The First 1000 Days: A Healthy Return on Investment

Elise Miller
Ted Schettler

Elise Miller, MEd, CHE Director, and Ted Schettler, MD, MPH, Science Director at SEHN and CHE, contributed the following article to the current edition of San Francisco Medicine, focused on human health and the environment, and especially the effects of early-life exposures. The full article can be found on the San Francisco Medical Society’s website. Join CHE on December 2nd for a call with contributors to the journal as they discuss neurotoxicants, climate change, cancer, and much more. 

Upward trends in a number of childhood diseases and disabilities are featured almost daily in the media. As many as one in six children in the US has a neurodevelopmental disability, including autism, ADHD, and speech or cognitive delays. The number of children needing special education has increased by 200 percent from a quarter century ago. The incidence of childhood leukemia and brain cancer is also on the rise, and asthma is still the number one reason for school absenteeism among school children.

Meanwhile, we have been learning a great deal more about how children’s earliest experiences, beginning in utero, can significantly influence their lifelong health.

Many studies show that “toxic stress”–intense, sustained adverse experiences–in childhood increases the risk of many health and behavioral problems in the short and long term, including intellectual delays, obesity, diabetes, and heart disease. This evidence has in turn prompted a surge of programs that provide support for new mothers and improved child care, such as Zero to Three and Early Head Start.

Other environmental influences on fetal development, starting even before conception, can of course be critical for lifelong health as well. Initiatives like the Program for Women, Infants and Children (WIC) take this into consideration with their emphasis on healthy nutrition before, after and during pregnancy. Efforts to address other social stressors like poverty and violence are also included in some maternal health programs in different health care systems as well as at local, county, and state levels across the country.

Various biologic mechanisms mediate the influence of environmental variables on child development, including genetic and epigenetic changes, altered molecular signaling patterns, and influences on hormonal and metabolic set points, which can lead to disturbances of organ structure and function over varying timeframes.

Another Highly Influential Factor: Chemical Exposures in Early Life

In addition to excessive stress and inadequate nutrition, a large and growing body of research shows that the developmental effects of pre- and post-natal exposures to toxic chemicals–now ubiquitous in air, water, food, soil, and consumer products–must also be considered. Most chemicals circulating in maternal blood can and do pass through the placenta and can adversely impact the developing fetus. Lead, alcohol, mercury, some pesticides, and flame retardants are among the best known, but in its Proposition 65 program, California lists 652 chemicals as reproductive/developmental toxicants. Biomonitoring programs, like CDC’s NHANES, show how commonly the general population is exposed to chemicals that can interfere with normal development with lifelong health consequences.

Continue reading the article on pages 10 and 11 of the journal.

Advertisements

Interview with Dr. Jeanne Conry

interview by Karin Gunther Russ
Coordinator of CHE’s Fertility and Reproductive Health Working Group

Dr. Jeanne Conry of American Congress of Obstetricians and Gynecologists
Roseville, California

Congratulations on receiving the Pacific Southwest EPA’s award for Children’s Environmental Health! What first brought you into environmental health work?

I had been working on preconception health care since 1998 when the American College of Obstetricians and Gynecologists, District IX (California) collaborated with the March of Dimes efforts to create guidelines on preconception health to meet Healthy People 2000 goals. The same group of professionals got together as a preconception health council in mid 2000. Reducing preconceptional exposure to chemicals was not part of the plan at the time.

Dr. Hani Atrash from the CDC was at the preconception health council, and connected me with Dr. Tracey Woodruff at the UCSF Program on Reproductive Health and the Environment (PRHE). Tracey came to the group and started doing her talks, and I knew we had to address environmental exposures and reproductive health.

What is your primary mission in your work?

Currently, physicians are not used to incorporating the results of environmental health studies into their clinical practice. More and more research is showing that chemicals and other environmental factors are negatively impacting fertility, pregnancy and fetal development. Clinicians need to be able to access that information, but in a practical way.

Continue reading

Your Brain on My Mind

Elise Miller, MEd, Director

A virtual flood of new studies on cognitive function influenced by air pollution, second-hand smoke, nutrition and other environmental factors has been published in the last couple weeks. One notable study on autism by researchers at UCSF and Stanford suggests that environmental conditions may contribute as much to autism as genetic heritability (Read more). Given that autism has long been considered almost exclusively “genetic”, this research will likely have a profound impact on how scientists, health professionals and parents think about how autism may occur in some individuals and not in others and why the numbers of those diagnosed with autism is significantly increasing.

