Growing Environmental Threats to Children's Health in Developing Countries:
(Running Title: Twin Threats to Children's Health)

January 2000

A. Karim Ahmed and Abraham M. George*

It is a sad commentary that children living in many regions of the world not only suffer from diseases caused by hunger, malnutrition and a variety of infectious agents, they are now exposed to an increasingly polluted environment. In a number of rapidly developing countries like China, India, Brazil, and Mexico, the adverse impact of environmental factors on children's health, such as exposures to polluted air, unclean water and other hazardous substances, has increased dramatically in recent years.

At present, millions of children in Asia, Africa and Latin America are still not immunized against common childhood diseases, while even more do not have access to basic health care. Given these disadvantages, the newly emerging environmental health threats significantly add to their current burden of diseases.

Recent health statistics show that the largest single cause of death globally in children below the age of five years is from acute respiratory diseases -- estimated to be nearly 4 million a year -- that arise from constant exposures to highly polluted indoor and outdoor air. Another 2.5 million young children die each year from intestinal diseases caused by ingesting bacterially contaminated water.

These environmentally linked deaths now exceed the estimated 1 to 3 million deaths each year from malaria (eight out of ten being children), which was recently categorized by the World Health Organization (WHO) as "public enemy number one".

Air pollution can greatly aggravate the ill effects of respiratory diseases such as bronchitis, asthma and other chronic lung diseases. These diseases have emerged as a serious public health problem for children in many regions of the world, including some developed countries. In addition, poor children on diets deficient in vitamins, minerals, and protein are especially vulnerable to the toxic effects of chemicals. This susceptibility arises because malnourished children have lesser capacities to ward off or eliminate environmental toxins from their bodies.

According to the United Nations Children's Fund (UNICEF), the average death rate of children below five years of age living in developing regions is nearly 14 times greater than those born in the more industrialized countries of Western Europe and North America. However, thirty years ago this difference was considerably less -- only 6-fold -- indicating an increasing gap in the status of children's health between developed and developing countries.

What accounts for these trends? One explanation is the unprecedented shift in population from rural to urban areas in many developing countries where cities and towns have witnessed explosive growth in the transportation and industrial sectors. Urban poverty in these countries compounds the problem even further.

By the beginning of the next decade, three out of four "megacities" (those cities with populations greater than ten million) will be located in developing regions where the rate of urban growth is projected to be four times greater than in rural areas. As a result, it is now expected that in many developing countries over 40% of the children under the age of fifteen will reside in urban areas.

The underlying reason for this environmental health crisis is the nature of industrial and urban growth in many developing regions where modern technologies have been introduced with almost no controls in place. While some health problems are linked to traditional sources such as smoky stoves used for cooking and heating, many more now arise from newly introduced technologies. These include exposures to polluted air from uncontrolled car and truck emissions and from a variety of industrial effluents, and other hazardous waste materials.

In a recent study by the World Resources Institute (WRI), it was shown that the top ten large cities with degraded air quality for children below the age of five years are located in Mexico, China, India, Iran, the Philippines and Brazil. In fact, in some cities of China and India, the air concentration levels of particulate matter and sulfur dioxide (two commonly measured air pollutants) were frequently found to be four to eight times in excess of WHO's recommended health guidelines.

For example, take the problem of lead poisoning. In many developing countries, childhood lead poisoning is one of the most serious environmental health problems, especially among young children living in urban areas. Even low levels of lead exposure in early childhood (at amounts that do not result in severe brain damage or death) can cause loss of cognitive and motor skills, behavioral disorders, reduced attention span and hyperactivity, with significant lowering of IQ and academic performance.

The largest source of childhood lead exposure in many developing countries is from leaded gasoline used in motor vehicles. Furthermore, there has been an extraordinary rise in the use of motor vehicles in many cities and towns, whose increase often outpaces population growth rates. Motor vehicles account for up to 90% of all airborne lead contamination in urban areas where leaded gasoline is still widely used. In contrast, leaded gasoline has been phased out during the past few decades in most developed countries.

An immediate course of action to address the pervasive problem of childhood lead poisoning is for developing countries to phase out leaded gasoline in the next five years. Equally important is the reduction of industrial air and water pollution by adopting stricter control measures, coupled with proper ways to dispose hazardous waste materials.

Triggered by early harmful environmental exposures, children develop serious chronic health problems even before they become adolescents. As they enter the workforce, their productivity is already diminished from poor health, and they continue to suffer from illnesses and, in some cases, from adverse neurological effects as reflected in a decrease in IQ. These long-term impacts of a degraded environment on society are unquestionably serious.

Recent studies by the World Bank have shown that childhood disease prevention programs, such as the phase-out of leaded gasoline, will result in health benefits that greatly outweigh the costs of preventive measures. In the final analysis, neglecting to address factors contributing to a polluted environment will severely compromise the ability of many developing countries to achieve a healthy, productive and sustainable society in the future.

* A. Karim Ahmed is President of the Global Children's Health and Environment Fund, Washington, DC, and Abraham M. George is Managing Trustee of The George Foundation, Bangalore, India.

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