1. Sevcikova L. 1, Jurkovicova J. 1, Stefanikova Z. 1, Sobotová, L. 1, Aghova L. 1, Machacova E. 2, Novakova J. 3, Hamade J. 3 1 Institute of Hygiene, 2 Institute of Epidemiology Faculty of Medicine Comenius University Bratislava 3 Slovak Institute of Public Health, Bratislava

2. Background The changes of health status and physical develop- ment of children and youth represent the sensitive indicators of endogenous and environmental impacts on health. Could the current collected indicators of health, of physical development and of environment contribute to recognition of these relations?

3. Methods  Health status of children and youth has been evaluated on the basis of routine statistical data on dispensarisation (Source: Institute of Health Information and Statistics, SR)  Physical measures height, weight, waist circumference, body weight indexes (BMI: W [kg]/H [m] 2 ) and Rohrer index (RI: W [kg]*10 5 / H [cm] 3 ) obtained from cross-sectional surveys in 1981, 1991 and 2001 on representative samples from all ages both genders were analysed and compared.  The selected environmental health indicators from Statistical Yearbooks of the SR and Reports from Ministry of Environment have been used  The program STATISTICA was used for analysis

4. Dispensarisation diseases per 10 4 registered children and youth Dispensarisation diseases / 10 4 registered From the year 1980 to 2000 gradual significant increase of chronic diseases in Slovak children and youth was detected. *** P<0.001 ***

5. Eye disorders per 10 4 registered children and youth *** P<0.001 ***

6. Respiratory diseases per 10 4 registered children and youth *** *** P<0.001 *** Allergic diseases from all resp. diseases per 10 4 registered children and youth

7. Diseases of musculoskeletal system per 10 4 registered children and youth *** P<0.001 ***

8. Diabetes Mellitus per 10 4 registered children and youth *** P<0.001 *** Hypertension per 10 4 registered children and youth ***

9. Diseases of kidneys and urinary tract per 10 4 registered children and youth *** P<0.001 ***

10. Mental and behavioral disorders per 10 4 registered children and youth *** P<0.001 ***

11. Children and youth from risky environment (dysfuntion of family) Dispensarisation / 10 4 registered *** P<0.001 ***

12. Age [ year ] Height The differences of height confirmed the continuing growth acceleration in Slovak boys and girls of all age groups from 2 years. The positive secular trend continues (1.4 cm in boys and 1.1 cm in girls per decade), definitive height is higher (boys: 179.6 ± 6.7 cm, girls 165.5 ±6.3 cm, P < 0.001). Terminative height stagnates in girls from 16 years of age. GirlsBoys [cm]

13. Age [year] The significant positive trend in boys' weight values has been similar to height. The significant increase of 1.2 kg (P < 0.001) per decade has been found out in 18 year old boys, their mean weight value in the year 2001 was 70.35±11.23 kg. The weight of girls has increased in age groups up to 15 years in range of 0.2-1 kg per decade. Mean weight values in older girls have been identical or decreased since 1981. kg BoysGirls Weight

14. Age [year] Waist circumference Waist circumference - sensitive measure of the upper distribution of body fat (central fatness) has increased in boys since 1981 in range 0.2 - 3.1 cm (P < 0.01). This measure increased in girls only in 3 - 12 years of age in range 0.1 - 1 cm (P < 0.05), but sharply decreased at the age of 15 - 18 (4.5 - 6.2 cm, P < 0.001). [cm] BoysGirls

15. BMI Values of BMI (measure of obesity) significantly increased in 9 - 15 year old boys (means 0.15 - 0.42 kg/m 2, P < 0.01) and in 7 - 11 year old girls (0.11 - 0.39 kg/m 2, P < 0.01) Age [year] kg/m 2 BoysGirls

16. years Rohrer’s Index Age [year] [10 5 kg/cm 3 ] The changes trend of RI have confirmed the trend of slimming girl population. Boys Girls

17. Consumption of foodstuffs / inhab. / year

18. Rate of the population supplied from water systems and connected up to public sewage systems (%) %

19. Monitoring of SO 2 emissions in SR Source: SHI 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Monitoring of NO x emissions in SR 250 200 150 100 50 0 600 500 400 300 200 100 0 Thous. t/year

20. Monitoring of TSP (Total suspended particles) in SR Source: SHI 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 Monitoring of CO emissions in SR 350 300 250 200 150 100 50 0 600 500 400 300 200 100 0 Thous. t/year

21. Natural increase of population % Natural movement of population Age groups 0-14 years and 15 -19 years in populations are singnificantly decreasing.

22. Life expectancy Source: SO SR

23. Consumer housing price health care indices transport % Cost of living indices for households of employees (1970 = 100 %) Source: SO SR

24. Conclusion  The significant increase of chronic diseases and disorders in children and youth during last decade are the result of many genetic, nutritional, environmental factors and also psychosocial factors linked with life style patterns.  Routine health statistics do not include some serious preventable diseases and disorders (obesity, poor posture) which have increasing trend in population of children and youth and development up to adulthood.  These results are in contradiction with indicators of physical growth of children and youth.

25.  …  The continuing growth acceleration has been confirmed in boys and girls, but has slowed down in the last decade.  Positive secular trend continues.  Continuing slimming trend in Slovak adolescent girls was found.  Emissions of major pollutants in total are decreasing in consequences liquidation of many stationary sources (heavy industry).  Rate of the population supplied from water systems and connected up to public sewage systems are increasing.

26.  …  Unfavourable development has been shown in social positions in majority of families, consumer price indices have sharply increased (housing, health care, transport).  Negative trends in health of Slovak children and youth could reflect current big social differencies, life style habits and continual non systematic preventive health care during certain periods of children life (school children, students, working youth).  Our results require further comprehensive analysis and international comparison.