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Environmental Threats to the Health of Children in the Americas
Pan American Health Organization (PAHO)
World Health Organization (WHO)
April 9-11, 2003Lima, Peru
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Lima, Peru 2003
Linkage between environmental exposuresand children’s health
Dr. Irena Buka, MB, ChB, F.R.C.P.(C)Chair of Expert Advisory Board onChildren’s Health & the Environment, CECAssociate Clinical Professor of PaediatricsUniversity of Alberta, Canada
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Objectives
1. To define paediatric environmental health
2. To discuss health consequences of environmental exposures on children
3. To address the barriers within the health sector
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Objetivos
1. Definir la salud ambiental de la infancia
2. Discutir las consecuencias en la salud de los niños por exposiciones
ambientales
3. Comentar sobre los obstáculos que enfrenta el Sector Proveedor de Salud
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Nuestra clinica para los niños es en el hospital Misiracordia
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- es protección de los niños de:
1. Físicos 2. Biológicos 3. Socio-ecónomicos 4. Psico-emocionales 5. Químicos
…peligros ambientales
La salud ambiental en la infancia
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Paediatric environmental health- is protecting children from:
1. Physical 2. Biological 3. Socio-economic 4. Psychoemotional 5. Chemical
…environmental hazards
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¿Cuáles son los efectos en la salud?
1. Asma2. Problemas del neurodesarrollo3. Cáncer4. Malformaciones congénitas5. Efectos immunológicos6. Alteraciones endócrinas
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What are the health effects?
1. Asthma2. Neurodevelopmental disorders3. Cancer4. Congenital malformations5. Immunological disorders6. Endocrine disruption
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Casos de asma reportados desde el nacimiento a los 19 años
Canadá, 1978 - 1996
0
5
10
15
1978 1980 1982 1984 1986 1988 1990 1992 1994 1996
% 2 N/A N/A 3 N/A N/A N/A N/A 12 12
* El estudio de 1984 incluyó sólo al grupo de 0-14 años.
* Nota: Porcentajes en cálculo relativo.
* Fuente: Health Canada. 1999. Measuring Up: A Health Surveillance Update on Canadian Children and Youth.
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Reported Asthma Prevalence, Birth to 19 Years
Canada, 1978 - 1996
0
5
10
15
1978 1980 1982 1984 1986 1988 1990 1992 1994 1996
% 2 N/A N/A 3 N/A N/A N/A N/A 12 12
* 1984 survey includes 0-14 years of age only.
* Note: Percentages are weighted estimates.
* Source: Health Canada. 1999. Measuring Up: A Health Surveillance Update on Canadian Children and Youth.
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Asma
Factores desencadenantes
1. Emisiones vehiculares (EV)NO2 hidrocarburospartículas de dísel
2. Ozono, O3
COV + NOxs en luz solar
- plantas eléctricas, EV, gasolina
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Asthma
Triggers
1. Motor vehicle emissions (MVEs)NO2 hydrocarbonsdiesel particles
2. Ozones O3
VOC’s + NOxs in sunlight
- power plants, MVEs, gasoline
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Asma
3. Compuestos de azufre SO2, H2SO4, H2S- plantas carboníferas- molinos de pulpa y papel- fundidoras
4. Partículas suspendidas- hollín, humo- piedras, suelo, polvo
Factores desencadenantes
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AsthmaTriggers
3. Sulphur compounds SO2, H2SO4, H2S- coal fired power plants- pulp and paper mills- smelters
4. Particulate matter- soot, smoke- rocks, soil, dust
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AsmaFactores desencadenantes
Humo de tabaco ambiental
Adhesivos para construcción, pintura, productos de limpieza, cosméticos
Plaguicidas
Alergenos, infecciones, factores emocionales
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AsthmaTriggers
Environmental tobacco smoke
Building adhesives, paint, cleaning agents, cosmetics
Pesticides
Allergens, infections, emotions
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Asma
Factores de riesgo
1. Predisposición genética
2. Nacimiento prematuro
3. Exposición temprana a infecciones virales
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Asthma
Risk Factors
1. Genetic predisposition
2. Prematurity
3. Early exposure to viral infections
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Trastomos del Desarrollo Neurológico
17% sordero, ceguera, deficienciasdel habla, parálisis cerebral,alteraciones emocionales-conductuales, trastomos del aprendizaje
