91% of the world's population is on average exposed to levels of air pollutants above the values recommended by the World Health Organization (WHO) for the protection of health, and this also affects, and above all, children who, as is known, they represent a particularly vulnerable part of the population.
These are some of the data that emerge from the document "Air pollution and children's health: clean air prescription" published by the WHO in October 2018. The report highlights once again the importance of external and internal air pollution for the Children's health, a problem that in the Ministerial Conference on the Environment and Health of the 53 States of the WHO European Region (Ostrava, 2017) had already been recognized as one of the main public health priorities to be addressed through compliance with the guidelines of the WHO, through a continuous process of improving air quality.
The document was presented at the end of October during the first World WHO conference on air pollution and health with the aim of verifying the state of the art on available evidence, gaps in knowledge and solutions to be adopted to reduce indoor and outdoor exposure levels and health risks from air pollution. The Conference was an opportunity to stress once again that air pollution is a global problem, even if the burden of the diseases imputable to it (in particular in the internal environment) is higher in low and middle income countries , particularly in Africa and Southeast Asia. The conference, preceded by workshops on specific topics, focused on the analysis of the existing scientific evidence between air pollution and health, stimulating research on the still uncertain aspects and on the need to continue the updating action on the reference values for the protection of health. Other aspects of the in-depth analysis concerned strategic actions and coordinated interventions between the various sectors which, in various aspects, are associated with air pollution (energy, transport, waste, construction, agriculture) and climate change, as well as a different organization and planning of urban areas, where most of the world's population lives.
Air pollution and children's health
An extensive scientific literature highlights the increased vulnerability of children to indoor and outdoor air pollution compared to adults. In fact, children experience higher levels of exposure than adults because they have, for example, a greater surface / volume ratio, greater metabolic activity and respiratory rates, tissues and organs with replication activity of high cells, immaturity of tissues, organs and systems (metabolic, immune, nervous, reproductive). The WHO estimates on the impact of air pollution on children's health are also well documented and allocate around 700,000 premature deaths for children under 5 to exposure to air pollution in outdoor and indoor environments.
The data on air pollution related to Italy place our country in a highly critical situation since 98% of children under 5 years live in areas where PM2.5 concentrations are higher than the levels recommended by the WHO for health protection. The analysis of air quality data for 2016 shows in urban areas, distributed throughout the national territory, average annual concentrations of PM2.5 higher than the WHO value (10 μg / m³), reaching average levels of 18 μg / m³ in the North (which affects the presence of the Padano basin), 16 μg / m³ in the Center and 13 μg / m³ in the South.
Among the main health effects of air pollution in children, in addition to pulmonary function reduction, asthma, acute lower respiratory tract infections, problems of neurobehavioral development, obesity, otitis and finally some childhood cancers . as, for example, leukemia and retinoblastoma, which may be associated with maternal exposures to carcinogenic pollutants of air pollution during the prenatal period. It should also be emphasized that exposures during childhood, in addition to determining measurable effects in the child, are projected in the following years, making the individual more vulnerable throughout his life. The implementation of preventive actions undertaken during the critical phase of adolescence can therefore produce immense benefits for public health in terms of reducing the burden of health conditions and costs.
In order to follow up on the commitments made in the previous Ministerial Conferences of the WHO, in particular those established in the European Action Plan for the Environment and Children's Health (Cehap)
the Parma Declaration was signed in which all countries have committed themselves to reducing the exposure of children to environmental risks. This framework strongly reiterates the importance of implementing strategic actions aimed at reducing exposures, with specific attention to the smallest, and through structural interventions of primary prevention aimed at reducing the emissions of pollutants demanded by local public administrators and national policies. , both with education, communication and training activities that allow families, paediatricians and teachers to recognize behaviors considered harmless or wrong that can expose children to high levels of concentration of pollutants.
To limit involuntary environmental exposures, one can for example: reduce the outdoor activities of children on days when there are poor air quality conditions; eliminate indoor passive smoke exposures; pay greater attention to the choice, quality and the emissive content of indoor pollution sources of homes, schools, gyms, areas of aggregation, etc. due to construction materials and furnishings; pay attention to the emissions due to the different indoor combustions (fireplaces, stoves, cooking of foods, incense sticks, perfumers, etc.) and to products for domestic and personal hygiene, which contain substances potentially harmful to health.
To fill the absence of an organic legislative framework on the issue of indoor air quality, the Higher Institute of Health (ISS) has set up a National Study Group (GdS) Indoor Pollution, which has long been working to improve the status knowledge of indoor environments and to provide technical-scientific documents in order to allow a series of promotion and prevention actions in line with the main indications of WHO, useful for reducing the exposure levels of the most vulnerable and sensitive population groups such as the children.
The awareness of the relevance of the environmental issue and health in childhood, linked to air pollution, but also extended to contaminants present in other environmental matrices (soil, water and food chain) that may have adverse effects on the health of children, has promoted the establishment, within the Department of Health and Environment, of a Temporary Interdepartmental Mission Center (Smti) dedicated to children.
This new structure, involving about 100 researchers from 8 Departments and Centers of the ISS, and the Statistics Service, aims to enhance the many experiences present in the Institute on the effects of pollution on child health, integrating in a programmatic path the available multidisciplinary skills ranging from exposure assessment to biomonitoring, from toxicology and risk assessment, from the conduct of etiological studies, to epidemiological surveillance of infant populations in contaminated sites; other relevant aspects requiring an integrated approach concern the issue of social inequalities, training, information and communication.
The establishment of the Smti will also promote the drafting of interdisciplinary and multi-institutional research projects and the production of guidance, consensus and guidance documents on strategic objectives, through the consolidation of a national network that includes the main structures who deal with child health, associations of pediatricians, cancer registries, congenital malformations registers, regional structures and the National Health Service (SSN) that participate in health surveillance programs in developmental age.