RISK COMMUNICATION AND THE PROTECTION OF
CHILDREN’S ENVIRONMENTAL HEALTH
Terri Damstra, Ph.D.
World Health Organization

Effective communication on the risks of environmental hazards to children is critical to developing intervention and prevention programs. Risk communication is not a one-way transfer of information from the expert to the non-expert, but an interactive process of exchange of information and opinion among individuals, groups, and institutions. Risk messages must be accurate, credible, and understandable. In order for risk messages on the environmental threats to children not be misleading, they must be evidence-based and placed in an overall framework of priority concerns regarding children’s health. In order to obtain a realistic perspective of the major issues related to children’s environmental health in Pacific Basin countries, a questionnaire was sent to participants prior to the meeting. The following tables summarizes the responses from 34 participants representing 12 countries.

TABLE 1

Summary of Questionnaire Results Regarding Major Environmental Threats

to the Health of Children in Pacific Basin Countries

Priority Health Concerns*

Sources

Agents

1. Respiratory Diseases - Traffic

- Air pollution

(indoor/outdoor)

- Industry

Particulates

Nox

Sox

Carbon Monoxide

2. Water-borne Diseases (diarrheal, G.I.) - Industry

- Inadequate sanitation

Bacteria

Parasites

3. Poisonings, Accidents - Household products

- Industry

Pesticides

Hazardous wastes

4. Impaired Neurobehavioural Development - Industry Lead, mercury, dioxin, PCBs
*Priority order based on percentage of responses.

TABLE 2

Summary of Questionnaire Results Regarding Risk Communication of

Children’s Environmental Health (CEH)

 

Government Awareness

Policies/Regulations

Availability of Data Bases

Mechanisms of Risk Communication*

Barriers of Risk Communication*

Opportunities to Improve Risk Communication*

Excellent (10%)

Some (55%)

None (35%)

1. Mass Media 1. Lack of expertise and resources. 1. Increased community awareness and concern.
2. Physicians, health professionals, educators. 2. Lack of communication among government sectors. 2. International pressures and concerns.
3. Government 3. Political/cultural influences. 3. Availability of electronic means of information dissemination.
*Priority order based on percentage of responses.

Mongolia surface water chemistry and its impact to human health 
P.Batima, Ph.D., Institute of Meteorology and Hydrology

The rivers in Mongolia are originate from one of the three largest mountain ranges: Mongol-Altai, Hangai-Huvsgul and Hentein. The rivers are divided into three main basins, depending on its drainage system: Arctic Ocean Basin (AOB), Pacific Ocean Basin (POB), and Internal Drainage Basin (IDB) of Central Asia. Mongolia water resources are unequally distributed over the country i.e. in the northern part of the country the available water per capita is 4-5 times more than the world average while it is 10 time less in southern part i.e. in the Gobi. Similarly water quality also has spatial character. The chemical composition of the rivers and their changes are related to variations in altitude and climatic conditions. For example: the rivers flowing from the high mountains have lower concentrations of ions, whereas the water in southern part has relatively high amount of ions. In other word the water in northern part of the country represent low salinity soft water while the water of the southern part represent high salinity hard water. 
The open surface water such as river, lake, spring and others are used as a source for drinking as well as agricultural water use in rural area. About 40 percent of the rural area use unsafe water for daily use. Therefore evaluation of surface water chemistry in terms of human health concern is important issue. Data present here show certain relation of water chemistry with some diseases occurred in rural area. Therefore this paper is aimed to discuss about circulatory and digestive and genito urine system diseases resulted from the water use that has high or too low contents of some dissolved salts in it. For instance: in the Gobi region where water is much harder than any other places the occurrence of high blood pressure per 10000 person is almost twice as many as in other places. It is also found that digestive and genito urine system disease increases with increased concentration of total dissolved salts. 
Key words: Calcium, magnesium, total dissolved salts, circulatory system disease, digestive and genito urine system disease. 


Aeroallergens in Singapore - outdoor environment
Dr. Fook Tim CHEW, Department of Paediatrics, National University of Singapore

Continuous air sampling of the outdoor airspora environment in Singapore has been carried out since 1990 at 3 different sites. Fungal spores were found to be numerically dominant, comprising between 86.0-89.4% of the total airspora which also consisted of spores of fern (6.2-8.6%) and pollen grains (4.4-5.4%). Conidia of Cladosporium were the most abundant fungal spore type, followed by the ascospores of Didymosphaeria, and the conidia of Curvularia, Drechslera and Pithomyces. The predominant fern spore present in the atmosphere was that of Nephrolepis auriculata (making up between 50.9-55.8% of the total fern spore counts), followed by spores of Dicranopteris linearis (24.4-27.1% of total fern spores), Stenochlaena palustris (5.2-6.2%), Asplenium nidus (2.0-3.8%), Pteridium aquilinum (2.8-3.6%) and Dicranopteris curranii (3.4-4.4%). With pollen grains, pollen of Elaeis guineensis, Casuarina equisetifolia and Kyllingia polyphylla were the most abundant (> 20% of total pollen depending on the site). Pollen of Acacia auriculiformis, Ptycosperma macarthuri and Podocarpus polystachyus were also found relatively frequent (>10% of the days surveyed). Seasonal variations in the spore or pollen densities were discernible despite the relatively uniform tropical climate. In addition, association between spore/pollen counts and local meteorological conditions were also analyzed and found to be highly correlated. This study has thus identified the unique airspora profile of the local Singapore environment. Sensitization to these airspora has also been documented. 


Regional Issues Concerning Children's Environmental Health - Singapore
Dr. Fook Tim CHEW, Department of Paediatrics, National University of Singapore

This presentation will look at several issues concerning children's health in relation to the environment in Singapore. The island city state of Singapore is notable for its modern and highly urbanized environment. To obtain leads into issues that may affect children in Singapore, we looked at it from the healthcare utilization perspective. The leading causes of hospitalization for children under the age of 15 years old are (1) accidents and injuries (accounting for 6.3% of the total), (2) asthma (5.6%), (3) congenital anomalies (5.0%) and other perinatal conditions (4.3%). The leading disease conditions seen in private practitioner clinics and government are upper respiratory tract infections (>50%) and asthma (8%). From these figures, it was noted that asthma figured prominently as a leading cause of morbidity in Singapore children. Our recent survey showed that at least 1 in 5 school children has been doctor diagnosed with asthma. A substantial degree under-recognition however still exist. Asthma has also been estimated (conservatively) to cost approximately US$37 million per annum in a population of 3 million. With atopy being highly associated with asthma, we thus evaluated the indoor and outdoor aeroallergen environment in Singapore. Dust mites were found to be highly prevalent in Singapore homes, with Blomia tropicalis being the most prevalent. The atopic population was found to be highly sensitized to the unique local mite fauna. The outdoor environment was also found to be an important source of allergens. Fungal spores were numerically dominant outdoors (86-89% of total airspora). Additionally, a total of 34 fern spore and 83 pollen types were also identified. Sensitization to the major pollen and spores has been documented. We have also observed that the childhood acute asthma exacerbation rates (documented as hospital admissions and emergency room visits) have distinct peaks in January-February, May and August each year. Ambient air pollutant levels may play a role in contributing to this seasonal variation. This presentation will also touch on the regional haze and its effects on respiratory health, particularly in children. 


