Fw: CHILDREN'S ENVIRONMENTAL HEALTH

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CHILDREN'S ENVIRONMENTAL HEALTH

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Children's Environmental Health: Risks and Remedies

Also available in PDF (PDF: 117KB)

by Liz Creel

(July 2002) Overall child mortality declined significantly in the

1990s, but environmental hazards still kill at least 3 million children under

age 5 every year.1 Such young children make up roughly 10 percent of the world's

population, but comprise more than 40 percent of the population suffering from

health problems related to the environment.2 Children worldwide require special

protection from longstanding risks such as smoke from traditional fuels and from

emerging risks such as exposure to an increasing number of hazardous chemicals.

Although new regulatory standards and greater awareness of

children's vulnerability to such hazards have improved children's situation in a

number of more developed countries, many children, especially in less developed

countries, continue to be exposed to toxins. Their vulnerability is exacerbated

by the lack of protective policies and medical and public health interventions.

Short-term curative responses can save some lives, but addressing underlying

risk factors is key for long-term change. Efforts to measure children's

environmental health risks, develop policies and programs to mitigate such

exposures worldwide, and strengthen efforts to address the problem at all levels

are needed. This policy brief, part of PRB's Emerging Policy Issues in

Population, Health, and Environment series, explores children's special

vulnerability, outlines the risks and the conditions that increase such risks,

and highlights what is being done to address the problem.

Children's Vulnerability

Due to their size, physiology, and behavior, children are more

vulnerable than adults to environmental hazards. Children are more heavily

exposed to toxins in proportion to their body weight, and have more years of

life ahead of them in which they may suffer long-term effects from early

exposure.3 Perinatal conditions, which can be influenced by environmental

conditions, cause 20 percent of deaths worldwide in children under age 5.4

Furthermore, fetal exposure to chemicals such as lead increases a child's

chances of having brain damage or developmental problems. Children at all ages,

not just the very young, are at greater risk than adults. Children under age 5

breathe more air, drink more water, and eat more food per unit of body weight

than adults do, so they may experience higher rates of exposure to pathogens and

pollutants. Typical childhood behaviors, such as crawling and putting objects in

the mouth, can also lead to increased risks. Children between ages 5 and 18 may

face higher risks of injuries, including exposure to hazardous chemicals, due to

their growing participation in household chores and work outside of the home.

Many school-age children attend schools without sanitation facilities, making

them more likely to contract various diseases and less likely to go to school.

According to UNICEF, about 10 percent of school-age African girls either do not

attend school during menstruation or drop out at puberty because of the lack of

sanitary facilities.5

Environmental Risks to Children's Health

Indoor Air Pollution

Half of the world's households use biomass fuels, including wood,

animal dung, or crop residues, that produce particulates, carbon monoxide, and

other indoor pollutants. The World Health Organization (WHO) has determined that

as many as 1 billion people, mostly women and children, are regularly exposed to

levels of indoor air pollution that are up to 100 times those considered

acceptable.6 Young children, who spend more time indoors, are more exposed to

the noxious byproducts of cooking and heating. In India, where 80 percent of

households use biomass fuel, estimates show that nearly 500,000 women and

children under age 5 die every year from indoor pollution, largely from acute

respiratory infections (ARIs).7 The figure for other less developed countries is

similar.8

Exposure to indoor pollutants can cause or aggravate ARIs, including

upper respiratory infections such as colds and sore throats, and lower

respiratory infections such as pneumonia. Acute lower respiratory infections are

one of the primary causes of child mortality in developing countries, and led to

2.2 million deaths in children under age 5 in 2001.9 ARIs can also increase

mortality from measles, malaria, and other diseases. Other factors that can

worsen ARIs include low birth weight, poor nutrition, inadequate housing and

poor hygiene conditions, overcrowding, and reduced access to health care.

