Healthy environments healthy children

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WHO Library Cataloguing-in-Publication Data

Healthy environments for healthy children: key messages for action.

1.Environmental health. 2.Environmental exposure. 3.Potable water. 4.Sanitation. 5.Child

welfare. 6.Infant welfare. I.World Health Organization. II.United Nations EnvironmentProgramme.

ISBN 978 92 4 159988 7 (WHO) (NLM classication: WA 30)ISBN 978-92-807-2977-1 (UNEP)

United Nations Environment Programme and World Health Organization 2010All rights reserved. Publications of the World Health Organization can be obtained from WHOPress, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +4122 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permissionto reproduce or translate WHO publications whether for sale or for noncommercialdistribution should be addressed to WHO Press, at the above address (fax: +41 22 7914806; e-mail: [email protected]).The designations employed and the presentation of the material in this publication donot imply the expression of any opinion whatsoever on the part of UNEP, UNICEF or WHOconcerning the legal status of any country, territory, city or area or of its authorities, orconcerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent

approximate border lines for which there may not yet be full agreement.

The mention of specic companies or of certain manufacturers products does not implythat they are endorsed or recommended by UNEP, UNICEF or WHO in preference to othersof a similar nature that are not mentioned. Errors and omissions excepted, the names ofproprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by UNEP, UNICEF or WHO to verify theinformation contained in this publication. However, the published material is beingdistributed without warranty of any kind, either expressed or implied. The responsibilityfor the interpretation and use of the material lies with the reader. In no event shall UNEP,UNICEF or WHO be liable for damages arising from its use.

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ContentsHealthy Environments for Healthy Children Key Messages for Action 3

Introduction 5

Global Environmental Change 7Climate Change 8Deforestation 10Biodiversity 12Land Degradation and Desertication 14

Water, Sanitation, and Hygiene 16Water 17Sanitation 19Hygiene 21Hazardous Waste 22

Nutrition, Growth and Development 23Nutrition 24Breastfeeding 26

Obesity 28

Vectors of Disease 30Malaria 31Dengue 33Tick-borne Diseases 34

Air 35Indoor Air Pollution 36

Outdoor Air Pollution 38Ozone 40

Chemicals 41Lead 42Mercury 43Pesticides 44Persistent Organic Pollutants (POPs) 46Household Products 47

Injuries 49

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Environmental Emergencies 52

Noise 54

Healthy Housing 56

Tools and Mechanisms Available to Recognize, Prioritize,Monitor and Promote Childrens Environmental Health 58

Environmental Burden of Disease Estimates 59

2009 Busan Pledge of Action on Childrens Health and Environment 64

References 68

Acknowledgements 70

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Healthy Environments for HealthyChildren key messages for action

This booklet presents key messages for action, summarized from a set ofchapters on different environmental health issues, available at www.who.int/ceh/publications/healthyenvironmentsforhealthychildren . The work is a result

of an on-going partnership between WHO, UNEP and UNICEF in the area of childrensenvironmental health, and seeks to update the 2002 joint publication Children inthe New Millennium: Environmental Impact on Health. 1

Over the last 20 years there have been acknowledgements at the highest level of theneed to protect the environment in order to underpin efforts to safeguard child health.As far back as 1989, States pledged in the Convention on the Rights of the Child 2 to combat disease and malnutrition taking into consideration the dangers andrisks of environmental pollution. Recently, the call for action to address childrensenvironmental health (CEH) has been gaining momentum, as more is known abouthow adverse environments can put childrens growth, development, well-being andvery survival, at risk. Notably, the G8 Siracusa Environment Ministerial Meeting, 3 (April, 2009) recently expressed We can do more to ensure that children are born,grow, develop and thrive in environments with clean air, clean water, safe food, andminimal exposure to harmful chemicals.

We have committed to this work faced with the knowledge that around three millionchildren under ve years die each year due to a number of largely preventableenvironment-related causes, 4 and conscious of the fact that environmental challenges,including climatic change and increased urbanisation, have the potential to makeevery one of the United Nations Millennium Development Goals, including those oneradicating poverty and improving the health and well-being of children and theircaregivers, less achievable. The poorest and most marginalized children in developingcountries suffer most. Although many commitments and international agreementshave been made in relation to protecting childrens health from environmental threats,progress towards stemming these risks has been slow.

Signicant action is now required to achieve healthier, safer and cleaner environments as this is not only imperative for child health, but also possible. Tools andmechanisms are available. Partnerships for acting together on many fronts, building

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http://www.who.int/ceh/publications/healthyenvironmentsforhealthychildrenhttp://www.who.int/ceh/publications/healthyenvironmentsforhealthychildrenhttp://www.who.int/ceh/publications/healthyenvironmentsforhealthychildrenhttp://www.who.int/ceh/publications/healthyenvironmentsforhealthychildren


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on existing programmes and adapting concrete actions to local needs, can make adifference.

WHO, UNEP and UNICEF are jointly taking a step forward in this booklet, proposing

key messages for concrete action to confront the environmental health issuesfaced by children, their parents and communities all over the world. The aim is toprovide decision makers at all levels (from the local to the international), includingcommunity leaders, teachers, health-care providers, parents, and other caregivers,with the information they need to promote healthier environments for children, usingpractical examples. The challenge is to ensure that everyone knows and understandsthe threats to child health and well-being from environmental risk factors and ismotivated to take practical action to minimize these risks.

The future of our children and their lives as adults depend on a full enjoyment of goodhealth in a safe, protective environment, from conception to adolescence and beyond.



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Introduction

Globally, children are disproportionately exposed to a myriad of environmental

threats. Evidence is mounting that worsening trends of global environmentaldegradation, including the erosion of ecosystems, increased pollution, and the

effects of climatic changes, contribute to the burden of disease confronting children,in both developed and developing countries. These circumstances are affecting theworlds ability to meet the Millennium Development Goals (MDGs) and the otherinternationally agreed upon development goals.

The health implications of environmental degradation for children are profound. Every

year, around three million children under ve die from preventable environment-related causes and conditions. This makes the environment one of the mostcritical contributors to the global toll of 8.8 million child deaths annually, 5 with thenoteworthy killers if a child survives the neonatal period being respiratory anddiarrhoeal diseases, and malaria. Air pollution, unsafe water, lead in soil, pesticideresidues in food, and ultra-violet radiation are a few of the multitude of environmentalthreats that may alter the delicate organism of a growing child, causing disease,developmental problems or adverse effects later in life.

Children are especially vulnerable, as they respond differently than adults whenexposed to environmental factors. Their immune defences are not fully mature andtheir developing organs are more easily harmed; thus environmental contaminants mayaffect children disproportionately. In addition, their airways are smaller than those ofadults, and irritating particles may act very fast, causing respiratory difculties. Theygenerally spend more time active and outdoors than adults, increasing their risk ofexposure considerably. Also proportionate to their size, children ingest more food,

drink more water and breathe more air than adults, and childrens normal activities such as putting their hands in their mouths or playing outdoors can result in higherexposures to certain contaminants. Even while in the womb, the child-to-be can alsobe exposed to adverse environmental risk factors that may give rise to diseases laterin life imposing a heavy burden on public health systems.

We still have an unnished agenda to control those diseases linked to unsafe waterand food, lack of sanitation and indoor air pollution. In addition, children may be

exposed to new or recently recognized risk factors: climate change, ozone depletion,manufactured nano-particles and endocrine disrupting chemicals (EDCs) are amongthe relatively new concerns. Harmful chemicals in soil and efuent, originating fromwaste, trafc or other activities may be present in places where children spend time.

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Some especially long-lasting contaminants (mercury and persistent organic pollutants POPs) are widely recognized as a threat to health and the environment and are thefocus of major international agreements.

Environmental threats and exposure are in many cases preventable. Pro-activecoordinated actions are required to raise awareness and reduce risk and vulnerability.Preventive interventions on the environmental management and health sector sideshave proven to be effective in protecting children from adverse exposures in manycountries and provide a wealth of knowledge and experience from which we can builda strong foundation for informed and effective action.

Drawing on these experiences, as well as advances in the research and data

available, we present in this booklet key messages for action in relation to the mainenvironmental threats to children.



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Actions to tackle global environmentalchange can be taken at all levels from

the international, to the national,community, school and individual,and can bring about immediatebenets to child health.

