Raising Healthy Childrenin a Toxic World

Philip J. Landrigan, MD, MSc, FAAPProfessor and Chairman

Department of Community & Preventive Medicine

Professor of Pediatrics

Director, Children’s Environmental Health Center

Mount Sinai School of Medicine

Greenwich, Connecticut

May 8, 2008

Patterns of Disease in Children Have Changed

• As nations move toward industrial development, patterns of disease and death change.

• Prior to industrial development, infectious diseases are the major causes of illness and death MUCH OF AFRICA, LATIN AMERICA AND ASIA TODAY

• After development, life expectancy increases and chronic diseases become the major causes of illness and death USA AND WESTERN EUROPE TODAY

Environmental Change is the Driving Force

The principal causes of illness, hospitalization and death

among children in America today are:

• Asthma• Cancer• Birth defects• Neurodevelopmental disorders• Obesity and diabetes

These diseases are on the rise

Estimated Percent Prevalence of Asthma by Age and Year, 1980-

2

3

4

5

6

7

8

9

1980 1985 1990 1995 2001 2002 2003 2004

Percent

Source: CDC MMWR, October 19, 2007 / 56(SS08);1-14;18-54

All AgesAll Ages

Children <18

The Increasing Prevalence of Asthma in the US1111111111111111

Source: National Cancer Institute

Source: National Cancer Institute

Incidence of Testicular Cancer

Annual Prevalence of Male Genital Birth Defects, 1968-2003

(per 10,000 live births)

5

10

15

20

25

30

35

40

45

1968

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

Pe

rce

nt

Source: CDC’s Metropolitan Atlanta Congenital Defects Program (MACDP)

Developmental Disabilities

• Affect at least 5-10 % of all children

• Include: Autism

Dyslexia ADHD Mental Retardation

• Reported prevalence is increasing

Overweight and Obesity

Source: Willet et al., New Eng J Med, 1999

• Prevalence has nearly quadrupled in American children

• 2.5-fold increased risk of overall mortality

• 4-fold risk of cardiovascular mortality

• 5-fold risk of diabetes

• Risk of hypertension, gall bladder disease, and some cancers

What is the Evidence that Toxic Chemicals in the Environment

Cause Disease in Children?

The Central Question in Pediatric Environmental Health:

• Children are surrounded by a large and ever increasing number of chemicals.

• Many of the chemicals to which children are at risk of exposure have not been tested for their possible developmental toxicity

• Children are more heavily exposed and more vulnerable to many environmental chemicals than adults

• These chemicals are detectable in most American children's bodies, even in newborn infants

Children’s Health and Toxic Chemicals: What We Know

Synthetic Organic Chemical Production

Most Chemicals to Which Children Are Exposed Have Not Been

Adequately Tested for Toxicity

• 80,000 + chemicals in commerce• 3,000 are high production volume (HPV)

chemicals - produced in quantities of 1 million pounds or more per year

• No basic toxicity information is available on half of HPV chemicals

• No information on developmental toxicity is available for 80% of HPV chemicals

Why Are Children Especially Vulnerable to Toxic Chemicals?

• Greater exposure pound-for-pound

• Decreased ability to detoxify many chemicals

• Heightened biological vulnerability – thalidomide, DES, fetal alcohol syndrome

• More years of future life

Children are not little adults

National Academy of Sciences, 1993

Evidence is Strong and Increasing

that Toxic Chemicals in the Environment

CauseDisease in Children

Toxic Chemicals Can Cause Neurodevelopmental Disorders

LEAD

• Principal source is lead paint and lead paint dust• Other sources – toys, imported dinnerware• 15-20% of cases associated with home renovation• Causes decreased IQ, shortened attention span, inability to concentrate, dyslexia and school failure• Any amount of lead is dangerous – No level is safe

Toxic Chemicals Can Cause Neurodevelopmental Disorders

LEAD

Toxic Chemicals Can Cause Neurodevelopmental Disorders

METHYL MERCURY

• Principal source is contaminated fish• Most methyl mercury in fish originates from coal-fired power plants• Effects on children similar to those of lead• Prevention – eat safe species of fish, avoid contaminated species www.thegreenguide.org

Toxic Chemicals Can Cause Neurodevelopmental Disorders

ORGANOPHOSPHATE PESTICIDES

• High-dose exposure can cause acute poisoning• Exposure during pregnancy to lower levels can

cause:small head circumference low birth weight developmental delaysADHDPervasive Developmental Disorder, a form of autism

Toxic Chemicals Can Cause Neurodevelopmental Disorders

ENVIRONMETAL EXPOSURES LINKED TO AUTISM

• Thalidomide• Misoprostol• Maternal rubella infection• Valproic acid

• Are there others among the thousands of untested chemicals to which our children are exposed daily?

