Healthy Environments for Children

في األطفال تنشئةسليمة بيئة

للمستقبل ضمان

Shape the Future of Life

World Health Organization

Eastern Mediterranean Region

Regional Centre for Environmental Health Activities

(WHO – CEHA)

Outline WHO work on Healthy Environments for

Children Environmental Burden of Disease Children’s special vulnerability Environmental risks to children’s health Key risk factors Target Action Monitoring indicators Healthy Places, Happy Faces

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Child and Adolescent Health The CAH Strategy Integrated Management of Childhood Illness (IMCI) The Stockholm Consultation

Task Force on CEH International Conference on Children’s Environmental

Health The Bangkok Statement: a pledge to promote the

protection of CEH CHILDREN IN THE NEW MILLENIUM: ENVIRONMENTAL IMPACT ON HEALTH

Task Force on Healthy Environments for Children (HEC) HEC Initiative (HECI) announced at WSSD HEC Alliance (HECA) …established in December 2002

Healthy Environment for Children: WHO Global work

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EURO London Meeting CHILDREN’S HEALTH AND THE ENVIRONMENT: A REVIEW

OF EVIDENCE

AMRO/PAHO Publication on environmental impact on

children’s health (1999) Video Full CHELAC (Regional strategy)

SEARO Informal consultations (2) Training workshop for the health sector

WPRO & SEARO: International Conference Bangkok

Healthy Environment for Children: WHO Global work

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WHO/EMRO Regional Initiative

Environmentally Healthy School Initiative in Jordan (1998-2001)

Task Force on HEC, October 2002 Consultation on HEC, Nov. 2002, Amman CEHA Database and Information Clearing House on HEC

started December 2002 World Health Day 2003 celebrations HEC project in Pakistan and Yemen (2003-2006) HEC Indicators monitoring. Piloting starts (2003) Jordan National Conference on HEC (April 2003) Saudi Arabia National Conference on HEC (April 2003) Pakistan Conference on HEC (April 2003) Lebanon pilot project on HEC in a Beirut suburb (starts 2003) WHO/EMRO Regional planning consultation on HEC (Late

2003)

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ENVIRONMENTAL THREATS MAY CAUSE UP TO ONE THIRD OF THE GLOBAL BURDEN OF DISEASE

Over 40% of this burden falls on children under the age of five who make up only about 10% of the world’s population.

25-33%Environmentalriisks

ENVIRONMENTAL BURDEN OF DISEASE

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IN 2000, MORE THAN 4.7 MILLION CHILDREN UNDER THE AGE OF FIVE DIED FROM ILLINESSES AGGRAVATED BY UNHEALTHY ENVIRONMENTS

Most of the 13,000 child deaths each day are due to the dangers present in the environments in which they live, learn, play and grow.

Environment-related illnesses can kill the equivalent of a jumbo-jet full of children every 45 minutes.

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IN 2000, UNHEALTHY ENVIRONMENTS CONTRIBUTED TO :

• 1.3 million diarrhoeal deaths, mostly from unsafe food and water, and inadequate hygiene practices.

• 2 million deaths from acute respiratory infections (ARI) aggravated by indoor air pollution.

• One million deaths from malaria, dengue fever, leishmaniasis, Japanese encephalitis, hepatitis and other environment-related infectious and vector-born diseases.

• 400,000 deaths from injuries including road accidents, drowning, burns, and poisoning. Five per cent of deaths due to injury in developing countries were from toxic poisoning.

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CHILDREN ARE AMONG THE MOST VULNERABLE TO ENVIRONMENTAL THREATS

Children are in a dynamic state of growth with cells multiplying fast and organ systems developing at a rapid rate.

Children breathe more air and consume more food and water in proportion to their weight.

Their central nervous system, immune, digestive and reproductive systems are more vulnerable than those of adults. Exposure to certain environmental toxins can lead to irreversible damage, and to diseases during adulthood.

Children are more exposed to unhealthy conditions and to dangerous substances because they live their lives closer to the ground and, especially in the early years, they are frequently exposed through hand-to-mouth activities.

WHY CHILDREN?

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Children in EMR

Children under 19, constitute 50% of EMR population

Respiratory infections, diarrhoeal diseases, injuries, and malaria account for more than 43% of under mortality.

