Throughout these hearings, the matter of dangerous levels of lead in paint, and what may be the effect of such levels on young children, has been the subject of active debate. I strongly support the need to eliminate lead from all paints intended for interior surfaces in order to protect the health of young children based upon the recommendation of the American Academy of Pediatrics that more than 0.06 percent lead in the dried film of paint is hazardous. I also believe that continuing research may be required to establish whether the maximum level in such paint should be 0.06 percent or lower. Accordingly, I shall request the Department of Health, Education, and Welfare to recommend proposals for continuing research in this area. At the same time I intend to request the Department of Housing and Urban Development to provide research that will determine ways for small paint producers to adopt those manufacturing procedures that will produce interior paints that use no lead additives. I understand that certain large paint manufacturers have been able to produce such products through their own research facilities. But most small paint producers do not have access to extensive research operations. For that reason I intend to pursue ways to provide possible Federal assistance to small paint producers for that purpose.

It is my hope that the information obtained throughout these hearings will assist the committee in developing legislation that can begin to effectively eliminate the hazards of lead based paint poisoning. I wish to welcome each of today's witnesses:

Dr. Merlin K. DuVal and Dr. John Zapp from the Department of Health, Education, and Welfare, and Dr. Stanley Greenfield from the Environmental Protection Agency.

I would like to welcome our witnesses for the administration this morning: Dr. Merlin K. DuVal, the Assistant Secretary for Health and Scientific Affairs and Robert Novick, Bureau of Community Environmental Management; Peter Hutt, Assistant General Counsel, Food and Drug Administration; and Dr. Roger Challop, Staff Pediatrician, Bureau of Community Environmental Management.

A graduate of Dartmouth College and Cornell University Medical College, Dr. DuVal has both practiced and taught surgery. In addition, he has held many offices during his career, has edited various publications, and is an outstanding doctor and administrator. Before coming to HEW, he was dean of the University of Arizona College of Medicine and director of the Arizona regional medical programs.

We welcome you back before the committee. I think we are primarily interested in a variety of different features this morning. We are interested in the problems of labeling and what can be done about this to insure the truth in the labeling of paints. We are interested in the percent of lead in paints and your views on this.

I understand you have some views and take a position. We are interested in when we are going to be able to seek commitments of the moneys which have actually been appropriated, and we are going to get some of that money out in the field, and whether you think we should be increasing these appropriations. We are glad to hear from you.

STATEMENT OF MERLIN K. DUVAL, M.D., ASSISTANT SECRETARY FOR HEALTH AND SCIENTIFIC AFFAIRS, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, ACCOMPANIED BY ROBERT E. NOVICK, DIRECTOR, BUREAU OF COMMUNITY ENVIRONMENT MANAGEMENT HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION, HEW; PETER HUTT, ASSISTANT GENERAL COUNSEL, FOOD AND DRUG ADMINISTRATION, HEW; ROGER CHALLOP, M.D., STAFF PEDIATRICIAN, BUREAU OF COMMUNITY ENVIRONMENTAL MANAGEMENT HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION, HEW

Dr. DUVAL. Thank you, Mr. Chairman. I would like to make sure that the guests that are with me at the head table are known to you. On my extreme left is Mr. Robert E. Novick, who is the Director of the Bureau of Community Environmental Management. On my left it Dr. Roger Challop, staff pediatrician, Bureau of Community Environmental Management; and on my right, Mr. Peter Hutt, Assistant General Counsel for the Food and Drug Administration.

I would like to say, Mr. Chairman, that I would like to express my personal regret that I was not able to be here on Monday when you originally requested me. This is a personal thing on my part, and I have an interest in this subject and wanted very much to be a part of it. Senator KENNEDY. We have had a lot of changes in the schedule. Our witnesses have been extremely accommodating and understanding. We are thinking of either postponing the hearings, delaying them even further, but I think it is a matter of sufficient importance that we really have to get about it, so I want to thank you for your appearance today.

