Early life opportunities for the prevention of non-communicable disease in developing countries
Noncommunicable diseases are responsible for the death of about 38 million people each year, with nearly three quarters of these deaths (28 million) occurring in low- and middle-income countries. The burden of adult chronic disease - to individuals, their families and their communities - is considerable and includes serious adverse effects on quality of life and productivity. Global public health efforts to minimize this escalating health and economic burden are challenged by the very nature of chronic disease. Its etiologies are complex and depend on a powerful dynamic between genetics, nutrition, toxicant exposures and the environments where we dwell.
For instance, cardiovascular disease is linked to air pollution, risks in the workplace, exposure to chemicals such as lead. A developing child's systems are especially vulnerable to heavy metals, air pollution, unsafe water, dangerous chemicals, and radiations. In addition, in a globalized evolving world, we are also exposed to changing environmental conditions, such as global climate change or the emergence of health issues caused by e-waste and an expanding list of persistent organic pollutants. Some environmental pollutants are endocrine disruptors and can have effects that may be linked to hormonal and developmental problems, as well as to certain types of cancer.
Environmental conditions concern also widespread diseases such as overweight and obesity that affects an estimated 42 million children worldwide. We know more today about intrauterine and early life exposures that may lead to disease during adult life. Developing countries face an added burden of poverty, communicable diseases due to lack of safe water and sanitation and acute respiratory infections due to high levels of indoor air pollution in combination with unhealthy housing.
In 1950, the first epidemiological studies demonstrated smoking as the main cause of the most common cancers. It took 50 years for action. We must not repeat that story. As evidence grows on the fetal determinants of adult disease, the importance of improving the surveillance and follow-up of pregnancy and promoting healthier environments for the mothers-to-be and pregnant women are recognized as priorities. The complexity and multi-sectorial nature of the issue requires a broad range of intervention channels to reduce risk factors and create safe and supportive environments in the home and community settings. Information, parents, schools, the health system and the environment represent key intervention channels.
Effective interventions will have a major impact on the health of coming generations and the future of society. Our Member States and the international community are calling for action. We have made a commitment to consider fetal environmental origins of disease at the Health and Environment Ministerial meetings, at the WHO International Conferences on child health and environment and cancer. We know we can prevent disease through healthier environments. We know primary prevention works. This heavy disease burden is not acceptable and is affecting the global commitment to meet the Millennium Development Goals.
In response to these challenges, the Department of Public Health and Environment (PHE) is working with partners in a number of activities.
This includes awareness-raising and advocacy, training activities, translating science into simple messages, promoting collaborative research between developing and industrialized countries, and coordinating long-term studies, especially with the emergence of new research tools, such as biomarkers.
Interventions work. The international community is calling for action. WHO is responding to the call.
- Developmental Origins of Health and Disease: Integrating Environmental Influences
- Environmental exposures: an underrecognized contribution to noncommunicable diseases
- Health Consequences of Environmental Exposures: Causal Thinking in Global Environmental Epidemiology
- Identifying important life stages for monitoring and assessing risks from exposures to environmental contaminants