Impact Report
2026

January 2025-July 2026

Download the Impact Report PDF

Pure Earth’s Ghana team stands with cookware during a community outreach event.

Executive Summary

Richard Reithinger

Vice President, Programs

It is estimated that more than 1 billion children, roughly one in three worldwide, carry blood lead levels above 5 µg/dL, the threshold at which the World Health Organization requires public health action. More than 90% of these affected children live in low- and middle-income countries.

Lead exposure is responsible for an estimated 3.5 million cardiovascular deaths each year, more than HIV, malaria and traffic deaths combined. A World Bank analysis found that in 2019, children under five years old worldwide lost an estimated 765 million IQ points from lead exposure; moreover, lead poisoning is thought to account for 20% of the education gap between high- and low-income countries.

1 billion+

children carry blood lead levels above 5 μg/dL.

3.5 million

cardiovascular deaths each year: more than HIV, malaria and traffic deaths combined.

765 million

estimated IQ points lost by lead exposure in children under five in 2019.

The response to this crisis must be country-owned. The most durable gains come from governments that build their own capacity to measure lead exposure, regulate its sources, and enforce laws that protect children and families.

That shift is already underway in the eleven countries profiled here, and we are committed to accelerating it. Governments that previously turned to Pure Earth for guidance on lead poisoning prevention and mitigation began acting independently. They collected baseline data to understand the scale and sources of the problem, passed and enforced standards, and built institutions with the potential to protect entire populations at risk.

A health worker tests a child’s blood lead level during a community education session in Bangladesh.

The path to a lead-free future runs through government-led, durable solutions, and five signals of systemic change show that path taking shape.

Five Signals of Systemic Change in National Lead Responses

Why Reduced Blood Lead Levels Are the Ultimate Goal

Every signal of systemic change in this report points to one goal: reducing lead in children’s blood. Blood lead levels (BLLs) are the truest indicator of harm we have. They show us where exposure is happening, how severe it is, and who is most affected. That is why reduced BLLs sit at the center of this framework: it’s the outcome every gear in this report is turning toward. BLL surveillance data can take years to show reductions, so we track five indicators that move first: the conditions that need to be in place before blood lead levels fall. Here’s where that shift is happening, and how.

A child plays on a newly remediated playground in Labanchora, Bangladesh, where cleanup cut soil lead levels by more than 99%.

The Five Signals in Action

Government Ownership and Independent Action

Pure Earth’s investments in government capacity are delivering results, with partner countries advancing toward self-sufficiency.

In the past year, Valenzuela City in the Philippines has made it standard practice, through local law and funding, for municipal doctors and nurses to test children with disabilities for lead poisoning and trace their exposure to its sources. Similar momentum has taken root at the national level in Bangladesh where the Department of Environment established its own steering committee that shut down more than 57 illegal used battery recycling facilities over the past two years. In 2026, Bangladesh’s Cabinet and Prime Minister approved its “National Strategy for a Lead-Free Bangladesh and Multi-Year Action Plan (2026-2035)” following an interministerial consultation that incorporated technical inputs from key stakeholders. In Ethiopia, Pure Earth supported the development of the country’s first National Roadmap for Lead Poisoning Prevention, establishing a goal of reducing childhood blood lead levels by 60% by 2030. Across these countries, the pattern is the same: governments are translating external support to drive their own responses to end lead poisoning. Indonesia’s government initiated a national lead action plan and, for the first time, allocated a domestic budget for supervising blood lead level surveillance. Similarly, Brazil’s Ministry of Environment launched the drafting of 2025-2030 national strategy for lead following catalytic support from Pure Earth.
Regulatory and Legal Advancement

In partnership with government, Pure Earth is helping set the standards and pass regulations that will protect millions of adults and children from lead poisoning.

For the first time, Ghana has set a legal limit on lead in the cookware families use every day. This milestone rests on BLL surveys and home-based assessments that mapped out how widespread the problem is and where the lead is coming from. Mexico is establishing new rules that will set legal limits on lead in consumer products, a regulatory step that could protect millions of people. The Philippines enacted its first city-level lead poisoning prevention ordinance. In Tamil Nadu, India, a state home to 81 million people, the Bureau of Indian Standards issued an amendment to its cookware standards in 2026 requiring certification for aluminum cookware and prompting regulators and manufacturers to bring uncertified producers into compliance with safer, lead-free production practices. A year ago, these achievements were only conversations. Today, they are codified commitments with the potential to protect not hundreds of people, but every family in a country that cooks with aluminum pots.
Measurable Exposure Reduction

Pure Earth’s programming is making communities safer for thousands of people today, and for the generations that follow.