Continue reading

Common Sense Steps

Frieda Slavin

Science is rarely certain about anything, and certainly not about most links between environmental exposures and health effects in people. Nonetheless, the evidence showing links to health grows ever stronger as research progresses and becomes ever-more sophisticated:

  • Scientists have generated compelling laboratory evidence revealing adverse effects in animals at low levels of exposure, affecting animal endpoints that are relevant to cancer, birth defects, reproductive effects, immune system dysfunctions, respiratory problems, learning and behavior problems, etc.
  • They have demonstrated that many of the underlying mechanisms causing those effects in animals are similar, if not identical, to human mechanisms.
  • They have documented human exposures to chemicals at levels that produce harm of many types in animals.
  • And they have identified trends in human health and disability that can be predicted on the basis of the above.

But establishing scientific certainty of harm to people is elusive at best and in many cases likely to be impossible before countless people would be affected adversely. After all, epidemiology can only establish harm after an epidemic has occurred. Purposefully carrying out controlled experiments on people is considered, appropriately, unethical. And thus we are left with the plethora of uncontrolled, largely unmonitored experiments currently underway because of ubiquitous exposure.

Given these limitations, and given that our current regulatory system is unlikely to strengthen exposure standards absent much firmer proof, what is a person, or a parent, or a family, to do?

Much good, practical advice is available on the web and in print. Some of the best places to turn for practical advice are listed below. In addition to pointing toward these resources, on this page we will highlight a few old themes (“constants”) and then focus on new issues that are emerging from recent research and analysis.

One general point: As you make choices about products to buy, things to do, food to eat, places to go, bear in mind that government standards for regulating environmental threats to health are at best a bare minimum and at worst completely inadequate and health threatening. So what you choose to do should always at least live up to those standards.

This is because government regulations represent a compromise negotiated between advocates for public health and parties, usually companies or trade associations, with an economic interest in protecting their access to the market. The playing field in which the negotiation takes place is strongly biased in favor of the vested interests, who have succeeded over several decades of lobbying to put in place evidentiary standards for proof of harm that make it very difficult to prevent marketing of new products, or removal of old, even in the face of compelling evidence of plausible harm. Decades of experience reinforce that conclusion.

Constants:

  • Smoking harms adults, children and the developing fetus. It’s not just the irritation of the smoke itself, it’s also compounds added to the tobacco, the paper and the filter that make their way into your lungs and your bloodstream. Rules #1-3: don’t smoke; don’t inflict second-hand smoke on someone else; and don’t allow smokers to share their second-hand smoke with you or your family, especially your young children.
  • The fetus is remarkably sensitive to alcohol. Avoid alcoholic beverages during pregnancy. Otherwise impacts can last a lifetime.
  • Ozone damages developing lungs. While studies have shown for some time that ozone can trigger asthmatic attacks, the latest research even implicates ozone in the actual causation of asthma itself. When ozone levels rise and local governments issue air pollution warnings, pay attention. Some local newspapers carry regular ozone notices. They are worth reading and heeding.
  • Pollutants in some fish can damage the fetus, undermining development of disease resistance and cognitive development. Heed fish advisories posted by public health agencies.
    New York State Dept of Health: Health Advisories on Chemicals in Fish
  • Some plastics leach biologically-active materials into food with which they come into contact, particularly when heated. If you must use plastic, at least don’t microwave food in it.

 


Web and print resources

The Children’s Health Environmental Coalition’s HealtheHouse: an interactive resource for parents to learn about simple and effective steps they can take to protect their baby from environmental harm within the home.

The GreenGuide’s product reports: “a one-stop, reliable and easy-to-use shoppers’ guide so that you can make wiser, more conscientious shopping decisions.” Reports available include “flea control,” “insect repellant” and “household cleaning supplies.”

Raising Healthy Children in A Toxic World, a book by Philip Landrigan, Herbert Needleman and Mary Landrigan.

The Resource Guide on Children’s Environmental Health, by the Children’s Environmental Health Network.

Cleaning for Health: Products and Practices for a Safer Indoor Environment, an excellent and thorough review of cleaning products by Inform, Inc.

The Healthy School Network: ways to reduce exposures at school.

The Healthy Building Network: steps to reduce exposures via better selection of building materials and hospital equipment.

A number of organizations offer solid information about ways to reduce pesticide use. Among them: