Poor environment creates wealth of problems. (Children's Health).

Diseases associated with environmental chemical pollution afflict American children at a cost of between $48.8 and $64.8 billion, a group of Mount Sinai School of Medicine researchers report in a paper to be published in the July issue of EHP.

The researchers looked at the impact of pollution on the incidence, prevalence, death rates, and economic costs associated with childhood lead poisoning, asthma, cancer, and developmental disabilities. Sickness within all four of these disease categories has been attributed to chemical pollutants in the environment, although asthma, cancer, and developmental disabilities are multifactorial problems also tied to important nonpollutant factors.

"Diseases of environmental origin are potentially preventable, if you can identify responsible toxicants and phase out exposure to them," says pediatrician Philip Landrigan, director of Mount Sinai's Center for Children's Health and the Environment and the paper's lead author. "Part of the problem is that real etiologic research trying to identify the environmental causes of diseases in children is in its infancy." Laying out the costs of diseases associated with childhood exposure to environmental pollutants, the paper argues for increased investment in basic etiologic studies, exposure tracking, and disease surveillance. Understanding toxicity also lags, the paper states: only 43% of chemicals produced in large volumes (more than 1 million pounds/year) have been tested for potential human toxicity, and only 7% have been studied for impacts on development.

The group used an "environmentally attributable fraction" model to estimate the percentage of cases that can reasonably be assigned to environmental pollutants for each disease category, and then used these percentages to calculate direct and indirect costs of environmentally attributable disease from existing disease cost estimates. Their work focused only on potentially preventable exposures to chemicals of human origin in the air, food, water, soil, home, and community. It did not consider the additional effects of diet, social and economic status, or use of alcohol, tobacco, or abused drugs.

The study attributes 100% of childhood lead poisoning to environmental lead exposure and 10-35% of childhood asthma, 2-10% of children's cancer, and 5-20% of neurobehavioral disorders in children to the effects of environmental toxcants. Costs of the diseases include not only direct costs such as hospital stays and emergency department use, but also such other factors as economic loss from premature death, disability, diminished function, need for remedial education, and reduced lifetime earning potential of affected children.

Experience has shown, states the paper, that accurate information on costs of illness can help focus preventive efforts and can add perspective to work focused exclusively on the costs of pollution prevention. "What this kind of analysis does is inform the policy debate," Landrigan says. "It helps let policy makers know how important is one set of problems compared to other sets of problems."

These numbers will be helpful, says Gina Solomon, a senior scientist at the Natural Resources Defense Council. "Everything in this country is justified in terms of cost and disease burden," Solomon says. "Doing this kind of analysis may get the attention that we need, given the huge burden of disease.