Aeroallergens in Singapore - indoor environment 
Dr. Fook Tim CHEW, Department of Paediatrics, National University of Singapore

The indoor environment of Singapore is rich sources of allergens. This presentation summarizes the allergenic profile of this island city state which is notable for its highly urbanized environment. We evaluated the prevalence and distribution of indoor allergens in a cross-section of 956 dust samples obtained from homes, childcare centres, schools, and a hospital. Additionally, we evaluated the dust mite fauna in 134 of these dust samples from 50 homes. Our results showed that homes had significantly higher concentrations allergens compared to the other locations, except for the cockroach allergens, where higher mean levels were found in schools. Within the homes, the highest concentrations of mite allergens were found in bedroom mattresses and carpets, whilst cockroach allergens were mainly concentrated in the storerooms and kitchens. Animal dander allergens were well distributed and not confined to homes with pets. Their highest levels were found in dust of soft furnishings, which included the sofas, carpets and mattresses. There was an absence of significant seasonal variation in dust mite allergen levels in the homes over a one year period. From our mite isolation studies, we found 130/134 (97%) samples infested with mites. All samples from sofas and carpets had more than 500 mites/g compared to 47/50 (94%) and 23/50 (46%) from mattresses and floors, respectively. Blomia tropicalis was the predominant mite (62% of total mites) followed by Dermatophagoides pteronyssinus (16% of total mites). Additionally, a unique fauna was observed with samples infested with less known dust mites such as Sturnophagoides brasiliensis, Tarsonemus granarius, Austroglycyphagus malaysiensis, Cheyletus malaccensis, Malayoglyphus intermedius and Suidasia pontifica. The results indicate that compared to public places, the home still consitutes a major reservior of indoor allergens. Allergens of the storage mite, B. tropicalis, should be considered as a major allergenic component of dust in Singapore. 


Mongolian climate and children health
M. Erdenetuya* and R. Erdenechimeg**)
* Scientist, Information and Computer Center of Ministry of Nature and Environment
** Doctor, Sukhbaatar Health Complex of Ulaanbaatar city

There are human death and distribution of disease on the World, because of the World climate changes and Weather unstable conditions. Human have adapted to the environment, but they still have unhealthy and healthy situation with the climate changes. In other word human health is fully dependent on weather conditions. In case of Mongolia, the severe continental climate has becoming the main factor of certain diseases and their quick distribution. In time assessment of weather impact to the human health could support the possibility to prevent from unsuitable impact to the human health and reduction of negative influences. Air pollution caused by human activity results in increase of some diseases of city inhabitants in Mongolia. About 55 percent of total population of Mongolia live in cities particularly 25 per cent live in Ulaanbaatar. Thus the purpose of this paper is to assess the relationship between air pollution of Ulaanbaatar city (the capital) and children's respiratory sickness. The result of the study snows clear linear relation of increased concentration of CO, SO2, NO2 in air and respiratory diseases. Its correlation coefficient was 0.83. Children's Respiratory diseases of children under 5 years old is 2-3 times higher in Ulaanbaatar than in rural area. The results are represented in time/seasonal bases i.e air pollution increases when air temperature changes exceeds 4.60C. Air pollution in Ulaanbaatar increases in winter time accordingly the pick of respiratory diseases occur in this period. Moreover, 25-42 percent of the inspected and 32.6 percent of treated patients have respiration diseases. 
Key words: respiration diseases, bioclimate, sulfur dioxide, air pollution. 


Cognitive and Behavioral Alterations from Environmental Contaminates
David O. Carpenter, M.D. - University at Albany, School of Public Health

There is increasing evidence that a variety of environmental contaminates, including metals like lead and methyl mercury and organic substances such as polychlorinated biphenyls (PCBs), dioxins and some pesticides, cause detrimental effects on intelligence and behavior in children. While all of these substances cause neurotoxicity at any age at high doses, prenatal or early postnatal exposure to such xenobiotics, when the brain is developing, causes damage which appears to be irreversible. 

The effects of lead and of PCBs on intelligence and behavior have been best studied. Lead exposure can come from dust from leaded gasoline, mining and smelter operations, lead added to paint and from various occupational sources and manufactured products. The levels of blood lead considered to be ?safe? have continued to fall, and now it is generally accepted that at levels of blood lead of 10 µg/dl or greater there is a decrement of IQ. The degree of IQ decrement is of the order of 4-8 IQ points for every 10 µg/dl increment in concentration. These children also show a shortened attention span, cause more disruptive behavior in school and are less likely than less exposed children to perform well academically. 

PCBs are persistent chlorinated compounds that are no longer manufactured and used in most parts of the world. Because they are resistant to degradation both in all animal species and in the environment, they have bioaccumulated in fish from contaminated waters. Fish consumption is the major but not the only route of exposure to humans. Like lead, PCB exposure in early life results in a reduction of IQ of between 4-8 IQ points. Animal studies also demonstrate hyperactivity and other behavioral abnormalities. Methyl mercury is often a co-contaminate in fish, and may have similar and even synergistic interactions with PCBs in causing IQ decrements and behavioral alterations. There is clear evidence of behavioral alterations in animals exposed to dioxins, furans and pesticides, but while there has been less clear demonstration of these effects in humans, it is likely that these substances also affect intelligence and behavior.

Environmental contamination which results in a reduction of the intelligence of the next generation is the ultimate pollution tragedy. It is very important to protect children from exposure to these agents.


Performing A Community Health Assessment
Elizabeth Guillette, Ph.D. - Bureau of Applied Research in Anthropology, University of Arizona

A manual describing the necessary steps for an initial community health assessment is presented. The manual is written for individuals who lack scientific training in research methods but are concerned about the influences of environmental contamination on the health of their community. Many communities of the world lack access to help from the scientific community. Steps covered include ways to identify local concerns, creating community interest in the topic, various approaches to assessment, analysis of data and writing the final report. The results of the study are meant to identify areas in which professional research may be of value and to stimulate local change for an improved environment. The manual is written in basic English, with definitions of scientific terms. Limited copies of the manual will be available for NGOs and community workers. 


TOXIC EXPOSURES AND POISONING IN CHILDREN
Jenny Pronczuk de Garbino, M.D., Task Force on the Protection of Children's Environmental Health, Department for the Protection of the Human Environment, World Health Organization

This paper presents an overview on toxic exposures in children (global aspects), on the type and circumstances of exposure, the main chemicals involved and the roles played by poisons centres (PCs) and related facilities. It states the main activities developed by the International Programme on Chemical Safety (IPCS) and the Task Force on the Protection of Children's Environmental Health, set up by the Department for the Protection of the Human Environment in July 1999. 

Poisons Centres and related units are in a strategic position to play a potential "sentinel" role in children's environmental health. New PCs are being established in developing countries, and joining the existing ones through networking arrangements that facilitate interaction and communications. Most centres interact with health authorities and the academic sectors, are staffed by professionals with experience in toxicology and related sciences, and are becoming involved in environmental health issues. More and more PCs are able to record acute and chronic toxic exposures in children in a harmonised manner, using controlled vocabularies and definitions. This will allow, in the future, the compilation of a valuable database on the main toxicological problems affecting children, including those of environmental origin. The analyses of such a database will help assess the burden of disease and collect the evidence for planning interventions. PCs are called to play a more proactive role in raising awareness about CEH and contribute to research, information dissemination, training and other activities required for the protection of children's environmental health and development. 


DDT pesticide residue in human milk
Dr. Frans.X.Suharyanto Halim
, Non-Communicable Diseases Research Center, National Institute of Health R&D, Min.of Health, Jakarta, Indonesia

Mother's milk is the main food for a baby also as a good media for assessing exposure of pesticide because it is easy to collect, non-invasive and has been shown to give an indication of long term accrual of pesticide residues. DDT was banned in Indonesia in the early 1980s (except for Malaria Eradication Programme), but since 1994 DDT has not been used anymore in Indonesia for Anopheles mosquito control. 