Asthma Studies in less developed countries have linked indoor air

pollution to lung cancer, stillbirths, low birth weight, heart ailments, and

chronic respiratory diseases, including asthma.10 Asthma, a disease

characterized by recurrent attacks of breathlessness and wheezing, affects

between 100 million and 150 million people worldwide. The disease causes over

180,000 deaths every year, including 25,000 children's deaths.11 Worldwide rates

of asthma have risen by 50 percent every 10 years since 1980; urbanization and

increased time spent indoors are strongly associated with this increase.12

According to WHO, prevalence of asthma symptoms in children in Brazil, Costa

Rica, Panama, Peru, and Uruguay varies from 20 percent to 30 percent; in Kenya,

it approaches 20 percent.13

The strongest risk factors for development of asthma appear to be

exposure to indoor allergens and a family history of asthma or allergies.

Exposure to environmental tobacco smoke (ETS, or secondhand smoke), chemical

irritants, air pollutants, and cold weather are also risk factors for the

disease, as are low birth weight, respiratory infections, and physical exercise.

Children whose mothers smoke have 70 percent more respiratory problems and

middle-ear infections than children of nonsmokers. Studies show that asthmatic

children's condition is significantly likely to be worsened by ETS.14

Outdoor Air Pollution

Data suggest that over 60 percent of the diseases associated with

respiratory infections are linked to exposure to air pollution.15 Outdoor

pollutants such as sulfur dioxide, ozone, nitrogen oxide, carbon monoxide, and

volatile organic compounds come mainly from motor vehicle exhaust, power plant

emissions, open burning of solid waste, and construction and related activities.

According to one report, children in cities with populations greater than 10

million are exposed to levels of air pollution two times to eight times higher

than the level WHO considers acceptable.16 In Mexico City, pollution levels are

well above WHO's limits of 90 micrograms per cubic meter (µg/m3) for

particulates and 50 µg/m3 for sulfur dioxide and nitrogen dioxide (see Figure

1).17

Figure 1

Polution Levels in Selected Cities

Note: WHO limits for nitrogen dioxide and sulfur dioxide are 50

µg/m3 for each type of pollutant.

Source: World Bank, World Development Indicators 2002.

Unsafe Drinking Water and Poor Sanitation

Contaminated water and inadequate sanitation cause a range of

diseases, many of which are life-threatening. The most deadly are diarrheal

diseases, 80 percent to 90 percent of which result from environmental factors.

In 2001, diarrheal infections caused nearly 2 million deaths in children under

age 5, primarily due to dehydration; many more children suffer from nonfatal

diarrhea that leaves them underweight, physically stunted, vulnerable to

disease, and drained of energy.18 Poor sanitation conditions and inadequate

personal, household, and community hygiene are responsible for most diarrheal

infections.19

Despite significant investments in improving water supplies and

sanitation over the last 20 years, about 18 percent of the world's population

still lacks access to safe drinking water, and nearly 40 percent have no access

to sanitation.20 At present, people in rural areas are the most affected,

although continual urbanization means that increasing numbers of people live in

densely populated cities, where they face shortages of potable water supplies

and sanitation systems, as well as growing pollution. More than 1 billion

people, mostly in Africa, Asia, and Latin America, currently live in slums or as

squatters.21

Infectious Disease Vectors

Vector-borne diseases, such as malaria, represent an international

public health problem, particularly in tropical areas of Africa, Asia, and Latin

America. Approximately 1 million children under age 5 in sub-Saharan Africa die

of malaria each year; malaria causes about 25 percent of all deaths among

children in the region, especially among children living in remote rural areas

with poor access to health services.22 Malaria also contributes to low birth

weight, one of the leading risk factors for infant mortality, because pregnant

women are more susceptible to both malaria and anemia.23

The prevalence of malaria is strongly related to environmental

factors such as irrigation and other agricultural practices, land clearing, and

changing demographic patterns. Higher temperatures, heavier rainfall, and other

changes in climate, as well as deforestation, increase the risk of malaria and

related epidemics.24

Exposure to Hazardous Chemicals

As countries pursue economic development, the increased risk of

exposure to chemical hazards may worsen other risks to children's health, such

as unsafe water and poor hygiene. Industrialization and modernized agriculture

have many benefits, but they have often been accompanied by problems, such as

exposure to pesticides, that disproportionately affect children. Other potential

toxins include lead discharged from battery-recycling operations; mercury in

fish; and nitrates, arsenic, and fluoride in drinking water.

In many countries, children are exposed to toxic chemicals in the

workplace. According to the International Labour Organization (ILO), more than

352 million children ages 5 to 17 engage in " economic activity, " an

internationally accepted standard that includes unpaid and illegal work and work

in the informal sector. Of those children, about 50 percent work in hazardous

occupations or situations, defined as those " likely to have adverse effects on

the health, safety, or moral development of children. " 25 The ILO has classified

mining, construction, manufacturing, retail, personal service, transportation,

and agriculture, as well as any work where a child works more than 43 hours per

week, as being hazardous.26 Hazardous labor is often informal: Some children

scavenge rubbish dumps, where they may be exposed to discarded batteries,

medical waste, and pesticides. In one district of Manila, for example, a

government report suggests that there are nearly 14,000 child scavengers.27

Lead Exposure to lead remains the main environmental problem for

young children in developing countries, according to Environmental Defense and

the Alliance to End Childhood Lead Poisoning.28 Even small amounts of lead can

be dangerous, especially for the development of the brain: Studies have shown

that IQ falls by up to six points for every 10 micrograms of lead per deciliter

of blood (µg/dl). Lead exposure can also cause anemia, kidney disease, hearing

damage, and impaired fertility; at high levels, it can result in coma or

death.29 Leaded gasoline accounts for 80 percent to 90 percent of airborne lead

pollution in some large cities, elevating the blood lead levels of people living

in the area.30 For example, Figure 2 shows that 75 percent of Indian children in

high-traffic areas have blood lead levels above 10 µg/dl. Children can also be

exposed to lead from food-can solder, lead-based paints, ceramic glazes,

drinking water systems, and cosmetics and folk remedies. Lead can contaminate

soil, air, drinking water, and food, thereby posing a significant threat to

young children, whose digestive systems absorb lead at significantly higher

rates than do those of adults.

Figure 2

Percentage of Indian Children With Average Blood Lead Levels

Above 10 µg/dl (n = 1,477)

Source: The Alliance to End Childhood Lead Poisoning and

Environmental Defense, The Global Dimensions of Lead Poisoning (1994).

Pesticides Pesticides, including some that have been banned in more

developed countries, are widely used in less developed countries. People who

come into contact with pesticides that are being applied to crops or who consume

food that is carrying pesticide residues can become ill. Pesticides can also

seep into the ground and contaminate drinking water.31 Although pesticides are

used worldwide, some regions are particularly affected: Central America, for

example, uses 1.5 kilograms of pesticides per person each year, more than any

other region.32

Symptoms of pesticide poisoning in children resemble those in

adults, and include eye, skin, and respiratory irritations and higher rates of

long-term health problems such as cancer.33 But children are much more

susceptible to these hazards, since they eat and drink more per unit of body

weight, making them likely to absorb higher amounts of pesticides from food and

water.34

Taking Action Against Risks

Environmental health risks to children are increasingly being

recognized as an international problem. Although progress has been made in

reducing mortality from environmentally mediated diseases, such as ARIs and

diarrheal disease, more needs to be done to prevent these illnesses and to focus

on new threats from increased industrialization, urbanization, and agricultural

commercialization. Global environmental threats such as climate change may

compound many of these issues, and efforts to mitigate certain hazards may

create other problems. For instance, efforts to provide more drinking water in

Bangladesh resulted in widespread poisoning, since the country's well water was

heavily contaminated with arsenic.35

Experience and research suggest there are a number of actions that

policymakers and planners can take to address environmental health threats to

children.

