While modern technology and science have spawned an age of glorious possibilities—longer life-span, better health, and unprecedented convenience, especially in transportation and global access to information—not all share in its bounty. Indeed, around the world, most do not. Growing problems steal the future of many children; the quality of their lives is eroded; they become less than what they would have been. Of these myriad challenges the Foundation has chosen to focus on environmental threats to children’s health, and in particular on three problems that scientific and medical research show to undermine the path of childhood development: lead poisoning, childhood asthma and endocrine disruption.
Central to each of these problems is the fact that children are more vulnerable to environmental contaminants than are adults. Their smaller size, different habits, and above all their still-developing bodily systems, mean that exposures of relatively little consequence to adults can have tragic consequences for kids. Central, too, is the reality that our current laws and regulations provide children inadequate protection.
Lead in the blood of young children is associated with substantial and irreversible harm, including lowered IQ, learning disabilities, impaired growth, hearing loss and other organ damage, hyperactivity and limited attention span. New data indicate that lead contamination at levels well below those associated with overt poisoning can cause antisocial behavior and delinquency in young boys, and that these effects foreshadow violent adult criminality. New studies also link lead exposure to hypertension: men with high blood lead levels are 50 percent more likely to suffer hypertension than those with low levels.
Blood lead levels have dropped dramatically over the past 15 years, a direct result of public steps taken to eliminate exposures from lead in gasoline and lead solder in food cans. Yet even as this progress has been achieved, target levels for acceptable exposure continue to drop as emerging scientific data demonstrate children’s extreme vulnerability to lead. Before 1970, for example, 60 micrograms per deciliter (µg/dL) was considered an acceptable blood lead level for children. Now three decades later, the CDC estimates that lead can cause harmful effects in children with blood lead levels as low as 10 µg/dL. According to CDC data, over 1.7 million American children are now lead poisoned—almost 9 percent of the 20 million children under age six.
In contrast to the progress made in reducing lead exposure from gasoline and food cans, efforts to eliminate exposures from lead-based paint and contaminated soils have been slowed by formidable economic obstacles. Victims of lead contamination for the most part lack the financial resources to combat the problem: the children most at risk live disproportionately in older, dilapidated neighborhoods in the nation’s central cities. Children living in poverty are four times more likely to have elevated blood lead levels than children from wealthier families, and African-American children are four times more likely to be lead poisoned than white children.
Protection from lead would yield significant health and economic benefits—recent analyses suggest that the net societal benefit of reducing the average blood lead concentration by only 1 µg/dL would exceed $17 billion annually. The public resources available for abating lead contamination, however, are trivial compared with the need. And all too often, the costs of abatement for rental housing in private ownership exceed the economic return on affected units, leaving landlords reluctant (at best) to invest in fixing the problem.
In 1992 Congress passed the Residential Lead-Based Hazard Reduction Act, commonly known as "Title X." This statute encourages steps that will prevent lead poisoning by managing the most dangerous exposures, rather than all exposures, recognizing that eliminating all lead from the housing stock is beyond the scale of current public commitments. Title X’s goal is to make properties "lead-safe," not "lead-free," by identifying and controlling lead-based hazards. In 1995 the Foundation supported efforts to implement Title X at the national level and began to lay the groundwork for a broader initiative that will feature local organizations working within communities to eliminate hazardous lead exposure from children’s lives. This initiative will be the focus of the Foundation’s grantmaking on lead poisoning in the coming year.
Asthma is the most common chronic disorder of childhood. It is the number one cause of children’s hospitalization and school absenteeism, costing some $9.5 billion annually in health care and lost productivity. According to the CDC, it now affects some 4.8 million American children. It is not only common, it is deadly; the death rate from asthma increased by about 10 percent per year during the 1980s. The highest death rate is now among blacks aged 15 to 24: 18.8 deaths per million in 1993.
The causes of these increases, indeed of asthma itself, are not well understood. Poverty creates conditions which make children vulnerable to asthma, which stimulate the onset of asthma attacks and which deprive asthma victims of needed care. Air pollution and its ability to irritate tissues in the lungs and air passageways also clearly plays a role. Emergency room visits by asthma victims escalate dramatically with air pollution events. Among acknowledged pollution factors are ground-level ozone, particulate matter and acid aerosols. Even after more than two decades of national efforts to clean the air, these pollutants are still present at levels dramatically higher than are deemed safe for children. As they persist, the societal and personal costs of asthma continue to mount. Foundation grants to alleviate the rising incidence of asthma focus principally on policy and advocacy favoring deployment of clean cars, especially zero-emission vehicles (see Energy and Climate) and, more broadly, on building a network of advocates working to eliminate environmental threats to children’s health.
The third area of focus is in the emerging science of endocrine disruption. Some human-made contaminants create risks for the developing embryo and fetus by interfering with endocrine, or hormone, signals necessary to guide fetal development. Their diverse effects have the potential to undermine reproductive abilities, erode intelligence, and interfere with the body’s ability to resist disease.
Some hormone disrupters are used as pesticides. Others are compounds used as industrial surfactants (spreading agents) or in plastics. Scientific findings clearly reveal that hormone-disrupting compounds have affected wildlife. Widespread die-offs of marine mammals, left mortally vulnerable to disease by the impact of contaminants on their immune systems, are among the most striking indicators of these risks. In humans, the impact of these compounds may not be manifest until the affected individual reaches puberty or beyond, even though exposure took place in the womb.
Scientific and medical experts are now raising new questions about the effects of contaminants on human health, questions that challenge traditional approaches to toxicology in public health. For one, the fetus is exquisitely sensitive to natural hormone signals, and remarkably vulnerable to low-level contamination. High-dose testing, the standard approach for assessing contaminants and the ways in which they cause cancers, is at best insensitive and at worst misleading when it comes to hormonal disruption. Low-dose exposures may have profound impacts not anticipated by high-dose experiments.
This emerging science is also forcing public health experts to think more comprehensively about ways in which risk factors interact. At the simplest level, it is now evident that different contaminants have combined or synergistic effects that may not be predictable from tests conducted on individual chemicals. More broadly, the ability of contaminants to undermine resistance to disease, as in the case of the marine mammals mentioned above, may mean that their health impacts are far more widespread and more fundamental than previously thought. A 1995 review conducted by the World Resources Institute demonstrates that certain pesticides weaken human disease resistance and heighten children’s vulnerability to common diseases that they would otherwise be able to survive. Foundation support on endocrine disruption during 1995 emphasized steps to further scientific understanding of these new risks, explorations of their policy implications, and educational efforts to raise awareness among different sectors of the public whose interests and health may be affected.
The Foundation also supported work on chemical contamination in two areas extending beyond environmental threats to children’s health: industrial and military pollution in the former Soviet Union and aquifer contamination in the United States. Grants in both of these areas helped provide local citizens with the tools and resources to advocate on behalf of their communities for better environmental protection. Particular emphasis was placed on improving electronic communication in the former Soviet Union to ensure the ability of grassroots advocates throughout the region to build common cause, to seek expertise beyond their immediate locality, and to benefit from one another’s experience.
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