Global EnvironmentalChange


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CLIMATE CHANGE, by altering weather patterns anddisturbing life-supporting natural systems, affects the basic requirements for healthand well-being: clean air and sufcient water, sufcient food, functioning ecosystems

and adequate shelter. There is growing evidence that climate change is contributingto the burden of disease, particularly in developing countries 6, where health-caresystems are under-equipped to deal with the compounding effects of these changes.Sustained and immediate climate change mitigation and adaptation measuresare essential for the protection of children, as many of their main killers (malaria,diarrhoea and undernutrition) are highly sensitive to climatic conditions.

1 Climate change is likely to increase

the frequency and intensity of naturaldisasters. Communities need to beinformed about risks and vulnerabilities,and supported to develop preparednessand response strategies, with a focuson the vulnerability of children andteaching them how to respond.

2 Climate change threatens water suppliesand quality. Communities need to besupported in managing water resourcesin an integrated way, protecting existingsources and the ecosystems thatsupport them, and sustainably utilizingsafe alternative sources (i.e. rainwaterharvesting).

3 Weather disruptions, exacerbatedby climate change, including risesin temperature and shifts in rainfall

patterns, will impact food supplies,

threatening nutrition and health. Waterstress and scarcity will increasinglyimpact community water supply.Communities should be supported interms of adjusting agricultural practicesto avoid losing crops to drought oroods, i.e. where available, using moredrought resistant crop varieties, bettersuited to the changed climate.

4 Climate change can make vector-bornediseases, such as malaria, which arehighly sensitive to temperature andrainfall, more widespread. Communitiesshould use insecticide-treated nets. Theyshould, if applicable, allow sprayers tocome into their homes to apply residualinsecticide on walls, and stop mosquitoesfrom breeding by eliminating stagnantwater areas, and improving sanitation.

Key messages: what every familyand community should know aboutclimate change



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5 Climate change will undermineair quality, compounding risks ofrespiratory diseases. Solar cookers andlamps, smokeless stoves and clean

energy alternatives are becoming more

affordable and should be promoted forhouseholds. Decreased fossil fuel usehas positive effects on child health.i

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DEFORESTATION. Forests play a critical role in regulatingthe worlds climate and supporting agricultural production, ltering and maintainingwater supplies, protecting against soil erosion, and preventing natural disasters.

Millions of people including children depend on forest products and servicesfor food, medicine, building materials, fuel for cooking and heating, and to supportlivelihoods. Deforestation is affecting the availability and production of food, accessto clean water, exposure to disease, vulnerability to disasters, and respiratory health,and thereby childrens health. The rich medicinal resources stored in forests areanother link to child health.

1 Deforestation affects the availability and

production of food directly through theavailability of forest foods and indirectlythrough the impact on land with seriousimplications for child nutrition.

2 Deforestation impacts watersheds,compromises aquifer levels and rainfallpatterns, and intensies ooding anddroughts, threatening water suppliesthat are vital for child health. Bypreserving and managing forests,communities are protecting valuablewater sources.

3 Deforestation leads to soil erosion andland degradation, which can lead todesertication, mudslides or oods, allwith signicant implications for childhealth and well-being. Communitiescan protect their land and improve its

productivity by planting trees, especially

indigenous types.

4 Deforestation and subsequent land-usechanges can increase vector breedinggrounds, making diseases such asmalaria more widespread. Families andcommunities can prevent such diseasesby preserving the forests and takingaction to stop mosquitoes and othervectors from breeding.

Key messages: what every familyand community should know aboutdeforestation

Children are more likely tosuccumb to natural disasters.They are born into this climatechange problem trees beingcut, rubbish being burned. These

are serious issues affecting achilds health and future.

Honorable Maria MutagambaMinister of Water and Environment Republicof Uganda



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5 Deforestation contributes to climatechange, which in turn impacts childhealth. By preserving the forests,communities are both mitigating and

adapting to climatic changes.

6 Deforestation impacts respiratory health with indoor air pollution from fuel-

wood use and outdoor air pollution fromfires set to clear land. Communitiesshould be supported in shifting tocleaner, more sustainable sources of

energy, and in using traditional energysources more efciently.

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BIODIVERSITY. Child health is highly dependent on themaintenance of functioning ecosystems that can provide clean water and air, foodand medicine. The loss of ecosystem productivity, such as decreased soil fertility or

over-shing, can lead to malnutrition, stunted growth and development, and increasedvulnerability to disease. Biodiversity loss and ecosystem degradation also compromisethe resilience of communities in the face of natural disasters, altering exposure andvulnerability to disease outbreaks, and increasing the risks faced by children livingin harsh environmental conditions.

1 Biodiversity plays a crucial role in childnutrition, enabling the production offoods, both wild and cultivated. Actionsto conserve biodiversity and promoteecosystem management help improvefood security and child nutrition, byproviding a stable environmental basisfor sustained food production. Supportshould be given to communities tocultivate a variety of traditional foods(including in school gardens), to plantand care for indigenous trees, and toorganize awareness campaigns.

2 Biodiversity loss compromises theability of ecosystems to provide andpurify water. Ecosystems, particularlywetlands, act as sponges that filterimpurities from rainfall and runoff.Children, in particular, need cleanwater to survive. 12 Communities needto be enabled to protect and manage

ecosystems in an integrated way,including protecting watersheds tosupport water supply and quality.

3 Biodiversity provides a unique andirreplaceable source for medicines andadvances in understanding disease,thereby supporting child health. Formany centuries, plants have been usedto make medicines, and more recently,soil microbes have provided the sourcefor antibiotics. New advances arebeing made all the time, reaping asyet unknown and innumerable benetsbiodiversity. Communities and youthgroups should be enabled to conserveand benet from their local biodiversity,including learning from traditionalpractices and focusing on plants thathave medicinal value.

Key messages: what every familyand community should know aboutbiodiversity



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4 Biodiversity is essential to reduce thevulnerability of communities. The lossof biodiversity destabilizes ecosystems,weakening their resilience and ability to

deal with the frequency and impact ofnatural disasters. Communities should

be enabled to preserve key ecosystems,such as mangrove forests and coralreefs which are natural buffers againstoods and storms.

.

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L A N D D E G R A D AT I O N A N DDESERTIFICATION. The consequences of land degradationand desertication include malnutrition and famine, and the increase of waterborne,infectious and respiratory diseases. They have massive socio-economic effectsincluding destroying livelihoods and deepening poverty. Studies show that the averageinfant mortality rate (about 46 per 1,000) in developing nations newly affected bydesertication, the so-called drylands, exceeds that for non-dryland countriesby one fth or more. 7

1 Land degradation and deserticationundermine ecosystem services,including soil productivity, withconsequences for food production andchild nutrition. Practical measures toprevent and restore degraded land,include a range of sustainable land,water, forest and livestock managementpractices. Planting trees in degradedland and among crops can havemany benets including restoring soilproductivity, preventing soil erosion andsequestering carbon.

2 The scarcity of water in drylandsreduces access to clean drinkingwater, adequate sanitation and waterfor food production and survival, withdirect impact on children. The lossof water sources forces people to usepolluted water. In addition, traditionalwater-fetchers, namely mothers and

children, must walk further to fetchwater, often alone increasing theircaloric and water need and puttingthem at risk of physical and sexualassault. 8 Sustainable integrated watermanagement is particularly urgent indry-land areas.

3 Land degradation and deserticationincreases wind-blown dust, causingsore eyes, dry skin (that cracks easilypermitting the entry of microbes andother infections), fever, coughing andother respiratory ailments. Communitiescan erect windbreaks and buffers toprevent the movement of soil particles.i.e. Trees, shrubs, and other plants canhelp reduce the movement of soils andsand and fences and boulders can actas barriers from soil, dust and sand.

Key messages: what every familyand community should know aboutdesertication



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4 Land degradation and deserticationhave enormous social costs. Worldwide,desertification threatens to swell bymillions the number of poor forced

to seek new homes and livelihoods,with direct implications for child well-

being. Improved natural resourcesmanagement and the creation of viablelivelihood alternatives for drylandpopulations are required to reverse

these trends.

dia r

are req

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Water, Sanitation andHygiene Eighty-eight per cent of cases ofdiarrhoea worldwide are attributable

to unsafe water, inadequatesanitation or insufcient hygiene.These cases result in up to1.5 million child deaths (for underthe age of 5) each year. 9 The only way to sustainably reducethis massive burden of disease isthrough the provision and use ofsafe drinking water, sanitation andimproved hygiene practices.