All these diseases are attributable to environmental conditions

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Key Environmental Health Risk Factors in EMR

Housing qualityHousehold water securityHygiene and sanitationAir pollution (indoor and outdoor) Injuries and accidentsChemical hazards (e.g. lead, pesticides)Disease vectors

Poverty, war, occupation and aggression bring additional hazards 11

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RISKS TO CHILDREN’S HEALTH

IN AIRGerms; indoor andoutdoor air pollutants; toxic chemicals, second hand tobacco smoke and pesticides; disease-transmitting insects.

IN FOOD

Chemical contaminants; natural toxins; germs.

IN WATERGerms; toxic chemicals and pesticides; breeding grounds fordisease-transmitting insects.

IN SOIL

Human and toxic chemical waste; germs; breeding grounds for disease-transmitting worms.

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UNSAFE PLACES:

Home, school, workplace, playground, street.

UNHEALTHY BEHAVIOURS:

Poor hygiene, scavenging, playing with dangerous materials, inappropriate

nutrition.

Environmental Risk Factors and their Health Effects

Community School

Setting Home

Risks factor Disease outcomesDiarrhoeal diseasesAcute respiratory InfectionsTuberculosisPerinatal effectsNutritional diseasesMalaria & other vector diseases Child cluster diseasesChronic respiratory diseases CancerInjuries & accidentsDrowningPoisonings Cognitive effects

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Health Outcomes – Chemical Contamination

ArsenicosisFluorosis

Health Outcomes – Chemical Contamination

ArsenicosisFluorosis

Water QuantityInsufficient quantities of safe water available for drinking, cooking and personal and

domestic hygiene

Water QuantityInsufficient quantities of safe water available for drinking, cooking and personal and

domestic hygiene

PovertyLack of access to

safe water resources

PovertyLack of access to

safe water resources

Water Quality- Contamination by pathogens - Chemical pollution (e.g. arsenic, fluoride)

Water Quality- Contamination by pathogens - Chemical pollution (e.g. arsenic, fluoride)

Hygiene-related diseasesTrachoma Scabies

Hygiene-related diseasesTrachoma Scabies

Health Outcomes -Pathogenic contamination Diarrhoeal diseases, Typhoid, Hepatitis A,E, F

Health Outcomes -Pathogenic contamination Diarrhoeal diseases, Typhoid, Hepatitis A,E, F

Household Water Security

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PovertyLack of access to

Basis sanitation infrastructure

PovertyLack of access to

Basis sanitation infrastructure

EducationLack on information on

health consequences of poor hygiene

EducationLack on information on

health consequences of poor hygiene

Pathogenic ContaminationOf the environment

and of drinking water resources

Pathogenic ContaminationOf the environment

and of drinking water resources

Poor HygieneIn a contaminated

environment leads to person-to-person

transmission of disease and contamination of food

Poor HygieneIn a contaminated

environment leads to person-to-person

transmission of disease and contamination of food

Health OutcomesDiarrhoeal diseases Trachoma ScabiesHelminthic infections-Ascariasis-Trichuriasis -Hookworm

Health OutcomesDiarrhoeal diseases Trachoma ScabiesHelminthic infections-Ascariasis-Trichuriasis -Hookworm

Sanitation and Hygiene

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Quality of Housing- Inadequate ventilation - Crowded, unsanitary conditions

Quality of Housing- Inadequate ventilation - Crowded, unsanitary conditions

PovertyLack of resources restricts options to obtain and use cleaner fuels and improved housing

PovertyLack of resources restricts options to obtain and use cleaner fuels and improved housing

Simple FuelsReliance on simple fuels and polluting, inefficient stoves restricts opportunities for education and economic activity to escape poverty

Simple FuelsReliance on simple fuels and polluting, inefficient stoves restricts opportunities for education and economic activity to escape poverty

Health Effects of Indoor PollutionFair evidence -Acute lower respiratory infections -Chronic obstructive pulmonary disease-Lung cancer (coal)Tentative evidence -Tuberculosis-Low birth weight-Cataract-Asthma-Other cancers

Health Effects of Indoor PollutionFair evidence -Acute lower respiratory infections -Chronic obstructive pulmonary disease-Lung cancer (coal)Tentative evidence -Tuberculosis-Low birth weight-Cataract-Asthma-Other cancers

