PROTECTING BROKEN HILL CHILDREN FROM LEAD IN THE 21ST CENTURY

This thesis uses a translational research approach and combines theoretical, empirical and experiential evidence to explore four key issues that provide further direction to current efforts to reduce lead exposure in Broken Hill, and more generally to improve management of environmental health risks in the community setting. A theoretical review argues for an adaptive response to program development, recognising that the solution to the problem is not straightforward. The review indicated the need for multi-pronged strategies including both population-based approaches and strategies focussing on particular risk groups. Unintended negative consequences must be scanned for and managed so as to ensure a positive benefit : harm ratio is maintained. A qualitative, interview based case study of successful lead exposure reduction programs identified the need for an accurate understanding of sources and pathways of exposure, which may need an iterative approach; effective control of those sources and pathways, adequate funding to undertake the work and active cooperation of relevant stakeholders. A qualitative, interview based case study of the Broken Hill Lead Reference Group found there was broad agreement as to what was required to further reduce lead exposure but that lack of recognition of constraints other organisations faced and overall lack of resources (funding and leadership) within the LRG significantly inhibited collaboration across the group and efforts to reduce lead exposure. Improving collaboration and leadership within this Group is necessary in the long term to reduce lead exposure. A before-after study of changes in participation in blood lead screening found that changing from venous to capillary screening and improving convenience both increased screening, and showed that restructuring services in response to community concern can effectively increase participation. A $13 million, five year program to reduce lead exposure in Broken Hill was established in 2015; considerably more funding is likely to be required