Paediatric environmental medicine: some peripheral issue, or a central point of crucial importance?
Paediatric environmental medicine
Fifteen years ago, when there was a deep and widespread concern about environmental risks for human health and - more generally - for the entire world ("ecological concerns") - many public health researchers had the impression that environmental medicine would develop into a thriving medical discipline of its own standing, and in some countries, including Germany, educational courses and certificates for environmental medicine were developed, offered and eagerly accepted. In Germany, about 100 paediatricians have entered and finished 200 hours of postgraduate education in environmental medicine. With fading general interest - concern of people and public media has been turning to other items, and physicians found out that there is not much money to be earned on this field – there are concerns that environmental medicine might become more or less a borderline subspecialty.
But public attention, from time to time, rises anew, as certain substances, threats, disasters are coming up to the surface, are spotlighted by medical science or, more so, by public media. Recent acutely discussed topics have been acrylamide, bisphenol, perfluorated tensides, phthalates, avian flu, and electromagnetic fields, to name just some chemical and some other toxicants or environmental threats. In our media-driven societe the proper (science-based) information and, as a result, allocation of financial and other resources to priority issues in environmental health continues to be difficult.
Paediatric environmental medicine, at the moment, appears not to be one of the priorities for paediatricians. A previous enquiry had shown that only the Deutsche Akademie für Kinder- und Jugendmedizin (German Academy of Paediatrics), but none of the other European societies, has an Environmental Committee. In planning and organising the Osnabrück workshop, we had informed and invited the chairmen, presidents or secretaries of the paediatric societies in Austria, Belgium, Denmark, Germany, Luxembourg, Netherlands and Switzerland. We have received no answer whatsoever. This is in contrast with the intense attention given to environmental issues some fifteen years ago.
Necessity of political dialogues
The International Workshop in Osnabrück from November 21 – 24, 2006 comprised nearly exclusively medical and scientific presentations and participants. This does not imply that we deem unnecessary the dialogue with e.g. such Non Governmental Organisations (NGOs) that engage and work for the protection of our environment, as Greenpeace, BUND (Bund für Naturschutz und Umwelt in Deutschland), or World Wildlife Fund (WWF).
These organisations recently have published several large reviews (Cameron and Smolka, 2005; WWF, 2005), including results from measurements of xenobiotics (as pesticides and a number of other chemical contaminants) in the blood of politicians, thereby aiming at large medial attention. The tenor of the cited papers was: We can measure over 300 "chemicals" in the human body which threaten or may harm our health. Similarly, Grandjean and Landrigan (2006) have quite recently published a review, giving a list of over 200 substances with proven neurotoxicity to humans, reminding of possibly many unknown toxicants and asking for continuing watchfulness. These are not useful approaches toward a basis for scientific or even political discussions on human environmental health. With progressing refinement of analytical methods, we doubtlessly will be able to detect even more substances. The relevance for human health depends largely on toxicity and on the dose of the supposedly noxious substance, on duration and way of exposure, and on susceptibility.
Psychosocial environmental factors
The psychosocial factors of children's environment are doubtlessly constituting the most important pathogenetic factor for children's well-being and health. Also, some of them are accessible to melioration. If we consider that there are limited financial resources, a thoughtful attribution of the available means will be essential in the future. In this context, an important part of the workshop was concerned with such issues: poverty, migration status, environmental justice; nutrition and obesity; public media and violence; consumption of legal and illegal drugs.
Long term sustainability
But also the "environment" sensu strictiori, i.e. the anthropogenic chemical and physical factors and conditions, need critical attention. Good data, knowledge and expertise are needed for correct risk assessment and risk management of nowadays pollutants and of those to be expected in the future, resulting from the implementation of new technologies. Thorough risk communication is mandatory in order to avoid expensive and ineffective measures. Thus, one may keep in mind the statement of the former EPA administrator William K. Reilly: "Huge sums of money are being spent on hypothetical risks experienced by few individuals while ecological matters affecting millions of people are not adequately addressed." (cited from Abelson, 1994).
Here we have one issue which subsequently will have to be discussed with NGOs, with engaged ecopolitical activists, with all those serious citizens who are worried about the future of our world. While in Central Europe the individual health of our children is endangered by factors as second hand smoke, car exhausts, fine particles, traffic, and noise, we must be deeply worried about what we do to the future of our children and grandchildren. Our generation with our consumer's mentality put at stake their future. Tropical and boreal deforestation, loss of biodiversity, climate change, scarce resources of safe drinking water, chemical and nuclear waste deposits and chemical contamination may prove to be unidirectional developments. We have to adjust our behaviour, our producer's output and consumer's wastes under the aspect of Enkeltauglichkeit (aptitude for the grandchildren's generation): will it harm, or will it suit the world of our grandchildren and our descendants beyond? This is the essence of an old tale from Karelia: Floods were rising, and the old raven father, being able to rescue only one of his children, carried his first son across toward the shore. "I will care for you in your old age, you shall be safe and sure" - said the first one. The father dropped him and let him drown in the water. - "I will study and learn, so that you will be proud of me"- promised the second son, which did not save him. "I will, just as you do now, have in mind the future of my grandchildren" - said the third child. This one the old raven father carried to the safe shore.