- Open Access
Children's environmental health: an under-recognised area in paediatric health care
© Gavidia et al; licensee BioMed Central Ltd. 2009
- Received: 11 December 2008
- Accepted: 06 February 2009
- Published: 06 February 2009
The knowledge that the environment in which we live, grow and play, can have negative or positive impacts on our health and development is not new. However the recognition that adverse environments can significantly and specifically affect the growth and development of a child from early intrauterine life through to adolescence, as well as impact their health later in adulthood, is relatively recent and has not fully reached health care providers involved in paediatric care.
Over the past 15 years, world declarations and statements on children's rights, sustainable development, chemical safety and most recently climate change, have succeeded in cultivating a global focus on children's health and their right to a healthy environment. Many international calls for research in the area, have also been able to identify patterns of environmental diseases in children, assess children's exposures to many environmental toxicants, identify developmental periods of vulnerability, and quantify the cost benefits to public health systems and beyond, of addressing environmentally related diseases in children. Transferring this information to front-line health care providers and increasing their awareness about the global burden of disease attributed to the environment and children's especial vulnerability to environmental threats is the salient aim of this commentary.
- Chronic Obstructive Pulmonary Disease
- Lower Respiratory Infection
- Environmental Tobacco Smoke
- Environmental Burden
- Environmental Threat
In 2004, the top five causes of death in low-income countries were pneumonia, followed by heart disease, diarrhoea, HIV/AIDS and stroke. In high-income countries, the list was lead by heart disease, followed by stroke, lung cancer, pneumonia, and asthma/bronchitis. Due to the expected economic growth in low and middle-income countries, globally by 2030, the four leading causes of death are predicted to be ischeamic heart disease, cerebrovascuar diseases (stroke), chronic obstructive pulmonary disease (COPD), and lower respiratory infections (mainly pneumonia); environmental exposures contribute significantly to these diseases.
Cardiovascular disease for example, such as ischaemic heart and cerebrovascular (stroke) diseases have been extensively associated with air pollution, workplace exposure to chemicals, such as lead, and exposure to environmental tobacco smoke (ETS), resulting in a total of 16% of the total burden of cardiovascular disease attributable to the environment, corresponding to 2.5 million deaths per year which could be prevented . In terms of total global disease burden of COPD, an estimated 42% of the burden can be attributed to the environment. Finally after combining the effects of indoor and outdoor air pollution and other indoor conditions, at least 42% of all lower respiratory infections can also be attributable to the environment in developing countries, while in developed lower respiratory infections countries, this rate is halved to 20%. Measured in disability-adjusted life years (DALY's), 36% of the global disease and injury burden falls on children under the age of 15, however in low-income countries, children are the bearers of more than 50% of the disease burden.
The burden attributable to the environment of such conditions, are avoidable and preventable, highlighting the full potential for environmental intervention to improve human health through effective management of the environments in which we live, grow and play, rather than simply treating diseases and ailments after they've occurred.
Health professionals in the "front line", dealing with children and adolescents, and interacting with their families and communities, are well positioned to recognize, investigate and help prevent environmentally related diseases and as such in a strategic position to collect data, undertake research, stimulate decision-makers to take action, and promote the education of family members and the general public. However, these groups are currently not adequately trained in this area.
The WHO department for Public Health and Environment provides excellent resources for assisting in the training of health care professionals in the front line, especially those in developing countries, who aim to increase their knowledge and understanding of children and environmental health. In addition, some tertiary institutions are now providing on-line education in Children's Environmental Health. A more adequately trained work force is required to reduce the environmental burden of disease suffered by children.
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