Childrens Health Strategy

Health Protection AgencyCentre for Radiation, Chemical and Environmental HazardsChemical Hazards and Poisons DivisionChiltonDidcotOxfordshire OX11 0RQUnited Kingdom

Tel: +44(0)1235 822895Email: [email protected]

March 2009ISBN 978-0-85951-638-9© Health Protection AgencyPrinted on chlorine-free paper

A Children’s Environment and Health Strategy for the UK

A C

hild

ren’s En

viron

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t and

Health

Strategy fo

r the U

K

Acknowledgements

This document has been prepared by the Health Protection Agency at the request of the Department of Health, on behalf of the Interdepartmental Steering Group on Environment and Health. This Steering Group consists of representatives of the following government and devolved administration departments and agencies:

Department for Business, Enterprise and Regulatory Reform

Department for Children, Schools and Families

Department for Communities and Local Government

Department for Environment, Food and Rural Affairs

Department of Transport

Department of Health (Chair)

Department of Health, Social Services and Public Safety (Northern Ireland)

Department of the Environment (Northern Ireland) – Environment and Heritage Service

Environment Agency

Food Standards Agency

Health Protection Agency

Scottish Environment Protection Agency

Scottish Government

Welsh Assembly Government

The views expressed in this document do not necessarily represent those of any single government or devolved administration department or agency.

We gratefully acknowledge the involvement of children and young people in providing their views, which have been invaluable. We also gratefully acknowledge the contribution made by all the consultees during the public consultation.

Prepared by Raquel Duarte-Davidson, Alexander Capleton, Stacey Wyke, Rob Orford, Tina Endericks and Gary Coleman


This document has been prepared by the Health Protection Agency at the request of the Department of Health, on behalf of the Interdepartmental Steering Group on Environment and Health.

Please direct any queries concerning this report to [email protected]

Copies of the report and supporting documents are available at http://www.hpa.org.uk/cehape

March 2009ISBN 978-0-85951-638-9© Health Protection Agency

�

Foreword 3

ExecutiveSummary 5

� Introduction 6

2 Water,SanitationandHealth �4

3 Accidents,Injuries,ObesityandPhysicalActivity �8

4 RespiratoryHealth,IndoorandOutdoorAirPollution 26

5 Chemical,PhysicalandBiologicalAgents 30

6 YouthParticipation 38

7 OverarchingIssuesandPriorities 42

8 SummaryofRecommendations 46

9 References 50

AppendixA SummaryoftheChildren’sEnvironmentandHealthStrategyRecommendationsfortheUK 54

AppendixB SummaryofPoliciesofRelevancetoChildren’sHealthandWell-being 56

Acknowledgements Insidebackcover

Contents

3

I welcome this Children’s Environment and Health Strategy

and the work being taken forward across the World Health

Organization (WHO) European Region to protect the health of

children from environmental hazards. This is vital to improve

the health not only of children, but also of the adults they will

become and future generations.

The WHO Children’s Environment and Health Action Plan covers

a very broad area of environmental hazards, many of which are

already being addressed within the UK. However, we cannot be

complacent. I support the proposed approach of building on

current initiatives, ensuring there is better coordination across

government and tackling locations such as schools and homes.

The identification of examples of good practice in the Strategy

and the sharing of these examples across the UK should help

make changes more effective and coherent.

This approach of linking the environment to the health of

children will help drive forward change and this Strategy

identifies some important areas where this is required. These

include some longstanding concerns such as hygiene in

schools, injuries and health inequalities and also areas which

are becoming increasingly important such as obesity, skin

cancers and the long-term chronic effects of chemicals and

pollutants in our environment. This forward-looking approach

will also help ensure that new concerns such as climate change

are addressed.

The delivery of this Strategy will involve close partnership

working between many public bodies, the government and

devolved administrations. The Health Protection Agency

is looking forward to playing its part in helping to deliver

this initiative.

The involvement of young people in the Strategy and the

careful consideration of their views has been an important and

welcome feature of its development.

Justin McCrackenChief Executive


Foreword

5

The ‘environment and health process’, led by the World Health

Organization (WHO) Regional Office for Europe, aims to support

the 53 member states of the WHO European Region as they

plan and implement national and international environment

and health policies. At the fourth WHO conference on

environment and health in 2004, ministers from the countries

across the WHO European Region, including the UK, agreed

to the development of the Children’s Environment and Health

Action Plan for Europe (CEHAPE). This plan commits countries

to the development of national Children’s Environment and

Health Action Plans to protect the health of children and young

people from environmental hazards. CEHAPE consists of four

Regional Priority Goals covering: water, sanitation and health;

accidents, injuries, obesity and physical activity; respiratory

health, indoor and outdoor air pollution; and chemical, physical

and biological hazards.

To meet the UK commitments to CEHAPE this Children’s

Environment and Health Strategy has been prepared in order

to provide an overview of current activities in the UK, make

recommendations on the measures necessary to improve

children’s and young people’s health by improving their

environment, and to encourage a coherent cross-government

approach to these issues.

Executive Summary

The UK, through a wide range of initiatives and policies,

has addressed many of the key concerns under CEHAPE.

As a consequence the UK is in a good position relative to

other European countries, having controlled many of the

environmental influences on children’s and young people’s

health included in CEHAPE. The Strategy aims to build on and

complement policies and activities already undertaken by

government departments, devolved administrations, local

and regional authorities and the National Health Service and,

as such, many of the recommendations are in the process

of being taken forward. In this way it will help encourage

a comprehensive, strategic approach to protecting and

improving children’s and young people’s health and well-being.

The challenge for the UK now is that, whilst the legislative

foundation on public health has been well developed and the

baseline in most Regional Priority Goals is very good, there are

areas that could still benefit from improvement. Addressing

these should be an important component for improving

children’s and young people’s health in the future. The specific

areas recommended for improvement are highlighted within

this Strategy.

This report will be submitted to the Department of Health and

the Interdepartmental Steering Group on Environment and

Health for their consideration.

6

1.1 Background

Children can be particularly susceptible to harm from

environmental hazards. This is because their bodies are still

developing and they may have relatively higher exposures

to environmental hazards than adults. There are still many

unknown factors, especially about cumulative effects and long-

term impacts of environmental hazards.

In order to help address this, in 2004 the World Health

Organization (WHO) European Region developed an action

plan to tackle major environmental risks to children’s health:

the Children’s Environment and Health Action Plan for Europe

(CEHAPE). This plan commits member countries to develop

national Children’s Environment and Health Action Plans to

reduce the burden of disease in children caused by major

environmental risk factors. The UK supported the development

of CEHAPE and committed to developing a child-focused

environment and health strategy for the UK.

The Children’s Environment and Health Action Plan for Europe

consists of four Regional Priority Goals, focusing on the main

causes of the environment-related burden of disease across

the 53 member states of the WHO European Region. These

are: water, sanitation and health; accidents, injuries, obesity

and physical activity; respiratory health, indoor and outdoor

air pollution; and chemical, physical and biological hazards

(Box 1.1).

Within the UK, CEHAPE is being taken forward through the

development of the Children’s Environment and Health

Strategy, which draws on many published reports and papers.

Amongst these is the report Health Protection in the 21st Century: Understanding the Burden of Disease: preparing for the future (HPA, 2005), which included a review of current

environment and health issues relevant to children. A number

of in-depth reviews were undertaken to provide a snapshot

of the situation in 2006/07 (Capleton and Duarte-Davidson,

2007; O’Connell and Duarte Davidson, 2007; Wyke et al,

2007; Capleton et al, 2008); these have been summarised in

a separate report: Children’s Environment and Health Action Plan: A Summary of Current Activities which Address Children’s Environment and Health Issues within the UK (HPA, 2007a). The

summary report provides background information and analysis

for the issues discussed here.

1 Introduction

Box�.� Children’sEnvironmentandHealth

ActionPlanforEuropeRegional

PriorityGoals

Regional Priority Goal I

To prevent and significantly reduce the morbidity

andmortalityarisingfromgastrointestinaldisorders

andotherhealtheffects,byensuringthatadequate

measuresaretakentoimproveaccesstosafeand

affordablewaterandadequatesanitationfor

allchildren.

Regional Priority Goal II

Topreventandsubstantiallyreducehealth

consequencesfromaccidentsandinjuriesand

pursueadecreaseinmorbidityfromlackof

adequatephysicalactivity,bypromotingsafe,secure

andsupportivehumansettlementsforallchildren.

Regional Priority Goal III

Topreventandreducerespiratorydiseasedue

tooutdoorandindoorairpollution,thereby

contributingtoareductioninthefrequencyof

asthmaticattacks,inordertoensurethatchildren

canliveinanenvironmentwithcleanair.

Regional Priority Goal IV

Toreducetheriskofdiseaseanddisabilityarising

fromexposuretohazardouschemicals(suchas

heavymetals),physicalagents(e.g.excessivenoise)

andbiologicalagentsandtohazardousworking

environmentsduringpregnancy,childhoodand

adolescence.

(WHO, 2004)

7

The development of the Children’s Environment and

Health Strategy was overseen by a cross-government

Interdepartmental Steering Group on Environment and Health,

chaired by the Department of Health, with representatives

from relevant UK government departments, agencies and

the devolved administrations (Box 1.2). The Health Protection

Agency (HPA) was commissioned by the Department of Health,

on behalf of the Interdepartmental Steering Group, to develop

the Children’s Environment and Health Strategy for the UK.

1.2 Scope and aims

The Children’s Environment and Health Strategy makes

recommendations on the measures necessary to ensure the

UK meets its commitments under CEHAPE, and helps provide a

coherent cross-government approach to improving children’s

and young people’s health by improving their environment.

Box 1.3 shows the definitions of environment and health and

children and young people as used in this Strategy.

The UK is in a relatively good position regarding environment

and health as it has long recognised the importance of, and

the health benefits to be gained from, a clean and healthy

environment. Over the past 150 years many initiatives have

led to a significant reduction in mortality and morbidity

through improving water and sanitation, air quality, nutrition,

housing quality, controlling exposures to chemical, physical

and biological hazards, and conducting research to further

our understanding of the links between the environment

Box�.2 Membershipofthe

InterdepartmentalSteeringGroup

onEnvironmentandHealth

DepartmentforBusiness,EnterpriseandRegulatory

Reform

DepartmentforChildren,SchoolsandFamilies

DepartmentforCommunitiesandLocalGovernment

DepartmentforEnvironment,FoodandRuralAffairs

DepartmentforTransport

DepartmentofHealth(Chair)

DepartmentofHealth,SocialServicesandPublic

Safety(NorthernIreland)

DepartmentoftheEnvironment(NorthernIreland)

–EnvironmentandHeritageService

EnvironmentAgency

FoodStandardsAgency

HealthProtectionAgency

ScottishGovernment

ScottishEnvironmentProtectionAgency

WelshAssemblyGovernment

Box 1.3 Definitions – environment and

healthandchildrenandyoung

people

Environment and healthincludesboththedirect

andindirecteffectsofchemical,physical(including

ionisingandnon-ionisingradiation,andnoise)and

biologicalhazardsonhealthandwell-being,and

encompassessomeaspectsofthephysicalandsocial

environment that influence health and well-being,

suchashousing,urbandevelopment,landuse

andtransport.

ForthedevelopmentoftheChildren’sEnvironment

andHealthStrategy,achild and young person isa

personunder�9yearsofage,whichincludesthe

foetus.Thereproductivecapacityofadultsandthe

healthofthebreastfeedingmotherarealsotaken

intoaccountwherethismayaffectthehealthofthe

childoryoungperson.

A C h i l d r e n ’ s e n v i r o n m e n t A n d h e A l t h s t r A t e g y f o r t h e U K

8

and health. As a result, legislation, administrative systems

and policies are in place that address substantially many

of the commitments made in CEHAPE. However, although

many of these initiatives have been successful, there still

remain opportunities to bring about further improvements in

children’s health through effectively managing environmental

hazards and environmental influences on children’s health

and well-being.

This Strategy focuses on environmental factors that impact on

children’s health, based on an assessment of current activities

and issues identified across the UK. It aims to work alongside

existing environment and health policies and initiatives whilst

identifying gaps and priority areas that may be taken forward

to increase protection of children’s health from environmental

hazards and encourage the development of environments that

facilitate and promote good health and well-being.

1.3 Why children and young people?

About a quarter of the population of the UK are children; in

2007 there were approximately 14.7 million young people

under 19 years of age living in the UK. Children and young

people can be especially vulnerable to environmental

determinants of disease (WHO, 2005a). For example, children:

• are still growing and developing, which means that

particular biological systems may be more susceptible

to harm from environmental hazards than those

of adults, and immunity to disease is not as well

developed,

• often experience different patterns and levels of

exposure to environmental hazards than adults

because they take in more food, water and air

per kilogram body weight than adults, consume a

different diet (particularly when very young) and can

absorb some chemicals more readily than adults,

• can be more vulnerable to unintentional injuries due

to their tendency for exploratory behaviour, play and

their relative inability to judge risks.

Since the early 1900s substantial improvements in the quality of

the environment in the UK have been made that have resulted

in measurable improvements in children’s health. For example:

• legislation has been enacted to control lead in

drinking water, paint, fuel, toys and from industrial

emissions and, as a result, blood lead levels in children

have declined significantly,

• deaths from unintentional injuries and poisonings

(including carbon monoxide) amongst children have

declined substantially over the past ten years as a

result in improvements in safety,

• international and national legislation to control

persistent organic pollutants has resulted in

measurable declines in the levels of these pollutants

detected in breast milk,

• the UK continues to maintain a high standard of

drinking water quality and many diseases once

associated with poor quality drinking water are

no longer a risk factor and outbreaks of disease

associated with the public water supply are now

infrequent.

Despite these advances, there are areas where children’s and

young people’s health can still be improved and in which

environmental factors play an important role. In particular,

changes in lifestyle and eating habits have resulted in a

decrease in physical activity and a rise in overweight and

obese children, and unintentional injuries continue to be a

leading cause of mortality and morbidity amongst children.

It is important to ensure that their environment promotes

healthy behaviours (e.g. walking and cycling), promotes well-

being (e.g. access to well-managed green spaces) and is not

detrimental to their health (e.g. through exposure to pollution

and unsafe environments). Additionally, the development of

new technologies (e.g. nanotechnology, mobile phones and

WiFi) may pose risks to children’s health that need to be fully

evaluated to ensure any risks are properly managed. As our

understanding of the links between the environment and

children’s health advances, areas where further improvements

could be made may be identified and hence require

further action.


9

1.4 Burden of disease in children and young people

To help understand the impact of the environment on

children’s health this needs to be considered within the context

of the broader burden of disease amongst children.

1.4.1 Births

Since 2002 the number of births in the UK has increased

steadily from about 670,000 births per year to about 770,000

in 2007 (GROS, 2008; NISRA, 2008b; ONS, 2004, 2008a).

1.4.2 Deaths

Childhood mortality has been decreasing since the beginning

of the 20th century. There are currently about 5200 deaths

per year from birth to 14 years old (GROS, 2008; NISRA, 2008a;

ONS, 2008c). The main causes of death (GROS, 2006; NIRSA,

2006; ONS, 2006a) vary between age groups and are:

• congenital malformations and conditions that

originate during the perinatal period (i.e. from the

24th week of gestation to 1 month after birth) for

children aged 0–12 months,

• congenital malformations, injuries, diseases of the

nervous system and neoplasms* for children aged

1–4 years,

• neoplasms, injuries and diseases of the nervous system

for 5–14 year olds.

1.4.3 Hospital admissions

In England approximately 1.8 million Finished Consultant

Episodes† are attributed to children aged 0–14 years and

account for about 12% of all such episodes. The main reasons

for being admitted into hospital for 0–14 year olds are

conditions that originate during the perinatal period, diseases

of the respiratory system (including asthma), and injuries and

poisonings (Hospital Episode Statistics, 2008).

1.4.4 General Practitioner visits

The main burden of disease falls on General Practitioners (GPs),

with approximately one-third of all GP consultations being

for patients aged 0–14 years (HPA, 2005). Around 50% of

these are attributable to infections: mainly respiratory tract

infections (including the common cold and ear and throat

infections) and intestinal infections. Visits for non-infectious

diseases include nervous system problems, skin diseases,

other respiratory diseases (such as asthma) and injuries and

poisonings (RCGP, 2006).

1.5 Policy context

1.5.1 European Union policy context

In 2003, the European Union (EU) developed a European

Environment and Health Strategy (CEC, 2003) in support of,

and in response to, the WHO Fourth Ministerial Conference

on Environment and Health. The strategy, also known as the

SCALE (Science, Children, Awareness, Legislation and Evaluation)

initiative, currently has a specific focus on children and aims to

reduce the burden of disease caused by environmental factors

in the EU, identify and prevent new health threats caused

by environmental factors and to strengthen EU capacity for

policy making in this area. The Strategy on Environment and

Health led to the European Environment and Health Action

Plan 2004–2010. The action plan has 13 specific actions,

including: developing a coherent approach to biomonitoring;

strengthening environment and health research; ensuring

potential hazards on environment and health are identified and

addressed; and improving indoor air quality. Children’s concerns

are integrated throughout the action plan and implementation

is being shared between member states, stakeholder groups,

the European Commission and international organisations.

Within the UK, the Department for Environment, Food and

Rural Affairs is the lead government department.

* A neoplasm is an abnormal mass of tissue, normally a tumour.† A Finished Consultant Episode is a single treatment episode dealt with by one consultant in the NHS which is independent of the number of days spent in hospital.


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1.5.2 UK policy context

Many of the areas highlighted for action in the CEHAPE Regional

Priority Goals are already being addressed in the UK. Therefore

it is important that the Children’s Environment and Health

Strategy complements, works with and builds on existing

policies and initiatives to ensure children’s environmental health

is comprehensively addressed throughout the UK. Some of the

English and devolved administration policies of relevance to

children’s health and well-being are listed in Box 1.4; a more

detailed list is provided in Appendix B.

It is envisaged that this Children’s Environment and Health

Strategy will work alongside the Children’s Plan (DCSF, 2007)

and Healthy Lives, Brighter Futures (DCSF and DH, 2009)

in England, and other similar initiatives in the devolved

administrations, to encourage a comprehensive, strategic

approach to addressing children’s health issues and ensuring

children enjoy as high a standard of health as possible.

