On average, an infant of six months drinks almost 10 times more water than the average adult, inhales almost twice the volume of air and, between the ages of one and five, eats three to four times more food per unit of body weight than an adult. Such consumption means children have a high degree of exposure to the environment, which makes them extremely prone to environment-related morbidity and mortality. According to estimates of the World Health Organisation (WHO), which has declared a ‘healthy environment for children’ the theme of this year’s World Health Day (7 April), over five million children die every year due to illnesses and other conditions caused by the environment in which they live, learn and play.
The nature of a child’s susceptibility is closely associated with the socio-economic conditions of the country in which he or she lives. Poor countries are often unable to provide adequate sanitation and drinking water, and children are at high risk to develop health problems as a result. The toxins and the pathogens with which a child comes in contact thus, disrupt normal physiology and biological functioning. Research suggests that over 40 percent of the global disease burden arising from environmental factors may fall on children under the age of five, who constitute only about 10 percent of the world’s population.
Among water borne diseases, diarrhoea is the prime killer. By the WHO’s numbers, the disease claims 2.2 million lives every year and is responsible for 12 percent of child deaths under five years of age in developing countries. In rural north India, over half of all diarrhoeal deaths occur in children below five. Malnourished children are more susceptible to pathogens. “Over half of the children under the age of five years in India are moderately or severely malnourished while 30 percent newborn children are significantly underweight”, says the National Human Development Report 2001 of the Planning Commission of India.
Roundworm, hookworm, tapeworm and whipworm infections couple with malnourishment in tropical countries to devastate bodies. In rural India, about 20 percent of outpatient morbidity results from worm-related ailments and, globally, about 400 million children of school-going age are afflicted with the problem. Fluoride and nitrate groundwater contamination affects around six million children in India, and in both Bangladesh and India the presence of arsenic in groundwater is a persistent problem.
According to UNICEF, in South Asia, Pakistan is the most successful South Asian country in combating under-five mortality. It ranks 43rd in the world in this measure, while Bhutan, India, Nepal and Bangladesh are ranked, respectively, 52, 54, 55, 58 and 130. Recent figures suggest that only about one-quarter of Indians and Nepalis have access to adequate sanitation. Another report says that sanitary conditions in Dhaka’s slums are especially grim, a significant finding since more than 50 percent of Dhaka’s residents live in slums, according to a 1999 United Nations Environmental Programme report.
Experts argue that, along with sanitation, children’s behaviour can significantly impact health. The intake of food with dirty hands, the improper washing of hands after defecation, along with exposure to open waste dumps, common throughout South Asia, pose health risks for scavengers, who are often children. Discarded batteries, pesticides, fluorescent lamps and medical waste are all serious health threats.
The air we breathe
Air pollution from transportation and industry also takes a toll. Around two million under-five children worldwide die every year from acute respiratory infections aggravated by pollutants in the air. A World Bank report confirms that South Asian countries face increased health costs stemming from environmental degradation caused by industrial pollution and atmospheric emission.
In Bangladeshi cities such as Chittagong, Dhaka, Kulna and Rajshahi, the air is laden with lead; the level of this toxic heavy metal has been found to be more than 450 nanograms per cubic metre of air, one of the highest levels in the world. As expected, the children are worst affected. The presence of lead in Dhaka children’s blood is five times the acceptable level. Such poisoning by lead in the atmosphere may cause haematological damage, renal dysfunction and even brain damage.
Deterioration in ambient air quality and resulting increases in respiratory and skin diseases have also become a cause of concern in Nepal’s Kathmandu valley. Some studies suggest that Kathmandu residents’ health costs from air pollution are almost USD 4 million every year. Emissions of more than 22,000 tonnes of carbon monoxide, 400 tonnes of nitrogen oxides and 333 tonnes of sulphur oxides from vehicles in 1983 have increased to 56,000 tonnes of carbon monoxide, 5000 tonnes of nitrogen oxides and 840 tonnes of sulphur oxides.
Respiratory ailments in children are associated with gaseous and particulate pollutants in the air. Asthma, which is more common in the West, kills about 5000 Americans every year. The rates of affliction are much lower in Asia – about eight percent on an average against the global average of 14 percent. In South Asia, Indians are most at risk for developing asthma. About 15-20 million people in India suffer from it, and one in every 10 children is asthmatic.
In the countryside, indoor air pollution (IAP) wreaks havoc. According to the World Bank, with 75 percent of Indian households burning wood, dung and crop residues, India has the largest number of IAP-related disease victims in the world. These biomass fuels, with their accumulated carbon monoxide and benzo(a)pyrene, primarily affect residents of poorly ventilated dwellings, damaging reproductive physiology that leads to congenital deformities in children. An estimated 500,000 women and children die in India every year from IAP-related conditions, one in every four people in the world to do so.
It is disturbing to note that today people carry over 300 unnatural chemicals in their bodies on average. Toxic chemicals and pesticides are accumulated in the body from a variety of sources. A foetus receives chemicals via the umbilical chord, and after birth, a child suckles pesticides and toxic chemicals like poly-chlorinated biphenyl from breast milk, which may lead to deformities of several organs. An Indian Council of Medical Research (ICMR) study shows that incidence rates of childhood cancer in India have gone up by 14 percent in the past decade. It will not be surprising if toxic chemicals in the environment are a major source of that increase.
The state of children’s health in South Asia, particularly in its links to environmental conditions, indicates how unchecked ‘development’, poor economic conditions and uncontrolled population growth have affected many people. A first step toward addressing this problem is increasing access to medication and immunisation, and improving disease surveillance.