Dr. DUVAL. I appreciate the opportunity to appear before this committee to discuss the problem of childhood lead poisoning. At the outset, I should like to emphasize that the successful elimination of the lead-based paint poisoning hazard is a shared responsibility—shared by the Federal Government, the States, local governments, communities, and individuals. Voluntary activities are an important component of this shared responsibility.

This child health problem will for the foreseeable future, be caused by lead-based paint which was applied mostly before 1950. Therefore, we believe that our major effort should be directed at identification and treatment of children affected, and reducing the hazard in their home environments.

A MEDICAL PERSPECTIVE

From a traditional medical point of view the cause, detection, and treatment of lead poisoning is reasonably well understood. However, when we step from the episodic treatment of individual cases into the more challenging arena of health maintenance and prevention for the population involved, we confront problems of almost unmanageable complexity. One important problem is that much of the data is incomplete and frustratingly inadequate. Nevertheless, these are the facts as we understand them today.

Despite its seriousness, lead poisoning is not a leading cause of mortality or morbidity among children. Available data indicates that

it accounts for about 1 percent of the deaths which occurs in the 1 to 4 age group; the true mortality rate may be somewhat higher because diagnoses are often imprecise and it is not generally a reportable disease.

Senator KENNEDY. What is the number one cause of deaths for infants under the age of 1?

Dr. DUVAL. Well between the age of 3 months and 12 months it would probably be sudden infant deaths.

Senator KENNEDY. That is another problem to deal with that we have talked about and are very interested in.

Dr. DUVAL. As you know, I share your interest, Mr. Chairman.

By comparison, motor vehicle accidents, congenital anomalies, and pneumonia each cause more than 10 times this number of deaths. Although lead poisoning is not a major cause of death in children, it does cause proportionately more deaths within the lower socioeconomic, nonwhite groups. This is primarily a disease of the poor, the black, the Spanish-speaking and other groups living in substandard housing. In New York, for example, as many as 86 percent of the reported cases of lead poisoning have occurred among black and Spanishspeaking persons although they make up less than 50 percent of the population.

The lead paint poisoning problem among children is particularly critical because, unlike most accidents and most other childhood illnesses, lead-paint poisoning is likely to produce residual problems, particularly damage to the central nervous system. This may range from relatively minor sensory-motor impairment through limited intellectual impairment to serious mental retardation. In addition, there is serious and we believe well-founded concern that elevated blood lead levels may cause permanent damage in children, even though clinical symptoms are never identified. Thus, it is one of the afflictions which contributes to continuing dependency among economically deprived portions of our population and their inability to extricate themselves from the frequently interrelated problems of disease and poverty.

SOME HUMAN DIMENSIONS

Although our data base is far from statisfactory, our best estimates indicate that approximately 2.5 million children in the United States live in dilapidated housing which, presumptively, due to age and location, may contain hazardous amounts of lead paint. These 2.5 million children are classified as "at risk." Mass screening projects conducted in high risk areas of seven cities indicate that approximately 20 to 40 percent of the children screened may have excessive amounts of lead in their blood.

Extrapolating these estimates to the country as a whole, we estimate that approximately 25 percent of these children at risk, or about 600,000 children, may have significantly elevated blood lead levels. About 50,000 to 100,000 of these children are apt to have sufficiently high blood lead levels to indicate medical treatment.

SOME ECONOMICS DIMENSIONS

Lead paint poisoning costs this Nation about $200 million annually. This estimate includes the lost earnings and the costs of treatment,

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education, and institutional care of those afflicted. In addition, there is an unquantified cost to society of approximately 200 deaths per year traceable to lead poisoning.

Recognizing the severity of this health problem, this Department has intensified its efforts to control lead poisoning in the past year. I would like to review these efforts with the committee at this time.

IMPLEMENTING ACTIVITIES

The Bureau of Community Environmental Management in our Health Services and Mental Health Administration has been assigned the responsibility for lead-based paint poisoning prevention. At the request of that Bureau, the Secretary appointed an intradepartmental committee with representation from the Food and Drug Administration, Social and Rehabilitation Service, Office of Child Development, Office of Education, National Institutes of Health, National Institute of Mental Health, Maternal and Child Health Services, and Community Health Services. The principal charge of this committee is to mobilize the resources of HEW effectively to control lead poisoning. Representatives of that group have been successful in securing recognition of the problem by the agencies administering the title XIX amendments to the Social Security Act-medicaid-those administering the neighborhood health center activities of the Department and those having other related programs.