Other key drivers that will influence future priorities in the UK

include climate change, sustainable development, transport,

housing growth and new technologies. In addressing these it is

important that the specific needs of children and young people

are taken into account.

1.6 Consultation process

A draft version of the Children’s Environment and Health

Strategy was available for consultation between 17 March

and 13 June 2008 (HPA, 2008). Interested parties were

asked to participate through a variety of means, including

a written consultation and a stakeholder workshop. The

consultation process adhered to the Code of Practice on

Consultation (Cabinet Office, 2005) and is in line with the

six consultation criteria set out in the code.

In total, 102 written consultation responses were received from

individuals, organisations, academics and expert committees

with an interest in one or more areas covered in the Strategy.

A list of respondents to the consultation and a summary of

responses are provided in the consultation report (HPA, 2009a);

a separate report presents the findings of the stakeholder

workshop (HPA, 2009b). Figure 1.1 summarises the types of

respondents providing a written response to the consultation.

A key element in the development of the Strategy in the UK has

been taking into consideration the views of children and young

people. They have been engaged from an early stage to ensure

this Strategy meets their needs and priorities. This process has

included looking at their understanding and awareness about

Figure 1.1 Types of respondents providing a written response to the consultation document on the Children’s Environment and Health Strategy for the UK*

Localauthority,�5%

Academic/research,�3%Primarycaretrust,��%

Children’s/youthorganisation,9%

Non-departmentalpublicbody,9%

Professional,8%

Government,7%Industry,2%International,�%

Charity/campaigngroup,�8%

Other,7%

*Thejointresponsesfromfourlocalauthoritiesandprimarycaretrustshavebeencountedseparately.


��

Box�.4 Majorpoliciesandinitiativesofrelevancetochildren’shealthandwell-being

UK policies

SecuringtheFuture.DeliveringUKSustainableDevelopmentStrategy(HMGovernment,2005)setsouthowthe

governmentaimstodeliverabetterqualityoflifeintheUK,nowandforgenerationstocome,throughensuring

sustainabledevelopment.

England

EveryChildMatters,ChangeforChildren(DfES,2004)setsoutthegovernment’scross-cuttingnationalframeworkfor

everychildtobehealthy,staysafe,enjoyandachieve,makeapositivecontributionandachieveeconomicwell-being.

ChoosingHealth:MakingHealthierChoicesEasier(DH,2004)outlineshowthegovernmentintendstoprovide

supportandinformationsothatindividuals’canmakehealthierchoices.Thisincludestargetstoreduceinfant

mortality,supportallchildrentoattaingoodphysicalandmentalhealth,reduceinequalities,andensurechildren

developagoodunderstandingofopportunitiesandrisksinchoicesthatimpacttheirhealth.

Children’sPlan:BuildingBrighterFutures(DCSF,2007)aimstomakeEnglandthebestplaceintheworldforchildren

andyoungpeopletogrowup.Itfocusesonstrengtheningsupportforfamilies,workingtowardsachievingworld

classschoolsandensuringchildrenhavemoreplacestoplay.

HealthyLives,BrighterFutures:theStrategyforChildrenandYoungPeople’sHealth(DCSFandDH,2009)presents

thegovernment’svisionforchildren’sandyoungpeople’shealthandwell-beingbyimprovingservicesandoutcomes

andminimisinghealthinequalities.

TackingHealthInequalities:AProgrammeforAction(DH,2003)isthecurrentcross-governmentstrategytocombat

healthinequalitiesandlaysthefoundationformeetingthegovernment’stargetstoreducethehealthgaponinfant

mortalityandlifeexpectancyby20�0.

Northern Ireland

InvestingforHealth(DHSSPS,2002)isthepublichealthstrategyforNorthernIrelandsettingouthowtoimprove

healthinNorthernIrelandandreducehealthinequalities.

OurChildrenandYoungPeople–OurPledge(OFMDFM,2006)isastrategyandactionplanaimedatensuring

children in Northern Ireland thrive and look to the future with confidence.

Scotland

TowardsaHealthierScotland (Scottish Office, 1999) is a public health strategy for Scotland with a focus on health

inequalitiesandimprovingchildrenandyoungpeople’shealth.

ImprovingHealthinScotland(ScottishExecutive,2005)providesaframeworktosupportanactiveprogrammeto

deliverhealthimprovementpolicyinScotland.

BetterHealth,BetterCare(ScottishGovernment,2007)setsoutthegovernment’sprogrammetodeliverahealthier

Scotlandbyhelpingpeopletosustainandimprovetheirhealth,especiallyindisadvantagedcommunities,ensuring

better,localandfasteraccesstohealthcare.

GoodPlaces,BetterHealth.ANewApproachtoEnvironmentandHealthinScotland(ScottishGovernment,2008a)is

an implementation plan looking at how the physical environment influences health.

EarlyYearsFramework(ScottishGovernment,2008b)setsouttheimportanceofgettingtheearlyyearsofachild’s

liferight(pre-birthto8yearsold)andgivingchildrenthebeststartinlife.

Wales

HealthChallengeWales(http://new.wales.gov.uk/hcwsubsite/healthchallenge/?lang=en)isaninitiativetoimprove

andprotecthealthandwell-beinginWales.

ChildrenandYoungPeople:RightstoAction(WelshAssemblyGovernment,2004)isthestrategicapproachadopted

inWalestoimproveoutcomesforchildrenandyoungpeoplefrombirthtoadulthood.


�2

the health effects of their environment and has highlighted the

issues which they consider important.

Detailed comments from the consultation document,

consultation with young people and stakeholder workshop

were used to inform and update this Strategy. In taking forward

particular comments, consideration was given to the technical

merit of the responses, the strength of views expressed, and

the practicality of particular suggestions. Expert opinion,

scientific evidence, relevance and value judgements were used

in selecting areas that should be revised in the Strategy from

the responses received.

1.7 Structure of the Children’s Environment and Health Strategy

This Strategy identifies priority areas to be taken forward in

the UK to continue to reduce the burden of disease in children

from environmental risk factors and promote good health

and well-being. This will help ensure a coherent approach is

taken across the UK to meeting the commitments made under

CEHAPE. It is recognised that the areas highlighted as priorities

in the Strategy may be adapted to meet specific local needs. It

will be important to undertake interventions that will generate

cost-effective benefits to children and young people’s health.

This Strategy is structured according to Regional Priority Goal

areas to reflect the format of the WHO CEHAPE priorities. The

information presented in Chapters 2–5 includes an overview

of the burden of disease, current status in terms of addressing

each specific Regional Priority Goal area and the areas that

may need to be addressed in the UK in the future. Within

each section examples of good practice or information on the

current state are presented to illustrate progress in specific

areas. Suggested interventions from the consultation are

presented in highlighted boxes in each chapter. The views

of children and young people are summarised in Chapter 6,

and issues relevant to children and young people are also

represented in boxes within each chapter. Overarching issues

and priorities are covered in Chapter 7 and a summary of

recommendations is presented in Chapter 8. Appendix A

summarises the Children’s Environment and Health Strategy

priorities according to Regional Priority Goal and to the burden

of disease. Unless specified, information presented in this

document is applicable to the whole of the UK.

1.8 What next?

The Strategy identifies areas where the environment

impacts on the health and well-being of children and young

people in the UK. Recommendations for action highlighted

within the Regional Priority Goals should be considered for

implementation by the relevant responsible local or national

government departments and organisations in order to realise

the health benefits of the Strategy.

An important element of the success of the Children’s

Environment and Health Strategy will be the engagement and

involvement of those with local and regional responsibility for

public health and the environment to ensure local action is

taken to address environmental hazards that are of relevance

to children and young people. These health professionals

include regional directors of public health, local and regional

authorities, directors of public health in primary care trusts,

public health observatories, directors of children’s services,

as well as environmental health professionals, environmental

health officers, environmental specialists (e.g. on air pollution

and contaminated land), land-use planners and other specialists

with an interest in public health, and the Local and Regional

Services of the Health Protection Agency.


�4

2.1 Why is this important?

In the UK, most gastrointestinal disorders are self-limiting and

of short duration and those affected do not necessarily seek

treatment through their General Practitioner’s (GP) surgery

(HPA, 2005). Children, particularly those under five years of age,

generally experience substantially more infectious intestinal

disease compared with the rest of the population (in the under

fives these are primarily caused by rotavirus). This is because

they will have had less prior exposure to such infections and

therefore will have less immunity. Children are more vulnerable

to complications such as dehydration following episodes of

diarrhoea and vomiting, which can result in the need for GP

consultations or, in serious cases, hospital admission.

The number of children and young people who suffer from

infectious intestinal disease as a result of consuming poor

quality drinking water in the UK is not known, but available

data suggests this constitutes only a small proportion of

cases (probably less than 2% of cases, based on data for

cryptosporidiosis*).

Outbreaks† of intestinal infectious disease are still common

in the UK and a significant minority are due to environmental

exposures (as opposed to food-borne outbreaks). In 2006,

25% (i.e. 183 out of 732) of reported outbreaks of infectious

intestinal disease in England and Wales were associated with

schools and 2% (14) with swimming pools (HPA, 2007b).

In Scotland, 3% (10) of outbreaks occurred in schools and

1 incident occurred in a swimming pool (Smith-Palmer

and Brownlie, 2006a,b,c; 2007). The number of children

experiencing infectious intestinal disease acquired from

outdoor bathing in poor quality water (other than swimming

pools) is not known.

2.2 Where are we now?

The UK enjoys a safe public water supply; compliance with

drinking water standards is greater than 99% and the number

of disease outbreaks associated with the public water supply

is low and has been declining for many years (Capleton and

Duarte Davidson, 2007). However, evidence suggests that

private water supplies, which serve a small proportion of the

population (1% in England and Wales, less than 1% in Northern

Ireland and about 3% in Scotland), are of variable quality,

therefore potentially posing a greater risk to children’s health

(HPA, 2007a). New legislation covering private water supplies

came into force in Scotland in 2006; similar legislation for

private water supplies was consulted upon in England in 2008

and is due to be consulted upon for Wales and Northern Ireland

in 2009.

There are a number of initiatives aimed at improving drinking

water quality further, including programmes to reduce the risk

2 Water, Sanitation and Health

Regional Priority Goal I

To prevent and significantly reduce the morbidity

and mortality arising from gastrointestinal

disorders and other health effects, by ensuring that

adequate measures are taken to improve access to

safe and affordable water and adequate sanitation

for all children by:

(a) ensuringthatallchildcareinstitutionsand

schoolsareprovidedwithadequatesafe

waterandbasicsanitation,ensuringsafeand

affordablewaterandadequatesanitation

infrastructureandservicedevelopment,

(b) implementingnationalplanstoincreasethe

proportionofhouseholdswithaccesstosafe

andaffordablewaterandadequatesanitation,

therebyensuringthatallchildrenhaveaccessto

cleanwaterandsanitation,and

(c) raisingawarenessamongthepopulation,

particularlycaregivers,andensuringthe

provisionofeducationonbasichygiene.

(WHO, 2004)

* Cryptosporidiosis is an intestinal infectious disease commonly associated with water supplies.

† Small, localised groups of people infected with a disease.

�5

of not meeting specific drinking water standards and improving

compliance with those standards. A new drinking water quality

standard for lead will come into force in 2013. Currently, levels

of lead must be below 25 micrograms per litre (µg/l), but the

new standard means that levels of lead will have to be below

10 µg/l. A number of actions are currently taking place across

the UK to meet this new standard (Box 2.1).

There has been an increasing number of households

suffering from water poverty as a result of water metering

and rising prices. The impact on children’s health and well-

being is unknown, but it has been suggested that it could

decrease opportunities for play, and be a factor influencing

compliance if, for example, public health advice is issued that

water needs to be flushed through the system following a

contamination incident (e.g. after flooding). It is also likely to

disproportionately affect families on low incomes.

Substantial improvements in bathing water quality have been

made in the UK over the past ten years, with over 96% of UK

bathing waters in 2007 meeting the minimum EU standards,

which entered into force in 2006 (Defra, 2008). However, a

small number of disease outbreaks have been associated with

swimming pools (HPA, 2007a), contributing to an increase in

cryptosporidiosis in local communities.

The UK enjoys excellent sanitation provision, with less than

1% of homes without basic amenities. There are a number

Box2.� Complyingwithareviseddrinking

waterstandardforlead

Actionstoreduceleadlevelsindrinkingwater

includethereplacementofleadpipes,theuseof

phosphatedosing(whichreducestheamountof

leadthatwilldissolveintodrinkingwaterfromlead

pipesandsolder),andthetestingoflevelsofleadin

watersupplies.TheDrinkingWaterInspectoratehas

recommendedthatlocalauthorities(inEnglandand

Wales)reviewhowoftenleadlevelsindrinkingwater

goabovethenewstandard,inordertoidentify

whetheradditionalactionisneededinaparticular

community.Oneexampleofthisispromoting

thefactthatwatercompanieswillreplacetheir

partoftheservicepipewhenthebuildingowner

indicatesthattheyarereplacingtheirdomestic

leadplumbing.Schoolsandchildcarecentresare

ofparticularinterest;theDepartmentforChildren,

SchoolsandFamilieshasrecommendedthatfor

schoolsbuiltbeforetheearly�950stheextentof

leadpipeworkwithintheschoolsshouldbeassessed,

andaprogrammedrawnupforitsremovalwhere

applicable(DfES,2003).

Box2.2 Improvinghygieneinschools

TheHealthProtectionAgencyhasdevelopeda

hygieneandhand-washinginitiativefordelivery

inprimaryschoolsacrossEnglandwhichhasbeen

pilotedin800schools.Itisbeingevaluatedby

lookingatchangesinhand-washingbehaviour,

raisedawarenessoftheimportanceofhand

washing,andareductioninabsenteeismofboth

pupilsandstaff.

FollowinganoutbreakofE.coliinschoolsinSouth

Walesin2005,theWelshAssemblyGovernmenttook

stepstoimprovehygieneandinfectioncontrolin

schools.Theseincludepublicationoftwobooklets:

• Mindthegerms!–distributedtoallnurseries,

playgroupsandotherchildcaresettingsin

Wales,

• Teachgermsalesson–distributedtoallprimary

andsecondaryschoolsinWales.

TheScottishGovernmentlaunchedaNationalHand

HygieneCampaigninJanuary2007.Thecampaign

includedahandhygienepackwhichwasdistributed

toalllocalauthoritynurseriesandprimaryschools

acrossScotlandandincludedaDVD,posters,stickers

andactivitymaterials.Thepackwastestedtoensure

thattheemphasiswasonmakinghandwashing

a‘fun’activityandincludedanumberofuseful

materialstohelpteachersdevelopfunhand-washing

relatedactivities.


�6

of initiatives throughout the UK to improve the condition of

poor quality housing. For example, in England, an initiative

of the Department for Communities and Local Government

aims to bring all social housing into decent condition by 2010

(DCLG, 2006a).

Several surveys of water and sanitation provision in UK schools

have highlighted a considerable variation in school sanitation

and access to drinking water. In England, the Building Schools

for the Future programme includes a standard specification

layout and design for toilets to help improve facilities (DfES,

2007). A number of initiatives are also under way to improve

personal hygiene in schools (Box 2.2). The Welsh Assembly

Government and the Scottish Government both have ongoing

programmes to improve access to cold, clean drinking water

in schools: the Proposed Healthy Eating in Schools (Wales)

Measure 2008 and the Nutritional Requirements for Food and

Drink in Schools (Scotland) Regulations 2008.

2.3 Areas for improvement

The main areas for the provision of clean water and sanitation

that may benefit from further action are listed below,

together with proposals of how these might be addressed

(Boxes 2.3 and 2.4).

2.3.1 Lead in drinking water

A review of means of further reducing exposure to lead

amongst children in the UK should be undertaken, taking into

account the relative short- and long-term costs and benefits to

children’s health.

There should be a coordinated programme to investigate the

levels of lead in drinking water in homes and schools (especially

in primary schools) and other childcare settings where levels

may be likely to go above the new standard (10 µg/l). This

programme should include childcare institutions and other

locations where children spend substantial periods of time.

2.3.2 Private water supplies

The number of disease outbreaks originating from private

water supplies is higher than that from public supplies. It is

therefore important to develop means to ensure that all private

drinking water supplies are properly documented, that there

is an adequate legislative basis and that compliance with the

standards is high. Further research into and surveillance of the

health impacts of contaminated private water supplies would

also be beneficial.

2.3.3 Water and sanitation in schools and childcare settings

Whilst the health impact of deficiencies in access to water and

sanitary provision in some schools has not been quantified, it

is prudent to continue to encourage and support initiatives to

improve sanitary provision, drinking water provision and hygiene

standards in all childcare settings. Such initiatives should aim to

ensure a consistent, high standard of sanitation facilities, access

to drinking water and hand-washing behaviour in all schools

and childcare settings.

Box2.3 Examplesofsuggestedinterventions

toreduceleadindrinkingwater

Riskmappingtoidentifywhereleadlevelsarelikely

togoabovethenewstandardof�0µg/l.

Banningtheuseofleadsolderonallpipework,

includingheatingsystems,toreducetheriskofits

useonwaterpipes.

Replacingleadpipeworkwhenandwherepossible.

Young people consider that Water and sanitation are a priority for most children and young people, particularly in the school environment. The most important issues raised by young people include: access to safe, clean toilet facilities and drinking water in schools, hygiene and hand washing.

�7

2.3.4 Bathing and recreational waters

There is currently a paucity of evidence on the health effects

of use of outdoor bathing and recreational waters in children

and consideration could be given to addressing this gap.

Also, further research on the use by children of recreational

waters other than beaches could help identify areas for

future action.

Although there are few cryptosporidium outbreaks attributed

to swimming pools, it is important that these continue to

be investigated to identify common factors so interventions,

such as water treatment regimes, can be developed further

to prevent future outbreaks. Environmental health officers

in local authorities in England no longer routinely submit

samples to the Health Protection Agency for swimming pool

monitoring, but instead rely upon self-monitoring by swimming

pool operators; continued monitoring of outbreaks associated

with swimming pools should be maintained to assess the

effectiveness of this new policy.

2.3.5 Water poverty

The impact of water poverty on children’s health and well-

being is not known. Measures should be taken to evaluate the

number of households at risk from water poverty and how

this may affect children’s health and well-being, with a view

to ensuring that children and families have access to all the

wholesome water they reasonably need.


toimprovesanitationandaccess

towaterinschoolsandchildcare

settings

Setminimumstandardsofprovision,accessand

hygienestandardsfordrinkingwaterandtoiletsin

alleducationalestablishments.

