Discuss the connection between health, environment and society It is important that you use examples from the readings attached below to support your claims.** Bates, Diane. 2009. Po

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Lead pipes for carrying drinking water were well recognized as a cause of lead poi- soning by the late 1800s in the United States. By the 1920s, many cities and towns were prohibiting or restricting their use. To combat this trend, the lead industry carried out a prolonged and effective campaign to promote the use of lead pipes. Led by the Lead Industries Association (LIA), representatives were sent to speak with plumbers’ organizations, local water authorities, architects, and federal offi- cials. The LIA also published numerous articles and books that extolled the ad- vantages of lead over other materials and gave practical advice on the installation and repair of lead pipes. The LIA’s activities over several decades therefore con- tributed to the present-day public health and economic cost of lead water pipes. (Am J Public Health. 2008;98:1584–1592. doi:10.2105/AJPH.2007.113555)

SINCE THE CENTERS FOR Disease Control and Prevention began to establish acceptable blood lead levels for young chil- dren in the 1960s, the concentra- tion at which blood lead levels have been thought to have signifi- cant health effects has steadily de- clined. That concentration has been reduced from 60 µg/dL to the current level of 10 µg/dL, which was established in 1991.1

Research conducted in the past few years, however, suggests that there are health effects below that level, and that IQ declines at a faster rate below 10 µg/dL than above.2,3

| Richard Rabin, MSPH

public concern when more than half the homes with lead service pipes were found to exceed the Environmental Protection Agency’s (EPA’s) action level of 15 parts per billion.12 Public in- terest in this matter is evident from a computer search of gen- eral interest and business publi- cations for the period between January 1995 and April 2007 with the terms water and lead pipes that yielded 220 articles.13

Recent US history has been marked by many environmental and public health crises initiated or exacerbated by corporate ac- tors despite knowledge (or rea- sonable suspicion) that an activ- ity or chemical exposure was particularly hazardous. Child- hood lead paint poisoning,14,15 as- bestos-related deaths,16,17 and to- bacco-related diseases and mortality18 are a few of these. Here I review the evidence that lead pipes for water distribution were installed well after they were considered a public health threat and examine the corporate activities and other factors con- tributing to their continued use.

Although lead-based paint is the single most important contributor to elevated blood lead levels in children, if just a few micrograms of lead per deciliter of blood are of concern and if we are to truly prevent the health effects of lead exposure in the United States, then water, as well as other sources of lead, must also be ad- dressed. Water consumption is es- timated to contribute, on average, about 10% to 20% of a child’s total lead intake, and for infants fed formula, 40% to 60% of their lead exposure.4

In the past 2 decades, legisla- tion and regulations at the fed- eral level have helped to reduce water lead concentrations.5–7

Nevertheless, lead in drinking water continues to be a public health concern. Over the past several years, significantly ele- vated lead levels in many cities have provoked public outcry. Lead-contaminated water in homes and schools has been de- tected in Boston, MA8,9; Durham, NC10; and Camden, NJ,11 among many others. In Washington, DC, in 2004, there was considerable

Lead Industry and

The

“A MODEST CAMPAIGN” Lead Water Pipes

 PUBLIC HEALTH THEN AND NOW 

the late 1800s to the early 1900s, numerous journal articles and re- ports appeared documenting the dangers to health of lead pipes.21–28 One published bibliog- raphy in 1943 listed more than 100 articles and reports in English on lead poisoning from drinking water.29 In 1890 the Massachu- setts State Board of Health ad- vised the state’s cities and towns to avoid the use of lead pipes.19 By the turn of the century, there was little doubt in the public health community that lead water pipes were to be avoided. By the 1920s, many cities had concluded that the engineering advantages of lead were outweighed by the pub- lic health risks, and local and state plumbing codes were revised to prohibit or limit the use of lead in pipes for water distribution.19,30

THE LEAD INDUSTRIES ASSOCIATION

The Lead Industries Associa- tion (LIA) was formed in 1928 as the lead industry’s trade organiza- tion. Its membership encompassed both producers and users of lead products and included all the major producers. Lead mining and manufacturing was domi- nated by just 6 companies (all LIA members) until the 1960s: the National Lead Company, American Smelting and Refining, Anaconda, the Hecla Mining Company, Eagle Picher, and the St Joseph Lead Company.31 The National Lead Company was by far the largest.32

As would be expected of an in- dustrial trade association, a central function of the LIA was to pro- mote the sale of its members’ products. Lead pipe, of course, was one of them.