5-10% trastornos del aprendizaje solos6-17% déficit de atención/hiperactividad
Schettler 2001
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Neurodevelopmental Disorders
17% deaf, blind, speech deficit cerebral palsy emotional/behavioral disorders learning disabilities
5-10 % learning disabilities alone6-17% attention deficit hyperactive
disorders
Schettler 2001
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Trastornos del Desarrollo Neurológico
Etiología 1. Genética
2. Ambiental
3. Social
70% causa desconocida
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Neurodevelopmental Disorders
Aetiology1. Genetics
2. Environmental
3. Social
70% unknown cause
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Neurotóxicos
- exposición crónica a dósis bajas
1. Pb, Hg2. PCBs3. Nicotina4. Tolueno5. Medicamentos ej. fenitoina
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Neurotoxicants
- chronic low dose exposure
1. Pb, Hg2. PCB’s3. Nicotine4. Toluene5. Medications eg. phenytoin
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Cáncer
Etiologia
10-20% genética
80% algún componente ambiental
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Cancer
Aetiology
10-20% genetic
80% environmental component
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Cáncer en la infancia
Etiología
Alteraciones genéticasRadiación: UV, ionizanteAlcohol, Humo de tabaco ambientalQuímicos Industriales y AgrícolasMedicamentos
Herbst 1971 Zahm & Deveza 1995
Schmidt 1998
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Childhood cancer
Aetiology
Genetic abnormalitiesUV and ionizing radiationE.T.S. alcoholIndustrial & agricultural chemicalsMedications
Herbst 1971 Zahm & Deveza 1995
Schmidt 1998
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Malformaciones Congénitas
Tasa de mortalidad infantil por cada 100,000nacidos vivos, 1997.
Canada 147-7
U.S.A. 159-2
Mexico 267-7
-2a causa de muerte en la población infantil
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Birth defects
1997 Infant death rates per 100,000 live births
Canada 147-7
U.S.A. 159-2
Mexico 267-7
- second leading cause of infant mortality
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Malformaciones Congénitas
Etiología
- medicamentos
- deficiencias nutricionales
80% desconocidas
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Birth defects
Aetiology
- medications
- nutritional deficiencies
80% unknown
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Efectos Inmunológicos
PCB’s - exposición in utero infecciones en niños
Haral. 1985
Pesticidas - suprimen células “asesinas” - predis. a leucemias, linfomas
Zahm & Deveza 1995
Humo de tabaco ambiental - infecciones en niños
Haral. 1985
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Immunological effects
PCB’s - in utero exposure infections in children
Haral. 1985
Pesticides - suppress killer cells - predispd to leuka, lymphoma
Zahm & Devesa 1995
E.T.S. - infections in children Haral. 1985
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Disruptores Endócrinos
PCB’s, dioxinas, DDT
Ésteres de ftalatos
- en humanos y vida silvestre
Longneckel et al. 1997
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Endocrine disruption
PCB’s, dioxins, DDT
Phthalate esters
- in humans and wildlife
Longneckel et al. 1997
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Disrupción Endocrina
- cuenta de espermatozoides, trastornos de la fertilidad
- criptorquidia, hipospadias, cáncer testicular
- pubertad precoz, cáncer de mama
Foster 1998
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Endocrine disruption
- sperm counts, difficulties conceiving
- cryptorchism, hypospadias, testicular cancer
- premature puberty, breast cancer
Foster 1998
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Obstáculos en el Sector Proveedor de Salud
1. Falta conciencia - recursos educativos2. Modelo Causa/Efecto - subdesarrollado3. Complejidad - Aspectos multifaceticos e la atención4. Bases de Datos - inadecuadas5. Investigación - Complicado, aplicable a egulación6. Prevención - precaución - responsabilidad
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Barriers in the health sector
1. Insufficient awareness, education, resources 2. Cause & effect model - undeveloped 3. Conditions complex - multifaceted aspects of care 4. Databases - inadequate 5. Research - intricate, policy applicable 6. Prevention - precautions - responsibility
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Más vale prevenir que remediar
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La población infantil constituye 30% de la población mundial,
- pero representa 100% de nuestro futuro
Naciones Unidas, 1998