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Environmental Injustice: Focus on Pediatric Neurodevelopmental Disorders

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The Children's Environmental Health Network ' ... Focus on children's health. Paradigm shift. Focus on wellness and prevention ... – PowerPoint PPT presentation

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Title: Environmental Injustice: Focus on Pediatric Neurodevelopmental Disorders


1
Environmental InjusticeFocus on Pediatric
Neurodevelopmental Disorders
AAIDD Toxic Exposures and Developmental
Disabilities Environmental Health Lecture
Series March 11, 2008
  • Lawrence D. Rosen, MD
  • Chair, Integrative Pediatrics Council
  • lrosen_at_integrativepeds.org

2
The State of Childrens Health
  • Cancer
  • Prematurity
  • Asthma/allergies
  • Obesity/Diabetes
  • Neurodevelopmental and Mental Health Disorders

3
Epidemiology
  • 1/150 in US with ASD
  • 1/100 in NJ with ASD
  • 1/60 boys in NJ with ASD
  • 1/12 in US with ADHD
  • 1/6 with neurodevelopmental disorder
  • Sharp increases also seen for depression, bipolar
    disorder, anxiety

4
Children as a priority
  • The health of our children is one of the most
    important investments we can make and should be
    among our top priorities.
  • -The Childrens Environmental Health Network
  • The true measure of a nations standing is how
    well it attends to its children their health
    and safety, their material security, their
    education and socialization, and their sense of
    being loved, valued, and included in the families
    and societies into which they are born.
  • - UNICEF, Child poverty in perspective An
    overview of child well-being in rich countries,
    Innocenti Report Card 7, 2007

5
How are we doing?
6
Environmental Injustice
  • Environmental Justice is the fair treatment and
    meaningful involvement of all people regardless
    of race, color, national origin, or income with
    respect to the development, implementation, and
    enforcement of environmental laws, regulations,
    and policies. (U.S. EPA)
  • Injustice is done when there exist health
    disparities based on these same factors.

7
Why Children?
  • Children are not little adults - CHE LDDI
    statement, November 2007
  • Neuroendocrine/immune development
  • Differences in exposure to environmental toxins
  • Doubly exposed (pre- and postnatal)
  • Differences in excretion
  • No political voice

8
The most vulnerable of the vulnerable
  • Many of the children who are most heavily
    exposed in our society to environmental toxins
    are the same children who are poor, the same
    children who have either no access or inadequate
    access to medical care.
  • - Dr. Philip Landrigan

9
CHE LDDI Scientific Consensus Statement
10
Environmental Triggers
  • Genetic/Epigenetic Interaction
  • Timing (prenatal and postnatal)
  • Mixtures/multiple exposures
  • List of potential stressors
  • Malnutrition
  • Stress
  • Infections, ant-infectives, vaccines
  • Toxins (air, land, water)

11
Host Factors
12
The Iceberg Model
PHENOMICS
METABOLOMICS
PROTEOMICS
GENOMICS
13
Specific Examples
  • Lead
  • Polychlorinated biphenyls (PCBs)
  • Polycyclic aromatic hydrocarbons (PAHs)
  • Nutrition
  • Stress

14
Lead
  • Even very low levels a/w ND differences
  • BLLs gt5 mcg/dL among 1- to 5-year-old children
    was 25.6
  • BLLs gt5 mcg/dL
  • 46.8 of non-Hispanic black children
  • 27.9 of Mexican American children
  • 18.7 of non-Hispanic white children
  • Older housing and poverty is greater risk
  • Compared with non-Hispanic white children,
    non-Hispanic black children were 3 times more
    likely to have a BLL 5-10 mcg/dl, 7 times more
    likely to have a BLL of 10-20 mcg/dL, and 13.5
    times more likely to have a BLL gt20 mcg/dL

Bernard SM, McGeehin MA Pediatrics 2003. Review
of Third National Health and Nutrition
Examination Survey, 1988-1994.
15
PCBs
  • PCB exposure affects development (multiple
    sources in LDDI statement)
  • Native American children at high risk
    multigenerational exposure
  • The most notable finding was the significant
    negative relationship between PCB levels and two
    separate measures of long term memory. There was
    also a negative relationship with a measure of
    comprehension and knowledge.
  • - Newman et al PCBs and cognitive functioning
    of Mohawk adolescents. Neurotoxicol Teratol. 2006

16
PAHs
  • Long known as carcinogens, more recently
    recognized as neurotoxic
  • Children gt risk due to inhalation
  • Inner city gt exposure
  • Prenatal exposure affects neurodevelopment
    (Perera NYC studies)
  • High prenatal exposure to PAHs was associated
    with lower mental development index at age 3
  • The odds of cognitive developmental delay were
    also significantly greater for children with high
    prenatal exposure

17
Malnutrition
  • Iron
  • Zinc/Copper
  • Vitamin D
  • Essential fatty acids (omega 3s)

18
Stress of Poverty
  • Multiple stressors (financial, social)
  • Increased rates of maternal depression
  • Alters neurohormones
  • Dr. Martha Farah (Center for Cognitive
    Neuroscience, U-Penn) Stress is Neurotoxic

19
Conclusions
  • Focus on childrens health
  • Paradigm shift
  • Focus on wellness and prevention
  • Precautionary principle
  • Interdisciplinary dialogue

20
References/Resources
  • Rosen LD, Imus D Environmental injustice
    children's health disparities and the role of the
    environment. Explore (NY). 2007
    Sep-Oct3(5)524-8.
  • CHEs LDDI Scientific Consensus Statement on
    Environmental Agents Associated with
    Neurodevelopmental Disorders www.healthandenviron
    ment.org
  • Integrative Pediatrics Council
    www.integrativepeds.org, see for more web
    resources

21
Environmental InjusticeFocus on Pediatric
Neurodevelopmental Disorders
AAIDD Toxic Exposures and Developmental
Disabilities Environmental Health Lecture
Series March 11, 2008
  • Lawrence D. Rosen, MD
  • Chair, Integrative Pediatrics Council
  • lrosen_at_integrativepeds.org
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