Pediatricians Turn Spotlight on Environmental Risks

Hospitals in Mexico and Argentina have specialized units focused on children's health and the environment. But the region as a whole has a long way to go in this area.

BUENOS AIRES - How many childhood respiratory problems are related to the fuel used in homes for cooking? How many cases of diarrhea are the result of drinking contaminated water? How can we detect the relationship between potential exposure to lead and learning problems in school?

"All populations are exposed to different environmental threats, but children are the most vulnerable, and if they live in conditions of poverty that fragility it is enormously exacerbated," said Jenny Pronczuk, expert in environmental health with the World Health Organization (WHO), in a conversation with Tierramérica.

Science has proven the link between exposure to certain substances and the development of disease, in the short and long term. However, most doctors only respond to symptoms, often without realizing that the causes of a child's illness remain.

Although in Latin America there is now greater political will to promote children's environmental health, "there is still a long way to go," according to Pronczuk. "More training is needed for health professionals," she said.

WHO data indicates that 40 percent of the global burden of diseases attributed to environmental factors affects girls and boys ages five and younger. This fact is most alarming in that this age group represents just 10 percent of the world population.

Children undergo rapid growth in their first years of life and they have greater capacity to absorb toxic agents. Their breathing is faster and their consumption of food and water is proportionally greater than it is for adults, so their susceptibility to environmental threats is greater.

However, many pediatricians are not prepared to approach disease from this perspective. "It is a new focus that requires an open mind," Daniel Beltramino, president of the Argentine Pediatric Society's health and environment commission, explained to Tierramérica.

Beltramino noted that just three years ago, the Society's workshops on this issue "were an embarrassment." "There were just 20 or 30 of us interested in the topic," he said. But earlier this month in Buenos Aires there was a seminar for specialists from South America's Southern Cone countries, and some people had to be turned away after the limit of 130 registered.

"Health professionals are on the front line in the battle to detect when symptoms are the product of the lack of access to clean water, contamination of soil, or the lack of planned urban areas," said the expert.

To confront these problems, experts in health, environment and education from around the world gathered in the Argentine capital Nov. 14-16 for the second International Conference on Environmental Threats to the Health of Children, and culminated with an exhortation "to transform knowledge into action."

The event, sponsored by the WHO, urged the broader dissemination of available tools to improve children's environmental health.

Beltramino laid out the different strategies underway in the region, such as degree programs in environmental health for pediatricians -- which didn't exist four years ago -- and the creation of environmental pediatric units in children's hospitals.

These units already exist in hospitals in Canada, United States and Mexico, and in the past five months three opened in Argentine hospitals. They provide assistance, training and research in children's environmental health issues.

"If there is a fire in a paint factory, [the unit doctors] are entrusted with protecting the children," the doctor cited as an example.

The pediatrician also underscored the importance of drawing up "national profiles of child environmental health" in order to determine where the national zones of risk and how to better attend to the affected population. Eighteen Latin American countries have already begun to put together these profiles.

International cooperation would permit follow-up of cases to study the relationship between environmental risk and disease, which cannot always be detected in the short term.

Industrialized countries are conducting epidemiological studies of cohorts (groups of people who share some factor in common) for various public health questions. The new approach would be to apply this sort of follow-up in the long term to understand the relationship between environment and health.

For example, experts study samples of umbilical cord blood from newborns, and then continue to study the evolution of these individuals through childhood, adolescence and adulthood.

"The symptoms of contamination from toxins can appear 20 years after exposure," explained Beltramino. "To know with certainty to what extent a specific toxin can produce cancer, 500,000 cases are needed," he said.

"That number of cases is impossible to track in just one country, but if we can agree on a single methodology to work in all countries, we can contribute to a global study of the problem with results from the short and long term."

* Marcela Valente is an IPS correspondent.