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WATER is vital to all aspects of human life. Healthy freshwater ecosystemsprovide essentials to life, health and livelihoods. In 2006 the number of people in theworld without access to a suitable water supply nally dipped below the one billion

mark .10

However, there are still 884 million people in need of access to improvedsources of drinking water, and therefore, much remains to be done .11 Expanding safedrinking water access would drastically cut the loss of life from water-related illnessand improve community health in developing countries.

1 Drinking unsafe (contaminated) watercan cause severe illness and evendeath. The immature immune systemsand small bodies of young childrencannot easily cope with the detrimentaleffects (i.e dehydration, fever andmalnutrition) of diarrhoeal diseases.Children under ve are therefore morevulnerable than any other age group tothe ill effects of unsafe water, poorsanitation and poor hygiene practice,particularly lack of proper handwashing.In the developing world 24,000 childrenfrom under the age of ve die every dayfrom preventable causes like diarrhoeacontracted from unclean water. 12 Nearly90% of the burden of diarrhoeal diseasemortality is borne by children under veyears old. 13

2 Simple and cost-effective householdtreatment and storage reducesdiarrhoeal disease. Water carrying andstorage containers need to be kept

clean, including the water therein,and covered to maintain water quality.Improvements in drinking-water qualitythrough household water treatment,such as boiling, filtration, solardisinfection, chlorination at point of useand adequate safe domestic storage,can lead to a reduction of diarrhoealepisodes by approximately 39 percent. 14

3 Having a water source near the homedecreases potential for contaminationduring transport and reduces the risksincurred and time that must be spent(mainly by women and girls) collectingwater, thereby signicantly improvingsafety and opportunities for education,productive activities and leisure time.

4 A lack of water security is an increasingproblem worldwide due to climatechange, over-use and degradation ofwater supplies. Population growth,

Key messages: what every family and

community should know about water

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urbanization, and increased demandfor food, energy and bio-fuels are alsoputting incredible strain on scarcewater sources. In little more than two

decades, it is estimated that 47 per centof the global population will be living inareas of high water stress. 15 This makes

it essential to promote sustainablemethods for managing water andextracting it efficiently, involving allusers. Increased availability of safe and

sufcient water reduces the risks tochildrens health and also encouragesbetter hygiene practice.

tlatio

ter stress w



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SANITATION facilities and services for the safe disposal of humanurine and faeces, garbage collection and wastewater disposal are crucial to maintainhealth and protect water resources. Inadequate sanitation is a major cause of disease

world-wide. Globally 2.6 billion people do not have access to adequate sanitation;1.1 billion almost a fth of the worlds population practice open defecation. 16 By far the great majority of people practising open defecation live in rural areas, butthis number is declining. However, partly because of rapid increases in the urbanpopulation, a growing number of people in urban areas defecate in the open. Diseasessuch as cholera, worms, diarrhoea and some malnutrition, among other maladies,that cause disease and death in millions of people are propagated by poor sanitarypractices. Improving sanitation is key to accelerating socio-economic development

and especially better health for children.

1 All faeces, including those of babiesand young children, should be disposedof safely and in an environmentally-acceptable manner. Making sure that allfamily members have access to a toilet,latrine or dedicated chamber-pot

that is cleaned daily is the best way toreduce exposure to faeces. The use ofsanitation facilities, together with goodhygiene practice, form direct barriersto the faecal-oral transmission routes ofpathogens.

2 Unsafe disposal of human waste risks

the contamination of unprotectedwater sources. Water-borne diseasesare transmitted through contaminatedand unsafe water. Disposal of faecesin all cases should be done so that it

does not contaminate water resources,particularly those used for householdsupply.

3 Involving children at school and homeand considering them as communicators

for behaviour change offers hope forsustainability. As the children grow,they will continue to implement andappreciate better sanitation andhygiene practices and inuence theirown children and community to do thesame.

4Everyone needs to be consulted inthe design, construction and use ofsanitation facilities to protect watersources and safely dispose of waste.Women in particular should be consulted

Key messages: what every familyand community should know aboutsanitation

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as the primary caregivers responsiblefor the toileting (and training) ofchildren and elderly. It is important forgovernments to support communities by

planning and facilitating construction oflow-cost latrines and toilet facilities.

5 Increased frequency and intensityof flooding may expose sub-surfacesanitation systems to greater leakage.Sanitation systems should be ood-proofed such as by raising latrine

slabs, in communities that are affectedby frequent flood events. Design ofwaste disposal systems needs to

consider the possibility of overtoppingand movement through the subsurfaceof contaminants, such as faecal bacteriaand viruses from buried waste.

6 Animal and human faeces should bekept away from homes, water sources,food and childrens play areas.Dedicated areas for human defecation,especially if there is no option other thanopen defecation, should be planned sothat even when faeces dry they cannot

be inhaled by humans, particularlychildren, because pathogens cansurvive and be aspirated.



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HYGIENE. Most germs which lead to diarrhoea and cholera come fromexposure to human and animal faeces. Many illnesses can be prevented by goodhygiene practices and access to sanitation. Much of the health benet of water supply

and sanitation is realized through changes in behaviour. Hygiene education andpromotion of good practice, especially in primary schools, should be a fundamentalcomponent of sanitation and water-supply programmes.

1 To obtain the health benefits ofimproved sanitation and water supply,key issues on how to change habitsand long-held beliefs about hygiene

need to be addressed. Sanitation issuesare unmentionable in some societies.Behaviour change programmes andhygiene education are particularlyessential in these societies.

2 All family members, including children,need to wash their hands thoroughly

with soap and water after any contactwith faeces and unsafe water, beforetouching or preparing food, and beforefeeding children. Children should alsowash their hands, particularly afterplaying with other children, who oftentransmit illnesses. Where soap is notavailable a substitute that is culturally

appropriate, such as ash, can be used.Washing hands with soap can reducethe risk of diarrhoeal diseases by up to47 per cent. 17

3 Raw or leftover food can be dangerous.Raw food should always be washedwith safe water or cooked; cooked foodshould be eaten without delay, storedin appropriate facilities if available, orthoroughly reheated.

4 Washing the face and hands with soapand water every day helps to preventdisease, including diarrhoea and eyeinfections. Untreated eye infectionscan lead to trachoma, which can causeblindness.

Key messages: what every familyand community should know abouthygiene

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HAZARDOUS WASTES. Both in industrialized anddeveloping countries, adults or children may come in contact with hazardous wastesin the connes of the home, living near a waste disposal site, or just coming across

hazardous waste incidents. Hazardous substances released from these sites canproduce injury or poisonings as they enter the body through the lungs, skin, and/ormouth.

1 Children are prone to contact withpotential sources of hazardous waste, asthey are little explorers with frequenthand-to-mouth activity, living and

playing close to the ground. They areat higher risk of exposure than adults tohazardous substances in water and soil.Even teenagers can be at risk, as theymay ignore warning signs and ventureinto contaminated areas.

2 Hazardous wastes are usually generated

in unsafe, industrial contexts, but mayalso be found in or around homes.Hazardous substances are sometimesdisposed of or stored near residentialareas, especially slums, representing arisk to children.

3 Childrens exposure to hazardouswastes can be reduced through

education. From the earliest stages,children can be taught to identifydanger signs, read and interpret labels,learn about hazardous wastes and be

prepared to protect themselves beforean emergency occurs.

4 Regulations on hazardous wastes needto be implemented everywhere theyare needed. Governments and theprivate sector need to be encouragedand monitored to ensure any wastes

with potential risks to human health aremanaged and discarded properly, i.e. inan environmentally friendly way, and insafe conditions and surroundings.

Key messages: what every familyand community should know abouthazardous waste



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Nutrition, Growth andDevelopment Undernutrition is theunderlying cause of at

least 3 million deaths eachyear, 18 and of more than onethird of deaths in childrenunder ve years of age.An undernourished childis signicantly more likelyto suffer from a seriousinfection or to die fromcommon childhood illnesses.Unhealthy and unhygienicenvironments and poorsanitation play a signicantrole in contributing towards

undernutrition. Undernutritionmay also be exacerbatedby more frequent or severeextreme weather eventscaused by climate change.

