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Coming together or children. (NIEHS News).

When it comes to environmental exposures and health, children are not just small adults. They also aren't "big rats," quipped Daniel Swartz, executive director of the Children's Environmental Health Network, a national organization devoted to protecting the fetus and child from environmental health hazards and promoting healthy surroundings. His remark drew a round of laughs, yet resounded with participants at a recent symposium titled "Children's Environmental Health: Identifying and Preventing Environmental Threats to Children." The attendees knew all too well that rodent studies are particularly difficult--even impossible--to accurately extrapolate to children.

Fortunately, the field of children's environmental health has moved beyond merely recognizing the unique vulnerability of children--it has advanced to understanding why and how they are more vulnerable than adults and toward developing and implementing ways to protect children, said Elaine Faustman, director of the Institute for Risk Analysis and Risk Communication at the University of Washington School of Public Health and Community Medicine in Seattle. Faustman helped plan the 24-26 February 2003 conference.

"We're in the midst right now of a scientific revolution about the links between environment and health that will provide tremendous opportunities to protect health," said John Peterson Myers, a senior research associate with Commonweal, an environmental research institute in Bolinas, California, and coauthor of the 1996 book Our Stolen Future. "The revolution, as it unfolds, will require a complete overhaul not only of specific regulatory standards, but of the entire approach that has been used to protect public health from environmental exposure."

Much work remains not only to fill existing research gaps but to successfully put policy and prevention efforts in place. "It's simply not enough to do a good basic science study, publish in the very best journals, and there it sits," asserted NIEHS director Kenneth Olden. "We want that information translated into public health policy and the practice of medicine. In order to do that, you need people, you need communities, you need stakeholders, you need journalists, you need everybody. So that's what this conference did--it brought everybody together."

Profiling Threats to Children

Besides assembling leaders in environmental health research, policy, community outreach, and communications, the conference succeeded in achieving its core goals, according to symposium planning committee members, who included NIEHS staff David Brown, Gwen Collman, and Kevin Wheeler. The main objectives included profiling environmental threats to children, addressing ways to translate science into action to protect children, identifying research gaps and initiating plans to fill them, and discussing ways to better communicate risk through strengthened media relations.

The symposium was divided into five key areas: respiratory disease and air quality, neurological impairments, childhood cancer, birth defects, and endocrine disruption. For each issue area, presenters and panelists discussed the current state of the knowledge, its application, research gaps, how research findings are being implemented in children's health care, implications for outreach policy, and communications and media relations by researchers and policy makers. Olden noted that other research areas such as violence and accidents are also important to children's environmental health, although they were not emphasized in the program agenda.

A general consensus was expressed across many broad themes at the conference. "Prevention of exposure is the single most effective means of protection against environmental threats," said Terri Damstra, a scientist in the International Programme on Chemical Safety Interregional Research Unit of the World Health Organization.

Moreover, in human health the timing of exposure remains the most critical factor in disease outcomes. In particular, a growing number of experts believe that fetal programming--critical exposures in the womb that can impact a child's development and health for life--will turn out to be a vital part of the story. "We will leave children behind [in terms of education and health] if we don't get a handle on exposure in the womb and early development," said Rich Liroff, policy director of the World Wildlife Fund's Wildlife and Contaminants Program.

Progress has been made on many fronts, especially research. "The universe of folks engaged in this research is expanding as rapidly as the pace of the science," Myers explained. "New papers are coming out every week, if not every day. Researchers are tackling old problems in new ways and extending the tools to address them." For instance, the growing use and development of increasingly sophisticated geographic information systems is helping researchers get a clearer picture of at-risk populations, reported Marie Lynn Miranda, who directs the Children's Environmental Health Initiative at Duke University.

From Consensus to Direction

Yet, more new approaches and paradigms for thinking about the problems are needed. For a start, "we must develop a more complex model of human diseases," Olden said, one that involves interaction between genetics and environment as a function of age, stage of development, and behavior.

