Setting priorities for children's environmental health indicators
At the global level, the recent WHO publication “Making a difference: indicators to improve children’s environmental health” sets priorities in terms of an analysis of the global burden of disease. Five major causes of death and illness in children under five emerge, with environmental exposures making a significant contribution to all of them:
- Perinatal illnesses – including low birthweight, stillbirths and congenital anomalies;
- Respiratory diseases – including pneumonia, tuberculosis, and asthma;
- Diarrhoeal diseases – including rotavirus infections, E.coli infections and cholera;
- Vector-borne diseases – especially malaria;
- Physical injuries – including traffic accidents, poisonings, drowning, falls and burns.
These five “big killers” of children under five have thus formed the focus for indicator development at the global level. However, environmental threats differ significantly among regions of the world and even among countries within a given region.
To respond to the specific needs of countries, regions should determine their own priorities for their regional efforts to collect children’s environmental health indicators, and these priorities are likely to be very different between developing and more developed regions of the world. In the context of regional pilots, the five “big killers” merely provide an example of how priorities can be identified.
The results of a regional or national environmental burden of disease assessment represent one way of prioritizing; however, prioritizing based on settings, public concern, previous political decisions, available interventions to tackle specific environmental problems, or financial and staff resources may be equally justified approaches. In any case, the ultimate goal is to protect children’s health. Whichever approach a region or country decides to take, it is important to make the underlying rationale for setting priorities transparent.