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Lead is one of the World Health Organization’s top 10 chemicals of public health concern. Lead poisoning affects 1 in 3 children worldwide. 90% of these children are in low- and middle-income countries.

Why We Focus on Lead Poisoning in Low- and Middle-Income Countries

1 in 2 children in low- and middle-income countries have lead poisoning.

There is no safe level of lead poisoning. According to the 2020 Toxic Truth report from UNICEF and Pure Earth, one third of the world’s children, about 800 million, have blood lead levels exceeding 5 micrograms per deciliter (µg/dL). 90% of children with high lead levels are in low- and middle-income countries (LMICs). The global cost of lead exposure is estimated to be between US$977 billion (2013) and US$6 trillion (2019).

The Global Burden of Disease estimates lead exposure causes 1.6 million deaths per year. A more recent World Bank analysis suggests that lead exposure causes 5.5 million deaths annually. In 2019, the World Bank analysis found that children under five years old worldwide lost 765 million IQ points from lead exposure, and about 95% of IQ point loss due to lead exposure were in LMICs.

To explore more data related to lead exposures around the world, visit Pure Earth’s interactive map

Understanding the Impacts of Lead Poisoning

Health and Societal Impacts

Lead is a cumulative toxicant that affects multiple body systems, including the neurological, hematological, gastrointestinal, cardiovascular and renal systems. According to the WHO, there is no known safe level of lead exposure. Relatively low levels of lead exposure that were previously considered ‘safe’ have been shown to damage children’s health and impair their cognitive development. Lead is a potent neurotoxin that, with even low-level exposure, is associated with brain damage, reduced IQ, decreased intelligence, learning difficulties, lower lifetime earnings, increased incidence of heart and kidney disease later in life, and increased tendency for violence. Children under the age of 5 years are at the greatest risk of suffering lifelong neurological, cognitive and physical damage and even death from lead poisoning. Older children and adults, as well, suffer severe consequences from prolonged exposure to lead in food, water and the air they breathe, including increased risk of cardiovascular death and kidney damage in later life.

An estimated 1.6 million to 5.5 million deaths are caused by lead exposure each year. Children are particularly vulnerable to lead poisoning due to their smaller size and higher rates of lead absorption. In 2019, children under five years old worldwide lost 765 million IQ points from lead exposure. Those living in LMICs lost 729 million IQ points, an average loss of 5.9 IQ points per child.

In adults, lead exposure causes a significant burden of disease as well. In 2019, 5.5 million adults died from cardiovascular disease from lead exposure. About 90% of CVD deaths and 95% of IQ point loss due to lead exposure were in LMICs. Exposure to lead before and during pregnancy can also be extremely harmful. Lead stored in an expectant mother’s bones from her earliest exposures can be released during pregnancy. This increases blood lead levels and poses risks to both the mother and unborn children, including miscarriage, stillbirth, premature birth and low birth weight. Research from the Center for Global Development found that lead poisoning alone could account for more than 20 percent of the learning gap between rich and poor countries.

For more information on the health and societal impacts of lead, please see The Toxic Truth Report, Pure Earth and UNICEF (2020), Exposure to lead: a major public health concern, 3rd edition, The World Health Organization (2023), and the Integrated Science Assessment (ISA) for Lead, United States Environmental Protection Agency (2024).

    Economic Impacts

    The global financial cost of lead exposure is between US$977 billion (2013) and  US$6 trillion (2019). US$6 trillion is equivalent to 7% of global GDP. According to the 2023 paper, Global health burden and cost of lead exposure in children and adults: a health impact and economic modelling analysis,  in low- and middle-income countries (LMICs), these costs accounted for more than 10% of GDP, or twice as high as in high income countries (HICs). More than three-fourths of the economic cost (77%) was due to cardiovascular disease deaths and associated income loss from premature mortality; nearly one-fourth of the economic cost (23%) was due to estimates of lower future income caused by IQ loss.

    The Toxic Truth Report

    The 2020 Toxic Truth report from UNICEF and Pure Earth revealed that lead poisoning is affecting children on a massive and previously unknown scale.  The report, the first of its kind, says that around 1 in 3 children – up to 800 million globally – have blood lead levels at or above 5 micrograms per deciliter (µg/dL), the level at which requires action. Nearly half of these children live in South Asia.

