Defining lead as the premiere environmental health issue for children in America: criteria and their quantitative application.

The principal environmental health issue for American children is pervasive lead poisoning from the many decades of lead contamination. Available scientific evidence cementing lead's premiere ranking is voluminous, multifaceted, and compelling. This evidence, however, requires organization into a clear and coherent body of science before it can be fully recognized or comprehended by either the scientific community or the general public and its representatives: public health officials, regulators, policy makers, and legislators. An attempt at such organization is presented and begins with the premise that there exist clear, objective criteria by which a premiere environmental health issue can be defined. A second premise is that these criteria sort themselves into three categories which cover the full spectrum of toxic contaminant-population relationships. They are: (1) economic and sociopolitical, (2) scientific and public health, and (3) societal risk assessment criteria. The first set of criteria includes economic and historical centrality, primacy of economic over public health considerations, a relatively narrow decision-making framework, and controlled flow of information on the toxicant, especially its negative impacts. The second set of criteria is also orthodox in scope: the toxicant should be indestructible, should accumulate in both the environment and the body, and should be a multimedia contaminant; it should produce toxicity in numerous organs with little impediment; toxicity should be produced with low/no threshold in huge numbers of the most vulnerable; and finally, effects should persist in the critical target organ(s). There is a third, more globally encompassing, set of criteria important for present-day requirements for risk assessment; e.g., the contaminant should produce full-spectrum population-wide as well as individual toxicity. Evidence for societal harm should be compelling. It should typify the increasing importance of the elements of preventive over clinical medicine and the substance should bring to bear the cost-benefit analysis of macro plus micro health risk. Lead exposure and toxicity is conclusively shown to meet ALL of these criteria and is the premiere environmental health threat to America's children.