Recommended procedures for case finding, and treatment, surveillance, and management of lead poisoning cases have been published under the title, "Medical Aspects of Childhood Lead Poisoning." Also, we convened an authoritative group of scientists to establish the limits of lead intake which children can absorb without causing undue accumulation of lead in the body. The findings of this group were published in the American Journal of Diseases of Children. Both of these publications have been widely distributed and are submitted for the record as a part of this statement.

We are also aggressively pursuing ways to reduce the costs involved in screening children, treating children, and reducing the hazard in dwellings. Proposed regulations governing the grant authorizations of title I and title II of Public Law 91-695 were published in the Federal Register on January 25. The 30-day comment period ended on February 24, so we expect to publish final regulations in the near future. Meanwhile we are completing the system for administering grant awards and we will commence announcing grants very shortly after the regulations are published. We expect to commence making awards by the end of March, and I can assure you that there will be no problem in committing, before June 30, the $62 million currently available for this program. These grants will further the lead poisoning control program by strengthening and expanding current activities and will permit additional communities to initiate lead poisoning control efforts.

Title IV of the act requires the Secretary to take such steps as may be necessary to prohibit the use of lead-based paint in the construction or rehabilitation of housing which is federally constructed or federally assisted in any way. Regulations adopted pursuant to this title were published in the Federal Register on March 7. These regulations require all Federal agencies and departments concerned with residential

housing construction to adopt regulations prohibiting the use of leadbased paint, to develop a plan to accomplish the prohibition and to submit the plan to the Secretary of the Department of HEW by June 7,

1972.

Food and Drug Administration regulations. The Food and Drug Administration, as an agency concerned with public health and safety, has also taken a number of steps directed at eliminating the hazard of lead-based paint in and around the home. These include publishing proposed regulations to limit lead in paints for household use, and requesting analyses of all manufacturers' paints for lead content.

On November 2, 1971, a proposal was published in the Federal Register by the Commissioner of FDA to declare paints and other surface coatings containing more than 0.5 percent lead, and specified levels of other critical elements and heavy metals, to be hazardous substances. In the same issue of the Federal Register, a notice was published on behalf of petitioners Joseph A. Page, et al., proposing that paints for household use containing more than minute traces of lead be classified as banned hazardous substances under the Federal Hazardous Substances Act.

Approximately 200 comments were received in response to these proposals. They represent the views of consumers, consumer groups, physicians, paint manufacturers and their associations, Government agencies, and the American Academy of Pediatrics.

The American Academy of Pediatrics suggested the banning of paints containing more than 0.06 percent of lead for use on interior surfaces, toys, and other children's articles. Most of the 41 other physicians; comments endorsed this suggestion.

Senator KENNEDY. If I may interrupt you, I am going to have to leave for the Judiciary Committee. Senator Schweiker is going to be here. I know that you may refer to some of these matters later, but I would like to ask some questions and I will ask that these appear after Dr. DuVal finishes the testimony.

If I could, I would like to ask a few questions and then let you proceed.

We have appropriated the money, $72 million which was appropriated last July, that is 8 months ago, and can you tell us when you are going to start getting that money out into the field?

Dr. DUVAL. My mid-March.

Senator KENNEDY. My mid-March. I have got the 10th of March. Do you mean by the 15th?

Dr. DUVAL. I think we have pretty much all the reactions in from the publications of the proposed rulemaking, and we can start making grants later in March.

Mr. NOVICK. The final action is the publication of the regulation in the Federal Register, then we can legally make grant awards. The regional health directors have been delegated the approval authority to approve and fund community requests for grants. The regional health directors may wish to consider all applications available before they actually decide which ones are best.

Senator KENNEDY. Have they not been doing that in the meantime? Mr. NOVICK. They have received a number of applications, but others are still coming into their offices.

It would seem a logical procedure to review most of them before committing the funds available.