Pediatric
Environmental health
Health and the environment
Both the state of health and disease are the final result of the variable interaction of two determinants, one endogenous, constitutional, and sometimes hereditary, and the other exogenous or environmental. Each consists of a multitude of factors, a few of them known, and most unknown. The paediatric population is particularly vulnerable to environmental pollutant factors, which cause adverse health effects in the short, medium and long term.
At the beginning of this millennium, our children live in a world very different from what all parents and paediatricians would like. Globally, more than 10 million children under the age of 5 die each year, and more than 150 million survive with irreversible sequelae that blight quality and years of life. 98% of morbidity and mortality occur in underdeveloped countries. Poverty, terrible, and avoidable, is a social environmental pollutant that prepares the territory for unhealthiness and malnutrition, because the main killers of the first lustre of life act: perinatal diseases, pneumonia, diarrhoea and malaria.
In Western countries, technological / industrial advances (clean drinking water, sanitation / sewerage measures, food hygiene, immunizations, cold chain, etc.) have controlled infectious and nutritional deficit pathologies, reducing infant mortality and lengthening life expectancy. But the rise, in most developed countries, of the neoliberal socio-economic model leads to progressive and unstoppable industrialization, with subsequent decontamination and MA pollution. This globalization is modifying the composition and worsening the quality of the natural habitats where our children live.
The growing social awareness of the adverse effects on human health of anthropogenic MA pollutants has led to several international organizations and institutions ( World Health Organization , UNICEF , European Union , US EPA , United Nations Environment Program) over the past decade. , etc.) to advance the study of the interactions between the environment and health. They promote a multidisciplinary approach and suggest to the governments and groups involved the creation of the legal bases and frameworks, and the allocation of the necessary financial funds for MA health in general and paediatric health in particular to become a reality in the near future.
Pediatric environmental health
The World Health Organization (WHO) defines paediatric environmental health (SMAP) as “the aspects of paediatric health, including quality of life, determined by the interaction of physical, chemical, biological, psychic and social MA agents. As well as the theoretical and practical aspects, to evaluate, correct, control and prevent the MA factors that negatively affect the health of present and future generations ».
This new, emerging and necessary paediatric subspecialty is, according to the WHO, one of the main and most important health challenges of this century. It includes, tangentially, the diagnosis and treatment, and mainly the detection and prevention of childhood and adolescent diseases caused by preconceptional, periconceptual, transplacental and postnatal exposure to physical, chemical, bio-
logical and social issues. It also addresses the creation of healthy spaces for children in places where they are born, grow, play and learn. To provide it with theoretical and practical content, it is necessary to develop strategies to analyse, identify, disseminate and solve the problems of the SMAP in specialized units or sections and centres of excellence ( Pediatric Environmnetal Health Specialty Unit , PEHSU).
The WHO also coordinates and promotes the Healthy Environments for Children Alliance (HECA), an international organization with the aim of recognizing and reducing MA risks, promoting regional policies, mobilizing resources and catalysing urgent and maintained actions.
Child and adolescent vulnerability
The greatest paediatric vulnerability, especially in childhood, to MA pollutants is reflected in the fact that more than 40% of the overall burden of diseases attributed to MA risk factors fall on children under the age of 5, who only account for 10 % of the population.
The causes of paediatric vulnerability are as follows: a) biological immaturity (anatomical and physiological); b) higher metabolic-energy rate; c) typical patterns of behaviour (permanence on the ground and hand-to-mouth activities); social helplessness in the face of signs of alarm; higher life expectancy; no participation in MA decisions. This vulnerability is perfectly reflected in the potential risk to a carcinogenic agent MA: it is increased by 10 when it acts in the first two years of life and by 3 between ages of 3 and 15. It is necessary to train paediatricians to show, monitor and improve these MA conditions, transforming them into healthy spaces for our children.
Reference and original text (with permission):
FerrÃs J, Ortega JA, Berbel O, Garcia J. Pediatric environmental health. Pediatr Catalana [Internet]. 2006; 66 (3): 92–104. Available at: http://webs.academia.cat/revistes_elect/view_document.php?tpd=2&i=2397