Encourage the development and support of community-level initiatives

to reduce environmental health threats to children. In many less developed

countries, municipal governments are increasingly managing local resources,

especially drinking water and firewood. Community- and household-level

interventions could also be adopted to reduce exposure to and transmission of

ARIs, diarrheal disease, and malaria. For instance, numerous field studies have

indicated that good personal and household hygiene practices can help reduce the

occurrence of diarrheal disease, even when there is no access to safe water or

modern sanitation.36

Continue to raise awareness and provide education about children's

environmental health issues. Since 1997, when the G-8 countries first declared

their responsibility for children's environmental health, many international,

regional, and national conferences have been held, and international

organizations have developed special units to address environmental health

concerns affecting children. In addition, several nongovernmental organizations

(NGOs), including the Children's Environmental Health Network and the

International Research and Information Network on Children's Health,

Environment, and Safety (INCHES), have been created specifically to protect

children from environmental hazards and to promote a healthy environment. At the

local level, efforts need to be made to teach children, families, and

communities to identify environmental threats to children, to adopt practices

that reduce risks of exposure, and to work with local authorities and the

private sector to develop prevention and intervention programs.

Promote the recognition, assessment, and study of environmental

factors that affect children's health and development. Efforts to encourage

research about environmental hazards might involve establishing research centers

or multidisciplinary studies; incorporating material on children's environmental

health into training for health care providers and other professionals; and

promoting the collection and dissemination of harmonized data. Current

multilateral efforts to advance international indicators for children's

environmental health include collaboration between Physicians for Social

Responsibility, INCHES, and the U.S. Environmental Protection Agency, based on

previous work by WHO and other organizations.

Reduce children's exposure to pollutants through education,

regulation, use of cleaner fuels, and reduction of environmental tobacco smoke.

Strategies for reducing deaths from pneumonia and other respiratory conditions

include cutting children's exposure to smoke from air pollution, cooking stoves,

and cigarettes. Some national governments have reduced indoor pollution by

promoting safer, more efficient, more durable cook stoves.37 International

health experts recommend a combination of educational programs and legislative

interventions to halt tobacco use in settings frequented by children.38

Regulations on air pollution need to be enforced in cities, and include phasing

out leaded gasoline, reducing emissions from coal-fired plants, and replacing

fossil fuels with cleaner energy sources.

Invest in programs to increase access to clean water and sanitation

facilities and to promote better hygiene practices. While diarrhea-related

deaths between 1990 and 2000 declined by 50 percent due to oral rehydration

therapy, there is little evidence that the incidence of diarrheal disease has

fallen.39 Efforts to combat diarrhea include combining appropriate drug therapy

with optimal breastfeeding practices, improving nutrition, increasing access to

clean water and sanitation facilities, and improving personal and domestic

hygiene.40 Several studies have shown that improving water and sanitation can

reduce the number of diarrheal episodes by between 20 percent and 26 percent.41

Furthermore, better hygiene practices, such as washing hands regularly, can

reduce the number of diarrhea cases by up to 35 percent.42

Strengthen interventions to prevent and treat malaria. While

progress has been made in reducing ARIs and diarrheal disease, deaths from

malaria have increased in the past 10 years, due in part to global climate

change and in part to the emergence of antibiotic-resistant strains of the

disease. Environmental improvements such as proper irrigation and drainage

techniques, combined with the use of insecticide-treated bed nets and adequate

medical treatment, could greatly reduce malaria's spread. Several international

initiatives, such as the Roll Back Malaria (RBM) partnership, have also been

instrumental in addressing the problem. RBM seeks to halve the global incidence

of malaria by 2010, and focuses on early diagnosis and prompt treatment; vector

control and use of insecticide-treated bed nets; malaria treatment for pregnant

women; and prevention of and response to epidemics.

Reduce children's exposure to lead, and screen for lead poisoning.

About 50 countries worldwide, including more than 20 less developed countries,

have phased out leaded gasoline.43 For instance, Thailand phased out leaded

gasoline between 1984 and 1996, and Bangkok's atmospheric lead levels have

decreased markedly.44 A survey of 1,000 children between 6 months and 72 months

old in Chiang Mai, another Thai city, revealed that only 4.6 percent of the

children had blood lead levels exceeding 10 µg/dl.45 Nevertheless, almost 100

countries (including countries in eastern Europe, the Middle East, and Africa)

still use leaded gasoline, and few countries have identified and addressed other

sources of lead in the environment.46

Efforts to phase out leaded gasoline and to reduce or eliminate

other sources of lead exposure include the Global Lead Initiative, sponsored by

the Alliance to End Childhood Lead Poisoning, to develop national action plans,

fund technical assistance projects, and encourage civic participation in

exchanging best practices and coordinating efforts within regions.

