · 2020-10-07T09:36:10.281Z · score: 4 (3 votes) · EA(p) · GW(p)

Hi Matt, thanks for your comment! We haven’t looked into this, but if we do we’ll let you know. As yet, we have not focused on water as a source of lead exposure because it is less of a contributor in lower-income countries where lead burdens are highest.

comment by Animal Ask · 2020-10-20T12:17:40.129Z · score: 4 (2 votes) · EA(p) · GW(p)

Great work Jack and Lucia!

comment by sbehmer · 2020-10-22T22:35:46.897Z · score: 1 (1 votes) · EA(p) · GW(p)

This looks great and thanks for posting! One question: how come those other organizations working in this space, who as you note have a track record of success in other countries, haven't expanded to countries like Malawi? In other words, why is lead exposure reduction in Malawi neglected by other actors?