How Much Would Reducing Lead Exposure Improve Children’s Learning in the Developing World?

Around half of children in low-income countries have elevated blood lead levels. What role does lead play in explaining low educational outcomes in these settings? We conduct a new systematic review and meta-analysis of observational studies on the relationship between lead exposure and learning outcomes. Adjusting for observable confounds and publication bias yields a benchmark estimate of a 0.12 standard deviation reduction in learning per natural log unit of blood lead. As all estimates are non-experimental, we present evidence on the likely magnitude of unobserved confounding, and summarize results from a smaller set of natural experiments. Our benchmark estimate accounts for over a fifth of the gap in learning outcomes between rich and poor countries, and implies moderate learning gains from targeted interventions for highly exposed groups (≈ 0.1 standard deviations) and modest learning gains (< 0.05 standard deviations) from broader public health campaigns. WORKING PAPER 650 · JULY 2023

[1]  P. Landrigan,et al.  Relation of blood lead levels and lead in gasoline: an updated systematic review , 2022, Environmental Health.

[2]  João Pedro Azevedo,et al.  The State of Global Learning Poverty: 2022 UpdateThe World Bank, UNESCO, UNICEF, USAID, FSDO, Bill and Melinda Gates Foundation, 2022, 77 p., Open Access , 2022, Population and Development Review.

[3]  Nicholas J. Sanders,et al.  A Thousand Cuts: Cumulative Lead Exposure Reduces Academic Achievement , 2022, SSRN Electronic Journal.

[4]  Fatemeh Rajati,et al.  The effect of lead exposure on IQ test scores in children under 12 years: a systematic review and meta-analysis of case-control studies , 2022, Systematic Reviews.

[5]  David K. Evans,et al.  How Big Are Effect Sizes in International Education Studies? , 2022, Educational Evaluation and Policy Analysis.

[6]  G. Gartlehner,et al.  Effectiveness of interventions for the remediation of lead-contaminated soil to prevent or reduce lead exposure - A systematic review , 2022, The Science of the total environment.

[7]  M. Longnecker,et al.  Re-expressing coefficients from regression models for inclusion in a meta-analysis , 2021, bioRxiv.

[8]  G. Leonardi,et al.  Reduction in Blood Lead Concentration in Children across the Republic of Georgia following Interventions to Address Widespread Exceedance of Reference Value in 2019 , 2021, International Journal of Environmental Research and Public Health.

[9]  Diancarlos P. de Andrade,et al.  IQ alteration induced by lead in developed and underdeveloped/developing countries: A systematic review and a meta-analysis. , 2021, Environmental pollution.

[10]  P. Winch,et al.  Making the invisible visible: Developing and evaluating an intervention to raise awareness and reduce lead exposure among children and their caregivers in rural Bangladesh , 2021, Environmental research.

[11]  H. Patrinos,et al.  Measuring human capital using global learning data , 2021, Nature.

[12]  Howard Hu,et al.  Blood lead levels in low-income and middle-income countries: a systematic review. , 2021, The Lancet. Planetary health.

[13]  B. Pineda,et al.  Cognitive Impairment Induced by Lead Exposure during Lifespan: Mechanisms of Lead Neurotoxicity , 2021, Toxics.

[14]  S. Luby,et al.  Child lead exposure near abandoned lead acid battery recycling sites in a residential community in Bangladesh: risk factors and the impact of soil remediation on blood lead levels. , 2021, Environmental research.

[15]  C. Karr,et al.  Heavy metals and neurodevelopment of children in low and middle-income countries: A systematic review , 2020, PloS one.

[16]  J. Bongaarts,et al.  United Nations Department of Economic and Social Affairs, Population Division World Family Planning 2020: Highlights, United Nations Publications, 2020. 46 p. , 2020 .

[17]  K. Rusmil,et al.  The Effects of Calcium Supplementation on Blood Lead Levels and Short-term Memory of Chronically Exposed Children: A Clinical Trial Study , 2020 .

[18]  Yue-Ming Jiang,et al.  Impact of Lead Exposure on Thyroid Status and IQ Performance among School-age Children Living Nearby a Lead-Zinc Mine in China. , 2020, Neurotoxicology.

[19]  H. Grönqvist,et al.  Understanding How Low Levels of Early Lead Exposure Affect Children’s Life Trajectories , 2020, Journal of Political Economy.

[20]  K. Smits,et al.  Remediation in developing countries: A review of previously implemented projects and analysis of stakeholder participation efforts , 2020 .