    This joint report by UNICEF and Pure Earth notes that lead is a potent neurotoxin that causes irreparable harm to children’s brains. It is particularly destructive to babies and children under the age of 5 as it damages their brain before they have had the opportunity to fully develop, causing them lifelong neurological, cognitive and physical impairment. Childhood lead exposure has also been linked to mental health and behavioural problems and an increase in crime and violence. Older children suffer severe consequences, including increased risk of kidney damage and cardiovascular diseases in later life, the report says.

    It is clear from evidence compiled that lead poisoning is a much greater threat to the health of children than previously understood. Although much more research needs to be conducted, enough data have recently emerged for decisive action to begin – and it must begin now.

    Common Sources of Lead Exposure

    The global sources of childhood lead exposure include, but are certainly not limited to: lead in water from the use of leaded pipes; lead from active industry, such as mining and used lead-acid battery recycling; lead-based paint and pigments; leaded gasoline (which has declined considerably in recent decades, but was a major historical source); and lead in spices, ceramics, metal cookware, cosmetics, ayurvedic medicines, toys and other consumer products.

    Parents whose occupations involve working with lead often bring contaminated dust home on their clothes, hair, hands and shoes, thus inadvertently exposing their children to the toxic element. Children are also exposed to lead in-utero through exposure of their mothers, with adverse impacts on neurobehavioural development that are comparable to those from childhood lead exposures.

    In low- and middle-income countries, common sources of lead exposure include:

    Informal Used Lead-Acid Battery Recycling

    One of the most concerning sources of lead exposure is the unsafe recycling of used lead-acid batteries (ULABs), most of which are found in cars, trucks and other vehicles. Recycling activities are often conducted in informal, unlicensed, and frequently illegal open-air operations close to homes and schools.

    Ceramics and Metal Cookware

    Lead-glazed pottery  is commonly used to cook and serve food in many countries such as Mexico, causing lead to leach into the food.

    Our research on lead in consumer goods in low- and middle-income countries uncovered that lead is being added to low-cost, locally made metal cooking pots in over a dozen low and middle-income countries, resulting in another source of lead exposure.

    Spices and Other Foods

    Spices, such as turmeric, are adulterated with lead chromate to enhance their color and weight in many countries. These lead-adulterated spices can contribute significantly to elevated blood lead levels among children and adults. The practice of adding lead-based pigments to enhance the color and weight of spices is occurring in several countries. Some of these contaminated spices find their way into kitchens worldwide through the global food supply chain. 


    Household products such as toys have been found contaminated with lead.


    Cosmetics such as eyeliners (kohl, kajal, and surma) have been found contaminated with lead.


    Lead in paint is unregulated in 55% of countries globally. Young children are exposed to lead from peeling paint chips and from lead dust. Explore more resources from the Global Lead Paint Alliance, Lead Exposure Elimination Project, IPEN, and the US Environmental Protection Agency.

    Program Highlights: Lead Poisoning Solutions

    Health Surveillance
    Health Surveillance

    Blood lead level testing and analysis is crucial to understanding the prevalence, severity and location of exposure. Pure Earth has developed a model to launch national childhood lead monitoring programs using a country’s existing health survey infrastructure to collect lead exposure data. To date this model has been used in the Philippines, Mexico and the Republic of Georgia. In 2023,  Pure Earth launched Strengthening Health Systems to Reduce Lead Exposure, partnership between Pure Earth and the Ministries of Health in Colombia, Indonesia, Kyrgyzstan, Maharashtra, India, and Peru to strengthen each country’s national healthcare system to better prevent lead poisoning.

    Source Analysis
    Source Analysis

    Pure Earth assesses consumer products, environmental media, and homes to identify the primary sources and exposure pathways that likely contribute most significantly to lead poisoning.

    In 2021, Pure Earth launched the Rapid Market Screening project in 25 countries. Supported by a grant from GiveWell, the Rapid Market Screening (RMS) program is a novel, wide-reaching assessment of lead (Pb) contamination in more than 5,000 samples of consumer goods and foods from markets across 25 low- and middle-income countries.

    Source-Specific Interventions
    Source-Specific Interventions

    Pure Earth designs and implements interventions to reduce the use and/or release of lead in products and industrial processes.

    In addition, Pure Earth remediates polluted communities, supports countries in developing and implementing strategies and programmatic approaches, and integrates communications such as education and awareness-raising training to inform stakeholders.