Children's Environmental Health Issues
STATEMENT OF PROBLEM AND SPECIAL INFORMATION
This chapter on children’s environmental health issues of necessity will have to have a lengthy introduction, some historical facts, and a more complete problem and special information statement than the rest of the chapters. It will be necessary to learn about the distinctive qualities and issues of the child versus the adult. Also, instead of having a separate chapter on the school and preschool environment, these topics are included in this chapter.
This chapter differs from the others because we are speaking about a specific group of people and how the various environmental pollutants and other social issues affect them, instead of learning about an overriding environmental concern and its subissues and the effects on humans and ecosystems.
If we do not protect and promote the health and welfare of our children, we lose our future. There is a huge economic cost to our society from the unintended consequences of building our global economy, through the production, use, and improper disposal of chemicals and chemical products, which have a profound effect on our children and their lives. (See endnote 23.)
Throughout recorded history, there has been the push and pull of using our children for working in industry as if they were small adults and could help sustain the family. This is still true in some emerging nations, as well as in industrialized nations, where children are exposed on a daily basis to chemicals known or suspected of causing cancer, developmental damage, reproductive damage, and neurological damage. Many of these chemicals persist in the environment for long periods of time and are carried to many distant areas from the point of origin, by water, air, and food.
(See endnote 42)
Throughout the industrial revolution and even afterwards in industrialized nations, children wearing highly flammable clothing were forced to work under intolerable conditions, such as long hours in filthy sweatshops, under extremes of temperature and poor lighting, and around open fires, and this led to injuries, disease, and early death. Children working in mines and as chimney sweeps were special problems, with enormous numbers of injuries, illnesses, and deaths. The ratio of women and children, because they were cheap labor, to men working in factories was four to one. The development of the steam engine allowed factories to be moved from areas around streams and rivers into the cities.
Women and children, especially, although men were also involved, had inadequate food, poor clothing, sparse medical care if any, and therefore a very short life span. They were afflicted with typhus fever, typhoid fever, diphtheria, rickets, tuberculosis, scarlet fever, smallpox, and of course cholera. The living conditions found by Chadwick, Shattuck, Griscom, and others were simply intolerable. (See endnotes 26, 27.) This was true of the 19th century, 20th century, and in some cases still occurring in the 21st century. Further, environmental disasters which occurred and affected large numbers of people had even more profound effects on children. Coal smoke and other industrial pollutants caused substantial deaths from respiratory disease and asthma. In 1900, in Australia, there was an epidemic of lead poisoning among children who ingested lead-based paint. In the 1950s, in Minimata Bay, Japan, methyl mercury in fish, ingested by children, caused limb defects and mental retardation. In the 1960s and 1970s, pregnant women who ingested polychlorinated biphenyl (PCB)-contaminated rice bran oil had fetuses that became small and sick children. Tobacco use has resulted in premature babies and compromised respiratory systems.
There are highly significant racial and ethnic differences, as there always have been (read the book The Jungle by Upton Sinclair, about the lives of ethnic minorities in Chicago at the beginning of the 20th century) in the rates of disease and disabilities from environmental toxicants, pollutants, and microorganisms. Apparently, this is due to these groups living in close association with areas of work, areas of significant pollution, in overcrowded housing in inner cities, or in agricultural areas where the individuals and children are in close contact with agricultural chemicals. Children were also potentially exposed to serious disease from microorganisms in childcare settings, at home, and at play.
The conditions of the 19th century and 20th century led to a variety of commissions that reported that the rate of sickness and death among children needed to be sharply reduced.
New laws were passed and working conditions for children improved. (See endnotes 28, 32.)
Child labor laws (part of the Fair Labor Standards Act of 1938) and mandatory school attendance helped reduce illness, injury, and death among children. The conditions of urban housing and neighborhoods were examined in great depth and numerous changes were made and continue to be made in the housing environment, school environment, work environment, and recreational environment. Further, many professional associations, civic organizations, the local and state government, the federal government, businesses and industries, and civic-minded individuals worked individually and at times together to improve the life of the child. (See endnote 12.)
In the developing world, there has been a failure to establish the foundations of good public health practice. There are highly persistent problems of water and airborne infections, diseases spread through mosquitoes and flies, poor environmental sanitation, overwhelming amounts of fecal material and solid waste, poor nutrition, and extremely poor housing. Children are most affected by these circumstances. In the industrialized world, even though some of these situations occur, children are most affected by where they live and environmental pollutants.
Children have always been exposed to diseases from microorganisms. However, with the onset of the use of antibiotics and successful vaccination programs, many of these diseases appeared to be a thing of the past. This is no longer true in many instances. Complacency, lack of good sanitary practices, contaminated water and food, overuse of antibiotics, refusal to vaccinate children based on highly erroneous so-called scientific data, and the emergence of new microorganisms have created the potential for very serious outbreaks of disease. Once again there is serious concern about the spread of cholera, cryptosporidiosis, hepatitis A and B, meningitis, pneumonia, rotavirus, shigellosis, tuberculosis, Escherichia coli 0157:H7, vancomycin resistant staphylococcal infections, hantavirus, Streptococcus infections, etc.
