INTRODUCTION

Environmental health risks to children are increasingly being recognized as a key concern now and into the next century. The United Nations Convention on the Rights of the Child states that the child has the right to enjoyment of the highest attainable standard of health and to health care facilities, and that children have the right to a safe environment. 198 Countries have signed the Convention. All UN member states except the U.S.A and Somalia have signed.

Civil society organizations, professional associations, advocacy leaders, government officials and intergovernmental organizations are beginning to recognize children's environmental health as a critical issue in the development of healthy, sustainable and just communities. The field of children's environmental health is growing, and it seems to be timely to establish a central meeting place at international level to provide information on factors affecting children's environmental health. It is relevant to establish a forum that facilitates access to facts and data globally; forum that helps to identify and connect with others working in the field of pediatric environmental health.

Preventing the effects of environmental degradation to human health - in particular child health - is a fundamental component of sound environmental policy and decision-making. The need exists for an international forum focused on children's environmental health, to ensure that we conduct the necessary research, share the latest data, link with colleagues from other regions, and strengthen the interdisciplinary and international nature of children's environmental health work. INCHES will aspire to meet this need.

MISSION STATEMENT

The mission of INCHES is to promote healthy and supportive environments that protects the fetus and child from environmental and safety hazards.

GOALS OF INCHES

Partners from all regions of the world will work together within the framework of the network to achieve the following goals:

1) increase understanding of and accord on how environmental factors influence child health;

2) create a global clearinghouse of research and information on children's environmental health;

3) educate and facilitate information exchange on the best practices and policies in children's environmental health;

4) identify information gaps and stimulate to new research; and

5) advocate for children's environmental health in the intergovernmental arena.

THE NETWORK: INCHES

INCHES will function as a coordinating structure for organizations and individuals involved with children's environmental health. Members will include: national and international professional associations, research and policy institutes, advocacy organizations, universities, parents' and children's organizations, national and intergovernmental agencies, and individuals. INCHES will reflect the perspectives of a wide spectrum of professions on the relationships between environment, health and children.

INCHES will provide a strong voice at the global level to promote the protection of children from environmental and safety hazards. This voice will represent many interests and will speak from the experience and expertise of members of the network, of science and of the best practices in policies and programmes.

The Internet will provide a platform for many of INCHES' activities. Through a Web site and extensive on-line communication, INCHES will create bridges among members in various regions and will increase the accessibility of information on children's environmental health. The use of the Internet is developing rapidly, but the distribution of hardware and software and thus the accessibility is uneven. INCHES will assist under-served regions and population groups that are lacking in electronic capabilities in their efforts to obtain access to the Internet.

DEVELOPING INCHES

In 1997, Childwatch International and the Dutch Association of Environmental Medicine initiated discussions via e-mail with a range of organizations on the formation of an international network on children's environmental health. In August 1998, they invited many of these discussants to a workshop in Amsterdam prior to the International Conference on Children's Environment and Health. The purpose of the workshop was to continue the discussion and to take the first steps of the International Children's Health and Environment Network (ICEH), now called the International Network on Children's Health, Environment and Safety.

Approximately 25 people participated, including:

-          Representatives from international and national advocacy organizations

-          Researchers and scientists from North America and from the European region, including the Russian Federation, Uzbekistan and the Ukraine, and from Latin America;

-          Officials of Intergovernmental organizations; and

-          Government officials

In the initial phase of the development of INCHES, the founding members of INCHES will share the responsibility for developing the network. At the International Conference on Children's Environment and Health a Coordination Committee and an Editorial Group were established. These groups will prepare the structure of the network. and will identify key areas of focus for INCHES, including major health effects and contaminants of interest, and will strive to place information about INCHES on the Internet as soon as possible.

ACTIVITIES OF INCHES

In its first phase of development, INCHES will identify the following:

-          priority issues for various regions within the membership of INCHES;

-          new members and users;

-          experts and existing research;

-          major research themes and gaps in the research; and

-          key points of policy intervention at the regional and global levels.