Nowhere is this starker than Labanchora, Bangladesh, where children once went to school on some of the most contaminated soil we’ve measured: 98,476 ppm, meaning 1 kg of soil contained roughly 100 g of lead. After a Pure Earth-led clean-up, lead concentrations in the soil were reduced by 99%, and 700 people no longer live and learn on poisoned ground. A similar story is unfolding in Ghana, where a smelter site that was poisoning the surrounding community has been cleaned up. In Indonesia, the local government in Tegal Regency has begun to fund its own remediation work, building off the prior support from Pure Earth. Work looks different in Mexico, where lead can be in the ceramic pottery that food is cooked in. With support from Pure Earth, dozens of businesses have now committed to lead-free production of pottery, with potters trained in lead-free glazing techniques. Ultimately, what starts as hundreds of people protected becomes the evidence base for national policy that can scale impact on entire populations.
Evidence Activating Policy

Pure Earth’s investment in evidence generation is directly shaping government decisions and budget commitments.

A Pure Earth-led analysis of lead-contaminated kale traced the lead not to the soil but to airborne emissions from a nearby smelter: a finding that has potential implications for food safety policy across low- and middle-income countries. In Indonesia, BLL data from more than 1,600 children strengthened the evidence base for Indonesia’s government to develop the National Action Plan for a Lead-Free Indonesia. In Peru, findings on contaminated cookware were embedded in national lead prevention strategies and are now included in the Public Prosecutor’s Office’s agenda.
Durable Institutional Capacity

Pure Earth is helping build the institutions that will carry this work forward long after any single project ends.

Pure Earth helped establish at least seven permanent national bodies, including a permanent national technical working group. Across several countries, Pure Earth has strengthened countries’ ability in lead testing and surveillance. For example, in Kyrgyzstan we established the country’s first heavy metals reference laboratory. Similarly, in Ghana, Ethiopia, and India, Pure Earth donated portable X-ray fluorescence (XRF) analyzers to national and state-level government ministries, training staff and enabling them to test environmental and other samples for lead contamination.
In closing, I invite you to read the more detailed country reports that follow as evidence of a movement taking root. The challenge ahead is still large, but the momentum behind it is more powerful, durable, and government-owned. Let’s build on this progress together. Join us.
Richard Reithinger
Vice President, Programs

A schoolgirl smiles in Pesarean Village, Indonesia, where the Tegal Regency government now funds its own cleanup of lead-contaminated land.

Building Durable, Government-Led Systems to Fight Lead Poisoning

A High-Level Overview on National and Local Progress

Across the countries where Pure Earth works, national and local governments are turning commitments into laws, building the systems, standards, and budgets to prevent lead exposure and poisoning at scale.

Where Government Commitments Stand in 2026

Tracking national strategies, regulations, and standards to prevent lead exposure in countries where Pure Earth works.

