World's children threatened. (International Health).

The first global conference to focus on children's environmental health was held in Bangkok, Thailand, on 3-7 March 2002. The International Conference on Environmental Threats to the Health of Children, sponsored by the World Health Organization, focused on threats to children in the Asian and Pacific regions, but many of these threats are also of worldwide importance. The meeting of more than 300 participants culminated with the issuance of The Bangkok Statement, a pledge to promote the protection of children's environmental health.[See box and Web at http:// ehp.niehs.nih.gov/bangkok/.]

Meeting attendees agreed that environmental threats to children's health can vary significantly from nation to nation. In developed countries, diseases transmitted by food, water, and animals are less important than chronic diseases linked to exposures to polluted air, pesticides, and heavy metals, but in many developing countries, particularly where poverty is endemic, children must contend with the double threat of both infectious diseases and industrial environmental insults. Press releases issued during the conference noted that three million children under the age of five are killed annually by diseases and injuries resulting from exposure to unsafe drinking water and inadequate sanitation, indoor air pollution, and accidents including poisonings. A major outcome of the meeting was the call for immediate removal of lead from gasoline in Asia, the major source of childhood exposure. New data from Thailand showed that blood lead levels in children are falling as leaded gasoline is phased out.

Says Elaine Faustman, director of the Center for Child Environmental Health Risks Research at the University of Washington in Seattle, who attended the meeting, "I go to a lot of conferences where the science is everything, but the more important thing [in Bangkok] was the larger voice. The sharing and commonality on some of the issues that people face around the world is just striking."

Faustman found especially memorable a breakout session on hazardous waste, where presenters described the many dangers to children who scavenge through waste dumps either as workers or simply searching for food. Such children are often exposed to leaking batteries and medical waste, among other toxicants. Other sessions focused on indoor and outdoor air quality issues such as biomass burning, ambient tobacco smoke, and leaded gasoline; and on developmental disorders and birth defects associated with exposure to persistent organic pollutants, lead, mercury, and endocrine disruptors.

The Bangkok Statement is an expression of intent rather than a concrete blueprint for action, but participants and organizers alike emphasized the utility of the increased networking and exchange of ideas provided by the conference. Terri Damstra, an attendee from the WHO International Programme on Chemical Safety, hopes one outcome will be participation by developing countries in the U.S. National Children's Study, a longitudinal cohort of children from embryo to late adolescence being planned by U.S. federal agencies.

Irma Makalinao, an attendee from the Philippine National Poisons Control and Information Service, said that there is beginning to be cooperation between research groups such as the Asia Pacific Association of Medical Toxicology and regional advocacy groups on children's environmental health issues.

Although industry was not formally represented in Bangkok, the American Chemistry Council (ACC) notes that in 2001, 35 of its members joined the EPA's Voluntary Children's Chemical Evaluation Program--a pilot program to assess the potential effects of chemicals on children. Peggy Geimer, acting chair of the ACC's Medical Outreach Subteam, says that the group supports research "identifying vulnerable groups, including fetuses and children, and characterizing factors that may place those groups at higher risk."

Research and activism on children's environmental health have increased rapidly in recent years. "This is something that people were barely talking about five years ago, neither in the U.S. nor overseas," says Philip Landrigan, director of the Center for Children's Health and the Environment at Mt. Sinai Medical School in New York. In Bangkok, Landrigan says, "There was amazing unanimity of opinion that people from all the different nations were strongly in support of The Bangkok Statement."