Raising Healthy Childrenin a Toxic World Philip J. Landrigan, MD, MSc,
FAAPProfessor and Chairman
Department of Community & Preventive Medicine
Professor of Pediatrics
Director, Children’s Environmental Health Center
Mount Sinai School of Medicine
Greenwich, Connecticut
May 8, 2008
Patterns of Disease in Children Have Changed
• As nations move toward industrial development, patterns of disease and death change.
• Prior to industrial development, infectious diseases are the major causes of illness and death MUCH OF AFRICA, LATIN AMERICA AND ASIA TODAY
• After development, life expectancy increases and chronic diseases become the major causes of illness and death USA AND WESTERN EUROPE TODAY
Environmental Change is the Driving Force
The principal causes of illness, hospitalization and death
among children in America today are:
• Asthma• Cancer• Birth defects• Neurodevelopmental disorders• Obesity and diabetes
These diseases are on the rise
Estimated Percent Prevalence of
Asthma by Age and Year, 1980-
2
3
4
5
6
7
8
9
1980 1985 1990 1995 2001 2002 2003 2004
Percent
Source: CDC MMWR, October 19, 2007 / 56(SS08);1-14;18-54
All AgesAll Ages
Children <18
The Increasing Prevalence of Asthma in the US1111111111111111
Source: National Cancer Institute
Source: National Cancer Institute
Incidence of Testicular Cancer
Annual Prevalence of Male Genital
Birth Defects, 1968-2003
(per 10,000 live births)
5
10
15
20
25
30
35
40
45
1968
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
Perc
en
t
Source: CDC’s Metropolitan Atlanta Congenital Defects Program (MACDP)
Developmental Disabilities
• Affect at least 5-10 % of all children
• Include: Autism
Dyslexia ADHD Mental Retardation
• Reported prevalence is increasing
Overweight and Obesity
Source: Willet et al., New Eng J Med, 1999
•Prevalence has nearly quadrupled in American children
•2.5-fold increased risk of overall mortality
•4-fold risk of cardiovascular mortality
•5-fold risk of diabetes
•Risk of hypertension, gall bladder disease, and some cancers
What is the Evidence that
Toxic Chemicals in the Environment Cause Disease in Children?
The Central Question in Pediatric Environmental Health:
• Children are surrounded by a large and ever increasing number of chemicals.
• Many of the chemicals to which children are at risk of exposure have not been tested for their possible developmental toxicity
• Children are more heavily exposed and more vulnerable to many environmental chemicals than adults
• These chemicals are detectable in most American children's bodies, even in newborn infants
Children’s Health and Toxic Chemicals: What We Know
Synthetic Organic Chemical Production
Most Chemicals to Which Children Are Exposed Have Not Been
Adequately Tested for Toxicity
• 80,000 + chemicals in commerce• 3,000 are high production volume (HPV)
chemicals - produced in quantities of 1 million pounds or more per year
• No basic toxicity information is available on half of HPV chemicals
• No information on developmental toxicity is available for 80% of HPV chemicals
Why Are Children Especially Vulnerable to Toxic Chemicals?
• Greater exposure pound-for-pound
• Decreased ability to detoxify many chemicals
• Heightened biological vulnerability – thalidomide, DES, fetal alcohol syndrome
• More years of future life
Children are not little adults
National Academy of Sciences, 1993
Evidence is Strong and Increasing
that Toxic Chemicals in the Environment
CauseDisease in Children
Toxic Chemicals Can Cause Neurodevelopmental Disorders
LEAD
• Principal source is lead paint and lead paint dust• Other sources – toys, imported dinnerware• 15-20% of cases associated with home renovation• Causes decreased IQ, shortened attention span, inability to concentrate, dyslexia and school failure• Any amount of lead is dangerous – No level is safe
Toxic Chemicals Can Cause Neurodevelopmental Disorders
LEAD
Toxic Chemicals Can Cause Neurodevelopmental Disorders
METHYL MERCURY
• Principal source is contaminated fish• Most methyl mercury in fish originates from coal-fired power plants• Effects on children similar to those of lead• Prevention – eat safe species of fish, avoid contaminated species www.thegreenguide.org
Toxic Chemicals Can Cause Neurodevelopmental Disorders
ORGANOPHOSPHATE PESTICIDES
• High-dose exposure can cause acute poisoning• Exposure during pregnancy to lower levels can
cause:small head circumference low birth weight developmental delaysADHDPervasive Developmental Disorder, a form of autism
Toxic Chemicals Can Cause Neurodevelopmental Disorders
ENVIRONMETAL EXPOSURES LINKED TO AUTISM
• Thalidomide• Misoprostol• Maternal rubella infection• Valproic acid
• Are there others among the thousands of untested chemicals to which our children are exposed daily?
