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Bull World Health Organ. 2017 Aug 1; 95(8): 604–606.

Published online 2017 Jul 24. doi: 10.2471/BLT.16.171736

PMCID: PMC5537744

PMID: 28804173

Environmental health policies for women’s, children’s and adolescents’ health

Maria Neira,a Elaine Fletcher,a Marie Noel Brune-Drisse,a Michaela Pfeiffer,a Heather Adair-Rohani,a and Carlos Doracorresponding authora

Author information Article notes Copyright and License information PMC Disclaimer

Environmental health risks especially affect women and children, because they are more vulnerable socially and because exposures to environmental contaminants create greater risks for children’s developing bodies and cognitive functions. According to the 2016 World Health Organization (WHO) estimates, modifiable environmental risk factors cause about 1.7 million deaths in children younger than five years and 12.6 million total deaths every year.1

Although the Global strategy for women’s, children’s and adolescents’ health (2016–2030)2 was launched during the United Nations Sustainable Development Summit 2015, governments rarely recognize the sustainable development agenda as a transformative factor for health. The sustainable development goals (SDGs) offer opportunities for countries to create healthier environments for women, children and adolescents.

This paper explores how the SDGs can be used to reduce environmental health risks and enhance the health of women, children and adolescents. In particular, we focus on drivers for urbanization and sustainable development (e.g. transport, housing, urban design and energy provision) that can advance the global strategy, but have not traditionally been a focus of health policy-making. We frame the discussion around the three pillars of the global strategy: survive, thrive and transform, while recognizing the inevitable overlap between these objectives.

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Since women and children are especially affected by the environment, intersectoral interventions that reduce environmental risks will improve early childhood survival as well as reducing risks of premature death throughout the life-course.

For instance, household air pollution from dirty fuels and inefficient cookstove technologies was estimated to have caused around 4 million premature deaths in 2012 and was responsible for more than half of deaths due to childhood pneumonia.3 Among women, indoor exposures to household cookstove smoke were estimated to cause 34% (452 548/1 336 601) of chronic obstructive pulmonary disease deaths, 21% (732 937/3 476 815) of stroke deaths, 19% (93 537/489 390) of lung cancer deaths and 14% (479 478/3 425 835) of ischaemic heart disease deaths in 2012.4,5

Improving access to reliable electricity and clean water in health-care facilities can also help reduce maternal and newborn mortality, as such infrastructure is a critical determinant of quality of care.6 A review of health-care facilities in 11 sub-Saharan African countries showed that an average of 26% of facilities had no electricity whatsoever.7 Another review of 54 low- and middle-income countries found that 38% (25 118/66 101) of health facilities lack a clean drinking water source.8 Ensuring that health-care facilities have access to power and water is a minimum requirement for attracting women to facilities and guaranteeing quality services for safe childbirth.

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Housing and energy sector interventions that promote the transition to cleaner fuels and technologies for domestic cooking, heating and lighting can not only reduce deaths but improve the health of the 3 billion people worldwide who are reliant upon inefficient and polluting cookstoves.

For this reason, the monitoring framework of the Global strategy for women’s, children’s and adolescents’ health (2016–2030) explicitly tracks an indicator for “primary reliance on clean fuels and technologies” in households as part of its thrive pillar.9 Examples of cleaner fuels and technologies include liquefied petroleum gas, biogas, ethanol and electricity including photovoltaic solar-power for lighting. Improving access to clean fuels and technologies can also reduce the burden of childhood burns and poisonings due to the use of kerosene for cooking and lighting.

While most of the estimated 3 million deaths annually from outdoor ambient air pollution are among adult populations, reducing such pollution exposures are also critical to improving children’s health and development across the life-course.10

Currently, more than 92% of the world’s urban population is exposed to average annual air pollution concentrations above WHO guideline levels for fine particulate matter PM2.5 – that is, particles smaller than 2.5 μm in diameter. In developing cities, concentrations may be many times above guideline levels,11 and children in these cities experience chronic exposure to high levels of PM2.5 and ground-level ozone.12 These chronic exposures reduce children’s lung function at critical developmental stages, which increase the risk for chronic respiratory illnesses including asthma, as well as cardiovascular disease, stroke and cancers later in life.13

Air pollution also affects the health of high-income populations. For example, 67% (1043/1546) of the high-income European cities monitored by WHO fail to meet WHO guidelines levels for PM2.5. A study of air pollution-related health impacts in 25 European cities, totalling nearly 39 million inhabitants, showed that in cities with air pollution above the WHO guideline for annual mean PM2.5, achieving compliance would add up to 22 (2-22) more months of life expectancy at the age of 30 years, as well as generating some 31 billion euros annually in health and related savings overall.14

In many low- and middle-income cities, the lack of efficient public transport infrastructure stimulates reliance upon private transport modes and further exacerbates air pollution. People lacking private vehicle access experience an increased risk of traffic injury due to the lack of safe pedestrian and cycling spaces.15 In addition, the lack of safe outdoor spaces for children to play and enjoy physical activity contributes to sedentary lifestyles for rich and poor alike, contributing to childhood obesity.16

Air pollution is just one of the routes by which environmental contaminants affect children’s development, both in utero and in the early years of life. Estimates show that about 200 million children worldwide fail to reach their full potential due to, among others, toxic exposures to lead and mercury, either directly or through water, foods and waste.17,18 Both mercury and lead negatively affect the nervous system of the developing fetus and slow the cognitive development of young children.

While noncommunicable diseases now constitute two-thirds of the environmentally-related health burden,1 controlling environmentally-related infectious diseases also remains a challenge. Infectious diseases continue to present significant risks for the unborn child and for young children whose adaptive immune systems are under-developed. For example, unplanned urbanization, often characterized by poor housing and deficient environmental services for water, waste and sanitation, is a factor in vector-borne disease transmission. Such urbanization, as well as changing climate patterns, has been recognized as a driver promoting the proliferation of Aedes aegypti, the primary vector for dengue and Zika viruses.19 The Zika virus can cause congenital Zika virus syndrome, including microcephaly.20 Urban planning that reduces vector breeding sites and improves house-screening measures, may help protect women and children from bites and reduce transmission risks of vector-borne diseases.21

27. Lighting a Billion Lives (website) http://labl.teriin.org/

Articles from Bulletin of the World Health Organization are provided here courtesy of World Health Organization


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