[21]  Michael W. Dzierlenga,et al.  Birth weight and perfluorooctane sulfonic acid: a random-effects meta-regression analysis , 2020, Environmental epidemiology.

[22]  P. Parsons,et al.  A comparison of blood and toenails as biomarkers of children's exposure to lead and their correlation with cognitive function. , 2019, The Science of the total environment.

[23]  Ronald J. Shadbegian,et al.  Early childhood lead exposure and the persistence of educational consequences into adolescence. , 2019, Environmental research.

[24]  J. Anetor,et al.  Positive and inverse correlation of blood lead level with erythrocyte acetylcholinesterase and intelligence quotient in children: implications for neurotoxicity , 2019, Interdisciplinary toxicology.

[25]  J. Currie,et al.  Replication data for: Do Low Levels of Blood Lead Reduce Children's Future Test Scores? , 2019 .

[26]  J. Higgins,et al.  Cochrane Handbook for Systematic Reviews of Interventions , 2010, International Coaching Psychology Review.

[27]  S. Hooper,et al.  Environmental lead exposure is associated with neurocognitive dysfunction in children with chronic kidney disease , 2019, Pediatric Nephrology.

[28]  G. Forte,et al.  Neurocognitive impact of metal exposure and social stressors among schoolchildren in Taranto, Italy , 2019, Environmental Health.

[29]  R. Skouta,et al.  Long‐term consequences of early postnatal lead exposure on hippocampal synaptic activity in adult mice , 2019, Brain and behavior.

[30]  Edson Severnini,et al.  The legacy lead deposition in soils and its impact on cognitive function in preschool‐aged children in the United States , 2019, Economics and human biology.

[31]  B. Lanphear,et al.  Prenatal, concurrent, and sex-specific associations between blood lead concentrations and IQ in preschool Canadian children. , 2018, Environment international.

[32]  Stephen B. Billings,et al.  Life after Lead: Effects of Early Interventions for Children Exposed to Lead , 2018, American Economic Journal: Applied Economics.

[33]  Gan Zhang,et al.  Effects of lead, cadmium, arsenic, and mercury co-exposure on children's intelligence quotient in an industrialized area of southern China. , 2018, Environmental pollution.

[34]  J. Caravanos,et al.  Cost Effectiveness of Environmental Lead Risk Mitigation in Low‐ and Middle‐Income Countries , 2018, GeoHealth.

[35]  R. V. Aert Correcting for publication bias in a meta-analysis with the p-uniform* method , 2018 .

[36]  J. Olivero-Verbel,et al.  Low blood lead levels impair intellectual and hematological function in children from Cartagena, Caribbean coast of Colombia. , 2017, Journal of trace elements in medicine and biology : organ of the Society for Minerals and Trace Elements.

[37]  K. Kordas,et al.  Effects of low-level prenatal lead exposure on child IQ at 4 and 8 years in a UK birth cohort study , 2017, Neurotoxicology.

[38]  J. Currie,et al.  Lead and Juvenile Delinquency: New Evidence from Linked Birth, School, and Juvenile Detention Records , 2017, Review of Economics and Statistics.

[39]  D. Belsky,et al.  Association of Childhood Blood Lead Levels With Cognitive Function and Socioeconomic Status at Age 38 Years and With IQ Change and Socioeconomic Mobility Between Childhood and Adulthood , 2017, JAMA.

[40]  Aurelio Tobías,et al.  Standardizing effect size from linear regression models with log-transformed variables for meta-analysis , 2017, BMC Medical Research Methodology.

[41]  C. Muller,et al.  Lead exposure and violent crime in the early twentieth century , 2016 .

[42]  D. Lewis,et al.  The Impact of Low-Level Lead Toxicity on School Performance among Hispanic Subgroups in the Chicago Public Schools , 2016, International journal of environmental research and public health.

[43]  T. Nettelbeck,et al.  Low‐level environmental lead exposure still negatively associated with children's cognitive abilities , 2016 .

[44]  Jacob Burns,et al.  Effectiveness of interventions to reduce exposure to lead through consumer products and drinking water: A systematic review. , 2016, Environmental research.

[45]  Doug Lind,et al.  Environmental Remediation to Address Childhood Lead Poisoning Epidemic due to Artisanal Gold Mining in Zamfara, Nigeria , 2016, Environmental health perspectives.

[46]  Tomás Rau,et al.  Early Exposure to Hazardous Waste and Academic Achievement: Evidence from a Case of Environmental Negligence , 2015, Journal of the Association of Environmental and Resource Economists.

