Detailed FCEHA Statement of Purpose

Statement of Purpose
The Florida Children’s Environmental Health Alliance (FCEHA) has been established to identify, validate, and develop solutions to address the adverse health effects to children occurring as a consequence of exposure to environmental hazards in Florida. It is a growing coalition with over fifteen partners representing government, academic, medical and community-based organizations committed to building a strong, sustainable and collaborative movement to protect current and future generations from harmful environmental exposures. FCEHA believes in environmental justice, the principle that people have the right to live in a healthy and safe environment regardless of their race and /or socioeconomic status. The main focus of the Alliance is to develop and implement targeted prevention strategies for children living in at-risk housing in Florida, starting with the southeastern counties of Florida (Monroe, Miami Dade, Broward, and Palm Beach). The Alliance will extend its efforts on the rest of the counties with similar environmental hazards in Florida.

Our Mission
The mission of FCEHA is to promote healthy and supportive environments that protect children from environmental hazards.

Our Goals

To increase understanding of and accord on how environmental factors influence children’s health through research;
Educate and facilitate information exchange on the best practices or models in children’s environmental health;
To create a Public Awareness Campaign (to influence health professionals, policymakers, legislators, the media, and community members);
To elevate public awareness of environmental hazards and how it affects children through culturally sensitive education;
Create a partnership in the community to help address and provide solutions to environmental health hazards in high-risk communities.

Guiding Principles for Children and Environmental Health
All children are affected by exposures to toxic environmental agents. It is our responsibility as a society to enable and ensure that all children grow up in a safe and healthy environment.

The future health of our children is our most important asset and requires commitment and dedication to the development of research, policy, and education for our nation’s prosperity.

Because all children are growing and developing, they are uniquely vulnerable to the health effects cause by environmental hazards. The health of the children is intrinsically linked to the health of our environment.

Many children live in communities that are disproportionately impacted by environmental problems. Eliminating environmental racism and improving the health and environment of these children should be a top national priority.

Solutions to complex environmental health problems require the ongoing communication and collaboration of many disciplines including medicine, public health, science, economics, and public policy. Affected communities also need to be active in the solution process. Creative solutions should be reached through inter-disciplinary problem solving and coalition building.

Background
The field of environmental health focuses on the relationships between human health and well-being and the influence of the physical, social, and societal environments. Pediatric environmental health is the diagnosis, treatment, and prevention of illness due to perinatal and pediatric exposures to environmental hazards. It also includes the creation of healthy environments for children.

Approximately 70,000 chemicals are in common use today, and more than 300 new chemicals are introduced into the environment each year. Little is known, however, about the impact of these substances on human health. Few of these chemicals have been tested for their effects on the central nervous system and thus there is a lack of information about the effects of most of these compounds on children. This lack of information makes it difficult to identify, diagnose and provide solutions to environmental health-related problems. Environmental health researchers increasingly recognize that a variety of health problems may be attributed in part to exposure to environmental factors.

Risk Characteristics of Children (How are children unique?)

Children’s immature organ systems are especially sensitive to environmental hazards. Immature developing organs and tissues are more vulnerable to the harmful effects of toxic exposures. Immature metabolic and physiological systems less effectively protect the child from toxic exposure and effects.
Children have greater risk of exposure and greater risk of harm compared to adults for many reasons that are unique to each developmental stage.
Children’s behavior and activity patterns that are characteristic of their exploratory behavior make children more vulnerable to environmental exposures.
Children have additional pathways of exposure that are not applicable to adults, e.g., in utero, via breast milk, and via toys, clothing, among others.
Children are more often involuntarily exposed and unable to avoid exposures of their own accord.

Quality of Life
Children have still got many years to live, so protection from environmental hazards early in life is cost effective with regard to saved years of life with potential good quality. Children are themselves active in environmental health protection: they are interested in environment and health matters; they are detectives and activists, agents of change. Children are complex and competent and, according to age and development, are full of capacity for tending their own health and environment.

