National Institute of Environmental Health Sciences

Children around the world, especially in lower-income countries, often face enormous disease burdens due to infections related to a lack of sanitation, vaccines, maternal prenatal care, and other necessities for health. This situation is widely known among medical and public health professionals and the public. What is less well recognized is the extent to which exposure to environmental contaminants can harm children throughout the course of their lives. A growing body of research suggests environmental exposures during childhood are contributing to global increases in non-communicable conditions and diseases in adults, including obesity, cardiovascular disease, and neurodegenerative diseases.

In early May, the World Health Organization (WHO) Department of Public Health, Environmental and Social Determinants of Health announced the naming of a new initiative aimed at integrating environmental health into children’s basic healthcare. Titled Pollution Free Environment for Healthy Generations, the initiative will be focused on increasing awareness and understanding of common environmental exposures, including prenatally and even preconceptionally, that are damaging the health of children around the world. NIEHS experts in children’s environmental health have been engaged in the development of the initiative, and the NIEHS-WHO Collaborating Centre for Environmental Health Sciences (WHOCC) is poised to help the initiatives meet its goals. The WHOCC will deliver and amplify messages through existing networks and communication tools, including those of other NIEHS programs.

WHO, with the support of Japan’s Chiba University, convened the first Meeting on Avoidable Early Life Environmental Exposures in June 2016. NIEHS Program Officers and Collaborating Centre Focus Area Leads for children’s health Kimberly Gray, Ph.D., and Jerry Heindel, Ph.D., participated in this meeting. Global experts discussed the state of the science, as well as data, tools, and other resources that had been developed to educate and communicate about such exposures. The group also laid out a draft roadmap for action by the health sector.

At the second meeting on the topic, held November 27 – 28, 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 to discuss avoidable early environmental exposures. During this meeting, NIEHS Health Science Policy Analyst and GEH Program Steering Committee Member Kimberly Thigpen Tart, J.D., M.P.H., advised participants on research translation and communication considerations and best practices. Based on this second meeting, WHO has now shared the next steps to implement its roadmap, identifying measures to:

• increase the visibility and accessibility of relevant WHO publications to a range of healthcare providers,
• encourage advocacy for preventive healthcare against harmful environmental exposures to children, and
• increase awareness on a broad front of the increasing urgency of this global environmental health problem.

“For various reasons, environmental exposures are often left out of children’s basic healthcare,” said Thigpen Tart. “This can be due to a lack of knowledge of the provider, a sense that the threat is not urgent, not having readily communicable information, or the perception that environmental exposures are a separate domain of healthcare or someone else’s responsibility.”

“This initiative recognizes that we must work harder to integrate considerations of a child’s environment as a priority in their healthcare, if we are to safeguard current and future generations,” said Thigpen Tart.

The slogan of the new initiative is “Pollution Free Generation.” The initiative aims to achieve this goal, in part, by developing and widely disseminating key messages that will improve awareness and understanding of the importance of considering children’s environmental exposures as a critical part of their health care. Key messages will first be targeted to several priority groups of health professionals, including community health workers, pediatricians, and obstetricians/gynecologists. “We need every health professional in the world who sees a child or parents-to-be to think ‘environment’ and promote prevention,” said Marie-Noel Bruné Drisse from the WHO Department of Public Health, Environmental and Social Determinants of Health.

Though the exact messages are still being developed, ideas discussed at the November meeting included: 1) sharing quantifiable estimates of children’s health impacts, such as asthma attacks, cancers, and neurological disorders, which could be avoided through environmental intervention; 2) obtaining information on a child’s environmental exposures as part of their medical history; and 3) maintaining credible materials that can be easily shared with parents and other caregivers.

Other issues that need to be addressed for the initiative to achieve full success were also discussed by meeting participants. These topics included the importance of testing messages for different audiences, delivering messages in ways that are accessible by particular health providers (e.g., mobile phone platforms might work best for community health workers in the field), and the necessity of making environmental exposure considerations fit easily within a given provider’s typical practice, including time constraints.

Next steps will include development of key messages that will be integrated by each provider group, identifying the best routes of dissemination, and planning for further implementation of roadmap activities, such as changes to health care and medical curricula to integrate environmental exposure knowledge into a provider’s education from the beginning, as well as through continuing education for health professionals.