Some studies concerned DDT pesticide residue in human milk was done in Kulonprogo, Central Java, 2 years and 8 years after spraying were 45.3 + 26.0 ug/g and 7.2 + 1.9 ug/g on the fat basis (Noegrohati,1992). However, in 1998 preliminary study was done in Jakarta (2 samples), the result 4.8 and 17.6 ug/g fat and in Tangerang (2 samples) the result 0.37 and 4.84 ug/g fat. This study was done together with Prof.Ian Shaw from Lancashire University, UK. It is inappropriate to draw firm conclusions from these preliminary results because they are derived from a very small number of samples, however they suggest that DDT is still in use in my country. If the result compared with other Asean countries also higher than the others.

The impact of DDT to human is still debated, and need sufficient evidence for reproduction
organ, caused brain damage and carcinogenic effect. Finally, DDT pesticide residue in human milk has to investigate in more samples to get how far DDT is still use in Indonesia, and to increase & tight monitoring of the use of DDT and law enforcement. As a result, residue of DDT in human milk could be minimized and the mother's milk safe for the baby. 


Immunotoxicology and Childhood Diseases
Yong Heo, Cheol Young Oh, Bo Wook Kim, Hyoung Ah Kim, WonJin Institute for Occupational & Environmental Health, Kyonggi-do Province, Korea, Yonsei University College of Medicine, Seoul,  Dept. of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea

Children are exposed to various environmental contaminants including heavy metals, fine particles, volatile organic compounds, polycyclic aromatic hydrocarbons, and pesticides through ingestion, inhalation, or skin contact. Human health risk from exposure to the environmental toxicants has been assessed primarily on carcinogencitiy, neurotoxicity, respiratory illness, and developmental effects. Since the immune system of children is undergoing maturation, an immunological perturbation resulting from exposure to an environmental toxicant may increase susceptibility to childhood diseases such as infectious diseases, allergic diseases, or cancer. Furthermore, a variety of neurological or endocrinological problems may be related with environmental toxicant-induced disturbances in immunohomeostasis, considering accumulated evidence of neuro-endocrine-immune system cross-talks. 
This presentation will focus on immunotoxicities of environmental toxicants with major concern worldwide because of its detrimental health effects on children populations. Immune-suppression and/or aberrant immune-potentiation (hypersensitivity or autoimmune disease) relevant with exposure to environmental immunotoxicants will be discussed. Ability of immunotoxicants to modify the activities of helper T cells, cytotoxic T cells, B cells, macrophages, and other immunoregulatory cells will be discussed as well as effects of the environmental toxicants on differentiation of naďve or precursor immune-component cells. Immunotoxicological methods for evaluation of potential immunotoxicities in experimental animals and humans will be described. Immunotoxicities of lead (Pb), mercury (Hg), nickel (Ni), diesel exhaust particles (DEP), environmental tobacco smoke, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), polychlorinated biphenyls(PCBs), and pesticides will be extensively addressed.


Some findings of a study on effects of herbicides and defoliation on health status of people living in A luoi Valley, Vietnam
Tran Manh Hung, M.D., Hoang Dinh Cau, M.D., Phung Tri Dung, M.D. National Committee for Investigation of the Chemicals used during the Vietnam War (10-80 Committee)

A large amount of herbicides and defoliation was used to destroy the forest of South Vietnam by the U.S. Army during the years 1961 to 1971. The levels of use for the military operation (Ranch Hand Operation) was 20 to 40 times greater than for normal agricultural usage. A luoi Valley is an area along the Ho Chi Minh trail. It was been one of the most heavily sprayed areas (approximately a half million gallons). Since 1993, a survey has been implemented by the 10-80 Committee with support from the Hatfield Group (Canada) to assess the environmental and epidemiological status of A luoi Valley and its population. 

The initial results show that the surrounding area of the Aso airfield has a very high level of dioxin concentration in soil. The ratios of reproductive abnormalities and congenital deformalities are two or three times higher as compared to the pre-war ratios. Analysis of dioxin concentration in poultry and fish show a significant level of dioxin, which could be a sign of the presence of dioxin in food chain. It is difficult to provide an exclusive conclusion since there are many uncertainties in our study. However, we could at least conclude that with the high levels of dioxin concentration of dioxin in soil, and especially the presence of dioxin in food chain, further studies on herbicides and defoliation on human health need to be carried out.


Environmental Health Issues of Children in Villages in the Vicinity of a Paper and Pulp Mill  
D Koh, SM Saw, MR Andjani*, Syafril Nurdin+, J Lee, ML Wong, SE Chia, CY Hong, CN Ong, Department of Community, Occupational and Family Medicine MD3. 16, Medical Drive, National University of Singapore, Singapore

Recently, some villagers living along Sungei Kampar, Sumatra, believed their health was affected by polluted river water. The main concern was skin complaints. It was perceived that effluent discharges from a pulp and paper mill was the cause.
A study was conducted of the health status and skin conditions of villagers living along the river in the vicinity of the mill. Three villages - Rantau Baru(R) 45 km upstream, and Sering(S) and Pelalawan(P), 8 km and 25 km downstream from the mill - were surveyed. 
One hundred houses in each village were randomly selected. Altogether, 145, 167, and 126 children <12 years from R, S, and P respectively were examined by a team of doctors. Response rates were >95%. River water was analysed on 3 occasions at locations upstream and downstream of the mill.
Age and sex distributions of children were similar in R, S and P. Immunization coverage was incomplete (34%, 31%, 56% for BCG). Two-week recall rates of diarrhoea (17%, 20%, 8%), fever (35%, 20%, 21%) and passing out worms (3.5%, 7.2% 2.4%) were reported. The majority (80%, 63%, 85%) did not have significant skin problems. Fungal infections and non-inflammatory skin conditions were the main disorders (18%, 32% and 8% respectively). Dermatitis was uncommon (2%, 5%, 2%), and not significantly different between upstream and downstream villages (p=0.11). Physical, chemical and biological parameters of water quality were generally acceptable for river water and similar upstream and downstream.
These findings suggest it is unlikely that river water is a cause of inflammatory skin disorders in the village children living downstream of the mill. Skin conditions appear to be less of a priority compared to other public health issues, e.g. incomplete immunization coverage, high rates of diarrhoea and fever.


EPIDEMIOLOGY OF CHILDHOOD ASTHMA
Christopher Lai, Department of Medicine & Therapeutics, The Chinese University of Hong Kong

Epidemiology provides information not only on the magnitude of problems a disease imposes on society but also helps shed light on its aetiology. In an attempt to better define the impact and aetiology of asthma, the International Study of Asthma and Allergies in Childhood (ISAAC) Phase I conducted standardised simple surveys in school children from most regions of the world. Two age groups (13-14 and 6-7 yrs) comprised over 0.7 million children were studied, of which 2/3 were from the older age group. Marked variations in the prevalence of asthma symptoms with up to 15-fold differences were seen between countries. The prevalence of wheeze in the last 12 months ranged from 2.1-32.2% in the older age group and 4.1-32.1% in the younger age group. Prevalence was highest in English-speaking countries and Latin America, and lowest in the less affluent countries in Asia, Eastern Europe and Africa.
These wide variations in asthma prevalence suggest that environmental factors are likely to be important aetiological determinants of this disease. Ecological analyses of the Phase I data confirmed a significant correlation between the prevalence of asthma symptoms and indicators of affluence, e.g. GDP, the per capita consumption of trans fatty acids, and the notification rates of tuberculosis (negative correlation). Phase II of the study is currently underway and will provide more information on the environmental risk factors for asthma at an individual level. 


