vulnerability of children to environmental assaults
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Vulnerability of Children to Environmental Assaults. Philip J. Landrigan, MD, MSc Mount Sinai School of Medicine New York, USA Workshop on Environmental Threats to the Health of Children in the Americas Lima, Peru April, 2003. - PowerPoint PPT PresentationTRANSCRIPT
Vulnerability of Children to Environmental Assaults
Philip J. Landrigan, MD, MScMount Sinai School of Medicine
New York, USA
Workshop on Environmental Threats to the Health of Children in the Americas
Lima, Peru April, 2003
Children Today are Surrounded by anEver Increasing Number of Chemicals
Synthetic Organic Chemical Production
Most of the chemicals to which children are exposed have not been properly
tested for toxicity
• 80,000 + chemicals in commerce• 2,863 produced or imported in quantities of 1 million p80,000 + chemicals in commerce• 2,863 produced or imported in quantities of 1 million pounds or more per year (high production volume [HPV] chemicals)• No basic toxicity information is publicly available for 43% of HPV chemicals• Full information on toxicity is publicly available for only 7% of HPV chemicals
--EPA: Chemical Hazard Data Availability Study, 1998
Children are Especially Vulnerable to Environmental Toxins
“Children are not Little Adults”
• Greater exposure pound-for-pound• Diminished ability to detoxify and
excrete many chemical toxins• Heightened biological vulnerability,
e.g., thalidomide, DES• More years of future life
US National Academy of Sciences, 1993
Patterns of Disease in Children Change
as Nations Undergo Transition to Industrialization
Infectious diseases exert a less powerful influence over patterns of disease and
deathChronic diseases become increasingly
importantThis phenomenon is termed the epidemiological transition
The Epidemiolgical Transition in the United States
The predominant causes of illness, hospitalization and death among children in the developed nations
today are chronic diseases of multifactorial and incompletely
understood etiology
“The New Pediatric Morbidity”
Evidence is accumulating that environmental factors
contribute to the causation of these diseases
Examples of the New Pediatric Morbidity
AsthmaPediatric Cancer
Birth defectsNeurodevelopmental disabilities
Childhood Cancer (Age 0-19), Age-Adjusted Incidence and Death
Rates, 1975-1996
Source: Pediatric Monograph 1999, Surveillance, Epidemiology, and End Results Program Division of Cancer Control and Population Sciences, National Cancer Institute.American Cancer Society, Surveillance
Research
U.S. Incidence of Testicular Cancer
The overall incidence of testicular cancer rose
substantially in the United States from 1973 to 1996. Specifically rates in white
males increased 51.2% over that period, while rates for
black males rose only 17.3% (the latter increase was not
statistically significant). While undescended testes,
inguinal hernia, and prenatal factors have been implicated as possible risk factors, the
cause of the trend in unknown.
Case Study in Developmental Disabilities - Lead Poisoning
A report from Queensland, Australia in 1904 described an epidemic of lead poisoning in young children.
Clinical and epidemiologic investigation traced the source of the outbreak to the ingestion of lead-based paint by children playing on verandahs.
This report led to the banning of lead-based paint in many nations, although not in the United States until 1978.
Clinical Lead Poisoning
Coma and convulsionsPeripheral neuropathy
Kidney failureAnemia
Subclinical Lead Poisoning
Decreased IQ
Altered behavior
Slowed nerve conduction
Elevated uric acid
Elevated FEP
Subclinical Toxicity
… the concept that relatively low dose exposure to certain chemicals … may cause harmful effects to health that are not evident with a standard clinical examination. The underlying premise is that there exists a continuum of toxicity, in which clinically apparent effects have their asymptomatic, subclinical counterparts.
Population Impact of Subclinical Toxicity
Population Impact of Subclinical Toxicity
Subclinical toxicity has become a widely recognized
phenomenon in Children’s Environmental health
•Lead•Methyl Mercury•Polychlorinated biphenyls (PCBs)•Certain pesticides (probably))
Children’s Environmental Health -The International Dimension
The export of toxic chemicals and hazardous processes from the industrially developed to the
developing nations of the world has the potential to profoundly
change patterns of morbidity and mortality, especially in children
Examples of the International Spread of Toxic Chemicals
• Bhopal • Asbestos export• Export of “banned” pesticides• Arsenic in Bangladesh• Pesticides in central Asia• Export of hazardous waste
Bhopal, India:
A Sentinel Event
Bhopal, India
Outside Carbide Factory. Bhopal, India
Bhopal, India
The International Spread of Lead in Gasoline
• Lead was first added to gasoline in 1922• By the 1970s, almost all gasoline produced worldwide
contained lead• In the USA, peak annual consumption was almost
200,000 tons (mid-1970s)• A disaster for public health
Recognition of toxicity to children led to removal of lead from gasoline
• led to removal of lead from petrol
Lead used in gasoline declined from 1976 through 1980
Year
1975 1976 1977 1978 1979 1980 1981
30
40
50
60
70
80
90
100
110
Gasoline lead
Lead
use
d In
gas
olin
e(1
000
tons
)
Source: Annest, Pirkle, Makuc, et al., Chronological trend in blood lead levels between 1976 and 1980. NEJM 1983; 308;1373-7.
Blood lead
Year
1975 1976 1977 1978 1979 1980 1981
30
40
50
60
70
80
90
100
110
9
10
11
12
13
14
15
16
17
Gasoline lead
Lead in gasoline and lead in bloodNHANES II, 1976-1980
Blo
od le
ad le
vels
(g
/dL)
Lead
use
d In
gas
olin
e(1
000
tons
)
Source: Annest, Pirkle, Makuc, et al., Chronological trend in blood lead levels between 1976 and 1980. NEJM 1983; 308;1373-7.
1974 1976 1978 1980 1982 1984 1986 1988 1990 1992
2
4
6
8
10
12
14
16
18
Blo
od
lead
leve
ls (
g/dL
)
0
1994 1996 1998 2000
Blood lead levels in the U.S. population 1976 -1999NHANES II, III, 99+
YearSource: CDC. National Report on Human Exposure to Environmental Chemicals, March 2001
Phase Out of Lead Worldwide
The beneficial effects of the removal of lead from petrol were seen in the following countries:
• USA• Western Europe• Australia• Canada• New Zealand• South Africa
• China• El Salvador • India• Mexico• Thailand
The International Export of Asbestos
Trends in World Production of Asbestos
Year Production (tons)
1963
1973
1978
1983
1988
1993
1994
1995
1996
2,922,000
4,614,000
5,159,000
4,276,000
4,323,000
2,650,000
2,410,000
2,308,300 (a)
2,140,000 (a) (a) Chrysotile only.
World Production of Asbestos by Country (tons), 1995
RussiaCanadaChinaBrazilZimbabweSouth AfricaGreeceSwazilandIndiaUnited StatesColombiaRomaniaYugoslavia
1,000,000510,800250,000180,000145,000100,00050,00030,00025,0009,0005,0003,0001,000
Principal Chrysotile Consuming Countries in 1994
Nation Annual usage (tons)Russia
China
Japan
Brazil
Thailand
India
South Korea
Iran
France
Indonesia
Mexico
Columbia
Spain
USA
Turkey
Malaysia
South Africa
TOTAL
700,000
220,000
195,000
190,000
164,000
123,000
85,000
65,000
44,000
43,000
38,000
30,000
29,000
29,000
25,000
21,000
20,000
2,021,000
Asbestos is Known to Cause the Following Diseases:
• Lung Cancer• Malignant Mesothelioma• Asbestosis• Other Malignancies
On the basis of these facts the Collegium Ramazzini has called for an international ban on all uses of asbestos. ICOH has
joined the Collegium Ramazzini in calling for this ban
Domestically Forbidden Pesticide Exports from USA, 1997-2000
• Products unregistered in the U.S. were exported at an average rate of 16 tons per day
• 57% of products were shipped to developing nations
• Over 21% of products were shipped to Belgium and the Netherlands
• The rest (22%) of products were shipped to unknown destinations, probably also developing nations
• Largest-volume chemicals exported– Butachlor (nearly 14 million pounds)– Carbosulfan (10.2 million pounds)
The WHO Program in Children’s Environmental Health
• An extremely positive development• The theme this year of World Health
Day is “Healthy Children in Healthy Environments”
The Bangkok DeclarationWe will have to continue to join together as we do today, to continue sharing our knowledge, experience, and support. This conference is a call to governments, civil society, the private sector, and the whole international scientist community to renew our commitment to children’s health by advancing a new vision for the 21st century – a vision in which every child has a healthy life and a clean environment.
Professor Le Hung LamHanoi School of Public Health, 2002
Actions Needed for Prevention
• Child-Protective Risk Assessment• Child-Protective Regulation• Right-to-Know Legislation• Children’s Environmental Health research• Training programs• Increased emphasis on the Precautionary
Principle – Presume that children are more vulnerable in the absence of evidence to the contrary
• International Program in Children’s Environmental Health
A New Direction in ResearchNational Children’s Study
• A multi-year prospective epidemiological study to examine the influence of children’s early life exposures to environmental toxins
• As many as 100,000 children followed from before birth to at least 18 years of age
• Explore simultaneous impact of many risk factors on the long term health of children
Critical Research Questions to be addressed through the
National Children’s Study
• Contribution of indoor and ambient air pollution to the origins of asthma
• Environmental causes of developmental disabilities in children
• Effects of endocrine disruption
• Causes of the rising incidence of certain pediatric cancers
Summary
What are Children?
• Our children are the current inhabitants of a developmental stage through which all humans must pass
• The protection of children is essential for the sustainability of the human species
• They are our future
Center for Children’s Health and the Environment
M o un t Sin a i Sch o o l o f M ed icin e