Tracking lead in the blood of Broken Hill

The Broken Hill Department of Rural Health (UDRH) is continuing a long-standing partnership with health groups in the town to monitor and reduce the amount of lead in the blood of the town's children.

The Broken Hill Department of Rural Health (UDRH) was set up in 1997 to improve health care in far western NSW by providing support, education and training for local health care workers.

In areas such as Broken Hill the University offers expertise and facilities that may not otherwise be within reach of the local health services due to financial and resourcing constraints. In regional areas, University researchers play an important part of a collaborative effort.

The Broken Hill UDRH has played a role in the long-running Broken Hill Lead Management program.

Broken Hill

Lead has been a part of life for the Broken Hill community for over one hundred years, having been mined in the town since 1884.

The effects of lead poisoning have historically been considered more of an occupational health and safety issue for those who worked in the town’s mines, rather than a community-wide health issue. A study carried out in the 1980s seemed to reinforce this view when all children surveyed were found to have blood lead levels below that considered a cause for concern at the time: 40 micrograms per decilitre of blood.

However, a subsequent study of the town’s dogs showed that they had elevated blood lead levels similar to the dogs of Port Pirie, a town with an active lead smelter. Also during the 1980s, an open-cut mine in the middle of town was recommissioned and Broken Hill suffered a drought. When three babies were born with delayed visual maturation – a sign of high lead exposure in utero – concern about blood lead levels was piqued.

A survey in 1991 showed that 86% of children in the 1-4 age group had blood lead levels of 10 micrograms or more, the current level considered to be a concern. In 1994 the State Government funded a lead management program in Broken Hill. It involved health promotion and environmental clean-up initiatives. Since then pre-school children in Broken Hill have been offered blood lead screening. This has contributed to the blood lead levels in children declining markedly.

“It’s important to note that the University didn’t initiate the blood lead program, it is the collaborative role that it has taken that is important. People in regional areas don’t often take to ‘outsiders’ coming in and telling them what to do, it’s important that units like this work with existing health bodies to solve problems, rather than solving them for them”, said Frances Boreland, the current University lead researcher on the program.

University researchers made, and continue to make, a valuable contribution to the monitoring of blood levels in the children of Broken Hill. Although there has been a significant result, the work of the program is not complete. Initially the program was reactive and took a confirmatory role in the study of blood lead levels. The program has since become more strategic. There is less active health promotion but screening is still occurring.

“In broad terms, the program has evolved to meet new challenges. Initially the aim was to get blood levels down, then to monitor to ensure levels stay down. Now it can take on a more strategic role in the management of blood lead levels. This is important in light of new developments, such as a proposed new mine in the centre of town”, said Boreland.

Over time, those bringing their children in for screening has dropped. Given the importance of monitoring to the ongoing management of lead in Broken Hill, Boreland, Professor David Lyle and a public health trainee from NSW Health investigated why.

“We did some work with the community to discover why the screening attendance had dropped. Over time there was less active promotion of the lead issue and people seemed to feel the real danger had passed, that it was no longer an issue. Also, some people were uncomfortable with the screening procedure so once they perceived the urgency had been removed, they made the choice not to put their children through it. These are two factors that seem to have contributed to the decline,” said Boreland.

The level of acceptable lead in the blood is also under review. The level acknowledged as being safe has dropped from 60 micrograms per decilitre in the 1960s to 10 today and there are moves to revise this level down further.

“Ongoing monitoring is important in light of the potential changes to acceptable levels of lead in the blood. It is possible that 10 will no longer be seen as a level that does not require concern or action. Germany has recently reduced the blood lead level of concern and the US and Canada are reviewing their guidelines”, said Boreland.

The Broken Hill UDRH will continue to provide the program with research and analysis support. It has also extended its research support role within the region through its collaboration in the Centre for Remote Health Research.

Established in 2003, the Centre for Remote Health Research is focussed on population health: supporting other health providers in the area, especially in public health and primary care. It provides training in research methods and the translation of UDRH research into policy and practice that will benefit not only Broken Hill, but other remote areas of Australia.