Reduce exposure to harmful pesticides by banning the use of the most

toxic chemicals, educating users, and encouraging the use of integrated pest

management to minimize the use of pesticides. In order to reduce the threat from

pesticide exposure, international organizations, national governments, and

industry have stepped up efforts to limit the exportation of dangerous

chemicals, help affected countries develop national action plans for handling

and disposing of pesticides, and encourage the use of environmentally friendly

alternatives. As of June 2002, more than 150 countries had signed (and 11 had

ratified) the Stockholm Treaty on Persistent Organic Pollutants, which phases

out or restricts the use of 12 chemicals, including nine pesticides that persist

in the environment and accumulate in the food chain. The treaty will become

legally binding once 50 countries have ratified it. National efforts are also

being developed. Costa Rica, for example, is fostering pesticide-free, organic

farming by devoting more than 9,000 hectares to organic cultivation of 30

crops.47

Evaluate and address the plight of children employed at hazardous

workplaces. Children are increasingly likely to be exposed to chemicals in the

places where they live, play, and work. Much attention has been paid recently to

mitigating environmental and other threats to children in all of these spheres,

particularly at hazardous workplaces.

As of May 2002, more than 120 countries had ratified the Convention

on the Worst Forms of Child Labor, which calls for withdrawing children age 16

and younger from intolerable and hazardous work situations, by identifying

hazards and developing effective monitoring systems.48

Conclusion

While overall child mortality declined by 10 percent in the 1990s,

much remains to be done to protect children from the myriad environmental

threats to their health. Reducing long-term threats requires that underlying

risk factors be addressed. Over the past 15 years, international, regional, and

national attention has focused on environmental hazards' effect on children's

health. Efforts now need to be made to measure these risks; build and strengthen

community, national, regional, and international coalitions to address the

problem; and develop policies and programs to prevent and mitigate environmental

hazards for children worldwide.

References

1.. United Nations Environment Programme (UNEP) et al., Children

in the New Millennium (New York: UNEP, 2002).

2.. UNEP et al., Children in the New Millennium.

3.. Dona Schneider and Freeman, Children's Environmental

Health: Reducing Risk in a Dangerous World (Washington, DC: American Public

Health Association, 2000).

4.. UNEP et al., Children in the New Millennium.

5.. UNEP et al., Children in the New Millennium.

6.. World Health Organization (WHO), " Danger in the Air, " accessed

online at www.who.int/inf-pr-2000/3n/pr2000-56.html, on June 18, 2002; and N.

Bruce et al. " Indoor Air Pollution in Developing Countries: A Major

Environmental and Public Health Challenge, " Bulletin of the World Health

Organization 78, no. 9 (2000): 1078-92.

7.. World Bank, Indoor Air Pollution Newsletter: Energy and Health

for the Poor, no. 2 (December 2000); and K. , " National Burden of Disease

in India from Indoor Air Pollution, " Proceedings of the National Academy of

Sciences of the United States of America 97, no. 24 (2000): 13286-93.

8.. WHO, Health and Environment in Sustainable Development: Five

Years After the Earth Summit (Geneva: WHO, 1997): 87; and Kirk et al.,

" Indoor Air Pollution in Developing Countries and Acute Lower Respiratory

Infections in Children, " Thorax 55, no. 6 (2000): 518-32.

9.. Hiremagalur N.B. Gopalan and , " Urban Air

Pollution Management Focusing on Children's Health " (paper presented at the

Workshop on Air Pollution in the Megacities of Asia, Seoul, South Korea, Sept.