Secondary Effects-Risk of burns - Injuries during fuel collection-Opportunity cost for time collecting fuel-Quality of life (smoky, sooty home, inadequate lighting)

Secondary Effects-Risk of burns - Injuries during fuel collection-Opportunity cost for time collecting fuel-Quality of life (smoky, sooty home, inadequate lighting)

Indoor Air Pollution

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Lead concentration in air and dust

Lead concentration in air and dust

Leaded gasoline, traffic density;industrial activity

Leaded gasoline, traffic density;industrial activity

Leaded paintsLeaded paints

Leaded pipes for water supplies

Leaded pipes for water supplies

Leaded cans for food and drinks

Leaded cans for food and drinks

Lead in cosmetics and folk remedies

Lead in cosmetics and folk remedies

Lead in foodLead in food

Occupational lead exposure

Occupational lead exposure

Lead concentration in water

Lead concentration in water

Neurological effects

IQ effects

Learning disabilities

Anaemia

Violent behavior

Other effects

Neurological effects

IQ effects

Learning disabilities

Anaemia

Violent behavior

Other effects

Body burden of lead, e.g. Blood lead

Body burden of lead, e.g. Blood lead

Distal Causes

Proximal CausesPhysical and

pathophysical causes

Outcome

Childhood Lead

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Focused research

Existing information and knowledge

Action for HealthyEnvironment for Children

Action through the healthand other sectors

Healthy PlacesHappy Faces

Clear policies

TARGET

FOR ACTION

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MAKING CHILDREN’S ENVIRONMENTS HEALTHIER

IN AIRUse of alternative biofuels; reduce traffic and industrial emission; reduce second hand tobacco smoke; bring treatment to sick children.

IN FOOD

Prevent contaminants entering the food chain; hygiene; bring treatment to sick children; promote breastfeeding and adequate feeding practices.

IN SOIL

Promote safe disposal of human and chemical waste; promote sanitary practices; bring treatment to sick children.

IN WATERImprove amount and quality of water; water maintenance; reduce vector-breeding sites; promote breastfeeding and adequate feeding practices; bring treatment to sick children

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SAFE PLACES:

Home, school, workplace, playground, street.

HEALTHY BEHAVIOURS:

Hygiene, protection form vectors transmitting diseases, breastfeeding and adequate feeding practices, playing in

clean environments

Home

Community

Ambient environment

Preventive Remedial actions actions

Preventive Remedial actions actions

A simple model of environmental health indicatorsThis recognizes three sets of environment health indicatorsThose that represent exposures to environmental hazards(exposure-side indicators), those that represent health effects arising from these exposures (health-side indicators ), and those that represent the responses to these risks (action indicators)

A simple model of environmental health indicatorsThis recognizes three sets of environment health indicatorsThose that represent exposures to environmental hazards(exposure-side indicators), those that represent health effects arising from these exposures (health-side indicators ), and those that represent the responses to these risks (action indicators)

Exposure-side Indicators Health-side Indicators

Action Indicators

Monitoring Children’s Environmental Health

Morbidity

Mortality

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Healthy Home Environments for Children

Store water in covered containers in safe, clean and cool places.

Promote the use of improved stoves and cleaner household fuels.

Wash your child’s and your own hands with water and soap before preparing food and eating, and after defecation.

Keep your child away from smoke during peak cooking times and do not smoke near children.

Store household cleaning products, pesticides, fuels and medicines away from children’s reach.

Use insecticide-treated bed-nets to prevent malaria.

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Healthy School Environments for Children

Ensure that clean running water and separate toilets are available for boys and girls.

Teach children about creating healthy environments.

Build and relocate schools and playgrounds away from traffic, noise, industrial and waste sites.

Maintain clean, well-ventilated, well-lit school buildings to promote health and learning.

Encourage healthy, well-balanced diets and regular exercise for children.

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Healthy Neighborhood / Community Environments for Children

Make public places smoke free. Organize waste management to promote a

healthy community. Plant trees and clean up streams. Advocate for safer roads and organized traffic. Eliminate the use of leaded gasoline. Take care of children in swimming areas, or

when playing in ponds and creeks. Maintain slides and swings to avoid in injuries. Plant trees to provide protection from the sun.

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