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National Institute of Environmental Health Sciences

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Integrating Greater Understanding of Avoidable Early Environmental Exposures Into Children’s Global Health

By Kimberly Thigpen Tart

In much of the world, “environmental health” focuses on diseases that stem from a lack of clean air, water, or sanitation. Exposures to chemicals, metals, and other environmental hazards are viewed as a more distant threat, if they are considered at all. However, over the past decade, scientific evidence has mounted demonstrating that exposure to environmental hazards in early life, in some cases prenatally or even prior to conception, can cause genetic and epigenetic changes that can impact children’s normal growth and development, as well as predispose them to chronic, non-communicable diseases such as obesity, cancer, and reproductive conditions much later in life. An ongoing effort by the World Health Organization (WHO) and a range of global partners recognizes that this new information dramatically changes the way we need to think about protecting the health of children.

Protecting Children From the Environment
(Photo courtesy of World Health Organization)

This effort, which began in 2016 and is led by WHO’s Department of Public Health, Environmental and Social Determinants of Health, seeks to create a more holistic view of a child’s environment — one that includes the entirety of avoidable early exposures — and to increase understanding among health care providers of what such exposures mean for a child’s current and future health. According to Marie-Noel Brune Drisse, WHO lead for children’s environmental health: “Environmental interventions during early life lead to a lifetime of health benefits. Be it at the hospital, clinic, or community level, every health care provider that sees a child or a parent-to-be should be aware of the links between environmental risks and disease, how children are uniquely exposed, and how to reduce these exposures. As well-respected members of their communities, health care providers are uniquely positioned to promote safer environments and policies for children.”

The First Meeting on Avoidable Early Environmental Exposures was held in June 2016 and brought together children’s environmental health researchers, pediatricians, and other experts to synthesize scientific information on avoidable contaminants, such as arsenic, lead, mercury, and phthalates, along with their related health effects; discuss possible interventions to reduce the risks to children; and formulate a “Roadmap for Action,” including WHO recommendations on specific exposures. The meeting led to a recent Lancet Planetary Health article explaining importance of increasing awareness of early exposures. NIEHS program officers Jerry Heindel, Ph.D., and Kimberly Gray, Ph.D., leads for the Children’s Environmental Health and Developmental Origins of Health and Disease focus areas of the WHO-NIEHS Collaborating Centre (WHOCC), participated in the meeting to contribute their expertise to the consideration of the available science. Gray noted, “It is essential to the mission of NIEHS to not only provide the foundation for scientific research but also to provide opportunities to translate the findings through outreach efforts to the broader stakeholder community. This is how science can create change that will protect our children and their futures from environmental contaminants.”

Meeting on Avoidable Early Life Environmental Exposures
Participants at the Second Meeting on Avoidable Early Life Environmental Exposures.
(Photo courtesy of Emiko Tadaka, WHO)

In February 2017, a project planning meeting was held at WHO headquarters to discuss implementation of the Roadmap and the need for an effective advocacy campaign to empower health professionals to include environmental health more integrally in children’s care. In November 2017, WHO assembled a global group of policy, advocacy, research translation, and education experts, along with medical practitioners, including obstetricians, pediatricians, midwives, health care workers, and others at the Second Meeting on Avoidable Early Environmental Exposures. Participants, including Kimberly Thigpen Tart, M.P.H., a member of the WHO-NIEHS Collaborating Centre Steering Committee, spent two days providing advice and expertise related to implementation of the Roadmap, including identifying audiences and their unique needs, developing key messages that would resonate with various health care providers, considering state-of-the-science communication and translation strategies and tools, and discussing policy changes, including changes to medical curricula, that would support implementation. According to Thigpen Tart, “As science professionals, we can sometimes take for granted that environmental threats to our health and that of our children are widely known and accepted, particularly among health care providers. This effort reminds us that there are large differences in both awareness and focus on these threats among health care professionals around the world and that we need to be doing far more to empower such providers by translating our science into the knowledge and tools they need to protect the health of their patients. The goal of this effort is to convey the concept of avoidable early exposures in ways that make clear how integral it is for health from the very beginning, and how powerful preventing such exposures can be for ensuring health over the long run.”

Participants are continuing to consult with WHO and each other on the Roadmap and the multitude of implementation ideas generated at the November meeting. NIEHS will continue to engage as a broader implementation plan takes shape and will consider appropriate ways its Collaborating Centre can support and amplify this critical activity for children’s environmental health.