Lead leaches into drinking water through corroded plumbing material that contains lead1. Lead pipes, plumbing material, and fixtures can be replaced by individual property owners or by public water systems. As of 2014, the federal Safe Drinking Water Act (SDWA) prohibits use of plumbing material that is not lead-free, defined as 0.25% lead for pipes, fittings, and fixtures, and 0.20% for solder and flux, decreased from the 1986 SDWA’s 8% lead allowance2. The 1991 Lead and Copper Rule (LCR) requires water utilities to monitor water quality and to take action if more than 10% of monitored taps exceed 15 parts per billion (ppb), the EPA’s lead action level for drinking water3. However, in 2015, the National Resources Defense Council’s analysis of the EPA violations list estimated at least 18 million Americans were served by water systems with lead contamination violations; this figure did not include some locations with known violations such as Flint, Michigan4. Violations exist in all 50 states5. As of 2012, scientists indicate no safe blood lead level (BLL). The Centers for Disease Control and Prevention (CDC) blood lead reference level for initiating public health actions to prevent further exposure and mitigate health effects is 5 micrograms per deciliter (µg/dL); it is estimated that over 500,000 children have BLLs at or above this level6, 7, 8.
Expected Beneficial Outcomes (Rated)
Reduced lead exposure
Other Potential Beneficial Outcomes
Improved health outcomes
Evidence of Effectiveness
Replacing lead pipes, plumbing material, and fixtures is a suggested strategy to reduce lead exposure and blood lead levels (BLLs), especially in children1, 9. Available evidence associates full service lead pipe and plumbing material replacement with reduced lead levels in drinking water10. Partial lead service line replacement can also reduce lead levels in the long-term, but has been shown to increase lead release in the short-term, especially if metal connections couple lead pipes to copper pipes1, 11, 12, 13. Additional evidence is needed to confirm the effects of full and partial lead pipe and plumbing material replacement on BLLs.
Full lead service line replacement removes the source of corrosion and lead leaching, reducing the likelihood of lead exposure. Lead pipe and plumbing material replacement appears to be most effective when combined with educational interventions. Filtering systems, water treatment measures, and other engineering interventions may also reduce lead in drinking water10.
Using plastic pipe connections or incorporating an insulating spacer between the pipes in partial lead pipe replacement can avoid the corrosion that increases lead release14, 15. Education efforts and system monitoring can help prevent lead exposure and lead poisoning during initial increases in lead release1. When lead remains in the water service system, contamination can be increased by corrosive water, water sitting in pipes, warm water temperatures16, 17, and high flow rates11.
Lead abatement can improve health outcomes for children and adults by reducing developmental disorders, attention deficit hyperactivity disorder-related behaviors (ADHD), anemia, hypertension, and kidney and brain damage18, 19, 20. Newborn infants are especially vulnerable to effects of lead exposure21; a St. Louis-based study suggests prenatal screening and proactive lead hazard remediation can prevent exposure among some newborns19. Reduced lead exposure may be linked to reductions in violent crime roughly twenty years after exposure would have occurred22, 23, 24.
Childhood lead poisoning occurs at higher rates among families with lower incomes and those living in older homes than their counterparts6, 7, 25, 26. On average, black children from low income families have higher blood lead levels than white or Hispanic children from low income families6.
Although lead pipe and plumbing material replacement is costly, cost benefit analysis finds positive net benefits and a high rate of return for lead abatement programs overall27, 28. Economic modeling suggests that future earnings and decreased medical costs for children who benefit from these programs range from 2-20 times the estimated costs of lead abatement29.
Impact on Disparities
The Madison Water Utility in Madison, Wisconsin was the first major water utility in the nation to fully replace all of the city’s lead pipes. The effort began in 2001, took over a decade, and cost approximately $19.4 million30. The Lansing Board of Water & Light (BWL) in Lansing, Michigan also removed all lead service lines; the project began in 2004, removed 12,150 active lead service lines, and cost $44.5 million31.
The 10 regional offices of the US Environmental Protection Agency (EPA) each have a designated Regional Lead Coordinator who oversees lead-poisoning prevention efforts, including lead pipe and plumbing material replacement32. Individuals can have their drinking water tested for lead contamination through certified laboratories; lists of certified laboratories are available through state or local drinking water authorities or by calling the EPA’s Safe Drinking Water Hotline33.