[47]  D. Lewis,et al.  The impact of low-level lead toxicity on school performance among children in the Chicago Public Schools: a population-based retrospective cohort study , 2015, Environmental Health.

[48]  Zachary F. Fisher,et al.  robumeta: An R-package for robust variance estimation in meta-analysis , 2015, 1503.02220.

[49]  Jiming Liu,et al.  Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range , 2014, BMC Medical Research Methodology.

[50]  Leif D. Nelson,et al.  P-Curve and Effect Size: Correcting for Publication Bias Using Only Significant Results , 2014 .

[51]  Hristos Doucouliagos,et al.  Meta‐regression approximations to reduce publication selection bias , 2014, Research synthesis methods.

[52]  B. Haryanto Effect of Calcium Supplementation on School Children’s Blood Lead Levels in Indonesia , 2013 .

[53]  J. Schwartz,et al.  Effect modification by transferrin C2 polymorphism on lead exposure, hemoglobin levels, and IQ. , 2013, Neurotoxicology.

[54]  J. Agnew,et al.  Elevated Blood Lead Levels and Reading Readiness at the Start of Kindergarten , 2013, Pediatrics.

[55]  Chonghuai Yan,et al.  Impact of Low Blood Lead Concentrations on IQ and School Performance in Chinese Children , 2013, PloS one.

[56]  E. Oster,et al.  Unobservable Selection and Coefficient Stability: Theory and Validation , 2013 .

[57]  G. Parrinello,et al.  Inverse association of intellectual function with very low blood lead but not with manganese exposure in Italian adolescents. , 2012, Environmental research.

[58]  J. Schwartz,et al.  Assessing windows of susceptibility to lead-induced cognitive deficits in Mexican children. , 2012, Neurotoxicology.

[59]  O. Mahrous,et al.  Environmental lead exposure among primary school children in Shebin El-Kom District, Menoufiya Governorate, Egypt. , 2012, The international journal of occupational and environmental medicine.

[60]  Han-Bin Huang,et al.  Childhood blood lead levels and intellectual development after ban of leaded gasoline in Taiwan: a 9-year prospective study. , 2012, Environment international.

[61]  J. Pettifor,et al.  The effect of calcium supplementation on blood lead levels in Nigerian children. , 2011, The Journal of pediatrics.

[62]  Dae-seon Kim,et al.  Effects of blood lead concentration on intelligence and personality in school children , 2010, Molecular & Cellular Toxicology.

[63]  Elizabeth Tipton,et al.  Robust variance estimation in meta‐regression with dependent effect size estimates , 2010, Research synthesis methods.

[64]  Bung-Nyun Kim,et al.  Co-exposure to environmental lead and manganese affects the intelligence of school-aged children. , 2009, Neurotoxicology.

[65]  J. Schwartz,et al.  Effect of Calcium Supplementation on Blood Lead Levels in Pregnancy: A Randomized Placebo-Controlled Trial , 2008, Environmental health perspectives.

[66]  J. Peabody,et al.  Associations between cognitive function, blood lead concentration, and nutrition among children in the central Philippines. , 2008, The Journal of pediatrics.

[67]  Patrick J. Parsons,et al.  Blood Lead Concentrations < 10 μg/dL and Child Intelligence at 6 Years of Age , 2007, Environmental health perspectives.

[68]  M. Greenwald,et al.  Blood lead levels and specific attention effects in young children. , 2007, Neurotoxicology and teratology.

[69]  Aimin Chen,et al.  Lead Exposure, IQ, and Behavior in Urban 5- to 7-Year-Olds: Does Lead Affect Behavior Only by Lowering IQ? , 2007, Pediatrics.

[70]  A. Singh,et al.  Lead decline in the Indian environment resulting from the petrol-lead phase-out programme. , 2006, The Science of the total environment.

[71]  Y. V. von Schirnding,et al.  Reductions in blood lead levels among school children following the introduction of unleaded petrol in South Africa. , 2006, Environmental research.

[72]  J. Vega-Dienstmaier,et al.  Lead levels and cognitive abilities in Peruvian children. , 2006, Revista brasileira de psiquiatria.

[73]  R. Stoltzfus,et al.  Deficits in cognitive function and achievement in Mexican first-graders with low blood lead concentrations. , 2006, Environmental research.

[74]  S. Rothenberg,et al.  Reduced Intellectual Development in Children with Prenatal Lead Exposure , 2005, Environmental health perspectives.

