Lead In Tap Water:

CDC Public Health Communications Need Improvement

GAO-11-279: Published: Mar 14, 2011. Publicly Released: Apr 4, 2011.

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In February 2004, the Centers for Disease Control and Prevention (CDC) was asked to assess the effects of elevated lead levels in tap water on Washington, D.C., residents. In April 2004, CDC published the results. However, an inaccurate statement and incomplete descriptions of the limitations of the analyses resulted in confusion about CDC's intended message. GAO was asked to examine (1) CDC's actions to clarify its published results and communicate current knowledge about the contribution of lead in tap water to elevated blood lead levels (BLL) in children and (2) CDC's changes to its procedures to improve the clarity of the information in its public health communications. GAO reviewed CDC communication policies and procedures and interviewed CDC officials.

CDC officials told GAO that although the agency does not have a policy to monitor the use of or clarify information in public health publications, the agency took actions to address confusion it created related to the 2004 Morbidity and Mortality Weekly Report (MMWR) article about elevated lead levels in Washington, D.C., tap water. For example, in 2008, CDC officials contacted District of Columbia Water and Sewer Authority officials requesting corrections to a statement in a fact sheet published by the water authority that incorrectly characterized information from the 2004 MMWR article. In addition, CDC also published articles in the 2010 MMWR intended to clarify the confusion, such as a June 25, 2010, article that discussed limitations about how information in the 2004 article could be used. While CDC took these actions, among others, to clarify confusion about the effect of elevated lead levels in District tap water, as of January 2011, CDC had no plans to publish an overview of the current knowledge about the contribution of elevated lead levels in tap water to BLLs in children, as suggested by a CDC internal incident analysis of issues surrounding the 2004 MMWR article. CDC officials told GAO they had begun an initiative and revised procedures designed to help ensure the accessibility and clarity of CDC public health communications, both agencywide and in the National Center for Environmental Health, the center responsible for lead poisoning prevention programs. For example, under the new initiative, CDC will revise existing procedures to help ensure that information that CDC publishes, such as guidelines and recommendations, is easily accessible by a common portal on CDC's Web site. While the initiative and revised procedures focus on making CDC information more accessible and on preventing errors or unclear statements in CDC communications, they do not include actions to address confusion that may arise after information is published, such as occurred with the 2004 MMWR article. Without agency procedures specifically addressing how and when to take action about confusion after publication, CDC runs the risk of inconsistent responses across the agency when its published information is not interpreted as CDC intended. CDC's mission to promote the nation's public health relies on its credibility in presenting accurate, reliable, and timely information. Communicating the agency's current knowledge about the health effects of lead levels in tap water and developing procedures that allow it to address confusion in a timely, consistent manner could improve the public's understanding of the effect of lead in water and help CDC mitigate the risk of confusion in other situations and protect its credibility. GAO is making two recommendations to CDC: (1) publish an article providing a comprehensive overview of tap water as a source of lead exposure and communicating the potential health effects on children and (2) develop procedures to address any confusion after information is published. CDC generally concurred with GAO's recommendations. For the second recommendation, while CDC described procedures it is developing, the agency did not explicitly address all components of the recommendation.

Status Legend:

More Info
  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendations for Executive Action

    Recommendation: To clarify confusion about the contribution of lead in tap water to elevated BLLs, the Director of CDC should publish an article in an MMWR Recommendations and Reports that conveys what is known and not known about tap water as a source of lead exposure and communicates the potential health effects in children of elevated lead levels in water in consultation with EPA, as appropriate.

    Agency Affected: Department of Health and Human Services: Public Health Service: Centers for Disease Control and Prevention

    Status: Closed - Implemented

    Comments: In August 2012, CDC published a MMWR supplement, Lead in Drinking Water and Human Blood Lead Levels in the United States, which describes the effects of exposure to lead on children and adults in general, and provides information about lead in drinking water and the history of studies that examined the effect of this exposure on children. It also notes challenges in quantifying the effects of lead in water on children. A goal of the Healthy People 2020 initiative is to eliminate elevated blood lead levels in children.

    Recommendation: To improve the clarity of CDC's published information on public health issues, the Director of CDC should develop procedures to review previously published information and determine whether additional information should be published to help ensure the correct understanding of the public health message. The procedures could include criteria to use when deciding how to respond in certain situations, such as the event in the District, in which (1) CDC learns of confusion about the public health message and determines that clarification or additional information should be published; or (2) CDC issues or releases a product in an expedited time frame or based on uncertain or incomplete information and determines additional information should be published to clarify the original public health message, even if there is no evidence of confusion.

    Agency Affected: Department of Health and Human Services: Public Health Service: Centers for Disease Control and Prevention

    Status: Closed - Implemented

    Comments: CDC's February 2012 Guidance on Scientific Integrity - Public Communications section now includes language establishing steps the agency will take when the agency learns of confusion about a CDC public health message or that additional information should be published to clarify the original message. For example, in the new guidance's Public Communications section, it directs that when the agency "learns of confusion about a CDC-issued public health message and determines that clarification or additional information should be published, CDC will take reasonable steps,using plain language, to address confusion."

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