We, the undersigned scientists, doctors and public health professionals, educators, environmental health engineers, community workers and representatives from a number of international organizations, from governmental and non-governmental organizations in South East Asian and Western Pacific countries, have come together with colleagues from different parts of the world from 3 to 7 March 2002 in Bangkok, Thailand, to commit ourselves to work jointly towards the promotion and protection of children’s health against environmental threats.

Worldwide, it is estimated that more than one-quarter of the global burden of disease (GBD) can be attributed to environmental risk factors. Over 40% of the environmental disease burden falls on children under 5 years of age, yet these constitute only 10% of the world population. The environmental burden of paediatric disease in Asia and the Pacific countries is not well recognized and needs to be quantified and addressed.

WE RECOGNIZE

That a growing number of diseases in children have been linked to environmental exposures. These range from the traditional waterborne, foodborne and vector-borne diseases and acute respiratory infections to asthma, cancer, injuries, arsenicosis, fluorosis, certain birth defects and developmental disabilities.

That environmental exposures are increasing in many countries in the region; that new emerging risks are being identified; and that more and more children are being exposed to unsafe environments where they are conceived and born, where they live, learn, play, work and grow. Unique and permanent adverse health effects can occur when the embryo, fetus, newborn, child and adolescent (collectively referred to as “children” from here onwards) are exposed to environmental threats during early periods of special vulnerability.

That in developing countries the main environmental health problems affecting children are exacerbated by poverty, illiteracy and malnutrition, and include: indoor and outdoor air pollution, lack of access to safe water and sanitation, exposure to hazardous chemicals, accidents and injuries. Furthermore, as countries industrialize, children become exposed to toxicants commonly associated with the developed world, creating an additional environmental burden of disease. This deserves special attention from the industrialized and developing countries alike.

That environmental hazards arise both from anthropogenic and natural sources (e.g. plant toxins, fluoride, arsenic, radiations), which separately and in combination can cause serious harm to children.

That restoring and protecting the integrity of the life-sustaining systems of the earth are integral to ensuring children’s environmental health now and in the future. Therefore, addressing global changes such as human population growth, land and energy use patterns, habitat destruction, biodiversity loss and climate change must be part of efforts to promote children’s environmental health.

That despite the rising concern of the scientific community and the education and social sectors about environmental threats to children’s health and development, progress has been slow and serious challenges still remain.

That the health, environment and education sectors must take concerted action at all levels (local, national, global), together with other sectors, in serious efforts to enable our countries to assess the nature and magnitude of the problem, identify the main environmental risks to children’s health and establish culturally appropriate monitoring, mitigation and prevention strategies.

WE AFFIRM

That the principle “children are not little adults” requires full recognition and a preventive approach. Children are uniquely vulnerable to the effects of many chemical, biological and physical agents. All children should be protected from injury, poisoning and hazards in the different environments where they are born, live, learn, play, develop and grow to become the adults of tomorrow and citizens in their own right.

That all children should have the right to safe, clean and supportive environments that ensure their survival, growth, development, healthy life and well-being. The recognition of this right is especially important as the world moves towards the adoption of sustainable development practices.

That it is the responsibility of community workers, local and national authorities and policy-makers, national and international organizations, and all professionals dealing with health, environment and education issues to ensure that actions are initiated, developed and sustained in all countries to promote the recognition, assessment and mitigation of physical, chemical and biological hazards, and also of social hazards that threaten children’s health and quality of life.

PROTECTION AND PREVENTION – To strengthen existing programmes and initiate new mechanisms to provide all children with access to clean water and air, adequate sanitation, safe food and appropriate shelter:

• Reduce or eliminate environmental causes and triggers of respiratory diseases and asthma , including exposure to indoor air pollution from the use of biomass fuels and environmental tobacco smoke.

• Reduce or eliminate exposure to toxic metals such as lead, mercury and arsenic, to fluoride, and to anthropogenic hazards such as toxic wastes, pesticides and persistent organic pollutants.

• Reduce or eliminate exposure to known and suspected anthropogenic carcinogens, neurotoxicants, developmental and reproductive toxicants, immunotoxicants and naturally occurring toxins.

• Reduce the incidence of diarrhoeal disease through increased access to safe water and sanitation and promotion of initiatives to improve food safety.

• Reduce the incidence of accidents, injuries and poisonings, as well as exposure to noise, radiation, microbiological and other factors by improving all environments where children spend time, in particular at home and at school.

• Commit to international efforts to avert or slow global environmental changes, and also take action to lessen the vulnerability of populations to the impact of such changes.HEALTH CARE AND RESEARCH – To promote the recognition, assessment and study of environmental factors that have an impact on the health and development of children:

• Establish centres to address issues related to children’s environmental health.

• Develop and implement cooperative multidisciplinary research studies in association with centres of excellence, and promote the collection of harmonized data and their dissemination.

• Incorporate children’s environmental health into the training for health care providers and other professionals, and promote the use of the environmental history.

• Seek financial and institutional support for research, data collection, education, intervention and prevention programmes.

• Develop risk assessment methods that take account of children as a special risk group.EMPOWERMENT AND EDUCATION – To promote the education of children and parents about the importance of their physical environment and their participation in decisions that affect their lives, and to inform parents, teachers and caregivers and the community in general on the need and means to provide a safe, healthy and supportive environment to all children:

• Provide environmental health education through healthy schools and adult education initiatives.

• Incorporate lessons on health and the environment into all school curricula

• Empower children to identify potential risks and solutions.

• Impart environmental health expertise to educators, curriculum designers and school administrators.

• Create and disseminate to families and communities culturally relevant information about the special vulnerability of children to environmental threats and practical steps to protect children.

• Teach families and the community to identify environmental threats to their children, to adopt practices that will reduce risks of exposure and to work with local authorities and the private sector in developing prevention and intervention programmes.ADVOCACY – To advocate and take action on the protection and promotion of children’s environmental health at all levels, including political, administrative and community levels:

• Use lessons learned to prevent environmental illness in children, for example by promoting legislation for the removal of lead from all gasoline, paints, water pipes and ceramics, and for the provision of smoke-free environments in all public buildings.

• Sensitize decision-makers to the results of research studies and observations of community workers and primary health care providers that need to be accorded high priority to safeguard children’s health.

• Promote environmental health policies that protect children.
• Raise the awareness of decision-makers and potential donors about known environmental threats to children’s health and work with them and other stakeholders to allocate necessary resources to implement interventions.
• Work with the media to disseminate information on core children’s environmental health issues and locally relevant environmental health problems and potential solutions.

For all those concerned about the environmental health of children, the time to translate knowledge into action is now.

Bangkok, 7 March 2002

*Original statement online at https://www.who.int/news/item/21-03-2002-the-bangkok-statement-a-pledge-to-promote-the-protection-of-children-s-environmental-health