Objectives: To describe locality-specific changes in blood lead levels of 1–4-year-old children in Broken Hill, NSW between 1991 and 2007. Methods: Annual age-sex standardised mean blood lead levels, blood lead screening clinic attendance rates and lead-dust levels for five lead-risk zones were calculated from routinely collected data. Results: Blood lead levels were similar in all localities in 2002, 2003, 2005 and 2006, after having been consistently higher in localities with highest environmental lead since 1991. Conclusions: Combining health promotion with a targeted clean-up has reduced the effect of locality on blood lead levels. Results are consistent with reduced contamination due to effective soil stabilisation and storm-water control.