Developguidanceforschoolinspectors(e.g.Ofsted

inEngland,EstyninWales)onminimumstandards

forsanitationandaccesstowaterinschoolsand

inspectagainstthesestandards.

Addprovisionandmaintenanceoftoiletstothe

NationalHealthySchoolsProgrammeNationalAudit

Criteria(HealthySchools,2007)andcorresponding

schemesinthedevolvedadministrations.


�8


Injuries are a leading cause of death and hospital admission

among children aged 0–14 years in the UK. In 2006,

299 children in the UK died as a result of unintentional injuries,

approximately half of whom were injured in transport accidents

(calculated from GROS, 2007, NISRA, 2007, and ONS, 2008b).

Injuries to children in the UK account for approximately

2 million visits to hospital accident and emergency

departments each year at a cost of over £146 million (Audit

Commission and Healthcare Commission, 2007). The number

of deaths caused by unintentional injuries amongst children

and young people has been declining for many years in the UK

(HPA, 2007a) and is amongst the lowest in developed nations

(UNICEF, 2007).

Obesity is a serious and growing public health problem in the

UK. The prevalence of overweight and obese children and

young people has increased rapidly in recent years (Figure 3.1).

For example, in England the prevalence of obesity in boys

and girls (aged 2–15 years) has risen from 11% and 12%,

respectively, in 1995, to 17% in boys and 15% in girls in 2006

(The Information Centre, 2008). In 2004, about a third of boys

(32.6%) and girls (34.1%) aged 2–15 years in England were

either overweight or obese. Similar proportions of overweight

and obese children have been found in Scotland. In Northern

Ireland, approximately 10% of 2–10 year olds are obese. It is

predicted that if obesity continues to increase at the same rate,

by 2025 approximately 15% of children and young people aged

under 20 years will be obese (current levels: 8% boys, 10% girls;

Government Office for Science, 2007).


3.2.1 Unintentional injuries

A range of initiatives aimed at preventing unintentional injuries

have contributed to the decline in deaths. These include

better building design, product and toy safety improvements,

education initiatives, better car and road environment designs,

and comprehensive road safety policies with a specific focus

3 Accidents, Injuries, Obesity and Physical Activity

Regional Priority Goal II

Prevent and substantially reduce health

consequences from accidents and injuries and

pursue a decrease in morbidity from lack of

adequate physical activity, by promoting safe,

secure and supportive human settlements for all

children. This will be addressed by:

(a) developing,implementingandenforcingstrict

child-specific measures that will better protect

childrenandadolescentsfrominjuriesatand

aroundtheirhomes,playgrounds,schoolsand

workplaces,

(b) advocatingthestrengthenedimplementation

ofroadsafetymeasures,includingadequate

speedlimitsaswellaseducationfordriversand

children,andenforcementofthecorresponding

legislation,

(c) advocating,supportingandimplementing

child-friendlyurbanplanninganddevelopment

aswellassustainabletransportplanningand

mobilitymanagement,bypromotingcycling,

walkingandpublictransport,inorderto

providesaferandhealthiermobilitywithinthe

community,and

(d) providingandadvocatingsafeandaccessible

facilities(includinggreenareas,natureand

playgrounds)forsocialinteraction,playand

sportsforchildrenandadolescents.

Bring about a reduction in the prevalence of

overweight and obesity by:

(a) implementinghealthpromotionactivitiesin

accordancewithWHOstrategiesandaction

plansondiet,physicalactivityandhealth,and

foodandnutritionand

(b) promoting the benefits of physical activity in

children’sdailylifebyprovidinginformationand

education,aswellaspursuingopportunities

forpartnershipsandsynergieswithother

sectorswiththeaimofensuringachild-friendly

infrastructure.

(WHO, 2004)

�9

Road traffic injuries are addressed through separate, but

complementary policies to those targeting other unintentional

injuries. The number of children and young people killed

or seriously injured as a result of accidents on the road has

declined in the last six years. The reduction has exceeded the

target set in the government’s strategy Tomorrow’s Roads:

Safer for Everyone to reduce deaths and serious injuries

amongst children by 50%† by 2010 in England, Scotland

and Wales (DfT, 2000). Recently, a road safety strategy for

children has been published, which amongst its priorities

includes promoting good practice in road safety education for

children, communicating road safety messages to children and

encouraging the use of 20 miles per hour traffic zones (DfT,

2007). Northern Ireland has a separate, but similar road safety

strategy also with a target to reduce children’s deaths and

serious injuries by 50% (DoE(NI), 2002).

Data from the All Wales Injury Surveillance System (Figure 3.2),

which shows the distribution of hospital admissions for

accidental injury by age and setting, highlights the importance

on children. However, there remain substantial socioeconomic

differences. Children living in more deprived areas have much

higher rates of unintentional injury. For example, children of

parents who have never worked or are long-term unemployed

are 13 times more likely to die from unintentional injuries

(Edwards et al, 2006).

In England, the government is committed to reduce the

number of unintentional and deliberate injuries to children

and young people through a public service agreement

(HM Government, 2008b). This is underpinned by the Staying

Safe Action Plan (DCSF, 2008). The Children’s Plan for England

(DCSF, 2007) highlights the need for a proportionate approach

to health and safety to allow children to take risks while

staying safe. Similar initiatives are in place in the devolved

administrations. For example, in Scotland recommendations for

improved child safety have been put forward in the Child Safety

Strategy (RoSPA, 2007), in Northern Ireland reducing injuries

is part of Investing for Health (DHSSPS, 2002), and in Wales

addressing injuries is a key theme of Health Challenge Wales*.

* Health Challenge Wales, http://new.wales.gov.uk/hcwsubsite/healthchallenge/?lang=en.

Figure 3.1 Prevalence of overweight children in the UK up to 17 years old (adapted from International Association for the Study of Obesity, 2007)

%overweight

<5

5–9.9

�0–�4.9

�5–�9.9

20–24.9

25–29.9

>30

Datanotavailable

(a)Boys

(b)Girls

Priorto�990�990–�9992000–2006


† Compared with the average for 1994–98.

20

of improved home safety for children under the age of 5 years.

It also illustrates the value of enhanced injury surveillance. Falls

in the home are the most common injury for those under

2 years old and falls account for 44% of all hospital admissions

for unintentional injuries for those under 14 years (Figure 3.3)

(HPA, 2005).

Accurate local and national health surveillance of injury rates

amongst children and young people is essential to develop

an accurate picture of injuries and enable the impact of

interventions to be monitored and evaluated effectively. Until

2003 the Department for Trade and Industry operated the

Home and Leisure Accident Surveillance Schemes. There are

regional injury surveillance schemes such as the All Wales

Injury Surveillance System and the Northwest England Trauma

and Injury Intelligence Group*, but there is currently no injury

surveillance system that gives detailed information about

accidents involving children for the whole of the UK. Recording

of UK accident and injury rates for children compares poorly

to information from countries with embedded national

injury surveillance systems (Lyons et al, 2002; Kirkwood and

Pollock, 2008). The Injury Observatory of Britain collates basic

information provided by hospital accident and emergency

departments, regional observatories and other partners. The

Royal Society for the Prevention of Accidents (RoSPA) and

industry partners are undertaking a feasibility study to create

an all-injury UK-wide surveillance system which would have

increased information (i.e. include product information) over

and above the minimum accident and emergency data set.

Hospital admissions caused by unintentional and deliberate

injuries to children and young people are one of the national

indicators for local authorities and local authority partnerships

in England and will help drive national and local delivery of

work to improve children’s and young people’s safety and meet

public service agreement targets (HM Government, 2008b).

There are many schemes which aim to educate children on

how to recognise and manage risks associated with accidental

injuries and poisonings (e.g. LASER, Crucial Crew and Junior

Road Safety Officers†). Educating parents and carers of children

about the most common accidents would help them develop

a more balanced view of risks and would help to reduce a

risk-averse culture that may inhibit children’s emotional and

physical development.

† The LASER (Learning About Safety by Experiencing Risk) Project, http://www.rospa.com/safetyeducation/laser/index.htm; Crucial Crew, http://www.crucial-crew.org; and Junior Road Safety Officer, http://www.jrso.com.

Figure 3.2 Distribution of unintentional injuries involving children and young people in Wales by age and location in 2004 (All Wales Injury Surveillance System, 2006)

Age,years

0–4

5–9

�0–�4

�5–�9

Home

Inju

ries

req

uir

ing

acc

iden

tan

dem

erg

ency

att

end

ance

Work School RTA Sport Public Other Unknown

�6,000

�4,000

�2,000

�0,000

8,000

6,000

4,000

2,000

0


* Trauma and Injury Intelligence Group, http://www.nwpho.org.uk/ait/.

2�

3.2.2 Obesity and physical activity

The Foresight Programme report on obesity sets out the scale

and complexity of the problem and highlights the influences

driving the long-term trend for weight gain across the UK

(Government Office for Science, 2007). Obesity is a complex

issue with a number of factors having a significant influence:

• there are some significant regional differences in

obesity prevalence (all ages) with a higher prevalence

in Scotland and the north of England,

• in families where both parents are overweight or

obese, children are significantly more likely to be

overweight or obese themselves,

• inequalities are also an important risk factor as

children and young people from more deprived

socioeconomic backgrounds have a higher prevalence

of obesity than their more affluent peers.

Other influences on the proportion of overweight and obese

children include physical activity levels, diet, education and

lifestyle factors.

A healthy balanced diet is an important factor in reducing

obesity. Parents and children need to understand more about

healthy eating, nutrition and health. There are a number of initiatives, including the Healthy Schools* and Health Promoting Schools† schemes and the 5-A-Day‡ initiative, which are helping

to address this. The impact of poor maternal nutrition on the

health and well-being of children and its effect on a healthy

lifestyle are also important.

The influence of marketing of high fat, salt and sugar foods is

a cause for concern. Box 3.1 highlights measures to reduce

the impact of ‘junk food’ TV advertising on children and

young people.

In England, the government has recently developed a public

service agreement target to ‘halt the year on year rise in

obesity among children under 11 by 2010’ (HM Government,

2008a). Additionally, the Children’s Plan (DCSF, 2007) and the

Healthy Weight, Healthy Lives Strategy (DH and DCSF, 2008)

set out a goal to reduce the proportion of overweight and

* Healthy Schools, http://www.healthyschools.gov.uk.† Health Promoting Schools, http://www.ltscotland.org.uk/healthpromotingschools/.‡ 5-A-Day, http://www.5aday.nhs.uk.

Figure 3.3 Hospital admissions as a result of unintentional injury amongst 0–14 year olds in England in 2005/06 (Hospital Episode Statistics, 2006)

Landtransportaccidents,9%

Accidentalpoisoningbyandexposuretonoxioussubstances,6.2%

Contactwithheatandhotsubstances,2.9%Exposure to smoke, fire and flames, 0.4%

Falls,44.7%

Exposuretoinanimatemechanicalforces,�8.7%

Otheraccidents,�6.0%

Accidentaldrowningandsubmersion,0.2%


22

obese children in the population to 2000 levels by 2020.

Tackling obesity is now one of the national requirements for

primary care trusts, in collaboration with local authorities and

other partners.

Low physical activity levels and sedentary behaviours are

associated with obesity amongst children and may be both a

cause and consequence of being overweight. There have been

significant changes in patterns of physical activity in children

across the UK (HPA, 2007a). From 1992 to 2003 there was a

9% decrease in the number of journeys to school made on foot

by children aged 5–10 years and a 5% decrease for 11–16 year

olds, with a corresponding increase in the number of journeys

by car.

In contrast, in England, there has been an increase in the

percentage of pupils participating in at least two hours of high

quality physical education and school sport (from 62% to 86%

between 2003/04 and 2006/07) in schools participating in the

Box3.� Restrictingadvertisingofhighfat,

saltandsugarfoodstochildren

Advertisementsmustavoidanythinglikelyto

encouragepoornutritionalhabitsoranunhealthy

lifestyleinchildren,andshouldnotemploy

‘pester-power’;promotionaloffersshouldbe

usedresponsibly(includingcartooncharacter

endorsements);andnutritionalclaimsneed

to be supported by sound scientific evidence.

Advertisementsforhighfat,saltandsugarfoods

arenotpermittedinoraroundprogrammesof

particularappealto4–�5yearoldsfrom�January

2008andwillbebannedfromallchildren’schannels

from�January2009(Ofcom,2007).

Box3.2 Examplesofinitiativesaimedatincreasingphysicalactivityamongstchildrenand

youngpeople

InEngland theNationalPhysicalEducation,SchoolSportandClubLinksStrategyprovidedgovernmentandlottery

fundingtoimproveschoolsportingfacilitiesandphysicaleducationupto2008.Theoverallobjectivehasbeento

enhancetheuptakeofsportingopportunitiesfor5–�6yearoldssothatatleast85%ofchildrenwilldotwohours

ofsportorexerciseaweekby2008.Theaimisthatby20�0allchildrenwillbeofferedatleastfourhoursofsport

everyweek.

InNorthern Ireland theFitFuturesimplementationplanaimstohalttheriseinobesityinchildrenandyoung

peopleby20�0.Theregionalstrategyforhealthandwell-beingbuildsonatargetofreducinglevelsofobesity

by50%by2025.

InScotlandtheNationalActivityStrategyScotlandaimsfor80%ofallchildrenunder�7yearstomeetthe

minimumrecommendedlevelsofphysicalactivityby2022.TheimplementationoftheSchools(HealthPromotion

andNutrition)Act2007andmajorprogrammesinschools,suchasActiveSchools,Y-DanceSchoolandTravel

Coordinators,andcommunityprogrammesincludingPathstoHealth,JogScotland,BeyondtheSchoolGatesand

GirlsontheMove,shouldcontributetowardsmeetingtheminimumrecommendedlevelsofphysicalactivity.

InWales,theClimbingHigherStrategyisa20-yearplanforsportandphysicalactivityforthewholepopulation.

Itincludesensuringyoungpeoplehaveawiderangeofpositivesportingandphysicalactivityexperiencesin

secondaryschool.InJune2006theFoodandFitness–PromotingHealthyEatingandPhysicalActivityforChildren

andYoungPeopleinWales5YearImplementationPlanwaslaunched,whichaimstosupportparents,childrenand

young people in their efforts to eat well, stay fit and achieve the highest possible standard of health.


23

School Sport Partnership Programme (The Information Centre,

2008). Examples of programmes to promote physical activity,

exercise and healthy eating throughout the UK are shown in

Box 3.2.

3.2.3 Access to green spaces

Having safe and accessible playgrounds and green spaces

benefits children through opportunities for play, social

interaction and controlled risk taking that, in turn, have positive

impacts on their physical, mental and emotional health and

well-being. Well-planned urban environments that take into

account the needs of children and young people also can

facilitate children’s access to facilities and independence.

However, opportunities for play can be limited by factors such

as a lack of access to and conflicts over use of local space, the

distance of the play area from home, safety fears and the need

for parental permissions to take part in particular activities or to

go to certain places. A number of initiatives are in place across

the UK to improve children’s access to safe and suitable play

facilities, and to encourage participation of children and young

people in the planning, transport and infrastructure process.

Also, in England, the Children’s Plan sets out proposals to create

more safe places for children to play outdoors in the natural

environment (DCSF, 2007).


A number of areas that may benefit from further action are

listed below, together with proposals of how these might

be addressed (Boxes 3.3 and 3.4).


Most injuries result from accidents in the home or road traffic

accidents; there are also considerable inequalities between

different groups. It is important to ensure that unintentional

injuries are given the same high priority throughout the UK

to ensure the same high levels of safety regardless of where

children live. There is a need for a more coordinated approach

to injury prevention. It is also important that a proportionate

approach is taken towards health and safety and injury

reduction to ensure children’s opportunities to experience risk

and participate in physical activity are not adversely restricted.

Improved risk and safety education and awareness are

also required.

Accurate surveillance of unintentional injuries, at local and

national level, is essential to enable the proper evaluation

of initiatives to reduce unintentional deaths and injuries

amongst children and young people. A feasibility study

under way by RoSPA and industry partners for a UK-wide

injury surveillance system may provide a means of ensuring

such surveillance.


A number of guidelines, policies and initiatives are in place to

promote healthy eating and counteract the increased trend in

overweight and obese children coupled with a lack of physical

activity. However, it is essential that systems are in place to

monitor and evaluate the success of these strategies. Currently,

a national child measurement programme operates in England

Young people consider thatOutdoor exercise and play are most important as they have the biggest effect on health, especially in relation to their mental health and happiness. Access to safe, clean green open spaces for play and exercise is an area where there was most call for improvement.Healthy eating is important and is linked to preventing obesity.Gangs, knife crime, accidents, computer games and parental concerns are barriers to outdoor play.


toreduceunintentionalinjuries

UK-wideimplementationofsuccessfulinterventions

toincludepracticalroadsafetyprogrammes,such

as Kerbcraft* and of 20 mph traffic zones around

schoolsandplayareas.

Cycletrainingandpromotingsafecyclingforall

schoolchildren.

Homesafetyawarenesscampaignsandhome

safetysupportandtrainingandadviceforvisiting

midwivesandhealthvisitors.

Fittingthermostaticvalvestonewandrefurbish

buildingstoreducethenumbersofscaldinjuriesto

children(asmandatoryinScotlandsince2006).

*Kerbcraft:roadsafetytraining,http://www.kerbcraft.org.

24

to measure obesity in Reception (age 4–5 years) and Year 6

(age 10–11 years). It is important that similar initiatives are

taken forward throughout the UK to ensure obesity levels are

monitored consistently. Similar initiatives are also required to

monitor changes in physical activity levels.


A strategic approach is required to ensure that all children and

young people have easy access to safe and well-maintained

green, open spaces that are in easy reach of their homes

so they can take full advantage of the benefits that such

spaces can provide. Over 80% of the population in the UK

lives in urban areas so healthy urban planning should be a

priority for the future. There should be improved planning

guidance and wider involvement of a range of stakeholders

(including children) in planning and developing green spaces

to ensure that they meet the needs of children and the

wider community.


toimprovephysicalactivityand

accesstogreenspaces

TheNationalInstituteforHealthandClinical

Excellenceguidelinesonphysicalactivityandthe

environment(NICE,2008)andNaturalEngland’s

standardonaccessiblegreenspace*shouldbe

appliedwhenplanninganddesigningurbanand

ruraldevelopments.

