ATSDR - Progress in Promoting the Health of Children [April 1998]

Agency for Toxic Substances and Disease Registry

Search | Index | Home | Glossary | Contact Us

Promoting Children's Health
Progress Report of the Child Health Workgroup, Board of Scientific Counselors
1998-1999

This publication was supported wholly by funds from the Comprehensive Environmental Response, Compensation, and Liability Act trust fund through the Agency for Toxic Substances and Disease Registry, Public Health Service, U.S. Department of Health and Human Services. The use of company or product names is for identification only and does not constitute endorsement by the Agency for Toxic Substances and Disease Registry, the Public Health Service, or the U.S. Department of Health and Human Services.

INTRODUCTION

This is the second report of a multidisciplinary Child Health Workgroup, which was formed
in 1996 to advise the Agency for Toxic Substances and Disease Registry (ATSDR [the
agency]) on ways for all agency programs and activities to bring child health issues into
clear, comprehensive focus. This workgroup was appointed by ATSDR's Board of Scientific
Counselors. Members of the workgroup were selected for their knowledge of children's
environmental health. The role of the workgroup is to (1) assess ATSDR's activities as they
pertain to individuals during prenatal life, infancy, childhood, and adolescence; and (2)
suggest changes or new actions to ensure that ATSDR's activities are fully effective in
serving the needs of children. The workgroup's first report, Healthy Children-Toxic
Environments: Acting on the Unique Vulnerability of Children Who Dwell Near Hazardous
Waste Sites, was issued in 1997 (ATSDR 1997a).

BACKGROUND

ATSDR is an agency within the U.S. Department of Health and Human Services (DHHS).
ATSDR works closely with state, local, and other federal agencies to reduce or eliminate
illness, disability, and death resulting from environmental exposure of the public and workers
to toxic substances emitted from waste sites, uncontrolled releases, and other point sources of
pollution (ATSDR 1997b). ATSDR divides its activities between those that relate to a
particular site and those that relate to a specific hazardous substance. Site-specific activities
include (1) public health assessments at hazardous waste sites and (2) health studies and
exposure investigations in communities located near such sites. Substance-specific activities
include publication of Toxicological Profiles for more than 200 priority hazardous
substances, identification of data needs associated with these substances, and applied
research to fill those data needs.

Uncontrolled hazardous waste sites are prevalent throughout the United States.
Approximately 40,000 such sites have been reported to federal agencies; more than 1,300
sites have been placed, on the basis of a hazard ranking system, on the National Priorities
List (NPL) (Johnson and DeRosa 1997). The potential adverse human health impact of
hazardous waste sites is a considerable source of concern to the general public as well as to
health professionals and government agencies. ATSDR estimates that 3-4 million children
less than 18 years of age live within 1-mile boundaries of at least one hazardous waste site.
African Americans, Native Americans, and people of Hispanic origins comprise a greater
proportion of these communities than those outside the waste site areas (Heitgerd et al.
1995).

ATSDR has long advocated a comprehensive approach to promoting safe environments for
children. Investigations by ATSDR and other institutions have confirmed-from more than
10 years of public health assessments, toxicologic investigations, epidemiologic studies, and
reviews by expert workgroups-that children have unique characteristics that often place
them at greater risk of adverse health effects when exposed to toxic substances emitted from
hazardous waste sites or chemical releases. Children who live near hazardous waste sites can
have greater exposures, greater potential for health problems, and less ability to avoid
hazards than do adults. Exposure to hazardous substances can cause growth and
developmental problems in children, such as learning disabilities, mental retardation, and
cerebral palsy. Such exposure also can result in hyperactive airways and cancer. This body of
data has been previously described (Appendix A), and several recent reviews are
recommended to the reader.

