HEALTH TOPICS A TO Z

The issues

More than three million children under five die each year from environment-related causes and conditions. This makes the environment one of the most critical contributors to the global toll of more than ten million child deaths annually -- as well as a very important factor in the health and well-being of their mothers.

Polluted indoor and outdoor air, contaminated water, lack of adequate sanitation, toxic hazards, disease vectors, ultraviolet radiation, and degraded ecosystems are all important environmental risk factors for children, and in most cases for their mothers as well. Particularly in developing countries, environmental hazards and pollution are a major contributor to childhood deaths, illnesses and disability from acute respiratory disease, diarrhoeal diseases, physical injuries, poisonings, insect-borne diseases and perinatal infections. Childhood death and illness from causes such as poverty and malnutrition are also associated with unsustainable patterns of development and degraded urban or rural environments.

Major environment-related killers in children under five years of age

• Diarrhoea kills an estimated 1.6 million children each year, caused mainly by unsafe water and poor sanitation.
• Indoor air pollution associated with the still-widespread use of biomass fuels kills nearly one million children annually, mostly as a result of acute respiratory infections. Mothers, in charge of cooking or resting close to the hearth after having given birth, are most at risk of developing chronic respiratory disease.
• Malaria, which may be exacerbated as a result of poor water management and storage, inadequate housing, deforestation and loss of biodiversity, kills an estimated one million children under five annually, mostly in Africa.
• Unintentional physical injuries, which may be related to household or community environmental hazards, kill nearly 300 000 children annually: 60 000 are attributed to drowning, 40 000 to fires, 16 000 to falls, 16 000 to poisonings, 50 000 to road traffic incidents and over 100 000 are due to other unintentional injuries.

Health-damaging exposure to environmental risks can begin before birth. Lead in air, mercury in food and other chemicals can result in long-term, often irreversible effects, such as infertility, miscarriage, and birth defects. Women's exposure to pesticides, solvents and persistent organic pollutants may potentially affect the health of the fetus. Additionally, while the overall benefits of breastfeeding are recognized, the health of the newborn may be affected by high levels of contaminants in breast milk. Small children, whose bodies are rapidly developing, are particularly susceptible - and in some instances the health impacts may only emerge later in life.

Furthermore, children as young as five years old sometimes work in hazardous settings. Pregnant women living and working in hazardous environments and poor mothers and their children are at a higher risk, as they are exposed to the most degraded environments, are often unaware of the health implications, and lack access to information on potential solutions.

Improving children and mothers' environmental health by addressing and tackling issues affecting their health, presents an essential contribution towards the achievement of the Millennium Development Goals (MDGs).

The solutions

In many cases, low-cost solutions for environment and health problems exist. For instance, simple filtration and disinfection of water at the household level dramatically improves the microbial quality of water, and reduces the risk of diarrhoeal disease at low cost. Improved stoves reduce exposures to indoor air pollution. Better storage and safe use of chemicals at community level reduces exposures to toxic chemicals, especially among toddlers, who explore, touch and taste the products found at home. Personal protection from malaria through the use of insecticide-treated mosquito nets has a proven track record of saving lives, particularly children's.

Education is also key - mothers who receive the information they need to understand the environmental risks present in their homes and communities are better equipped to take appropriate action to reduce or eliminate exposure.

WHO action

WHO's programmes and initiatives on water and sanitation, vector-borne diseases, indoor air pollution, chemical safety, transport, ultraviolet radiation, nutrition, occupational health, food safety and injury prevention all address issues critical to the environmental health and well-being of children. These programmes support awareness raising, training and advocacy; prepare tools for identification of key hazards and assessment of health impacts; and provide guidance to policymakers, professionals and communities on "good practice" solutions.

WHO and its partners also lead and coordinate research and global knowledge-sharing about the long-term impacts of major environmental hazards on child health. For instance, long term children's studies to examine the relationship between environmental factors, childhood health and development are being promoted in ten pilot countries, where thousands of pregnant women and their children will be recruited in the next few years.

To tackle indoor air pollution, WHO is supporting the thorough assessment of the health and broader impacts of household energy solutions, such as improved stoves or ventilation. Bringing together the evidence from projects around the world by 2010 will enable policymakers, households and women in particular to make informed choices about the most suitable good practice solutions.

WHO is helping improve water and sanitation in several ways. A WHO-led international network has brought together more than 60 collaborating organizations in a new International Network to Promote Household Water Treatment and Safe Storage. The Network engages with decision-makers, raises grassroots awareness, and supports research. Currently, projects to improve household water management - and thus reduce rates of diarrhoeal disease - are under way in 50 developing countries, involving the mothers as key players in these initiatives.

The storage of drinking water in the domestic environment has an important implication: in many countries, the Aedes mosquitoes breed in small water collections in and around the house that transmit the dengue virus. Its most virulent form (Dengue haemorrhagic fever) is very severe. Outbreaks are on the increase, and children are the main victims. Yet, keeping these household water collections free from mosquito breeding only requires simple measures: storing drinking water under cover so that mosquitoes cannot deposit their eggs. Pregnant women and mothers, as the caregivers providers, play a key role in carrying out such simple actions that can have tremendous benefits for their own health, as well as for their child's.

In initiatives that cut across all sectors, a WHO-led environmental burden of disease study is providing a more comprehensive assessment of the contribution that environmental hazards make to specific childhood diseases and disabilities. Capacity building among professionals is another important activity. For instance, a Training Package for Health Care Providers enables those on the "front-line" of maternal and child health care to recognize, assess, prevent and treat environmentally-related diseases.

WHO also coordinates two interagency partnerships specifically related to children and environmental health. These involve a range of UN institutions, governments and NGOs. The partnerships include the Healthy Environments for Children Alliance (HECA), launched at the 2002 World Summit on Sustainable Development (WSSD), that aims to raise awareness and support policymaker and community action on children, health and environment issues. HECA is now supporting country-level projects that focus on addressing multiple risks in an integrated and cross-sectoral manner, in home and school settings.

Also launched at the WSSD summit, the Children's Environmental Health Indicators (CEHI) Initiative aims at improving country-level assessment of children's environmental health issues through better monitoring and reporting of key childhood environmental health indicators. This initiative is closely linked to the preparation of national profiles on the status of children's environmental health, that enable countries to do rapid assessments on the situation of their children and the means available to provide solutions. Regional pilot projects to improve monitoring and reporting of such indicators are already under way in Africa, Europe, the Middle East, Latin America and the Caribbean, and North America.

The way forward

There are over 600 million children under five in the world today. They represent the future of the planet and boundless human potential. However, only mothers who are themselves healthy, and in a position to provide a healthy, clean and safe environment can preserve their child's right to life. In order to achieve this goal, it is important for decision-makers at international, regional and national levels, together with non governmental organizations, communities and families to join efforts in recognizing and addressing key environmental hazards. This may include policy action, advocacy, prevention, and grassroots participation.

Action to reduce and eliminate the key environmental hazards to childhood and maternal health will help "Make every child and mother count."

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