Achild’srighttoplayshouldbeexplicitly

acknowledgedbytheUKgovernment.

*NaturalEngland:Greenspace,availableathttp://www.english-nature.org.uk/special/greenspace/.


26


Children and young people can be more susceptible to the

effects of poor air quality, both indoors and outdoors, as their

lungs are still developing and they take in proportionately more

air than adults (WHO, 2005b). Although the actual health

impacts are difficult to quantify, indoor and outdoor air pollution

can adversely affect children’s health in a number of ways.

Indoor air pollution (e.g. from fossil fuel appliances and

environmental tobacco smoke) has been linked with

increases in lower respiratory tract infections, rhinitis, cough,

exacerbation of wheeze and asthma, and effects on the foetus.

Chronic carbon monoxide exposure can lead to behavioural

deficits in children and harm the unborn child; also children can

be particularly susceptible as they may suffer health effects in

a shorter period of time than an adult breathing in the same

concentration of carbon monoxide (HPA, 2007c). Exposure to

high levels of carbon monoxide can be fatal.

Outdoor air pollution (e.g. from vehicle exhausts, industry and

the products of combustion) has been associated with a range

of respiratory effects in children. For example, high levels of

outdoor air pollution have been linked with exacerbation of

asthma and respiratory tract infections and the evidence on the

health effects linked to living in proximity to major roads and

traffic is increasing (e.g. Gauderman et al, 2007).

Whilst not a cause, air pollution can exacerbate asthma;

an estimated 30% of the acute exacerbations of asthma in

children are related to outdoor air pollution (HPA, 2005).

Deaths from asthma in the UK are rare, but amongst children

and young people, asthma is a major reason for General

Practitioner (GP) consultations and hospital admissions.

Between 1955 and 2004 the prevalence of asthma increased

in children two- to three-fold, but has flattened or may even

have fallen recently (Anderson et al, 2007). However, GP

consultations for asthma amongst children and young people

have been declining since the mid-1990s, probably as a result

of improved medical care (Anderson et al, 2007). In 2005 GP

consultations for asthma in England and Wales were 275 and

462 per 10,000 amongst 1–4 and 5–14 year olds, respectively

(RCGP, 2006); hospital admissions for asthma in 2006 were 45

and 23 per 10,000 for 0–4 and 5–14 years olds, respectively, in

the UK (Lung and Asthma Information Agency, 2008).

Regional Priority Goal III

Prevent and reduce respiratory disease due

to outdoor and indoor air pollution, thereby

contributing to a reduction in the frequency of

asthmatic attacks, in order to ensure that children

can live in an environment with clean air. This is to

be achieved through:

(a) developingindoorairqualitystrategiesthattake

into account the specific needs of children,

(b) implementingtheFrameworkConvention

onTobaccoControlandsettinguphealth

promotionprogrammesthatwillreduce

smokingprevalenceandtheexposureof

pregnantwomenandchildrentoenvironmental

tobaccosmoke,

(c) improvingaccessofhouseholdstohealthierand

saferheatingandcookingsystemsaswellas

cleanerfuel,

(d) applyingandenforcingregulationstoimprove

indoorairquality,especiallyinhousing,

childcarecentresandschools,withparticular

referencetoconstructionandfurnishing

materials,and

(e) reducingemissionsofoutdoorairpollutants

fromtransport-related,industrialandother

sourcesthroughappropriatelegislationand

regulatorymeasureswhichensurethatair

qualitystandardssuchasthosedevelopedunder

EUlegislationtakeintoaccountthevaluessetby

theWHOAirQualityGuidelinesforEurope.

(WHO, 2004)

4 Respiratory Health, Indoor and Outdoor Air Pollution

27


4.2.1 Indoor air pollution

Currently there is a lack of coordinated action to improve

indoor air quality. Building regulations set standards for

ventilation in buildings, including schools and childcare settings.

Voluntary measures and improved understanding are also

important in improving indoor air quality.

There have been a number of public health initiatives aimed

at reducing children’s exposure to environmental tobacco

smoke; a recent example is shown in Figure 4.2. A smoking ban

was introduced in Scotland in 2006 and in England, Northern

Ireland and Wales in 2007, which prohibits smoking in any

public building, workplace, vehicle or other enclosed structure

other than an individual’s own home or car. There have been

some concerns that the ban may result in a displacement of

smoking to the home, which could lead to increased exposure

of children and young people to tobacco smoke. However,

a study in Scotland has shown that the ban on smoking

in public places has resulted in a reduction in exposure to

Figure 4.1 Number of days exceeding 50 µg/m3 (particles) compared with health objective for 2004: urban sites 1992–2006 (Defra, 2006)

�992

Nu

mb

ero

fd

ays

Year

Sites with insufficient data capture are excluded

2006

�80

�60

�40

�20

�00

80

60

20

0

40

�994 �996 �998 2000 2002 2004

Average

HighestsitevalueexcludingLondonMaryleboneRoad

Objectivelevel*

Lowestsitevalue

*Objectivelevel:nottoexceed50µg/m3onmorethan35daysby3�December2004.

Figure 4.2 Warning on tobacco products highlighting the need to protect children from exposure to tobacco smoke (Source: Department of Health)


28

environmental tobacco smoke amongst children and young

people, particularly in families where neither parent smokes

or only the father smokes (Akhtar et al, 2007). Similar studies

have been commissioned by the Welsh Assembly Government

and the Department of Health, Social Services and Public

Safety in Northern Ireland. During 2008 the Department of

Health consulted on the future of tobacco control, part of

which specifically considered protecting children and young

people from smoking and invited comments on whether

more should be done to protect children from exposure to

environmental tobacco smoke at home and in private vehicles

(DH, 2008a).

Deaths from carbon monoxide exposure amongst children have

declined substantially over the past ten years and now there

are fewer than ten deaths per year (HPA, 2007a). However,

there is evidence of a lack of awareness of the dangers of

carbon monoxide exposure amongst the general public in

the UK and potentially an increasing problem in vulnerable

groups. Recently concern has been raised about the potential

for chronic carbon monoxide poisoning in home environments

that may be undetected and unreported (Wright, 2002). To

help improve gas safety, the Health and Safety Executive has

announced a new gas registration scheme for gas installers that

will run for the next ten years (HSE, 2008).

4.2.2 Outdoor air pollution

Outdoor air quality in the UK has improved greatly over the

past few decades; however, there are still localised areas

(Figure 4.1) where people are exposed to high pollution

episodes (O’Connell and Duarte-Davidson, 2007). Current UK

legislation sets standards and objectives for a variety of outdoor

air pollutants known to have health effects; this legislation

reflects mandatory European Air Quality Limit Values. Local

authorities have a statutory responsibility to produce local

air quality management plans which identify areas where

air pollution is likely to exceed statutory limits and outline

how these will be addressed. In addition, there are initiatives

aimed at keeping people informed about local air pollution

(e.g. Box 4.1).

The Air Quality Strategy for England, Scotland, Wales and

Northern Ireland (Defra et al, 2007) provides a framework

within which air quality policies are taken forward for the UK

and enables actions to be taken to improve and provide advice

on air quality where necessary.

There are a number of initiatives aimed at promoting more

sustainable means of transport to and from school, which in

turn can help reduce traffic congestion and have beneficial

impacts on air pollution. Section 7.3 provides further details

and examples of such initiatives.

There are inequalities in the distribution of air pollution, with

the most deprived areas in England, Scotland and Northern

Ireland generally experiencing higher pollutant concentrations

(NETCEN, 2005). This is largely because most deprived

communities are in urban areas, which typically experience

higher levels of air pollution (HPA, 2007a)*.

* In Wales, the most deprived communities are in rural areas and, therefore, typically do not experience high air pollution episodes.

Box4.� airTEXT–keepingpeopleinformed

aboutlocalairpollution

airTEXTisaserviceprovidedthroughoutLondon

thatsendsairpollutionalertsandhealthadvice

tothosewhoaremostlikelytobeaffectedbyair

pollution.Textsaresentwhenpollutionlevelsreach

moderateorhigherinmorethanone-tenthofthe

selectedLondonborough.Thisserviceisavailable

toall,anditisafreeserviceforpeoplewithasthma,

emphysema,bronchitis,heartdiseaseorangina,or

forpeoplelivingorworkinginLondon.Thereisan

onlineregistrationformandalertscanbereceived

bytext,recordedvoicemessageorbye-mail.Alerts

aresenteithertheeveningbeforeorthemorning

ofanexpectedairpollutionepisode,allowing

individualstoprepareandrespondaccordingly.Each

alertcontainsbriefinformationaboutsymptomsand

healthadvice.

Young people consider that Air pollution was an area of concern and was recognised as something that directly affects their health; they supported the need for clean fresh air and green unpolluted spaces.

Car pollution was a main area of concern and was recognised as having an impact on their health and well‑being.

There was overwhelming support for further restrictions on smoking, including a complete ban.

29


A number of areas that may benefit from further action are

listed below, together with proposals of how these might

be addressed (Boxes 4.2 and 4.3).


Provision of a coordinated policy approach, action plan and

improving public information on indoor air quality would be

beneficial. Currently there is a lack of coordinated action within

government to improve indoor air quality and it is important

to establish where overall responsibility lies. There may also

be benefits in preparing an action plan to address indoor air

quality. In particular, more work may be needed to increase

public awareness of the risks associated with carbon monoxide

exposure and the importance of properly maintained fossil-

fuelled appliances. Public awareness campaigns that have

worked well for smoke detectors in the UK could also be used

for carbon monoxide monitors.

Further research to quantify the incidence and impact of

chronic carbon monoxide poisoning may be beneficial. This

should specifically consider whether children are more severely

affected than adults and, if necessary, identify ways to prevent

such exposures.

Continued efforts should be made to educate adults as to the

effects of smoking on children’s health and encourage them

to continue to minimise children’s exposure. With the advent

of the ban on smoking in public places and the restriction on

the sale of tobacco to the over 18 year olds, children’s primary

source of exposure will now almost certainly be the home

and car environments. As socioeconomic status is one of the

primary determinants of children’s exposure to environmental

tobacco smoke, it is important to focus efforts towards the

most vulnerable groups.


Local air quality management Guidance on local air quality

action plans should be extended to include measures which

can be taken to reduce the exposure of susceptible groups,

including children. Outdoor air quality policy and legislation

focuses on achieving health-based air quality objectives in

all areas where people are exposed. Action plans developed

by local authorities could prioritise more susceptible groups,

including children, within the general population, and guidance

could be provided on what actions are practical and effective.

Evidence in this area is sparse, and care must be taken not

to move the problem to other locations where sensitive or

vulnerable groups are exposed.

Improving understanding Evidence on the health effects

linked to proximity to major roads and traffic is increasing and

may have implications beyond childhood in to adult life. This

is an area that requires a review of the available literature and

evidence in order to determine the best course of action.


toreducetheimpactofsmokingon

children

Publiceducationcampaignstopromoteamessage

thatitisunacceptabletosmokewhenchildrenare

around.

Measurestoprohibitsmokinginprivatecarscarrying

children.

Legislationtoremovetobaccoproductsfromviewin

retailoutlets(asinScotland).


toreduceexposuretooutdoorair

pollution

Extension of successful zones that reduce traffic

emissions,suchastheLondonLowEmissionZone.

Sitingofnewschools,childcarefacilitiesand

playareasshouldincludeanassessmentofthe

surroundingairquality.

Implementationoftheexposurereduction

frameworkforparticles,assetoutintheAirQuality

Strategy(Defraetal,2007).


30


Children in the UK are exposed to a range of chemical, physical

and biological hazards, some with chronic or cumulative

exposure that have effects on their health and well-being. The

impacts of many of these are difficult to quantify as available

data is limited.

The main known health effects of exposure to chemical,

physical and biological hazards on children in the UK are

highlighted below.

5.1.1 Chemicals

The number of deaths and hospital admissions of children and

young people as a result of unintentional poisonings declined

overall between 2000 and 2007 by about 50%, whereas the

number of hospital admissions remained approximately the

same (HPA, 2007a; ONS, 2008c). In 2007, 23 children and

young people (under the age of 15 years) died in England

and Wales (ONS, 2008c) and, in 2006/07, 10,150 children and

young people were admitted to hospital in England as a result

of unintentional poisonings (Hospital Episode Statistics, 2008).

The chronic effects of chemical exposures on children and

young people are less well understood and quantified in the

UK. However, where links between chronic exposure and health

effects have been established (e.g. lead and neurological

development), effective action has already been taken to

reduce exposure.

5.1.2 Ionising and non-ionising radiation

Exposure to ionising radiation is known to result in an increased

risk of developing cancer. However, studies on the effects of

exposure to natural and other background radiation, such

as the naturally occurring radioactive gas, radon, have not

identified an effect on incidence rates. There may, however, be

a small increased risk which is difficult to measure.

Ultraviolet radiation, the main source of which is the sun, is a

direct cause of skin cancer. The risk of skin cancer is increased

by high childhood exposure to ultraviolet radiation. The

Regional Priority Goal IVReduce the risk of disease and disability arising from exposure to hazardous chemicals (such as heavy metals), physical agents (e.g. excessive noise) and biological agents and to hazardous working environments during pregnancy, childhood and adolescence.

Reduce the proportion of children with birth defects, mental retardation and developmental disorders, and decrease the incidence of melanoma and non‑melanoma skin cancer in later life and other childhood cancers by:

(a) passingandenforcinglegislationandregulationsandimplementingnationalandinternationalconventionsandprogrammesto:•reduceexposureofchildrenandpregnant

womentohazardouschemical,physicalandbiologicalagentstolevelsthatdonotproduceharmfuleffectsonchildren’shealth,

•protectchildrenfromexposuretoharmfulnoise(suchasaircraftnoise)athomeandatschool,

•ensureappropriateinformationonand/ortestingforeffectsonthehealthofdevelopingorganismsofchemicals,productsandtechnologiesbeforetheirmarketingandreleaseintotheenvironment,

•ensurethesafecollection,storage,transportation,recovery,disposalanddestructionofnon-hazardousandhazardouswaste,withparticularattentiontotoxicwaste,

•monitorinaharmonisedwaytheexposureofchildren,aswellasmenandwomenofreproductiveage,tohazardouschemical,physicalandbiologicalagents,

•ensurethatinternationalagreementsonthecontrolofchemicalpollutantsandhazardouswasteareapplied,

(b) implementingpoliciestoraiseawarenessandendeavourtoensurereductionofexposuretoultravioletradiation,particularlyinchildrenandadolescents,and

(c) promotingprogrammesincludingthosefortheadequatedisseminationofinformationtothepublicthatwillpreventandminimisetheconsequencesofnaturaldisastersandmajorindustrialandnuclearaccidentsandtakeintoconsiderationtheneedsofchildrenandpeopleofreproductiveage. (WHO, 2004)

5 Chemical, Physical and Biological Agents

3�

incidence of skin cancers amongst 20–24 year olds has risen

substantially in the UK, and is generally higher amongst young

people in Scotland than in England (Figure 5.1).

Evidence to date suggests that, in general, there are no adverse

effects on the health of the population of the UK as a result

of exposure to electromagnetic fields below nationally and

internationally accepted exposure guideline levels. However,

there are a number of epidemiological studies, including

studies from the UK, showing an association between exposure

to power frequency fields at home and/or from living close

to high voltage power lines and a small excess of childhood

leukaemia. At present no plausible biological mechanism

has been identified to explain this excess, if real, and there

is uncertainty about what aspect of electromagnetic field

exposure, if any, might be responsible. With regard to

radiofrequency fields, the widespread development in the

use of mobile phones worldwide has not been accompanied

by associated, clearly established increases in adverse health

effects, including in children.

5.1.3 Noise

Research has shown that exposure to noisy environments at

school can adversely affect children’s learning and educational

attainment. The impact of such exposures at a national level

has not been quantified.

5.1.4 Biological hazards

Exposure to biological hazards from environmental sources

can result in gastrointestinal illness amongst children, a

principal source of which is food poisoning. This highlights

the importance of good understanding of basic food hygiene

measures. Food poisoning cases amongst children have

declined and levelled off in recent years and, in 2006, there

were just over 20,000 cases in children and young people

of food poisoning recorded by microbiology laboratories in

England and Wales. A Food Standards Agency’s study (FSA,

2000) of intestinal infectious disease identified that cases

diagnosed in microbiology laboratories under-represent the

proportion of all cases. Other sources of environmentally

derived gastrointestinal illness include person-to-person contact

and contact with animals.

Figure 5.1 Incidence of malignant melanoma in 20–24 year olds in England and Scotland (ISD Scotland, 2006; ONS, 2006b)

Scotland,females

England,females

Scotland,males

England,males

Rat

ep

er�

00

,00

0p

op

ula

tio

n(3

-yea

rro

llin

ga

vera

ge)

�0

8

6

4

2

0

�982 �985 �990 �995 2000 2005Year


32


In the UK there is robust legislation and a wide range of

initiatives to protect the public from environmental and

occupational exposure to chemicals, biological hazards

(particularly food safety and hygiene) and ionising (e.g. radon)

and non-ionising radiation (e.g. ultraviolet radiation and

radiofrequency electromagnetic fields). Excessive noise is also

addressed through regulations, which provide local authorities

with powers to deal with and investigate complaints.

5.2.1 Chemicals

Legislation and initiatives aimed at protecting the public from

exposure to chemicals have led to reduced exposures of many

chemicals in children and young people (some examples are

given in Box 5.1). However, there is still much to learn regarding

children’s exposure, the variables that influence exposure and

whether there are any associated health effects. The main

concern is that health effects are often difficult to quantify and

may be as a result of chronic exposures to single chemicals

or mixtures of chemicals, although new and developing

techniques, such as human biomonitoring, are providing

opportunities to improve understanding and evaluate exposure.

Although legislation and safety initiatives have decreased

unintentional poisonings in children in the last 20–30 years,

accidental poisonings remain a significant risk. There is a lack

of understanding of the reasons for many of the unintentional

poisonings amongst children in the UK and of effective

interventions to continue to reduce such incidents.