Risk Assessment for Children and Other Sensitive Populations
Dr. Philip J. Landrigan, Mount Sinai School of Medicine

Children form a unique subgroup within the population who require special consideration in risk assessment. Children are not little adults. Their tissues and organs grow rapidly, developing and differentiating. These development processes create windows of great
vulnerability to environmental toxicants. Furthermore, the exposure patterns of children to environmental chemicals are very different from those of adults. Traditional risk assessment has generally failed to consider the special exposures and the unique susceptibilities of infants and children. Adoption of a new child-centered agenda for research and risk assessment is necessary
if disease in children of toxic environmental origin is to be identified, understood, controlled, and prevented. This agenda needs to be multidisciplinary. Specific requirements within the agenda include: (1) exploration and quantification of unique patterns of exposure for children (2) adoption of new, more sensitive approaches to testing chemicals that can recognize the consequences of exposure during early development (3) identification, through clinical and epidemiologic studies, of etiologic associations between environmental exposures and pediatric disease and (4) elucidation, at the cellular and molecular levels, of the pathogenetic mechanisms
of pediatric environmental illness.


Agent Orange and Its Effects on Children's Health
Dr. Le Hung Lam, Hanoi School of Public Health

Agent Orange was an herbicide employed during the years 1961 to 1971 in the Vietnam War. It is the code name for a mixture of 2,4,5-T (2,4,5.-trichlorophenoxyacetic acid 545.4 Kg/m3) and 2,4-D (2,4-dichlorophenoxyacetic acid 485.1 kg/m3), altogether weighing 1 285 kg/m3. Associated with the 2,4,5-T moiety is the impurity, dioxin, (2,3,7,8-tetrachlorodibenzo-p- dioxin). This paper is to review currently epidemiology and environmental studies on Agent Orange and its effects on children's health in Vietnam. Surveys of Vietnamese soldiers show that 5% of the children fathered by veterans who were heavily exposed to Agent Orange were born with birth defects, compared to only 1% for soldiers who remained in North Vietnam and avoided exposure. A survey among Vietnamese veterans shows that the relative risk in the heavily exposed group is 4.27, with a Chi square of 22.22 and p<0.001 with 95% confidence interval is 8.28-617.29. A case-control study in 2 similar villages in South Vietnam showed the birth defect in a sprayed village was 4 times higher than in an unsprayed village (Relative risk: 4.2). A cohort study showed an obvious correlation between dioxin exposure and birth defects in newborns: relative risk: 3.24, chi-square: 18.64, p<0.001. An analytical study of breast milk contaminated with dioxin in South Vietnam showed that: Dioxin levels in breast milk of nursing mothers living in South Vietnam tend to increase gradually from the mean value of 1331.0 ppt (in1970) to 498.5ppt (in 1987-1988). Hanoi, an area exempt from spraying missions, showed the lowest dioxin levels (TCDD=2.2ppt TEQ=8.8ppt) meanwhile, in South Vietnam, TCDD and TEQ in Ho Chi Minh city are respectively 7.7ppt and 18.5ppt and in Song Be are 17.0ppt and 31.7ppt (on basis of fat containing in breast milk). A chromosomal analysis in generation F2 of Agent Orange exposed veterans has noted higher frequency of most chromosome aberrations than that of control group (p<0.001). Even with the limitations on research in Vietnam, there are strong indications that exposure to dioxin has led to a significant increase in serious birth defects.


Environmental threats to the health of children in Cambodia
Long Vudthy, Participatory Action Research Specialist for United Nations Volunteers & Project Manager for Community Khmer Traditional Medicine, Lucent Rainbows Foundation, Cambodia

Cambodia is one among the poor countries that was affected by the civil war almost two decades. So far, every infrastructure like: school, road, irrigation
system and especially, the hospital are not found to be rehabilitated. These factors often cause many trouble to the people especially, the children. Major issues that threaten to the children's health are from many factors:

Children of the poorest families living in rural areas where the primary health care information is not adequately disseminated or the children whose parents lack the family hygiene often face with many health problems. This would lead them to various types of diseases like diarrhea and dysentery as very much often these diseases are caused by unclean water from their hand-made wells, the wells that have always covered by annual flood or refilled by cattle's waste or of other various contaminated elements.

Homeless children. Group of homeless children are also affected by health problems as normally, they live by the roadside and malaria is also found in these children as well, as at the night time they have slept without mosquito-net. Some children are breathing with the bad smell of ugly atmosphere from the pile of the garbage everyday, possible exposing to trace dioxins in the dangerous smoke from uncontrolled open burning. These children generally go to the rubbish pit to pick up beer-bottles, beer-can or eat expired food being thrown away by sellers. Groups of these children are found to be infected by Typhoid Fever as the bacteria goes from their fingers to the mouths while eating without properly washing.

- Children eat expired food sold in the market by bad business people.
- Drinking water of bad quality from hand-made well as the water is mixed with Iron element and bacteria.
- Uncontrolled garbage. Uncontrolled garbage in city or around the houses is also another serious problem to the health of children through the flies, mice or other insects that are transmitted agents.
Mosquito is another agent that bring up with malaria at the night time and another type of these mosquitoes that are called "Tiger mosquitoes" can cause the dengue fever to the children at the day time. The sources of these insects are from the pile of garbage or rubbish pit. 
- Using pesticide: In Siem Reap alone from the end of 1999 till the very beginning of the year 2000, about 23 % of children age from 6 to 12 years old in the village around Angkor Park are found to have skin disease because of pesticide (toxic drug) like DDT being used by farmers where many farmers have grown the vegetable, water melons. 

Children exploitation. Many children were smuggled or sold to the neighboring countries and forced to be the beggars by groups of bad people who absorb the benefit over the children. (Some children were forced to receive type of medicine that destroyed their limbs and then they became disable. This is what the thugs thought that it could be the easy way to beg). All income that children received from generous people were confiscated by these bad people and the children can get only very little benefit through their efforts.

The environment of the child, children's energy and their sense of wonder; we mean the atmosphere, situation, condition, among the body of the children; the air, water, ground and soil, and of the living threats, from HIV, viral hepatitis and polio, of having enough nourishment, the landmine kill the small body, of refugee trauma, of family and of mothers, and of the Khmer women depression relief.

"Home" for some children at the Phnom Penh city dump consists of makeshift shelter located on top of the garbage

A young girl scavenging for food and items to sell at the Phnom Penh city dump


Children and Environmental Toxicants: The Philippine Experience
Irma Makalinao, M.D., Department of Pharmacology and Toxicology University of the Philippines College of Medicine; National Poison Control and Information Service University of the Philippines - Philippine General Hospital

Various forms of toxicants beginning at the home environment confront the Filipino child. Data from our Poison Center shows that accidental poisoning occurs as a consequence of exposure to household poisons like kerosene, insecticides, rat killers, naphthalene balls and bleaching agents to name a few. Since 1991, accidental ingestion of a dancing firecracker called "watusi" became an important cause for mortality and morbidity among our children. White phosphorus is the most toxic component of "watusi". While exposure to environmental tobacco smoke has been an old problem, today the Filipino child is threatened by in-utero exposure to a methamphetamine.

At the national level, the Filipino child is exposed to various hazards from industry and occupations engaged in by the adults in their environment. For example, neurotoxicity following metallic mercury exposure from gold torching in the home environment has been documented. Toxicity following chronic exposure to lead and mercury is an area of major concern. There are
on-going community health assessments being undertaken jointly by the National Poison Control and Information Service and the Department of Health. Chelation therapy among school children in Tagum, Davao with elevated blood mercury levels has been done beginning in 1997.

