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In this short article we introduce the concept of sustainable development and its significance to child health using climate change as an example. Environmental issues, in the long term, are as important to children's health as smoking, accidents, and poor parenting are in the short term, yet have hitherto had little publicity or discussion within paediatric circles.
What is happening to children's health in the world? In the developed world cardiovascular disease, diabetes, cancer, and dental disease are all on the increase, while in the developing world malnutrition, infectious disease, and injuries are still rife. At present, inequalities of health and wealth—both within and between nations—appear to be increasing,1 with an adverse impact on children's health. The Ottawa charter for health promotion states that the fundamental conditions for health are peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity.2 The evidence for the connections among the environment, the economy, and social change are compelling and any change within one inevitably affects the others.
Climate change
For the first time in history, the economic activity of the human population has become so vast that it is beginning to change the gaseous composition of the lower and middle atmospheres. This is now called human induced global climate change (HIGCC), which in turn will have a significant impact on a future generation of children. There seems no doubt that climate change is a genuine phenomenon.3 The main cause of climate change is the greenhouse effect, which is related to the massive increase in use of fossil fuels with consequent liberation of CO2 into the atmosphere. Before man started burning oil and coal and gas, the atmosphere contained about 280 parts CO2 per million—now the figure is about 360 ppm. Methane concentrations are now more than double what they were in the pre-industrial age. Nine of the 10 hottest years on record have occurred since 1993.4 Global average surface temperatures have increased by 0.3–0.6°C since the late 19th century.5 This is a statistically significant trend, which, if it continues, will lead to a rise in temperature between 3–5°C by the year 2100; this is now accepted by most of the international scientific community, which has concluded that an anthropogenic influence on the global climate is discernible.6 This increase contrasts with a global temperature increase since the last ice age (10 000 years ago) of about 5°C.5 Human beings have further interfered with the equilibrium by destroying large areas of vegetation, mainly forest, which acts as a carbon sink by trapping carbon dioxide in plant carbohydrates.7
EFFECT OF CLIMATE ON HUMAN HEALTH
Extremes of temperature affect people directly, leading to excess mortality in both hot and cold spells. Eventually the indirect effects of greater warmth: increased vector borne disease—estimates of 60% of the world population being exposed to malaria by the latter half of this century8—increased natural disasters,9rising sea level10 (and population displacement), and increased pollution, will have a far larger impact on health than the direct effects.
FOOD PRODUCTION AND NUTRITION
Worldwide, total production of food is likely to remain constant but the production of food is likely to favour the higher latitudes with developing countries around the equator suffering most. Many communities that rely on traditional agriculture may lack the resources and adaptability to switch to alternative crops and production methods. One study has forecast the additional number of hungry people attributable to climate change by the year 2060 to be between 40 and 300 million.11 Children would be the group most severely affected by food shortages.
SEA LEVEL
A projected increase of 0.2–1.0 m by 2100 is the current best estimate of sea level change.10 This is two or three times greater than the change in the last century. Over half the world's population lives within 60 km of the sea. Delta areas are most likely to be affected many of which are densely populated. At today's population level an increase of 0.5 m would approximately double the number of people who suffer flooding annually—currently around 46 million. The rise in sea level would be compounded by extreme weather events, particularly floods and storms in coastal areas.
INFECTIOUS DISEASES
All vector borne diseases are predicted to increase as a result of warming and changed rainfall. It is estimated that the current 45% of the world's population who live in zones of potential malaria transmission would increase to around 60% in the next 100 years.12 Children are particularly susceptible to malaria.
SPECIFIC IMPACT ON CHILD HEALTH
The health impacts of environmental change will affect all age groups but children are among the most vulnerable to these effects. Some of these are noticeable now, namely the postulated effects of motor vehicle pollution in contributing to asthma and respiratory problems,13 14 the effect of lead poisoning on neurological development, the effects of ozone depletion on skin cancer, and the indirect effect of the growth of road traffic on patterns of children's exercise,15 prevalence of obesity, and pedestrian injury rates.
