From theory to action: Implementing the WSSD Global Initiative on children's environmental health indicators
Complementary data collection efforts
Based on experience, identifying a lead agency to co-ordinate the effort to bring together information on children’s environmental health and integrate input from many different players is essential. Given the intersectoral nature of children’s environmental health, many different agencies of different sectors, e.g. health, environment, water and sanitation, agriculture, energy, labour and education, have an important contribution to make.
Under the MEME model, environmental, health, sociodemographic and policy information will need to be brought together from a wide range of sources (e.g. census data, child mortality data, child morbidity data, health care data, housing data, environmental data) for reporting on the state of children’s environmental health. Some of this information will be readily available (e.g. a lot of child health information is regularly collected through health surveillance systems), while other information (e.g. data on children’s exposures to different environmental threats) will be scarce.
Two dimensions are important in reporting children’s environmental health indicators: geography and time. Why is geography important? Good children’s environmental health information may be available for one district of a country but not for the whole country. Similarly, it may be available at the national level but not at the level of the district that wants to evaluate the impact of its programme to improve children’s environmental health. Why is time important? A snapshot of children’s environmental health taken at a single point in time will not allow us to track progress and to evaluate any policies and actions to improve children’s environmental health. Our long-term goal is to achieve regular collection of information that is representative at the national and/or district level, and that addresses the priority children’s environmental health issues defined by the country or region.
Depending on the priority a country or group of countries assigns to collecting information on children’s environmental health and the resources made available, several data collection approaches can be taken. In the short term, existing data can be used to compile a report on children’s environmental health, while additional data collection will often be needed to fill the gaps in issues not adequately covered, and to improve data quality. While countries should start with what is feasible, this first effort will need improvement over time.
Country-based provision of existing data into a common framework
An essential starting point for any effort to report on children’s environmental health is to review which data are already available through national data collection systems, who collects them, whether they are routinely assessed, and whether the data quality is sufficient. Data sources may include health information systems, disease surveillance systems, census data, household surveys, and environmental monitoring of water or air pollution; similarly, existing community level projects, such as Healthy Cities or Health-Promoting Schools, can provide important data and insights. In this way, all the relevant data are brought together in one place. This allows a first estimation of the national status of children’s environmental health and the identification of essential future monitoring needs. Moreover, it contributes to harmonized reporting of CEH indicators through the regional pilot and global effort. Annex 2 provides an example of how the development of national profiles on children’s environmental health, undertaken by WHO/AMRO for several countries in Latin America, South America and the Caribbean, can help answer important questions about country level information collection systems.
Using existing data from international data sources
We recognize that many international data and indicator sources already exist which will help us get started. Reporting indicators relies on “decades of work at many levels, from the field workers who administer the censuses and household surveys to the committees and working parties of the national and international statistical agencies that develop the nomenclature, classifications and standards fundamental to an international statistical system.”11 Many such efforts are already underway through the United Nations System. They report on child health in general or environmental conditions in general, therefore understanding the status of children’s environmental health is not possible based on these sources alone. Yet, they can contribute to regional and national reporting on children’s environmental health indicators (Annex 3), either by providing ready-made indicators or by supplying the data needed to construct new indicators.
Complementary collection of new data at the international level
The design and implementation of a new survey to collect data requires an enormous investment of staff and financial resources and will not be feasible for this effort. There may, however, be options to integrate additional questions into existing surveys, e.g. the Demographic and Health Surveys (DHS), the World Health Survey, the Living Standards Measurement Survey, or the Multiple Indicators Cluster Survey (see Annex 3). With these established surveys, it will always be a challenge to establish the importance of information on children’s environmental health against many other competing needs and interests and against the overall limitations of questionnaire length. Nevertheless, the inclusion of few selected and pre-tested questions into the core questionnaire or into an adaptation of the questionnaire at the country level may be feasible. We invite partners to assist with advocating for the broadening of these surveys, and to help identify and/or test specific questions for inclusion (Box 3).
In addition, CEHI is working closely with the United States Agency for International Development and other partners to develop an environmental health module for the DHS. Countries will be able to choose to implement all or parts of this module during DHS data collection.
Box 3
First, existing data mainly reflect health outcomes and remedial actions, but they rarely expose the responsible environmental risk factors. However, knowledge about these risk factors is essential for countries to strengthen preventive programmes in addition to responsive medical care. This will help to avert diseases, save children’s lives, improve families’ livelihoods and reduce the burden on a nation’s health care system. Secondly, existing data are not suitable for identifying vulnerable population groups that are at greatest risk from environmental risk factors, for example, urban slum populations. To maximize programme benefits, it will be important for countries to target these high risk groups, especially when resources are limited. Finally, CEHI not only brings existing data together but can also make a major contribution towards improving data quality by stimulating focused new data collection.
Why invest scarce resources into collecting additional data?
Complementary collection of new data at the national level
Integration of additional questions into an existing survey may also be possible at the national level, especially if there is political support for the reporting of children’s environmental health indicators. Ongoing surveys that may allow for a broadening of scope include nutritional surveys, school surveys, household surveys or health care surveys. To make data collection sustainable and to ensure the best use of the data generated, strong links with the public health system are essential.