The magnitude of lead poisoning among Filipino children cannot be underestimated. Significant sources of lead exposure include unleaded gasoline, battery recycling and mining activities to name a few. In 1996, one of the worst mining accidents took place in the Marinduque Island. Over a period of several weeks 2 million cubic meters of tailings poured from the tunnel into the Makulapnit and Boac rivers making them unsuitable for use.
In response to this environmental disaster, an immediate community health assessment was conducted in Boac, Marinduque where elevated levels of lead, copper and cadmium was documented for the fist time in a few of the residents examined. In 1997, 7 out of 41 children examined had blood lead levels (BLL) between 11 - 13 ug/dL. Six months later, the levels went up to 13 - 19 ug/dL. Varying degrees of malnutrition and anemia were noted. The children complained of weakness, easy fatigability, dizziness, poor weight gain and abdominal discomfort. EMG-NCV studies showed that all the seven children exhibited mild to moderate motor-sensory polyneuropathy the etiology of which was non-specific. In another batch of children with levels below 20 ug/dL initial nerve stimulation studies for children were
mildly abnormal. Abnormalities were the reduction in the amplitude of the compound muscle action potential of the peroneal (6/8), tibial (4/8) and median nerves (3/8). Abnormalities in the reduction of the amplitude of the sensory action potential of the median and ulnar nerves were found in one patient. Vitamin and mineral supplementation has been started. After nearly 1 - 2 years of follow-up chelation therapy with DMSA was initiated for the symptomatic children while carefully monitoring them for any adverse effects. A remarkable improvement in the over-all health status of the children was noted immediately post-chelation. It is very difficult to ignore the fact that lead has no physiologic value in the human body.
Recent studies show that adverse neurobehavioral effects may occur at blood lead levels below 10ug/dL. Thus, the decision to finally chelate a child must be done on an individual basis.


Deterioration of children's health due to environmental causes is directly related to the increase in breast cancer incidence
Danilo V. Meneses, Philippine Breast Cancer Network

In the region of Western Mindanao with a population of 2.8 million where 75% live below poverty level, only 120,664 or one fourth of households have access to safe water facilities - all in the urban areas of the three provinces. This situation can be understood from the fact that only 14% of 17,563 hectares for reforestation has been accomplished and an aerial view confirms that much of the rainforest areas have already been denuded. In Zamboanga del Sur, severely eroded areas constitute 269,170 hectares or about 41% of the total land.

The three bodies of water in Zamboanga del Norte - Murcillagos Bay, Gipit River and Siocon River - are contaminated with high concentration of mercury due to the operation of gold mining. There already have been reports of children suffering from hemoglobinuria, a disease resulting from massive destruction of the RBC due to metal intoxication.

In Zamboanga City, the Tumaga River continues to deteriorate with the growing number of industrial firms along its banks. The city sewerage system itself drains untreated waste water right into the R.T.Lim Blvd. beach resort, a weekend resort for the city folks. Moreover, not one of the hosipitals in the area has an approriate biomedical waste disposal system. 

The UNICEF now regards the mortality rate of children under five (U5MR) as a truer indicator of a population's well being, rather than the infant mortality rate (IMR). The Philippine's latest figures in 1995 showed that the national U5MR is 53. Western Mindanao (Region 9) reported higher rates: Zamboanga del Norte 83.10, Basilan 82.82 and Zamboanga del Sur 78.57.

Today, Western Mindanao has the highest increase in cancer incidence rate in the entire island at 76% over the last recorded period and for which now stands to be the 4th leading cause of death in this region. Breast cancer is not only the leading type for women but for all cancers as well.

Women have been taught to look within themselves for the cause of their breast cancer genes, their unwise reproductive choices or their stressful lifestyle. Although these factors may contribute to breast cancer and other cancers, they are only part of the story. What about the dioxin in breast milk? What about pesticides in amniotic fluid? What about mercury in drinking water? The toxic world we live in is wounding our children before they are born: sometimes these wounds lead to birth defects, sometimes to asthma. Sometimes they lead to breast
cancer or other cancers.

The greatest risk of getting breast cancer tomorrow is being born today in a developing country. The greatest risk of not surviving breast cancer today is just being a woman in the Philippines.


Persistent Organochlorine Residues in Human Breast Milk from Cambodia, India, Japan and the Philippines
Maricar S. Prudente, Shinsuke Tanabe, Mafumi Watanabe and Annamalai Subramanian, De La Salle University-Manila, Philippines Center for Marine Environmental Studies, Ehime University, Japan Annamalai University, India

Concentrations of persistent organochlorine residues such as hexachlorocyclohexane isomers (HCHs), hexachlorobenzene (HCB), chlordane compounds (CHLs), dichlorodiphenyltrichloethane (DDTs) and polychlorinated biphenyls (PCBs) were determined in milk, sampled in 1998-1999 from mothers living in Cambodia, India, Japan and Philippines. Formula milk powder from two leading food companies in Japan were also analysed for residues of these organochlorine compounds. Differences in contaminant pattern was observed among the countries with DDTs found to be rather high in Cambodia, HCHs highest values in samples from India and those from Japan have high PCBs residues. While OCs residues were at comparatively lower levels in the milk samples from the Philippines, it was evident that breast milk samples analysed here have higher residual OCs concentrations compared with the very minimal residues found in formula milk powder studied.


ENVIRONMENTAL POLLUTION IN TRADITIONAL SMALL SCALE & COTTAGE INDUSTRIES - OCCUPATIONAL HEALTH FOR WOMEN AND CHILDREN
Dr. S.Rajamani and Ms.R.Ramya, Department of Environmental Technology, CLRI., India

In most of the South Asian countries including India for socio-cultural and economic reasons, among others, occupational health of women workers, direct and indirect influence on children call for specific attention since large percentage of women are engaged in unorganized, traditional and unprotected small scale and cottage industrial sector such as Beedi (indigenous cigarette) rolling, match and fire works, hair collection from animal skins in tanneries etc. Even in Organized industries like electronics and chemical industries, emphasis for in-depth in study and support to the improvement of occupational health and safety of the "female" workers is considered essential. This is not only because of women's biological requirements as child bearers and nurtures but also because of the distinctly different nature of their roles on the labour market.

Some of the studies reveal that in the Beedi industries where more than 2 million female workers are involved, the main hazard is tobacco dust, which was found to cause, among others, burning sensation of the eyes, conjunctivitis, mucosal dryness, occupational dermatitis and bronchitis. The investigation on gynecological health aspects indicated that more than 90% women workers have some problem or other like, exhaustion, dizziness, pain in the lower abdomen, menstrual period began earlier than due date, frequent miscarriages etc. In addition to social and cultural reasons, insufficient safety and Environmental problems like inadequate ventilation, absence of separate wash and bathing areas for women workers, particularly in industries handling hazardous chemicals like tanneries, electrochemical units result in the transfer of pollutional effect to young children at home and child growth in case of pregnant women.

Systematic studies on occupational health of women and environmental threats to children are gaining importance in countries like India. Though legislation exist for monitoring of working environment and social security benefits, the lack of ability to realize Environmental problems and inadequate information or skills have not resulted in desire improvement.