Sustainable development
The concept of sustainable development was first discussed by the World Commission on Environment and Development in its reportOur common future in 1987.16Their definition was “ . . .development that fulfils the needs of the present generation without endangering the needs of future generations”. In essence it stipulates that no environmental burdens, such as the build up of greenhouse gases, pollution of seas and rivers, unmanageable amounts of waste, and loss of natural habitats, should be inherited by future generations—thus establishing the principle of intergenerational equity. A useful concept is the “ecological footprint”: the surface area required to feed and absorb the waste of a person, group or city. The footprint of London equals the UK's entire area of productive land, around 125 times London's surface area, a total of 19.7 million hectares. European citizens average a footprint of three hectares each, North Americans require between four and five, yet worldwide only one and a half hectares of productive land is available per person.17 At the United Nations Earth Summit in Rio de Janeiro in 1992, over 150 countries signed up to a global action plan for the 21st century—Agenda 21. They announced the Rio Declaration of Environment and Development,18 the first principle of which states that “ . . .human beings are at the centre of concerns for sustainable development. They are entitled to a healthy and productive life in harmony with nature”. Sustainable development attempts to improve the quality of human life, while living within the carrying capacity of supporting ecosystems. The objectives of sustainable development are to ensure the quality of life both for people now and for generations to come. In this sense it is rooted in responsibility and justice for others—can we accept that the developed nations currently use 50 times more energy per person than the developing nations; that the 57.5 million people added to the northern hemisphere population during this decade will add more greenhouse gases to the atmosphere than the roughly 900 million added to the southern hemisphere; that global warming is likely to lead to a rise in sea level which will displace 30 million people living in low lying areas in India alone? The debate over the relative importance of population control in developing countries (is there a need for a “one child world”?19) and reduction of consumption in the rich developed countries was well covered in a recent special issue of the BMJ (9 October 1999). There has been a measure of agreement internationally that action must be taken, and at the world conference on sustainable development in Kyoto, Japan in 1997,20 a target of 8% reduction of 1990 emissions of CO2 by 2010 was set for the European Union countries, 7% for the USA, and 6% for Japan and Canada. The UK government has taken a lead and has set itself a target of 20% reduction. The means of meeting this target will be by home energy efficiency programmes, increased business energy efficiency, increased road vehicle efficiency, and reduced road traffic.
Local Agenda 21 (LA 21)
Agenda 21 recognises that success depends on action at a local level and that local authorities have a vital role to play: all are expected to have a clear strategy in place by the year 2000. These strategies could include protection of the environment by minimising waste, meeting social needs by ensuring access to good food at low cost, and promoting economic success by encouraging access to local facilities in ways which make less use of the car.
What is the role of paediatricians in sustainable development? Paediatricians have four roles to play in relation to sustainable development and child health:
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to educate themselves and to ensure that this subject becomes part of the teaching and training of paediatricians
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to advocate for the principles of sustainable development both locally and nationally
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to set a personal example by adopting the principles of sustainable development in their own lifestyles
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to develop appropriate research methods to assess the health impact of policy decisions on children.21
A practical personal agenda might include
Energy—insulating and draught proofing your home, reducing thermostat settings, using low energy light bulbs, and switching off appliances when not in use Waste—reusing containers, buy loose not packaged products, complain about overpackaging, composting green waste, and recycling bottles, paper, plastic Transport—avoiding unnecessary car travel, walking or cycling to work, sharing car journeys, using a compact energy saving car, driving at moderate speeds, lobbying for better public transport, teleconferencing rather than meeting Purchasing power—buying local goods or recycled products, buying repairable goods, avoiding disposable products, using local shops, buying local holidays or supporting ecotourism Food—growing your own, buying local food, buying organic food, buying Fair Trade goods, reducing meat intake Leisure—joining local environmental and wildlife groups, supporting Local Agenda 21 initiatives Family planning—no more than one child per adult National—support the government's targets for CO2 reduction and lobby for maintaining this commitment together with the introduction of green taxes (polluter pays)
Conclusion
The fact that an individual's health and quality of life depend to a great extent on the physical, social, and economic environment in which they live is hardly controversial. Not only can we intuitively recognise this as being true but there is an increasing weight of scientific evidence attempting to explain patterns of health inequality in terms of social, economic, and geographical factors. The more the health impact of social and economic policies is recognised, the more obvious the importance of sustainable development will become. By adopting a sustainable development philosophy in our personal and work lives, we begin to change the way we and others think about “progress”, and the values upon which society is based. The concept and philosophy of sustainable development is possibly the most important concept to emerge at the end of 20th century. We believe that if all people, from the individual to the transglobal international company, understood and took decisions based on sustainable development principles, they would significantly reduce inequalities within and between today's and future generations, improve the quality of their own lives, and preserve the planet earth for our children.