Climate Change and ChildrenA Human Security Challenge

UNICEF Innocenti Research Centre


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NUTRITION. Undernutrition is the underlying cause of morethan a third of all child deaths in developing countries. It blunts the intellect,saps productivity and perpetuates poverty. Undernutrition is not only the lack of

quality food; it is also caused by frequent episodes of infectious illnesses, lack ofcare, inadequate health services and unhealthy environments. Poverty, illiteracy,inequitable social norms and discriminatory behaviour also underlie undernutrition.Poor agricultural productivity, environmental degradation, poor socio-economicstatus and climate change are among some of the factors that cause or combineto limit the ability of people to produce and/or acquire food. Unhealthy andunhygienic environments with poor sanitation and inadequate hygiene are alsomajor contributing factors to undernutrition, because diseases, especially diarrhoea

and worms proliferate in these contexts. Children deserve to be well nourished andtherefore healthy, productive and able to learn. Good nutrition benets families, theircommunities and global development.

1 Proper nutrition during pregnancyand good feeding practices in earlychildhood have lifelong effects. Theperiod of a childs most rapid physical

growth and development is also theperiod of greatest vulnerability. Stuntingthat occurs before age two cannot bereversed later, and it negatively impactsa persons ability to learn, to workand to prosper throughout their life.Thus to prevent undernutrition and itsrelated consequences, it is particularly

important to ensure good nutrition meaning a sufcient caloric intake anda good mix of carbohydrates, protein,fats, and vitamins & minerals. This isparticularly important during pregnancy.

Exclusive breast-feeding during the rstsix months of life is vital to nourish anddevelop the immune system of the child.Promotion of exclusive breastfeeding,

including encouraging mothers tocontinue up to two years of life, is avital lifesaving practice.

2 All family members, including children,

need to wash their hands thoroughlywith soap and water after any contactwith faeces and prior to preparing and

eating food. Handwashing is one of thekey steps that can be taken to avoidgetting sick and spreading germs toothers. Keeping hands clean will helpprevent diarrhoeal diseases and help

Key messages: what every familyand community should know aboutnutrition



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limit the transmission of respiratorydisease. Handwashing can also playan important role in combating a hostof other illnesses, such as helminths

(worms), eye infections (e.g. trachoma)and skin infections (e.g. impetigo). 19,20

3 Improved production and use of locallyavailable plant crops, including throughcommunity and school gardens, canincrease intake of vitamin and mineral-rich foods. Children need foods rich

in vitamins and minerals (especiallyvitamin A, iron, zinc and iodine) toprotect their physical wellbeing andmental abilities. For example, manychildren are much more likely to getsick and die from infectious illnessesbecause of a lack of immune system-boosting vitamin A in their bodies.

Vitamin A comes from breast-milk, darkgreen leafy vegetables, and from red,orange and yellow fruits and vegetables,as well as from animal-source foodssuch as eggs, milk and liver. Childrenshould also be taken to receive vitaminA supplements and de-wormingtreatments in areas where child-survival

campaigns are being conducted.

4 Promoting sustainable agriculturalpractices and improved eco-system

management, including of soil, water,bio-diversity and coastal areas, supportsthe production of food, both wild andcultivated. Such practices can help

communities cope with some of thenegative consequences of climatechange, particularly in regions wherelivelihoods depend heavily on rain-basedagriculture and animal production, andwhere droughts and floods, and theresultant crop failures, have a seriousimpact on the survival and nutrition of

children and mothers. 5 Iodized salt is essential to prevent

learning disabilities and delayeddevelopment in children. Small amountsof iodine are essential for childrensgrowth and development. Many dietsare low in iodine. The best way to ensure

people get enough iodine is to iodize salt.Iodine, especially for pregnant womenand young children, is essential toprevent stillbirth, miscarriage, cretinism,mental, hearing or motor deficits,and reduced economic productivity.It has been shown that children fromcommunities and populations who are

iodine decient, can lose on average13.5 IQ points. 21

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BREASTFEEDING of infants under two years of age hasa huge impact on child survival, with the potential to prevent at least one milliondeaths in children under ve in the developing world. 22

1 An infant should be exclusivelybreastfed until 6 months of age. Thismeans that she/he receives no otherfood or drink, not even water, otherthan breast milk, with the exception ofdrops or syrups of vitamins, minerals ormedicines. Thereafter, breastfeeding,along with appropriate complementaryfeeding should continue up to 2 yearsor beyond. Newborn babies should haveskin to skin contact with their mothersand begin breastfeeding within onehour of birth. A study in Ghana foundthat having the baby start to breastfeedsoon after birth stimulates the mothersmilk production and can reduce overallneonatal mortality by around 20%. 23,24

2 Breast milk alone is the best possiblefood and drink for a baby as it containsthe right balance of all nutrients aninfant needs for the rst 6 months oflife for optimal growth. It also containsnumerous anti-infective factors such asantibodies and white blood cells. Evenin hot, dry climates, breast milk containssufcient water for a babys needs.

3 Babies fed on breast milk have fewerillnesses, are less likely to die and areless malnourished than babies who areformula-fed. Bottle-feeding is a riskwhere parents may not be able to affordsufcient milk-powder, may not be ableto sterilize teats and feeding bottles,and where there is a lack of clean andsafe water. When a baby is given wateror other drink made with water, the riskof getting diarrhoea or other illnessesincreases. Breastfeeding should alsobe encouraged in developed countries.A study in the United Kingdom foundthat 6 months of exclusive breastfeeding

Key messages: what every familyand community should know aboutbreastfeeding

Among the key causes ofhunger are natural disasters,conict, poverty, pooragricultural infrastructureand over-exploitation of theenvironment.

World Food Programme 2009http://www.wfp.org/hunger

er-e oo ent.

o ro eww.wfp un

key causeralp



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was associated with a 53% decrease inhospital admissions for diarrhoea anda 27% decrease in respiratory tractinfections. 25 Studies from developing

countries show that infants who are notbreastfed are 6 to 10 times more likelyto die in the rst months of life thaninfants who are breastfed. 26 Diarrhoeaand pneumonia are more commonand more severe in children who arearticially fed. Other acute infections,including otitis media, Haemophilus

inuenzae meningitis, and urinary tractinfection, are less common and lesssevere in breastfed infants. 27

4 Between the ages of 6 months and 2years a baby benets from breast milkas well as needing other foods. Whenintroducing food into an infants diet,

care should be taken on how the foodis handled. Food should be stored inan appropriate place and hands shouldbe washed before handling. The foodsshould contain the right nutrients andshould be fed frequently to ensure theinfant grows properly.

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OBESITY and overweight are dened as abnormal or excessive fataccumulation that presents a risk to health and are based on weight-for-height andBMI-for-age. Obesity is a complex condition, one with serious social and psychological

dimensions, that affects virtually all age and socioeconomic groups and threatensto overwhelm both developed and developing countries. Environmental conditionsaffect food availability and quality of nutrition as well as levels of physical activity.Prevalence of obesity in children and adolescents is on the rise in both developedand developing regions, with an estimated 115 million obese people in the latter. 28 In 2007, an estimated 22 million children under the age of ve years wereoverweight throughout the world .29 In more developed countries, childhood obesityis most common in low-income households, because it is driven in part by low-cost

foods of poor nutritional value. Economic growth, modernization, urbanization andglobalization of food markets are just some of the forces thought to underlie theobesity epidemic.

1 To combat obesity and create anenvironment conducive to healthyeating and living, measures are neededthat simultaneously address a numberof issues, from the quality of nutritionand enhanced levels of physicalactivity, to land use, air pollution, andurban planning and transportationissues, and far-sighted policy action topromote agricultural/food systems thatare socially and environmentally moreresponsible.

2 Childhood obesity is dangerous tohealth. Many adverse health effectsassociated with being overweight areobserved in children and adolescents.

Being overweight during childhood andparticularly adolescence is related toincreased morbidity and mortality inlater life from chronic diseases suchas type 2 diabetes, cardiovasculardisease, hypertension and stroke, andcertain forms of cancer. Psychosocialeffects and stigma associated with beingoverweight can be damaging for a child.

