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The Vulnerability of Children to Their Environment
From: Columbia University
| By:
David Satcher |
EDITOR'S INTRODUCTION |
 According to David Satcher, M.D., Ph.D. (right), the United States surgeon general and assistant secretary for health in the Department of Health and Human Services, children are more sensitive than adults to the impact of their environment. They also have less control over the nature of that environment--facing exposures in utero and throughout their childhood. Given the unique vulnerability of children, Satcher stresses the role of individuals, communities and the government in ensuring that children have a chance at a "healthy start" in life. |
 want to begin by commending the Columbia Center for Children's Environmental Health and the National Institute for Environmental Health Sciences for this conference. I think it's a critically important conference. The issues being discussed here are indeed issues of life and death, and certainly quality of life. |
Many of you know I like to tell stories. I read somewhere about a man who lived in the nineteenth century. His name was Charles Francis Adams, and he liked to keep diaries. One day he wrote in his diary, "I went fishing today with my son. It was a day that was wasted." His son, Brook Adams, also kept a diary. On that same day Brook wrote, "I went fishing today with my father, the most wonderful day of my life." I imagine the father was concerned that they didn't catch any fish and he didn't do a good job of teaching his son how to bait the hook. The reasons for his disappointment don't really matter. The point is that the time and investment we make in children tends to be much more valuable than we think. |
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| Satcher discusses how children interact with their environment. | |
The Public Health Service started as the Marine Hospital Service in 1798. The first surgeon general was appointed in 1871. From the beginning, the basic principle behind the Public Health Service has been: to the extent that we respond to the health needs of the most vulnerable among us, we do the most to promote the health of the nation. That's been our basic guiding philosophy and principle until this very day. |
A healthy start
We feel very strongly that when it comes to health, children are the most vulnerable for many, many reasons. Since I've been surgeon general, we've made it a priority to make sure that every child has the optimal chance for a healthy start in life. Think about what that means. What does it take for a child to have the optimal chance for a healthy start in life? It takes parents who are ready to be parents. It takes healthy parents, especially a mother who is taking folic acid to minimize the risk of neurotube defects. It takes a safe pregnancy--safe from tobacco, safe from alcohol, safe from pesticides--for a child to have a healthy start in life. |
In some ways, children are defenseless. They don't choose the time or place where they will be born. They don't choose what they're going to be exposed to in utero. They're dependent upon us adults in order to have a healthy start in life. If they don't get that healthy start, it can affect the rest of their lives. Just think about how critical that is. Think about how awesome our responsibility is as individuals, parents and as a community to make sure that every child has the optimal chance for a healthy start in life. I don't think there's anything more important we can do. |
When a child is born, it needs a safe and nurturing environment, nurtured by parents and others. It needs to be safe from violence and toxins like secondhand smoke. A child also needs things like breast-feeding and a place to sleep. All of these things are critical. |
It's also important that this healthy start continues throughout childhood. That is one of the sad things about teenage pregnancy. Often, when children become pregnant, they're still developing themselves, they're still starting themselves. And all of a sudden they have the responsibility for the beginning of another life. And that's why we're so happy that teenage pregnancies are coming down in this country-though maybe not fast enough. |
Children and their environment
We know a lot already about the impact of the environment on children. In the last 30 years I think we have learned a lot. We still have a lot of questions, but we certainly have learned a lot. We know how vulnerable the bodies of children tend to be to the environment. They have such a large surface area relative to total body mass that they're exposed to much more than the rest of us. They consume more water, more food, more air per unit of body weight than adults by far--7 to 10 times as much. |
So when children are exposed to pesticides, the impact is greater. One estimate is that the average child has consumed half of the pesticides that he or she will consume throughout life by the time he or she is 5 years of age. |
It has to do with this relationship that children have with the environment, how close they are to the ground. Since they like to get even closer, they consume lead chips or whatever. They're in tune, they're in touch with their environment, but all the while they're dependent upon us to make sure their environment is safe. |
Stopping and talking about the health and safety of children relative to the environment is something that's really, really critical to do--whether we're concerned about pharmaceuticals, pesticides, air and water pollution, lead poisoning, toxic waste dumps, secondhand smoke, PCBs, and on and on. |
