Environmental Risks to Children's Health

INDOOR AIR POLLUTION

Half of the world's households use biomass fuels, including wood, animal dung, or crop residues, that produce particulates, carbon monoxide, and other indoor pollutants. The World Health Organization (WHO) has determined that as many as 1 billion people, mostly women and children, are regularly exposed to levels of indoor air pollution that are up to 100 times those considered acceptable.6 Young children, who spend more time indoors, are more exposed to the noxious byproducts of cooking and heating. In India, where 80 percent of households use biomass fuel, estimates show that nearly 500,000 women and children under age 5 die every year from indoor pollution, largely from acute respiratory infections (ARIs).7 The figure for other less developed countries is similar.8 Exposure to indoor pollutants can cause or aggravate ARIs, including upper respiratory infections such as colds and sore throats, and lower respiratory infections such as pneumonia. Acute lower respiratory infections are one of the primary causes of child mortality in developing countries, and led to 2.2 million deaths in children under age 5 in 2001.9 ARIs can also increase mortality from measles, malaria, and other diseases. Other factors that can worse ARIs include low birth weight, poor nutrition, inadequate housing and poor hygiene conditions, overcrowding, and reduced access to health care.

Asthma Studies in less developed countries have linked indoor air pollution to lung cancer, stillbirths, low

birth weight, heart ailments, and chronic respiratory diseases, including asthma.10 Asthma, a disease characterized by recurrent attacks of breathlessness and wheezing, affects between 100 million and 150 million people worldwide. The disease causes over 180,000 deaths every year, including 25,000 children's deaths.11 Worldwide rates of asthma have risen by 50 percent every 10 years since 1980; urbanization and increased time spent indoors are strongly associated with this increase.12 According to WHO, prevalence of asthma symptoms in children in Brazil, Costa Rica, Panama, Peru, and Uruguay varies from 20 percent to 30 percent; in Kenya, it approaches 20 percent. 13 The strongest risk factors for development of asthma appear to be exposure to indoor allergens and a family history of asthma or allergies. Exposure to environmental tobacco smoke (ETS, or secondhand smoke), chemical irritants, air pollutants, and cold weather are also risk factors for the disease, as are low birth weight, respiratory infections, and physical exercise. Children whose mothers smoke have 70 percent more respiratory problems and middle-ear infections than children of nonsmokers. Studies show that asthmatic children's condition is significantly likely to be worsened by ETS.14

Outdoor Air Pollution

Data suggest that over 60 percent of the diseases associated with respiratory infections are linked to exposure to air pollution.15 Outdoor pollutants such as sulfur dioxide, ozone, nitrogen oxide, carbon monoxide, and volatile organic compounds come mainly from motor vehicle exhaust, power plant emissions, open burning of solid waste, and construction and related activities. According to one report, children in cities with populations greater than 10 million are exposed to levels of air pollution two times to eight times higher than the level WHO considers acceptable. 16 In Mexico City, pollution levels are well above WHO's limits of 90 micrograms per cubic meter (g/m3) for particulates and 50 g/m3 for sulfur dioxide and nitrogen dioxide (see Figure

Causes of Death in Children

Infectious and parasitic diseases remain the major killers of children in the developing world, partly as a result of the HIV/AIDS epidemic. Although notable success has been achieved in certain areas (for example, polio), communicable diseases still represent seven out of the top 10 causes of child deaths, and account for about 60 per cent of all child deaths. Overall, the 10 leading causes represent 86 per cent of all child deaths. There has also been a modest decline in deaths from measles, although more than half a million children under 5 years of age still succumb to the disease every year. Malaria causes around a million child deaths per year, of which 90 per cent are children under 5 years of age. In this age group the disease accounts for nearly 11 per cent of all deaths. The overall number of child deaths in India has fallen from approximately 3.5 million in 1990 to approximately 2.3 million in 2002. This impressive decline is a result of a reduction in overall child mortality rates of about 30 per cent, and a decline in total fertility rates of around 10 per cent. A similar picture is emerging in China, where the number of child deaths has decreased by 30 per cent since 1990, owing to a reduction in child mortality of 18 per cent and a 6 per cent decline in total fertility. As in India, the most notable change in the cause-of-death pattern in China over the past decade is an increase in the proportion of pre-natal death

Effects of dust
Dust is composed of tiny particles of many kinds of solid materials. The particles have diameters of less than 0.0025 millimeters (0.0001 inches); a million typical dust particles would have a total volume equal to about one grain of sand. The particles consist of minerals, organic matter, soot, radioactive materials, and salt from evaporated sea spray. In relatively pure air there are fewer than 500 particles of dust per cubic centimeter (1 cc = 0.06 cu inches), whereas dirty air may contain more than 50,000 particles per cc. Inside a house where there is much activity, the concentration of organic dust alone may reach 100,-000 particles per cc; the particles include bacteria, spores, and bits of cotton, wool, wood, and hair, in addition to the usual amounts of soot and minerals.

Beneficial Effects of Dust

Dust is both beneficial and harmful. If there were no dust in the atmosphere, much less rain and snow would fall, because dust particles are the nuclei on which are formed the water droplets and ice crystals of clouds. In order for water vapor to condense in the absence of dust, the relative

humidity would have to be very much greater than 100$. Two kinds of particles may be distinguished. Hygroscopic nuclei are soluble particles that can convert water vapor into liquid water droplets at less than 100% humidity. Sublimation nuclei are nonsoluble particles on which water vapor is deposited in the form of ice.

Harmful Effects of Dust

The time and money spent on ridding homes, offices, streets, and clothing of their accumulated dust is incalculable. Dust inhaled in normal quantities is ejected by the lungs, but in greater concentration it may accumulate instead. This leads to such diseases as silicosis, which occurs among workers exposed to silica dust produced by grinding and drilling operations, and which in turn may result in tuberculosis. In addition, radioactive dust from nuclear explosions continually falls to earth or is washed down by rain. It presents a potential danger of overexposure to radioactivity, especialry to those radioactive substances that are absorbed and retained by the body. Finally, dust storms remove valuable topsoil and reduce the productivity of farmlands.

Effects of smoke
Indoor air pollution is not an indiscriminate killer. It is the poor who rely on the lower grades of fuel and have least access to cleaner technologies. Specifically, indoor air pollution affects women and small children far more than any other sector of society. Women typically spend three to seven hours per day by the fire, exposed to smoke, often with young children nearby. Over half of all people cooking on biomass live in India and China. However the proportion of the population cooking on biomass is highest in sub-Saharan Africa, rising to over 90% of the population in many countries. This is a chronic problem for people living in rural areas of developing countries, but not exclusively - there is a growing problem in the cities as well. Illnesses caused by indoor air pollution include acute lower respiratory infection. A child is two to three times more likely to contract acute lower respiratory infection if exposed to indoor air pollution. Women who cook on biomass are up to four times more likely to suffer from chronic obstructive pulmonary disease, such as chronic bronchitis. Lung cancer in women in China has been directly linked to use of coal burning stoves. In addition there is evidence to link indoor air pollution to asthma, tuberculosis, low birth weight and infant mortality and cataracts.