Child Health and the Environment.

By Donald T. Wigle

Oxford:Oxford University Press, 2003. 396 pp. ISBN: 0-19-513559-8, $55 cloth.

It is amazing how many books are now available for the new field of pediatric environmental health. For health practitioners, the American Academy of Pediatrics Handbook of Pediatric Environmental Health (second edition in press) is available, as is Children's Environmental Health, published by the American public Health Association (2000) A "how-to" manual for families by Landrigan et al., Raising Healthy Children in a Toxic World (2002), is now in its second edition. The World Health Organization has provided a report on global aspects, Children in the New Millennium (2003). There are many books on policy aspects, some for advocates--Wargo's Our Children's Toxic Legacy (1998) and Schettler et al.'s Generations at Risk (2000)--and others conveying contrary views--Juberg's Are Children More Vulnerable to Environmental Chemicals? (2002). So, do we need Wigle's new book? Resoundingly, yes!

This concise volume is jam-packed with information. Its broad coverage includes epidemiology, toxicology, medicine, exposure assessment, and risk management. Organized logically and evidence-based, each chapter systematically covers health effects, exposures, risk management, and conclusions. Gene--environment interactions are well integrated. Issues of risk assessment and precaution are woven together well. The expert presentations on the epidemiology of hazards and exposures are exceptional; these are nicely buttressed by well-written, but less thorough, presentations of the toxicology and environmental literature. This well-written book is filled with nuggets that hold the interest of the reader and includes useful summary tables and an excellent index. For each hazard, Wigle presents his conclusions about the state of the science. Wigle maintains a wonderful website (http://www.mclaughlincentre.ca/) that includes expanded bibliographies for each chapter and extensive updates of many of the epidemiology summaries.

The book addresses chemical, biologic, and physical agents regulated by the U.S. Environmental Protection Agency (EPA; lead and other metals, polychlorinated biphenyls/dioxins, pesticides, hormonally active agents, and radiation) as well as certain major exposure pathways (indoor air, outdoor air, and water). For discussion of these exposures, there is nothing else like this book on the market today. Disappointingly, chemicals are covered only as pollutants of air or water or as endocrine active substances. Biotechnology is not covered at all. Key issues for chemicals--hazard assessment, chemical and consumer product risk management, conduct of toxicology studies, the role of the National Toxicology Program, and potential exposures to children via consumer and household products--are omitted. Several hazards not regulated by the U.S. EPA--pharmaceuticals, food additives, nutritional supplements, and foodborne pathogens, molds, and fungi--are not covered. Also, very little is included on the social, ethical, and behavioral aspects of pediatric environmental health. Further, the book does not cover issues important for developing countries, such as parasites, poor sanitation, chemical mishandling, child labor, and waste scavenging.

The least comprehensive sections of the book are those on risk management, in which large areas--the right to know, pollution prevention, economic instruments and pollutant trading, and consumer education--are missing. Thus, for pesticides, there is no mention of integrated pest management. For air pollution, there is no mention of reducing vehicle miles driven (e.g., more efficient design of communities and transportation systems).

This book isn't for everyone. The reader should have more than a passing familiarity with basic concepts of environmental and public health. It is a very useful book for teaching public health, medical, and nursing students at the graduate and postgraduate level worldwide. It would be useful to any scientist who is interested in an overview of the field. All and all, it is an important contribution to the field and a handy addition to the reference shelf.

Lynn R. Goldman is a professor in the Department of Environmental Health Sciences, Johns Hopkins University Bloomberg School of Public Health.