Introduction to the subject area

Children's exposure to pollutants in the air, water, food and soil is a major contributor to increased morbidity and mortality, especially in low and middle income countries. The World Health Organization (WHO) estimates that approximately one third of the disease burden in developing countries is attributed to modifiable environmental factors.

The following specific areas of focus have been identified as very important:

1. Household Air Pollution

About 3 billion people use solid fuels (biofuels or coal) for cooking and they breathe air that is heavily polluted from burning these fuels. Ninety percent of rural households in low-income countries and a total of two thirds of the households in developing countries use biomass fuels for cooking and/or heating. This creates levels of particulate and pollutant gas mixtures that are much higher than permitted under typical regulatory limits. Globally, 4.3 million deaths were attributable to household air pollution in 2012, almost all in low and middle income countries. Thirteen percent of these deaths (534,000) were among children under 5 years of age, and the deaths were primarily from lower respiratory illnesses. Behavioral interventions such as keeping children away from the stove during cooking, using dry wood, and cooking outdoors, whenever possible, can be recommended by health care workers.

2. Tobacco

Worldwide, more than a thousand million adults smoke. About 6 million people a year, almost 16,000 every day, are killed by tobacco. This is more than killed by any other agent. By 2025, tobacco will kill 10 million people a year, 70% of them in low and middle income countries. Around 700 million, or almost half of the world's children, breathe air polluted by secondhand smoke. Secondhand smoke contains more than 4000 different chemical compounds, many of which are poisons Secondhand smoke exposure is linked to upper and lower respiratory illness, including otitis media and asthma, sudden infant death syndrome (SIDS), and some cancers. There is no safe level of exposure to secondhand smoke. The World Health Organization has urged all countries to pass laws requiring all indoor public places to be 100% smoke-free. Pediatricians can take an active role in supporting and educating parents about smoke-free public policies.

3. Lead

Children with elevated lead levels in their blood have lower intelligence scores, more language difficulties, attention problems, and behavior disorders. These adverse effects on intellectual development of children are seen at blood-level concentrations below 10 g/dL. Blood lead concentrations well above this level are frequently reported in children from Africa and Asia.

Leaded petrol has been a major source of children's exposure to lead. Currently, all but 4 countries have eliminated lead from petrol. Children also may be exposed from the use of lead ore in eye cosmetics and from lead in ceramic dishes or paint. Lead paint has long been outlawed in developed countries, but no legislation prevents lead paint from being sold in many parts of Asia and India. Children may be exposed from backyard cottage industries (eg, battery recycling). Children also may be exposed from living or playing near areas where mining occurs. A mass lead intoxication in northern Nigeria during 2010 resulted in the deaths of more than 200 children whose parents were engaged in small-scale gold mining activities. Pediatricians can be an important voice for policies to reduce children's exposure to lead.

4. Unsafe water, poor sanitation, and hygiene

The provision of safe drinking water is just as important as safe air to breathe. Nearly1.1 billion people in the world are still without access to safe drinking water. Nearly 2.6 billion people, including half of all Asians, lack access to sanitary means of excreta disposal.

With proper sanitation, proper hygiene, and safe drinking water, diarrhea can be decreased 22% and deaths resulting from diarrhea can be decreased 65%. Because diarrhea accounts for 12% of the deaths of children younger than 5 years, improvements in water and sanitation are critical to the child health agenda.

5. Housing and vector-borne diseases

A considerable proportion of the disease burden for four key vector-borne diseases, malaria, schistosomiasis, Japanese encephalitis, and dengue, falls on children under 5 years of age. Several of these diseases are related to construction and housing design. Malaria risk is great for people living in poorly constructed houses (eg, with thatched roofs) than for those living in houses with brick and plaster walls and tiled roofs. Malaria risk is also increased if housing is located near water where mosquitoes can breed.

