healthy environments for children تنشئة الأطفال في بيئة سليمة ضمان...
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Healthy Environments for Children
في األطفال تنشئةسليمة بيئة
للمستقبل ضمان
Shape the Future of Life
World Health Organization
Eastern Mediterranean Region
Regional Centre for Environmental Health Activities
(WHO – CEHA)
Outline WHO work on Healthy Environments for
Children Environmental Burden of Disease Children’s special vulnerability Environmental risks to children’s health Key risk factors Target Action Monitoring indicators Healthy Places, Happy Faces
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Child and Adolescent Health The CAH Strategy Integrated Management of Childhood Illness (IMCI) The Stockholm Consultation
Task Force on CEH International Conference on Children’s Environmental
Health The Bangkok Statement: a pledge to promote the
protection of CEH CHILDREN IN THE NEW MILLENIUM: ENVIRONMENTAL IMPACT ON HEALTH
Task Force on Healthy Environments for Children (HEC) HEC Initiative (HECI) announced at WSSD HEC Alliance (HECA) …established in December 2002
Healthy Environment for Children: WHO Global work
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EURO London Meeting CHILDREN’S HEALTH AND THE ENVIRONMENT: A REVIEW
OF EVIDENCE
AMRO/PAHO Publication on environmental impact on
children’s health (1999) Video Full CHELAC (Regional strategy)
SEARO Informal consultations (2) Training workshop for the health sector
WPRO & SEARO: International Conference Bangkok
Healthy Environment for Children: WHO Global work
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WHO/EMRO Regional Initiative
Environmentally Healthy School Initiative in Jordan (1998-2001)
Task Force on HEC, October 2002 Consultation on HEC, Nov. 2002, Amman CEHA Database and Information Clearing House on HEC
started December 2002 World Health Day 2003 celebrations HEC project in Pakistan and Yemen (2003-2006) HEC Indicators monitoring. Piloting starts (2003) Jordan National Conference on HEC (April 2003) Saudi Arabia National Conference on HEC (April 2003) Pakistan Conference on HEC (April 2003) Lebanon pilot project on HEC in a Beirut suburb (starts 2003) WHO/EMRO Regional planning consultation on HEC (Late
2003)
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ENVIRONMENTAL THREATS MAY CAUSE UP TO ONE THIRD OF THE GLOBAL BURDEN OF DISEASE
Over 40% of this burden falls on children under the age of five who make up only about 10% of the world’s population.
25-33%Environmentalriisks
ENVIRONMENTAL BURDEN OF DISEASE
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IN 2000, MORE THAN 4.7 MILLION CHILDREN UNDER THE AGE OF FIVE DIED FROM ILLINESSES AGGRAVATED BY UNHEALTHY ENVIRONMENTS
Most of the 13,000 child deaths each day are due to the dangers present in the environments in which they live, learn, play and grow.
Environment-related illnesses can kill the equivalent of a jumbo-jet full of children every 45 minutes.
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IN 2000, UNHEALTHY ENVIRONMENTS CONTRIBUTED TO :
• 1.3 million diarrhoeal deaths, mostly from unsafe food and water, and inadequate hygiene practices.
• 2 million deaths from acute respiratory infections (ARI) aggravated by indoor air pollution.
• One million deaths from malaria, dengue fever, leishmaniasis, Japanese encephalitis, hepatitis and other environment-related infectious and vector-born diseases.
• 400,000 deaths from injuries including road accidents, drowning, burns, and poisoning. Five per cent of deaths due to injury in developing countries were from toxic poisoning.
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CHILDREN ARE AMONG THE MOST VULNERABLE TO ENVIRONMENTAL THREATS
Children are in a dynamic state of growth with cells multiplying fast and organ systems developing at a rapid rate.
Children breathe more air and consume more food and water in proportion to their weight.
Their central nervous system, immune, digestive and reproductive systems are more vulnerable than those of adults. Exposure to certain environmental toxins can lead to irreversible damage, and to diseases during adulthood.
Children are more exposed to unhealthy conditions and to dangerous substances because they live their lives closer to the ground and, especially in the early years, they are frequently exposed through hand-to-mouth activities.
WHY CHILDREN?
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Children in EMR
Children under 19, constitute 50% of EMR population
Respiratory infections, diarrhoeal diseases, injuries, and malaria account for more than 43% of under mortality.