CDC-Lead facts - Centers for Disease Control and Prevention (CDC). Lead: Facts, tips, tools, training, and resources for childhood lead poisoning prevention.
NRDC-Lead violations map - National Resources Defense Council (NRDC). What’s in your water? Flint and beyond: Explore lead problems across America.
US EPA-Lead - US Environmental Protection Agency (US EPA). Lead: Lead poisoning is preventable.
US EPA-Lead in drinking water - US Environmental Protection Agency (US EPA). Ground water and drinking water: Basic information about lead in drinking water.
US EPA-Protect your family - US Environmental Protection Agency (US EPA), US Consumer Product Safety Commission, US Department of Housing and Urban Development (US HUD). Protect your family from lead in your home. Washington, DC: US Environmental Protection Agency (EPA); 2012.
NSF-Lead in drinking water - NSF International. Lead in drinking water and a consumer guide to NSF certified lead filtration devices for reduction of lead in drinking water.
NMC PHC-Guidance and tools - Navy and Marine Corps Public Health Center (NMC PHC). Guidance and tools.
Flint Water Study-Guide and resources - Flint Water Study. FlintWaterStudy.org guide and resources.
GREE-Lead exposure - Glennon Real Estate Experts (GREE). Lead in your home: How to safely identify issues and avoid exposure.
* Journal subscription may be required for access.
1 CDC MMWR-Brown 2012 - Brown MJ, Margolis S. Lead in drinking water and human blood lead levels in the United States. Morbidity and Mortality Weekly Report (MMWR). 2012;61(Suppl):1-9.
2 US EPA-SDWA Sec 1417 - US Environmental Protection Agency (US EPA). Section 1417 of the Safe Drinking Water Act (SDWA): Prohibition on use of lead pipes, solder, and flux.
3 US EPA-LCR - US Environmental Protection Agency (US EPA). Drinking water requirements for states and public water systems: Lead and Copper Rule (LCR).
4 NRDC-Olson 2016 - Olson E, Fedinick KP. What’s in your water? Flint and beyond. New York City: National Resources Defense Council (NRDC); 2016.
5 NRDC-Lead violations map - National Resources Defense Council (NRDC). What’s in your water? Flint and beyond: Explore lead problems across America.
6 White 2015 - White BM, Bonilha HS, Ellis C. Racial/ethnic differences in childhood blood lead levels among children <72 months of age in the United States: A systematic review of the literature. Journal of Racial and Ethnic Health Disparities. 2015:1-9.
7 NCHH-Lead 2014 - National Center for Healthy Housing (NCHH). Preventing lead exposure in US children: A blueprint for action. 2014.
8 CDC-Lead facts - Centers for Disease Control and Prevention (CDC). Lead: Facts, tips, tools, training, and resources for childhood lead poisoning prevention.
9 US EPA-Lead - US Environmental Protection Agency (US EPA). Lead: Lead poisoning is preventable.
10 Pfadenhauer 2016* - Pfadenhauer LM, Burns J, Rohwer A, Annette E. Effectiveness of interventions to reduce exposure to lead through consumer products and drinking water : A systematic review. Environmental Research. 2016;147:525-536.
11 Cartier 2012* - Cartier C, Arnold RB, Triantafyllidou S, Prévost M, Edwards M. Effect of flow rate and lead/copper pipe sequence on lead release from service lines. Water Research. 2012;46(13):4142-4152.
12 Cartier 2013* - Cartier C, Doré E, Laroche L, et al. Impact of treatment on Pb release from full and partially replaced harvested lead service lines (LSLs). Water Research. 2013;47(2):661-671.
13 Edwards 2013* - Edwards MB, Bocarro JN, Kanters MA. Place disparities in supportive environments for extracurricular physical activity in North Carolina middle schools. Youth & Society. 2013;45(2):265-85.
14 Wang 2012* - Wang Y, Jing H, Mehta V, Welter GJ, Giammar DE. Impact of galvanic corrosion on lead release from aged lead service lines. Water Research. 2012;46(16):5049-5060.