[75]  S. Rothenberg,et al.  Testing the Dose–Response Specification in Epidemiology: Public Health and Policy Consequences for Lead , 2005, Environmental health perspectives.

[76]  Herbert L. Needleman,et al.  Low-Level Environmental Lead Exposure and Children’s Intellectual Function: An International Pooled Analysis , 2005, Environmental health perspectives.

[77]  S. Counter,et al.  Neurocognitive Impairment in Lead-Exposed Children of Andean Lead-Glazing Workers , 2005, Journal of occupational and environmental medicine.

[78]  Chong-huai Yan,et al.  [Parental education to reduce blood lead levels in children with mild and moderate lead poisoning: a randomized controlled study]. , 2004, Zhonghua er ke za zhi = Chinese journal of pediatrics.

[79]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[80]  R. Canfield,et al.  Intellectual Impairment in Children with Blood Lead Concentrations below 10 μ g per Deciliter , 2003 .

[81]  T. Matte,et al.  The effect of lead-based paint hazard remediation on blood lead levels of lead poisoned children in New York City. , 2003, Environmental research.

[82]  H. Zuberi,et al.  Lead-associated deficits in stature, mental ability and behaviour in children in Karachi , 2002, Annals of tropical paediatrics.

[83]  J Q Shi,et al.  A sensitivity analysis for publication bias in systematic reviews , 2001, Statistical methods in medical research.

[84]  S Duval,et al.  Trim and Fill: A Simple Funnel‐Plot–Based Method of Testing and Adjusting for Publication Bias in Meta‐Analysis , 2000, Biometrics.

[85]  G. Smith,et al.  Bias in meta-analysis detected by a simple, graphical test , 1997, BMJ.

[86]  S. Pocock,et al.  Environmental lead and children's intelligence: a systematic review of the epidemiological evidence , 1994, BMJ.

[87]  T. Matte,et al.  Retrospective study of the impact of lead-based paint hazard remediation on children's blood lead levels in St. Louis, Missouri. , 1994, American journal of epidemiology.

[88]  W. Snodgrass,et al.  Environmental exposure to lead and children's intelligence at the age of seven years , 1993 .

[89]  D. Bellinger,et al.  Low-level lead exposure, intelligence and academic achievement: a long-term follow-up study. , 1992, Pediatrics.

[90]  W. W. Manser,et al.  Trace element studies on Karachi populations. Part V: Blood lead levels in normal healthy adults and grammar school children. , 1990, JPMA. The Journal of the Pakistan Medical Association.

[91]  K W Kizer,et al.  Preventing lead poisoning in children. , 1990, The Western journal of medicine.

[92]  A. Bell,et al.  LOW‐LEVEL EXPOSURES TO LEAD; THE SYDNEY LEAD STUDY , 1989, Developmental medicine and child neurology.

[93]  D. Rice,et al.  Low-level lifetime lead exposure produces behavioral toxicity (spatial discrimination reversal) in adult monkeys. , 1987, Toxicology and applied pharmacology.

[94]  Duncan Laxen,et al.  INFLUENCE OF BLOOD LEAD ON THE ABILITY AND ATTAINMENT OF CHILDREN IN EDINBURGH , 1987, The Lancet.

[95]  Ashley M. Fox,et al.  Lead exposure and academic achievement: evidence from childhood lead poisoning prevention efforts , 2018 .

[96]  F. Trachtenberg,et al.  Neuropsychological function in children with blood lead levels <10 microg/dL. , 2007, Neurotoxicology.

[97]  M. Sinnett,et al.  A randomized trial of calcium supplementation for childhood lead poisoning. , 2004, Pediatrics.

[98]  A. Ramadan,et al.  Impact of lead exposure on health status and scholastic achievement of school pupils in Alexandria. , 2003, The Journal of the Egyptian Public Health Association.

[99]  M. Rahbar,et al.  Factors associated with elevated blood lead concentrations in children in Karachi, Pakistan. , 2002, Bulletin of the World Health Organization.

[100]  P. Succop,et al.  The developmental consequences of low to moderate prenatal and postnatal lead exposure: intellectual attainment in the Cincinnati Lead Study Cohort following school entry. , 1993, Neurotoxicology and teratology.

[101]  Yun-Chul Hong,et al.  Environmental Lead Exposure and Attention Deficit/Hyperactivity Disorder Symptom Domains in a Community Sample of South Korean School-Age Children , 2014, Environmental health perspectives.