The EU Regulation on the Registration, Evaluation and

Authorisation of Chemicals, which came into force in June 2007,

is aimed at ensuring a high level of protection of human health

and the environment from chemicals. It replaces 40 existing

legislative instruments combining them into a single, coherent

system. Risk assessments take into account exposures of

vulnerable groups including children (Capleton et al, 2008).

The effects of chemical exposures in utero and early life are

poorly understood and require further research. Whilst the

incidence of environmentally induced congenital abnormalities

(in both live and still birth) is difficult to estimate, there are

well-established links between developmental abnormalities

and the environment (Hens, 2007). Surveillance of congenital

abnormalities is important if we are to understand the true

impact of the environment on human development and

disease. Although there are local reporting mechanisms in

place to register congenital abnormalities at birth, it is not

consistently applied throughout the UK. Evidence suggests

that the incidence of some congenital abnormalities (such as

gastroschisis) is increasing in industrialised countries (Hens,

2007). It is important that we gain a full understanding of the

effect of the environment on pre- and post-natal development

so that suitable interventions can be taken to reduce the

disease burden.

Box5.� Controllingchildren’sexposureto

chemicalstoprotecttheirhealth

Leadposesarisktochildrenasitcanaffectthe

developmentofthenervoussystem.Inthelast

20–30yearslegislationandotheractionshavebeen

putinplacetocontrolleadintheenvironment

andprotectchildren’shealth.Thesehaveincluded

banningleadinpetrol,restrictingtheuseofleaded

paintandtheuseofleadintoys,controllinglead

infoodandcontrollingemissionsofleadfrom

industrialprocesses.Asaresult,therehasbeena

substantialreductioninbloodleadlevelsinchildren,

sothatmedianbloodleadlevelsinthe�990s

(�–3µg/dl)haddeclinedapproximatelyten-fold

comparedwithlevelsinthe�960s(23µg/dl).

Measurestocontrolexposuretopersistentorganic

pollutants(suchaschlorinatedpesticides,dioxins

andpolychlorinatedbiphenyls)havebeenputin

placeoveranumberofyearsandhaveincluded

implementinginternationalandnationallegislation

tocontroltheproduction,use,storageandsources

ofemissionsofthesechemicals.Monitoringof

breastmilkhasshownareductioninlevelsof

persistentorganicpollutantsovertime(byover50%

forsomepollutants).Thishasresultedinadecrease

inexposurestopersistentorganicpollutantsin

breastfedbabies.


33

An increased demand for building has led to a greater use of

brownfield sites. The Contaminated Land Exposure Assessment

model* used to derive soil guidelines is aimed at protecting

children as the most sensitive group. However, it is important

to ensure that information is communicated effectively

concerning contaminated land to address public anxieties,

particularly in situations such as the building of schools on

previously contaminated land.


The carcinogenic risks of ionising radiation are generally

higher for exposures in childhood than for exposures later in

life (HPA, 2005). The principal source of exposure to ionising

radiation for children in the UK is from radon gas in homes,

schools and other childcare settings. The Health Protection

Agency has undertaken detailed mapping of domestic radon

levels throughout the UK, and is responsible for advising the

UK government on appropriate action to reduce exposure for

adults and children.

Evidence suggests that observable raised cancer risks may

occur below the existing UK action level for radon in homes.

A review of the current action level† for radon in homes is

under way, taking into account recent scientific evidence from

the Advisory Group on Ionising Radiation, the Committee on

Medical Aspects of Radiation in the Environment (COMARE), the

World Health Organization and the International Commission

on Radiological Protection. Draft advice is likely to be published

for consultation in 2009.

COMARE has written to the government in England and the

devolved administrations (January 2008) alerting them to

three recommendations from its meeting of October 2007.

One is a recommendation to treat schools the same as

homes for radon protection purposes, i.e. to use an action

level of 200 becquerels per cubic metre (Bq/m3) rather than

the occupational level of 400 Bq/m3. The Health Protection

Agency is currently working with the Health and Safety

Executive (HSE) on developing a programme with the aim of

bringing radon exposure levels in schools to well below the

regulatory standard.

Medical exposures to ionising radiation are increasing, as new

diagnostic techniques are adopted. The UK Ionising Radiation

(Medical Exposure) Regulations 2000 require that healthcare

staff pay special attention to medical exposures of children and

the foetus in order to justify medical exposures in children and

protect them from unjustified risks.

The UK environment agencies and the Food Standards Agency

operate a comprehensive system for monitoring radioactivity in

food and the environment, the results of which are published

annually (e.g. EA et al, 2007). The Food Standards Agency

is responsible for ensuring that the levels of radioactive

substances in foods are properly controlled to meet relevant UK

and international safety standards.

Non-ionising radiations include ultraviolet radiation and

electromagnetic fields. Although the focus of public anxieties

varies, the principal public health concern is exposure to

ultraviolet radiation, as a direct cause of skin cancer. There have

been a number of public health campaigns and awareness-

raising initiatives in the UK aimed at improving sun protection

knowledge and behaviour in children and young people

(Box 5.2), and the government has made a commitment

to increase funding for awareness programmes (DH, 2007).

However, the effectiveness of these initiatives needs to be

evaluated as a matter of good practice.

There is concern about the use of sunbeds by children and

young people. In England, the Department of Health has

recently announced that it intends to review options for

regulation of the cosmetic tanning industry, taking into account

the scale of use by minors, with a view to ensuring the health

of children and young people is adequately protected (DH,

2007). In Scotland, the Public Health etc (Scotland) Act 2008

includes measures for controls on the use of sunbeds, such as

a ban on operators from allowing the use of sunbeds by under

18 year olds in commercial premises, banning the sale or hire of

sunbeds to the under 18s and banning the use of unsupervised

or coin-operated sunbeds. However, it is important to ensure

that the same level of protection is afforded to children

throughout the UK.

* Contaminated Land Exposure Assessment, http://www.environment-agency.co.uk/.† The action level is the annual radon concentration in a home above which remedial action is recommended to decrease the risk of lung cancer. Currently the action level is 200 becquerels per cubic metre (Bq/m3).


34

The widespread use of mobile phones has led to concerns

about possible health effects associated with exposure

to radiofrequency electromagnetic fields, particularly in

children. Overall, evidence available suggests that exposure to

radiofrequency fields below established guidelines does not

cause adverse health effects in the general population, but

in view of scientific uncertainties, a precautionary approach

has been recommended for children’s use of mobile phones.

Recently, concern has been expressed about exposures to

radiofrequency fields generated by wireless local area networks

and WiFi, particularly in schools. Current evidence suggests that

exposures are below international guideline levels and therefore

do not pose a health risk to children. However, research is

ongoing to better understand the levels and patterns of

exposure from these technologies.

5.2.3 Noise

Whilst the impact of noise on children’s learning and

educational attainment has been studied, little is known about

other impacts of noise on children’s health and well-being.

Current specifications for the acoustic design of schools set

standards for sound insulation for new and refurbished schools,

including standards for sound insulation of teaching areas.

Currently, in accordance with the EU Noise Directive, noise

maps are being prepared throughout the UK for major roads,

railways and cities and may assist in identifying those affected,

including schools, by excessive background noise (Capleton

et al, 2008).

Box5.2 Examplesofinitiativesandcampaignsforprotectingchildrenfromthesun

Thereareanumberofinitiativesandcampaignsaimedatdevelopinggreaterawarenessoftherisksofskincancer

and promoting good sun protection behaviour, which are specifically focused on children.

TheSunSmart initiative,commissionedbytheUKHealthDepartmentsandrunbyCancerResearchUK,hasan

ongoingschoolsprogrammethatprovidessunprotectionguidelinestoschools,andencouragesschoolstodevelop

theirownsunprotectionpoliciesandincorporatesunprotectioneducationintothecurriculum.

Beat the Burn –theCharteredInstituteofEnvironmentalHealthworkedwithsevenWelshlocalauthoritiesin2004

tosupportaseriesofskincancerawarenesscampaignstopromotetheSunSmartcode,targetingyoungpeople

andparents.Activitiesincluded:posterswithsunprotectionadvicenearbeachesinAnglesey;aseriesofeventsin

Wrexham including a National Play Day attended by over 500 children; and Merthyr Tydfil Pink Nose Day, which

involved�3schoolsandencouragedchildrentoapplypinksunscreenontheirnosefortheday.

NHS Fife and NHS Tayside Keep Yer Shirt on Projectwasruntoraiseawarenessoftheimportanceofskincancer

preventionandreducetheriskofsunburninpre-schoolchildren.Theprojectincluded:workshopsfornursery

staffandothercarersofchildren;workingwithparentsofpreschoolchildren;encouragingpre-schoolchildcare

establishmentstodevelopandimplementsunawarenesspolicies;andprovidingshadestructuresinnurseriesand

playgroups.

AspartofNorthernIreland’sCare in the Sunprogramme,aLivingWillowsforShadeprojecthasbeenundertaken

wherebysuchstructuresarebuiltinschoolplaygroundstoprovideshadeforpupils.Aspartoftheprogramme,

eachschoolisrequiredtodevelopaCareintheSunpolicybasedonDepartmentforEducation(NorthernIreland)

guidelinesandfacilitatethedesignandbuildingofwillowshadestructures.TheschemewasfundedbytheBig

LotteryFundandenabled48schoolstohavelivingwillowshadestructures.


35

Recently concerns have been raised about the use of high

frequency audio devices (e.g. ‘Mosquito’ devices) used to deter

anti-social behaviour and loitering and the effect on children’s

and young people’s health and well-being. An HSE evaluation

of such devices concluded that there would appear to be little

likelihood of long-term ill health; however, the impact on well-

being still remains unclear.

There is also concern about the use of personal music players

by children and young people and the long-term effects

on hearing. The Royal National Institute for Deaf People’s

‘Don’t Lose the Music’* campaign aims to increase public

awareness about sound and hearing damage. The European

Scientific Committee on Emerging and Newly Identified

Health Risks recently evaluated such devices and concluded

that hearing damage may occur if prolonged use occurs at

excessive volumes and recommended that further research

be undertaken as to how such music players are used and

factors that make individuals susceptible to hearing loss

(SCENIHR, 2008).


Disease surveillance is an important tool to understand

the effects of biological hazards on health and highlights

patterns of disease within populations. Problems with disease

surveillance systems include under-reporting of infections and

low rates of microbiological testing, which can lead to bias

towards detecting more severe cases and cases in high risk

groups such as infants.

The Food Standards Agency strategic plan for 2005–2010 aims

to reduce food-borne disease in the general population by

promoting awareness about food hygiene, focusing particularly

on schools. To support this strategy there are a number of

initiatives throughout the UK (e.g. Cooking Bus, Spud’s Zone

and the Elementary Food Hygiene Training) that promote food

hygiene messages to children.

5.2.5 Emergency preparedness

Proper and effective planning and preparation for emergencies

(natural, industrial and deliberate) is critical to minimise the

consequences of such events and to ensure an effective

response. It is important to take into account the needs of

vulnerable groups, such as children, who may have specific

needs. In the UK, the NHS emergency planning guidelines

(DH, 2005) refer to the needs of vulnerable groups, including

children, and recommend that specific plans should be

developed for schools, nurseries, childcare centres and medical

facilities for children. More detailed guidelines for the NHS,

that address the needs of children in emergency situations,

are being developed, and children have been involved in some

emergency planning exercises to gain a better understanding

of their needs (e.g. Exercise Young Neptune – see Box 5.3).

Other emergency planning guidance also considers the needs

of children. For example, guidance on heat waves refers to

the vulnerability of babies and young children (DH, 2008b),

and guidelines for sampling after a chemical incident refer to

the need to consider ‘sensitive sites’ such as schools, crèches,

and playgrounds where many children may be together

(DETR, 1999).

* Don’t Lose the Music, http://www.dontlosethemusic.com.

Box5.3 ExerciseYoungNeptune

–managingchildreninmajor

incidents

ExerciseYoungNeptunewasheldinDecember2006

totesttheproceduresformassdecontaminationof

childrenandtheirbehaviouralandpsychological

impact.TheHealthProtectionAgency,UKFire

andRescueNewDimensionProgramme,UKNHS

AmbulanceServiceandPoliceChemical,Biological,

RadiologicalandNuclearteamsparticipatedinthe

exercise. Sixty-five children, aged between 6 and

�4yearsold,wererecruited.Aftertheexercise,the

participatingchildrengavefeedbackbycompleting

questionnairesandinsmallgroupdiscussions.This

information,togetherwiththeformalexercise

evaluation,willhelpemergencyrespondersto

reviewoperationalprocedures(Turneretal,2007).


36

However, there may still be scope to give greater consideration

to the needs of children and young people, e.g. by ensuring

children are routinely considered in emergency planning

exercises, where appropriate, ensuring that their needs are

prioritised, and by ensuring measures deployed during an

emergency (e.g. decontamination clothing and antidotes)

have been thoroughly evaluated for use by children and

young people.


Generally, children and young people’s health is well protected

from chemical, physical and biological hazards. However, there

are some areas that may benefit from further action. These

areas are listed below.

5.3.1 Chemicals

Ways to further reduce the number of deaths and hospital

admissions of children from accidental poisoning need to be

identified. A better understanding of the current trends and

patterns of poisonings would help identify interventions and

areas that would benefit from further research.

There is still much to learn about children’s exposure to single

chemicals and chemical mixtures in the UK, including a better

understanding about where children are exposed (e.g. in the

home, schools and outdoor environment). Research to fill

these gaps should include the use of new techniques such

as biomonitoring. The UK should develop a robust human

biomonitoring programme to monitor exposures and evaluate

interventions (e.g. legislation) to reduce exposure (e.g.

Box 5.1). Such studies should be representative of children in

the UK and consider exposures to chemical mixtures as well as

single chemicals.

Further research is required into better understanding

the health effects of chemical exposures and particularly

understanding harm during embryonic development, a greater

understanding of the transgenerational effects of in utero chemical exposure as well as neurological developmental

toxicology and other lifelong effects potentially resulting from

exposures early in life.

A strategic review of systems for surveillance of congenital

abnormalities would be timely with a view to making

recommendations to improve upon the current surveillance

systems in the UK.


Householders in radon affected areas should continue to be

encouraged to participate in radon testing and to reduce radon

levels in houses which are above the action level. Whilst there

have been several campaigns, the proportion of householders

installing remedial measures to reduce radon in homes is still

relatively low. Encouraging householders to consider radon

mitigation should continue.

Landlords and employers in radon affected areas should be

encouraged to participate in radon testing and to reduce levels

in buildings which are above the action level. In particular, all

schools and childcare settings in radon affected areas should

be tested for radon and, if above the action level, should take

measures to reduce the exposure of pupils and staff.

COMARE has recommended that schools should be treated

the same as homes for the purposes of radon protection.

This would mean that the current radon action level for

homes of 200 Bq/m3 should be applied to schools and other

childcare environments.

Good sun protection behaviour should be encouraged in

children and young people. Campaigns across the UK should be

coordinated and evaluated. It is important to ensure that sun

protection behaviour and knowledge is taught consistently to a

high standard across the UK. Schools and childcare institutions

should continue to develop and implement sun protection

policies that are known to be effective, such as including shade

in play areas.

The use of sunbeds and tanning parlours by children and young

people should be prevented or reduced and means to do

Young people consider that Chemicals in beauty products and pesticides in the food chain, waste reduction, recycling, healthy eating and the risk of radon in schools (especially primary schools) are areas of concern.

37

this need to be explored further and implemented across the

UK. Measures could include restricting the use of commercial

sunbeds and tanning parlours to those over a specified age

(e.g. 18 years) and ensuring that information about health risks

is provided with retail sunbeds.

Further research is needed to improve the understanding of

possible health effects of electromagnetic field exposures

(e.g. from mobile phones, base stations, electrical wiring

and appliances and overhead power lines) in children, young

people, pregnant women and foetuses. A comprehensive

understanding of exposures in the UK is important to be able to

interpret results of national and international studies and give

better health advice.

5.3.3 Noise

Children and young people are affected by noise and their

education can suffer directly. Noise maps, which are currently

being produced for major roads, railways and cities, could

be used to identify schools likely to be affected by noise and

identify where noise interventions may be most useful.

Further research is needed to improve understanding of the

non-auditory effects of background noise, high frequency noise

devices and personal music players on children and young

people. Further investigation is also needed as to how personal

music players are used and the impact on the hearing of

children and young people.


Schools should continue to teach and encourage food hygiene

to establish good habits at an early age. The surveillance

system for food-borne diseases is an important way to identify

health effects of biological hazards; however, this could

be strengthened.


Children and young people should be routinely considered

and, where appropriate, included in emergency preparedness

exercises in order to understand and take better account of

their needs. Specific consideration should be given to the

needs of children and young people, by ensuring, for example,

antidotes and equipment such as decontamination clothing

are suitable for use by children and young people of all ages,

and that their needs are prioritised in relevant emergency

situations (e.g. access to sanitation and clean water following a

flooding incident).


38

6.1 Overview

The involvement of young people is an important element

of the Children’s Environment and Health Strategy in the UK.

Various youth groups have been engaged internationally and

within the UK from an early stage to identify the issues they

consider most important and to assess their understanding

and awareness about the effects of the environment on

their health.

6.2 Youth consultation process

Thirty official youth delegates from across the WHO

European Region attended the WHO Ministerial Conference

on Environment and Health in 2004 when the Children’s

Environment and Health Action Plan for Europe (CEHAPE) was

launched (WHO, 2004). During this meeting, they held a Youth

Parliament at which a Youth Declaration* was developed,

expressing their views on CEHAPE and highlighting food

security, safety and quality, access to clean water, air pollution

and green spaces, waste, tobacco and alcohol, and education

as priority areas.

The involvement of young people has continued throughout

the process. In the UK young people have been consulted

through a number of ways including workshops, discussions

and questionnaires in a number of settings (mainly schools

and the UK Youth Parliament), covering different age groups

(from 11–18 years), sexes and geographical locations. The views

of young people on the impact of the environment on their

health are presented below.

6.3 What is important to young people?

A number of workshops held with the UK Youth Parliament

and a Youth Partnership Group highlighted the fact that young

people do not naturally make a link between their health and

the environment. However, once this connection is identified,

young people show an advanced understanding of health, the

environment and how these impact on each other.

The top five health issues that they consider important are (in

descending order): mental health; obesity and healthy eating;

lung cancer, asthma and allergies (pollution related); sexual

health; and drug use. Mental health was one of the key health

concerns for young people, who agreed that they “want to

be happy”.

Young people identified general good health as being

vibrant, alive, full of energy and “having one’s life on

track”, whilst physical health was not being obese, moving

around easily and being active. This was linked to exercise,

healthy eating, drinking water, avoiding too many sweets,

not smoking or drinking too much alcohol, fresh air and

a clean home environment. They considered that the

government, local authorities, the National Health Service and

individuals all have a responsibility in ensuring good health in

young people.

With respect to the impact that the environment (in its

broadest sense) can have on health, young people generally

think that it is important to consider social issues and

environmental concerns together, including the social

environment (such as peer pressure), the green environment

(e.g. parks and open spaces) and the close association that

food, nutrition and exercise have with the environment. The

social environment was also linked to health (e.g. drug abuse

leading to poor mental health or open green environments

with space for outdoor activities resulting in vibrant and

energetic children).

When asked to list what they consider as good and bad health,

they identified the environmental factors that they associated

with these. These are presented in Figure 6.1.* WHO (2004): Fourth Ministerial Conference on Environment and Health, Youth Declaration, http://www.euro.who.int/document/e83350.pdf.

6 Youth Participation

39

Figure 6.1 Young people’s ideas of good and bad health and associated environmental factors


40

During 2004 the WHO initiated an internet project called

‘Young Minds’*. Pupils in the UK involved in this project

considered that young people generally feel poorly informed

and worried, and want to learn more about the environment

and its impact on their health, but that they do not trust what

they are told by the media or the government. They identified

TV and the internet as the best sources of information and

want to be better informed so that they can take responsibility

and make their own decisions relating to the environment and

its impact on their health.

In response to a questionnaire survey in 2007 the majority

(83%) of UK Youth Parliament respondents thought that

the environment impacted on their health. Cheaper leisure

facilities and clean green spaces were generally viewed as the

main areas for improvement. They also prioritised what they

considered the most important environmental issues as follows

(in descending order): nutrition (47%), immediate environment

(home, school, leisure place; 30%), air pollution (18%) and

exposure to chemicals (2%). Other things identified as being

important included global warming, safety, education, and

drugs and alcohol. Healthier eating and more (free) sports

facilities, together with improved education for both young

people and parents on diet, food, mental health and being

healthy, and improving health services, were also considered

priorities for action.

During 2007, the Northern Ireland Commissioner for Children

and Young People met and obtained the views from over

2000 children and young people across Northern Ireland.

Amongst their top priorities were play and things to do and

protection (which included road safety and bullying).

The Children’s Commissioner for Wales led a number of events

in 2008 that involved 400 children and young people (aged

7–18 years old). From these a number of ideas were suggested

to improve the environment, including greater recycling, less

crime, more trees, less pollution, banning smoking and limiting

alcohol intake.

6.4 Young people’s views on the Children’s Environment and Health Strategy

The following sections highlight responses received through a

questionnaire sent to the UK Youth Parliament that relate to the

individual Regional Priority Goal areas.

6.4.1 Water, sanitation and health

Access to safe, clean toilet facilities and to clean drinking water

in schools, hygiene and hand washing were considered a high

priority. Young people also identified that toilets attracted

bullies and smokers. Several young people said that they would

avoid drinking in the day so that they would not need to use

toilet facilities.

6.4.2 Accidents, injuries, obesity and physical activity

Improved and affordable leisure and exercise facilities, green

space (more trees and less concrete), less litter and healthier

eating were highlighted as areas for improvement.

Most children and young people identified outdoor exercise

and play as most important as it has the biggest effect on

their health, especially in relation to their mental health and

happiness; access to safe, clean and green open spaces for play

and exercise was also considered a priority. Gangs, knife crime,

accidents and computer games were considered to be barriers

to playing outdoors. Parental concerns were also mentioned as

often preventing children from playing outside.

Healthy eating was identified as important and linked to

preventing obesity as was access to space and play. Young

people linked obesity to fast food, lack of exercise and laziness.

Suggestions proposed to improve healthy eating included

better food labelling, better (and free) school dinners, limits

on pesticides, more organic foods, more variety in local shops,

government regulations on (battery) farming and changing

attitudes. In particular, improving school food and educating * Young minds – exploring links between culture, health and environment, http://www.young-minds.net/ym/top/index.php.


4�

both students and parents about healthy eating were seen as

areas for attention.

6.4.3 Respiratory health, indoor and outdoor air pollution

Young people recognised air pollution as something that

directly affected health and there was support for clean fresh

air and green unpolluted spaces. Improved and cheaper public

transport was highlighted as a way of reducing car pollution.

There was overwhelming support for further restrictions on

smoking, including a complete ban. Although smoking is

prohibited in indoor public spaces, young people feel that they

now encounter more smoke from people driven to smoking on

the street.

6.4.4 Chemical, physical and biological agents

Exposure to chemicals was not generally considered an issue

that has an impact on young people in the UK. Those concerns

raised were about chemicals in beauty products and pesticides

in the food chain. Waste reduction, recycling and risk of

radon exposure in schools (especially primary schools) were

also highlighted.

6.5 Conclusions

Young people’s understanding of the relationship between the

environment and their health is not intrinsic; however, upon

development of the ideas through discussion sessions, they are

quick to provide examples of where they think the environment

affects their well-being. Children and young people have

strong feelings about the importance of good health and,

although the relationship is complex, they understand that

their behaviour and environment impact upon their well-being.

Engaging children and young people should be integral when

implementing recommendations from the Strategy so that they

are adopted into youth culture.

Young people have strong views about which aspects of the

Strategy are most important to them. The key areas they

identified during this youth consultation fell into two different

groupings, those related to Regional Priority Goal areas:

• better toilets and hygiene in schools,

• improved access to clean drinking water in schools,

• healthier eating and reduced obesity,

• affordable and improved facilities for physical exercise,

• more clean green spaces,

• improved transport (cleaner and fewer cars),

• less pollution,

• ban smoking,

• chemicals in beauty products and pesticides in the

food chain,

• waste reduction, recycling, healthy eating and radon in

schools (especially primary schools),

and those related to overarching issues:

• improvements in mental health,

• better education and information for young people

and parents regarding health and the environment,

• peer pressure and current attitudes can be barriers to

maintaining a healthy lifestyle.


42

A number of overarching issues are common to more than one

Regional Priority Goal area. These are discussed below.

7.1 Inequalities

In the UK there is an uneven distribution of exposure to

environmental hazards amongst children according to

socioeconomic group and region. There is increasing

evidence that environmental inequalities are a real problem

which affect all the Regional Priority Goal areas. For example,

inequalities in children’s health exist in mortality and

morbidity from unintentional injuries (including poisonings),

obesity and physical activity (HPA, 2007a) and exposure to

environmental pollution (HPA, 2005). However, the causes,

effects and distribution are varied and complex. Therefore,

health inequalities should be a major consideration in taking

the Strategy forward, linking with other strategies aimed

at addressing health inequalities, such as Tackling Health

Inequalities: Programme for Action (DH, 2003). Specifically,

groups that may need to be considered, in addition to those

already highlighted, are:

• those living in the most deprived communities in

the UK,

• children and young people with disabilities or long-

term medical conditions (e.g. asthma),

• gypsy and traveller children.

7.2 Settings

As children and young people spend most of their time either

at home, in educational establishments or outdoors, focusing

on improving the environment in these locations may be

of more benefit than looking at environmental risk factors

individually. It may also enable a more holistic approach to

be taken to reducing the burden of disease associated with

environmental risk factors and improving children’s health

and well-being.

7.2.1 Homes

Children spend a substantial part of their lives in the home

environment, particularly before the age of five years; therefore

this is a key area where the environment impacts on the health

of children. Safety in the home is an important aspect: for

example, in 2004 over 60% of hospital accident and emergency

admissions for children under the age of five years in Wales were

due to unintentional injuries that occurred within the home

(Figure 3.2). There is legislation regulating some aspects of

the home environment (e.g. building regulations and housing

health and safety regulations). However, effective change

requires the participation and motivation of householders.

Environmental hazards in the home environment of importance

to children include lead in drinking water, injury and poisoning

risks, environmental tobacco smoke, radon and food hygiene. It

is important that children are accommodated in decent housing

that is not over-crowded.

There is evidence that changes in eating habits and physical

activity are more likely to be maintained when the behaviour

of the whole family is changed. Therefore, where appropriate,

interventions should be targeted at the whole family.

7.2.2 Community settings

The wider social and community environment can also have an

important impact on well-being, e.g. opportunities for young

people, amenities and transport. The 2004/05 survey of English

housing undertaken by the Department for Communities and

Local Government identified that householders felt that the

most important area for improvement was ‘opportunities and

facilities for children and young people’ (DCLG, 2006b). The

government has established several public service agreements

and a Sustainable Communities Plan (ODPM, 2003) that aim

to build stronger, more sustainable communities and a better

quality of life. The public service agreements include ones

to halve the number of children in poverty by 2010/11, build

more cohesive, empowered and active communities, and make

communities safer (HM Government, 2007a,b,c).

This is also being taken forward in the Children’s Plan (DCSF,

2007), which emphasises the need for strengthened support

for parents and families. For example, the Plan highlights the

continued development of the SureStart Children’s Centres to

7 Overarching Issues and Priorities

43

provide drop-in centres for parents and outreach services, and

provide advice and information on areas of concern for parents

and children. It is also taking forward the development of safe

places to play outdoors as one of its key areas.

7.2.3 Schools, nurseries and other childcare settings

In the UK primary school children spend approximately

6.5 hours a day in the school environment for 190 days a year.

Secondary school children, and those involved in extracurricular

activities, spend up to 8 hours a day in school. The school

environment is subject to considerable regulation, but may

still lend itself to further improvement. Many of the concerns

relate to the location and age of schools. In England, the

Building Schools for the Future programme aims to refurbish or

renew every secondary school. This will help to ensure a more

consistent approach to a range of environmental health issues

in schools. In particular, there are now standard specifications

for school toilets and the acoustic design of schools, and

building guidance and regulations help ensure environmental

health issues are taken into account when building new schools

or renovating existing facilities.

Nurseries are important for pre-school age children and their

parents and by 2010 all three and four year olds will be offered

15 hours of free nursery education per week. Preschool and

primary years are important for the foundation of children’s

knowledge, understanding and skills relating to healthy

lifestyles, food nutrition and health. Many lifelong dietary habits

are established before the age of ten. The National Institute

for Health and Clinical Excellence guidelines for physical

activity and the environment (NICE, 2008) highlight the role of

nurseries and other childcare facilities in minimising sedentary

activities and implementing actions to reduce obesity.

The Healthy Schools* programme in England and the Health

Promoting Schools† initiative in Scotland (which takes a whole-

school approach) are both important for ensuring children have

a healthy environment at school.

7.3 Sustainable development

Sustainable development and wider environmental planning

are important ways of linking many of the recommendations

made within the Strategy.

The UK Sustainable Development Strategy aims to enable

all people satisfy their own basic needs and enjoy a better

quality of life without compromising the quality of life of

Box7.� Sustainabletransportandthe

journeytoschool

TheWalking Bus picksupchildrenatsetpoints

alongaroutetoschoolandthechildrenwalkin

pairswithanadult‘driver’atthefrontandadult

‘conductor’attherear.Therouteisselectedtoavoid

busyroadswherepossibleand,alongwithreducing

traffic around the school, can reduce children’s

exposuretoairpollution.

Park and Strideschemesencourageparentswho

normallydrivetheirchildrentoschooltopark

furtherawayfromtheschoolandwalktheirchildren

the final part of the journey to reduce traffic around

theschoolgates.Thismay,inturn,reducethe

amount of traffic-generated air pollution to which

childrenareexposed.

InScotland,SchoolTravelCoordinatorsworkwith

schoolsintheirareastodevelopandimplement

travelplans.SUSTRANS,thesustainabletransport

charity,providesgrantstoschoolsforcapitaland

resourceprojects,includingfundingforcycle

storagefacilities,lockers,improvedpathsand

walkwaysandsupportmaterialsforwalkingbuses

andothersimilarinitiatives.

InNorthernIreland,Travelwise NIisaroads

serviceinitiativedesignedtoencouragetheuseof

sustainabletransportoptions.Itswebsiteprovides

informationforparentsongettingtheirchildrento

schoolbycycling,walkingbusesorcarsharing.* Healthy Schools, http://www.healthyschools.gov.uk/.† Health Promoting Schools, http://www.ltscotland.org.uk/healthpromotingschools/.


44

future generations (HM Government, 2005). Sustainable

development has important implications for children’s and

young people’s health and well-being. For example, promoting

more sustainable modes of transport can lead to more

walking, cycling and use of public transport by children and

young people, which in turn can reduce traffic-generated

pollution and noise levels, increase physical activity of children

and young people, enable them to develop a greater sense

of independence and have positive impacts on obesity. The

Education and Inspections Act 2006 places a general duty

on all local authorities in England to assess the school travel

needs of all pupils in their area and to promote the use of

safe and sustainable modes of travel. Some examples of

sustainable transport initiatives are presented in Box 7.1. Whilst

the Sustainable Development Strategy focuses on the whole

population, it is important that the benefits to children’s health

and well-being are taken into account when considering

sustainability issues.

It is important to involve the public and stakeholders in

developing a vision for green space, and planning decisions

more generally (including the planning of schools), to ensure

they meet the needs of the community.

7.4 Mental health

Mental health is a key concern of children and young people

and many aspects of the environment can influence children’s

and young people’s mental health and well-being (e.g.

access to green spaces and play facilities, noise and lead). The

importance of mental health is also highlighted by the fact that

one in ten children between the ages of 0 and 15 years of age

in the UK has a clinically identifiable mental health problem

(Green et al, 2005). Therefore the impact of environmental

factors on children’s and young people’s mental health needs

to be recognised and better understood in order that they can

be effectively managed.

7.5 Horizon scanning – climate change and new technologies

A number of emerging environment and health issues may

impact on children’s health. Climate change could affect a

number of the areas highlighted in the Regional Priority Goals.

Examples include increased food-borne diseases caused by

warmer summers, changes in drinking water quality caused

by flooding and increased intense rainfall events leading to

an increased numbers of bacteria in surface waters, increased

water temperatures and a decrease in the efficiency of removal

of microbes from drinking water (DH and HPA, 2007). Skin

cancers may also rise due to increased exposure to sunlight

and ground level ozone concentrations are likely to increase,

which may lead to an increase in respiratory illness in sensitive

individuals (DH and HPA, 2007).

There are also new technologies for which the potential health

impact on the general population and, in particular, children is

poorly understood. Examples include personal care products

that are increasingly making use of nanotechnology and

wireless computing networks commonly found in schools and

homes. New technologies should be assessed for their potential

health impacts during childhood and later on in life.

7.6 Monitoring and evaluation

In the UK a considerable amount of information is routinely

collected that is relevant to environment and health issues for

children and young people. Although routine surveillance of

infections and waterborne diseases has taken place for some

time, evidence suggests that this could be strengthened.

There is also routine surveillance of road traffic injuries and

obesity levels. However, there is a lack of good quality and

robust information and analysis about chemical exposures,

unintentional poisonings and injuries, and their causes and

impact on children’s health and well-being, particularly the

long-term and cumulative effects.


45

The findings of routine health surveillance can help to inform

the development of effective public health actions to prevent

acute and chronic health consequences of environmental

hazards. These data can be used to evaluate the effectiveness

of specific interventions in terms of a reduction in the burden of

disease in the targeted population.

Whilst there are many initiatives aimed at improving children’s

environmental health, only a small number appear to have

been thoroughly evaluated with regard to their benefit to

children (e.g. Kerbcraft). Evaluation should be an essential

component of any public health intervention and needs to

be built into any interventions taken forward as a result of

this Strategy. Outcome measures may be short-term health

improvements (e.g. reducing injury rates), or longer-term

positive health effects (e.g. reducing skin cancer rates).

Monitoring and evaluating the effectiveness of current

initiatives and policies will help provide information to guide

future policy development and actions.

Part of monitoring and evaluating the impact of the Children’s

Environment and Health Action Plan for Europe (CEHAPE)

may include the use of environment and health indicators

as promulgated by the WHO (Pond et al, 2007). The use

of indicators provides information on the current state of a

particular issue (e.g. obesity or air pollution) and can be used

to identify changes over time and evaluate the impact of

particular policies.

In support of the commitments made under CEHAPE,

the Health Protection Agency has taken forward the

development of a core set of children’s environment and

health indicators. The aim of the indicators is to describe the

burden and distribution of hazards, childhood disease and

injury attributable to environmental risks within the region

concerned and to provide intelligence to inform interventions,

particularly in terms of reducing inequalities. The indicators

were piloted in the West Midlands and a final report will be

produced later in 2009.


46

8.1 Regional Priority Goal I

8.1.1 Lead in drinking water

A review of means of further reducing exposure to lead

amongst children in the UK should be undertaken, taking into

account the relative costs and benefits to children’s health.

There should be a coordinated programme to investigate the

levels of lead in drinking water in homes and schools (especially

in primary schools) and other childcare settings where levels

may be likely to go above the new standard (10 µg/l).

8.1.2 Private water supplies

Means should be developed to ensure that all private drinking

water supplies are properly documented, that there is an

adequate legislative basis and that compliance with the

standards is high. Further research into and surveillance of the

health impacts of contaminated private water supplies would

also be beneficial.

8.1.3 Water and sanitation in schools and childcare settings

Continued encouragement and support should be given to

initiatives to improve sanitary provision, drinking water provision

and hygiene standards in all childcare settings (e.g. standards

for school toilets and hand-washing initiatives), with the aim

of ensuring a consistent high standard of sanitation facilities,

access to drinking water and hand-washing behaviour in all

schools and childcare settings.

8.1.4 Bathing and recreational waters

There is currently a paucity of evidence on the health effects

of use of outdoor bathing and recreational waters in children

and consideration could be given to addressing this gap. Also,

further research on the use by children of recreational waters

other than beaches could help identify areas for future action.

Investigation of cryptosporidium outbreaks attributed to

swimming pools should be continued to identify common

factors so that interventions, such as water treatment regimes,

can be developed further to prevent future outbreaks.

8.1.5 Water poverty

Measures should be taken to evaluate the number of

households at risk from water poverty and how this may affect

children’s health and well-being, with a view to ensuring that

children and families have access to all the wholesome water

they reasonably need.

8.2 Regional Priority Goal II


Unintentional injuries should be given the same high priority

throughout the UK to ensure high levels of safety regardless

of where children live. There is a need for a more coordinated

approach to injury prevention. It is also important that a

proportionate approach is taken towards health and safety

and injury reduction to ensure children’s opportunities to

experience risk and participate in physical activity are not

adversely restricted. Improved risk and safety education and

awareness are also required.

Accurate surveillance of unintentional injuries, at local and

national level, is essential to enable evaluation of initiatives to

reduce unintentional deaths and injuries amongst children and

young people.


It is essential that systems are in place to monitor and evaluate

the success of strategies to reverse the increasing numbers

of overweight and obese children and young people and to

continue to encourage changes in lifestyle and behaviour to

achieve appropriate levels of physical activity. It is important

that initiatives are taken forward throughout the UK to ensure

8 Summary of Recommendations

47

obesity levels are monitored consistently. Similar initiatives are

also required to monitor changes in physical activity levels.


A strategic approach is required to ensure all children and

young people have easy access to safe and well-maintained

green, open spaces that are in easy reach of their homes

so they can take full advantage of the benefits that green,

open spaces can provide. There should be improved planning

guidance and wider involvement of a range of stakeholders

(including children) in planning and developing green spaces

to ensure that they meet the needs of children and the

wider community.

8.3 Regional Priority Goal III


Provision of a coordinated policy approach, action plan and

improving public information on indoor air quality would be

beneficial. There may also be benefits in preparing an action

plan to address indoor air quality. In particular, more work may

be needed to increase public awareness of the risks associated

with carbon monoxide exposure and the importance of

properly maintained fossil-fuelled appliances.

Further research to quantify the incidence and impact of

chronic carbon monoxide poisoning may be beneficial.

This should consider whether children are more severely

affected than adults and, if necessary, identify ways to prevent

such exposures.

Continued efforts should be made to educate adults as to the

effects of smoking on children’s health and encourage them

to continue to minimise children’s exposure. As socioeconomic

status is one of the primary determinants of children’s exposure

to environmental tobacco smoke, it is important to focus

efforts towards the most vulnerable groups.


Guidance on local air quality action plans should be extended

to include measures which can be taken to reduce the

exposure of susceptible groups, including children. Action plans

developed by local authorities could prioritise more susceptible

groups, including children, within the general population, and

guidance could be provided on what actions are practical

and effective.

Evidence on the health effects linked to proximity to major

roads and traffic is increasing and may have implications

beyond childhood into adult life. There is a need to improve

understanding in this area and this requires a review of the

available literature and evidence in order to determine the best

course of action.

8.4 Regional Priority Goal IV

8.4.1 Chemicals

Ways to further reduce the number of deaths and hospital

admissions of children from accidental poisoning need to be

identified. A better understanding of the current trends and

patterns of poisonings would help identify interventions and

areas that would benefit from further research.

There is still much to learn about children’s exposure to single

chemicals and chemical mixtures in the UK, including a better

understanding about where children are exposed (e.g. in the

home, schools and outdoor environment). The UK should

develop a robust human biomonitoring programme to monitor

exposures and evaluate interventions (e.g. legislation) to

reduce exposure.

Further research is required to improve understanding of

the health effects of chemical exposures and, particularly,

understanding harm during embryonic development, a greater

understanding of the transgenerational effects of in utero

chemical exposure as well as neurological developmental

toxicology and other lifelong effects potentially resulting from

exposures early in life.


48

A strategic review of systems for surveillance of congenital

abnormalities would be timely with a view to making

recommendations to improve upon the current surveillance

systems in the UK.


Householders in radon affected areas should continue to be

encouraged to participate in radon testing and to reduce radon

levels in houses which are above the action level. Whilst there

have been several campaigns, the proportion of householders

installing remedial measures to reduce radon in homes is still

relatively low. Encouraging householders to consider radon

mitigation should continue.

Landlords and employers in radon affected areas should be

encouraged to participate in radon testing and to reduce levels

in buildings which are above the action level. In particular, all

schools and childcare settings in radon affected areas should

be tested for radon and, if above the action level, should take

measures to reduce the exposure of pupils and staff.

COMARE has recommended that schools should be treated

the same as homes for the purposes of radon protection.

This would mean that the current radon action level in

homes of 200 Bq/m3 should be applied to schools and other

childcare environments.

Good sun protection behaviour should be encouraged in

children and young people. Campaigns across the UK should be

coordinated and evaluated.

The use of sunbeds and tanning parlours by children and young

people should be prevented or reduced and means to do

this need to be explored further and implemented across the

UK. Measures could include restricting the use of commercial

sunbeds and tanning parlours to those over a specified age

(e.g. 18 years) and ensuring that information about health risks

is provided with retail sunbeds.

Further research is needed to improve the understanding of

possible health effects of electromagnetic field exposures

(e.g. from mobile phones, base stations, electrical wiring

and appliances, and overhead power lines) in children, young

people, pregnant women and foetuses.

8.4.3 Noise

Children and young people are affected by noise and their

education can suffer directly. Noise maps, which are currently

being produced for major roads, railways and cities, could

be used to identify schools likely to be affected by noise and

identify where noise interventions may be most useful.

Further research is needed as to improve understanding of the

non-auditory effects of background noise, high frequency noise

devices and personal music players on children and young

people. Further investigation is also needed as to how personal

music players are used and their impact on the hearing of

children and young people.


Schools should continue to teach and encourage food hygiene

to establish good habits at an early age. The surveillance

system for food-borne diseases is an important way to identify

health effects of biological hazards; however, this could

be strengthened.


Children and young people should be routinely considered

and, where appropriate, included in emergency preparedness

exercises in order to understand and take better account of

their needs.


50

AkhtarPC,CurrieDB,CurrieCEandHawSJ(2007).Changesinchildexposuretoenvironmentaltobaccosmoke(CHETS)studyafterimplementationofsmoke-freelegislationinScotland:nationalcrosssectionalsurvey.BMJ,335, 545–549

AndersonRH,GuptaR,StrachanDPandLimbES(2007).50yearsofasthma:UKtrendsfrom�955to2004.Thorax,62, 85–90

AllWalesInjurySurveillanceSystem(2006).AllWalesAccidentandEmergency(A&E)AttendanceAnalysis2004.AccessedMarch2009athttp://www.capic.org.uk/

AuditCommissionandHealthcareCommission(2007).BetterSafeThanSorry.PreventingUnintentionalInjuryofChildren.London,AuditCommission

Cabinet Office (2005). CodeofPracticeonConsultation.London, Cabinet Office. Accessed October 2007 at http://www.cabinet-office.gov.uk/

CapletonACandDuarte-DavidsonR(2007).DevelopmentofaUKChildren’sEnvironmentandHealthStrategy.RegionalPriorityGoalI:Water,SanitationandHealth.AccessedSeptember2007athttp://www.hpa.org.uk/cehape/

CapletonAC,WykeSM,O’ConnellSEandDuarte-DavidsonR(2008).DevelopmentofaUKChildren’sEnvironmentandHealthStrategy.RegionalPriorityGoalIV:Chemical,PhysicalandBiologicalHazards.AccessedSeptember2007athttp://www.hpa.org.uk/cehape/

CEC(2003).AEuropeanEnvironmentandHealthStrategy.AccessedMarch2009athttp://eurlex.europa.eu/

DCLG(2006a).WhatisaDecentHome?London,DepartmentforCommunitiesandLocalGovernment.AccessedNovember2006athttp://www.communities.gov.uk/

DCLG(2006b).HousinginEngland2004/05.AReportPrincipallyfromthe2004/05SurveyofEnglishHousing.London,DepartmentforCommunitiesandLocalGovernment.AccessedNovember2006athttp://www.communities.gov.uk/

DCSF(2007).TheChildren’sPlan.BuildingBrighterFutures.London,DepartmentforChildren,SchoolsandFamilies

DCSF(2008).StayingSafe:ActionPlan.London,DepartmentforChildren,SchoolsandFamilies

DCSFandDH(2009).HealthyLives,BrighterFutures:theStrategyforChildrenandYoungPeople’sHealth.London,DepartmentofHealth

Defra(2006).E-digestStatisticsabout:AirQuality.ConcentrationsofParticulates.AccessedMay2007athttp://www.defra.gov.uk/

Defra(2008).BathingWaterDirective.AccessedMarch2009athttp://www.defra.gov.uk/

Defra,ScottishExecutive,WelshAssemblyGovernmentandDepartmentofEnvironmentforNorthernIreland(2007).TheAirQualityStrategyforEngland,Scotland,WalesandNorthernIreland,Volume�.London,DepartmentforEnvironment,FoodandRuralAffairs

DETR(�999).EnvironmentalSamplingafteraChemicalAccident. London, The Stationery Office

DfES(2003).GuidelinesforEnvironmentalDesigninSchools.BuildingBulletin87(2ndEdition).London,DepartmentforEducationandSkills

DfES(2004).EveryChildMatters,ChangeforChildren.London,DepartmentforEducationandSkills

DfES(2007).Standard Specifications, Layouts and Dimensions 3. ToiletsinSchools.London,DepartmentforEducationandSkills

DfT(2000).Tomorrow’sRoads:SaferforEveryone.London,DepartmentforTransport

DfT(2007).ChildRoadSafety.Achievingthe20�0Target.London,DepartmentforTransport

DH(2003).TacklingHealthInequalities:AProgrammeforAction.London,DepartmentofHealth

DH(2004).ChoosingHealth.MakingHealthyChoicesEasier.London, The Stationery Office

DH(2005).TheNHSEmergencyPlanningGuidance2005.London,DepartmentofHealth

DH(2007).CancerReformStrategy.London,DepartmentofHealth

DH(2008a).ConsultationontheFutureofTobaccoControl.London,DepartmentofHealth

DH(2008b).HeatwavePlanforEngland.ProtectingHealthandReducingHarmfromExtremeHeatandHeatwaves.London,DepartmentofHealth

DH(2008c).HealthInequalities:ProgressandNextSteps.London,DepartmentofHealth

DHandDCSF(2008).HealthyWeight,HealthyLives:ACross-GovernmentStrategyforEngland.London,DepartmentofHealthandDepartmentofChildren,SchoolsandFamilies

DHandHPA(2007).HealthEffectsofClimateChangeintheUK,AnupdateoftheDepartmentofHealthreport200�/2002.HealthEffectsofClimateChangeintheUK,ExpertGroup.London,DepartmentofHealth

DHSSPS(2002).InvestingforHealth.Belfast,DepartmentforHealth,SocialServicesandPublicSafety

DoE(NI)(2002).NorthernIrelandRoadSafetyStrategy2002–20�2.Belfast,DepartmentfortheEnvironment.AccessedDecember2007athttp://www.roadsafetyni.gov.uk/

EA,EHS,FASandSEPA(2007).RadioactivityinFoodandtheEnvironment,2006.RIFE�2.Bristol,Belfast,London,Stirling,EnvironmentAgency,EnvironmentandHeritageService,FoodStandardsAgencyandScottishEnvironmentProtectionAgency

EdwardsP,GreenJ,RobertsIandLutchmanS(2006).Deathsfrominjuryinchildrenandemploymentstatusinfamily:analysis of trends in class specific death rates. BMJ,333,��9–�2�

FSA(FoodStandardsAgency)(2000).AReportontheStudyofInfectiousIntestinalDiseaseinEngland.London,TheStationery Office

9 References

5�

GaudermanWJ,VoraH,McConnellR,BerhaneK,GillilandF,ThomasD,LurmannF,AvolE,JunzliN,JerrettMandPetersJ (2007). Effect of exposure to traffic on lung development from�0to�8yearsofage:acohortstudy.Lancet,369,57�–577

GreenH,McGinnityA,MeltzerH,FordTandGoodmanR(2005).MentalHealthofChildrenandYoungPeopleinGreatBritain,2004.Basingstoke,PalgraveMacMillian

Government Office for Science (2007). TacklingObesity:FutureChoices–ProjectReport(2ndEdition).London,DepartmentofInnovation,UniversitiesandSkills

GROS (General Register Office for Scotland) (2006). VitalEventsReferenceTables2005.AccessedMarch2009athttp://www.gro-scotland.gov.uk/



HealthySchools(2007).NationalHealthySchoolsProgramme.NationalAudit.AccessedMarch2009athttp://www.healthyschools.gov.uk/

HensL(2007).EnvironmentalImpactsonCongenitalAnomalies–InformationfortheNon-expertProfessional.InCongenitalDiseasesandtheEnvironment(PNicolopoulou-Stamatietal,Eds),pp409–450.Springer

HMGovernment(2005).SecuringtheFuture.DeliveringUKSustainableDevelopmentStrategy.London,TheStationeryOffice

HMGovernment(2007a).PSADeliveryAgreement9:Halvethenumberofchildreninpovertyby20�0–��,onthewaytoeradicatingchildpovertyby2020.London,HMTreasury

HMGovernment(2007b).PSADeliveryAgreement2�:Buildmorecohesive,empoweredandactivecommunities.London,HMTreasury

HMGovernment(2007c).PSADeliveryAgreement23:Makecommunitiessafer.London,HMTreasury

HMGovernment(2008a).PSADeliveryAgreement�2:Improvethehealthandwellbeingofchildrenandyoungpeople.London,HMTreasury

HMGovernment(2008b).PSADeliveryAgreement�3:Improvechildrenandyoungpeople’ssafety.London,HMTreasury

HospitalEpisodeStatistics(2006).Primarydiagnosis:summary2005–06.AccessedMarch2009athttp://www.hesonline.nhs.uk/

HospitalEpisodeStatistics(2008).Primarydiagnosis:summary2006–07.AccessedMarch2009athttp://www.hesonline.nhs.uk/

HPA(2005).HealthProtectioninthe2�stCentury.UnderstandingtheBurdenofDisease;preparingforthefuture.London,HealthProtectionAgency.AccessedMarch2009athttp://www.hpa.org.uk/cehape/

HPA(2007a).Children’sEnvironmentandHealthActionPlan.ASummaryofCurrentActivitieswhichAddressChildren’sEnvironmentandHealthIssueswithintheUK.Chilton,HealthProtectionAgency.AccessedMarch2009athttp://www.hpa.org.uk/cehape/

HPA(2007b).GeneraloutbreaksofinfectiousintestinaldiseaseinEnglandandWales:2006.HealthProtectionReport,1(28)

HPA(2007c).Carbonmonoxide.AccessedFebruary2008athttp://www.hpa.org.uk

HPA(2008).Children’sEnvironmentandHealthStrategyfortheUnitedKingdom–ConsultationDocument.AccessedMarch2009athttp://www.hpa.org.uk/cehape/

HPA(2009a).Children’sEnvironmentandHealthStrategyfortheUnitedKingdom.ASummaryofOutputsofthePublicConsultation.AccessedMarch2009athttp://www.hpa.org.uk/cehape/

HPA(2009b).Children’sEnvironmentandHealthStrategyfortheUK–ConsultationWorkshop.AccessedMarch2009athttp://www.hpa.org.uk/cehape/

HSE(HealthandSafetyExecutive)(2008).HSEsignscontractwithCapitatorunthenewgasinstallersregistrationscheme.AccessedMarch2009athttp://www.hse.gov.uk/

InternationalAssociationfortheStudyofObesity(2007).GlobalTrendsinOverweight.AccessedMarch2009athttp://www.iotf.org/

ISDScotland(2006).MalignantMelanomaoftheSkin,AnnualIncidence(�980Onwards).AccessedNovember2006athttp://www.isdscotland.gov.uk/

KirkwoodGandPollockA(2008).Preventinginjuryinchildhood.BMJ,336(7658),�388–�389

LungandAsthmaInformationAgency(2008).Asthma.AccessedMarch2009athttp://www.laia.ac.uk/

LyonsRA,JonesS,KempA,SibertJ,ShepherdJ,RichmondP,BartlettCandPalmerSR(2002).Developmentanduseofapopulationbasedinjurysurveillancesystem:theAllWalesInjurySurveillanceSystem(AWISS).InjPrev,8(�),83–86

NICE(NationalInstituteforHealthandClinicalExcellence)(2008).PhysicalActivityandtheEnvironment.AccessedMarch2009athttp://www.nice.org.uk

NETCEN(2005).AirQualityandSocialDeprivationintheUK.AnEnvironmentalInequalitiesAnalysis.AccessedJune2007athttp://www.airquality.co.uk/

NIRSA(NorthernIrelandStatisticsandResearchAgency)(2006).RegistrarGeneralAnnualReport2005–Section6Details–CauseofDeath.AccessedMarch2009athttp://www.nisra.gov.uk/

NIRSA(NorthernIrelandStatisticsandResearchAgency)(2007).RegistrarGeneralAnnualReport2006–Section6Details–CauseofDeath.AccessedMarch2009athttp://www.nisra.gov.uk/

NISRA(NorthernIrelandStatisticsandResearchAgency)(2008a).Deaths.AccessedMarch2009athttp://www.nisra.gov.uk/

NISRA(NorthernIrelandStatisticsandResearchAgency)(2008b).VitalStatistics.AccessedMarch2009athttp://www.nisra.gov.uk/


52

O’ConnellSEandDuarte-DavidsonR(2007).DevelopmentofaUKChildren’sEnvironmentandHealthStrategy.RegionalPriorityGoalIII:RespiratoryHealth–IndoorandOutdoorAirPollution.AccessedSeptember2007athttp://www.hpa.org.uk/cehape/

ODPM(2003).SustainableCommunities:BuildingOurFuture.London, Office of the Deputy Prime Minister. Accessed February2008athttp://www.communities.gov.uk/

Ofcom(2007).TelevisionAdvertisingofFoodandDrinkProductstoChildren.FinalStatement.AccessedMay2007athttp://www.ofcom.org.uk/

OFMDFM(2006).OurChildrenandYoungPeople–OurPledge.ATenYearStrategyforChildrenandYoungPeopleinNorthernIreland,2006–20�6. Belfast, Office of the First MinisterandDeputyFirstMinister

ONS (Office for National Statistics) (2004). KeyPopulationandVitalStatistics.LocalandHealthAuthorityAreas.PopulationandvitalstatisticsbyareaofusualresidenceintheUnitedKingdom,2002.SeriesVSNo.29,PP�N.25.London,TheStationery Office