We are endeavoring to keep abreast of any impending changes in plumbing codes. . . .

We have also been investigating the use of lead in service pipe and other applications. We have been accumulating useful infor- mation pertaining to lead and expect soon to make it the basis of a modest educational cam- paign within the limits of the current budget.33

Although most of the lead in- dustry’s efforts to promote the use of lead in plumbing emphasized the positive (i.e., the advantages of lead over other materials), there clearly was some concern that the potential health hazard of lead pipes could jeopardize the market for lead pipes. In his 1929 report to the membership, the secretary noted that,

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BACKGROUND

Although the use of lead pipes for water distribution has a cen- turies-old history, installation of lead pipes in the United States on a major scale began in the late 1800s, particularly in the larger cities.19 By 1900, more than 70% of cities with populations greater than 30 000 used lead water lines.19 Although lead was more expensive than iron (the material of choice until that time), lead pipes had 2 significant advantages over iron ones: they lasted much longer than iron (about 35 years compared with 16) and, because they are more malleable, they could be more easily bent around existing structures.19

Concerns about the potential toxicity of lead from water that passes through lead pipes were documented even before lead came into widespread use. In 1859 a collection of articles was published presenting the views of various engineers, physicians, and public health officials. The editor of those articles began by noting the objections raised by residents of New York City and Boston to the introduction of lead for service pipes (the pipes that carry water from the street main to a building) and indoor plumbing:

In other cities of the United States and of Europe the same feeling has at times more or less agitated the public mind, without leading however, thus far, to any serious modification of the long established practice [of installing lead pipes], that I am aware of, except in Hartford, Conn.20(pi)

With the large-scale introduc- tion of lead service pipes, numer- ous public health and newspaper accounts of lead poisoning from drinking water began to appear with increasing frequency. From

“ ”

Water is much more wholesome from earthen- ware pipes than from lead pipes. For it seems to be made injurious by lead, because white lead paint is produced from it; and this is said to be harmful to the human body.

Vitruvius, first-century-BC Roman architect and engineer, De architectura

Of late the lead industries have been receiving much undesirable publicity regarding lead poison- ing. I feel the association would be wise to devote time and money on an impartial investi- gation which would show once and for all whether or not lead is detrimental to health under certain conditions of use.33

This public alarm over lead exposure can be attributed at least in part to reports in the popular press. In 1924, the New York Times reported on a medical conference that high- lighted nonindustrial sources of lead, including lead paint.34

During the Depression, it was not uncommon for poor per- sons to use old battery casings for fuel, and there were news- paper reports of families being lead poisoned.35,36

 PUBLIC HEALTH THEN AND NOW 

Although subsequent LIA re- ports implied that the secretary primarily had lead paint in mind as the cause of this adverse public- ity, the association also felt the need to address the public’s con- cerns regarding lead pipes. For in- stance, in 1930 the LIA investi- gated a case of lead poisoning in conjunction with the Charleston Water Works.37 (The findings of the investigation were inconclu- sive: lead service pipes had re- cently been installed, but contami- nation of the home was possible because the father was a house painter.38)

From its inception until at least the early 1970s, the lead pipe man- ufacturers and their association used a wide variety of methods to promote their products, including the publication of numerous educa- tional materials and model stan- dards, attendance at professional meetings, and lobbying of local, state, and federal government agen- cies. In 1931, the LIA prepared a booklet and a “model” standard for lead pipes.39 It also published the first edition of the book, Useful In- formation About Lead,40 which de- scribed the many products made of lead. The chapter on plumbing ad- vises that “the best material in a water service, though it may be slightly more expensive at first, is really an economy, and the best material is usually lead.”40(p74) The exception, it notes, is

when the water is very soft, or of swampy or peaty origin, that lead should not be used, but under those conditions other metals are also soluble, so lead may be used by adding a little sodium silicate solution to the water, as is done occasionally– or using tin-lined lead pipe.40(p74)

The LIA’s 1934 annual meet- ing minutes record an “intensive” effort to reverse the downward

trend in the use of lead pipes; con- tacts are reported with city offi- cials, master plumbers, and plumbing associations. Over the next 2 decades, the LIA continued to promote lead pipes through contacts with plumber organiza- tions and local boards, by lobby- ing federal agencies, and by pub- lishing newsletters.

