Introduction and Definitions
Children´s environmental health - Introduction
Health and disease always result from the interaction of endogenous factors (individual disposition) and exogenous influences. In phenylketonuria, heredity is the important determinant, but diet is also of importance. Traumatic fracture most often is due to exogenous physical forces, but bone fragility is not to be neglected. The sum of exogenous factors which always play a role whenever health and disease, salutogenesis and pathogenesis are concerned, can be termed environment. In environmental medicine, this is called gene-environment interaction.
This issue of IJHEH, reflecting the proceedings of a workshop held in Osnabrück in November, 2006, deals with environmental health in children. Whilst environment, in its larger sense, comprises the climate as well as molds, ticks and bacteria, the macroscalic environment around the living areas and microenvironmental factors as indoor air, environmental medicine in its stricter sense deals with a limited set of physical and chemical anthropogenic factors that may threaten or harm human health.
Environmental medicine is concerned with three rather distinct fields:
(1) Environmental medicine is a clinical discipline, caring for individuals, offering diagnostic and therapeutic procedures. Environmental medicine is taking environmental hazards as a potential influence on the pathogenesis of diseases. Environmental medicine cares as well for individuals that fear environmental hazards as a reason of their symptoms, but where there is no evidence that the environmental hazards are the causing factor of the symptom. Serious cases of environmentally related intoxication are rare in Central Europe. This could be because cases are not diagnosed due to a severe lack of knowledge of paediatricians. Another major reason is that within the last decades many environmental hazards have become rarer in Europe due to legislation and increased attention from many parts, to the benefit of the children’s health. One has to remain, however, on the qui vive, since there are many things between heaven and earth that we do not see or recognize or appreciate correctly. There are large scientific gaps regarding distinct or suspected or yet entirely unnamed environmental factors. Examples that have only recently surfaced are: acrylamide, bisphenol, carbon monoxide, DEHP (phthalates), fine particles, and fungous toxins, to spell just a few from the beginning of the toxicological alphabet.
(2) Environmental health means primary prevention regarding exposure to well identified environmental toxicants or conditions. Prevention often is seen as a task of public health services, of government, legislation, and administration. This can concern fields as different as chronic lead intoxication, fine particles and smog, or noise prevention. This is a wide area where yet much has to be done, also in Central Europe.
(3) Finally, ecopolitical concerns, environmental health policy are the crucial field where environmental medicine has and will retain an everlasting task. This challenge is a very specifically paediatric aspect. Differently from the tasks of, say, physicians treating orthopedic or ophthalmologic patients, our nowaday's paediatric clientele will want to live in a sustained world for more centuries to come.