Raising Healthy Children in a Toxic World

1
Raising Healthy Childrenin a Toxic World

• Philip J. Landrigan, MD, MSc, FAAP
• Professor and Chairman
• Department of Community Preventive Medicine
• Professor of Pediatrics
• Director, Childrens Environmental Health Center
• Mount Sinai School of Medicine
• Greenwich, Connecticut
• May 8, 2008

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Patterns of Disease in Children Have Changed

• As nations move toward industrial development,
  patterns of disease and death change.
• Prior to industrial development, infectious
  diseases are the major causes of illness and
  death MUCH OF AFRICA, LATIN AMERICA AND ASIA
  TODAY
• After development, life expectancy increases and
  chronic diseases become the major causes of
  illness and death USA AND WESTERN EUROPE TODAY

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Environmental Change is the Driving Force
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The principal causes of illness,
hospitalization and death among children in
America today are

• Asthma
• Cancer
• Birth defects
• Neurodevelopmental disorders
• Obesity and diabetes

These diseases are on the rise

5
The Increasing Prevalence of Asthma in the
US 1111111111111111
Children lt18
All Ages
Source CDC MMWR, October 19, 2007 /
56(SS08)1-1418-54
6
Source National Cancer Institute
7
Source National Cancer Institute
8
Incidence of Testicular Cancer
9
Source CDCs Metropolitan Atlanta Congenital
Defects Program (MACDP)
10
Developmental Disabilities

• Affect at least 5-10 of all children
• Include Autism
• Dyslexia ADHD Mental
  Retardation
• Reported prevalence is increasing

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Overweight and Obesity

• Prevalence has nearly quadrupled in American
  children
• 2.5-fold increased risk of overall mortality
• 4-fold risk of cardiovascular mortality
• 5-fold risk of diabetes
• Risk of hypertension, gall bladder disease, and
  some cancers

Source Willet et al., New Eng J Med, 1999
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The Central Question in Pediatric Environmental
Health
What is the Evidence that
Toxic Chemicals in the Environment Cause
Disease in Children?
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Childrens Health and Toxic Chemicals What We
Know

• Children are surrounded by a large and ever
  increasing number of chemicals.
• Many of the chemicals to which children are at
  risk of exposure have not been tested for their
  possible developmental toxicity
• Children are more heavily exposed and more
  vulnerable to many environmental chemicals than
  adults
• These chemicals are detectable in most American
  children's bodies, even in newborn infants

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Synthetic Organic Chemical Production
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Most Chemicals to Which Children Are Exposed Have
Not Been Adequately Tested for Toxicity

• 80,000 chemicals in commerce
• 3,000 are high production volume (HPV) chemicals
  - produced in quantities of 1 million pounds or
  more per year
• No basic toxicity information is available on
  half of HPV chemicals
• No information on developmental toxicity is
  available for 80 of HPV chemicals

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Why Are Children Especially Vulnerable to Toxic
Chemicals?

• Greater exposure pound-for-pound
• Decreased ability to detoxify many chemicals
• Heightened biological vulnerability
  thalidomide, DES, fetal alcohol syndrome
• More years of future life
• Children are not little adults
  

National Academy of Sciences, 1993
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Evidence is Strong and Increasing that Toxic
Chemicals in the Environment CauseDisease in
Children
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Toxic Chemicals Can Cause Neurodevelopmental
DisordersLEAD

• Principal source is lead paint and lead paint
  dust
• Other sources toys, imported dinnerware
• 15-20 of cases associated with home renovation
• Causes decreased IQ, shortened attention span,
  inability to concentrate, dyslexia and school
  failure
• Any amount of lead is dangerous No level is
  safe

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Toxic Chemicals Can Cause Neurodevelopmental
DisordersLEAD
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Toxic Chemicals Can Cause Neurodevelopmental
DisordersMETHYL MERCURY

• Principal source is contaminated fish
• Most methyl mercury in fish originates from
  coal-fired power plants
• Effects on children similar to those of lead
• Prevention eat safe species of fish, avoid
  contaminated species www.thegreenguide.org

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Toxic Chemicals Can Cause Neurodevelopmental
Disorders ORGANOPHOSPHATE PESTICIDES

• High-dose exposure can cause acute poisoning
• Exposure during pregnancy to lower levels can
  cause

• small head circumference
• low birth weight
• developmental delays
• ADHD
• Pervasive Developmental Disorder, a form of autism

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Toxic Chemicals Can Cause Neurodevelopmental
DisordersENVIRONMETAL EXPOSURES LINKED TO AUTISM

• Thalidomide
• Misoprostol
• Maternal rubella infection
• Valproic acid
• Are there others among the thousands of untested
  chemicals to which our children are exposed
  daily?