Mechanisms and Triggers of Asthma
Dr. Peter D. Sly, Paediatric Environmental Health Group, TWVT Institute for Child Health Research, Curtin University of Technology, and Murdoch University

Recent epidemiological studies have demonstrated that several asthma syndromes exist and suggest that they may have different risk factors. The main syndromes are: transient infantile wheeze viral-associated wheeze and atopic asthma. The role of atopy in asthma is well recognized but the reasons why many atopics do not develop asthma are less well understood. Initial priming of T-cells to environmental allergens occurs inutero. At birth the normal T-cell response to food and inhalant allergens is to produce cytokines typical of the T helper type 2 (TH-2) response, ie IL4, 5, 9 & 13. By late childhood, the normal response has changed to a TH-1 type response, producing interferon gamma and IL-10. The failure of this normal
immune deviation seems to underlie the development of atopy. Exposure to allergens may not be enough to produce allergic sensitization. Environmental irritants may act to increase the prevalence of asthma by producing airway inflammation and this may increase the risk of sensitization. However, atopic sensitization appears to be a necessary but not sufficient state for the development of asthma. Other factors are required to consolidate the inflammatory response and produce the airway-remodeling characteristic of asthma. The prevalence of atopy and asthma are higher in the developed world. A decrease in the overall microbial load children are exposed to may be responsible. However, the relationship between early respiratory infections and the development of asthma is unclear. Primary prevention will require a better understanding of the mechanisms involved in initiating asthma.


Risk Assessment Issues and Approaches to Children's Environmental Health
Babasaheb Sonawane, Ph.D., National Center for Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency

In 1995, the Administrator of the Environmental Protection Agency (EPA) was directed to explicitly and consistently take into account environmental health risks to infants and children in all risk characterizations and public health standards set for the United States. In 1996, EPA announced a National Agenda to Protect Children's Health from Environmental Threats. On April 21, 1997 President Clinton issued an Executive Order (EO) on the Protection of Children from Environmental Health Risks and Safety Risks. The 1996 Food Quality Protection Act (FQPA) contains specific provisions to protect the health of infants and children in the absence of complete data on the harmful effects of pesticides and calls for the re-evaluation of nearly 10,000 existing pesticide tolerances within ten-year period. The 1996 Safe Drinking Water Act Amendments include a new focus on setting priorities based on risk to sensitive subpopulations from exposure to drinking water contaminants. These and some other drivers such as the National Academy of Sciences report in 1993 on Pesticides in the Diets of Infants and Children and the Office of Science and Technology report issued in 1997 on Investing in our Future: a National Research Initiative for America's children for the 21st century? have focused our attention on the children's environmental health.
Toxic responses in infants and children can differ markedly from those observed in adults. Differences in the developing infant and child effect absorption, dose, distribution, metabolism, and excretion of xenobiotics, and therefore, adverse health outcomes. The most distinguishing characteristic of infants and children is that different organ systems develop at different rates and at different phases of life. Children may be more susceptible to chemical exposures affecting proliferating cells and developing tissues, therefore, issues of concern pertain to all steps in the risk assessment process. In considering whether risk assessment approaches are protective of children, there is a concern whether the current methods for hazard identification are adequate to detect environmental agents of public health concern. For example, standard animal bioassays for identification of carcinogenic agents does not include perinatal exposure. Similarly, emphasis of most of the epidemiological studies is based on healthy adult males. Infants and children differ from adults, both qualitatively and quantitatively for exposures to environmental agents because they consume more food, drink more water, and breathe more air per unit of body weight than adults do, therefore, they are likely to be exposed to higher levels of potential toxicants such as pesticides, air and water contaminants. The micro- and macroenvironment and associated activity patterns of infants and children rapidly change through development and also vary by demographic and cultural differences. Very limited data exist for exposure assessment of infants and children. Differences in pharmacokinetics (absorption, distribution, metabolism and excretion) by inhalation, ingestion, and dermal routes of exposure may have impact on adjustment of dose-estimates to account for differences in infants and children from adults. The current default approaches for extrapolation dose-response data such as linear in the low dose region to estimate the potency of carcinogens, does not incorporate any provision for vulnerability of infants and children. An important question for developing any guidance to assess risk of environment agents of concern is to recognize differences between children and adults and to incorporate mode of action information. Admittedly, the differences in dose, and mechanism of action data are lacking for quantitative risk estimation. We need to generate sufficient information regarding the differences in exposure, susceptibility, and toxicity for infants and children to better characterize the risk of environmental agents of concern. The U.S. EPA and other federal agencies are actively promoting and supporting research in this area and have created a database called "CHEHSIR": Children's Environmental Health and Safety Inventory of Research. CHEHSIR is currently available on line at www.epa.gov/chehsir. (Disclaimer: The views expressed in the abstract are that of the author and does not reflect the U.S. EPA policy or endorsement).


Exposure assessment of environmental microbes for children in southern Taiwan
Dr. Huey-Jen Su, Dept. of Environmental and Occupational Health, National Cheng Kung University Medical College, Tainan, Taiwan, ROC

While children's health effects resulting from exposure of general air pollutaion remain the focus of much research interest, increasing literature has suggested associations between damp environments, microbial exposure, and higher prevalence of respiratory symptoms and diseases.

We have conducted a series of studies characterising the environmental microbial exposure of children living in Tainan City, a typical metropolitan city in southern Taiwan where high temperature and humidity present year-round. A representative gourp of homes were selected
for environmental measurements based on data from a prior questionnaire survey of housing characteristics. Respiratory health evaluation, mostly by diary record and some including clinical assessment, was conducted on children living in these homes.

Our results indicate that exposure to airborne microbes can be a more significant factor affecting the children's respiratory health while exposure of other air pollutants are also taken into account. In addition, significantly higher levels of airborne fungi were observed in this region than those seen in either northern Taiwan or other parts of the world. Around 65% of the child's mattresses are with Der p 1 levels greater than 2 ug/g, seasonal effects seem to be a critical factor for the concentations and distributions of domestic microbes. Finally, higher symptom scores are shown in children from homes with higher fungal concentrations, and higher
total IgE are also found in these children.

Future investigations are desired to futher quantify how the long-term exposure to these high levels of environmental microbes may affect the children's health in general and how these effects may vary with the seasons.


The Global Burden of Environmental Disease in Children
Dr. William A. Suk, National Institute of Environmental Health Sciences (NIEHS)

Patterns of illness in children have changed dramatically in this century. Chemical toxicants in the environment as well as poverty, racism, and inequitable access to medical care are factors known and suspected to contribute to causation of a variety of pediatric diseases. Children are at risk of exposure to over 15,000 high-production-volume synthetic chemicals, nearly all of them developed within the past 50 years. These chemicals are used widely in consumer products and are dispersed in the environment. Children appear uniquely vulnerable to chemical toxicants because of their disproportionately heavy exposures and their biological growth and development. The etiologies of many diseases of childhood are due to a combination of factors, including genetic susceptibility and environmental exposures during vulnerable periods of development. 
Over the years, estimates have been made of the portions of mortality and morbidity that can be attributed to environmental factors. These figures are especially important to assess risk critical to the health and well-being of children. In the world today, it is the health of children under five years of age that is most damaged by poor environmental quality. It is estimated that one-quarter to one-third of all ill health in the world today may be attributable to environmental factors. Environmental exposure is a major factor both in the infectious diseases that tend to affect the poorest population groups and, to a lesser extent, in the chronic diseases that tend to affect the richer groups. The implication is that many of the most critical health problems in children cannot be solved without major improvement in environmental quality. This presentation will be a charge to the conference summarizing the major issues and major needs surrounding the disease and dysfunction burden on children's health in response to environmental exposures. 


Thanal Conservation Action & Information Network
Usha S., Deepa V.S., Sridhar, R., and Jayakumar C., Thiruvananthapuram, India

Periya in Keralam of India is a village. This is similar to any other rural villages of India but being in Keralam the village has a good number of people and greenery. The midland laterite hills and the nearby sea adds richness in biological diversity. 

Every year the Plantation Corporation of Kerala bring their helicopters and sprays endosulfan in their Cashew plantation. About 1300 families live adjacent to the plantation. The children are usually excited to see the helicopters and they come out to see the machine. They also get a show of some unknown stuff. The Corporation workers and managers said that those are harmless and safe.