In addition to social media being used to spread erroneous information concerning the health effects of vaccinations and the determination of some people to try to convince others not to vaccinate their children, other types of erroneous information have been spread. For instance, there is supposed to be a “5-second rule, 10-second rule, or 15-second rule” depending on the part of the country that you live in which states that “if an object or food falls on the floor, if you snatch it up immediately within the appropriate time, the individual can give it back to the infant or small child to consume or play with.” This is entirely and completely wrong and based on information that was made up by someone. Anything that’s on the floor for any amount of time is contaminated and every floor is contaminated no matter how well it is cleaned. Children are particularly susceptible to disease and therefore even greater care must be taken about anything that they will ingest or put into their mouths, as children do.
In the past, there have been many special commissions to improve the health of children. In April 1997, President Clinton issued Executive Order 13045, Protection of Children from Environmental Health Risks and Safety Risks, which directed federal agencies to make a concerted effort to deal with the health issues of children because of their increased susceptibility to toxic chemicals and air pollutants. The Executive Order established an interagency task force, chaired by the administrators of the US Environmental Protection Agency (EPA) and the US Department of Health and Human Services. It also created in the EPA an Office of Children’s Health Protection, and the Children’s Health Protection Advisory Committee.
The World Health Organization Task Force for the Protection of Children’s Environmental Health organized the Fourth Ministerial Conference on Environment and Health in Budapest, Hungary in 2004 to be totally devoted to children’s health issues. (See endnote 30.)
Globally, there has been a substantial reduction in the number of children dying because greater attention has been given to the prevention of disease and injury. However, a great many children’s deaths still occur in sub-Saharan Africa and Southeast Asia. Diarrheal-type diseases, typically caused by contaminated water or food, continues to be the second leading cause of death in children under 5 years of age globally. Many of these children are malnourished, have impaired immunity, and may be living with people who have HIV and therefore are even more susceptible to the effects of diarrheal-type diseases, especially dehydration which can lead rapidly to death.
The child mortality rate in industrialized countries is much lower than the previously mentioned regions of the world. Many of the deaths are related to poor maternal care, poor nutrition, secondhand smoke from tobacco, diarrhea, pneumonia, malaria, and measles.
Infant mortality rates in American cities especially among African-American children are much higher than among non-African-American children. Although poor prenatal care and unsafe sleeping practices may be part of the problem, environmental factors have to be considered. Also there is a vast environmental health concern about lead-based paint in the older housing stock found in the inner cities where especially the underserved minorities live, which creates serious risk for children for elevated blood lead levels.
The Commission for Environmental Cooperation working with public health organizations and the governments of Canada, Mexico, and the United States released the first ever report on children’s health and environmental indicators in North America on January 26, 2006. The report presented 13 indicators of environmental problems that affected children. They included outdoor air pollution, indoor air pollution, asthma, blood lead levels, lead in the home, industrial releases of lead, industrial releases of selected chemicals (153), pesticide residues on foods, drinking water contamination, general sanitation including lack of sanitary sewers, and waterborne diseases. Older homes in all three countries contribute to the lead poisoning problem. Mexico has the worst challenge regarding water and basic sanitation, which leads to disease and injury. Approximately 123 million children are at risk in the three countries. (See endnote 15.)
As an example of the current problems of exposure to toxic chemicals or environmental pollutants, which may harm the health of 74 million children in the United States, the Government Accountability Office states that 66% of the children live in counties which exceed the allowable levels for at least one of the six principal air pollutants that cause or aggravate asthma. The medical costs alone are estimated to be $3.2 billion per year.
There is a disparity between Latino children and other children in the United States. Although, Latino children only make up 16% of the total population of children, they suffer disproportionately from exposure to air pollutants, pesticides, toxic industrial chemicals, and lead and mercury from candy, traditional folk remedies, religious practices, etc. In addition, a substantial number of these children tend to live either in agricultural settings, with all the problems of agricultural chemicals and migrant labor habitats, or in crowded urban settings and poor housing. An advisory group has lowered the reduced action blood lead levels to 5 pg/dL, however no blood lead level is acceptable.
Latino children appear to be more susceptible than the general population to environmental toxicants. Multiple exposures to environmental toxicants are added to preexisting disease, poor nutrition, poor healthcare, lack of food, and other problems, which increases the potential for serious acute disease, chronic disease, currently and later in life, and injuries. There is also a huge barrier to protecting the children because the parents and children lack understanding of the significance of environmental exposures. English as a second language may also be a serious barrier.
In the United States for children over 1 year of age and adolescents, injuries are the leading cause of death and sustained disability. Globally, the injury problem is substantial, with many injuries due to road traffic crashes. The response by various governments to this severe problem of preventable injuries is underwhelming regarding the provision of funds, research activities, and other resources.
There are many organizations and industries working to improve the health of children through correction or amelioration of the problems of the environment. These organizations (professional, civic, foundations, etc.) and how they interact with governmental entities will be discussed in various parts of this presentation.