Europe’s children face health problems that are different from other regions of the world. Dr Roberto Bertollini of the World Health Organization’s European regional office identifies the main threats and defines WHO’s approach to tackling the problems.
What are the main threats to children’s health? How do they differ from those facing adults?
Bertollini: The answer depends on which part of the world we are talking about. In developing countries, although much progress has been made in recent years, children’s health is still heavily affected by traditional diseases such as diarrhoea, measles, malnutrition, respiratory disorders and more recently HIV/AIDS. A large burden of disease and disability can be attributed to these preventable diseases and big efforts have been made to address these problems in the most affected areas with the help of donor countries, international agencies and NGOs.
In developed countries, the children are affected by a number of diseases associated with both exposure to environmental factors, such as air pollutants or chemicals present in water and food, as well as to problems associated with the social patterns typical of the western developed societies. In some countries of the world we are seeing a kind of epidemiological transition with children, as well as adults, affected both by diseases typical of under-developed situations and problems arising from urbanisation and increased environmental degradation.
In addition, recent data show that adolescents in many transition and developed countries are taking up risk behaviours, which will affect their health as adults. Typically smoking, alcohol consumption and unsafe sexual behaviour are assuming a worrying dimension in contemporary societies.
Which are the key environmental factors affecting the health of children in Europe?
Bertollini: Children are particularly vulnerable to environmental exposures for a variety of reasons. From conception to adolescence, rapid growth and development processes occur that can easily be disrupted by exposures to toxicants. These aspects make children particularly susceptible to developmental hazards acting in certain windows of susceptibility during growth.
Children’s metabolic pathways, especially in the first months after birth, are immature. As a consequence of this biochemical immaturity, children’s ability to detoxify and excrete chemicals differs from that of adults. This is well known in paediatric pharmacology; lower per kilogram doses and longer intervals are recommended for most drugs during the first weeks and months of life.
Children are, in proportion, more heavily exposed per unit of body weight to environmental toxins than adults. They drink more water, eat more food and breathe more air than adults in relation to their body weight.
Children have more years of life ahead of them than adults, so they have more time to develop chronic diseases. Such conditions take several decades to appear and may be triggered by early environmental exposures or determined by continuous exposure.
Several environmental factors have a specific effect on children’s health. Although a precise estimate of the impact for Europe as a whole is difficult, we can judge that the health hazards associated with air pollution are among the most important risk factors, particularly in the urban environment. The impact of the exposure to chemicals in food and water is less well characterised on a population basis but may be particularly relevant for selected population sub-groups in certain areas.
In considering environmental factors, we should not forget the role of the social environment, particularly the changing role of the family and the school as well as the role of the media and of the communication industry in changing the context in which children live and grow. This broad "environmental exposure" may have significant consequences on young people’s behaviour and have long-term effects on population health in the decades to come. In addition, global environmental changes such as those associated with global warming and changing climate may modify the distribution of disease vectors as well as the patterns of exposure to microbiological hazards and air pollutants with consequences which are difficult to predict in the next decades, but which may be particularly relevant in the countries more vulnerable to these changes.
What is the best approach to tackling some of the risks to children’s health?
Bertollini: As a public health organisation, WHO advocates primary prevention as the main tool to improve population health and ensure well-being. This applies particularly to children’s health and to the role of environmental exposures. In many instances, it is difficult to address the problems and reduce the occurrence of certain diseases through early diagnosis for instance. The only real tool is the actual reduction of exposure. A typical example comes from air pollution. Individual choices may actually affect the pattern of air pollution, like changing transportation habits, but the individual exposures cannot be addressed without an overall public health policy affecting the whole population.
How can those concerned with promoting and protecting children’s interests - such as the UN, national governments, and non-governmental organisations - be more closely involved in the development, implementation and enforcement of child-focused health and environment policies?
Bertollini: Several projects and activities are being carried out in the world by many partners in the attempt to promote and protect children’s health. Large projects such as Roll-Back Malaria, Stop TB or the recent efforts aiming to reduce the impact of HIV/AIDS in poor populations are just examples of the great commitment being made in this direction. Most recently, WHO has recognised the need to strengthen the co-ordination in work on children’s health and environment in view of the fact that a large disease burden affecting children’s health is attributable to environmental exposures. This global Children, Environment and Health Initiative aims to make the best use of available resources to maximise results and to avoid duplications and overlapping among the many partners involved. It is a true effort to move from research and understanding towards practice and solutions. The Director-General of WHO is launching globally this initiative at the World Summit on Sustainable Development (WSSD) in Johannesburg and we expect that partners around the world will join us in this very important endeavour.
During your recent visit to Brussels with Dr Gro Harlem Brundtland, WHO Director-General, a decision was taken on extending collaboration between WHO and the European Commission on children’s health and environment. What specific events and areas of action are planned?
Bertollini: The collaboration between the European Commission and WHO in this particular area has been very positive in recent years, especially between the European Region of WHO and the EC. One of the first tangible results of this collaboration has been the publication of a book named "Children’s health and environment: A review of evidence" prepared by WHO European Centre for Environment and Health in Rome and the European Environment Agency. This publication, which will be reviewed periodically, intends to facilitate the exchange of information and knowledge and improve the priority setting for actions by Member States and local authorities. In addition, WHO and EC are collaborating in developing a set of environmental health indicators for Children’s Health and Environment, and most importantly, are working very closely in the preparation of the next European Ministerial Conference on Environment and Health of 2004, which will have Children’s Health and Environment as its main theme. The purpose of the conference is to gain approval for an action plan by all Member States of the European Region of WHO as a tool to guide future actions and monitor achievements regarding children, health and environment.
Commission strategy in the making
DG Environment has begun working on a Community strategy and policy on "Environment and health". One of the objectives of the policy would be to identify the risks for human health of types and groups of contaminants identified in the Sixth Environment Action Programme, taking into account particularly vulnerable groups such as children and the elderly.
Interview completed Monday 19 August 2002.
Info
Dr Roberto Bertollini
Director, Technical Support
WHO Regional Office for Europe
8 Scherfigsvej
2100 Copenhagen
Denmark
Tel: +45 39 17 13 48
Fax: +45 39 17 18 92
E-mail: heg@who.dk