3-5, 2001)

10.. Kirk R. and Sumi Mehta, " The Burden of Disease From

Indoor Air Pollution in Developing Countries: Comparison of Estimates " (paper

presented at USAID Global Consultation: The Health Impact of Indoor Air

Pollution and Household Energy in Developing Countries: Setting the Agenda for

Action, Summary Report for Participants, Washington, DC, May 3-4, 2000).

11.. WHO, " Bronchial Asthma: Fact Sheet, " accessed online at

www.who.int/inf-fs/en-fact206.html, on June 12, 2002.

12.. Schneider and Freeman, Children's Environmental Health.

13.. WHO, " Bronchial Asthma: Fact Sheet. "

14.. International Consultation on Environmental Tobacco Smoke and

Child Health, " Consulation Report, " WHO/NCD/TFI/99.10 (Geneva: WHO, 1999).

15.. Kirk R. et al., " How Much Global Ill Health Is

Attributable to Environmental Factors? " Epidemiology 10, no. 5 (1999): 573-84.

16.. Devra and o H.N. Saldiva, Urban Air Pollution Risks

to Children: A Global Environmental Health Indicator (Washington, DC: World

Resources Institute, 1999).

17.. United Nations Population Division, " World Urbanization

Prospects: The 1999 Revision, " accessed online at www.un.org/esa/population/

publications/wup2001/wup2001dh.pdf, on June 12, 2002.

18.. UNICEF et al., " Global Water Supply and Sanitation

Assessment: 2000 Data, " accessed online at www.childinfo.org/eddb/water.htm, on

June 12, 2002.

19.. WHO, Health and Environment in Sustainable Development.

20.. UNICEF et al., " Global Water Supply and Sanitation

Assessment: 2000 Data. "

21.. United Nations Human Settlements Programme, " The State of the

World's Cities, 2001 " (Nairobi, Kenya: United Nations, 2001).

22.. H. Gelband and S. Stansfield, " The Evidence Base for

Interventions to Reduce Under-Five Mortality in Low- and Middle-Income

Countries, " CMH Working Paper Series, no. WG5:9 (Geneva: WHO Commission on

Macroeconomics and Health, 2001).

23.. UNICEF, " Malaria Statistics, " accessed online at

www.childinfo.org/

eddb/Malaria/index.htm, on March 18, 2002.

24.. Gurinder S. Shahi et al., International Perspectives on

Environment, Development, and Health: Toward a Sustainable World (New York:

Springer Publishing Company, 1997).

25.. International Programme on the Elimination of Child Labour

and the Statistical Information and Monitoring Programme on Child Labour, Every

Child Counts: New Global Estimates on Child Labour (Geneva: International Labour

Office, 2002).

26.. International Programme on the Elimination of Child Labour

and the Statistical Information and Monitoring Programme on Child Labour, Every

Child Counts.

27.. Environmental News Service, " Children Bear the Heaviest

Burden of Environmental Disease, " accessed online at www.who.int/peh/

ceh/articles/burden.htm, on June 19, 2002.

28.. The Alliance to End Childhood Lead Poisoning (AECLP) and

Environmental Defense (ED), Global Dimensions of Lead Poisoning: An Initial

Analysis (Washington, DC: AECLP and ED, 1994).

29.. Yasmin E. Von Schirnding and F. Fuggle, " A Study of

the Distribution of Urban Environmental Lead Levels in Cape Town, South Africa, "

Science of the Total Environment 188, no. 1 (1996): 1-8.

30.. Helen Gavaghan, " Lead, Unsafe at Any Level, " Bulletin of the

World Health Organization 80, no. 1 (2002): 82.

31.. U.S. Environmental Protection Agency, " Assessing Health Risks

from Pesticides, " accessed online at www.epa.gov/pesticides/

citizens/riskassess.htm, on June 13, 2002.

32.. César Chelala, " Environmental Impact on Child Health "

(Washington, DC: Pan American Health Organization, 2000).

33.. Weeks et al., eds., Preventing Occupational Disease and

Injury (Washington, DC: American Public Health Association, 1991).

