Urgent action needed across Europe to tackle childhood disease related to environmental conditions

Authors of a study in this week's issue of THE LANCET are calling for urgent governmental action across Europe to tackle childhood disease and deaths associated with poor environmental conditions in Europe.

The study-supported by the WHO Regional Office for Europe, European Centre for Environment and Health, Rome Office-serves as the basis for the Children's Environment and Health Action Plan for Europe (CEHAPE) to be adopted next week at the WHO Fourth Ministerial Conference on Environment and Health in Budapest, Hungary (23-25 June 2004).

40% of the global disease burden associated with the environment affects children aged 5 years or younger. Children in European countries, although generally wealthier and healthier than children in many other regions of the world, are vulnerable to poor health outcomes associated with unsafe and unhealthy environments. Francesca Valent from the Institute of Hygiene and Epidemiology, University of Udine, Italy, and colleagues from the Institute for Child Health "Burlo Garofolo" in Trieste, Italy, estimated the burden of disease attributable to outdoor and indoor air pollution, inadequate water and sanitation, lead exposure, and injury among European children and adolescents.

The investigators assessed the environmental effects on health in terms of mortality and disability adjusted life years (DALYs), a combination of years shortened by early mortality and the number of years spent living with a disease or disability.

Between 2 and 6% of deaths among young children (0-4 years) were attributable to outdoor air pollution; indoor pollution-closely associated with acute lower respiratory-tract infection-caused over 4% of deaths and 3% of DALYs; mild mental retardation resulting from lead exposure accounted for just over 4% of DALYs.

For children aged up to 14 years, diarrhoea-attributable to inadequate water and sanitation-accounted for around 5% of deaths and 3*5% of DALYs.

Injuries (such as road-traffic accidents, falls, and injuries caused by war or violence) were a major cause of death and DALYs for children across the entire age range assessed (0-19 years), accounting for 22% of deaths and 19% of DALYs.

Dr Valent comments: "Our findings indicate the urgent need for interventions aimed at reducing children's exposure to unsafe water, outdoor and indoor air pollution, and lead, and at preventing injuries. Action can result in substantial public-health gains... Interventions aimed at ensuring use of clean fuels and universal access to improved water and sanitation, clean air, and safer buildings and transport require the involvement of the environment and health sectors and also action in sectors such as transport, energy, urban planning, and education. Whereas the health and environment sectors are responsible for disseminating information, building awareness, training professionals, and promoting healthier behaviours, governments as a whole need to provide the legislative, financial, and policy basis for environmental protection."