Europe's legacy to its children—a healthier environment?

Abstract

Today the EU is welcoming ten new nations—among them countries that have had to substantially transform themselves after the consequences of years of totalitarian rule. During the next few months,The Lancet plans to look at the specific health achievements and challenges for each of these countries. Today's issue puts the spotlight on the Czech Republic (p 1443). One of the most difficult issues for these nations remains the environmental sector. Many have a poor record for safe and clean water, high levels of air pollution from old combustion plants, and inadequate hazardous waste treatment. For example, the Czech Republic had, with 595 per 100000 people, the highest prevalence of microbiological foodborne disease in the European region in 2001. Smoking and exposure to environmental tobacco smoke is widespread. WHO data from 2000 show that in Hungary, 42% of adults and 19% of 15-year-olds smoke. But progress towards a cleaner and healthier environment has been painfully slow worldwide. In its annual report 2004 (p 1448), released last week, the World Economic Forum rated achievements to reach the environmental targets set out in the Millennium Development Goals as three out of ten, indicating that less than a third of necessary efforts have been made to reach the objectives of halving the number of people with no access to clean water and sanitation and stabilising greenhouse gas emissions. “The negotiation of more than 500 multilateral environmental agreements appears to have left Mother Nature singularly unimpressed”, say the report's authors. The failure to look after our environment now, and to provide the foundation of healthy living for future generations, will cause and exacerbate chronic diseases and deaths for years to come. The single most vulnerable population group is children. Unhealthy environments cause an estimated 5 million deaths in children per year worldwide, and contribute to about one third of the total burden of disease among children. But there are some encouraging signs. Europe has finally recognised the need to put children at the heart of the agenda for environmental health. Next month, ministers representing both health and environment, together with other stakeholders from the 52 countries of the WHO European Region, will get together in Budapest for the Fourth Ministerial Conference on Environment and Health to discuss emerging data and to adopt the Children's Environment and Health Action Plan for Europe. The emphasis is on four regional priority goals: safe water and adequate sanitation; protection from injuries and adequate physical activity; clean outdoor and indoor air; and chemical-free environments. Laudable goals. But are they achievable? Or will we lament in 5 years' time the failure to progress any of these objectives just as we do with the Millennium Development Goals today? Would it not be better to pick only a few areas where clear disease causation and a high disease burden is proven and commit to immediate and specific Europe-wide legislation? In a supplement to last month'sPediatrics, the summarised evidence helps such priority setting: a ban of smoking in all public places and in children's houses; a drastic reduction of lead exposure; lowering of traffic speed in residential areas; and access to clean drinking water. Yet, paediatricians and public-health physicians do not seem to feature prominently at the Budapest conference. After bringing environmental and health ministers together, it is now time for doctors to take a front seat in a new specialty of environmental paediatric health. In the USA, Pediatric Environmental Health Specialty Units were established in 1998. In 2002, the Ambulatory Pediatric Association launched the first fellowship programme in paediatric environmental health. The National Children's Study, a longitudinal study of environmental influences on children's health, was authorised by the federal Children's Health Act in 2000, and will follow more than 100 000 children from birth to 21 years of age. The first preliminary results are expected in 2008/9. Europe should follow this example. Otherwise Budapest will host yet another empty talking shop.