SALUD INFANTIL Y MEDIO AMBIENTE

SALUD INFANTIL Y MEDIO AMBIENTE
Dra. J. Pronczuk OMS/OPS

Los niños representan el futuro de las sociedades
Es crucial proteger su salud y su ambiente para que: Logren todo su potencial como individuos Sean miembros contribuyentes para la sociedad Provean la base del desarrollo sustentable Alcanzar los Objetivos del Milenio: Reducir la mortalidad infantil Asegurara la sustentabilidad medio-ambiental WHO <<READ SLIDE.>> The term “children” refers to all age groups, from conception (embryonic and fetal stages) to the end of adolescence. References: Children in the New Millennium, Environmental impact on health. UNEP, UNICEF, WHO, 2002. Healthy Environments for Children Booklet. Geneva, World Health Organization, 2002.

SALUD INFANTIL Y MEDIO AMBIENTE
1. Cuál es el impacto de los factores ambientales sobre la carga global de enfermedad? 2. Porque se magnifican los efectos de contaminantes en agua, aire, alimentos, suelos y objetos en la infancia? 3. Efectos sobre la salud y el desarrollo: comprobados o sospechados… 4. Algunos ejemplos 5. Posibles soluciones 6. Acciones de OMS/OPS

DESAFÍOS PARA LA SALUD HUMANA Y EL DESARROLLO
A number of new driving forces and global environmental changes pose challenges to human health and to the environment. These challenges contribute to environmental degradation – and environmental degradation disproportionately affects children. <<READ SLIDE.>> <<NOTE TO SPEAKER: The driving forces and global environmental changes mentioned are self-explanatory. However, speakers may need to expand on one or two of the points, if considered relevant.>> Ref: Gracey. Child health implications of worldwide urbanization. Rev Environ Health, 2003, 18:51. The upsurge of urbanization, often poorly planned and uncontrolled, has caused major impacts on human societies for at least two centuries. Urban environments and urbanized lifestyles have strong influences on health and well-being, including on infant and childhood populations in developed and underdeveloped countries, as well as among societies in developmental and environmental transition around the world. Urbanization will inevitably have significant impacts on the health of future generations. Notably, the health consequences of urbanized lifestyles are not confined to residents of cities and large towns but rather are becoming manifest in rapidly changing, previously traditional societies in rural and remote areas because globalization is altering infant feeding practices and the dietary habits and lifestyle patterns of their children. In underdeveloped countries, overcrowding and environmental pollution are huge problems that are exacerbated by undernutrition and infection, particularly respiratory and diarrhoeal diseases. In developed societies, other problems such as injuries; poisonings; violence; drug abuse; exposure to chemical, biological, industrial, and atmospheric pollutants, including pesticides; sexually transmissible diseases; and 'lifestyle' diseases, including obesity and cardiovascular disease risk, are of great current and potential importance.

NUEVAS FUERZAS IMPULSORAS Globalización Industrialización Urbanización Pobreza e inequidad social Consumo no sustentable Crecimiento poblacional Comercio y transporte químico A number of new driving forces and global environmental changes pose challenges to human health and to the environment. These challenges contribute to environmental degradation – and environmental degradation disproportionately affects children. <<READ SLIDE.>> <<NOTE TO SPEAKER: The driving forces and global environmental changes mentioned are self-explanatory. However, speakers may need to expand on one or two of the points, if considered relevant.>> Ref: Gracey. Child health implications of worldwide urbanization. Rev Environ Health, 2003, 18:51. The upsurge of urbanization, often poorly planned and uncontrolled, has caused major impacts on human societies for at least two centuries. Urban environments and urbanized lifestyles have strong influences on health and well-being, including on infant and childhood populations in developed and underdeveloped countries, as well as among societies in developmental and environmental transition around the world. Urbanization will inevitably have significant impacts on the health of future generations. Notably, the health consequences of urbanized lifestyles are not confined to residents of cities and large towns but rather are becoming manifest in rapidly changing, previously traditional societies in rural and remote areas because globalization is altering infant feeding practices and the dietary habits and lifestyle patterns of their children. In underdeveloped countries, overcrowding and environmental pollution are huge problems that are exacerbated by undernutrition and infection, particularly respiratory and diarrhoeal diseases. In developed societies, other problems such as injuries; poisonings; violence; drug abuse; exposure to chemical, biological, industrial, and atmospheric pollutants, including pesticides; sexually transmissible diseases; and 'lifestyle' diseases, including obesity and cardiovascular disease risk, are of great current and potential importance.

NUEVAS FUERZAS IMPULSORAS Globalización Industrialización Urbanización Pobreza e inequidad social Consumo no sustentable Crecimiento poblacional Comercio y transporte químico CAMBIO AMBIENTAL GLOBAL Cambio climático Deterioro de la capa de ozono Desertificación/deforestación Incendios forestales Pérdida de la biodiversidad Uso de ciertas biotecnologías A number of new driving forces and global environmental changes pose challenges to human health and to the environment. These challenges contribute to environmental degradation – and environmental degradation disproportionately affects children. <<READ SLIDE.>> <<NOTE TO SPEAKER: The driving forces and global environmental changes mentioned are self-explanatory. However, speakers may need to expand on one or two of the points, if considered relevant.>> Ref: Gracey. Child health implications of worldwide urbanization. Rev Environ Health, 2003, 18:51. The upsurge of urbanization, often poorly planned and uncontrolled, has caused major impacts on human societies for at least two centuries. Urban environments and urbanized lifestyles have strong influences on health and well-being, including on infant and childhood populations in developed and underdeveloped countries, as well as among societies in developmental and environmental transition around the world. Urbanization will inevitably have significant impacts on the health of future generations. Notably, the health consequences of urbanized lifestyles are not confined to residents of cities and large towns but rather are becoming manifest in rapidly changing, previously traditional societies in rural and remote areas because globalization is altering infant feeding practices and the dietary habits and lifestyle patterns of their children. In underdeveloped countries, overcrowding and environmental pollution are huge problems that are exacerbated by undernutrition and infection, particularly respiratory and diarrhoeal diseases. In developed societies, other problems such as injuries; poisonings; violence; drug abuse; exposure to chemical, biological, industrial, and atmospheric pollutants, including pesticides; sexually transmissible diseases; and 'lifestyle' diseases, including obesity and cardiovascular disease risk, are of great current and potential importance.

NUEVAS FUERZAS IMPULSORAS Globalización Industrialización Urbanización Pobreza e inequidad social Consumo no sustentable Crecimiento poblacional Comercio y transporte químico DEGRADACIÓN AMBIENTAL CAMBIO AMBIENTAL GLOBAL Cambio climático Deterioro de la capa de ozono Desertificación/deforestación Incendios forestales Pérdida de la biodiversidad Uso de ciertas biotecnologías A number of new driving forces and global environmental changes pose challenges to human health and to the environment. These challenges contribute to environmental degradation – and environmental degradation disproportionately affects children. <<READ SLIDE.>> <<NOTE TO SPEAKER: The driving forces and global environmental changes mentioned are self-explanatory. However, speakers may need to expand on one or two of the points, if considered relevant.>> Ref: Gracey. Child health implications of worldwide urbanization. Rev Environ Health, 2003, 18:51. The upsurge of urbanization, often poorly planned and uncontrolled, has caused major impacts on human societies for at least two centuries. Urban environments and urbanized lifestyles have strong influences on health and well-being, including on infant and childhood populations in developed and underdeveloped countries, as well as among societies in developmental and environmental transition around the world. Urbanization will inevitably have significant impacts on the health of future generations. Notably, the health consequences of urbanized lifestyles are not confined to residents of cities and large towns but rather are becoming manifest in rapidly changing, previously traditional societies in rural and remote areas because globalization is altering infant feeding practices and the dietary habits and lifestyle patterns of their children. In underdeveloped countries, overcrowding and environmental pollution are huge problems that are exacerbated by undernutrition and infection, particularly respiratory and diarrhoeal diseases. In developed societies, other problems such as injuries; poisonings; violence; drug abuse; exposure to chemical, biological, industrial, and atmospheric pollutants, including pesticides; sexually transmissible diseases; and 'lifestyle' diseases, including obesity and cardiovascular disease risk, are of great current and potential importance.