All of these items will be ongoing activities of INCHES. Once INCHES is established, the main activities will be to:

-          collect, categorize and disseminate research information on children's environmental health;

-          create opportunities for colleagues in the field to share experiences and learn from each other;

-          advocate at the international level for policies that reflect and respect the special vulnerability of children;

-          support the creation of local, national and regional networks on children's environmental health; and

-          organize meetings, seminars and symposia on emerging issues in this field.

The focus is on children, but due consideration will be given also to research on the potential consequences in a broader sense of exposure to human beings to hazardous factors early in life. It is thus essential to avoid environmental disorders that may occur in adulthood due to exposures suffered as a child or a fetus.

WHAT IS ENVIRONMENTAL HEALTH?

The World Health Organization defines environmental health as follows:

"Environmental health includes both the direct pathological effects of chemicals, radiation and some biological agents and the effects (often indirect) on health and well-being of the broad physical, psychological, social and aesthetic environment, which include housing, urban development, land use and transport".

Promoting children's health requires protecting them from harmful environmental exposures. These exposures include: harmful physical, chemical and biological microorganisms and pollutants in water, air, soil and food. These exposures may be intentional or inadvertent as well as accidents. The immediate environment of children often includes a range of health hazards from lack of access to clean safe water, inadequate sanitation, lack of nutritious food, and inadequate waste management systems.

Children may be affected as well by broader environmental pressures, including climate change and persistent organic pollutants, global environmental changes such as global warming, decreases in the ozone layer, and the Greenhouse effect. Suggested indirect effects on human health include decreased immunity and vaccine efficacy, and decreased crop and plankton availability.

WHY ARE CHILDREN DIFFERENT?

Children are in a dynamic state of growth, as many vital systems such as the nervous, immune, and respiratory systems are not fully developed at birth. Because children are still developing, exposure to environmental hazards may result in disruption of their normal development and may cause permanent damage.

Vulnerability: the fetus

It is established that the fetus is highly vulnerable to environmental exposures, like DES, tobacco smoke, lead. The fetus should be protected from environmental hazards including smoking by the pregnant mother. Even before conception the "fetus" is in danger: The relationship between pesticide residues in water, food or from handling pesticides in agricultural business has been considered to affect sperm quality.

Exposure

Until they are fully grown, children consume more food and fluids and breathe in more air, relative to their body size, than adults. Children spend more time closer to the ground than adults, and the hand-to mouth behavior of younger children increases their exposure to toxicants in dust and soil as well. Crowding, for example in day care institutions and schools increases the risk of indoor environment, for example transmission of infections, noise and bad indoor quality.

Dependency on adults

Especially small children depend totally on adults creating a healthy environment and protecting them from environmental hazards. New Research findings, and concerns and questions from environmental groups, parents and consumer interest organizations have inspired new interest in the relations between environmental factors and child health.

INCHES will seek to provide facts and answers to organizations, schools, parents and local and regional authorities to questions about environmentally induced or triggered health effects to children.

Quality of life

Children have still got many years to live, so protection from environmental hazards early in life is cost effective with regards to saved years of life with potential good quality. Children are themselves active in environmental health protection: they are interested in environment and health matters, they are detectives and activists, agents of change. Children are complex and competent and, according to age and development, are full of capacity for tending their own health and environment.

EFFECTS OF THE ENVIRONMENT ON CHILDREN'S HEALTH

Some of the environmental health effects and specific toxicants more directly related to child health include:

-          Asthma:

Asthma morbidity and deaths among children and young people have increased vastly during the last decade. In many countries asthma has become the leading cause of hospital admissions for children. 670.000.000 children suffer from Acute Respiratory Infections.

-          Waterborne infections:

Waterborne infections such as diarrhoeal diseases and hepatitis A affect thousands of children globally, particularly in developing and newly independent countries.

-          Neurodevelopmental and endocrine disrupters;

-          Accidents;

-          Traffic pollution;

-          Skin diseases linked to the over-exposure to ultraviolet radiation;

-          Allergic diseases;

-          Attention deficit disorders;

-          Children's occupational diseases;

-          Environmental (second-hand) tobacco smoke (ETS):

Children exposed to tobacco smoke at home have far more days of restricted activity, several additional days of bed confinement and miss more school days each year than do children not exposed. Effects of tobacco smoke may increase the effect of indoor natural radioactivity.

