1. Raising Healthy Children in a Toxic World Philip J. Landrigan, MD, MSc, FAAP Professor and Chairman Department of Community & Preventive Medicine Professor of Pediatrics Director, Children’s Environmental Health Center Mount Sinai School of Medicine Greenwich, Connecticut May 8, 2008

2. Patterns of Disease in Children Have Changed As nations move toward industrial development, patterns of disease and death change. Prior to industrial development, infectious diseases are the major causes of illness and death MUCH OF AFRICA, LATIN AMERICA AND ASIA TODAY After development, life expectancy increases and chronic diseases become the major causes of illness and death USA AND WESTERN EUROPE TODAY

3. Environmental Change is the Driving Force

4. The principal causes of illness, hospitalization and death among children in America today are: Asthma Cancer Birth defects Neurodevelopmental disorders Obesity and diabetes These diseases are on the rise

5. Source: CDC MMWR, October 19, 2007 / 56(SS08);1-14;18-54 All Ages Children <18 The Increasing Prevalence of Asthma in the US 1111111111111111

6. Source: National Cancer Institute

8. Incidence of Testicular Cancer

9. Source: CDC’s Metropolitan Atlanta Congenital Defects Program (MACDP)

10. Developmental Disabilities Affect at least 5-10 % of all children Include: Autism Dyslexia ADHD Mental Retardation Reported prevalence is increasing

11. Overweight and Obesity Source: Willet et al., New Eng J Med, 1999 Prevalence has nearly quadrupled in American children 2.5-fold increased risk of overall mortality 4-fold risk of cardiovascular mortality 5-fold risk of diabetes Risk of hypertension, gall bladder disease, and some cancers

12. What is the Evidence that Toxic Chemicals in the Environment Cause Disease in Children? The Central Question in Pediatric Environmental Health:

13. Children are surrounded by a large and ever increasing number of chemicals. Many of the chemicals to which children are at risk of exposure have not been tested for their possible developmental toxicity Children are more heavily exposed and more vulnerable to many environmental chemicals than adults These chemicals are detectable in most American children's bodies, even in newborn infants Children’s Health and Toxic Chemicals: What We Know

14. Synthetic Organic Chemical Production

15. Most Chemicals to Which Children Are Exposed Have Not Been Adequately Tested for Toxicity 80,000 + chemicals in commerce 3,000 are high production volume (HPV) chemicals - produced in quantities of 1 million pounds or more per year No basic toxicity information is available on half of HPV chemicals No information on developmental toxicity is available for 80% of HPV chemicals

16. Why Are Children Especially Vulnerable to Toxic Chemicals? Greater exposure pound-for-pound Decreased ability to detoxify many chemicals Heightened biological vulnerability – thalidomide, DES, fetal alcohol syndrome More years of future life Children are not little adults National Academy of Sciences, 1993

17. Evidence is Strong and Increasing that Toxic Chemicals in the Environment Cause Disease in Children

18. Toxic Chemicals Can Cause Neurodevelopmental Disorders LEAD Principal source is lead paint and lead paint dust Other sources – toys, imported dinnerware 15-20% of cases associated with home renovation Causes decreased IQ, shortened attention span, inability to concentrate, dyslexia and school failure Any amount of lead is dangerous – No level is safe

19. Toxic Chemicals Can Cause Neurodevelopmental Disorders LEAD

20. Toxic Chemicals Can Cause Neurodevelopmental Disorders METHYL MERCURY Principal source is contaminated fish Most methyl mercury in fish originates from coal-fired power plants Effects on children similar to those of lead Prevention – eat safe species of fish, avoid contaminated species www.thegreenguide.org

21. Toxic Chemicals Can Cause Neurodevelopmental Disorders ORGANOPHOSPHATE PESTICIDES High-dose exposure can cause acute poisoning Exposure during pregnancy to lower levels can cause:  small head circumference  low birth weight  developmental delays  ADHD  Pervasive Developmental Disorder, a form of autism

22. Toxic Chemicals Can Cause Neurodevelopmental Disorders ENVIRONMETAL EXPOSURES LINKED TO AUTISM Thalidomide Misoprostol Maternal rubella infection Valproic acid Are there others among the thousands of untested chemicals to which our children are exposed daily?

