country’s most vulnerable population is a good measure of the burden of environmental pressures on human beings.
In the policy arena, child mortality is narrowly
The narrowness has a purpose. Children phase: beyond the shadow of neonatal complications, but still highly vulnerable to health risks that older children tend to overcome. Among these are environmentally borne illnesses, many of which are preventable. That the two leading causes of child mortality have direct causal links to environmental conditions is a strong rationale for including child mortality in the EPI.5 Pneumonia, which is the leading cause of child mortality worldwide, is exacerbated by household and outdoor air pollution, both of which are environmental impacts measured by the EPI.6 Diarrhea is the second leading cause, and it is almost always triggered by poor sanitation and lack of access to clean drinking water. It also affects nutritional uptake in the body, thereby contributing to malnutrition. However once it is acquired—via any of a multitude
of bacterial and viral agents—diarrhea is easily treated. Whether a country effectively treats its water, how that water is distributed, and access to sanitation and basic healthcare are revealed in
Malaria is the third leading cause of child mortality, and a strong case can be made that it too has environmental causes.7 Among the integrated strategies international health organizations, control of malaria’s vector—Anopheles 8
Methods to control mosquito populations include reducing deforestation in vulnerable areas, modernized irrigation systems (that also reduce water consumption), and reductions in standing water.9 In many cases, intervention at the environmental and biological levels has been shown to be as effective at reducing malaria rates as the use of insecticides. Also, research is beginning to show strong correlations between a warming climate and an increase in cases of vector-borne diseases like malaria. The fourth MDG, to reduce child mortality by two-thirds of 1990 levels by 2015, is an ambitious one. Even so, great reductions have been seen worldwide, largely through intervention programs for diseases and increased sanitation.10
4
World Health Organization and UNICEF. (2013) Accountability for maternal, newborn, & child survival, the 2013 update.
5
accessed: January 10, 2014. World Health Organization and UNICEF. (2013) Ending Preventable Child Death from Pneumonia and Diarrhea by 2025: The integrated Global Action Plan for Pneumonia and Diarrhea (GAPPD). Available: http://apps.who.int/iris/
6
Liu, L., Johnson, H. L., Cousens, S., et al. (2012) Global, regional, and national causes of child mortality: an updated
7
World Health Organization and UNICEF. (2013) Accountability for maternal, newborn, & child survival, the 2013 update.
8
accessed: January 7, 2014. World Health Organization. (2004) Global strategic framework for integrated vector management. Available: http://whqlibdoc.
9
control. Tropical Medicine and International Health 6:677–687. World Health Organization and UNICEF. (2013) Accountability for maternal, newborn, & child survival, the 2013 update.
10
accessed: January 7, 2014.
2014 EPI
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