The association issued a bulletin for distribution to water works officials. LIA members who pro- duced plumbing supplies made donations to the Plumbing and Heating Industries Bureau. The usefulness of cooperation with that organization was clear:

As the Bureau was founded to promote the wider use of mod- ern plumbing, it is essential that the role which lead plays in modern plumbing installations be not overlooked. Our cooper- ation with this Bureau will in- sure that lead receives ample and proper consideration.41

A key part of the campaign to boost sales of lead pipe was the hiring of an agent to, in the words of the LIA secretary,

work on our behalf and I am pleased to report that the work has more than met with an excel- lent reception. It has grown so quickly and so strongly that it has reached a stage at which it is re- ally too large a problem for one man working in the Eastern part of the United States alone to han- dle. We have rekindled an inter- est on the part of master and journeymen plumbers in the use of lead. We have pointed out to municipalities the risks that they run in advocating substitutes for lead and have received the en- dorsement of numerous impor- tant State master plumbers and journeymen plumbers associa- tions with whom the subject has been discussed. . . .Since the first of the year, even greater ad- vances have been made and we firmly believe that in a compara- tively short time there will be growing evidence of the advanta- geous results accuring [sic] to our members from this work.41

The report of the LIA’s agent, Robert Dick, enumerates the year’s specific accomplishments:

(a) One code approved and put into operation, requiring lead wherever it is advisable to use lead in the plumbing system.

(b) One town enforcing the use of lead throughout plumbing systems although not called for by its code.

(c) Nine cities and towns with revised codes calling for lead throughout. These codes now ready to be submitted to the various councils for adoption.

(d) Forty-eight cities and towns working on revisions to require lead throughout, but with the codes not yet ready for submis- sion to council.

(e) Forty-eight cities and towns in which no immediate action can be taken due either to polit- ical or financial conditions, or in a few cases, to opposition to the use of lead.41

Although this report does not mention the health-related reasons lead had been losing ground to other plumbing materials, it does discuss the economic pressures brought on by the Depression:

The present time is a critical time for this work because dur- ing the depression years, the plumbing industry has experi- enced intense competition from the installations of handymen and others not actually engaged in the plumbing business so that the plumbers are now look- ing for anything that will pro- tect their interests against these outsiders.41

Dick went on to explain that re- quiring the use of lead would be in the interest of professional plumbers because the installation of lead fixtures and pipes required a level of skill that others did not possess. This self-interest on the part of plumbers probably ac- counts for the reported success that the LIA had in persuading the

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 PUBLIC HEALTH THEN AND NOW 

numerous plumber organizations to endorse the use of lead. Even into the 1940s, this economic mo- tivation played some role in plumbers’ desire to allow or even require lead. In Denver in 1947, when a proposal was made to per- mit iron and steel for domestic plumbing, the master plumbers organization blamed “self-seeking speculative builders,” and one journeyman plumber was quoted as attributing the proposal to an attempt to “move ‘90-day won- ders’ and handymen into an in- dustry which protects the health of the community.”42(p77)

According to the secretary, 1938 was a banner year for the LIA. The association now had 3 representatives working on its Plumbing Promotion Program. Most of their time was taken up that year by attendance at 24 state conventions of master plumbers and by speaking at 19 of them. Outreach materials were produced and distributed to plumbers who were actively attempting to change their local building codes. The as- sociation’s trade publication, Plumbers’ Forum, had a mailing list of 22500. Plans were announced to “work with various housing au- thorities to have lead specified in the plumbing of . . . large develop- ments.”43 Plumbing code regula- tions were changed in Pennsylva- nia (to require lead for plumbing), Massachusetts (removal of the 5- foot limitation on lead), and in dozens of other cities. In this con- nection, the secretary reminded the members that

