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Environment, injury, and child health in Europe

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The children’s environment and health action plan for Europe (CEHAPE) was on the agenda for the Fourth Ministerial Conference on Environment and Health held in Budapest at the end of June 2004. An action plan released by the European Commission on June 9 included 13 actions to be implemented by 2010, including expansion of environmental research and training. A WHO sponsored study of the environmental burden of disease (EBD) in children (

) was carried out in order to provide data for the development of CEHAPE.

The EBD was assessed in terms of deaths and disability-adjusted life years (DALYs) from published data but gaps in data and potential sources of error and uncertainty have limited the analyses. Nevertheless useful conclusions can be drawn. Analyses were restricted to four environmental factors (outdoor air pollution, indoor air pollution, water and sanitation, and lead exposure) and injury. It was estimated that outdoor air pollution accounted for 6.4% of all deaths in children under the age of 5 years and acute lower respiratory tract infection due to indoor air pollution accounted for 4.6% of deaths in this age group. Diarrhoea from inadequate water supply and sanitation accounted for 5.3% of deaths in children under the age of 15 years. Morbidity was not estimated for outdoor air pollution but it was calculated that indoor air pollution accounted for 3.1% of DALYs (children aged 0–4 years), lead exposure (by causing mild mental retardation) for 4.4% of DALYs (children aged 0–4), and inadequate water and sanitation for 3.5% of DALYs in children aged 0–14 years. (Figures for deaths and DALYs from indoor air pollution are not included for western Europe because of lack of adequate data.) Injury was the cause of 22.6% of deaths and 19% of DALYs in children and adolescents aged 0–19 years.

The WHO divides Europe into three subregions: EurA (broadly western Europe), EurB (a swathe of countries from Poland, through the Balkans and Turkey, to the southern countries of the former USSR), and EurC (broadly the rest of the former USSR and former satellites). The environmental risk factors were much stronger or more prevalent in EurB and C than in EurA and consequently the EBD was much higher in these subregions.

Appropriate actions, targeted according to need, should result in substantial gains in childhealth. Environment, health, transport, energy, urban planning, and education sectors will have to be involved as well as governments as a whole.