Technical Advisor & Committee
Chair: Ruth Etzel (USA)

Members 2013-16:
M. TezerKutluk (Turkey)
NanthalileMugala (Zambia)
Archana Patel (India)
Stella Michailidou (Cyprus)
History within the IPA
Training Package for Health Care Providers
Improving the capacity to diagnose, prevent and manage paediatric diseases linked to the environment

A growing number of diseases in children from rural and urban areas are linked to unsafe, degraded environments. However, many health care providers are unable to recognize, assess and manage environmentally-related diseases in children.

How should this problem be addressed?

Enabling those "in the front line" - the health professionals dealing with children and adolescent's health- to recognize and assess diseases linked to, or triggered by environmental factors. Paediatricians, family doctors, nurses, primary and other health care workers should be trained on the relationships between children's health and the environment through the use of harmonized training materials, adaptable to the specific needs of countries and professional groups.

What are the benefits of training health care providers?

Increased understanding about the influence of environmental factors on children's health
Improved quality of diagnosis and management of environmentally-related health and developmental effects
Capacity to discuss environmental risks with patients, parents, educators and the media
Advocacy skills for sensitizing decision-makers about high priority issues for action
Enhanced potential for research on children's health

What is the WHO Training Package for Health Care Providers?

A collection of over 30 modules with internationally harmonized information and peer-reviewed materials to enable health care workers to be trained, and also to become trainers of their peers and colleagues. The modules include extensive notes and references, case studies and self-evaluation tools, backed up by manuals and guidelines. A selected team of experienced professionals from over 15 countries, the International Paediatric Association (IPA) and selected NGOs are participating in its preparation.

This initiative was made possible thanks to the financial support provided by the US EPA Office of Children's Health Protection, that also made available useful data, graphics and text for the modules.

What issues are covered?

The special vulnerability of children to physical, chemical and biological environmental threats
The health and developmental effects of specific chemical, physical and biological hazards (e.g. pesticides, persistent toxic pollutants -POPs- , lead, arsenic, radiation, noise, moulds, other) present in specific settings (e.g. home and surroundings, school, recreation areas, workplace, fields, other)
Sources, routes and mechanisms of exposure (contaminants in air, water, food, cosmetics, objects, toys, medical devices, that may be inhaled, ingested or absorbed...)
Illustrative case studies.

How are the training programmes organized and by whom?

Training events are organized according to the needs identified by the countries and/or scientific groups concerned and financial resources available. WHO provides technical advice on the contents and methodology. The event may go from a 1-day introductory course to a full 40-hour course that enables to cover the entire contents of the package. WHO and its partners provide the initial training and distribution of materials, some of which are available as informal versions in Spanish, French and Russian thanks to the contribution of partners in different countries.

please register to download below Mentioned training modules!

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1. Why children
2. Children are not little adults
3. Indoor air pollution
4. Outdoor air pollution
5. Lead
6. Mercury
7. Pesticides
8. POPs
9. Water
10. Paediatric environmental history
11. Cancer
12. Food safety
13. Global climate change
14. Injuries
15. Noise
16. Occupational exposure
17. Radiation
18. Respiratory diseases
19. Children's Environmental
20. Second-hand tobacco smoke and children
21. Mycotoxins.
22. Children and chemicals.
23. Biomarkers and human biomonitoring.
24. Immune diseases and children.
25. Developmental and environmental origins of adult disease.
26. Children & neurodevelopmental disorders.
27. Endocrine disorders.
28. Sanitation and hygiene.
29. Children and other heavy metals.

Future Plan of action
Future plans 2017-18

1. Global Alliance for the Elimination of Lead Paint

a) IPA Children's Environmental Health TAG will continue its participation with WHO on the Interim Advisory Group for the Global Alliance for the Elimination of Lead Paint international campaign on lead poisoning prevention.

2. Global Tobacco Control

a) The Environmental Health Technical Advisory Group will continue to work with the AAP and the Indian Academy of Pediatrics on the global tobacco control program.