All these diseases are attributable to environmental conditions
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Key Environmental Health Risk Factors in EMR
Housing qualityHousehold water securityHygiene and sanitationAir pollution (indoor and outdoor) Injuries and accidentsChemical hazards (e.g. lead, pesticides)Disease vectors
Poverty, war, occupation and aggression bring additional hazards 11
RISKS TO CHILDREN’S HEALTH
IN AIRGerms; indoor andoutdoor air pollutants; toxic chemicals, second hand tobacco smoke and pesticides; disease-transmitting insects.
IN FOOD
Chemical contaminants; natural toxins; germs.
IN WATERGerms; toxic chemicals and pesticides; breeding grounds fordisease-transmitting insects.
IN SOIL
Human and toxic chemical waste; germs; breeding grounds for disease-transmitting worms.
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UNSAFE PLACES:
Home, school, workplace, playground, street.
UNHEALTHY BEHAVIOURS:
Poor hygiene, scavenging, playing with dangerous materials, inappropriate
nutrition.
Environmental Risk Factors and their Health Effects
Community School
Setting Home
Risks factor Disease outcomesDiarrhoeal diseasesAcute respiratory InfectionsTuberculosisPerinatal effectsNutritional diseasesMalaria & other vector diseases Child cluster diseasesChronic respiratory diseases CancerInjuries & accidentsDrowningPoisonings Cognitive effects
Hou
sing
cond
itio
ns
Indo
or a
ir
Em
erge
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situ
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Rec
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Tra
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Occ
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n vir
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Dis
ease
vec
tors
Pes
tici
des
and
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r ch
emic
als
UV
Rad
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o n
Lea
d
Out
door
air
Wat
ersa
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tion
and
Foo
d sa
fety
an
d su
pply
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Health Outcomes – Chemical Contamination
ArsenicosisFluorosis
Health Outcomes – Chemical Contamination
ArsenicosisFluorosis
Water QuantityInsufficient quantities of safe water available for drinking, cooking and personal and
domestic hygiene
Water QuantityInsufficient quantities of safe water available for drinking, cooking and personal and
domestic hygiene
PovertyLack of access to
safe water resources
PovertyLack of access to
safe water resources
Water Quality- Contamination by pathogens - Chemical pollution (e.g. arsenic, fluoride)
Water Quality- Contamination by pathogens - Chemical pollution (e.g. arsenic, fluoride)
Hygiene-related diseasesTrachoma Scabies
Hygiene-related diseasesTrachoma Scabies
Health Outcomes -Pathogenic contamination Diarrhoeal diseases, Typhoid, Hepatitis A,E, F
Health Outcomes -Pathogenic contamination Diarrhoeal diseases, Typhoid, Hepatitis A,E, F
Household Water Security
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PovertyLack of access to
Basis sanitation infrastructure
PovertyLack of access to
Basis sanitation infrastructure
EducationLack on information on
health consequences of poor hygiene
EducationLack on information on
health consequences of poor hygiene
Pathogenic ContaminationOf the environment
and of drinking water resources
Pathogenic ContaminationOf the environment
and of drinking water resources
Poor HygieneIn a contaminated
environment leads to person-to-person
transmission of disease and contamination of food
Poor HygieneIn a contaminated
environment leads to person-to-person
transmission of disease and contamination of food
Health OutcomesDiarrhoeal diseases Trachoma ScabiesHelminthic infections-Ascariasis-Trichuriasis -Hookworm
Health OutcomesDiarrhoeal diseases Trachoma ScabiesHelminthic infections-Ascariasis-Trichuriasis -Hookworm
Sanitation and Hygiene
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Quality of Housing- Inadequate ventilation - Crowded, unsanitary conditions
Quality of Housing- Inadequate ventilation - Crowded, unsanitary conditions
PovertyLack of resources restricts options to obtain and use cleaner fuels and improved housing
PovertyLack of resources restricts options to obtain and use cleaner fuels and improved housing
Simple FuelsReliance on simple fuels and polluting, inefficient stoves restricts opportunities for education and economic activity to escape poverty
Simple FuelsReliance on simple fuels and polluting, inefficient stoves restricts opportunities for education and economic activity to escape poverty
Health Effects of Indoor PollutionFair evidence -Acute lower respiratory infections -Chronic obstructive pulmonary disease-Lung cancer (coal)Tentative evidence -Tuberculosis-Low birth weight-Cataract-Asthma-Other cancers
Health Effects of Indoor PollutionFair evidence -Acute lower respiratory infections -Chronic obstructive pulmonary disease-Lung cancer (coal)Tentative evidence -Tuberculosis-Low birth weight-Cataract-Asthma-Other cancers
