Remember the story about the girl who never wanted to grow up? One reason was that it’s more fun to be a kid. While children grow, play and learn, adults deal with mostly boring things and forget about children. Policy making is just one of these things that adults do, often without remembering that children are different and deserving of special attention. They deserve this consideration not only because they will outlive us, but also because they depend on us for everything, including their health and environment.

The World Health Organization (WHO) has announced that children, from before conception to adolescence, are more vulnerable than adults to a variety of environmental hazards. A major conference of Europe’s ministers of health and environment in Budapest this June aims to change things in favour of the kids. One in three deaths of young people in Europe is attributable to environmental threats, according to WHO’s European Burden of Disease Report. The report estimates the burden on children of disease and injury attributable to different environmental risk factors.

The study is based on 2001 data. It groups children into the ages of 0- 4, 5-14, and 15-19. Europe is divided into three regions. The Euro A region includes countries with very low mortality rates for children and very low rates for adults: Andorra, Austria, Belgium, Croatia, the Czech Republic, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Israel, Italy, Luxembourg, Malta, Monaco, the Netherlands, Norway, Portugal, San Marino, Slovenia, Spain, Sweden, Switzerland and the United Kingdom. Euro B consists of countries with low rates for children and low rates for adults: Albania, Armenia, Azerbaijan, Bosnia and Herzegovina, Bulgaria, Georgia, Kyrgyzstan, Poland, Romania, Serbia and Montenegro, Slovakia, Tajikistan, FYR Macedonia, Turkey, Turkmenistan and Uzbekistan. Euro C includes states with low mortality for children and high rates for adults: Belarus, Estonia, Hungary, Kazakhstan, Latvia, Lithuania, Moldova, Russia and Ukraine.

	Poor Roma children pose amid piles of rubbish in the run-down neighboorhood of Stolypino in Plovdiv, Bulgaria. Photo: REUTERS/DIMITAR DILKOFF

WHO has estimated that worldwide outdoor pollution causes 800,000 premature deaths every year through lung cancer and cardiovascular and respiratory diseases. Particulate matter is a major culprit. A significant burden of mortality in children is attributable to outdoor air pollution, particularly in the B and C regions, according to the report. If particulate matter concentrations in Euro B and C decreased to the European Community guideline level of 40 milligrams per cubic metre by 2005, then the lives of 3,217 children ages 0-4 would be saved in Euro B and 1,340 in Euro C annually.

To illustrate the value of the findings, the researchers counted the “healthy life years” lost due to environmental factors. This universal measurement unit called DALY, or disability-adjusted life year, takes into account not only deaths caused by environmental threats but also disabilities. The measurement allows for a comparison of human health across geographical regions and different population groups

In the European region, the estimated burden of disease due to lead poisoning in children under five accounts for around 480,000 DALYs, or 4.4 percent of all DALYs in children in this cohort. Levels vary across the region: estimated percentages of children in urban areas with elevated mean blood-lead levels (greater than 10 micrograms per decilitre) ranged from 0.1 to 30.2 percent in 2001. Lead is a particularly pernicious enemy of children. Sources include car exhaust, the use of old lead water pipes, old paints, industrial emissions, contaminated air and soil, and improperly glazed ceramic cooking pots. Over 9,000 deaths and 320,000 DALYs could be prevented every year in the Euro B region if children were no longer exposed to indoor smoke from the burn ing of solid fuels. Shifting households in Euro B and Euro C from solid fuels to cleaner liquid or gaseous fuels is the solution, the report states.

The report points out the high potential of savings in deaths and DALYs through simple improvements in personal hygiene. Providing a regulated water supply and sanitation services, including partial treatment of sewage, for children in Euro B would save approximately 3,700 lives and 140,000 DALYs, the report says. The environmental burden of disease (EBD) study represents the first attempt to assess the overall impact of the environment on children’s health in the European region.

