In a report to be published in the Lancet on 19 June 2004, experts assess for the first time the overall impact of the environment on child health in the WHO European Region: 100 000 deaths and 6 million years of healthy life lost (or DALYs) ever year, in children and adolescents from birth to 19 years of age, are caused by outdoor and indoor air pollution, unsafe water, lead and injuries.
This accounts for 34% of deaths from all causes and 25% of DALYs from all causes in this age group. The Environmental Burden of Disease study, supported by WHO and carried out by the Institute of Hygiene and Epidemiology, University of Udine and the Burlo Garofalo Institute for Child Health in Trieste, also estimates the number of lives and disabilities that could be saved by reducing children's exposure to these hazards in the Region.
"Although the report carries some ominous warnings, it also opens the door to a healthier future for Europe's children," says Dr Marc Danzon, WHO Regional Director for Europe. "In order to know which interventions and strategies to use, governments must first be able to assess and compare the magnitude of risks accurately. This unique report presents data in a comparative and internally consistent way, thus providing a framework for policy-makers to prioritize actions and protect our children's health from environmental hazards."
The findings of the Environmental Burden of Disease study provide the core knowledge-base for an action plan to be tabled for adoption by Europe's ministers of health and environment gathering in Budapest on 23-25 June 2004, at the Fourth Ministerial Conference on Environment and Health organized by the WHO Regional Office for Europe. The children's environment and health action plan for Europe (CEHAPE) defines priority actions to reduce exposure, prevent injuries and achieve substantial public health gains. For example, phasing out lead from petrol has proven effective at reducing brain disorders associated with elevated blood lead levels. Similarly, multisectoral approaches including engineering, educational and law enforcement interventions have been shown to reduce injury incidence and consequences.
The need for child-specific estimates of the burden of disease is critical for decision-making. The fundamentals of paediatrics – that children are not just "little adults" – have not traditionally been considered in policy-making, standard-setting or legislation. Children from preconception to adolescence are more vulnerable than adults to a variety of environmental factors, because their organ systems are rapidly developing; they live and play "closer to the ground"; latency agents have a longer time in which to work; and they have less control over their environment than adults.
Injury is the leading cause of death among children and adolescents from birth to 19 years across the WHO European Region, with the highest proportion of deaths among teenagers (15-19 years). Up to 13 000 children aged 0-4 years die from particulate matter outdoor air pollution and 10 000 as a result of solid fuel use at home. In the same age group, lead poisoning is responsible for over 150 000 DALYs. In children aged 0-14 years, 13 000 deaths are due to poor water and sanitation. The table below shows the share of health impact from deaths and years of healthy life lost for each environmental risk factor, among children aged 0-4 years and 0-14 years.
The report also shows that children's exposure to environmental factors is not uniform across the European Region. Children living in particularly adverse conditions, such as poor and abandoned children, street children, those who are exploited or trafficked and those suffering from the consequences of armed conflict, are at highest risk of injuries, psychological trauma, acute and chronic infections and noncommunicable diseases, impaired growth and development, disability and death. Marked differences across the Region and across age groups indicate the need for targeted action, for example in specific countries, regions, or populations.
"The good news is that many lives have already been saved in parts of the Region that have adopted and implemented strong policies," notes Dr Roberto Bertollini, Director, Division of Technical Support, Health Determinants, WHO Regional Office for Europe. "The Budapest Conference provides a fantastic opportunity to share lessons learned and demonstrate European leadership in crafting a safer, fairer and healthier future for our children."
More information on the Environmental Burden of Disease study (http://www.euro.who.int/mediacentre/20020617_1) and the Fourth Ministerial Conference on Environment and Health (http://www.euro.who.int/budapest2004) is available on the WHO Europe web site and from the experts listed below.