Despite the expanding knowledge base on potentially toxic exposures and the known neurotoxic effects of many compounds, such as those containing mercury and manganese, there has been a lack of research into the effects of children's exposure to such compounds, said Philip Lee, a senior scholar at the Institute for Health Policy Studies at the University of California, San Francisco, School of Medicine. For example, researchers know that manganese is a neurotoxicant that contributes to inattention, impulsivity, and hyperaggression. They also know that infants have virtually no ability to excrete excess manganese. Yet, infants are commonly exposed to manganese at fairly high concentrations in cow's milk and soy formula.

Prevention policies and strategies also need improvement. Lead has been removed from gasoline, plumbing pipes, new paint, and other sources, dramatically reducing childhood blood lead levels nationally. But lead exposure remains a major problem, according to recent papers on the subject. Too many children are still being exposed through sources in old housing, such as old paint, Lee said. Physicians are treating these children after the fact, which is too late, as studies reveal irreversible damage is done even when lead is removed from the blood through chelation therapy.

Olden advocated a three-pronged approach to children's environmental health. First, identify risk factors, be they genetic or environmental, from basic fundamental clinical, community, and population-based studies. Second, develop ways to reduce exposure to those risk factors to prevent their expression. And finally, translate knowledge and scientific information into public health policy and medical practice. "I encourage [NIEHS-funded] scientists to do all three," Olden said. "Without that, we are not doing our job."

"If there's one area where we need improvement in public health and also in science in general, it is risk communication to the public through the media," Lee added. Science and environmental journalists at the symposium encouraged researchers and policy advocates to help the media do its job. They explained the tight time and space constraints, the need to simplify ideas for a lay audience, and other pressures that journalists face in trying to get stories out, factors that often frustrate scientists. On the other hand, journalists will happily "take spoon-feeding" to ensure they are understanding scientists' stories correctly, said Reuters health and science correspondent Maggie Fox. "Sometimes we can help extend the limits of what can be said on a subject," added Francesca Lyman, a veteran environmental columnist and author.

Moving Forward

Part of the challenge facing researchers is managing the uncertainty entailed in the scientific process. Although work remains to fill the research gaps across the five key areas of children's health covered at the symposium, there will always be uncertainty. It's inherent in the scientific process. For example, the role the environment plays in birth defects is still largely unknown. A recent report estimated the number of birth defects that are environmentally related to be 3-25%. Such a range of uncertainty makes informing the public difficult.

Moreover, calls for more research often end up frustrating the advocacy community. While more research is generally considered a good thing, a call for more research may be a ploy to stall a sound new policy from being implemented. Panelists emphasized the need to implement prevention strategies and take action in the face of uncertainty because that's what the world of research is all about. In many cases, enough data have been collected to implement safer and better practices. It's more a matter of challenging existing perceptions about what is dangerous and improving communication with communities. Policies have not always progressed with the science, but have been mired in a metaphorical Jurassic period, Myers asserted.

Many panelists also encouraged participants to expand the push to improve children's environmental health internationally. Developing countries, in particular, face more daunting threats, especially when compounds outlawed in the United States are still in widespread use there, and prevention, outreach, and policy lag further behind that in this country.

Olden plans to continue working to sustain the momentum that the NIEHS and others have generated in recent years on the children's environmental health front. Together, the NIEHS and the U.S. Environmental Protection Agency have funded 12 children's environmental health research centers, with the first 8 centers opening in 1998. A request for applications for funding of up to 6 new centers was discussed at the meeting. Funding for 8 of the existing 12 centers will run out this fiscal year, but existing centers may reapply under the new request for applications.

For more than 30 years the NIEHS has sponsored research on a host of threats to child health including asthma, birth defects, learning and behavioral disorders, developmental disorders, cancer, and low birth weight. Bringing stakeholders together is one way to further build momentum in this field. "We don't want to lose the enthusiasm generated by this symposium," Olden said. Above all, he said, "I don't want us to forget what we're really talking about are children. These are not bland statistics, but real people."
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Author:Wakefield, Julie
Publication:Environmental Health Perspectives
Date:Apr 1, 2003
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