WORLD HEALTH ORGANIZATION - Tobacco Free Initiative
International Consultation on Environmental Tobacco Smoke (ETS) and Child Health
11-14 January 1999 Geneva, Switzerland
Consultation Report (excerpts) [link to full report on WHO website]
Table of Contents
III. Health effects of children's exposure to tobacco smoke 6
A. Respiratory health and middle ear disease 6
B. Foetal growth 8
C. Sudden infant death syndrome (SIDS) 8
D. Neurodevelopmental effects 9
E. Cardiovascular effects 10
F. Childhood cancers 10
G. Summary 11
IV. Measurement: health impact, exposure and economic impact 11
A. Measuring health impact 12
B. Measuring exposure 12
C. Measuring economic impact 13
D. Extrapolating to developing countries 14
E. Summary 14
V. Interventions to eliminate children's exposure to environmental tobacco smoke 14
A. The need for action 14
B. Strategies for reducing children's exposure to tobacco smoke 15
VI. Conclusions and recommendations 16
VII. Background Reading 18
VIII. Annex 1 20
IX. List of Participants 21
Responding to the 1997 Declaration on Children's Environmental Health of the Environment Leaders of the Eight (G8)*, WHO convened an International Consultation on Environmental Tobacco Smoke (ETS) and Child Health in Geneva, Switzerland from 11 to 14 January 1999. The Consultation brought together experts from developed and developing countries to examine the effects of ETS on child health and to recommend interventions to reduce these harmful effects and eliminate children's exposure.
The Consultation concluded that ETS is a real and substantial threat to child health, causing death and suffering throughout the world. ETS exposure causes a wide variety of adverse health effects in children, including lower respiratory tract infections such as pneumonia and bronchitis, coughing and wheezing, worsening of asthma, and middle ear disease. Children's exposure to environmental tobacco smoke may also contribute to cardiovascular disease in adulthood and to neurobehavioural impairment.
The Consultation also concluded that maternal smoking during pregnancy is a major cause of sudden infant death syndrome (SIDS) and other well-documented health effects, including reduced birth weight and decreased lung function. In addition, the Consultation noted that ETS exposure among nonsmoking pregnant women can cause a decrease in birth weight and that infant exposure to ETS may contribute to the risk of SIDS.
The scope of these health effects on children is broad, given that almost half of the world's children are regularly exposed to ETS. Most have no choice in the matter. Preventing children's exposure to tobacco smoke will lead to improved child, adolescent, and ultimately adult health, resulting in reduced mortality and substantial savings in health care and other direct costs.
Swift action to highlight the need for strong public policies to protect children from exposure to tobacco smoke is essential. These policies should aim to ensure the right of every child to grow up in an environment free of tobacco smoke. This can be achieved by two complementary strategies: eliminating children's contact with tobacco smoke in utero and in childhood, and reducing overall consumption of tobacco products. Effectively implementing these strategies requires combining educational programmes and legislative interventions aimed particularly at eliminating tobacco use in settings frequented by children.
* Canada, France, Germany, Italy, Japan, Russian Federation, United Kingdom of Great Britain and Northern Ireland, United States of America
In response to the Declaration on Children's Environmental Health, adopted by the Environment Leaders of the Eight (G8) in May 1997, the World Health Organization (WHO) convened an International Consultation on Environmental Tobacco Smoke (ETS) and Child Health in Geneva from 11 to 14 January 1999. Experts from developing and developed countries gathered to examine the effects of exposure to tobacco smoke on child health and to develop recommendations for action to eliminate this exposure.
The adverse health effects of tobacco use among smokers are well described. Tobacco use generally begins during adolescence and continues through adulthood, sustained by addiction to nicotine. Smoking causes about four million deaths annually, mainly attributable to cardiovascular disease, lung cancer and other cancers, and chronic lung disease. Tobacco smoke is also an important source of indoor air pollution, contributing to a noxious environment, eye irritation, and unpleasant odour. Recent evidence demonstrates that ETS exposure increases risks of lung cancer and ischaemic heart disease among non-smoking adults.
The vast majority of children exposed to tobacco smoke do not choose to be exposed. Children's exposure is involuntary, arising from smoking, mainly by adults, in the places where children live, work and play. Given that more than a thousand million adults smoke worldwide, WHO estimates that around 700 million, or almost half of the world's children, breathe air polluted by tobacco smoke, particularly at home. The large number of exposed children, coupled with the evidence that ETS causes illness in children, constitutes a substantial public health threat.
This report concludes that the evidence of this harm to children is consistent and robust. Even if certain questions still require further research, there is more than sufficient evidence of harm to demand action to reduce children's involuntary exposure to tobacco smoke. Furthermore, this involuntary and harmful exposure can also be seen as a human rights violation, given the provisions of Articles 6 and 24 of the 1989 United Nations Convention on the Rights of the Child. These articles create obligations for signatory governments to guarantee children's right to life, to create an environment that maximizes the survival and development of children, and to implement measures ensuring and recognizing children's right to the highest attainable standard of health. In addition, the Convention's reporting guidelines include the requirement to identify risks to children from environmental pollution and report measures taken to reduce these risks.
The report addresses the threat to child health in three sections. The first summarizes the health effects of children's exposure to tobacco smoke. The second addresses measurement issues central to action: measuring health impacts, children's exposure and the economic burden of that exposure. The third turns to interventions and includes evidence of effective policies and programmes to reduce children's exposure to tobacco smoke along with a framework for designing cost-effective responses to this threat. It is intended that this report will serve as an impetus for taking strong and immediate action to ensure that children around the world can grow up in an environment where their health is not compromised by being forced to breathe other people's tobacco smoke.
To see the full report on the WHO website click here.
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