	ILL EFFECTS: The Karabash copper smelter in Russia has poisoned the local population, soil and crops with highly toxic mercury and lead. Photo: REUTERS/SERGEI KARPUKHIN

There are three main steps to offset the health risk from lead pollution, according to Leda Nemer from WHO’s Regional Office for Europe. First, governments must continue enacting legislation on lead content in petrol and building materials. Second, governments must develop and enforce regulations to minimise risks from hazardous building materials such as lead, asbestos, wood preservatives (in particular creosote and arsenic), polybrominated flame retardants, radon and volatile organic compounds. Third, biomonitoring of lead, polychlorinated biphenyls (PCBs), and chlororganic pesticides must be carried out regularly in at-risk infants and mothers.

A healthy environment is becoming a privilege of the wealthy, the report suggests. According to Tomas Kosatsky, epidemiologist at WHO’s Global Change and Health European Center for Environment and Health, wheezing is now more frequent among children from poorer families. Although ailments like asthma can be decreased by curbing air pollution, parental education about the benefits of decreasing allergens, reducing indoor furnace smoke and eliminating tobacco smoke is much more effective, Kosatsky explains.

The WHO report provides a framework for policymakers and the public to compare the impact of selected environmental risk factors on the health of the population. It serves as a basis for priority setting, and, when combined with an analysis of cost effectiveness, it shows how to best allocate resources.

The state of children’s health in a degraded environment will be the subject of policy determination and multi-sectoral debate in Budapest, as European health ministers and civil society groups meet for the World Health Organization’s Fourth Ministerial Conference on Environment and Health on June 23-25.

	In Romania, protesters railed against the national health policy in 2003. Photo: REUTERS/SERGEI KARPUKHIN

According to WHO, 5 million children worldwide die every year because of unhealthy surroundings. Responding to this alarming statistic, the WHO Regional Office Europe has adopted “the future of our children” as the theme of the conference. The event will focus on how to ensure a healthier environment for coming generations, not only in Europe but the world over. In Hungary, European ministers are expected to reach a consensus and make political commitments to ensure safer environments for children through the adoption of the Children’s Environment and Health Action Plan for Europe (CEHAPE).

CEHAPE is a science-based political commitment developed by member countries of the European Union to harmonise priority action and policies to protect and enhance children’s health with respect to environmental hazards, said Roberto Bertollini, Director of Health Determinants at WHO. According to WHO, CEHAPE will outline measures to reduce environmental exposures linked to a wide range of ailments afflicting children, including asthma, injuries, neurodevelopmental disorders, cancer, and food-borne and water-borne diseases. It will target environmental threats such as indoor and outdoor air pollution, environmental tobacco smoke, road traffic, the effects of global climate change, contaminated food and water, contaminants in toys, unsafe buildings and radiation.

CEHAPE has suggested a menu of effective measures to protect children’s health and environment, said Bertollini. These were developed by WHO’s member states, international organisations and NGOs, and they aim to provide guidance to national and local health and environment authorities in developing national CEHAPEs.

According to Bertollini, the declaration, to be adopted by the ministers in Budapest, ensures strong political commitment to ongoing processes since the Third Ministerial Conference on Environment and Health, held in 1999 in London. The statement highlights new issues such as extreme weather events and housing and health, and describes tools for policy making such as environment and health information systems. The declaration targets the impacts of environment on children’s health and shines a spotlight on the countries from Eastern Europe, Caucasus and Central Asia (EECCA) as well as South Eastern Europe.

A five-year work plan accompanies the declaration, though NGO representatives find it vague and therefore of little use. In line with established tradition, civil society organisations have organised their own event to run parallel with the ministerial conference: the Healthy Planet Forum.

The Budapest conference is the fourth in a series that started in Frankfurt in 1989. The aim was to eliminate the most significant environmental threats to health as quickly as possible, believing that it is better to prevent problems before they happen. Environmental health issues cross sectors, and the conferences are unusual in that they bring together different stakeholders to take decisions, working with and across ministries and involving intergovernmental organisations, civil society organisations and other groups.