▪ Abstract Lead poisoning is the most significant and prevalent disease of environmental origin among US children. Despite over 100 years' knowledge of the special hazards of lead exposure for young children, it has taken over a century for effective primary prevention to be adopted. Obstacles to primary prevention have included deliberate campaigns by industry to prevent restrictions upon such uses on lead as plumbing, paints, and gasoline additives; influence of industrial support of biomedical research at major US medical schools; lack of appropriate policy mechanisms to identify and control lead exposures; and opposition to investing resources in lead poisoning prevention. The removal of lead from gasoline, which began in the United States in 1972 and was completed in 1995, has resulted in almost fourfold reductions in median blood lead levels in US children from 1976 to 1991. Increased screening and interventions to identify and abate lead sources, such as lead in housing, also contributed to this major public health success. Nevertheless, lead exposures remain prevalent, although increasingly less generally distributed. Perhaps because of the renewed “ghettoization” of lead, support for lead poisoning prevention has waned. Objections to investing public and private resources in screening and source abatement have challenged the continuing commitment of public health officials to prevention. The demonstrable success and social benefits of preventing lead toxicity are cited in support of continued preventive health policies.