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Highlights

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.

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Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Centers for Disease Control and Prevention 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.
Closed - Implemented
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.
Centers for Disease Control and Prevention 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.
Closed - Implemented
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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