The following specific areas of focus have been identified as very important:
1. Unsafe water, poor sanitation, and hygiene
Nearly 1.1 billion people in the world are still without access to safe drinking water. Nearly 2.4 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.
2. Indoor Air Pollution
The provision of air that is safe to breathe is just as important as safe water. About 2.5 billion people use solid fuels (biofuels or coal) for cooking and they breathe air that is heavily polluted with pollutants 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 gas and particulate pollutant mixtures that are much higher than permitted under typical regulatory limits. About 3.6% of the global burden of disease can be attributed to indoor air pollution from the use of solid fuels. 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.
3. Tobacco
More than a thousand million adults smoke worldwide. About 5 million people a year – almost 14,000 every day – are killed by tobacco, more than are killed by any other agent. By 2025, tobacco will kill 10 million people a year, 70% of them in developing 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. 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 urges all countries to pass laws requiring all indoor public places to be 100% smoke-free. Pediatricians can take an active role in educating parents and supporting smoke-free public policies.
4. Lead
Children with elevated lead levels have lower intelligence scores, more language difficulties, attention problems, and behavior disorders. A major source of exposure to children has been leaded petrol. Currently, all but 16 countries have eliminated lead from petrol. Pediatricians can be an important voice for policies to reduce children’s exposures to lead from petrol.
5. Vector-borne diseases
A considerable proportion of the disease burden for four key vector-borne diseases – malaria, schistosomiasis, Japanese encephalitis, and dengue, dengue hemorrhagic fever – falls on children under 5 years of age. Several of these diseases are related to housing construction and design. Malaria risk is greater for people living in poorly constructed houses (e.g., with incomplete thatched roofs) than for those living in houses with complete brick and plaster walls and tiled roofs. Malaria risk also increases if housing is located near water where misquotes can breed.
There is a striking mismatch between the amount of attention paid to children’s environmental health in the rich countries and poorer countries. This is especially startling because data suggest that exposures to children in poor countries may be much more frequent and severe than in rich countries.
