"Protecting our environment is critical to protecting our children's health."
In 1988, the Agency for Toxic Substances and Disease Registry (ATSDR) published The Nature and Extent of Lead Poisoning in Children in the United States: A Report to Congress (2). This document, which discussed the potential for lead contamination to disproportionately affect the health of our nation's children, represented one of the earliest efforts to identify environmental health threats to children and call for their reduction. With the institution of ATSDR's Child Health Initiative in April 1996 and the publication of the U.S. Environmental Protection Agency's (U.S. EPA's) Environmental Health Threats to Children in September 1996, the nation's research and policy communities began to focus on children as specific susceptible populations for a multitude of environmental insults(3).
The purpose of this position paper is to review current, information on the status of children's environmental health, with particular emphasis on the implications for environmental public health. Further, this paper reviews and provides support for the National Agenda to Protect Children's Health from Environmental Threats.
It is intended to be used as a basis from which environmental and public health practitioners and colleagues in related fields can initiate discussions of children's environmental health with policy makers at all levels-local, state, national, and worldwide.
Children are different; that is, they are not "little adults." Children one through five years of age eat three to four (or more) times as much food per pound of body weight as the average American adult. The air intake of a resting infant is twice that of an adult (2). In their first six months of life, children drink seven times as much water pound per pound as the average adult (4). Because children eat more calories, drink more water, and breathe more air per pound of body weight than do adults, they are exposed to more pollutants per pound of body weight (3). Children's systems are still developing; therefore, they are more susceptible to environmental threats. Exposure to toxic substances can affect growth of fetuses, infants, and children. In addition such exposures may impair development of children's nervous systems and cause abnormal development because of hormonal or immunologic effects. Finally, infant immune systems are less well developed; thus, they may be less able than healthy adults to recover rapidly from exposure to microbes such as cryptosporidium (3).
Increasingly, statistics are being reported that point out the dangers confronting children: Ten million children under 12 years of age live within four miles of a hazardous waste dump (1).
Eighty percent of a person's lifetime exposure to potentially damaging ultraviolet light occurs before the age of 18 years. Ultraviolet rays pose a threat to children because severe sunburns experienced in childhood increase the likelihood that an individual will develop malignant melanoma, the most deadly kind of skin cancer. Last year, there were an estimated one million new cases of skin cancer in the United States (3). Children have more future years of life ahead of them than do most adults; therefore, they have more time to develop any chronic diseases that may be triggered by early environmental exposures. Many diseases that are triggered by exposure to volatile organic compounds, as well as leukemia caused by benze, breast cancer caused by certain endocrine disrupters such as DDT, and possibly some chronic neurological diseases such as Parkinson's disease and Alzheimer's disease are now thought to be the product of multistage processes that require many years to evolve. Toxic exposures sustained in childhood appear more likely to lead to these diseases than the same exposures encountered during adulthood (4).
It should also be noted that children's behavior exposes them to different environmental hazards than adults. Children may magnify their exposures to toxicants in the environment by (1) typical hand-to-mouth behavior, which increases ingestion of any toxicants in dust or soil, and (2) play activities close to the ground, which also increase their exposure to toxicants in dust and soil as well as to any toxicants that form low-lying layers in the air, such as certain pesticide vapors (2).
The National Environmental Health Association (NEHA) fully endorses and supports both the Child Health Initiative and the National Agenda to Protect Children's Health from Environmental Threats (2,3). The agenda includes the following points:
Upon adoption, NEHA should disseminate this paper as widely as possible by release to the membership, publication in the journal of Environmental Health, provision of copies of this paper to affiliates to share with their members, and provision of copies of this paper to similar professional associations for their review. Affiliates and members should be encouraged to provide comments to legislators based on the information contained herein, or to provide a copy of this document as augmentation to their own comments.
The committee foresees the only fiscal impact on NEHA with the adoption of this paper to be the cost of making and mailing copies. The fiscal impact of the problem will be felt mainly by the parents of the children exposed to environmental threats. In addition, state and local environmental and public health programs will be affected by implementation of childhood exposure hazard prevention programs.
(Original paper prepared by Laura Thacker, R.S., Director, Racine Health Department, Racine, Wisconsin; and Ginger L. Gist, Ph.D., D.A.A.S., Senior Environmental Health Scientist, Agency for Toxic Substances and Disease Registry)
2. ATSDR (1988), Report to Congress on the Impact and Extent of Childhood Lead Poisoning in the United States, Atlanta; U.S. Department of Health and Human Services, Public Health Service.
3. U.S. EPA (1996), Environmental Health Threats to Children, Washington, D.C.: Office of the Administrator.
4. Landrigan, P.J. (July 6, 1995), "Report Card Shows Need to Better Protect Our Children From Health Threats in Our Environment," press conference.
5. National Research Council, Committee on Pesticides in the Diet of Infants and Children (1993), "Pesticides in the Diets of Infants and Children", Washington, D.C.: National Academy Press.
6. Needleman, H. (February 21, 1997), Address to the Children's Environmental Health Network Conference, Washington, D.C.