Dr. Lucia Coulter, Lead Exposure Elimination Project (LEEP)

Serving as a “Charity Entrepreneur,” after a Career in Clinical Medicine: An Interview with Dr. Lucia Coulter of the Lead Exposure Elimination Project (LEEP)

August 20, 2021 – By Jared Mueller, Director – Mayo Clinic Innovation Exchange

Lead poisoning imposes massive costs on individuals — and on national economies. Individual victims of lead poisoning can suffer lifelong cognitive and cardiovascular problems. Their communities suffer from the burden lead exposure imposes on individual lives, on health systems, and on the nations where human capital is undermined by lead’s health impacts.

Dr. Lucia Coulter is the co-founder and director of the Lead Exposure Elimination Project (LEEP), a charitable organization focused on reducing the human cost of lead poisoning. A medical doctor, Dr. Coulter previously worked as a physician in London, and has both clinical and research experience. Dr. Coulter graduated from the University of Cambridge with an M.B., B.Chir. in Clinical Medicine and an M.A. in Natural Sciences. In addition to her professional service, Dr. Coulter has contributed expertise to a number of effective altruist projects.

Q: Can you describe your transition from practicing clinical medicine to founding a startup charity working across multiple continents?

LC: In my experience, medicine has been very helpful as preparation for running a charity startup. The scientific background has helped me to be analytical and cost effectiveness-focused. Medicine also helps to develop communication and decision-making skills, and the ability to learn fast and act in stressful situations — which is useful in any startup.

I really enjoyed clinical medicine. I absolutely loved working in the hospital. On balance, I decided that starting a health nongovernmental organization (NGO) focused on a big and neglected problem would enable me to have a larger impact than if I remained in a huge system that would probably function just as well without me.

This discrepancy in impact relates directly to the importance of social determinants of health, global health inequality, and the high returns on investment for prevention-oriented activities. For example, in the U.K., the National Health Service will fund an intervention that could provide a patient with an additional quality-adjusted life year (QALY) for around £25,000. In low- and middle-income countries (LMICs), there are often opportunities to preserve a QALY for as little as £25 — around $35 USD, as of August 2021.

Q: Can you share more about LEEP’s model and work?

LC: We focus on advocating for the introduction and effective enforcement of policies that regulate use of lead paint in countries that face large and growing burdens from lead poisoning. One in three children worldwide have lead poisoning, which has huge impacts on neurodevelopment, health, income, and flow-through effects.

Researchers at New York University found that the neurodevelopmental and cognitive effects that individuals suffer as a result of lead exposure cost the world more than $1 trillion annually. More than $50 billion of that annual cost is borne by the United States, as we have seen in the tragic case of the recent water crisis in Flint, Michigan, but the vast majority of these economic losses due to lead are felt by low-and middle-income countries, where lead burdens are higher and where losses can be equivalent to over 6% of gross domestic product (GDP) each year. Those cost figures also do not reflect the expected impacts of future cardiovascular disease, and other health consequences that frequently result from excessive lead exposure.

In the United States, research has found that about 70% of the lead contributing to elevated blood levels in children is attributable to lead paint, lead paint mixed with house dust, and lead-contaminated soil. There is reason to believe the role of lead paint is the major contributor to lead poisoning challenges in LMICs, as well.

Q: The government of Malawi has been an important collaborator with LEEP in your early years. Can you share more about your work there?

LC: Our team has run paint sampling studies in Botswana and Malawi. LEEP is also now in the process of running studies of paint in Madagascar and Zimbabwe. Our work in Botswana found that much of the household paint in the country is imported from South Africa, where lead paint regulation is well-established — and paint in Botswana that we analyzed did not feature high levels of lead. Meanwhile, the solvent-based paint we studied in Malawi demonstrated high levels of lead.

Our meetings with the Malawi Bureau of Standards and the country’s Health Ministry where we shared this new data have led the Malawi government to start the process of updating their paint standards to a 90 parts-per-million limit, in line with the WHO’s and UN’s recommended limits. The government has also announced a commitment to enforcing lead paint regulation in the country and have begun monitoring the lead content of paint.

Industry plays an important role as well, so we have met with local lead paint manufacturers to support their reformulation efforts going forward with technical advice. Those firms will be working with the Bureau of Standards on a timeline for transition to safer paint formulations.

Q: What breakthrough innovations in healthcare delivery or technology excite you most?

LC: At the moment I’m excited about any technologies that will make it easier to address childhood lead poisoning in countries with fewer public health resources. A big barrier at the moment is just data — most countries have very little blood lead level testing, and very little monitoring of sources of lead exposure. As a result, we do not currently know who is most exposed to lead, and which sources of lead exposure are most important. If we knew this, we could develop more highly impactful interventions to reduce lead exposure and help children live longer, healthier, and happier lives.

So technologies like cheap and effective portable finger prick blood lead level analysis would be amazing, as would cheaper ways of measuring the lead content of potential sources in the environment, or even more accessible ways to compare isotopes of lead in blood to lead in the environment.

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