To be developed
In development
Adopted
Implemented

Government commitments to prevent lead exposure, by country
Country	Commitment Type	Government Commitment	Status
Bangladesh	National Strategy	National Strategy for a Lead-Free Bangladesh and Multi-Year Action Plan (2026-2035), led by the Ministry of Environment, Forest and Climate Change, formalized through a tri-partite Memorandum of Understanding establishing a government-owned framework.	Adopted
Brazil	National Strategy National Regulatory Standard	National Strategy for Joint Actions to Combat Lead Contamination 2025-2030, launched at the ministerial level by the Ministry of Environment and Climate Change. Brazil enacted Law No. 15,441/2026, establishing a maximum lead concentration of 90 ppm for most paints and surface coatings.	Adopted
Ethiopia	National Roadmap	The National Roadmap for Lead Exposure and Poisoning Prevention establishes an ambitious national goal of reducing childhood blood lead levels by 60% by 2030, providing a clear framework for coordinated action, policy implementation, and long-term prevention efforts.	Adopted
Ghana	National Regulatory Standard	Ghana Standards Authority formally published the new lead standard for aluminum cookware and through support from Pure Earth is planning a post development implementation of the standards.	Implementation
India	Institutional Body, Sub-national standard	Bihar's State Food and Safety Department approved formation of an Intergovernmental Panel for Lead; the Bureau of Indian Standards (BIS) is formally engaged on cookware manufacturing standards in Tamil Nadu.	Adopted
Indonesia	National Strategy Government Financing	National Action Plan for Lead-Free Indonesia, a binding multi-agency framework under development by the Coordinating Ministry for Human Development and Culture; Tegal Regency is independently financing its own remediation budget line.	In development
Kyrgyzstan	National Strategy	A lead surveillance indicator was written into the National Development Program 2030, making lead monitoring a government commitment with an implicit budget obligation.	Adopted
Mexico	National Regulatory Standard	Federal Commission for Protection Against Health Risks drafted two binding environmental health standards, including a BLL action threshold for non-occupational populations. In addition, the Ministry of Health, the Senate, and the Congress adopted formal measures to advance a bill aimed at banning lead oxide in products intended for human consumption.	In development
Philippines	Sub-national Law	Valenzuela City enacted the Lead Exposure Prevention and Child Protection Ordinance of 2025, the country's first city-level law institutionalizing BLL screening and enforcement, co-funded from the city's own budget.	Adopted

Why This Matters

Of the nine governments above, six have already moved from intention of their commitment to adoption of strategies, policies, and regulations to limit and minimize the effects of lead exposure and poisoning. This is a binding sign that governments are acting on this issue with their own laws, budgets, and institutions. This solidifies the trajectory Pure Earth has seen succeed before in the Republic of Georgia. This report focuses on the programmatic activities Pure Earth is directly engaged in and does not capture all global progress on lead pollution and risk mitigation supported by other partners. For a fuller picture, visit the Partnership for a Lead-Free Future website. If your country’s work with Pure Earth is not represented here, contact [email protected] to be included in future updates.

Community health workers in Indonesia train to test children’s blood lead levels.

Bangladesh

175.7 million

people¹

$2,597

GDP per capita¹

Bangladesh has one of the largest numbers of lead-poisoned children of any country in the world. Between 2025–2026, its government became the first across Pure Earth’s program portfolio to scale independent enforcement action.

A girl watches a cleanup crew remove lead- contaminated soil in Labanchora, Bangladesh.

38.3%

Percent of children 1-4 years with blood lead levels (BLL) ≥ 5 μg/dL*

5.2 μg/dL

Estimated mean BLL of children 1-4 years*

3.6%

Estimated associated cost of lead-related IQ loss in children younger than 5 years, as a share of GDP ***

91,948

Estimated annual deaths from lead **

$17.7 billion

Estimated associated costs of cardiovascular deaths from lead ***

2.2 million

Estimated annual disability-adjusted life years (DALYs) lost to lead **

*BBS and UNICEF MICS (2025) **IHME Global Burden of Disease (2023) ***World Bank (2019)

National Lead Response

Developed/exists
Under development
Does not exist

Regulatory & Policy Frameworks

National lead strategic plan
Lead banned in paint
Occupational safety standards include lead
Policies on max allowable contamination levels

Measurement & Awareness Raising

National representative baseline BLL survey
National total diet study
Routine monitoring of BLLs in high-risk populations
Routine monitoring of environmental samples
Lead in national health information system
Lead in national environmental information system
Public awareness campaigns

Response Infrastructure & Capacity

National lead technical working group
Laboratories for blood lead testing
Laboratories for environmental testing
Poison control center
Clinical lead poisoning management guidelines
Epidemiological guidelines for lead exposure
Budgetary allocation for lead activities

National lead response indicators reflect the existence of structures and frameworks but are not an assessment of their efficacy or adequacy.

Bangladesh’s Progress On The
Five Signals Of Systemic Change

Community members in Bangladesh rally to raise awareness about the dangers of lead poisoning.