We have an awesome responsibility to protect children and the health of children in their environment. We've got to make the commitment to invest in the health of children, invest time and resources. Hearing about programs in Harlem that relate to Columbia Center for Environmental Health and how you're working together is very encouraging. |
Federal efforts for child environmental health
What are we doing at the federal level as it relates to environmental health? There are several things. I want to discuss something that I'm responsible for managing. In April 1997, President Clinton issued the Executive Order on Child Environmental Health Risk and Safety. He asked that a task force be established that would include the heads of all the Cabinets. He asked the two Cabinet heads, Donna Shalala, the secretary of the Department of Health and Human Services, and Carol Browner, the administrator of the Environmental Protection Agency (EPA), to co-chair this task force. On this task force are all of the department heads--Housing and Urban Development (HUD); Education; Justice; and Agriculture. In addition, White House leaders, the Office of Science and Technology Policy and the Office of Management and Budget are involved. |
The responsibility of this task force is to look at how the environment affects the health of children in this country. Each department learns how its various programs can improve the relationship between children and their environment and create more healthy relationships. That task force has now been working for over two years. It's been a very vigorous task force that I've enjoyed working with. The task force is focused now on four work groups based on the areas that stood out when we looked at all of the risks from the environment. |
Asthma work group
Asthma is the number one work group because, for one thing, it's the most common chronic disorder among American children today. Not only that, but since 1980 the number of children under 5 years of age with asthma has tripled. Asthma disproportionately affects children in urban communities, like the communities surrounding this university. So asthma is out of control in this country especially among minority children and children who live in urban communities. |
Out of the asthma work group came the recommendation to add 50 million to Medicaid to encourage communities to develop innovative strategies for managing and applying the guidelines for managing asthma. Also out of this task force we have now funded eight centers throughout the country to do research on child environmental health and safety. Two of them happen to be in New York City--Columbia and Mt. Sinai. |
Injury work group
Another work group area is injury. Today, the major threat to children's lives in this country is injury-- nearly all of them preventable. Ranging from motor vehicle crashes to firearms to drowning, injuries account for many deaths among children. Motor vehicle crashes, for example, are still the leading cause of injury among children 5 to 14 years of age. So, injuries are a major concern. They represent this dynamic relationship of children to their environment and what happens when that relationship is not held in check. |
Cancer work group
The third work group that has grown out of this task force is childhood cancer. Cancer is the most common cause of disease related to mortality for children between the ages of 1 and 14. Whereas motor vehicle crashes are the leading cause of death, the most common of disease-related mortality is childhood cancer. We estimate that approximately 8,000 American children are diagnosed with cancer every year and about 1,600 children die from cancer every year. |
There has been a lot of debate about the extent to which there has been a dramatic increase in cancer, or whether we are just doing a better job of detecting it in children. The fact of the matter is that childhood cancer is a serious problem and a serious concern. |
Developmental disorders
The fourth area is developmental disorders. Birth defects are the leading cause of infant mortality and morbidity, accounting for one in five infant deaths. Other developmental disorders cause growth retardation and other health problems. |
I spent the weekend in a geriatric conference in Williamsburg, Virginia. The interesting thing is that you hear now about all of the families in which older parents are taking care of older children with developmental disorders. These children are now living to old age, even with Down's syndrome. It's an interesting phenomenon taking place in this country where developmental disorders are becoming aging problems. Often parents are not getting any help in taking care of those children. Sometimes they end up near death themselves. One of their major concerns is, "What is going to happen to this child with this developmental disorder when I die?" |
The point I want to make is that what happens to children very early can often affect the quality of their lives, even into old age. When we talk about the environmental impact upon children, we are not just talking about what they are going to experience as children. As we're able to keep people alive with developmental disorders and continue to improve the quality of their lives, then we need to think more seriously about what we can prevent with aggressive programs. |
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