23. Air Pollution Causes Asthma New York City, before and after a photochemical smog. Before After Smog on 5 th Avenue

24. Chemicals and Radiation Can Cause Childhood Cancer Solvents, especially benzene Parental employment in industries that use solvents – painting and printing Pesticide exposure, especially prenatally

25. The Solution Progress Against Environmental Disease in Children Requires Work in These Areas: Testing chemicals for toxicity RESPONSIBILITY OF THE FEDERAL GOVERNMENT Research Patient care Training the next generation of pediatricians

26. Programs on the Environment and Children’s Health at Mount Sinai The National Children’s Study The Autism Discovery Project – AUTISM The Center for Children’s Environmental Health and Disease Prevention Research – ENDOCRINE DISRUPTORS, PREMATURTE PUBERTY & BREAST CANCER The Pediatric Environmental Health Specialty Unit – CLINICAL SERVICES FOR CHILDREN & FAMILIES Fellowship in Environmental Pediatrics - EDUCATION Growing Up Healthy in East Harlem – ASTHMA PREVENTION & PESTICIDE USE REDUCTION

27. The National Children’s Study A multi-year prospective epidemiological study that will follow 100,000 children from early in pregnancy to 18 years of age Mount Sinai leads the study in NY and NJ The Goals: 1.To discover the environmental exposures that cause disease and disability in childhood and throughout life 2.To translate this science into a roadmap for prevention

28. Critical Research Questions for the National Children’s Study What are the preventable causes of autism, ADHD and other developmental disabilities? What are the effects of early exposures to endocrine disrupting chemicals? Are there chemical exposures that increase risk of obesity and diabetes? What are the preventable causes of pediatric cancer?

29. Prevention DISEASE CAUSED BY TOXIC CHEMICALS IN THE ENVIRONMENT IS PREVENTABLE Prevention is best achieved by discovering hazards and then preventing exposures. Prevention needs to proceed on 3 levels: 1. Home 2. Community 3. Society

30. Prevention in the Home - The Value of Eating Organic “Consumption of organic produce appears to provide a relatively simple way for parents to reduce their children's exposure to OP pesticides.” Curl CL, Fenske RA, Elgethun K, University of Washington.Curl CLFenske RAElgethun K Families who consume an organic diet can reduce their pesticide exposure levels by 90% as compared to families who consume conventional supermarket food CDC

31. Prevention in the Community Integrated pest management Pesticide neighbor notification laws Green schools Plant trees Insist on construction of sidewalks Maintain parks and playspaces

32. Prevention Works Example: The removal of lead from gasoline

33. In 1976, US EPA began phase-out of lead from gasoline Lead use in gasoline declined from 1976 through 1980 Year 1975197619771978197919801981 30 40 50 60 70 80 90 100 110 Gasoline lead Lead used In gasoline (1000 tons) Source: Annest, Pirkle, Makuc, et al., Chronological trend in blood lead levels between 1976 and 1980. NEJM 1983; 308;1373-7.

34. Decline in Blood Lead Levels Greatly Exceeded Expectation

35. 1974197619781980198219841986198819901992 0 20 40 60 80 100 2 4 6 8 10 12 14 16 18 Blood lead Gasoline lead Beginning in 1980, EPA further restricted lead use in gasoline. Gasoline lead levels continued to decline through 1991 Lead used In gasoline (1000 tons) Blood lead levels (  g/dL) Source: CDC. National Report on Human Exposure to Environmental Chemicals, March 2001

36. Environmental Disease is Preventable Declining Blood Lead Levels in the U.S. 1976–1999 18 1974197619781980198219841986198819901992 2 4 6 8 10 12 14 16 Blood Lead Levels (µg/dL) 0 1994199619982000 Year 2.7 2.0

37. Protecting Children against Environmental Threats to Health Thank You!