SIGNAL SPOTLIGHT

Government Ownership and Independent Action

Bangladesh has started building the architecture needed to measure and act on lead for the long term. The Ministry of Environment, Forest and Climate Change (MoEFCC) leads a multi-stakeholder steering committee comprising a total of 35 ministries, departments, UN agencies, and NGO stakeholders to address lead pollution. In addition, a National Strategy for a Lead-Free Bangladesh and Multi-Year Action Plan, running through 2035, locks in that mandate. Government ownership is most visible in terms of enforcement. Between January 2024 and May 2026, the Department of Environment conducted enforcement actions at 57 informal used lead-acid battery recycling facilities, shutting down illegal operations, filing cases against 77 factories, initiating legal action against eight factory owners, and imposing approximately 5.79 million Bangladeshi Taka, or nearly $47,000, in fines.

Regulatory and Legal Advancement

Bangladesh is starting to write the rules that will govern its lead response for the next decade. To formalize the National Strategy for a Lead-Free Bangladesh and Multi-Year Action Plan (2026–2035) institutionally, Pure Earth, MoEFCC, and the Department of Environment signed a tri-party MoU establishing a formal cooperation framework for managing lead pollution and transitioning the informal battery sector to the formal economy.

Measurable Exposure Reduction

The most striking result in early 2026 came from a site in Labanchora where children had been going to school and living in a residential establishment. Soil lead in the primary smelter zone measured a median of 98,476 ppm before remediation, which is a level so toxic it is difficult to contextualize. After remediation across 1.2 hectares, that figure dropped by more than 99%. Hazardous waste was stabilized and removed under the Department of Environment’s supervision, with post-remediation XRF readings confirming results. The 700 people, including children, who live and go to school on that land are no longer on one of the most contaminated sites Pure Earth has ever documented.

Evidence Activating Policy

The decision to prioritize Labanchora was informed by data. Initial BLL testing of 202 people found that 90.6% exceeded the CDC’s 3.5 µg/dL action threshold, providing the scientific basis for both soil cleanup and community mobilization. In addition, environmental assessments found metal cookware in community homes averaging 640 ppm lead concentration, with individual samples reaching 1,343 ppm, identifying ongoing exposure sources that soil clean-up alone cannot address and flagging a clear target for future interventions addressing cookware as a source of lead exposure. In 2026, post-cleanup BLL testing will produce the first before-and-after health impact data from the site, building the case for scaling this model nationally. Building on field experience from four remediation projects, MoEFCC and the Department of Environment, together with Pure Earth Bangladesh developed Bangladesh’s first Toxic Sites Identification Protocol and Investigation, Remediation, and Risk Reduction Guidelines for informal used lead- acid battery recycling sites in 2025 to improve site assessment, monitoring, and cleanup.

Durable Institutional Capacity

Before 2025, Bangladesh had no formal governance architecture for lead poisoning prevention. By the end of the year, it had two interlocking structures that will outlast any single project or funder. The tri-partite MoU and the MoEFCC Steering Committee together constitute a framework for accountability and coordination that belongs to the government, not to Pure Earth or other partners. A Pure Earth environmental expert seconded into the Ministry of Environment is building technical capacity from the inside, transferring knowledge in a way that stays when the secondee eventually leaves. The national strategy will create a decade-long accountability framework that commits Bangladesh to action through 2035, long after the current phase of support ends.

¹ World Bank, World Development Indicators, 2025.

Brazil

212.8 million

people¹

$10,713

GDP per capita¹

Brazil is one of Pure Earth’s newest country offices, and the institutional architecture built in year one sets a model for how quickly this work can take root.

An official walks Pure Earth and government partners through a public health laboratory in Brazil

7.2%

Percent of children 0-19 years with blood lead levels (BLL) ≥ 5 μg/dL**

2.6 μg/dL

Estimated mean BLL of children 0–19 years **

1.9%

Estimated associated cost of lead-related IQ loss in children younger than 5 years, as a share of GDP ***

51,279

Estimated annual deaths from lead **

$83.2 billion

Estimated associated costs of cardiovascular deaths from lead ***

1.1 million

Estimated annual disability-adjusted life years (DALYs) lost to lead exposure **

**IHME Global Burden of Disease (2023) ***World Bank (2019). These estimates do not represent findings from epidemiological surveillance studies conducted in Brazil.