ONS (Office for National Statistics) (2006a). MortalityStatistics.Cause.SeriesDH2No.32.AccessedMarch2009athttp://www.statistics.gov.uk/

ONS (Office for National Statistics) (2006b). CancerStatisticsRegistrations.Registrationsofcancerdiagnosedin�982–2005.AccessedNovember2006athttp://www.statistics.gov.uk/

ONS (Office for National Statistics) (2008a). LiveBirths.FertilityHighestfor34Years.AccessedMarch2009athttp://www.statistics.gov.uk/

ONS (Office for National Statistics) (2008b). MortalityStatistics.DeathsRegisteredin2006.AccessedMarch2009athttp://www.statistics.gov.uk/

ONS (Office for National Statistics) (2008c). MortalityStatistics.DeathsRegisteredin2007.AccessedMarch2009athttp://www.statistics.gov.uk/

PondK,KimR,CarroquinoM,PiradP,GoreF,CucuA,NemerL,MacKayM,SmedjeG,GeorgellisA,DalbokovaDandKrzyzanowskiM(2007).WorkgroupReport:DevelopingEnvironmentalHealthIndicatorsforEuropeanChildren:WorldHealthOrganizationWorkingGroup.EnvironHealthPerspect,115,�376–�382

RCGP(2006).WeeklyReturnsServiceAnnualPrevalenceReport2005.London,RoyalCollegeofGeneralPractitioners.AccessedDecember2007athttp://www.rcgp.org.uk/

RoSPA(2007).ChildSafetyStrategy.PreventingUnintentionalInjuriestoChildrenandYoungPeopleinScotland.AccessedDecember2007athttp://www.injuryobservatory.net/documents/childsafetystrategy_scotland.pdf

SCENIHR (Scientific Committee on Emerging and Newly Identified Health Risks) (2008). Potentialhealthrisksofexposuretonoisefrompersonalmusicplayersandmobilephonesincludingamusicplayingfunction.AccessedMarch2009athttp://ec.europa.eu/health/ph_risk/committees/04_scenihr/scenihr_opinions_en.htm

ScottishExecutive(2005).ImprovingHealthinScotland–TheChallenge. Edinburgh, The Stationery Office

ScottishGovernment(2007).BetterHealth,BetterCare:ActionPlan.Edinburgh,ScottishGovernment

ScottishGovernment(2008a).GoodPlaces,BetterHealth.ANewApproachtoEnvironmentandHealthinScotland.ImplementationPlan.Edinburgh,ScottishGovernment

ScottishGovernment(2008b).TheEarlyYearsFramework.Edinburgh,ScottishGovernment

Scottish Office (1999). TowardsaHealthierScotland–AWhitePaperonHealth.Edinburgh, Stationery Office

Smith-PalmerAandBrownlieS(2006a).GeneraloutbreaksofinfectiousintestinaldiseasereportedtoObSurvduringthefirst quarter of 2006. HPSWeeklyReport,40,No.2006/25

Smith-PalmerAandBrownlieS(2006b).GeneraloutbreaksofinfectiousintestinaldiseasereportedtoObSurvduringthesecondquarterof2006.HPSWeeklyReport,40,No.2006/37

Smith-PalmerAandBrownlieS(2006c).GeneraloutbreaksofinfectiousintestinaldiseasereportedtoObSurvduringthethirdquarterof2006.HPSWeeklyReport,40,No.2006/49

Smith-PalmerAandBrownlieS(2007).GeneraloutbreaksofinfectiousintestinaldiseasereportedtoObSurvduringthefourthquarterof2006.HPSWeeklyReport,40,No.2007/�3

TheInformationCentre(2008).StatisticsonObesity,PhysicalActivityandDiet:England,January2008.AccessedMarch2009athttp://www.ic.nhs.uk/

TurnerL,JewkesF,AmlotRandSimpsonJ(2007).ExerciseYoung Neptune: mass decontamination of children field exercise,2ndofDecember2006.ChemicalHazardsandPoisonsReport,No.9,20–22

UNICEF(2007).ChildPovertyinPerspective:AnOverviewofChildWell-beinginRichCountries.Florence,UnitedNationsChildren’sFund

WelshAssemblyGovernment(2004).ChildrenandYoungPeople:RightstoAction.Cardiff,WelshAssemblyGovernment

WHO(2004).Children’sEnvironmentandHealthActionPlanforEurope.FourthMinisterialConferenceonEnvironmentandHealth,Budapest,23–25June2004

WHO(2005a).Children’sHealthandtheEnvironment.AGlobalPerspective.Geneva,WorldHealthOrganizationRegionalOffice for Europe

WHO(2005b).EffectsofAirPollutiononChildren’sHealthandDevelopment.AReviewoftheEvidence.Geneva,WorldHealth Organization Regional Office for Europe

WrightJ(2002).Chronicandoccultcarbonmonoxidepoisoning:wedon’tknowwhatwe’remissing.JAccidEmergMed,19,386–390

WykeSM,CapletonAC,O’ConnellSEandDuarte-DavidsonR(2007).DevelopmentofaUKChildren’sEnvironmentandHealthStrategy.RegionalPriorityGoalII:Accidents,Injuries,ObesityandPhysicalActivity.AccessedSeptember2007athttp://www.hpa.org.uk/cehape/


54

Summary of Children’s Environment and Health Strategy Priorities according to Regional Priority Goal (RPG)

RPG I Water, sanitation and health

RPG II Accidents, injuries, obesity and physical activity

RPG III Respiratory health, indoor and outdoor air pollution

RPG IV Chemical, physical and biological hazards

Preventingharm

Ensurecompliancewiththeleadindrinkingwaterqualitystandard

Improvedocumentationandqualityofprivatewatersupplies

Continuetoimprovesanitationfacilitiesinschoolsandchildcaresettings

Reduceexposuretocryptosporidiuminswimmingpools

EnsureacoordinatedapproachtoinjurypreventionthroughouttheUK

Promoteawarenessofrisksassociatedwithcarbonmonoxide

Educateadultsabouttheeffectsofenvironmentaltobaccosmokeonchildren

Developguidanceonlocalairqualitymanagementtoconsiderchildren specifically, whereappropriate

Encourageradontestingandremediationbyhouseholdersandlandlords

Considerapplyingtheradonactionlevelforhomestotheschoolandotherchildcareenvironments

Investigateoptionsforreducingorpreventingtheuseofsunbedsamongstchildrenandyoungpeople

Identifyschoolsaffectedbyhighnoiselevelsandimplementprotectivemeasures

Continuetoconsiderandinvolvechildrenandyoungpeopleinemergencyplanningandpreparednessexercises

Promotinghealth

Improvehygienebehavioursinchildren(e.g.hand-washing)

Continuetoencouragephysicalactivityamongstchildrenandyoungpeople

Improveaccesstoandstrategicplanningofgreenspaces

Greaterconsiderationandinclusionofchildrenandyoungpeopleinplanningurbanandresidentialareas

Developacoordinatedpolicyapproachtoindoorairqualitythatconsiderschildren specifically

Continuetoencouragehealthysunprotectionbehaviouramongstchildren

Continuetoteachchildrenaboutfoodhygiene

Improvingunderstanding

Investigatefurthertheimpactsofbathingwaterqualityonchildhealth

Improveunderstandingoffactorsinvolvedindiseaseoutbreaksassociatedwithswimmingpools

Evaluatetheimpactofwaterpovertyonchildhealthandwell-being

Investigatefurtherincidenceandeffectsofchroniccarbonmonoxidepoisoning

Reviewevidenceofproximitytomajorroadsand traffic and impact onchildhealthandlungdevelopment

Investigatethenon-auditoryhealthandwell-beingimpactsofnoiseonchildren

Identifymeanstofurtherreduceunintentionalpoisonings

Improveunderstandingofchildren’sexposuretochemicals

Improveunderstandingofchildren’sexposure to electromagnetic fields

Improveunderstandingofneurologicaldevelopmentalandotherhealtheffectsfromchemicalexposureinuteroorinearlylife

Improvingintelligence

Improvesurveillanceofinfectiousintestinaldisease(includingwaterbornedisease)particularlyamongstchildren

ImproveinjurysurveillancethroughouttheUK

Monitorsuccessofobesityandphysicalactivityinitiatives

Improvesurveillanceofbiologicalhazardssuchasfood-bornediseases

Reviewsystemsforreportingandsurveillanceofcongenitalabnormalities

Appendix A

Summary of the Children’s Environment and Health Strategy Recommendations for the UK

55

Summary of Children’s Environment and Health Strategy Priorities according to Burden of DiseaseKey areas Key recommendations Improving surveillance Improving understanding

Gastrointestinalillness

Continuetoteachchildrenaboutfoodhygiene

Improvehygienebehavioursinchildren(e.g.hand-washing)

Continuetoimprovesanitationfacilitiesinschoolsandchildcaresettings

Improvedocumentationandqualityofprivatewatersupplies

Reduceexposuretocryptosporidiuminswimmingpools

Improvesurveillanceofwaterbornedisease,particularlyamongstchildren

Improveunderstandingoffactorsinvolvedindiseaseoutbreaksassociatedwithswimmingpools

Investigatefurthertheimpactsofbathingwaterqualityonchildhealth

Evaluatetheimpactofwaterpovertyonchildhealthandwell-being

Injuriesandpoisonings

Promoteawarenessofrisksassociatedwithcarbonmonoxide

Ensureadequatesurveillanceofinjuriesandpoisonings

Improveunderstandingofunintentionalpoisoningsamongstchildrenandidentifymeansofreducingsuchevents

Obesityandphysicalactivity

Continuetoencouragephysicalactivityamongstchildrenandyoungpeople

Improveaccesstoandstrategicplanningofgreenspaces

Greaterconsiderationandinclusionofchildrenandyoungpeopleinplanningurbanandresidentialareas

Monitorsuccessofobesityandphysicalactivityinitiatives

Respiratoryhealth

Educateadultsabouttheeffectsofenvironmentaltobaccosmokeonchildren

Developacoordinatedpolicyapproachtoindoorairqualitythatconsiderschildrenspecifically

Developguidanceonlocalairqualitymanagementtoconsiderchildrenspecifically, where appropriate

Reviewevidenceofthehealthimpactsonchildhealthandchildlungdevelopmentofproximitytomajorroads and heavy traffic

Investigatefurthertheincidenceandeffectsofchroniccarbonmonoxidepoisoning

Radiation Continuetoencouragehealthysunprotectionbehaviouramongstchildren

Investigateoptionsforreducingorpreventingsunbeduseamongstchildrenandyoungpeople

Considerapplyingtheradonactionlevelforhomestotheschoolandotherchildcareenvironments

Encourageradontestingandremediationbyhouseholdersandlandlords

Improveunderstandingofchildren’sexposure to electromagnetic fields

Noiseandchemicals

Ensurecompliancewiththeleadindrinkingwaterqualitystandard

Identifymeanstofurtherreduceunintentionalpoisonings

Ensureadequatenoisecontrolinschoolenvironments

Reviewsystemsforreportingandsurveillanceofcongenitalabnormalities

Improveunderstandingofchildren’sexposuretochemicals

Investigatefurtherthenon-auditoryhealthandwell-beingimpactsofnoiseexposureonchildren

Improveunderstandingoftheneurologicaldevelopmentalandotherhealtheffectsfromchemicalexposuresinuteroorinearlylife


56

andwell-beingbyimprovingservicesandoutcomesandminimisinghealthinequalities.

TackingHealthInequalities:AProgrammeforAction(DH,2003)waslaunchedinJuly2003andisthecurrentcross-governmentstrategytocombathealthinequalities.Backedby�2departments,thisprogrammelaysthefoundationformeetingthegovernment’stargetstoreducethehealthgaponinfantmortalityandlifeexpectancyby20�0.Anevaluationofprogressandnextstepswaspublishedin2008(DH,2008c).

Northern IrelandInvestingforHealth(DHSSPS,2002)isthepublichealthstrategyforNorthernIrelandsettingouthowtoimprovehealthinNorthernIrelandandreducehealthinequalities.

OurChildrenandYoungPeople–OurPledge(OFMDFM,2006)isastrategyandactionplanaimedatensuringchildreninNorthern Ireland thrive and look to the future with confidence.

ScotlandTowardsaHealthierScotland (Scottish Office, 1999) is a public healthstrategyforScotlandwithafocusonhealthinequalitiesandimprovingchildrenandyoungpeople’shealth.

ImprovingHealthinScotland(ScottishExecutive,2005)providesaframeworktosupportanactiveprogrammetodeliverhealthimprovementpolicyinScotland.

BetterHealth,BetterCare(ScottishGovernment,2007)–thisActionPlansetsoutthegovernment’sprogrammetodeliverahealthierScotlandbyhelpingpeopletosustainandimprovetheirhealth,especiallyindisadvantagedcommunities,ensuringbetter,localandfasteraccesstohealthcare.

GoodPlaces,BetterHealth(ScottishGovernment,2008a)isanimplementationplanlookingathowthephysicalenvironmentinfluences health, with a particular focus on children.

EarlyYearsFramework(ScottishGovernment,2008b)setsouttheimportanceofgettingtheearlyyearsofachild’sliferight(pre-birthto8yearsold)andgivingchildrenthebeststartinlife.

WalesHealthChallengeWales(http://new.wales.gov.uk/hcwsubsite/healthchallenge/?lang=en)isaninitiativetoimproveandprotecthealthandwell-beinginWales.

ChildrenandYoungPeople:RightstoAction(WelshAssemblyGovernment,2004)isthestrategicapproachadoptedinWales,basedontheUnitedNationsConventionontheRightsoftheChild,forimplementingtheChildrenAct2004andimprovingoutcomesforchildrenandyoungpeoplefrombirthtoadulthood.

UK policiesSecuringtheFuture.DeliveringUKSustainableDevelopmentStrategy(HMGovernment,2005)setsouthowthegovernmentaimstodeliverabetterqualityoflifeintheUK,nowandforgenerationstocome,throughensuringsustainabledevelopment.ItincludesanumberofindicatorsofgeneralrelevancetotheChildren’sEnvironmentandHealthStrategy(e.g. air pollution, flooding and environmental inequality) and some of specific relevance to children, including childhood poverty,healthinequality(infantmortality),childhoodobesity,gettingtoschool,andchildrenkilledorseriouslyinjuredinroadaccidents.TheseindicatorsareusedtomonitorprogressonimplementingtheSustainableDevelopmentStrategyonanannualbasis.

EnglandEveryChildMatters,ChangeforChildren(DfES,2004)setsoutthegovernment’scross-cuttingnationalframeworktobuildservicesaroundtheneedsofchildrenandyoungpeopleinEngland.Thisaimsforeverychildtobehealthy,staysafe,enjoyandachieve,makeapositivecontributionandachieveeconomicwell-being.ThisisunderpinnedbytheChildrenAct2004whichprovidesthelegislativebasisforthisframework.

ChoosingHealth:MakingHealthierChoicesEasier(DH,2004)outlineshowthegovernmentintendstoprovidepracticalsupportandinformationtoimproveindividuals’accesstoservicessothattheycanmakehealthierchoices.Thisfocusesonanumberofareas,includingchildrenandyoungpeople,andaimstoreduceinfantmortality,supportallchildrentoattaingoodphysicalandmentalhealth,reduceinequalities,andensurechildrendevelopagoodunderstandingofopportunitiesandrisksinchoicesthataffecttheirhealth.

Children’sPlan:BuildingBrighterFutures(DCSF,2007)aimstomakeEnglandthebestplaceintheworldforchildrenandyoungpeopletogrowup.Itfocusesonanumberofgoalsfor2020whichhavebeendevelopedfollowingconsultationwithparentsandyoungpeople.Thesegoalsincludestrengtheningsupportforfamilies,workingtowardsachievingworld-classschools,involvingparentsintheirchildren’slearning,andensuringchildrenhavemoreplacestoplayandexcitingthingstodo.

EducationandInspectionsAct(2006)placesastatutorydutyonthegoverningbodiesofmaintainedschoolstopromotethewell-beingofchildrenandyoungpeopleaswellastheiracademic achievement. In part fulfilment of this duty the DepartmentforChildren,SchoolsandFamiliesisdevelopingguidanceforschoolsonpromotingwell-being.

HealthyLives,BrighterFutures:theStrategyforChildrenandYoungPeople’sHealth(DCSFandDH,2009)presentsthegovernment’svisionforchildren’sandyoungpeople’shealth

Appendix B

Summary of Policies of Relevance to Children’s Health and Well-being

Acknowledgements

This document has been prepared by the Health Protection Agency at the request of the Department of Health, on behalf of the Interdepartmental Steering Group on Environment and Health. This Steering Group consists of representatives of the following government and devolved administration departments and agencies:

Department for Business, Enterprise and Regulatory Reform

Department for Children, Schools and Families

Department for Communities and Local Government

Department for Environment, Food and Rural Affairs

Department of Transport

Department of Health (Chair)

Department of Health, Social Services and Public Safety (Northern Ireland)

Department of the Environment (Northern Ireland) – Environment and Heritage Service

Environment Agency

Food Standards Agency


Scottish Environment Protection Agency

Scottish Government

Welsh Assembly Government

The views expressed in this document do not necessarily represent those of any single government or devolved administration department or agency.

We gratefully acknowledge the involvement of children and young people in providing their views, which have been invaluable. We also gratefully acknowledge the contribution made by all the consultees during the public consultation.

Prepared by Raquel Duarte-Davidson, Alexander Capleton, Stacey Wyke, Rob Orford, Tina Endericks and Gary Coleman


This document has been prepared by the Health Protection Agency at the request of the Department of Health, on behalf of the Interdepartmental Steering Group on Environment and Health.

Please direct any queries concerning this report to [email protected]

Copies of the report and supporting documents are available at http://www.hpa.org.uk/cehape

March 2009ISBN 978-0-85951-638-9© Health Protection Agency

Health Protection AgencyCentre for Radiation, Chemical and Environmental HazardsChemical Hazards and Poisons DivisionChiltonDidcotOxfordshire OX11 0RQUnited Kingdom

Tel: +44(0)1235 822895Email: [email protected]

March 2009ISBN 978-0-85951-638-9© Health Protection AgencyPrinted on chlorine-free paper


A C

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ren’s En

viron

men

t and

Health

Strategy fo

r the U

K

Childrens Health Strategy

Documents

Transcript of Childrens Health Strategy