1 Opportunity for International Cooperation in the Next Generation of Birth Cohort Studies of Child Health and the Environment of Child Health and the Environment Ruth A. Etzel, MD, PhD World Health Organization

World average How much disease could be prevented by modifying the environment ? Current evidence - best conservative estimate 24% Source: Preventing disease through healthy environments, WHO, 2006

New or "re-emerging" threats to children's health and development  Nanoparticles  Ozone depletion  Radiation  Persistent organic pollutants  Endocrine disruption  Others… WHO NEED TO KNOW ABOUT EMERGING ISSUES WHO

Guide to Undertaking a Birth Cohort Study A six-year WHO effort guided by Professor Jean Golding at University of Bristol in the UK WHO consultation in Montreux, Switzerland in Oct 2003 WHO consultation in Washington, DC in August 2004 WHO consultation in Cuernavaca, Mexico in November 2004 WHO consultation in Bangkok, Thailand in August 2005 Publication in Paediatric and Perinatal Epidemiology, vol 23, July 2009

We live in the era of BIG Big Macs and big size cola drinks Big children Big houses (McMansions) Big cohort studies just getting off the ground (McCohorts)

Schematic of the development of the relationship between the timing of an environmental insult (from preconception through birth) and “windows” of susceptibility by system. From Silbergeld and Patrick, 2005

NOW is the opportunity: Cohorts that began in 2011 or later Exposures of study investigators (to other investigators) during this window may profoundly influence the next generation of cohort studies

Solid Groundwork International Childhood Cancer Cohort Consortium (I4C) CHICOS and ENRIECO COPHES and DEMOCOPHES PhenX Toolkit

WHO interests Promote coordination of the next generation of birth cohort studies Core measures for collection across multiple large new birth cohorts Basis for further international collaborations

Childhood death and disability from environmental causes is preventable There is much we still do not understand about the effects of chemicals in the environment on child health and development WHO promotes translation of results into public health policy to protect children