This happened for nearly two decades. The people of the region are now mostly affected and the children are the worst affected. The pesticide endosulfan is persistent and stays in soil for more than five years. The children get the poisoning regularly through the skin from the soil. The paper is on the diseases of children, the threats to the children and the profit of the Corporation at the cost of child's health.


Regional Environmental Issues Concerning Children's Health - A Situationer
Corazon Yabes-Almirante M.D., Perinatal Center Phil. Children's Medical Center

Environmental threats to children's health are many and in the Phil. and its neighbors (ASEAN countries) these are identified to be associated with poverty, livelihood, effects of natural calamities (volcano eruptions, forest fires, flooding). In addition there is the issue of toxic waste
which is unique to the Philippines.
Inadequate water supply and sanitation and exposure to vector-borne diseases are associated with poverty. As of 1996 the Philippines ranks no.32 out of 100 in potential exposure to polluted water. Singapore is no.5, Thailand 18 Malaysia,25 and Indonesia,59. In 1998,80.8% of households in the Philippines had sanitary toilets 86.8% had safe water and 62.5% of households did not buy street foods. Malaria is present in 0.345 % of population in the Philippines,0.008% in Singapore, 0.177% in Thailand, 0.299 in Malaysia, 0.870% in Cambodia, 1.111% in Laos, 1.189% in Vietnam. Widespread exposure of large number of children to heavily polluted air is a relatively new public health issue. More people live in expanding urban 
and industrial zones than at any other time in history. Poor controlled industrial emissions and automobile exhausts are products of increased urbanization and rapid industrialization, which could have been avoided with proper control in place the experience of the European countries. No matter what source of air pollution, children are more severely affected than adult. A 3 year old absorbs 2 times that of an adult per unit body weight. The air pollutants are TSP, BS, PM-10, Lead, SO2, NO2, CO. TSP and black smoke, SO2 were the pollutants of the Mt. Pinatubo and Mt. Mayon eruptions, 
forest fires in Indonesia and the Philippines in 1997, 1998 and February 2000. Children in rural areas maybe spared air pollution from automobile exhausts and industrialization but they are exposed to indoor pollution, burning of biomass fuel and to pesticides and chemical fertilizers used for agriculture. Extremely dangerous pest killers banned in developed countries such as parathion, paraquet, chlordane, hundane and PCP are dumped and sold to unsuspecting developing countries.
The Philippines, Thailand and Indonesia are ranked number 10 out of 10 for potential exposure to polluted outdoor air. Malaysia is ranked no.4 and Singapore no. 1. The effects of pollutants and infectious agents are exacerbated by inadequate nutrition. Children who are malnourished and deficient in micronutrients are more vulnerable to the ill-effects of polluted air and water. In 1996, 30% of children under 5 years in the Philippines were underweight,40% had Vitamin A deficiency and 24% had Iodine deficiency. Malaysia had 23% underweight under 5 year old, 25% and 26% Vitamin A and Iodine deficiencies Indonesia 35%, 60% and 50% Cambodia 40%, 75 and 19% 
Laos' 44%, 40 and 34%, respectively. Pollutants not only affect the children but also the unborn and the newborn. A study was done comparing the carboxyhemoglobin levels of mothers and their newborns in Quezon City and Samal Island, Davao. The CoHb levels of the mothers and their infants were higher in Quezon City than in Samal Island. Some babies from Quezon City had values higher than 10% but were asymptomatic. The issue of toxic waste from former U.S.bases Clark and Subic in the Philippines was dramatized recently with the death due to leukemia of a 6 year old living in one of the evacuation centers. Weston international conducted a baseline study on water supply in August 1997 and recommended closure of wells that were contaminated. Other contaminated areas were also identified and a task force was created January 18,2000 to address immediately identified environmental and health concerns. It is not just toxic waste but also solid waste disposal that has become a problem. As of 1994 4,800 metric tons of solid waste was produced in Manila and this could be doubled in 5 years if nothing is done. Sanitary landfill will not be enough and incineration was not accepted. Electromagnetic field, dubbed the asbestos of the 90s, to which we are exposed whenever electricity is used is the scourge of the future. It is exemplified by high tension wires, radioclocks, cellular phones. Extremely low frequency fields like video display terminals, televisions interact at the cellular level and may affect the unborn and may cause cancer. There has been no extensive study but there have been reports of the effect of VLFEMF on cancer, congenital malformation, abortion, still-birth, and fetal growth.


Dioxins in the foodchain of Ya-Er Lake area, China
Y. Xu1, W.Z. Wu1, K.W Schramm2, B. Henkelmann2, A.Kettrup2, 1 State Key Laboratory of Freshwater Ecology and Biotechnology, Institute of Hydrobiology, Chinese Academy of Sciences, Wuhan , China, 2 GSF-National Research Center of Environment and Health, Institute of Ecological Chemistry, Germany

The consumption of contaminated fish and eggs can be significant contributions to the daily intake of PCDD/F, especially in the case when people use wastewater and sewage sludge for fish culture in some industry area. Ya-Er Lake is located in the middle part of China connecting the Yangtze River. The lake was heavily polluted by discharging chloralkali effluent from 1965-1993. We selected the five oxidation ponds near effluent inlet in the lake area as our study sites and investigated the transfer and biooaccumulation of PCDD/F in Ya-Er Lake area. Water, sediment, macroinvertebrate, fish, fish-eating bird, duck, duckeggs and human milk were collected and analyzed in 1997. As high as 420 ng I-TEQ /kg of PCDD/F found in sediment demonstrate the serious pollution of the lake by PCDD/F. Our study results indicates: the high concentration of PCDD/F in sediment can accumulate by aquatic organisms and humans through various pathways. Benthic invertebrate and aquatic plants with plenty of root system accumulate PCDD/F from sediment and water. Snail, mussel and shrimp take up PCDD/F from water and maintain the emission concentration patterns. But fish tend to selectively accumulate 2,3,7,8-substituted isomers from the aquatic environment. As the top predators, the fish-eating bird and pen-cultured duck are highly contaminated by PCDD/F due to the bioaccumulation via foodchain. The preferential residues of the 2,3,7,8-substituted PCDD/F in the fish, duck, fish eating bird and human milk may show the important biotransformation of PCDD/F. The high bioaccumulations in fish, pen-cultured duck, fish eating bird,their eggs and human milk are related the high concentration of PCDD/F in sediments. In Ya-Er Lake area, fish is the primary protein resource, the daily intake of PCDD/F for the local resident is calculated as 9.14 pg I-TEQ /kg body weight/day, which is considerably higher than the TDI of WHO for PCDD/F (1 pg I-TEQ/kg body weight/day).


Air Pollution and Children's Health in Hong Kong
Tak-sun Ignatius YU, Dept. of Community & Family Medicine, The Chinese University of Hong Kong

Air pollution is the most important environmental concern of people in Hong Kong and a number of studies have been carried to look at the health effects among children over the past ten years.

Four cross sectional studies were conducted during the years 1989 to 1995 comparing the respiratory health of children living in different communities of Hong Kong with contrasting air quality. Three studies were conducted among schoolchildren aged 8-12 and the other one was among pre-school children. All studies showed a higher prevalence of respiratory symptoms and illnesses in communities with poorer air quality after adjusting for potential confounding variables. The studies among schoolchildren also showed poor ventilatory function and increased bronchial hyper-reactivity in the more polluted communities. Legislation was introduced in 1990 to reduce the sulfur contents of industrial fuels and following that, significant reductions of respiratory symptoms and bronchial hyper-reactivity were observed.

