1. If environmental exposure of the general public to a considerable extent takes place through various routes of entry, quality standards for one source of exposure (e.g. air, food, water) will not protect public health adequately. This is the case for inorganic lead. 2. Biologically available lead (lead in blood levels) and parameters of subclinical response may be expected to be feasible for indirect estimation of total environmental exposure; the feasibility has been studied. 3. Lead in blood levels (PbB) in target groups of the general population portray the total environmental exposure to Pb for this group. Such groups should include at least 50 subjects, of same sex, similar socio-cultural class, with narrow age range, and preferably at high risk (exposure or susceptibility). 4. Neither average levels nor one maximum level, but the distribution of levels in 98% of the target group should be taken as parameter of external exposure. 5. The maximum acceptable individual level for adults is PbB=40 Μg Pb/100ml; because of increased uncertainty in regard to pregnancy and developing neonate this level should be lowered to PbB=35 Μg Pb/100 ml. 6. Taking into account the maximum acceptable level of 35 Μg Pb/100 ml in 98% of subjects, and the normal variability of PbB levels as occurring in practice, the following distribution of PbB levels is proposed as biological quality guide: 98% ≦35 Μg Pb/100 ml, 90% ≦30 Μg Pb/100 ml, 50% ≦20 Μg Pb/100 ml. PbB levels in women should be corrected to male level on the basis of hematocrite. 7. If the general distribution of PbB levels in a target group exceeds the proposed guide, total exposure in the environment studied is too high; action should be undertaken directed at the total environment. If the distribution only exceeds the guide at high PbB levels, a point source of external lead exposure is probable; action should be directed at this source. 8. If in the environment total exposure to lead is too high, subsequent studies should determine contribution through various routes and sources: quality standards for air, food, water may have to be imposed; the same applies to emission standards. 9. Due attention to errors of measurement of Pb in blood is necessary. 10. It is not yet possible to propose a biological quality guide based upon Pb in urine or hair. 11. It is not possible to propose a biological quality guide based upon ALAD-activity in erythrocytes, neither on ALA-excretion in urine. 12. The proposed biological quality guide for lead in blood could enter governmental regulations, and so become a biological quality standard, if prevention of direct adverse effect on human health is aimed at.
Read full abstract