15 St. Clair 2012 - St. Clair J, Stamopoulos C, Edwards M. Technical note: Increased distance between galvanic lead: Copper pipe connections decreases lead release. Corrosion. 2012;68(9):779-783.
16 Laidlaw 2016 - Laidlaw M, Filippelli G, Sadler R, Gonzales C, Ball A, Mielke H. Children’s blood lead seasonality in Flint, Michigan (USA), and soil-sourced lead hazard risks. International Journal of Environmental Research and Public Health. 2016;13(4):358.
17 WCLPP-Report 2014 - Wisconsin Childhood Lead Poisoning Prevention Program (WCLPP), Wisconsin Department of Health Services (WI DHS). 2014 Report on childhood lead poisoning in Wisconsin. 2016.
18 Armstrong 2014 - Armstrong R, Anderson L, Synnot A, et al. Evaluation of evidence related to exposure to lead. Canberra: National Health and Medical Research Council; 2014.
19 Berg 2012* - Berg DR, Eckstein ET, Steiner MS, Gavard JA, Gross GA. Childhood lead poisoning prevention through prenatal housing inspection and remediation in St. Louis, MO. American Journal of Obstetrics and Gynecology. 2012;206(3):199.e1-199.e4.
20 NCHH-Jacobs 2009 - Jacobs DE, Baeder A. Housing interventions and health: A review of the evidence. Columbia: National Center for Healthy Housing (NCHH); 2009.
21 Vigeh 2014* - Vigeh M, Yokoyama K, Matsukawa T, Shinohara A, Ohtani K. Low level prenatal blood lead adversely affects early childhood mental development. Journal of Child Neurology. 2014;29(10):1305-1311.
22 Wolpaw Reyes 2015* - Wolpaw Reyes J. Lead exposure and behavior: Effects on antisocial and risky behavior among children and adolescents. Economic Inquiry. 2015;53(3):1580-1605.
23 NBER-Wolpaw Reyes 2007 - Wolpaw Reyes J. Environmental policy as social policy? The impact of childhood lead exposure on crime. National Bureau of Economic Research (NBER). 2007. Working Paper 13097.
24 Feigenbaum 2015 - Feigenbaum JJ, Muller C. Lead exposure and violent crime in the early twentieth city. Cambridge: Harvard University; 2015.
25 Korfmacher 2014 - Korfmacher KS, Malone J, Jacobs D. Local housing policy approaches to preventing childhood lead poisoning. Public Health Law Research: Making the Case for Laws that Improve Health. 2014.
26 Reed 2011a* - Reed W. Preventing childhood lead poisoning. In: Lemelle AJ, Reed W, Taylor S, eds. Handbook of African American Health: Social and Behavioral Interventions. New York: Springer; 2011:103-11.
27 Cochrane-Nussbaumer-Streit 2016* - Nussbaumer-Streit B, Yeoh B, Griebler U, et al. Household interventions for preventing domestic lead exposure in children. Cochrane Database of Systematic Reviews. 2016;(12):CD006047.
28 Gould 2009 - Gould E. Childhood lead poisoning: Conservative estimates of the social and economic benefits of lead hazard control. Environmental Health Perspectives. 2009;117(7):1162-7.
29 Jones 2012* - Jones DJ. Primary prevention and health outcomes: Treatment of residential lead-based paint hazards and the prevalence of childhood lead poisoning. Journal of Urban Economics. 2012;71(1):151-164.
30 WCIJ-Schmidt 2016 - Schmidt S. First in the nation: City of Madison replaced all lead pipes. WisconsinWatch.org; Wisconsin Center for Investigative Journalism (WCIJ). February 1, 2016.
31 BWL-Lead information - Lansing Board of Water and Light (BWL). BWL lead protection strategy.
32 US EPA-Lead contacts - US Environmental Protection Agency (US EPA). Lead: EPA regional lead contacts.
33 US EPA-Protect your family - US Environmental Protection Agency (US EPA), US Consumer Product Safety Commission, US Department of Housing and Urban Development (US HUD). Protect your family from lead in your home. Washington, DC: US Environmental Protection Agency (EPA); 2012.
Related What Works for Health Strategies
To see citations and implementation resources for this strategy, visit:
To see all strategies: