Environmental pollution and child health

Free access to clean air is undoubtedly a fundamental human right. A person breathes an average of 10 million times a year. Children naturally breathe faster than adults, and when they live in a polluted environment, they absorb more pollutants. Household air pollution is a significant form of indoor air pollution, mostly relating to cooking and heating methods used in developing countries. Since much of the cooking is carried out with biomass fuel, in the form of wood, charcoal, dung and crop residue, in indoor environments that lack proper ventilation, millions of people, primarily women and children, face serious health risks. Household air pollution has been shown to increase the risk for a wide range of adverse cardiorespiratory, paediatric and maternal outcomes, particularly in poorer low- and middle-income countries. The right to health provides a valuable opportunity to engage different parties to advocate for climate action. The public debate on the climate crisis has so far failed to recognise the interconnected nature of these issues.

Air pollution affects the health of 17 million babies in the world. In addition, today’s trends of removing children from nature create problems for them and their society. It has also been shown that prenatal and early exposure to air pollution can lead to serious consequences, including the development of asthma in children in urban areas when exposed to nitrogen dioxide (NO₂) in the long term. There are potential associations with many diseases and complications during the lifetime and the quality-of-life levels, especially in developing countries. Some examples are diabetes, low birth weight, premature births, cognitive decline and dementia, Parkinson’s disease, the impairment of cognitive development in children and poor mental health outcomes across the lifespan. Air pollution can be just as dangerous as passive smoking; of course, active smoking is more dangerous to health. Living on busy roads carries about the same risk as passively smoking 10 cigarettes a day, and exercise should be avoided there during rush hour or when pollution levels are high. By reducing air pollution levels, it appears that the disease burden from stroke, heart disease, lung cancer, as well as chronic and acute respiratory diseases can be reduced. Environmental pollution, especially air pollution, severely impacts child health, causing respiratory issues (asthma, infections), developmental delays, lower cognitive function and long-term risks like heart disease, as children’s developing bodies and higher breathing rates make them uniquely vulnerable from the womb through childhood. Vigorous exercise increases the ventilation rate up to 17 times in children, which makes children’s vigorous play and exercise particularly unsafe in highly polluted areas.

India continues to experience some of the highest levels of ambient particulate matter globally. Exposure begins antenatally and is associated with low birth weight, prematurity, increased neonatal and infant mortality, acute lower respiratory infections, asthma, wheeze and impaired lung growth. Indoor air pollution from biomass fuel use remains a significant contributor, especially in rural and peri-urban areas. Although access to cleaner cooking fuels has expanded through national initiatives, sustained use and adequate ventilation remain inconsistent. Clinical implications are recurrent pneumonia, poor asthma control, chronic cough or exercise intolerance, which should prompt an environmental exposure history, including household fuel use and ventilation. Children in India remain at risk from chronic exposure to lead, pesticides and naturally occurring groundwater contaminants such as arsenic and fluoride. These exposures are strongly linked to neurodevelopmental delay, behavioural problems, reduced IQ and school underperformance, often without early overt clinical signs. Clinical implications include developmental delay, learning difficulties or unexplained behavioural issues, which should prompt consideration of chronic toxic exposure. The higher sensitivity of children to air pollution is due to some differences from adults, including physical differences, since children have less developed thermoregulatory systems, for example, a lower sweating rate and a higher body surface/mass ratio, which means a higher rate of heat exchange with the environment metabolic differences, since they have a higher metabolic rate than adults and therefore greater sensitivity to heat waves or frost, cardiovascular differences, since they have a lower cardiac output than adults, a smaller total blood volume, and therefore less adaptability to significant increases in temperature and pollution; behavioural differences, since they spend more time outdoors often with intense activities so their exposure to heat and pollutants is increased.

Air pollution affects the development of children’s intellectual and motor skills (cognitive impairments). It damages the lung function of children, even if they are not exposed to high but to lower levels of exposure. A total of 93% of children worldwide under the age of 15 years are exposed to particulate matter (PM2.5) levels above the World Health Organization air quality guidelines. More than 40% of people worldwide – including 1 billion children under the age of 15 – are exposed to elevated levels of indoor air pollution. The main causes are cooking with polluting technologies, the use of bad fuels and old ‘sick buildings’. About 600,000 deaths among children under 15 were attributed to the effects of both household and outdoor air pollution in 2016. A total of 160 million children were found in areas of high or extreme drought and over 500 million children in areas with a very high frequency of flooding. Malnutrition caused by climate change is predicted to lead to an increase of up to 130,000 deaths among children under 5 years of age in 2030, while harming children’s developmental potential and health in the long term, of their immune system.

Indoor air can be contaminated with a mixture of air pollutants, hazardous chemicals, radon and Mold, leading to significant health effects. It is estimated that 2 million disability-adjusted life years are lost annually in the European Union due to poor indoor air quality. Especially, when polluting fuels or other technologies for cooking, lighting and heating are regularly used in homes, such as fireplaces, cigarette smoke, kerosene heaters, gas stoves, petrol equipment, candles and incense, children are much more sensitive to household air pollution. Mechanical or natural ventilation of the building must ensure suitable conditions in terms of temperature and humidity and maintain indoor pollutant concentrations at acceptable levels. The symptoms of the sick building syndrome are the following: Shortness of breath, dry cough, sore throat, runny nose, tearing, headaches, dizziness, nausea, mental fatigue and confusion, physical fatigue, lethargy and digestive disorders. Efforts to improve indoor air quality require a comprehensive approach, including building design and management, structural products and education to promote positive behaviour.

There is global concern over the increase in solid waste generation due to intense urbanisation and industrialisation in recent years. Effective solid waste management is oriented toward both developed and developing countries due to its adverse effects and impacts on human health and the environment, respectively. Human exposure to dioxins from waste incineration has been shown to be associated with the risk of carcinogenesis; in addition, heavy metals at toxic waste sites as well as polycyclic aromatic hydrocarbons formed during incomplete combustion of organic materials, lead to human carcinogenesis, such as in the lung, skin and bladder and leukaemias in children. Moreover, exposure to microplastics can also occur through inhaled air, which can affect important biological processes in the human body and cause disruption of the endocrine and immune systems. Microplastics may have a negative impact on motility, reproduction and development and can cause carcinogenesis. The implementation of new solid waste management methods is imperative.