Types of Environmental Factors that can have an Effect on Children Health

Chemical agents alone account for several tens of thousands of substances that are in use annually. Lead is a metal that causes childhood lead poisoning. An estimated 404,000 children under the age of six in the United States have levels above the CDC’s level of concern of 10 µg/dl. Childhood lead poisoning has been linked with damage to the brain and central nervous system, learning difficulties, lower I.Q. scores, behavioral problems, hearing problems, kidney damage and at high levels with coma and death. Pesticides are an important category of such contaminants that are commonly present in the environment. Children are often exposed to toxicants through agricultural and home use of pesticides. Low-level exposures to pesticides have been associated with cancer, neurobehavioral impairment, and immune dysfunction. Naturally occurring mercury sources include cinnabar (ore) and fossil fuels, such as coal and petroleum. Environmental contaminants has resulted from mining, smelting, and industrial discharges. Mercury in lakes and stream sediments can be converted by bacteria into organic mercury compounds (eg, methyl mercury) that accumulate in the food chain. Consumption of fish with high levels of methyl mercury by pregnant women in Minamata Bay, Japan, in the 1950s resulted in at least 30 cases of infantile cerebral palsy. To prevent this from occurring, several states have issued advisories about consumption of fish from contaminated waters. Large ocean fish, such as tuna, swordfish, and shark, may have increased methyl mercury content owing to exposure from naturally occurring sources of mercury pollution. Arsenic exists in a number of valence states and in both organic and inorganic forms. In its trivalent form, it is a sulfhydryl-containing enzyme poison. In the pentavalent arsenate form, it competitively substitutes for phosphate, leading to rapid hydrolysis of the high energy bonds in adenosine triphosphate. Because it is an enzyme poison, it affects almost all organ systems. Among the important health effects of low-level, chronic ingestion of arsenic are skin cancer, peripheral vascular disease, peripheral neuropathy, portal hypertension, renal insufficiency, and bone marrow suppression. Nitrates themselves are not toxic to humans, but can be converted to more reactive and toxic nitrites by gut bacteria. Nitrates in drinking water above the EPA level of 10 mg/L may cause fatal methemoglobinemia in infants.
Indoor air quality has become a health concern in recent years because energy costs have led to building designs that reduce air exchanges and because new synthetic materials have become more widely used in home furnishings. Combustion pollutants in the home arise primarily from gas ranges, particularly when they malfunction or are used as space heaters, and from improperly vented wood stoves and fireplaces. Combustion of natural gas results in the emission of nitrogen dioxide (NO2) and carbon monoxide (CO). Cooking or heating with wood results in the emission of liquids (suspended droplets), solids (suspended particles), and gases such as NO2 and sulfur dioxide (SO2). Symptoms of CO intoxication include headache, dizziness, fatigue, lethargy, weakness, drowsiness, nausea, vomiting, loss of consciousness, skin pallor, dyspnea, on exertion, palpitations, confusion, irritability, irrational behavior, coma, and death. Exposure to high levels of NO2 and SO2 may result in acute mucocutaneous irritation and respiratory effects. Many household furnishings and products contain volatile organic compounds (VOCs) as residues or carriers. Exposure to VOCs may result in dermal, mucocutaneous, and non-specific effects. Depending on the dominant compounds and route and level of exposure, signs and symptoms may include upper respiratory tract and eye irritation, rhinitis, nasal congestion, rash, pruritus, headache, nausea, and vomiting. Environmental tobacco smoke (ETS) is a mixture of several toxic compounds and is the primary cause of poor indoor air quality and respiratory health problems in children. Maternal smoking or exposure to ETS affects the fetal stage of life because the fetus is exposed to “passive smoking” through the placenta. ETS has been documented as a major influence on childhood asthma. Children of mothers who smoke more than 10 cigarettes per day are twice as likely to develop asthma. An estimated 8,000 to 26,000 new cases of asthma occur annually in children in this risk group. Examples of biological agents that influence children’s health include molds, fungi, bacteria and allergens such as pet dander and dust mites that can cause asthma. Air pollution affects children more than adults because of their narrower airways, more rapid rate of respiration, and the fact that they inhale more pollutants per pound of body weight. Asthma morbidity and deaths among children and young people have increased vastly during the last decade, especially in developed countries including USA. Among persons under the age of 20, the prevalence of asthma increased by 42% between 1980 and 1987.
Consumer Households Products, including cleaning agents, personal care products, hobby products and solvents, are also dangerous to children. Although these products contain warning labels, they are often used or stored carelessly and may be left within children’s reach. Poisonings most frequently occur in children under the age of five. The substances most frequently involved in human poisonings are cleaning agents, followed by analgesic drugs, cosmetics, and cough and cold medicines.
Physical agents that have been studied for their effects on children’s health include discharge of energy leading to injury, electromagnetic frequency, radiation, ultraviolet radiation, radon and radionuclides. Injuries are the leading cause of death in the United States among children and teenagers. Today, trauma has replaced infectious disease as the most important threat to our children. Injuries now claim almost 20,000 lives each year among the 0-19 age group. In 1995, 77% of all deaths among 15 to 24 year olds were due to injuries, as were 52% of all deaths of 5to 14 year olds.

Critical Issues
In summary, children are exposed to a variety of environmental hazards, including indoor and outdoor air pollution, lead, mercury, pesticides, other heavy metals, and PCBs and dioxin. These contribute to certain childhood diseases, such as lead poisoning, asthma and leukemia. The impact of increased exposure to adverse environmental factors must be considered as a contributor to the observed increased in health problems.