3 Childhood obesity is increasing in low-income communities and developingcountries, especially in urban areas,resulting in a double burden ofundernutrition and overnutrition sideby side. 30 To achieve gains in childrensnutritional health these two problems

Key messages: what every familyand community should know aboutchildhood obesity



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must be addressed simultaneously.Once considered a problem only inhigh-income countries, overweight andobesity are now dramatically on the rise

in low- and middle-income countries,particularly in urban settings. Ananalysis of several studies has shownthat breastfeeding may have a protectiveeffect on the prevalence of obesity. 31,32 The strong relationship betweenquality of diet and obesity indicatesthat appropriate complementary feeding

with diverse, nutrient rich foods, canbe protective against overweight andobesity. In countries facing doubleburden malnutrition (both under andover-nutrition), optimal infant and youngchild feeding is critical. Support forschool food programs and community

gardens can increase access to healthyfoods.

4 Childhood obesity is influenced

by changes in lifestyle due tomodernization, the affordability,availability and promotion of unhealthyfoods, and a lack of information abouthealthy eating. It is a problem that mustalso be addressed in education systems,nutritional programmes, governmentpolicies and initiatives by the private

sector. It is important to ensureneighbourhoods that are walkable, andlocal markets that offer healthful food.Families who have access to safe placesto be active, are likely to be more activeand to eat more healthy foods whichboth help avoid and tackle obesity.

lile

oid and t

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Vectors of Disease Changing temperatures andpatterns of rainfall are expected toalter the geographical distribution ofinsect vectors that spread infectiousdiseases. Of these diseases, malariaand dengue are of greatest publichealth concern

WHO Director-General Dr Margaret Chan7 April 2008http://www.who.int/mediacentre/news/statements/2008/s05/en/


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MALARIA is caused by parasites that spread from person to personthrough the bites of infected mosquitoes. Malaria is preventable and treatable,yet a child dies of malaria every 30 seconds .33 The main symptoms include: fever,

chills, headache, diarrhoea and vomiting. Severe complications and death mayoccur if malaria is not diagnosed and treated promptly with effective medicines.The effectiveness of conventional control programmes are increasingly hampered bydrug resistance and insecticide resistance. Children and pregnant women are mostvulnerable to the disease. Changes, often man-made, to ecosystems can alter theecological balance and context within which vectors breed, develop, and transmitdiseases. Human exposure and vulnerability to disease outbreaks are also affectedby changing ecosystems. For example, deforestation and subsequent changes in

land-use can make vector-borne diseases such as malaria more widespread and theirtransmission more intense in some parts of the world.

1 Use of insecticide-treated nets provideseffective protection against malaria.Malaria transmitting mosquitoesusually bite at night. All communitymembers, but especially children and

pregnant women, should be protectedagainst being bitten. Sleeping under aninsecticide-treated net is the best wayto prevent mosquito bites.

2 Vector control remains an effectivemeasure to combat malaria. IntegratedVector Management includes a

combination of interventions, adaptedto local circumstances, including indoorresidual spraying with insecticide,use of insecticide-treated nets, andenvironmental management approaches,

such as land and water resourcemanagement.

3 Spraying indoor walls with syntheticpesticides such as DDT, malathion

or pyrethroids is an effective methodto interrupt transmission and protectcommunities from malaria. Expertsare concerned however, that incorrectapplication and management of DDTcan have a damaging effect on theenvironment and health. There is alsoconcern over increasing mosquito

resistance to the pesticide. Effortsare underway to combat malaria withan incremental reduction of relianceon DDT, by supporting sustainablealternatives. These include chemical

Key messages: what every familyand community should know about

malaria

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and non-chemical methods ranging fromincreasing distribution of insecticide-treated nets, eliminating potentialmosquito breeding sites, environmental

engineering, securing homes with meshscreens and deploying mosquito-repellent trees and the introduction ofsh that eat mosquito larvae.

4 Families and communities can helpprevent malaria by controlling mosquitobreeding grounds. Filling in, draining or

securing places where water collects,and cleaning areas inside and aroundtheir houses where mosquitoes can hidecan help reduce the number of vectorspresent in homes.

5 Children are particularly vulnerable tomalaria. A child with fever should be

seen immediately by a trained healthworker, either in the community orat a health facility. In highly endemicareas they need to receive appropriateanti-malarial treatment as quickly aspossible. For falciparum malaria, thecurrently recommended anti-malarialtreatment is an artemisin-based

combination therapy.

6 Pregnant women are particularlyvulnerable to malaria. Pregnant womenare more likely to develop complicationsfrom malaria. During pregnancy, the

disease can cause severe anaemia (thinblood), miscarriage, premature birth, orstillbirth. Babies born to mothers whohave had malaria during pregnancyare likely to be born underweight andtherefore more vulnerable to infection ordeaths during their rst year. In malariaendemic areas, women should sleep

under an insecticide-treated net everynight, and be seen by a trained healthworker if a fever or other symptoms ofmalaria develop.

7 Public awareness campaigns aboutthe dangers of malaria and denguefever are especially important in places

where these diseases were previouslyeradicated or which have historicallybeen too cold for mosquitoes to breed.Malaria could easily be introduced inareas where malaria vectors are stillpresent.



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DENGUE is a viral illness that is spread among humans by the bitesof infected Aedes mosquitoes. Symptoms range from a mild fever, to incapacitatinghigh fever, with severe headache, pain behind the eyes, muscle and joint pain, and

rash. There are no specic antiviral medicines for dengue. It is important to maintainhydration. The most severe form of dengue (haemorrhagic fever) affects mainly children.Dengue occurs in more than 100 tropical and subtropical countries around the world,mostly in urban and semi-urban areas. 34 It often spreads rapidly, causing epidemicsthat disrupt the health services and affect the economies of countries. Approximatelyone third of the worlds population lives in areas where there is a risk of denguetransmission. An estimated 50 million infections occur each year, with 500,000 casesof dengue haemorrhagic fever and at least 18,000 deaths, mainly among children. 35

1 Dengue is spread through the bitesof mosquitoes which thrive close tohumans. They are present in urbanareas and bite mainly in the earlymorning and late afternoon, and theonly way to control or prevent thedisease is to control the mosquito.

2 Dengue haemorrhagic fever is verysevere and affects mainly children. Itcauses fever, abdominal pain, vomiting,and bleeding. An early diagnosis andtreatment are required.

3 Early recognition of the warning signs

of serious illness and prompt clinicalcare can save lives. Dengue has anunpredictable clinical course. Mostpatients have a period of fever lasting27 days.

4 It is very difcult to curb an epidemicof dengue once it has begun. Thebest investment is in mosquito control,training health care providers on therecognition and treatment of dengue andpreventing epidemics from occurring.

5 E n v i r o n m e n t a l m a n a g e m e n tapproaches to controlling mosquitoesare essential and involve inuencingland, water or vegetation conditions soas to reduce vector habitats. Methodsto control egg-laying by femalemosquitoes include improving waterstorage, covering water containers, jars

and drums, proper disposing of usedautomobile tires and other items thatcollect rainwater, in combination withusing select insecticides or biologicalmethods.

Key messages: what every familyand community should know aboutdengue

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TICK-BORNE DISEASES are transmitted to humansthrough tick bites. Depending on the country where you live, you may get exposedto different ticks carrying different diseases. Children who play, walk and camp in

infested areas during the tick season (usually spring to early autumn) are at risk. Theseasonal transmission and distribution of diseases that are transmitted by ticks (i.e.Lyme disease, tick-borne encephalitis) may be affected by climate change.

1 Tick-borne diseases are spread by ticksbiting humans. Ticks may be carriedover long distances because theyremain attached to their hosts (i.e. deer)for many days.

2 Appropr ia te c lo th ing providesprotection. Insect repellents in spraysor powders can be used to protectpeople and animals from tick bites.

Curbing vegetation growth and usinginsecticides in a controlled manner canhelp to reduce tick habitats.

3 Check the body for possible ticksafter being outdoors where ticks arecommon. Ask your health care providerfor guidance on how to safely removeticks.

Key messages: what every family andcommunity should know about tick-borne disease

WHO. Africa Malaria Day, Nigeria, April 25th 2001. Children installing a malaria bednet.



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Indoor air pollution and householdenergy is an issue that concernsmany sectors. Although this is anenergy problem, it is not a traditionalconcern of the energy sector. It is a

health problem but the answer onlypartly lies within the health sector.It is an environmental problem butthe environment sector is oftentoo isolated to put comprehensivesolutions into practice. Therefore,the implementation of technicalsolutions, such as cleaner fuels orimproved stoves, calls for joint actionby several different sectors.

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INDOOR AIR POLLUTION from solid fuel use is aknown risk factor for pneumonia and other acute infections of the lower respiratorytract (ALRI) among children under ve as well as chronic obstructive pulmonary

disease and lung cancer among adults. Inhaling indoor air pollution doubles the riskof pneumonia and other acute respiratory infections (ARI) and was responsible fornearly 900,000 child deaths in 2004. 36 It may also be associated with an increasedrisk of low birth weight and asthma. Globally, pneumonia remains the leading causeof child deaths.

1 Indoor air pollution from solid fuel useis a neglected problem that requiresurgent action. In developing countries,the traditional use of householdenergy can pose a serious threat tochildrens health: cooking and heatingwith biomass fuels and coal produceshigh levels of small particles, carbon

monoxide and hundreds of otherpollutants. Newborns and infants areoften carried on their mothers backwhile cooking, or kept close to the warmhearth. Consequently, they spend manyhours breathing polluted air during theirrst years of life when their developingairways and their immature immune

systems make them particularlyvulnerable.

2 Many low-cost or no-cost approachesexist to reduce exposure to indoor air

pollution, while meeting householdenergy needs, and decreasing theamount of fuel needed. Switchingfrom wood, dung or charcoal to moreefcient, modern and less polluting fuelswill bring about a noticeable reductionin health problems.

3 Programmes to improve access tocleaner fuels and improved stoves cangenerate large health and productivitygains and are highly cost-benecial.Similarly, locating the stove outsideor in a well-ventilated area may bea partial remedy. Eaves spaces andextraction through smoke hoods can

also curb indoor air pollution levels.Changing behaviours plays an importantsupportive role, (i.e. keeping childrenaway from the smoking hearths, dryingfuel wood before use, using lids on pots

Key messages: what every familyand community should know aboutindoor air pollution from solid fueluse



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to shorten cooking time and improvingventilation by opening windows anddoors).

4 Other indoor air pollutants may alterchildrens health. These includesecond-hand tobacco smoke ,pesticides, cleaners, disinfectants and

solvents used in the homes. Humidor unventilated homes can also breedmould and mites in homes or otherplaces where children spend much of

their time. No smoking, safe use andstorage of household chemicals andgood ventilation can ensure that childrengrow up in a healthier environment.

ier en

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OUTDOOR AIR POLLUTION remains a seriousproblem in cities throughout the world, particularly in the mega-cities of developingcountries. It is estimated that a quarter of the world population is exposed to

unhealthy concentrations of air pollutants .37

Children are particularly at risk due tothe immaturity of their respiratory systems. Pollution levels tend to be the highestclose to the pollution source (i.e. smoke stacks, coal-burning factories). Howeversome pollutants are transported over long distances in the air, often for hundreds orthousands of kilometres, causing health problems far away from the sources.

1 In urban areas, a signicant proportionof air pollution is generated by older

vehicles (with poor vehicle maintenanceand low fuel quality). In some cities, airpollution can reach such high levels thatpeople may be advised to stay indoorsand schools might close. Cost-effectivestrategies exist to reduce pollution levels,including more integrated transportand land use (i.e. the development of

high capacity, dedicated busways andpedestrian/cycle networks), reducingtransport pollution emissions through theuse of cleaner (lead-free, low-sulphur)fuels and cleaner vehicle standards andtechnologies, and establishing air qualitymonitoring and warning capacities.

2 Contaminants in the air include ground-level ozone, particulate matter, carbonmonoxide, lead, sulfur dioxide, andnitrogen dioxide. Several of thesepollutants, including ozone and

particulate matter, are associated withincreases in respiratory-related diseases

in children, including reduction oflung function, increases in respiratorysymptoms, and increased severity orfrequency of asthma attacks. Leaddamages the central nervous systemin children and is a dangerous aircontaminant in countries where it isadded to gasoline. It has been shown

that when lead is removed fromgasoline, lead levels in childrens blooddecrease.

Key messages: what every familyand community should know aboutoutdoor air pollution

Climate change will undermineair quality, compounding risks ofrespiratory diseases. Decreaseddependence on fossil fuels willhave a positive health effect onchildren.



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3 Rural areas are affected by outdoorair pollution primarily from burningagricultural land and forest fires. Inaddition, with growing desertication,dust storms may become major

contributors to outdoor air pollution.

4 Reduction of exposure decreases therisk of health effects. Common airpollutants affect health with a severityproportional to the pollution level.Communities should act urgently toreduce health risks by identifying and

reducing emissions from local pollutionsources.

5 Relatively low pollution levels can stillhave an effect on heath especially whenpeople are exposed to the pollutant for along time. Exposure can often start veryearly in childhood.

6 Actions to reduce air pollution willbenefit child health beyond theavoidance of direct impacts, particularlyin terms of lowering emissions of certaingreenhouse gases, and thus helping tomitigate climate change and its impacton health.

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OZONE, the thin layer at the top of the earths stratosphere that protectsfrom the suns harmful ultraviolet radiation, plays a major role in maintaining theEarths living systems. Some chemical reactions cause the stratospheric ozone layer to

break down and become depleted. The chemicals that are responsible for ozone layerdepletion are called Ozone Depleting Substances. Ground-level ozone is a health riskfor humans, as it may cause shortness of breath and headache, trigger asthma andirritate the eyes and throat. Normally these effects stop soon after exposure ceases,but long-term exposure can cause permanent health problems. While the ozone inthe stratosphere protects life, excess ozone in the air at ground level is harmful toour health.

1 Protect children from high ozone levelsin the air. This prevents asthma crises

in predisposed children or other effects(e.g. in case of urban summer smog).Standards for ozone levels in air areset up by relevant authorities as well asadvisories for the community.

2 Protect children from the effects ofozone depletion. The skin and eyes

should be protected from sun exposure,especially when it is hot and the sun ishigh, with hats, sunglasses and coveringclothes. Face and eyes, especially,should be protected childrens skin ishighly prone to sunburn.

3 Be aware about freezers, refrigerators,spray cans, air conditioners and

pressurized cans that have ozone-layerdepleting substances and should berecycled with special care. Labels ofthese products should be checked tomake sure that they are ozone-friendly.

Key messages: what every family andcommunity should know about ozone



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Chemicals Contaminants in air, water, food andsoil, such as heavy metals, pesticidesput children at risk of acute poisoning.


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MERCURY poses a particular threat to the development of the childin utero and early in life. It occurs in various forms, including the liquid, shinyquicksilver (elemental mercury) that vaporizes readily and enters into a global

cycle that ends up accumulating in some types of large predatory sh, seafood, andmarine mammals. Methyl mercury (an organic form of mercury) also accumulatesin sh, and represents a signicant health risk to the fetus if contaminated sh areconsumed by the mother. In the last decade, concern has increased about the specialsusceptibility of the fetus and small child to heavy metals during the critical windowsof vulnerability. Their special behaviours and dynamic physiology may predisposethem to higher environmental exposures and adverse effects. Children may also beexposed to inorganic mercury through the skin by using soaps and creams which

contain mercury.

1 Children should not be allowed tohandle or play with elemental mercury(quicksilver).

2 Avoid eating fish with high levels ofmercury. While a well-balanced diet that

includes a variety of sh contributes tohealth and childrens proper growth anddevelopment, some sh and shellshcontain higher levels of mercury thatmay harm an unborn baby or youngchilds developing nervous system.Local advisories about which types ofsh tend to contain higher levels should

be made available to parents.

3 Contact the health or environmentd e p a r t m e n t i f m e r c u r y i sspilled never vacuum a spill. Neverheat or burn mercury.

4 Advocate use of non-mercury containing

products, such as mercury-freethermometers (digital), blood pressuremeters, batteries and dental llings.

Key messages: what every familyand community should know aboutmercury

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PESTICIDES. In recent decades, the adverse effects of pesticideshave raised concern. On a broad scale, pesticides bring benets they are usedby farmers to spray crops and treat livestock; and they are used in public health

programs that can include indoor spraying of individual houses or public places,such as schools. However, pesticides can disrupt ecological balances by killingnatural biological controls. This situation can cause outbreaks of pests previously ofminor importance and lower crop yields. Once used, pesticides may end up in theair, water, and land, where they can cause harm to non target species. By pollutingecosystems, they diminish biodiversity. By contaminating groundwater, lakes, rivers,and other water bodies, they endanger water consumption, shing, and other wateruses, often vital for life and livelihoods. By polluting soil, they endanger children

playing in elds or gardens.

1 Keep pesticides away from children.Store pesticides and toxic chemicalswhere children can not reach them never put them in containers thatchildren can mistake for food or drink.Read product labels and follow thespecic instructions for using pesticides.

2 Children behave and play differentlythan adults, resulting in greater potentialexposure to pesticides. In addition toplaying closer to the ground, normalhand-to-mouth activity means thatchildren may be exposed to morepesticides in dust and soil. A child whois already weakened by dehydration ormalnutrition will be more susceptible totoxic effects from pesticide exposure.

3 Store food and trash in closed containersto keep pests such as ies, cockroaches,and rodents from coming into the home.Use baits and traps when you can;place baits and traps where childrencan not reach them. This can reducethe need for pesticides in the home.

4 Keep children, toys, and pets awaywhen pesticides are applied. Do notallow children to play in elds, orchards,and gardens after pesticides have beenused. Ventilate the rooms sprayed withpesticides thoroughly, before letting thechildren in for playing or sleeping.

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5 Wash fruits and vegetables underrunning water before eating and peelthem whenever possible.

6 Consult with the poison centre if a childhas been exposed to a pesticide or if

you have any concern. Make sure youknow how to contact them rapidly, incase of need.

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PERSISTENT ORGANIC POLLUTANTS(POPS) are a group of chemicals of particular concern. They break downslowly in the environment, so are persistent, can travel long distances through air,water and living creatures, and can be found in areas where they were never usedor produced. They store easily in fatty tissue and build up in food-chains. Childrenmay be exposed to these POPs when still in the womb and during breastfeeding,even in areas where such substances were never used. The Stockholm Conventionon Persistent Organic Pollutants is a global treaty to protect human health and theenvironment from these chemicals and was adopted in 2001 and entered into force2004. It requires measures to eliminate or reduce the release of POPs into theenvironment.

1 Children and adults are exposed toPOPs primarily through food, sh, meat,and dairy products. Large quantities ofPOPs were produced as pesticides andindustrial chemicals during the 20thcentury. Most of these uses have nowstopped. Some POPs are unintentionalby-products of industrial and otherprocesses. The use of best availabletechniques and best environmentalpractices can greatly reduce theproduction and release of these POPs.

2 During early infancy, children alsocome into contact with persistentand bio-accumulative substancesthat are passed on to them throughbreastfeeding. This can be a majorsource of exposure to infants. Becausebreast milk, even when contaminated,is the best source of nutrition for infants,

protecting mothers from exposure totoxic contaminants is crucial.

3 Measures to reduce or eliminate POPsinclude targeting their production, use,unintended production, and identifyingstockpiles and wastes containing POPsand managing them in a safe, efcientand environmentally-sound manner.

Key messages: what every family andcommunity should know about POPs



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HOUSEHOLD PRODUCTS. Cleaners, solvents,and caustic products used to keep homes clean, in addition to pharmaceutical andhygiene products found within the home, may be toxic if ingested by children. About

20,000 children die every year as a result of poisoning;38

hundreds of thousandsmore accidentally ingest poisonous substances or drugs. Prevention of exposure iseasy when families know a few simple facts about poisons.

1 Children are little explorers that easilynd out and taste products in the home.

If a child is found playing with colourfulbottles or medicines or any otherproduct found in the house, make surehe/she has not taken any. In case ofdoubt, call the Poison Centre for advice.In most cases, washing the mouth eyesand hands of the child may be enough but it is best to consult a specialized

centre or see a health provider, in orderto evaluate the risk of poisoning.

2 Keep all chemicals and medicines outof the reach of children. It is importantto keep all household products insafe places, either locked or stored inplaces which children will neither see

nor access. This applies to cleaningproducts in kitchen and bathroom,parafn or kerosene, medicines, fuelsand caustic products in the garage orpesticides in the shed.

3 Child-resistant lids are proven to savechildrens lives, as they may provide

parents and child-care providers withprecious time to stop children fromtouching or ingesting the contents.

4 Families and communities should beaware of the Poison Centre. The Worlddirectory of poison centres (Yellow Tox)http://www.who.int/ipcs/poisons/centre/

directory/en/ has the list of the existingpoison centres around the world.

5 Where feasible, use natural householdcleaning products: such as vinegar,lemon juice, and baking soda.

Key messages: what every familyand community should knowabout prevention of poisoning fromhousehold products

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Every day around the world the livesof more than 1800 families aretorn apart by the loss of a child toan unintentional injury or so-calledaccident that could have been

prevented. Once children reachthe age of ve years, unintentionalinjuries are a most important threat totheir survival. Unintentional injuriesare also a major cause of disabilities,which can have a long-lastingimpact on all facets of childrenslives: relationships, learning andplay. Among those children who livein poverty, the burden of injury ishighest, as these children are lesslikely to benet from the protectivemeasures others may receive.

WHO Director-General Margaret Chan and UNICEF Executive Director, Ann VenemanForeword to World Report on Child Injury Prevention, WHO and UNICEF, 2008

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INJURIES used to be spoken of as accidents. There has been a moveaway from the use of the term accident because of its connotations of inevitabilityand lack of apparent cause. In contrast, injuries are a result of events that can be

predicted and prevented. Injuries can be categorized in a number of ways. The mostcommonly used categorization is according to intent: unintentional injuries (roadtrafc injuries, burns, drowning, poisoning and falls); and intentional injuries thatare the consequences of acts of violence, either inter-personal (such as homicideor collective violence such as war) or self-directed (suicide, self-harm). The mostcommon type of injury depends on the childs age and sex. For example, in children1 4 years of age, drowning is the leading cause of death due to injury, while inchildren 5 9, drowning, road trafc accidents and animal bites are the leading

causes. In those 10 17, road trafc deaths are the leading cause. Girls are morelikely than boys to suffer from burn-related injuries, while boys are more likely todie from road trafc injuries and drowning .40 Road-trafc injuries are the leadingcause of injury-related deaths worldwide. Many of the unintentional injuries happenin or near the home and almost all can be prevented. While many of the steps toprevent these injuries must be taken by governments, there are steps families andcommunities can take to protect children from injuries.

1Unintentional injuries account foralmost 85% of child injury deaths. 41 Almost all of these injuries can beprevented. The most common typesof unintentional injuries include burns,drowning, poisonings and falls.

2 Fire causes a majority of burn-related

deaths. Many burns in young childrenare from hot liquid, hot tap wateror steam. Children should be wellsupervised and kept away from res,

cooking stoves, lamps, matches andgeneral appliances.

3 A small child can drown in a fewcentimetres of water. Children shouldnever be left alone when they are in ornear water including in a ood situation.Unnecessary accumulation of water

should always be drained and wellsand rain water collection sites shouldbe covered.

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4 Falls are the leading cause of traumaticbrain injury in children. It is oftenfalls from high places, such as beds,changing tables and stairs and off play

equipment that cause the most seriousinjuries. Using stair gates and guardrails will often prevent children fromfalling down stairs.

5 Children under five years old areparticularly at risk on the roads. Youngchildren do not think before they

run onto the road. Families need to

watch them carefully. Make childrenuse helmets while riding bikes andmotorized cycles and use safety beltsand properly installed child safety seats

wherever possible when riding in cars.

6 Bites and stings can be prevented. Avoidleaving children alone and make themaware of the potential dangers of insectsand other creatures (i.e. snakes andspiders bite; scorpions and bees sting).In case of a bite or sting, consult with a

health care facility or poison centre.o

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EnvironmentalEmergencies


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ENVIRONMENTAL EMERGENCIES.Children, including the unborn child, are particularly vulnerable to the healthimpacts of environmental health emergencies, whether of natural, technological

or deliberate origin. This is due to their greater vulnerability to physical dangers,their increased susceptibility to toxic exposures and communicable diseases, and,particularly for young children, to their limited maturity and capacity to cope withemergency situations and escape danger. Furthermore, children are also likely tosuffer long-term psychological consequences from such traumatic events. It is ofoutmost importance that childrens specic vulnerabilities and needs are taken intoaccount when planning for and responding to environmental health emergencies.

