Children's Health and the Environment: A Transatlantic Dialogue
Landrigan, Philip J., Tamburlini, Giorgio, Environmental Health Perspectives
Important steps to protect children against environmental threats to health have been taken over the past decade in both the United States and Europe This progress is based on the shared recognition that infants and children are very different from adults in their exposures and their susceptibility to toxic chemicals and that they therefore require special protections in risk assessment, regulation, and law. But despite this common scientific foundation, developments in children's environmental health (CEH) on the two sides of the Atlantic have been quite different. These contrasting and sometimes complementary advances reflect the differing social, legal, and regulatory cultures of the two continents.
Recognition among policy makers of the unique vulnerability of children had its origins in the United States and dates from the publication in 1993 of the National Research Council (NRC) report Pesticides in the Diets of Infants and Children (National Research Council 1993). This report found striking differences between children and adults in exposure as well as in susceptibility to toxic chemicals. The report identified large gaps in regulatory practice and called for expansion of toxicologic testing to assess threats to development. It also urged reform of risk assessment and regulation to enhance protection of children. The central contribution of the NRC report was to elevate consideration of the vulnerability of children from the specialized area of pediatrics to the broad realm of national policy formulation.
The recommendations of the NRC report were incorporated into federal policy in the United States in 1996 through the Food Quality Protection Act (FQPA), the principal U.S. statute governing use of pesticides (FQPA 1996). The FQPA affirms the unique vulnerability of children. It requires explicit consideration of children in risk assessment and mandates child-protective safety factors in regulation. These principles were reaffirmed in April 1997 in an Executive Order on Children's Environmental Health and Safety requiring all agencies of the U.S. government to consider children's health and safety in all policy decisions (Clinton 1997). This U.S. experience was shared internationally and led to promulgation in May 1997 of the Miami Declaration on Children's Environment Health, a declaration approved unanimously by the environmental ministers of the G-8 nations (Environment Leaders' Summit of the Eight 1997).
In recent years, CEH policy development has slowed in the United States, but the nation continues to make important contributions in research and medical practice. These advances date from 1998, when the National Institute of Environmental Health Sciences and the U.S. Environmental Protection Agency established a national network of Centers for Children's Environmental Health and Disease Prevention Research, now 11 in number. These interdisciplinary centers have matured into strong generators of scientific knowledge, they have produced unprecedented gains in environmental pediatrics, and they have been effective incubators of the careers of young scientists and physicians who will become the next generation of leaders in CEH.
Research in the centers has made important contributions to understanding of the environmental causes of asthma, neurobehavioral disorders, endocrine dysfunction, autism and low-level lead toxicity. Findings from this work are already guiding disease prevention. Reports highlighting the accomplishments of the centers are presented in this issue of Environmental Health Perspectives.
The National Children's Study (NCS) is a second emerging research development in the United States (National Children's Study 2005). The NCS is a prospective epidemiologic study that will follow 100,000 children--a statistically representative sample of all children born in the United States--from (or before) conception to 21 years of age. The goal is to identify the factors in the environment--chemical, biologic, physical, and psychosocial--that alone or in combination influence children's health, growth, development, and risk of disease (Trasande and Landrigan 2004). …