The following are defined as the main areas of concern in Europe:
Asthma, allergies and respiratory infections
Asthma and atopic (asthma related, such as hay fever and eczema) disorders are the leading cause of chronic respiratory illness
Factors playing a role, particularly in early life, are: infectious/microbial burden, environmental tobacco smoke/maternal smoking in pregnancy, allergens, smog (particulate in the air)
Acute respiratory infections are the single largest cause of childhood mortality under 5 years and the main environmental risk factor is indoor air pollution (Smith et al, 2001)
Actions: Reduce environmental tobacco smoke and air pollution; set safe standards for children, including during pregnancy.
Injuries
Between 30-40% of deaths among children aged 1-14 years are caused by injury
Road traffic injuries are the leading cause of injuries across Europe, but the East-West difference is due mainly to other causes such as drowning, accidental poisoning, fires, and falls.
Actions: The health burden of injuries calls for immediate action. Develop national capacity to assess patterns and causes of injuries to use as a basis for locally relevant policies; enhance health systems to manage injuries (emergency, rehabilitation). Proposed measures include urban and home safety programmes, helmets use, community-based interventions.
Neuro-developmental disorders
Up to 10% of children suffer developmental disabilities in certain populations
The central nervous system (CNS) is particularly vulnerable to toxic exposures in early development
Early CNS damage is likely to be irreversible, which may impact on quality of life, social and economic achievements
Exposures: lead, methyl mercury, PCB (polychlorinated biphenyl), possibly solvents, pesticides, other industrial chemicals.
Actions: Set up exposure monitoring in at-risk areas; reduce exposure in air, water, soil, food, etc. through setting safe standards for children; reduce exposure through information policies for healthy behaviour.
Cancer
Children under the age of 10 years are among the groups most vulnerable to food- and water-borne diseases. For example, in 1998 salmonellosis incidence was over 2,000 per 100,000 children under 4 years of age compared with under 500 cases per 100,000 persons in the over 15 years age group in the Czech Republic.
Actions: Identify hazards along the food chain (especially during final food preparation), establish control procedures to effectively reduce or eliminate hazards (Hazard Analysis And Critical Control Point system).
Almost one third of the global burden of disease can be attributed to environmental risk factors, over 40% of this burden falls on children under 5 years of age that constitute no more than 12% of the world’s population (Smith et al, 1999).
Adapted from a presentation by Roberto Bertollini and Ondine von Ehrenstein, WHO Regional Office for Europe (www.euro.who.int/childhealth) presented at Greenweek, Brussels, 15-19 April 2002.
International initiatives
The International Research and Information Network on Children’s Health, Environment and Safety (INCHES) has produced an excellent position paper on the theme of children’s health and the environment taking a child rights’ approach
The International Society of Doctors for the Environment (ISDE) has produced a "Declaration on Children and their health and their environment."