A time series analysis looked into the relationships between daily levels of air pollutants and daily hospital admissions into all public hospitals with 24-hour emergency services during the years 1994 and 1995. Children under 5 accounted for 31% of respiratory diseases. Using Poisson regression models and following the APHEA protocol, the number of admissions due to respiratory diseases was found to be significantly associated with the levels of NO2, PM10 and O3, with relative risks of 1.020, 1.019 and 1.019 respectively for an increase of pollutant level by 10g/m3.

Air pollution control would likely bring improvements to the health of children in Hong Kong.


Risk Communication in Japan.
Yoko Tsurugi, Sinya Matsuda
Department of Preventive Medicine and Community Health
University of Occupational and Environmental Health, Japan

During the period of rapid economic expansion after World War 2, the environmental contamination and nature destruction became major social problem in Japan. Of course, there had existed the environmental pollution before the war, general public believed that the black smoke from the factory was  just the symbol of the industrialization.

 However, these development produced the outbreak of severe Industrial Pollution, such as Itaiitai disease(intoxication of Cadmium), Minamata disease(intoxication of Organic Mercury), Asthma and COLD in principal industrial zones.

  Japanese government, regarding this situation as Crisis for the first time, enacted the Basic Law for Environmental Pollution Control in 1967 and established the Environmental Agency in 1971.These situation and movement made the general public become increasingly hazard conscious. General public began to regard the environmental pollution as the Risk on their health. These policies, combined with efforts of both citizens and local government, corporate investment in pollution prevention and technological developments showed remarkable results by mid-1980s.

  However, our socioeconomic system and lifestyle have been changed. During these years of economic growth, mass production, mass consumption and mass disposal have become an even more an integral part of both Japan's socioeconomic activities and its way of life. Then new, complex and various environmental problems has occurred.

 Even the Basic Law for Environmental Pollution control ware drafted ton combat serious industrial pollution, it could no longer deal adequately with these new problems.

So, Japanese government enacted new law, the Basic Environmental Law in 1993 and formulated the Basic Environmental Plan in 1994.

 Environmental Risk is defined that 'potentially harmful effects on human health and ecosystem resulting from the production, utilization and disposal of chemical substances,' in the Basic Environmental Law. Living in the convenient society, we can only reduce these risks and it is difficult to make quality standards. So, Environmental Risk Management must be done and to make correct judgement, we have to share the correct information about risk.

 Risk communication is the one of the methods to exchange information. In Japan, we have a kind of risk communication system, but it still has a lot of barriers. Effective risk communication is not something that comes naturally. It is a product of knowledge, preparation, training and practice.


Environmental Threats to the Health of Children
Jim Fitzgerald, Southern Australia Department of Human Services, Australia

In South Australia, as with many developed areas of the world, asthma is a high- incidence ailment and the major environmental-related health condition among children. Other environmental health threats discussed in this presentation included poor water quality in remote Aboriginal communities, cyanobacterial toxins in potable water sources and recreational lakes, and various circumstances of exposure to lead. Increasingly, in the multicultural milieu which is a feature of Australian society, exercising cultural sensitivity in risk communication is becoming important.

Of these environmental health concerns, the one for which effective risk communication and community participation is best exemplified is the chronic lead exposure in the lead-smelter town ofPt Pine. Over some 16 years, in conjunction with a major effort to reduce general and point source lead exposures, a concerted program of risk communication and risk 'ownership' has been undertaken among the 15,000 residents. This has involved a number of ongoing activities including the establishment of education programs in the schools and pre-schools so that students and parents are

aware of the risks. A mascot dinosaur cartoon character- 'Pea-bee' -has been created to spread the message of risk and avoidance, and he appears in print foffi1 on a large range of products suitable for young children. Community awareness is also

maintained through regular advertising in the local media, the provision of qualified speakers at service clubs, and through offering free blood tests; current blood testing compliance in children over the age of 5 is 95%. These activities are coordinated and run from an on-site Environmental Health Centre which also houses a laboratory for conducting blood-lead tests and lead exposure-related research. The experience gained in risk communication in Pt Pine has been extremely useful in dealing with environmental health risks in other situations. 


Fundamental Components of Risk Communication and Building Networks for Communication
Ms. Joy E. Carlson, Children's Environmental Health Network, United States

Risk communication traditionally was thought to be the imparting of knowledge from professionals to the community about specific actions to take to reduce the risk of injury or harm. Today we know that risk communication is an interactive process that occurs between community and professionals and also includes policymakers, scientists, health care providers, as well as community members. The importance of involving multi-sectoral and multi-disciplinary stakeholders is illustrated through the example of the Children's Environmental Health Network, USA. Its mission is to promote a healthy environment and to protect the fetus and child from environmental hazards. This national organization has helped to create the field of children's environmental health. It has framed the

policy and research agendas for the US, trained health care providers, and involved researchers, policymakers, health care professionals, and national organizations in this effort. (More information is available at http:// www. cehn. org)

Fundamental components of risk communication for any topic or group include:

What is the message? Is it the right message for the specific audience you are addressing?,

Who is the audience-- know your target audience, what their needs and concerns are. Involve them in the risk communication process at all times.

Who is the Messenger? Part of knowing the audience is knowing whom they will trust; have a messenger people can believe.

What actions are you suggesting? What actions are you requesting that your audience take (i.e for community it may be to stop eating fish as frequently, for policymakers it may be to include children in regulations, for health care providers it may be to take an environmental health history)? What actions are you, the risk communicating community, willing to take to work alongside these different constituencies to address the problems?


RISK COMMUNICATION AND THE PROTECTION OF CHILDREN’S ENVIRONMENTAL HEALTH
Terri Damstra, Ph.D.,
World Health Organization

Effective communication on the risks of environmental hazards to children is critical to developing intervention and prevention programs. Risk communication is not a one-way transfer of information from the expert to the non-expert, but an interactive process of exchange of information and opinion among individuals, groups, and institutions. Risk messages must be accurate, credible, and understandable. In order for risk messages on the environmental threats to children not be misleading, they must be evidence-based and placed in an overall framework of priority concerns regarding children’s health. In order to obtain a realistic perspective of the major issues related to children’s environmental health in Pacific Basin countries, a questionnaire was sent to participants prior to the meeting. The following tables summarizes the responses from 34 participants representing 12 countries.

TABLE 1

Summary of Questionnaire Results Regarding Major Environmental Threats to the Health of Children in Pacific Basin Countries

Priority Health Concerns*

Sources

Agents

1. Respiratory Diseases - Traffic

- Air pollution

(indoor/outdoor)

- Industry

Particulates

Nox

Sox

Carbon Monoxide

2. Water-borne Diseases (diarrheal, G.I.) - Industry

- Inadequate sanitation

Bacteria

Parasites

3. Poisonings, Accidents - Household products

- Industry

Pesticides

Hazardous wastes

4. Impaired Neurobehavioural Development - Industry Lead, mercury, dioxin, PCBs
*Priority order based on percentage of responses.

TABLE 2

Summary of Questionnaire Results Regarding Risk Communication of Children’s Environmental Health (CEH)

Government Awareness

Policies/Regulations

Availability of Data Bases

Mechanisms of Risk Communication*

Barriers of Risk Communication*

Opportunities to Improve Risk Communication*

Excellent (10%)

Some (55%)

None (35%)

1. Mass Media 1. Lack of expertise and resources. 1. Increased community awareness and concern.
  2. Physicians, health professionals, educators. 2. Lack of communication among government sectors. 2. International pressures and concerns.
  3. Government 3. Political/cultural influences. 3. Availability of electronic means of information disemmination.

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