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This chapter examines childhood lead poisoning, which causes severe and irreversible cognitive and nervous system impairment, as well as behavioral problems, in more than half a million American children each year. While the United States has addressed some causes of lead poisoning, a core group of children, concentrated in poor, urban areas in the Northeast and Midwest, remains at high risk. In nearly every state, manufacturers of lead paint and other lead products have not been held responsible for this harm, even though they were aware of the risks of lead poisoning since the nineteenth century. Many landlords in lead poisoning cases succeed in shifting the blame from themselves to the tenants, arguing that mothers are the actual cause of harm to the child. Because the American legal system has traditionally preferred to find a single cause of harm that cuts off others’ responsibility, many children injured by exposure to lead fail to receive compensation and treatment for their injuries.

Defining Vulnerabilities opens with a description of the history of childhood lead poisoning in the United States, which frames the puzzle at the center of this book: why and how did environmental health scientists, whose defining focus is on the effects of the environment on human health, make “gene-environment interaction” their mantra?How do we understand how scientists deeply committed to protecting public health decided to shift their research practices inside the human body and to the molecular level? The introduction provides a brief overview of the central analytic categories of the book, including fields, institutions, socially skilled actors, and biopolitics.

This chapter provides an introduction to the contested dynamics between medical knowledge, public policy, and grassroots political action. The chapter examines how lead’s victims and their advocates responded to a once “invisible” and newly recognized environmental disease. It also analyzes official state responses in relation to international biomedical and public-health intervention norms and practices. The chapter argues the state’s Official Protocol worked to minimize the parameters of lead-poisoning risk by, among other measures, raising international action thresholds—doubling the threshold for the lead level in blood and quintupling it for that in water. It conformed a set of de-facto policies and regulatory interventions focusing and circumscribing state action on lead poisoning within the spatial realm of squatter settlements, the cultural realm of the urban poor, and the ecological realm of soil.

The book’s introduction presents the origins, character, scope, and implications of the Uruguayan lead-poisoning epidemic. The chapter situates the epidemic within a political and economic context of neoliberal reform and crisis and in relation to the global and biomedical history of the disease. The chapter outlines the author’s ethnographic research methods and the book’s principal social actors and research sites. The theoretical foundation of the book follows a political ecology of health perspective, with focused analyses of environmental justice, knowledge/power, and governance/resistance.

The link between exposure to lead and children’s cognitive problems was implied in the earliest medical reports of frank lead poisoning of young children in Australia in the 1800s (Lin-Fu 1992). Children with acute severe toxicity of lead (Pb) are now rarely seen in the United States. However, millions of children may have subclinical neurobehavioral disorders associated with chronic low-level exposure to lead, representing a major public health concern (Bellinger 2008a). Lead is a nonessential metal that is recognized as a source of toxic exposure, with the developing nervous system particularly vulnerable. Because of this, U.S. regulations limiting the lead content of gasoline and household paint have led to a gradual reduction of the average blood lead concentration of Americans over the last three decades. Average blood lead levels of children in the United States dropped an estimated 78% from 1976 to 1991 (Brody et al. 1994; Caldwell et al. 2009). Despite these reductions in exposure to lead, new advances in research techniques have documented harmful consequences associated with lower blood lead levels. This raises the possibility that there is no threshold for occurrence of lead-induced toxicity. Bellinger (2008a) refers to “the silent pandemic of neurodevelopmental disorders resulting from children’s continuing exposure to low levels of lead.” The developing brain may be more sensitive to exposure to lead than the adult. Since the pioneering work of Needleman and colleagues (1979), a large scientific literature has documented the deleterious effects of pre- and neonatal exposure to lead. Decrements in IQ scores have proven to be among the most sensitive and consistent consequences of a child’s exposure to lead, but other cognitive and behavioral changes have been described as well, including attention-deficit hyperactivity disorder (ADHD). Among the important current sources of children’s exposure to lead is household dust (Dixon et al. 2009) the lead content in old water pipes, batteries, and from contamination by numerous industrial processes. Pre and postnatal exposure to cigarette smoke is a cofactor with lead exposure in children’s conduct disorders (Braun et al. 2008). Diagnosis of lead-induced disorders involves the determination of exposure to lead and the atomic absorption assay of lead in whole blood.