It must be remembered that adoption of laws, as above, is slow work, but once adopted, make a relatively permanent re- quirement of lead. In many cities, we have successfully opposed ordinance or regulation revisions which would have reduced or eliminated the use of lead. We have prevented elimination of

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lead work from examinations for plumbers’ licenses in New York and other cities, and have introduced license examina- tions with a lead work require- ment in many places where no examinations for lead work were formerly required.43(pp3–4)

In cities where lead had fallen out of favor for a number of years, there was the danger that, even if a revised plumbing code rein- stated lead as a permitted or re- quired material, there would not be a sufficient number of plumbers trained in its installation and repair. Consequently, the LIA expended some effort to train a labor force skilled in working with lead. Coop- erating with the Federal Commit- tee on Apprentice Training, in 1938 the LIA established classes in several cities, including Chicago; Pittsburgh; San Francisco; St Paul, Minnesota; Wilkes-Barre, Pennsyl- vania; Youngstown, Ohio; and Phoenix. In addition, it began preparation of the section on lead of the Standard Text on Plumbing, to be published by the National Association of Master Plumbers.44

The pipe manufacturing mem- bers of the LIA were also con- cerned about the failure of lead plumbing, stemming from poor quality goods, and thereby leading to the discontinuation of lead products. In response, the LIA de- veloped a series of standards for various lead plumbing products, including pipes and caulking. Ac- cording to the LIA secretary, nu- merous entities adopted these standards, including the American Water Works Association, New York City, and several other cities.44

In 1940 several federal agen- cies including the War and Navy Departments, the Public Buildings Administration, and the US Hous- ing Authority were involved in major construction projects for “defense building.” As a result, LIA staff expended much effort in

Washington to ensure the inclu- sion of lead in the specifications for plumbing. Their efforts appar- ently met with considerable suc- cess, because “lead plumbing is now included in many Federal government master specifications where it had been excluded for many years.”45 But because these specifications were only optional, association staff had to make per- sonal visits to many of the federal construction projects to persuade those in charge that lead was preferable to other materials. These efforts were also successful, according to the secretary.

At the same time, the LIA initi- ated or continued several activities that it expected would have long- term benefits for the lead industry by institutionalizing the use of lead in plumbing nationwide:

A simplified standard for lead fittings was put into effect at the end of the year. Also the first steps toward obtaining a Com- mercial Standard for lead pipe, traps and bends and calking lead, promulgated by the Na- tional Bureau of Standards, were taken. It is expected that Federal Specifications for lead pipe, traps and bends will fol- low soon after adoption of the Commercial Standards.45(p6)

An initial success was the publi- cation in 1940 by the Bureau of Standards of a new Plumbing Manual,46 which served as the basis for the specification of lead plumbing in federal construction projects. The manual has a cau- tionary note: “Lead piping in water-supply lines shall not be used unless it has been definitely determined that no poisonous lead salts are produced by contact of lead with the particular water supply.”46(p14) However, given the numerous factors that could affect a water supply’s plumbosolvency, it is not clear how it could be known for certain in advance that

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“no poisonous salts” would be dis- solved in the water.

By the 1940s, the lead industry had become alarmed at the pub- lic’s growing wariness of all things lead, including lead pipes:

There is hardly an outlet for lead to which one can turn today without encountering, in some measure, the question of the lead hazard to the public. So fundamental is this problem to the future welfare of the lead in- dustries and the continued man- ufacture and use of many impor- tant lead products, such as white lead, red lead, litharge, sheet lead and lead pipe that unless some immediate attention is paid to the problem above and

Lead Alloys, and Lead Compounds,49

the industry continued its promo- tion of lead service lines; more than 1500 copies were sold in the first 2.5 months after publica- tion.50 However, this edition did not caution the reader (as it did in 1931) about conditions under which lead might not be advisable.