34.. U.S. Environmental Protection Agency, " Pesticides and Food:

Why Children May Be Especially Sensitive to Pesticides, " accessed online at

www.epa.gov/pesticides/food/pest.htm, on June 13, 2002.

35.. Allan et al., " Contamination of Drinking Water by

Arsenic in Bangladesh: A Public Health Emergency, " Bulletin of the World Health

Organization 78, no. 9 (2000): 1093-103.

36.. Massee Bateman and McGahey, " A Framework for Action:

Child Diarrhea Prevention, " accessed online at www.ehproject.org/Pubs/

GlobalHealth/GlobalHealthArticle.htm, on June 17, 2002.

37.. World Bank, Indoor Air Pollution: Energy and Health for the

Poor 1, accessed online at http://lnweb18.worldbank.org/ sar/sa.nsf, on June 13,

2002.

38.. Tobacco Free Initiative, " Consultation Report, " accessed

online at www.ash.org.uk/html/passive/html/who-ets.html, on June 13, 2002.

39.. Gordon McGranahan et al., Environmental Change and Human

Health in Countries of Africa, the Caribbean and the Pacific (Stockholm:

Stockholm Environment Institute, 1999).

40.. Billig and Diane Bendahmane, " Diarrhea Prevention:

Lessons Learned, " accessed online at www.ehproject.org/PDF/

Lessons_Learned/diarrhea_prevention.pdf, on June 19, 2002.

41.. A. Esrey et al., " Interventions for the Control of

Diarrheal Diseases Among Young Children: Improving Water Supplies and Excreta

Disposal Facilities, " Bulletin of the World Health Organization 63, no. 4

(1985): 757-72; A. Esrey et al., " Effects of Improved Water Supply and

Sanitation on Ascariasis, Diarrhea, Dracunculiasis, Hookworm Infection,

Schistosomiasis, and Trachoma, " Bulletin of the World Health Organization 69,

no. 5 (1991): 609-21; and Sharon R.A. Huttly et al., " Prevention of Diarrhea in

Young Children in Developing Countries, " Bulletin of the World Health

Organization 75, no. 2 (1997): 163-74.

42.. Huttly et al., " Prevention of Diarrhea in Young Children in

Developing Countries. "

43.. AECLP, " Launching a Global Lead Initiative: A Proposal to the

World Summit on Sustainable Development " (draft, Washington, DC: AECLP, 2002).

44.. Naree Boontherawara et al. " Traffic Crisis and Air Pollution

in Bangkok, " Thailand Environment Institute Quarterly Environment Journal 4, no.

2 (1994): 4-36.

45.. Tippawan Prapamontol et al., " Lead Screening in Young

Children From Northern Thailand " (Chiang Mai, Thailand: Chiang Mai University,

Research Institute for Health Sciences, 1999).

46.. AECLP, " Worldwide Phase-Out of Leaded Gasoline: An

International Environmental Health Priority, " accessed online at

www.globalleadnet.org/pdf/WorldwidePhase.pdf, on June 14, 2002.

47.. Pan American Health Organization, " Promoting Health in the

Americas: Annual Report of the Director, 2001, " accessed online at

www.paho.org/english/DBI/OD302.htm, on June 14, 2002.

48.. International Labour Organization, " International Program to

End Child Labor: Text of the Convention, " accessed online at www.ilo.org/

public/english/standards/ipec/ratification/convention/text.htm, on

June 14, 2002.

Acknowledgments

Liz Creel prepared this policy brief with assistance from PRB staff

and other colleagues. Thanks are due to Lori Ashford, Buffy Baumann, -Mark

De Souza, Igrec, Vijay Rao, and Yinger, PRB; , U.S.

Environmental Protection Agency; Borrazzo, U.S. Agency for International

Development; Hopfl-, Physicians for Social Responsibility; Philip

Landrigan, Mount Sinai School of Medicine; Pronczuk de Garbino, World

Health Organization; and Swartz, Children's Environmental Health Network,

all of whom reviewed drafts and provided useful comments.

This work has been funded by the Foundation and the Summit

Foundation.

PRB's Population, Health, and Environment Program disseminates the

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