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Air Pollution Causes Asthma
Before
Smog on 5th Avenue
After
New York City, before and after a photochemical
smog.
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Chemicals and Radiation Can Cause Childhood Cancer

• Solvents, especially benzene
• Parental employment in industries that use
  solvents painting and printing
• Pesticide exposure, especially prenatally

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The SolutionProgress Against Environmental
Disease in Children Requires Work in These
Areas

• Testing chemicals for toxicity
• RESPONSIBILITY OF THE FEDERAL GOVERNMENT
• Research
• Patient care
• Training the next generation of pediatricians

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Programs on the Environment and Childrens Health
at Mount Sinai

• The National Childrens Study
• The Autism Discovery Project AUTISM
• The Center for Childrens Environmental Health
  and Disease Prevention Research ENDOCRINE
  DISRUPTORS, PREMATURTE PUBERTY BREAST CANCER
• The Pediatric Environmental Health Specialty Unit
  CLINICAL SERVICES FOR CHILDREN FAMILIES
• Fellowship in Environmental Pediatrics -
  EDUCATION
• Growing Up Healthy in East Harlem ASTHMA
  PREVENTION PESTICIDE USE REDUCTION

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The National Childrens Study

• A multi-year prospective epidemiological study
  that will follow 100,000 children from early in
  pregnancy to 18 years of age
• Mount Sinai leads the study in NY and NJ
• The Goals
• To discover the environmental exposures that
  cause disease and disability in childhood and
  throughout life
• To translate this science into a roadmap for
  prevention

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Critical Research Questionsfor the National
Childrens Study

• What are the preventable causes of autism, ADHD
  and other developmental disabilities?
• What are the effects of early exposures to
  endocrine disrupting chemicals?
• Are there chemical exposures that increase risk
  of obesity and diabetes?
• What are the preventable causes of pediatric
  cancer?

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PreventionDISEASE CAUSED BY TOXIC CHEMICALS IN
THE ENVIRONMENT IS PREVENTABLE

• Prevention is best achieved by discovering
  hazards and then preventing exposures.
• Prevention needs to proceed on 3 levels

1. Home
2. Community
3. Society

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Prevention in the Home -The Value of Eating
Organic

• Consumption of organic produce appears to
  provide a relatively simple way for parents to
  reduce their children's exposure to OP
  pesticides.
• Curl CL, Fenske RA, Elgethun K,
  University of Washington.
• Families who consume an organic diet can reduce
  their pesticide exposure levels by 90 as
  compared to families who consume conventional
  supermarket food
• CDC

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Prevention in the Community

• Integrated pest management
• Pesticide neighbor notification laws
• Green schools
• Plant trees
• Insist on construction of sidewalks
• Maintain parks and playspaces

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Prevention Works
Example The removal of lead from
gasoline
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In 1976, US EPA began phase-out of lead from
gasoline Lead use in gasoline declined from 1976
through 1980
110
100
90
80
Gasoline lead
Lead used In gasoline (1000 tons)
70
60
50
40
30
1975
1976
1977
1978
1979
1980
1981
Source Annest, Pirkle, Makuc, et al.,
Chronological trend in blood lead levels between
1976 and 1980. NEJM 1983 3081373-7.
Year
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Decline in Blood Lead Levels Greatly Exceeded
Expectation
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Beginning in 1980, EPA further restricted lead
use in gasoline. Gasoline lead levels continued
to decline through 1991
18
100
16
14
80
12
60
Lead used In gasoline (1000 tons)
Blood lead
10
Blood lead levels (mg/dL)
Gasoline lead
40
8
6
20
4
0
2
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
Source CDC. National Report on Human Exposure to
Environmental Chemicals, March 2001
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Environmental Disease is Preventable Declining
Blood Lead Levels in the U.S. 19761999
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Thank You!
Protecting Children against Environmental Threats
to Health