Throughout the 1950s, the LIA continued its outreach to plumb- ing and related professionals. Lead, the LIA’s trade journal with a quarterly publication schedule and a distribution list of more than 50 000, carried a steady stream of articles on plumbing.51

The textbook, Lead Work for Mod- ern Plumbing,52 which was first published in 1952, had by early 1956 reached a total distribution of more than 6500.53

The theme of a continuous, se- rious threat to the lead industry because of the public’s alarm over the danger of lead exposure is again made explicit a few years later by the LIA’s secretary:

I cannot overemphasize [the] importance [of our health and safety work]. The toxicity of lead poses a problem that other nonferrous industries generally do not have to face. Lead poi- soning, or the threat of it, hurts our business in several different ways. While it is difficult to count exactly in dollars and cents, it is taking money out of your pockets every day.54(p4)

As before, he is most concerned about lead paint, but he makes clear that lead pipe sales are also at risk:

There is a law suit now pending in Milwaukee in which an apart- ment building tenant is suing the owner for $200,000 damages for alleged lead poisoning from water passing through the build- ing’s lead service pipe. Success of a suit like this could well mean the end of lead services not only in Milwaukee, but in Chicago and many another city, amounting to thousands of tons

of lead a year. We are working with the defense, and although the case does not come to trial for some months, our latest infor- mation is most encouraging.54(p4)

Promotional activities contin- ued at least until 1972, when the LIA issued the sixth printing of its text Lead Work for Modern Plumbing.52

THE HISTORICAL CONTEXT

Given the medical and public health view that lead pipes were a clear danger to the public, one may ask how the lead industry could persist, with at least moder- ate success, in promoting and sell- ing lead water pipes. Several fac- tors contributed. One relates to the lingering doubts among water engineers and water authorities about the risks of lead pipes. Throughout the 19th century, at- tempts had been made by some physicians to link lead water pipes to cases of severe illness. How- ever, these were met with consid- erable skepticism by water author- ities, most of the medical community, and the general pub- lic: not everyone consuming water from lead pipes became sick, many of the symptoms of lead poisoning mimic those of other diseases, and the medical tests for diagnosing lead poisoning were not well developed. However, by the early 20th century, publica- tion of the many medical articles and reports of the previous 20 to 30 years had made a compelling case for a relation between lead water pipes and lead poisoning.19

As indicated above, plumbers and water works engineers and of- ficials favored lead pipes for their durability and other practical ad- vantages. In addition, an extensive discussion among water works professionals and officials at their meetings and in their publications

“ ”

I cannot overemphasize [the] importance [of our health and safety work]. The toxicity of lead poses a problem that other nonferrous indus- tries generally do not have to face. Lead poi- soning, or the threat of it, hurts our business in several different ways.

beyond what the Association has already accomplished and is cur- rently doing, the opposing forces may grow strong enough to do us injury which it would take years of work to correct.47

Between 1941 and 1949, the LIA reduced its plumbing cam- paign field staff from three to two. However, it continued its usual pro- motional work around lead pipes:

The promotional work in the plumbing and water works field continues as in the past . . . with master and journeyman plumbers, plumbing inspectors, instructors and others, to see that lead is adequately provided for by plumbing codes through the country and to see that plumbers are trained to know how to han- dle and install lead work.48(p5)

In the LIA’s 1952 book Lead in Modern Industry: Manufacture, Applications and Properties of Lead,

not be installed where the water supply was “soft” (lacking in cer- tain minerals, primarily magnesium and calcium) or high in carbonic acidic (carbon dioxide dissolved in water).55,56,59,61 The LIA’s Robert Ziegfeld also advanced this argument but suggested that con- ditions that affected lead would also attack other metals. (He ne- glected to mention, however, that other metals, such as iron and copper, are not as toxic as lead.62) Another argument in favor of the use of lead pipes was that over time a thin coating forms on the interior pipe surface that prevents further corrosion. Furthermore, various chemicals could be added to the water to reduce the acidity. However, research and experience from the mid-1800s to the early 1900s in the United States and Great Britain provided consider- able evidence that many other fac- tors as well (not often discussed by water works professionals) could influence the plumbosolvency of a water supply.19 In other words, whereas a water supply that is hard or alkaline is less likely to re- sult in an unhealthy concentration of lead, such a result may occur because of other factors. An ex- ample was provided by a 1928 study of several towns and cities in Illinois that had very hard water. In that study, lead levels ranged from 0.02 to 0.50 parts per million (1.3 to 33 times the modern EPA standard).66