NUEVAS FUERZAS IMPULSORAS Globalización Industrialización Urbanización Pobreza e inequidad social Consumo no sustentable Crecimiento poblacional Comercio y transporte químico DEGRADACIÓN AMBIENTAL CAMBIO AMBIENTAL GLOBAL Cambio climático Deterioro de la capa de ozono Desertificación/deforestación Incendios forestales Pérdida de la biodiversidad Uso de ciertas biotecnologías Desproporcionada vulnerabilidad de los niños, que sufren mayores efectos, actuales, y futuros A number of new driving forces and global environmental changes pose challenges to human health and to the environment. These challenges contribute to environmental degradation – and environmental degradation disproportionately affects children. <<READ SLIDE.>> <<NOTE TO SPEAKER: The driving forces and global environmental changes mentioned are self-explanatory. However, speakers may need to expand on one or two of the points, if considered relevant.>> Ref: Gracey. Child health implications of worldwide urbanization. Rev Environ Health, 2003, 18:51. The upsurge of urbanization, often poorly planned and uncontrolled, has caused major impacts on human societies for at least two centuries. Urban environments and urbanized lifestyles have strong influences on health and well-being, including on infant and childhood populations in developed and underdeveloped countries, as well as among societies in developmental and environmental transition around the world. Urbanization will inevitably have significant impacts on the health of future generations. Notably, the health consequences of urbanized lifestyles are not confined to residents of cities and large towns but rather are becoming manifest in rapidly changing, previously traditional societies in rural and remote areas because globalization is altering infant feeding practices and the dietary habits and lifestyle patterns of their children. In underdeveloped countries, overcrowding and environmental pollution are huge problems that are exacerbated by undernutrition and infection, particularly respiratory and diarrhoeal diseases. In developed societies, other problems such as injuries; poisonings; violence; drug abuse; exposure to chemical, biological, industrial, and atmospheric pollutants, including pesticides; sexually transmissible diseases; and 'lifestyle' diseases, including obesity and cardiovascular disease risk, are of great current and potential importance.

MORTALIDAD INFANTIL Y MEDIO AMBIENTE
Cada año mueren más de de menores de 5 años por causas y afecciones relacionadas con el medio ambiente Afecciones diarreicas Afecciones respiratorias Malaria/enfermedades por vectores Lesiones/Intoxicaciones Qué pasa con quienes sobreviven?

MORTALIDAD INFANTIL Y MEDIO AMBIENTE
En países en desarrollo los niños pierden como promedio, 8 veces más años de vida sana por habitante que los niños de otros países, debido a enfermedades de origen ambiental. En los países más pobres: N° de años de vida sana perdidos por afecciones respiratorias: 800 veces mayor, y por enfermedades diarreicas:140 veces mayor. Retraso mental causado por plomo en gasolina es 30 veces mayor en zonas donde se utiliza con respecto a zonas donde se ha eliminado. AMBIENTES SALUDABLES Y PREVENCIÓN DE ENFERMEDADES Hacia una estimación de la carga de morbilidad atribuible al medio ambiente A. Prus-Ustun y C. Corvalan – OMS, Ginebra, 2006

QUÉ IMPORTANCIA TIENEN LOS EFECTOS DEL MEDIO AMBIENTE SOBRE LA SALUD?
Atribuibles a factores ambientales: - 24% de la carga de morbilidad mundial (años de vida sana perdidos) - 23% de la mortalidad global Los factores de riesgo ambiental influyen en 85 de los 102 tipos de enfermedades del Informe Mundial de la Salud (2004) Mortalidad atribuible a factores ambientales en un 25 % en países en vías de desarrollo y el 17% en países industrializados … llega hasta el 36% entre 0 y 14 años!

Enfermedades con la mayor contribución causal del medio ambiente
La barra verde oscura más la barra verde clara del diagrama representan la carga de morbilidad total. Restraso mental (causado por el plomo) tal como se define en la lista de enfermedades de la OMS correspondiente a 2002 accesible en internet ( AVAD: una medida ponderada de la mortalidad, la morbilidad y la discapacidad.

Las enfermedades pediátricas relacionadas con causas ambientales son de alto costo socio-económico
Incremento de gastos médicos Enfermedad, discapacidad y muerte Ausencia escolar por enfermedad Menor productividad de los padres por ausencia laboral Agonía y dolor de las familias y la comunidad Reducción a largo plazo de la productividad del país It is important to stress that all the effects and diseases resulting from chemical, physical and biological threats have high social and economic costs. <<READ SLIDE.>> Picture: WHO. Child hospitalized due to cholera, in Peru.