1 Worldwide, large numbers of drowningdeaths are associated with cataclysmicoods and ocean waves, which, in asingle event, can leave thousands dead.Children accounted for about one thirdof those who died during the Indian

Ocean tsunami in 2004. 42

2 Children in makeshift urban settlementsare often highly vulnerable to oodingand health systems in these places aregenerally less able to cope.

3 Environmental emergencies can lead to

migration. Children are psychologicallymore sensitive to sudden disruptions oftheir lives caused by forced migration.

4 Education is not only a right, but insituations of emergencies, chronic crisesand early reconstruction, it providesphysical, psychosocial and cognitiveprotection which can be both life-savingand life-sustaining. Millions of children,

youth and adults have beneted fromthe efforts of education authorities andhumanitarian agencies.

5 Schools can start right now with theaddition of some teaching about safetyand natural hazards.

Key messages: what every familyand community should knowabout prevention of environmentalemergencies

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Noise Although noise pollutionreceives little publicattention, there is evidencethat current environmentallevels of noise are damaging

our hearing.


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NOISE is undesirable sound. Studies in Europe suggest that noiseinuences child mental health in terms of hyperactivity and that it may affect childstress responses and sense of well-being. 43 Noise and crowding adversely affect the

interactions of caregivers with infants and toddlers. Parents in noisy environmentsare less likely to be highly involved in their childs activities.

1 Exposure to moderate levels of noisecan cause psychological stress.Annoyance, inability to concentrateand symptoms such as headaches,tiredness and irritability are commonpsychological reactions to noise. Thedegree of annoyance is related to thenature of the sound.

2 Health-relevant transport policies willreduce traffic noise and its impactson mental health, and contributeto the reduction of air pollution andgreenhouse gas emissions.

Key messages: what every familyand community should know about

prevention of noise

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Healthy housing refers to the conceptof a safe haven and acknowledges theneed for children to have a home thatdoes not create any health-relevantexposure or environmental threat.

Healthy Housing


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HEALTHY HOUSING is of special importance for children.As the design and architecture of housing is usually adapted to the average size andbehaviour of adults, all the risk factors of housing (staircases, stove and oven, water

heater, electricity, and cleaning detergents) are much more dangerous for children.They cannot anticipate the consequences of their behaviour, they cannot see what ison the table, and what is a small step for an adult is a huge step for a child. Lookingat the home from the perspective of a toddler makes many dwelling items turn intoa threat. Children are more vulnerable to indoor exposures due to their behaviour,the low level of immune system capacity, and the fact that they have relative tobody weight a much higher intake of pollutants than adults.

1 Everybody and every family has a rightto housing.

2 Inadequate housing conditions arenot only uncomfortable, but canhave signicant health effects for allhousehold members. In an ideal case,healthy housing covers the provision of

functional and adequate physical, socialand mental conditions for health, safety,hygiene, comfort and privacy.

3 Housing inadequacy is a special threatto children and the elderly. Dependingon age and behaviour, a variety ofhousing issues need to be considered.

Especially for small children, the notyet fully developed capacity of theirimmune system should be taken intoaccount.

4 Inadequate housing conditions are notexclusively linked to low socio-economicstatus.

5 Residents can do a variety of things toimprove housing conditions and preventor reduce the risk of injuries anddisease, such as considering building

products, architectural design, light andspace conditions, ventilation capacities,non-toxic cleaning products and wastedisposal.

6 Local authorities, housing agencies andowners have a key responsibility for thequality of the housing stock and the

quality of the neighbourhood.

7 National governments play a major roleby setting the overall standards andlegal context for housing constructionand renovation.

Key messages: what every familyand community should know about healthy housing

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Improved information on childrens

environmental health impacts,coupled with disease quanticationmethods, provides a strong basis foraction.

Tools and MechanismsAvailable to Recognize,Prioritize, Monitor andPromote ChildrensEnvironmental Health


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ENVIRONMENTAL BURDEN OF DISEASEESTIMATES are a quantication of the health impacts related to theenvironment at population level. The World Health Organization is issuing estimatesof health impacts globally and by region caused by a number of risk factors includingindoor and outdoor air pollution, water, sanitation and hygiene, climate change,UV radiation and lead. Such estimates highlight the importance of the variousenvironmental risks in terms of health impacts in a comparative way, and providesupport for policy setting.

Why are estimates on the disease burden from the environment important?Decision makers want to know: How much disease is currently caused dueto environmental risks? and How much disease burden could be averted byenvironmental improvements? Evidence about how much disease is caused byenvironmental risks can assist in highlighting a public health problem and point topossible solutions for disease prevention.

Can environmental disease estimates specically highlight the impact on childrenshealth?The disease burden from environmental risks can be estimated specically forchildren. Such estimates also highlight the particular vulnerability of children whenfacing environmental risks. For example, while 24% of the global burden of diseaseis attributable to the environment, as much as 33% is attributable to the environmentfor children. 44 Burden of disease estimates are useful tools for additional purposes.They can be used for monitoring trends over time or to monitor the impacts ofdisease reduction activities. They can be used to estimate the cost-effectivenessof intervention activities. And nally, they can be used to raise awareness amongthe general population and policy makers about the health impacts caused by theenvironment.

Who can develop environmental burden of disease estimates?Generally such estimates are developed by universities, specialized institutes,government agencies, or non-governmental organizations with a public health orenvironment background. The methods and their application are provided by theWorld Health Organization. The initial effort is most often to identify the sourcesof information and collect the required data in the country, because both healthstatistics and environmental exposure data are needed to develop the environmentalburden of disease estimate.

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1 For every country, an estimate of theenvironmental burden of disease isavailable. It contains a general overviewby disease group, and more specicinformation for major risk factors.Further information is available at:www.who.int/quantifying_ehimpacts/ countryproles.

2 Major health impacts caused bythe environment can be estimatedspecically for children.

3 Environmental burden of diseaseestimates can point to major threats tochildrens health and assist in identifyingpriorities for action, such as awarenessraising, education, information, or policymaking around an environmental risk.

Key messages: how can informationon health impacts from theenvironment be used?



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NATIONAL PROFILES ON THE STATUS OF CHILDRENSENVIRONMENTAL HEALTH. Preparing a National Prole on ChildrensEnvironmental Health enables the country (or, as necessary, the province, state orgeographical area) to assess and summarize the status of childrens environmentalhealth, highlighting the successes and challenges of current national activitiesand policies, and offering a baseline to evaluate progress. The rapid assessmentsare primarily qualitative and descriptive, and may be done in a relatively shorttime (one to three months time). They are planned and done in an interactive,consultatory manner, involving different sectors, and may complement the more in-depth quantitative efforts to assess childrens health. They serve as a good basis forselecting, developing and reporting on childrens environmental health indicators, aswell as dening and identifying activities that will reduce environmental threats tochildrens health. Further information is available at: http://www.who.int/ceh/proles/natproles/en/index.html

CHILDRENS ENVIRONMENTAL HEALTH INDICATORS. Childrensenvironmental health indicators are aimed at improving the assessment of childrensenvironmental health, monitoring the effects of interventions to improve childrenshealth in relation to the environment and reporting on the state of childrensenvironmental health. The Global Initiative on Childrens Environmental HealthIndicators was launched at the World Summit on Sustainable Development in2002. The initiative builds on existing international, regional and national workon child health and environmental indicators. These are being applied in manyregions across the world through regional pilots and contributing projects to providecomprehensive information on the status of childrens environmental health. Theseaim to help identify key environmental risks to childrens health, pointing towardsareas with strong needs for effective interventions. They provide opportunities toinform and guide the implementation of monitoring surveillance systems for childrensenvironmental health. The Global Initiative on Childrens Environmental HealthIndicators is supported by the Ofce of Child Health Protection at US EnvironmentalProtection Agency. http://www.who.int/ceh/indicators/en/

WHOS TRAINING PACKAGE FOR THE HEALTH SECTOR ONCHILDRENS HEALTH AND THE ENVIRONMENT is a collection of

more than 30 modules with internationally harmonized information and peer-reviewedmaterials that are used to train health care workers, and enable them to becometrainers. The modules include extensive notes, references and case studies. They arebacked up by manuals and guidelines and also evaluation instruments. The issuescovered include:

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The special vulnerability of children to environmental threats. The health and developmental effects of specic chemical, physical and biological

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Healthy environments healthy children