Centers for Disease Control and Prevention (CDC) got a public lesson in post-publication clarification when the GAO’s report “CDC Public Health Communications Need Improvement” was published earlier this week.
The GAO report takes us back to Washington, D.C., in the year 2001, when the District’s Water and Sewer Authority became aware of lead levels in the area’s tap water that were surpassing the EPA’s limit of 15 parts per billion. The elevated levels – now attributed to a change made in the disinfection process in 2000 – were reported to both the EPA and the public starting in 2002.
In early 2004, the District of Columbia Department of Health (DCDOH) asked the CDC to assess the effects of the elevated lead levels on D.C. residents. CDC is generally responsible for developing lead poisoning prevention programs, as well as collaborating with federal and state partners to prevent lead poisoning. Elevated blood lead levels (BLLs) can cause behavior problems and learning disabilities in young children, as well as miscarriage in pregnant women.
In April of 2004, the CDC published their preliminary assessment in an article in the Morbidity and Mortality Weekly Report (MMWR), the agency’s “primary vehicle” for disseminating public health information.
But this particular dissemination of public health information backfired.
While the article suggested that no children tested had been found to have concerning BLLs, it was later established that some children’s BLLs had exceeded CDC’s “established level of concern.” According to CDC officials, the article “may have led some people to improperly minimize concerns about lead exposure and conclude that lead in the water had never been a problem.”
CDC took several steps toward addressing the confusion surrounding the article – for instance, the original online article is now preceded by two links to “Notices to Readers” published in 2010 that note the “limitations of methods employed and the manner in which findings were communicated.”
But it wasn’t enough. According to the GAO, “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.”
The GAO reports that the CDC has begun an initiative to revise procedures designed to “help ensure the accessibility and clarity of CDC public health communications,” but that the initiative does not address “how and when to take action about confusion after publication.” (emphasis added)
Therefore, the GAO recommends that CDC do the following: (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 has “generally concurred” with the recommendations.