EFECTOS Órganos Sistemas Funciones Desarrollo Supervivencia

EFECTOS Órganos Sistemas Funciones Desarrollo Supervivencia RIESGOS Físicos Químicos Biológicos Sociales

EFECTOS Órganos Sistemas Funciones RIESGOS Desarrollo Físicos
Supervivencia RIESGOS Físicos Químicos Biológicos Sociales MEDIO Agua, Aire, Alimentos Suelo, Objetos

Supervivencia RIESGOS Físicos Químicos Biológicos Sociales MEDIO Agua, Aire, Alimentos Suelo, Objetos ZONA/LUGAR Rural/urbano Hogar, Escuela Parque, Campo Calle, Trabajo

Supervivencia RIESGOS Físicos Químicos Biológicos Sociales MEDIO Agua, Aire, Alimentos Suelo, Objetos ZONA/LUGAR Rural/urbano Hogar, Escuela Parque, Campo Calle, Trabajo ACTIVIDADES Comer, Beber, Dormir, Respirar, Jugar, “Probar", Hurgar…

Supervivencia RIESGOS Físicos Químicos Biológicos Sociales MEDIO Agua, Aire, Alimentos Suelo, Objetos SUSCEPTIBILIDAD Ventanas críticas Edad, Nutrición Pobreza ZONA/LUGAR Rural/urbano Hogar, Escuela Parque, Campo Calle, Trabajo ACTIVIDADES Comer, Beber, Dormir, Respirar, Jugar, “Probar", Hurgar…

Supervivencia RIESGOS Físicos Químicos Biológicos Sociales EFECTOS Órganos Sistemas Funciones Desarrollo Supervivencia MEDIO Agua, Aire, Alimentos Suelo, Objetos SUSCEPTIBILIDAD Ventanas críticas Edad, Nutrición Pobreza ZONA/LUGAR Rural/urbano Hogar, Escuela Parque, Campo Calle, Trabajo ACTIVIDADES Comer, Beber, Dormir, Respirar, Jugar, “Probar", Hurgar…

AMBIENTES COMPLEJOS, PROBLEMAS MÚLTIPLES, ENCARES ESTRATÉGICOS EFECTOS
Órganos Sistemas Funciones Desarrollo Supervivencia RIESGOS Físicos Químicos Biológicos Sociales EFECTOS Órganos Sistemas Funciones Desarrollo Supervivencia MEDIO Agua, Aire, Alimentos Suelo, Objetos SUSCEPTIBILIDAD Ventanas críticas Edad, Nutrición Pobreza ZONA/LUGAR Rural/urbano Hogar, Escuela Parque, Campo Calle, Trabajo ACTIVIDADES Comer, Beber, Dormir, Respirar, Jugar, “Probar", Hurgar…

PORQUÉ HAY MAYOR PREOCUPACION SOBRE SALUD INFANTIL Y MEDIO AMBIENTE?
Datos epidemiológicos y estimaciones alarmantes Mayor conocimiento sobre: Vulnerabilidad especial del feto, del niño y del adolescente Importancia del momento y tipo de exposición Interacciones entre ambiente y salud Exacerbación de los efectos en situación de malnutrición, pobreza, estrés y conflicto Nuevas tecnologías de estudio Existencia de áreas de intervención inmediatas Objetivos del Milenio

SALUD INFANTIL: PRINCIPALES RIESGOS AMBIENTALES
Agua inadecuada Falta de higiene/saneamiento Contaminación aire interior/exterior Enfermedades por vectores Riesgos químicos Lesiones no intencionales ... RIESGOS EMERGENTES! According to WHO, there are six main GLOBAL environmental risk factors for children. <<NOTE TO USER: The six risk factors will be described in more detail in the following slides.>> Household water insecurity. This is one of the main causes of diarrhoea. Safe drinking-water, as defined by the WHO Guidelines, does not represent any significant risk to health over a lifetime of consumption, including different sensitivities that may occur at different life stages. Poor hygiene and sanitation. This leads to inadequate washing and cleaning practices, and therefore to disease. Air pollution, both indoor and outdoor. This triggers or aggravates respiratory diseases. Disease vectors. These cause one million deaths a year in children, due to malaria, dengue fever, leishmaniasis, Japanese encephalitis and others. Chemical hazards. Injuries and accidents. Injuries including road accidents, drowning, burns and poisoning cause deaths per year. EMERGING ISSUES! These include global change (climate and others), ozone depletion, electromagnetic radiation, contamination by persistent organic pollutants... Refs: Healthy environments for children and a healthier planet. Booklet. Geneva, WHO, 2002. WHO Guidelines for drinking-water quality,3rd ed. Geneva, World Health Organization, 2004 ( WHO