Prevention
The key to protection is prevention. Recently, Congress and federal agencies have recognized children’s environmental health issues. In November 1996, the U.S. Environmental Protection Agency (EPA) released a report, “Environmental Health Threats to Children”, and announced that for the first time children would be considered in all EPA risk assessment and standard-setting procedures. Congress passed the Food Quality Protection Act in 1996, which specifically focuses on setting standards to protect children from pesticide residues and other hazards in foods.

The Alliance is working on identifying high-risk areas that contain environmental hazards, and teaching residents how to get the help they are entitled to. The Alliance prints and distributes a pamphlet that describes in detail the severity of environmental hazards, identify the symptoms and long-term effects of exposure to environmental hazards and most importantly, it teaches the parents of the at-risk children how to avoid the exposure to environmental hazards including lead and environmental triggers of asthma for now. The pamphlets (that are available in English, Spanish and Creole) are distributed to the residents of low-income areas by placing them in small grocery stores, bodegas, churches and places of worship. The Alliance participates in health fairs that are organized by different agencies in the community.

The Alliance is now a non-profit corporation and has received the appropriate 501c(3) tax status. The organization is now reaching out to parents of children at risk of exposure to environmental hazards, leaders in education and health as well as other concerned individuals who are interested in serving on the board as members. The Alliance is also seeking financial support for the grass roots campaign and to assist with a comprehensive study on environmental hazards affecting children in the South Florida community.

One of the main approaches that FCEHA is working on is using Community Health Workers (CHWs). Legislators, policymakers, health care providers, public health professionals, and consumers have been searching for feasible strategies to overcome the barriers to providing increasingly inaccessible and costly health care that have contributed to troubling health disparities among groups. While there is no quick fix to the overall problem, one promising strategy that has been used internationally and which many communities have begun to adopt is the enlistment of CHWs. CHWs are community members who work almost exclusively in community settings and serve as connectors between health care consumers and providers to promote health among groups that have traditionally lacked access to adequate care. CHWs are employed in diverse health care settings, including community-based organizations, insurance companies, hospitals, and health departments. Importantly, they come from the same underserved neighborhoods and share the same cultural experiences as the people they serve, thus bridging the gap between health care agencies and local communities. Community Health Workers are also known as: lay health educators, promotoras, community health advisors, community health representatives, outreach workers, patient navigators, doulas, frontline workers. Through their first-hand experience and understanding of underserved and marginalized communities, CHWs are able to tackle the socioeconomic and cultural experiences that often result in disparities in health and health care. U.S.-based and international CHW programs have successfully demonstrated the effectiveness of CHWs in helping underserved individuals access health care in appropriate manners. CHWs reach underserved populations more effectively that high-cost media campaigns or high-tech interventions and can help improve the quality of care at comparatively low cost.

From November 1984 to July 1988, Dr. Gasana, as Assistant Professor and Head of the Rwandan Medical School Center for Public Health Department of Environmental and Occupational Hygiene, conducted community-based studies in the area of environmentally related diseases and health conditions in underserved and/or minority communities while working at the University Center for Public Health. This Center is an institute established by the WHO (World Health Organization) in 1967. Its mission was to serve as a "Reference Health Center" for the entire country in the area of primary health care (PHC) and provide theoretical and practical training in public health to the medical and public health students. The health professionals were able to reach out to the communities and provide help in the eight components of PHC [1) Health Education; 2) Promotion of Food Supply and Proper Nutrition; 3) Adequate Supply of Safe Water and Basic Sanitation; 4) Maternal and Child Health Care, including Family Planning; 5) Immunization against Major Infectious Diseases; 6) Prevention and Control of Locally Endemic Diseases; 7) Appropriate Treatment of Common Diseases and Injuries; and 8) Provision of Essential Drugs] using Community Health Workers (CHWs). In exchange for their services, they were given free preventive and curative care for themselves and their immediate family.

Dr. Gasana has been successful on a very small scale in expanding this concept in the communities of West Perrine and Little Haiti in Miami, FL through USEPA-funded research grants entitled "West Perrine” and “Little Haiti” Environmental Coalition Sanitation and Childhood Lead Poisoning Projects. Members of the coalition served as CHWs since there is a parallel between the work done through the Environmental Coalition and the concept of primary health care. Now, there is a renewed effort of promoting CHWs in Miami by a number of health related organizations in the county. Dr. Gasana is working with these organizations to draw the attention to the environmental hazards affecting children in the community.

For additional information on the Florida Children’s Environmental Health Alliance (FCEHA), please contact Email: Email Janvier Gasana .