Recognizing these special vulnerabilities, ATSDR in 1996 launched an initiative to place a
special agencywide emphasis on environmental hazards to children's health and to
emphasize child health in all agency programs and activities. The Child Health Initiative was
introduced by Barry L. Johnson, Ph.D., former ATSDR Assistant Administrator, and directed
by ATSDR Chief Medical Officer Robert W. Amler, M.D. The Child Health Workgroup in
its first report (ATSDR 1997a) published goals and objectives for each of ATSDR's four
divisions (Division of Health Assessment and Consultation, Division of Health Education
and Promotion, Division of Health Studies, and Division of Toxicology). The workgroup
also reviewed opportunities to extend ATSDR's outreach to children, families, and
communities through collaboration with other government agencies and through partnerships
with several key nongovernment organizations. During the same period, ATSDR staff
compiled the ATSDR Children and Youth Health Activities Inventory (ATSDR 1997c),
which is to be updated in 1999 as a complementary document to this report.

In early 1998, the workgroup reconvened to review ATSDR's programs and recommend
additional actions that would improve ATSDR's effectiveness in promoting the health of
children who dwell near hazardous waste sites. Progress and new opportunities for action (a
3-year plan) were discussed with ATSDR division directors and other representatives. In
addition, the workgroup discussed opportunities for substantive coordination with other
agencies and nongovernmental organizations.

NATIONAL PROGRESS IN 1997

Federal Executive Order and Task Force

On April 21, 1997, President Clinton issued Executive Order No. 13045 (Appendix B). This
order launched actions throughout the federal government to strengthen policies and improve
research to protect children's health from environmental and safety risks and to ensure that
new safeguards consider special risks to children. In particular, the Executive Order created a
Task Force on Environmental Health and Safety Risks to Children with cabinet-level
participation from nine federal agencies and departments that have programs affecting
children's environmental health and safety and five White House offices. The Task Force is
charged with coordinating those programs, recommending a research agenda, and identifying
new priorities. The participating agencies, departments, and offices were directed to closely
examine the special risks and disproportionate impact that poor environments and lax safety
standards have on children. The Executive Order also created an Interagency Forum on Child
and Family Statistics.

The Task Force is cochaired by DHHS Secretary Donna Shalala and Environmental
Protection Agency (EPA) Administrator Carol Browner. The Task Force has appointed a
Senior Staff Planning Committee, cochaired by Richard Jackson, M.D. (DHHS) and Ramona
Trovato (EPA), and two standing subcommittees: (1) program implementation, cochaired by
Barry L. Johnson, Ph.D. (DHHS) and Jerry Clifford (EPA); and (2) data needs and research,
cochaired by Kenneth Olden, Ph.D. (DHHS) and William Farland, Ph.D. (EPA). In addition,
federal strategy groups have been formed to address the following four priority areas: asthma,
unintentional injuries, cancer, and developmental disorders.

The Child Health Workgroup noted in its first report the need for national leadership in
children's environmental health. The workgroup encouraged ATSDR to seek such oversight.
In the ensuing months the President initiated, through the Task Force, the type of leadership
that was envisaged. Although ATSDR was not seminal, it has taken a prominent role in the
Task Force that was formed.

Other Mandates and Federal Actions

ATSDR's Child Health Initiative received a directive from the House-Senate Conference
Committee on Appropriations in its appropriations language for FY 1998. ATSDR
designated $1 million in direct funding for child health projects. ATSDR also signed, on
April 21, 1998, a memorandum of understanding (MOU) with EPA's Office of Solid Waste
and Emergency Response (OSWER), which implements the Superfund program. This MOU
(Appendix E) provides an administrative basis for coordination between the two
organizations of public health practices to promote children's health and remedial actions to
protect children's health from environmental threats posed by hazardous waste sites,
uncontrolled releases, and other point sources of pollution. ATSDR also signed an
Interagency Agreement with EPA's Office of Water to disseminate a joint advisory on fish
contaminated with mercury to pediatricians, obstetrician-gynecologists, and other primary
health care providers in the Great Lakes region.