AIRE INTERIOR Y EXTERIOR
CONTAMINACIÓN DEL AIRE INTERIOR Y EXTERIOR WHO Humo de tabaco y combustibles sólidos - Infección Respiratoria Baja – y posiblemente otitis - En Italia: 21% de las IRAs en <2 años por humo de tabaco CO y gases tóxicos – efectos pulmonares y sistémicos Ozono - vinculado a crisis de asma Hongos, humedades, ácaros - asma HPA (Hidrocarburos Policíclicos Aromáticos) in utero More than two billion people worldwide continue to depend on solid fuels, including biomass fuels (wood, dung, agricultural residues) and coal, for their energy needs. Cooking and heating with solid fuels on open fires or traditional stoves results in high levels of indoor air pollution. Indoor smoke contains a range of health-damaging pollutants, such as small particles and carbon monoxide (CO), and levels of particulate pollutants may be many times higher than accepted guideline values. Ref: WHO, World Health Report 2002 (according to which indoor air pollution is responsible for 2.7% of the global burden of disease). There is consistent evidence that exposure to indoor air pollution can lead to acute lower respiratory infections in children under 5 years old, and chronic obstructive pulmonary disease and lung cancer (where coal is used) in adults. Acute respiratory infections, in particular pneumonia, continue to be the biggest killers of young children and cause more than 2 million deaths annually. This is almost exclusively a problem of children in developing countries. Some countries are reporting a rising trend of "wheezing”. The heavy use of coal and biomass fuels (the most polluting fuels) is linked to respiratory (and other) effects on children. Suspended pollutants may carry infectious agents into the lungs and also predispose to infection: other particles may carry chemicals that predispose to lesions and infection. Not only particles are noxious, but also carbon monoxide and other toxic gases released as products of combustion (the complete explanation is given in the Respiratory Diseases Module). Second-hand tobacco smoke is a major concern. Picture: WHO, C. Gaggero. Child housework, Costa Rica

CONTAMINACIÓN DEL AIRE INTERIOR Y EXTERIOR
Hidrocarburos Aromáticos Policíclicos (HAP) emitidos por el tráfico, plantas de energía y humo de tabaco atraviesan la placenta y causan: - reducción del crecimiento fetal y post-natal - bajo peso al nacer (Sram et al, EHP 113, Abril 2005) - disminución de capacidades cognitivas en niños de 3 años - problemas del aprendizaje escolar (Perera et al, EHP 114, Agosto 2006) More than two billion people worldwide continue to depend on solid fuels, including biomass fuels (wood, dung, agricultural residues) and coal, for their energy needs. Cooking and heating with solid fuels on open fires or traditional stoves results in high levels of indoor air pollution. Indoor smoke contains a range of health-damaging pollutants, such as small particles and carbon monoxide (CO), and levels of particulate pollutants may be many times higher than accepted guideline values. Ref: WHO, World Health Report 2002 (according to which indoor air pollution is responsible for 2.7% of the global burden of disease). There is consistent evidence that exposure to indoor air pollution can lead to acute lower respiratory infections in children under 5 years old, and chronic obstructive pulmonary disease and lung cancer (where coal is used) in adults. Acute respiratory infections, in particular pneumonia, continue to be the biggest killers of young children and cause more than 2 million deaths annually. This is almost exclusively a problem of children in developing countries. Some countries are reporting a rising trend of "wheezing”. The heavy use of coal and biomass fuels (the most polluting fuels) is linked to respiratory (and other) effects on children. Suspended pollutants may carry infectious agents into the lungs and also predispose to infection: other particles may carry chemicals that predispose to lesions and infection. Not only particles are noxious, but also carbon monoxide and other toxic gases released as products of combustion (the complete explanation is given in the Respiratory Diseases Module). Polycyclic aromatic hydrocarbons (PAHs) are an important class of toxic pollutants released by fossil fuel combustion. Other pollutants include metals and particulate matter. PAH–DNA adducts, or benzo[a]pyrene (BaP) adducts as their proxy, provide a chemical-specific measure of individual biologically effective doses that have been associated with increased risk of cancer and adverse birth outcomes. In the present study we examined the relationship between prenatal PAH exposure and fetal and child growth and development in Tongliang, China, where a seasonally operated coal-fired power plant was the major pollution source. In a cohort of 150 nonsmoking women and their newborns enrolled between 4 March 2002 and 19 June 2002, BaP–DNA adducts were measured in maternal and umbilical cord blood obtained at delivery. The number of gestational months occurring during the period of power plant operation provided a second, more general measure of exposure to plant emissions, in terms of duration. High PAH–DNA adduct levels (above the median of detectable adduct level) were associated with decreased birth head circumference (p = 0.057) and reduced children's weight at 18 months, 24 months, and 30 months of age (p < 0.05) , after controlling for potential confounders. In addition, in separate models, longer duration of prenatal exposure was associated with reduced birth length (p = 0.033) and reduced children's height at 18 (p = 0.001) , 24 (p < 0.001) , and 30 months of age (p < 0.001) . The findings suggest that exposure to elevated levels of PAHs, with the Tongliang power plant being a significant source, is associated with reduced fetal and child growth in this population. Key words: birth outcome, coal-burning emission, cord blood, fetal and child development, PAH–DNA adducts. Environ Health Perspect 114:1297–1300 (2006) . doi: /ehp.8939 available via [Online 4 April 2006] Picture: WHO, C. Gaggero. Child housework, Costa Rica Picture PAHs:

SUSTANCIAS QUÍMICAS PREOCUPANTES
Plomo y mercurio Plaguicidas COPs Nitratos Flúor Arsénico Micotoxinas Otras… <<NOTE TO USER: List the main chemicals of concern (and why there is concern) in your country. For more information see the corresponding modules on the chemicals mentioned.>> Some examples are listed below: lead: a major development toxicant, worldwide; mercury: distribution ubiquitous, may affect the fetus and child; pesticides: their unsafe use creates important public health and environmental problems; POPs: persistent organic pollutants: are they linked to reproductive dysfunction? Cancer? (Pesticides include aldrin, dieldrin, chlordane, DDT, endrin, heptachlor, mirex, toxaphene. Industrial chemicals include PCBs and HCB. Unintended by-products include dibenzodioxins, dibenzofurans. For more information, see presentation on "POPs"); nitrates: risk of methaemoglobinaemia in newborns; fluorides: risk of dental and/or osteoskeletal fluorosis in some countries; arsenic: serious problem of contamination of drinking-water in Bangladesh, India, and a few other countries – (intervention illustrated in the slide); mycotoxins: an endemic problem in some African countries; and other chemicals. WHO

SALUD INFANTIL Y AMBIENTE RESPUESTAS DE OMS/OPS
Asociándose a investigadores y profesionales de salud y ambiente de distintos países, OMS/OPS está desarrollando actividades para identificar, determinar y actuar sobre las amenazas ambientales presentes - y eventualmente las futuras - sobre la salud infantil.

SALUD INFANTIL Y AMBIENTE RESPUESTAS DE OMS/OPS
Regionales OPS, EURO, AFRO, EMRO, WPRO Procesos "HEMA": Ministros de Salud y Ambiente Actividades técnicas: Perfiles Nacionales de SIMA Paquete de Capacitación para el Sector Salud Historia Pediátrica Ambiental (hoja verde) AIEPI Indicadores de SIMA Centros de Salud Infantil Ambiental Investigación en cooperación internacional: Estudios longitudinales de cohorte

MDG 4: reducir la mortalidad infantil
La protección de la salud infantil a través de ambientes sanos y seguros contribuye al logro de los Objetivos de Desarrollo del Milenio MDG 4: reducir la mortalidad infantil MDG 7: asegurar la sostenibilidad ambiental Crear ambientes más sanos, limpios y seguros para los niños – a través de una mayor seguridad química – contribuirá a un futuro mejor para el mundo “Moldeando el Futuro de la Vida" (“Shaping the future of life“) Día Mundial de la Salud , Abril, 2003

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