Children's Environmental Health

Transcription

1 Children's Environmental Health Paris - April 2011 CHILDREN'S HEALTH AND THE ENVIRONMENT IN WHO Dr. Maria Neira Public Health and Environment World Health Organization

2 IMPACT OF ENVIRONMENT ON HEALTH How much disease could be prevented by modifying the environment? What is the modifiable environment? Pollution Ionizing radiation, UV and EMF Occupational risks Built environment (incl. housing, land use, roads) Agricultural methods, irrigation schemes Man-made climate change, ecosystem change Related behaviour (e.g. handwashing) Current evidence = 24%

3 ENVIRONMENTAL RISKS ASSESSMENT Rigorously assessed disease burden estimates cover only a fraction of environmental exposures "WHO Global Health Risks". WHO, 2009 known unknown

4 ENVIRONMENTAL HEALTH CONCERNS IN DEVELOPING WORLD Every year more than children under 5 die due to diseases linked to the environment mostly in the developing world Diarrhoeal disease Respiratory diseases Malaria/Vector-borne disease Poisonings/Injuries What happens with those who survive?

5 NON-COMMUNICABLE DISEASES 80% of chronic disease deaths occur in low and middle income countries 22 million children under 5 years old overweight (2007) If the major risk factors for chronic disease were eliminated, at least 80% of heart disease, stroke and type 2 diabetes and 40% of cancer would be prevented

6 The children of today increased trend in the risk of Asthma Obesity Learning disabilities, IQ Reproductive organ disorders Cancer Other EARLY ENVIRONMENTAL ORIGINS OF DISEASE

7 EARLY ENVIRONMENTAL DETERMINATS OF HEALTH EXPOSURE DURING CRITICAL PERIODS Ceppi/Corra DISEASE LATER IN LIFE

8 MOTHER'S ENVIRONMENT, FETAL DEVELOPMENT AND THE ORIGINS OF ADULT DISEASE MATERNAL ENVIRONMENT + MATERNAL & PLACENTAL PHYSIOLOGY FETAL ENVIRONMENT Intrauterine E U-Placental unit + GENOME RESPONSES TO ADVERSE ENVIRONMENTS: 1. Accelerate maturation 2. Save nutrients 3. End pregnancy ALTERED: FETAL GROWTH INTERACTION PRE- AND POST-NATAL ENVIRONMENTS FETAL ORIGINS OF DISEASE

9 New recognition and in some instances, new knowledge about their special susceptibility: The significance of TIMING OF EXPOSURE - Exposure to DES in utero cancer later in life (girls) - Exposure to Hg or Pb in utero neurological/learning disabilities Mechanisms of action: - interference with genetic expression - disturbance of the endocrine system - alteration of cell development - other Needs: more research risk assessment to consider the characteristics of fetus/child

10 PRIMARY PREVENTION Health determinants versus spending US $ 5.3 Trillion Prevention < 5% Environment Very little is spent on primary prevention despite huge potential to reduce the growth in health expenditures. Illicit drugs Physical Inactivity Tobacco Alcohol Unsafe Sex Treatment & Overhead Other Factors influencing health World-wide health expenditures Source: Estimated from OECD, WHO, and Prevention Institute data

11 HOUSEHOLD ENERGY, IAP AND HEALTH 3 billion people rely on solid fuels Solid fuels comprise % of the total fuels used worldwide Cooking and heating levels indoor air pollution Dung Wood Agricultural residues Charcoal Coal Most concern: particulate matter and carbon monoxide Women and children heavily exposed Nigel Bruce/ITDG

12 INTERVENTIONS WORK! New evidence on health impact of interventions China NISP 200 million improved chimney stoves 3 Cohort studies Comparison of long-term users of improved stove vs. traditional For all 3 outcomes 25-50% reduction in risk, for men and women Disease HR 95% CI COPD Men Women Pneumonia (deaths) Men Women Ca lung Men Women

13 TOBACCO SMOKE AND OUTDOOR AIR POLLUTION Secondhand smoke + urban air pollutants: Effect greater than the sum of individual effects Reduced fetal growth, lower birth weight Problems in learning and school performance Women who quit smoking during pregnancy and who are exposed to second-hand smoke: babies born with more gene mutations (umbilical cord blood studies)

14 SECOND HAND TOBACCO SMOKE Exposure to second hand tobacco smoke caused 21,000 lung cancer deaths in Cigarette smoking in homes, restaurants, other work and public places exposes adults and children to significant levels of air pollutants, including carcinogens. Policies designed to eliminate cigarette smoking in work and public settings have been shown to be effective measures for reducing exposure to second-hand smoke. SOLUTIONS EXIST!