Air Pollution Causes Asthma
New York City, before and after a photochemical smog.
Before
After
Smog on 5th Avenue
Chemicals and Radiation Can Cause Childhood Cancer
• Solvents, especially benzene• Parental employment in industries that
use solvents – painting and printing • Pesticide exposure, especially prenatally
The Solution
Progress Against Environmental Disease in Children Requires Work in These Areas:
• Testing chemicals for toxicity RESPONSIBILITY OF THE FEDERAL GOVERNMENT
• Research• Patient care•Training the next generation of pediatricians
Programs on the Environment and Children’s Health at Mount Sinai
• The National Children’s Study• The Autism Discovery Project – AUTISM
• The Center for Children’s Environmental Health and Disease Prevention Research – ENDOCRINE DISRUPTORS, PREMATURTE PUBERTY & BREAST CANCER
• The Pediatric Environmental Health Specialty Unit – CLINICAL SERVICES FOR CHILDREN & FAMILIES
• Fellowship in Environmental Pediatrics - EDUCATION
• Growing Up Healthy in East Harlem – ASTHMA PREVENTION & PESTICIDE USE REDUCTION
The National Children’s Study
• A multi-year prospective epidemiological study that will follow 100,000 children from early in pregnancy to 18 years of age
• Mount Sinai leads the study in NY and NJ
The Goals: 1. To discover the environmental exposures that cause
disease and disability in childhood and throughout life
2. To translate this science into a roadmap for prevention
Critical Research Questionsfor the
National Children’s Study
• What are the preventable causes of autism, ADHD and other developmental disabilities?
• What are the effects of early exposures to endocrine disrupting chemicals?
• Are there chemical exposures that increase risk of obesity and diabetes?
• What are the preventable causes of pediatric cancer?
Prevention
DISEASE CAUSED BY TOXIC CHEMICALS IN THE ENVIRONMENT IS PREVENTABLE
• Prevention is best achieved by discovering hazards and then preventing exposures.
• Prevention needs to proceed on 3 levels:
1. Home2. Community3. Society
Prevention in the Home -The Value of Eating Organic
“Consumption of organic produce appears to provide a relatively simple way for parents to reduce their children's exposure to OP pesticides.”
Curl CL, Fenske RA, Elgethun K, University of Washington.
Families who consume an organic diet can reduce their pesticide exposure levels by 90% as compared to families who consume conventional supermarket food
CDC
Prevention in the Community
• Integrated pest management
• Pesticide neighbor notification laws
• Green schools
• Plant trees
• Insist on construction of sidewalks
• Maintain parks and playspaces
Prevention Works
Example: The removal of lead from gasoline
In 1976, US EPA began phase-out of lead from gasoline
Lead use in gasoline declined from 1976 through 1980
Year
1975 1976 1977 1978 1979 1980 1981
30
40
50
60
70
80
90
100
110
Gasoline lead
Lead
use
d In
gas
olin
e(1
000
tons
)
Source: Annest, Pirkle, Makuc, et al., Chronological trend in blood lead levels between 1976 and 1980. NEJM 1983; 308;1373-7.
Decline in Blood Lead Levels Greatly Exceeded Expectation
1974 1976 1978 1980 1982 1984 1986 1988 1990 1992
0
20
40
60
80
100
2
4
6
8
10
12
14
16
18
Blood leadGasoline lead
Beginning in 1980, EPA further restricted lead use in gasoline.Gasoline lead levels continued to decline through 1991
Lead
use
d In
gas
olin
e(1
000
tons
)
Blo
od le
ad le
vels
(g
/dL)
Source: CDC. National Report on Human Exposure to Environmental Chemicals, March 2001
Environmental Disease is Preventable Declining Blood Lead Levels in the
U.S. 1976–1999
18
1974 1976 1978 1980 1982 1984 1986 1988 1990 1992
2
4
6
8
10
12
14
16
Blood Lead Levels (µg/dL)
0
1994 1996 1998 2000
Year
2.72.0
Protecting Children against Environmental Threats to Health
Thank You!
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