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National Institute of Environmental Health Sciences

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Putting Environment in Global Health

By John Balbus
Annals of Global Health - Cover

Though decades of research testify to the powerful, long-term influence of environmental exposures on children’s health, these impacts are often underappreciated in the context of other major global health problems.

As non-communicable diseases constitute a growing burden in developing as well as developed countries, the public health community is increasingly focusing on the role of toxic exposures in the causation of cancer, heart disease, autism, and other illnesses. In many cases, these decisive, often irreversible exposures occur early in life or in utero. The World Health Organization (WHO) estimates that environmental hazards are responsible for nearly 25 percent of all deaths and 36 percent of deaths in children. Given the emerging evidence of the scale of these dangers, NIEHS and its Global Environmental Health program have been working to raise awareness around environmental impacts and epigenetics, and to support effective interventions that begin upstream.

The recent special issue of Annals of Global Health, Children’s Health in a Changing Environment, marks a milestone effort to “put the ‘e’ in global health,” that is, to integrate an environmental lens into the mainstream global health agenda. Under the leadership of guest editors William Suk, Ph.D., and Peter Sly, M.D., D.Sc., the special issue highlights children’s unique vulnerabilities and underscores the need for a coordinated agenda to protect them during their formative years.

“Environmental pollution is responsible for almost 9 million deaths each year, nearly three times as many deaths as are caused by AIDS, tuberculosis, and malaria combined,” says Phillip Landrigan, M.D., a pediatrician at the Mount Sinai Hospital, the Editor-in-chief of the Annals of Global Health and contributor to the special issue. “Despite their great magnitude, environmental issues have largely been missing from the global health agenda and constitute a low priority in international development. Thus the environmental threat has continued to grow, as pollution quietly becomes one of the world's largest killers.”

The special issue was inspired by two conferences on similar themes: A 2014 meeting of the WHO Collaborating Centers in Children’s’ Environmental Health in Honolulu, Hawaii and a 2015 meeting of the Pacific Basin Consortium in Jakarta, Indonesia. The guest editors solicited a number of papers, publishing a total of nine reviews and seven original articles.

The reviews explore a range of issues related to pediatric environmental exposures, from Landrigan, et al.’s review of the influence of climate change and other global trends to Zheng et al.’s discussion of how toxic exposures impact children’s growth trajectories.

A particularly timely contribution focuses on environmental exposures in a post-Millennium Development Goal era. After acknowledging the many public health victories achieved between 2000 and 2015, Suk and colleagues identify remaining health inequities that are exacerbated by societal trends and climate change. They propose a transdisciplinary action plan to rectify current gaps in our understanding of early-life environmental stressors; describe the impacts of climate change and other global trends on vulnerable populations; and promote advanced exposure assessment and biomarker development. This precautionary framework offers a blueprint for academics and clinicians committed to mainstreaming environmental considerations into global health and development policy.

The original research included in this issue is similarly noteworthy for its broad scope and interdisciplinary diversity. One example is the article by Sly, et al. on children’s environmental health indicators in Australia. For indigenous and non-indigenous children in Australia, Sly’s research team investigated the availability, accessibility, and timeliness of data for the WHO Children’s Environmental Health Indicators for physical injury, insect-borne disease, diarrheal disease, perinatal disease, and respiratory disease. They found the data on exposure indicators to be insufficient, as much of it was not child-specific or did not extend beyond the indigenous community. Outcome indicators were more readily available but not yet comprehensive. The authors conclude that the Australian government’s perception of key indicators often diverges from the WHO Children’s Environmental Health Indicator recommendations, a discrepancy that is common in many countries worldwide.

Covering a wide range of topics, including carbon emissions, electronic waste, WHO indicators, and infant cereal, these 16 articles capture the breadth and complexity of pediatric environmental health on a global scale, articles highlight the need for a richer, more interdisciplinary dialogue, and their contributors are already preparing the next phase of the conversation.

"This special issue on children's environmental health was intended to call attention to often underestimated environmental threats to global health,” says Landrigan. “The forthcoming report of the Global Commission on Pollution, Health and Development, organized by the Lancet-Global Alliance on Health and Pollution and Mount Sinai, will further amplify this theme, and present detailed estimates of the global burden of disease due to pollution and associated economic costs.” This report is expected in early 2017.