ORGANIZATION OF INFORMATION

As listed above, the collecting, categorizing and disseminating of information will be a centerpiece of INCHES' work. A sample list of themes within which the information can be organized include:

-          Children's health and health outcomes (such as asthma, cancer, lead poisoning)

-          Environmental hazards to children (such as radiation, indoor air pollution, pesticides)

-          Health promoting settings and policies

-          Consumer products: hazards and safe alternatives (such as toys, home items, gardening items)

-          Information for health care providers

-          Exposure

-          Child development issues

-          A directory of members of INCHES

-          Frequently asked questions

-          Upcoming conferences and meetings

All information posted by INCHES on the Internet must state source so that it is clear whether the information is preliminary results, is from peer-reviewed scientific journals or from national or international scientific reports.

INTERNATIONAL POLICIES

Two key international statements support the call for increasing research and policy to reduce environmental hazards to children: the Declaration on Children's Environmental Health by the G7 plus the Russian Federation (G8), and the United Nations Convention on the Rights of the Child.

The Declaration on Children's Environmental Health was adopted and signed at the summit of the Environment Leaders of the G7 plus Russia, held in Miami, Florida on 5-6 May 1997. This Declaration affirms that preventing exposure is the single most effective means of protecting children against threats to child health. The leaders at this summit called for recognition of children's environmental health as a priority in their countries as well as in bilateral and multilateral agendas. In addition, they called on intergovernmental institutions, including the World Health Organization (WHO) and the United Nations Environment Programme (UNEP) to give further attention to children's health, especially the environmental, economic and social dimensions.

The United Nations Convention on the Rights of the Child supports a new understanding of and respect for children and their needs and rights.The Convention underlines the social responsibility to protect children, and to provide for them necessary support and service. Children are recognized as individuals with rights and opinions, and children should participate, according to age and competence, in decisions affecting their lives.

The Convention states that the child has the right to the highest attainable level of health (Article 24, section 1), and the right to a safe environment. This calls for a review of current knowledge and of current policies. New research has been inspired by this Convention, addressing children's specific situations and living conditions, and new findings will potentially influence policy making.

All policy should be assessed through the lens of child rights. Children have the capacity to be active citizens and consumers and to be active environmentalists and concerned patients. INCHES will explore ways to link with networks and groups of children involved in environmental and health issues.

NATIONAL INITIATIVES

As developments in the international arena draw attention to children's environmental health issues, some governments are beginning to establish policies and programs to address these issues on a national level. One key example is that of the United States. In 1996, the Food Quality Protection Act was enacted, establishing a limit value for pesticide residues in food. The Act included a 10-fold uncertainty factor for children, to ensure that children would be protected when not enough data were available to determine child-specific limit values. In 1997, the President signed the Executive Order for the Protection of Children from Environmental Health Risks and Safety Risks.

Also in 1997, the US Environmental Protection Agency established an Agency-wide policy that would consistently and explicitly evaluate the environmental health risks of infants and children in all of the risk assessments, risk characterizations, and environmental and public health standards that are set for the United States.

By making children a priority, the US Environmental Protection Agency expects that the new policy will encourage new, much needed research to provide the child-specific data needed to thoroughly evaluate the health risks children and infants face from pollution in air, land and water.

INCHES will seek to acquire information about various successful national initiatives and will work to initiate additional initiatives around the world.

ROLE OF CIVIL SOCIETY

Organizations and individuals of civil society play a key role in children's environmental health initiatives the local, national and global levels. They stimulate, inform, advocate, educate, identify problems and solutions, and articulate issues from unique perspectives. They are a crucial part of the formula in creating healthier environments.

As researchers uncover new information and new questions about environmental influences on children's health, professional associations and advocacy organizations bring this information to the political arena and call for action to protect children. Similarly, parents, teachers and others around the world are increasingly raising questions and voicing concern for the safety of children in their communities. This brings needed political attention to local children's environmental health issues, and may provide the impetus for new research and policies.

As a multi-disciplinary concern, children's environmental health requires the active engagement of government and civil society, including parents, children, and many diverse disciplines that collaborate to develop effective solutions.

Marie Louise Bistrup and Peter van den Hazel