15 BUT WE MUST ACT NOW! 1944: Smoker = Glamour 1950, firsts epidemiological studies demonstrating smoking as the main cause of the most common cancers 1969: Smoker = Villain 1969, cigarette advertising on television and radio banned in US It took 50 years : Motion Picture Association of America included smoking as a factor in rating movies 2003, 192 Member States of the WHO unanimously adopted the Global Framework Convention on Tobacco Control 2011 Asturias Declaration: : a call for action

16 STRATEGIC DIRECTIONS 1. Reach decision-makers, donors and influential sectors with information to trigger action 2. Identify political platforms 3. Translate "conventions" into policies and interventions 4. Set up strategic partnerships: identify the role each one of us may play 5. Train future professionals: environment as a determinant of health and disease. 6. Defining the research agenda

17 1. Reach decision-makers, donors and influential sectors with information to trigger action Many available tools Publications Technical assistance to countries Influencing policies: National profiles CEH Indicators Initiative (CEHI) Burden of disease estimates and global health observatory Overall: building partnerships for action Commitments: CEH Global Action Plan Reaching new audiences - for instance: Public media (magazines?) Policy-makers: how to empower them

18 2. Identify political platforms to promote CEH High-level Meeting of UN General Assembly on the Prevention and Control of NCDs. New York. September 2011 The Earth Summit - Rio plus 20, Conference. Rio de Janeiro. June 2012 Health and Environment Ministerial Meetings of the Regions G8/G20 meetings World Health Assembly?

19 3. Translate "conventions" into policies and interventions Contributing "health" to international conventions Climate Change Conventions/Meeting of the Parties Partnership for Clean Indoor Air Chemicals Conventions Stockholm Convention (POPs)) Basel convention Rotterdam Initiative on Mercury WHO/UNEP Lead in paint initiative Responding to international calls e.g: 2008 Libreville Declaration 2009 "Busan Pledge for Action" 2010 Asturias Declaration Millennium Development Goals (3, 4, 5, 7)

20 4. Strategic partnerships: identify the role each of us may play Governmental organizations UN organizations (e.g UNEP and UNICEF) NGOs (e.g ISDE, INCHES) Academia, hospitals, health sector and researchers Collaborating centres Within WHO (e.g Regional offices, other departments on Child Health, Injuries, Reproductive Health, Tobacco Free Initiative) Other sectors?

21 5. Training professionals: environment as a determinant of health and and disease WHO Training Package for the Health Sector Many training courses in all regions with help of key partners (e.g regional offices, USEPA, ISDE, IPA, many others) Integrated into university curricula Reached paediatricians, family doctors, nurses Sub-package being developed on reproductive health and environment Future direction: Empowering the health sector to create political change

22 6. Defining the Research Agenda Consideration and study of environmental factors in diseases key for: developing new prevention strategies decreasing disease prevalence and severity Need for international harmonization to have validity of results Need for collaboration between developing and industrialized countries Increased understanding of the mechanisms through which environmental agents disrupt organs/systems will help improve prevention and treatment strategies. Benefits from research will not be limited to children: it will translate into health for men and women equally, and yield findings that will benefit everybody

23 ENDOCRINE DISRUPTORS PUBLICATION Due to continuing concerns regarding EDCs,, WHO was requested to provide an objective state-of of-the- science assessment A global perspective was prepared by over 65 international scientific experts using the weight-of of- evidence approach. WHO and UNEP are now working on an update to this document.

24 A "3 UN" PUBLICATION WHO/UNEP/UNICEF joint commitment Update of Children in the New Millennium Summary of key messages for action for communities and families global environmental change water pollution sanitation and hygiene nutrition, growth & development vectors of disease air pollution chemicals injuries environmental emergencies noise healthy housing

25 Presents tools for action Includes 2009 Busan Pledge for Action on CEH Spanish, French and English

26 THE IMPORTANCE OF PREVENTING CHILDHOOD DISEASES THROUGH HEALTHY ENVIRONMENTS Healthy children in healthy environments: the basis for sustainable development.