Low-cost investments to save children

by Cesar Chelala

NEW YORK — In the world today there are over 600 million children under 5 years old. They represent the best hopes for the planet, yet more than 5 million of them die every year as a result of environment-related diseases. Their deaths could be prevented by using low-cost and sustainable tools and strategies for improving the environment.

This is one of the main conclusions of a recent World Health Organization study, the first ever country-by-country analysis of the impact of environmental factors on health. The collected data show that 13 million deaths worldwide could be prevented by improving the environment. In some countries, more than one-third of the disease burden could be prevented by environmental changes.

Information collected in this study is crucial to letting countries select appropriate intervention methods. According to the WHO study, in 23 countries, more than 10 percent of deaths are due to: unsafe water (including poor sanitation and hygiene) and indoor air pollution such as from solid fuel used for cooking.

Most of the deaths are among children under 5, and are attributable mainly to intestinal and respiratory infections.

People living in industrialized countries are affected as well. Among environmental factors that impact health are pollution, occupational factors, ultraviolet radiation, the constructed environment, and climate and ecosystem changes. WHO also considers factors such as people’s behavior.

The integrity of the global environment is being increasingly compromised by the deterioration of the atmospheric ozone layer and an ever-higher concentration of gases responsible for the greenhouse effect. To the degree that these factors intensify, the health of populations will be seriously impacted.

Environmental factors affect children’s health from the time of conception and intra-uterine development through infancy and adolescence. These factors can even exert an influence prior to conception, since both ovules and sperm can be damaged by radiation and chemical contaminants.

It has been widely demonstrated that children are more susceptible than adults to environmental factors because, among other reasons, they are still growing and their immune systems and detoxification mechanisms are not yet fully developed. Children make up almost half the population of developing countries.

Interventions both at the community and the national level can significantly improve the environment, including promotion of safe-water treatment and storage, and the reduction of air pollution. The last measure by itself could save almost a million lives a year.

A series of measures being taken at the local level are having a significant impact on improving the environment. Among these are the Healthy Homes Project in South Africa, Health-Promoting Schools in Vietnam, the Environmentally Healthy School Initiative in Jordan, and the Integrated Solid Waste Management Program in Ecuador.

For example, in an overcrowded and unsanitary inner-city building housing several hundred people in South Africa, conventional environmental health control measures had failed. So, a democratically elected tenants committee initiated a series of measures to deal with the main problems affecting the building and its inhabitants. This project has laid the foundation for a participatory way of dealing with environmental problems in inner-city buildings.

In Vietnam, a project to make schools cleaner and safer through the efforts of teachers and members of the community resulted in extremely positive outcomes as measured by field visits. A similar initiative called the Environmentally Healthy School Initiative was launched in Jordan in 1996, leading to improved conditions including better sanitation, better water supplies, tree plantings and cleaning campaigns.

In Ecuador, the city of Loja was afflicted with dumping yards in inhabited areas, which led to outbreaks of infections and contagious diseases. Through an intensive sensitization and education campaign in which community members played a key role in establishing a sanitary landfill and a means for properly disposing of recyclable materials, there was a manifest improvement in the quality of life for Loja residents. Children, in particular, increased their awareness about the environment and their role in improving it.

In the Americas, an outstanding series of environmental activities is carried out by Ecoclubs, nongovernmental organizations made up basically of children and adolescents who coordinate their activities through several community institutions.

Such initiatives are taking place worldwide with the aim of improving the environment and, as a result, people’s health. The planning, design, monitoring and management of the physical environment have provided ideal terrain for children’s participation.

Cesar Chelala, M.D., Ph.D., is an international public health consultant and the author of “Environmental Impact on Child Health,” a publication of the Pan American Health Organization.