Our large-scale experiment with children's health

Budapest, 24 June 2004

Our large-scale experiment with children's health and the need for close monitoring

Professor Jacqueline McGlade
Executive Director, European Environment Agency

Address to World Health Organisation Fourth European Ministerial Conference on Environment and Health

Budapest, 24 June 2004

Mr Chairman, Ministers, Ladies and Gentlemen,

The environments of our children - their air, water, food, consumer products and habitats - are contaminated with cocktails of low levels of gases and particles from fossil fuel combustion, largely untested chemicals and other environmental stressors, such as noise, damp, microbes, and tobacco smoke.

We are happy to enjoy the benefits from the economic activities that create these pollutants, but we are only just beginning to find out what this large-scale experiment with children's health is actually doing to them. We do not even really know what the economic and social benefits would be if much of this pollution were removed through better implementation of existing measures or more innovative and integrated policies.

If our children knew how much we do not know about this large-scale experiment they would be shocked - and if we told them what we do know they would perhaps be even more shocked.

For the four priority diseases that the European Action Plan on environment and health is focusing on:

• we do not know if 20% or 80% of the rising cancer rate in children is caused by factors such as the many hundreds of animal carcinogens present at low levels in consumer products and the environment;
• we do not know whether environmental factors are contributory causes of 5% or 50% of childhood asthma and other respiratory diseases; although WHO has just announced that for all respiratory diseases in European 0-4 year olds it lies somewhere between 2 and 6%;
• We do not know whether the rising rates of birth defects in the reproductive organs of boys, or the rising rates of infertility or of breast, testes and prostate cancers in many parts of Europe are caused, in part, by endocrine disrupting chemicals;
• we do not know how many of the 30 000 chemicals are damaging the brains of children, lowering their IQ in the same way as lead in paint and petrol or PCBs in fish and breast milk.

But does reducing environmental pollution improve public health? Policy effectiveness knowledge is very scarce but we do know that there is a link.

For example:

• Improving water quality in Europe over the last 25 years has led to improvements in health;
• Reducing lead from paints and petrol reduces body burdens of lead;
• Removing carcinogens from workplaces has led to less cancer;
• Reducing outdoor and indoor air pollution from transport, industry and tobacco smoke has led to valuable reductions in respiratory diseases and disabilities:
  • the ban on coal sales in Dublin in 1990 led to a 10-15% reduction in deaths from heart and respiratory diseases;
  • the reduction in air pollution in former East Germany after 1990 led to improvements in respiratory symptoms and lung function;
  • reducing NO2 in Linz, Austria led to a 15-20% improvement in the lung function of the children studied;
  • short term reductions in transport levels during the Atlanta Olympic games and the Vienna marathon showed improvements in respiratory health;
  • and a ban on smoking in public places in the US has reduced hospital admissions for acute heart attacks.

Overall, reducing environmental pollutants and stressors could lead to reductions in perhaps 5-20% of environmentally induced deaths, diseases and disabilities in Europe's children, with significant savings to future health and education budgets.

The overall economic benefits of these actions on environmental pollutants are large but not quantified, at least for the EU. In the USA it has been estimated that $40 billion of savings a year can be achieved from taking lead out of children's environments.

But how do we begin to fill the information gaps that constrain our ability to act in reducing environmental pollution?

Let us recall what kinds of data and information have helped us in the past:

• An open minded atmospheric scientist spots an unexpected trend in a routine long-term data series collected over several decades for other research purposes. This was how the hole in the ozone layer was discovered, which is now contributing to increased skin cancers in children and suppression of their immune systems.
• A curious physician shifts his research focus from measuring lead in children's blood to measuring lead in their 'milk' teeth to get a better measure of the cumulative lead dose. He related body burdens of lead to IQ in an epidemiological study based on stored teeth and showed that leaded petrol damages children's brains during their foetal and infant development.
• Coordinated surveillance of asthma in children across Europe reveals that trends are really rising (not just that diagnoses have improved), and that asthma is a multi-causal disease involving genes, diet and immunity and several environmental pollutants.

From these examples we can see that identifying and responding to early warnings of health hazards requires many different players, including the public and research scientists, and many different sources of information and knowledge, integrated in ways which bring out the complex linkages between our children's environments and their health.

Much can be gained from existing sources, often collected for other purposes. But now, new, coordinated and shared information needs to be generated to fill the large gaps in knowledge. For example, only 14% of large volume chemicals have sufficient publicly available data to do a minimal risk assessment, and that only for exposure to one substance at a time.

Such information systems provide major benefits by:

• Identifying priorities for environmental exposure reductions;
• Identifying early warnings of potentially costly hazards;
• Making the public aware so that they can better identify and avoid environmental health hazards;
• Destroying myths such as 'asthma is only caused by traffic fumes', or 'only 2% of cancer is caused by environmental factors';
• Estimating the effectiveness of policy measures;
• Helping to identify savings on health and education budgets.

So what should the role of the EEA, in partnership with countries, the European Commission, WHO and others, be over the next five years?

We have two main priorities:
- To promote the collection of integrated environmental exposure data via better balanced and co-ordinated monitoring and modelling of environmental media; and
- To turn scattered data into a reliable information service. This will be done by formulating relevant environment and health indicators and assessments as well as by presenting information on the scales needed by different users. These scales range from the "backyard" of a national minister - in other words, the whole country - down to the local neighbourhood of citizens who want to know more about the environment in which they live.

Many elements of such an information service are already in place, although mostly at country level. But even more needs to be done if we want to look our children in the eye and say that our ongoing large-scale experiment is not damaging to their health.

The Agency will be extending its geo-referenced information service in partnership with our member countries, WHO, academics and NGOs over the next 12 months to meet the growing demand for regional and local information about health and the environment, whilst not increasing the burden of reporting.