Declaration on Children and their health and their environment
Discussed and approved at the ISDE General Assembly (Washington, 2001)

ISDE, consisting of physicians and health professionals, is strongly concerned about the potentially devastating and possibly irreversible effects of children’s health by multiple factors in the environment. We urge all stakeholders to take prompt and effective actions to achieve significant reductions in hazardous exposures to children.

Environmental health risks to children are increasingly being recognised and the awareness is growing that there is a need to protect children from the damaging health effects of environmental degradation. The Convention on the Rights of the Child states (Article 24, paragraph 1) that a child has the right to 'the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health', particularly as they bear a disproportionate risk to the rest of the population.

There is a growing body of scientific evidence that demonstrates the wide array of children's health problems that can be brought on and/or exacerbated by environmental exposures. Examples of the major environmental health problems affecting children are:

· Asthma deaths among children and young people have increased tremendously during the last decade and asthma is now the leading cause of hospital admissions for children in many countries

· Children exposed to tobacco smoke at home have more days of restricted activity, bed confinement, and missed school days each year than other children.

· Lead poisoning affects millions of children aged five and under, especially in countries which continue to permit lead in gasoline and paint

· Millions of children under the age of 12 live within four miles of a toxic waste dump, or live on a waste dump

· Polluted waters can affect children when they come into contact with rivers or lakes and through the consumption of certain freshwater fish

· The re-emergence of vector-borne diseases, particularly malaria, is occurring as a result of climate and land-use changes

· The effects of desertification and deforestation on children's health are enormous

· Children may face developmental defects to the endocrine system, growth or mental retardation and neurobehavioural toxicological effects as a result of environmental exposure to pesticides, persistent organic pollutants and other chemicals

· Children are at greater toxicological risk after exposure to chemicals because their systems are still developing and because they consume more food and fluids and they breathe more air, relative to their body size, than adults

· Children's behaviour (early hand-mouth activity, their indoor and outdoor play activities) mean that they are at increased risk of exposure to dust, soil and other environmental contaminants as compared to adults

· In several parts of the world, child labour is still accepted as a way to provide sufficient family income. In these countries an increasing number of children are at risk of occupational diseases and injuries.

Taking these facts in account ISDE would like to see action on the following points:

· The best way to protect children from environmental hazards is to reduce or eliminate harmful environmental exposures. In addition, in setting protective measures, including emission standards, food safety standards and all other regulations, the relatively high exposure and susceptibility of children must be taken into account.

· to build an international platform for multi-disciplinary expertise and a forum to present and discuss the latest research findings in paediatric environmental health. The overall objective is to stimulate actions that may contribute to the understanding of the relationship between the environment and the health status of children. An aim is to improve the quality of the environment and thus the health and well-being of children

· stimulate research on the relationship between environmental contamination and children's health and advocate policy to minimise childhood exposure to environmental contaminants

· more research into the environmental causes of ill health in children, especially into neurological diseases.

There are very few studies of children and delayed effects of acute Organo Phosfate poisoning, despite evidence from adults that delayed psychological deficits occur. There needs to be long term prospective epidemiological studies of the health impacts of Organo Phospate and Organo Chloride pesticides, with a focus on intellectual development. There has been virtually no action since the ‘early warnings’ of Angle in 1968, on the neurotoxicological effects of Organo Phospate poisonings, even though the extent of these effects ‘might exceed the effects currently presented by lead’ (Weiss, 1997). Data from poison centres could be the basis for some of these studies.

· develop a greater awareness among health professionals of children's health and the environment and enhance public awareness regarding environmental hazards and children's health

· encourage national governments, inter-governmental organisations and international agencies to review current standards and to set new public health and environmental standards to ensure protection of children's health

· promote research projects to protect children, particularly by identifying and stimulating research into their unique susceptibility and high exposure to environmental pollutants

· communicate internationally about the action and research priorities needed in the different countries of the world in order to assist policy and decision making

· facilitate contacts between individual researchers and organisations by using electronic networking; in order to have better linkages between exposure and health data via different stakeholders in the field of children’s environmental health.

· promote educational efforts concerning children's environmental health threats, in order to provide better consumer information to families about children's risks; and to educate health professionals to identify, prevent and reduce toxic threats to children.

· apply the lessons from the histories of thalidomide, DES, lead, etc. and don’t use children as guinea pigs - especially as, compared to adults, children get little or no benefit from the environmental exposures that we give them

· put children at the centre of government policies on housing, poverty elimination, income support, and health.

· give children relevant legal protection with safety standards for chemicals that take their special vulnerabilities into account. For example provide in regulation an extra 10-fold safety margin for children, as well as provisions for the cumulative exposures of children to pesticides. 10,000 existing pesticide tolerances need to be re-assessed.

· reduce children’s exposures to chemicals, radiation and other potential causes of ill-health, prioritising persistent and bioaccumulating substances, especially pesticides and other toxic chemicals to which children are exposed in food ,water, and consumer products, (such as the phthalates in children’s toys), utilising the precautionary principle whenever risks are likely to be serious and irreversible.

· give the public the right to know what their children are exposed to with adequate consumer product labelling laws and accessible toxic emissions registers, like the toxic release inventories in the USA. There is no equivalent in Europe, despite OECD recommendations, although there are one or two Member State systems e.g. the UK and the Netherlands.

· improve the education and awareness of parents, teachers and other guardians of children so that they can help create safer environments for them. Equivalents of the American Academy of Pediatrics’ “Handbook of Environmental Health for Children”, and the “Resource Guide” and training materials for US doctors and nurses produced by the Children’s Environmental Health Network, California, would be helpful in this.

Taking steps now to prevent disease, illness, and injury will not only diminish the potential for wide-spread children’s suffering but reduce the high costs of treating illnesses which might have been avoided.

ISDE commends the commitment of many nations to negotiate an internationally binding and verifiable agreement establishing targets and timetables for meaningful reductions in emissions harmful for children.

At the same time, ISDE urges to take immediate action to advance policies designed to increase the protection of children around the world and to accelerate the development of regulation and standards that are effective in protection children’s health.

The time has come for the nations of the world to act. The science is credible, and the potential impacts profound. Prudence — and a commitment to act responsibly on behalf of the world's children and all future generations — dictate a prompt and effective response.