Beyond its work on sanitation, the Young Lords responded to a series of other neighborhood problems that fell within the scope of public health. In the fall, the group launched its first children’s breakfast program alongside the Black Panthers. In tandem with community groups and hospital medical and administrative staff, the group was thrust into a larger political debate about the changing structure of healthcare in the city to which it contributed a document called the Young Lords’ 10-Point Health Program and Platform. In what is perhaps the Young Lords’ most enduring legacy, the group brought militancy to a pre-existing campaign against childhood lead poisoning that pressured City Hall to take action on a silent public health crisis. But, why health? Close analysis of this lesser-known campaign reveals that larger forces steered the Young Lords’ turn to health. They were, in part, following the example of the Cuban Revolution, which made dignified healthcare-for-all a signature aspiration of revolutionaries around the world. They were also propelled by post-war changes in the structure of medical care in the U.S. as well as by high rates of illness among the new migrants and the unintended consequences of their greater access to healthcare in the age of civil rights, which ironically also increased the incidence of medical discrimination.

This chapter challenges the prevailing narrative that mothers are risky to their children’s health, discussing the myriad ways in which mothers are portrayed as dangerous to their children’s health—and are often held legally responsible for it. This often occurs simultaneously with society’s failure to acknowledge the significant contributions to children’s health made by fathers and other men, as well as more distant, but equally significant, social, economic, and physical factors. The chapter introduces the role of unconscious psychological processes in influencing the decisions of key legal players.

This chapter examines factors that account for health disparities, government response to public health threats to African Americans, and sociohistorical influences on perceived fairness of the public health system. It first cites evidence showing that African Americans receive a poorer quality of health care than whites before turning to a discussion of African Americans' distrust of the public health establishment and especially the biomedical community. It then explores the problems facing many “safety-net” urban public hospitals that serve the poor and uninsured and goes on to analyze lead poisoning as a classic example of an environmental health threat that disproportionately impacts low-income children and children of color. The chapter also looks at three experiments that illustrate the legacy of racial discrimination and bias treatment in medical research: the federally funded Public Health Service Tuskegee Syphilis Study, the East Baltimore Childhood Lead Paint Experiment, and pesticide tests on children in Florida. Finally, it evaluates government responses to epidemics and bioterrorism threats.

During the belle époque, a vision of Parisian garment workers as guardians of a French cultural monopoly on luxury taste was deployed by trade industrialists, labor inspectors, philanthropists, and government officials assessing the state of the garment industry. In examining exhibition reports, ministerial inquiries, and labor reform commissions, it becomes evident that assertions of French fashion genius were threaded throughout debates about industrial trade and regulation for audiences both abroad and at home. This reveals a peculiarly French investment in fashion and tastefulness. Furthermore, national taste supremacy combined with fears about the vulnerability of the couture industry to stymie attempts at regulating workplace and environmental hazards in this period. This chapter begins by exploring rhetoric about the Parisian garment worker around the Franco-British Exhibition of 1908, when French and British commentators alike praised French luxury garment products, and evoked Paris as the site of garment trade art and Parisian workingwomen as the preternaturally tasteful if antediluvian instruments of that art. It then interrogates how such encomia to garment worker taste and vulnerability operated in two debates about workplace reform during the belle époque: efforts to eliminate night garment work and those to regulate toxic substances in artificial flowermaking.

Chapter 6 considers how environmental justice activists perceive the ascendance of research on gene-environment interaction. This chapteropens with a case study of a 2002 court case-Tamiko Jones, et al., v. NL Industries, et al. (Civil Action No. 4:03CV229)-in which genetic arguments were used to undermine plaintiffs’ claims that their children’s cognitive and behavioral deficits were caused by lead poisoning. It then describes activists’ fears that research on gene-environment interaction will serve as a “smoke screen” for the social-structural dynamics underlying the disproportionate burden of environmental risks and illness borne by communities of color in the United States. However, it alsoconsiders to activists’ cautious interest in using molecular techniques to generate proof of environmental exposures and their deleterious effects.

This chapter notes that, in a historical context, American children are generally quite healthy. Nevertheless, when compared with other economically developed countries, today the United States falls short, especially in measures of infant mortality, preterm birth, and childhood injury and death. This can be attributed in large part to class- and race-based disparities, as well as to stressors, such as environmental hazards, physical and sexual abuse, domestic violence, and substance abuse and mental illness. The American legal system has largely taken a hands-off approach to many of these problems, and children have suffered as a result.

This chapter considers the comprehensive risks to children’s health, which are complex and often interconnected. Only by taking collective responsibility to protect children’s health will the real risks to children’s health be reduced. It is time to embrace the precautionary principle. Instead of addressing children’s health problems by scapegoating mothers, society would be better served by addressing broader risks to childhood health, especially those related to poverty and living in poor inner-city neighborhoods. Offering voluntary medical and social services to mothers is the key to improving children’s health.