Coordination of environmental health policies and programs among the DHHS component
agencies is accomplished by the Environmental Health Policy Committee (EHPC). In 1997,
EHPC formed the Subcommittee on the Public Health Approach to Children and the
Environment. In addition, the EHPC Subcommittee on Risk Communication, chaired by
ATSDR Assistant Administrator Barry L. Johnson, Ph.D., has devoted special attention to
strategies and methods to communicate the environmental health risks to children.

In 1997, EPA created an Office of Children's Health Protection (OCHP) to make the
protection of children's health a fundamental goal of environmental protection in the United
States. OCHP works in three broad program areas-regulatory affairs, science, and
community affairs and outreach-to achieve the following outcomes: (1) ensure that EPA
health standards are protective of children, beginning with selecting five of the most current
EPA standards and establishing procedures for review of new standards as they are
developed; (2) coordinate child health issues across EPA and ensure integration of EPA's
regulatory and other actions that affect children's health; (3) research and set new policies on
children's susceptibility and exposure to environmental toxins; and (4) expand community
right-to-know and education on children's health. OCHP in 1997 convened a national
conference on children's cancer and announced a grant program funded jointly with the
National Institute of Environmental Health Science (NIEHS) and the National Center for
Environmental Health (NCEH). Six grants are to be awarded in 1998 for academic centers of
excellence to conduct research on children's environmental health. This represents a
discipline-expanding effort that will visibly increase interest in children's environmental
issues. The research centers will enfold basic research and population research that engages
the communities being studied in the design and implementation phases of the research.

At the Centers for Disease Control and Prevention (CDC), a Children's Health Working
Group has prepared a report, CDC's Role in Children's Health. This report proposes a new
vision for CDC activities on behalf of children's health. The working group estimated that
CDC devotes about half of its resources to solving the public health problems of children.
The report notes increasing concern about the health of children and the implications of
changes in society and in the health care system specifically for children. The working group
met in a 1-day retreat to conceptualize five broad CDC goals for the health of children.

Additional steps have been taken by the federal government to provide environmental health
and safety protection for children, such as the Food Quality Protection Act, the Safe Drinking
Water Act, new standards for passive restraints for children in cars, and administrative action
to protect children from tobacco, lead, and other hazards.

Scientific Progress

Dr. Barry L. Johnson, former ATSDR Assistant Administrator, highlighted three areas for the
workgroup in which information in the recent past has brought focus on the needs for
continued progress in improving the environmental safety of children. First, environmentally
acquired polychlorinated biphenyls (PCBs) have had an adverse effect on brain development
in children (Lonky et al. 1996; Huismann et al. 1995; Koopman-Esseboom et al. 1996).
Second, birth weight is emerging as a marker indicating the effect of toxicants on fetuses.
Low birth weight is an issue of gravest concern, and it should engage the attention of
environmental scientists and policy makers (Fein et al. 1983; Fein et al. 1984; Barry and
Bove 1997; Croen et al. 1997; Vianna and Polan 1984). Third, effects on the endocrine
system of the developing human have been reported (Koopman-Esseboom et al. 1994). The
results of these studies lead all concerned with the environment and the health of American
and other children to raise the level of their concern and ensure that the necessary steps are
taken to keep the focus of environmental science on children.

Recent research findings were summarized in February 1997 at the 1st National Research
Conference on Children's Environmental Health, convened by the Children's Environmental
Health Network (CEHN) and cosponsored by ATSDR and several other organizations.
ATSDR disseminated the proceedings of this conference (CEHN 1997a) and CEHN's
Resource Guide on Children's Environmental Health (CEHN 1997b) to several hundred
officials in state health departments, ATSDR workgroup members, and other partner
organizations outside government. Two additional reports, Our Children At Risk: The
5 Worst Environmental Threats To Their Health (Mott 1997) and Putting Children First:
Making Pesticide Levels in Food Safer for Infants and Children (Wallinga 1998), were
published by the Natural Resources Defense Council, one of ATSDR's partner organizations.

Back to Contents Return to: Child Health Home Page

For more information, contact ATSDR at:
1-800-CDC-INFO or e-mail (public inquiries)