Air Pollution Causes Asthma

New York City, before and after a photochemical smog.

Before

After

Smog on 5th Avenue

Chemicals and Radiation Can Cause Childhood

Cancer

• Solvents, especially benzene• Parental employment in industries that

use solvents – painting and printing • Pesticide exposure, especially prenatally

The Solution

Progress Against Environmental Disease in Children Requires Work in These Areas:

• Testing chemicals for toxicity RESPONSIBILITY OF THE FEDERAL GOVERNMENT

• Research• Patient care•Training the next generation of pediatricians

Programs on the Environment and Children’s Health at Mount Sinai

• The National Children’s Study• The Autism Discovery Project – AUTISM

• The Center for Children’s Environmental Health and Disease Prevention Research – ENDOCRINE DISRUPTORS, PREMATURTE PUBERTY & BREAST CANCER

• The Pediatric Environmental Health Specialty Unit – CLINICAL SERVICES FOR CHILDREN & FAMILIES

• Fellowship in Environmental Pediatrics - EDUCATION

• Growing Up Healthy in East Harlem – ASTHMA PREVENTION & PESTICIDE USE REDUCTION

The National Children’s Study

• A multi-year prospective epidemiological study that will follow 100,000 children from early in pregnancy to 18 years of age

• Mount Sinai leads the study in NY and NJ

The Goals: 1. To discover the environmental exposures that cause

disease and disability in childhood and throughout life

2. To translate this science into a roadmap for prevention

Critical Research Questionsfor the

National Children’s Study

• What are the preventable causes of autism, ADHD and other developmental disabilities?

• What are the effects of early exposures to endocrine disrupting chemicals?

• Are there chemical exposures that increase risk of obesity and diabetes?

• What are the preventable causes of pediatric cancer?

Prevention

DISEASE CAUSED BY TOXIC CHEMICALS IN THE ENVIRONMENT IS PREVENTABLE

• Prevention is best achieved by discovering hazards and then preventing exposures.

• Prevention needs to proceed on 3 levels:

1. Home2. Community3. Society

Prevention in the Home -The Value of Eating Organic

“Consumption of organic produce appears to provide a relatively simple way for parents to reduce their children's exposure to OP pesticides.”

Curl CL, Fenske RA, Elgethun K, University of Washington.

Families who consume an organic diet can reduce their pesticide exposure levels by 90% as compared to families who consume conventional supermarket food

CDC

Prevention in the Community

• Integrated pest management

• Pesticide neighbor notification laws

• Green schools

• Plant trees

• Insist on construction of sidewalks

• Maintain parks and playspaces

Prevention Works

Example: The removal of lead from gasoline

In 1976, US EPA began phase-out of lead from gasoline

Lead use in gasoline declined from 1976 through 1980

Year

1975 1976 1977 1978 1979 1980 1981

30

40

50

60

70

80

90

100

110

Gasoline lead

Lead

use

d In

gas

olin

e(1

000

tons

)

Source: Annest, Pirkle, Makuc, et al., Chronological trend in blood lead levels between 1976 and 1980. NEJM 1983; 308;1373-7.

Decline in Blood Lead Levels Greatly Exceeded Expectation

1974 1976 1978 1980 1982 1984 1986 1988 1990 1992

0

20

40

60

80

100

2

4

6

8

10

12

14

16

18

Blood leadGasoline lead

Beginning in 1980, EPA further restricted lead use in gasoline.Gasoline lead levels continued to decline through 1991

Lead

use

d In

gas

olin

e(1

000

tons

)

Blo

od le

ad le

vels

(µg

/dL)

Source: CDC. National Report on Human Exposure to Environmental Chemicals, March 2001

Environmental Disease is Preventable Declining Blood Lead Levels in the U.S.

1976–199918

1974 1976 1978 1980 1982 1984 1986 1988 1990 1992

2

4

6

8

10

12

14

16

Blo

od

Lead

Levels

(µ

g/

dL)

0

1994 1996 1998 2000

Year

2.72.0

Protecting Children against Environmental Threats to Health

Thank You!