The lead industry also benefited from the absence, at the federal level, of the regulation of environ- mental health hazards. As several authors have noted, before the 1960s, the federal government did not play an active role in protect- ing the public from environmental or occupational hazards.67–70 In the Progressive Era of the first 2 decades of the 20th century, the federal government’s legitimate

role was to investigate hazards and recommend solutions to the re- sponsible industry but not to legis- late changes. In her investigations of the occupational hazards in sev- eral industries, including those with lead exposure, Alice Hamilton (a pioneer in occupational medi- cine in the United States) high- lighted serious health hazards and made recommendations for their abatement but did not suggest leg- islative interference.67 The next 4 decades marked a period of even less government activism, as man- ufacturers were assumed to investi- gate and control the hazards that they created.67 The public health disasters of asbestos and lead paint, noted above, can be seen as products of this laissez faire era.

Another factor impeding a greater focus on lead pipes was the much greater concern regard- ing infectious diseases compared with the attention paid to environ- mental toxins in the first half of the 20th century.71 Prevention of water-borne diseases was a partic- ular focus of attention for profes- sionals who designed and installed domestic plumbing. Some indica- tion of this greater concern about communicable disease can be seen from a computer search of American Journal of Public Health articles. The search terms water and cross-connection (a common cause of infectious disease from drinking water) yielded 20 articles for the 1930 to 1950 period, whereas lead pipes yielded only 3. Indeed, at least 1 of the National Lead Company’s advertisements promoted lead pipes as providing a more “sanitary” water supply.72

CONTINUED USE OF LEAD PIPES

The year 1930 is often given as the date after which few lead water pipes were installed in the

 PUBLIC HEALTH THEN AND NOW 

clearly indicates that many of them were not as convinced as their counterparts in the public health community that lead water pipes were an unacceptable health haz- ard.55–63 This divided opinion can be seen in articles in professional journals, plumbing texts, and pub- lications of more general interest. For example, the author of an arti- cle in the Journal of the American Water Works Association in 1938 believed the dangers of lead pipes to be exaggerated:

Lead ions seem to have a bad reputation, although some of it is not deserved when it comes to the traces found in most pu- rified water supplies. If the very small amounts which persons ingest by drinking water and eating food, were as harmful as some people believe them to be, there would be many more cases of lead poisoning than are known to occur.57(p248)

In 1934 and again in 1945, the American City, a magazine report- ing on general and technical de- velopments in the urban environ- ment, approvingly reported on the installation and longevity of lead service pipes.64,65

On the other hand, Harold Bab- bitt, a professor of sanitary engi- neering, strongly opposed the use of lead water pipes:

Lead is sufficiently soluble in water to offer a real menace to health and for this reason its use in contact with potable water should be restricted if not prohib- ited. Tests by the Massachusetts State Board of Health have shown lead content as high as 3 to 5 parts per million in natural waters and an increase of 50 to 100 per cent, and even more after the water has been standing in lead pipe. Since 0.5 parts per million is considered dangerous to health, the use of lead in water pipe or in contact with potable water should be prohibited.63(p267)

A common, middle point of view was that lead pipes should

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United States,19,30 and this down- ward trend was almost certainly the case. However, the reports and meeting minutes of the LIA cited above indicate that it had some success in slowing, and even in some cases reversing, that movement. Evidence of con- tinued installation of lead pipes comes from other sources as well. The plumbing codes of some major cites, including Boston73,74

(JE Richardson, Boston Water and Sewer Commission, personal com- munication, January 29, 2007); Milwaukee, WI54; Philadelphia, PA74; Denver, CO42; and Chicago, IL,43,75 still called for lead many years, even decades, beyond 1930. Besides these major cities, there is much suggestive evidence, both direct and indirect, that the installation of lead water pipes continued on a significant scale throughout the United States well beyond 1930. Cities and states usually based their plumbing codes on 1 of 3 model codes: the Building Officials and Code Ad- ministrators’ (BOCA) plumbing code, the International Council of

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