Secondary Effects-Risk of burns - Injuries during fuel collection-Opportunity cost for time collecting fuel-Quality of life (smoky, sooty home, inadequate lighting)
Secondary Effects-Risk of burns - Injuries during fuel collection-Opportunity cost for time collecting fuel-Quality of life (smoky, sooty home, inadequate lighting)
Indoor Air Pollution
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Lead concentration in air and dust
Lead concentration in air and dust
Leaded gasoline, traffic density;industrial activity
Leaded gasoline, traffic density;industrial activity
Leaded paintsLeaded paints
Leaded pipes for water supplies
Leaded pipes for water supplies
Leaded cans for food and drinks
Leaded cans for food and drinks
Lead in cosmetics and folk remedies
Lead in cosmetics and folk remedies
Lead in foodLead in food
Occupational lead exposure
Occupational lead exposure
Lead concentration in water
Lead concentration in water
Neurological effects
IQ effects
Learning disabilities
Anaemia
Violent behavior
Other effects
Neurological effects
IQ effects
Learning disabilities
Anaemia
Violent behavior
Other effects
Body burden of lead, e.g. Blood lead
Body burden of lead, e.g. Blood lead
Distal Causes
Proximal CausesPhysical and
pathophysical causes
Outcome
Childhood Lead
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Focused research
Existing information and knowledge
Action for HealthyEnvironment for Children
Action through the healthand other sectors
Healthy PlacesHappy Faces
Clear policies
TARGET
FOR ACTION
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MAKING CHILDREN’S ENVIRONMENTS HEALTHIER
IN AIRUse of alternative biofuels; reduce traffic and industrial emission; reduce second hand tobacco smoke; bring treatment to sick children.
IN FOOD
Prevent contaminants entering the food chain; hygiene; bring treatment to sick children; promote breastfeeding and adequate feeding practices.
IN SOIL
Promote safe disposal of human and chemical waste; promote sanitary practices; bring treatment to sick children.
IN WATERImprove amount and quality of water; water maintenance; reduce vector-breeding sites; promote breastfeeding and adequate feeding practices; bring treatment to sick children
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SAFE PLACES:
Home, school, workplace, playground, street.
HEALTHY BEHAVIOURS:
Hygiene, protection form vectors transmitting diseases, breastfeeding and adequate feeding practices, playing in
clean environments
Home
Community
Ambient environment
Preventive Remedial actions actions
Preventive Remedial actions actions
A simple model of environmental health indicatorsThis recognizes three sets of environment health indicatorsThose that represent exposures to environmental hazards(exposure-side indicators), those that represent health effects arising from these exposures (health-side indicators ), and those that represent the responses to these risks (action indicators)
A simple model of environmental health indicatorsThis recognizes three sets of environment health indicatorsThose that represent exposures to environmental hazards(exposure-side indicators), those that represent health effects arising from these exposures (health-side indicators ), and those that represent the responses to these risks (action indicators)
Exposure-side Indicators Health-side Indicators
Action Indicators
Monitoring Children’s Environmental Health
Morbidity
Mortality
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Healthy Home Environments for Children
Store water in covered containers in safe, clean and cool places.
Promote the use of improved stoves and cleaner household fuels.
Wash your child’s and your own hands with water and soap before preparing food and eating, and after defecation.
Keep your child away from smoke during peak cooking times and do not smoke near children.
Store household cleaning products, pesticides, fuels and medicines away from children’s reach.
Use insecticide-treated bed-nets to prevent malaria.
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Healthy School Environments for Children
Ensure that clean running water and separate toilets are available for boys and girls.
Teach children about creating healthy environments.
Build and relocate schools and playgrounds away from traffic, noise, industrial and waste sites.
Maintain clean, well-ventilated, well-lit school buildings to promote health and learning.
Encourage healthy, well-balanced diets and regular exercise for children.
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Healthy Neighborhood / Community Environments for Children
Make public places smoke free. Organize waste management to promote a
healthy community. Plant trees and clean up streams. Advocate for safer roads and organized traffic. Eliminate the use of leaded gasoline. Take care of children in swimming areas, or
when playing in ponds and creeks. Maintain slides and swings to avoid in injuries. Plant trees to provide protection from the sun.
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