3. International Pediatric Environmental Health Leadership Institute

a) The full work of the International Pediatric Environmental Leadership Institute will continue in 2015-2016. Monthly updates on new research findings in children's environmental health will be developed by Dr. Etzel and posted on the IPA website:

4. Pre-Congress Workshop at Congress of Pediatrics - August 2016

a) The Technical Advisory Group will hold a Pre-Congress Workshop on Child Health and the Environment at the 2016 Congress of Pediatrics in Vancouver.

5. National Conference of the Indian Academy of Pediatrics Environment & Child Health Group - December 2015

a) The Technical Advisory Group will help present the WHO Training Package for the Health Sector on Children's Environmental Health at the 4th national conference of the Indian Academy of Pediatrics Environment & Child Health Group.

6. IPA Ihsan Dogramaci Prize in Children's Environmental Health

a) The Prize will be widely advertized in the next 2 years to enable the IPA to identify a possible recipient to be awarded at the 2016 Congress of Pediatrics in Vancouver.
Resource Material

In 2015, 5.9 million children under age five died. The major causes of child deaths globally are pneumonia, prematurity, intrapartum-related complications, neonatal sepsis, congenital anomalies, diarrhoea, injuries and malaria. Most of these diseases and conditions are at least partially caused by the environment. It was estimated in 2012 that 26% of childhood deaths and 25% of the total disease burden in children under five could be prevented through the reduction of environmental risks such as air pollution, unsafe water, sanitation and inadequate hygiene or chemicals.

Children are especially vulnerable to environmental threats due to their developing organs and immune systems, smaller bodies and airways. Harmful exposures can start as early as in utero. Furthermore, breastfeeding can be an important source of exposure to certain chemicals in infants; this should, however, not discourage breastfeeding which carries numerous positive health and developmental effects (4). Proportionate to their size, children ingest more food, drink more water and breathe more air than adults. Additionally, certain modes of behaviour, such as putting hands and objects into the mouth and playing outdoors can increase children’s exposure to environmental contaminants. Don’t pollute my future! The impact of the environment on children’s health.


Program activities

Environmental Health Committee Goals/Objectives for 2011:

Continue to Develop the Pediatric Environmental Health Leadership Institute

Goal/Objective 1:  Put Children's Environmental Health Training Modules on the IPA website and advertise to pediatricians worldwide

Goal/Objective 2: In collaboration with at least 3 National Pediatric Societies, conduct workshops to train pediatricians in children's environmental health and improve their capacities for leadership in the recognition, diagnosis, prevention and management of pediatric diseases linked to environmental factors and enable them to offer advice and information to policymakers in their communities.  Consider holding workshop in Mumbai, India in conjunction with the 14th World Conference on Tobacco or Health in March, 2009

Goal/Objective 3: Standardize, evaluate and ensure the competence level of pediatricians in children�s environmental health through an international credentialing program that will be implemented in coordination with National Pediatric Societies.

Goal /Objective 4:  Facilitate global communications, networking and exchange of ideas among pediatricians on prevention and treatment of childhood illnesses linked to the environment.

Goal/Objective 5:  Write a manuscript for the peer-reviewed literature summarizing the progress in developing the Pediatric Environmental Health Leadership Institute

Goal/Objective 6:  Write a grant to support the development of a rapid response team of pediatricians with specific training who could respond to requests from the World Health Organization and other organizations when environmental disasters occur and a pediatrician�s advice is needed.

Goal/Objective 7:  Work with other organizations towards the elimination of tobacco from homes with children and the elimination of lead from petrol.

IPA Statements and publications


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Recent publications about Children's Health and the Environment

Children�s Exposure to Mercury Compounds

Healthy Environments for Healthy Children

Children's Environmental Health Units

Childhood Lead Poisoning

Persistent Organic Pollutants: Impact on Child Health

Educational Leaflets