On April 21, 1997, President Bill Clinton signed Executive Order 13,045: Protecting Children's Environmental Health. The signing of the Order represented a significant victory in the effort to protect children's health from unsafe substances in the environment. The Order consists of four main parts: 1) establishment of a Task Force on Environmental Health Risks and Safety Risks to Children, 2) research coordination and integration, 3) evaluation of all regulatory actions for their effects on children's environmental health and safety, and 4) convening an Interagency Forum on Child and Family Statistics.

First, the Order specified the establishment of a Task Force on Environmental Health Risks and Safety Risks to Children, made up of high-ranking administrative officials. The Task Force co-chairs are the Secretary of Health and Human Services and the Administrator of the EPA.¹ The charge to the Task Force is to make recommendations to the President on policies, priorities, research agendas, partnerships, and legislation.¹ Each biennium the Task Force must prepare a report on "research, data, or other information that would enhance our ability to understand, analyze, and respond to environmental health risks and safety risks to children."¹ Four Federal workgroups were formed in April of 1998 to focus on the key issues of asthma, unintentional injuries, cancer, and developmental disorders. The Task Force was directed to exist for 4 years, and on October 9, 2001, President Bush signed Executive Order 13,229 to extend the work of the Task Force for an additional 18 months. On April 18, 2003, the task force was extended an additional two years.² Priorities identified for the extension period include examining programs for reducing childhood asthma and lead poisoning.

Second, Executive Order 13,045 calls for the coordination and integration of all federal research initiatives and the promotion of sharing of information on government, academic, and private research.¹ In 1999, the National Institute for Environmental Health Sciences (NIEHS) announced the Children's Environmental Health and Safety Inventory of Research (CHEHSIR), a public, web-based database created in response to Executive Order 13,045.³ The database contains information on federally-funded or -sponsored contracts, interagency research agreements, grants, research projects, and cooperative research agreements.

Third, the Order specifies that proposed federal rules must be evaluated for the effect of the rules on children's environmental health and safety and an explanation provided as to why the planned rule is the most preferable alternative.¹

Finally, the Order calls for establishment of an Interagency Forum on Child and Family Statistics to produce an annual report on the well-being of American children.¹

Environmental Protection Agency Initiatives

Policies

In 1995, EPA Administrator Carol Browner announced a new policy to "explicitly and consistently take into account environmental health risks to infants and children in all risk characterizations and public health standards."⁴

In the fall of 1996, the EPA announced a new National Agenda to Protect Children's Health from Environmental Threats.⁴ To implement the National Agenda, the EPA established a new office to deal with issues specific to children.

The Office of Children's Health Protection

In May 1997, Carol Browner announced the creation of the Office of Children's Health Protection (OCHP). She said that it "is an office that will allow us to carry out the review of existing public health and environmental standards, as well as further our understanding of children's environmental health and ensure that awareness of their unique sensitivity to environmental threats guides all of our actions at the EPA."⁵ The OCHP's mission is to "make the protection of children's health a fundamental goal of public health and environmental protection in the United States."⁶ The three primary areas on which the OCHP focuses are: 1) education and outreach, 2) research and risk assessment, and 3) standards and regulations.

MDH staff correspond with OCHP staff, as well as the EPA's Region 5 coordinator for children's environmental health. MDH staff have commented on OCHP materials and sponsored presentations in Minnesota.

The Children's Health Protection Advisory Committee

In December of 1997, EPA established an external Children's Health Protection Advisory Committee (CHPAC) with balanced representation from the public, industry, pediatric medicine, community organizations, environmental organizations, science/academia, nursing, and federal, state, local, and tribal government.⁷ The purpose of the Committee is to obtain expert advice on children's environmental health issues, including the evaluation of pertinent EPA standards, communications and outreach, and science.⁷ Minnesotans who have served on the CHPAC discuss committee proceedings with MDH staff.

Strategy for Research on Environmental Health Risks to Children

The EPA's Office of Research and Development (ORD) put forth a new Strategy for Research on Environmental Health Risks to Children in October of 2000. The goal of the strategy is to prioritize research on children's environmental health and reduce uncertainty in risk assessments for children.⁸

ATSDR Initiatives

The Agency for Toxic Substances and Disease Registry (ATSDR) has made children's special susceptibilities and exposures a special focus of health studies, assessments, and other initiatives. The ATSDR completes toxicological profiles for more than 250 hazardous substances. Information on the effects of these substances on children's developing systems, unique exposure pathways, biomarkers, interactions of chemicals, and data needs to assess risks to children are now included in toxicological profiles. The ATSDR also investigates and assesses the risks posed by hazardous waste sites. Children have been a focus of public health assessment evaluations and training sessions to teach federal and state agency staff how to conduct public health assessments. Studies to evaluate the relationship between exposures to hazardous substances and health outcomes are also undertaken by the ATSDR. These studies focus on a variety of health endpoints, including cancer, birth defects, infant mortality, asthma, and immune system function.⁹ In 2002, MDH sponsored a seminar on environmental exposures and child health in which ATSDR's Chief Medical Office provided information on studies, investigations, and education related to toxic substances.

The ATSDR Child Health Workgroup is a multidisciplinary panel of experts that makes recommendations to the agency on research and policy directions for pediatric environmental health practice. The Children's Trust is an initiative by the ATSDR to develop an action plan to help communities understand children's risks, educate residents about risks and prevention, and encourage agencies and organizations to create safe environments for children. This project will include the development of a comprehensive database with resources available for community use. The ATSDR has also published Case Studies in Environmental Medicine: Pediatric Environmental Health for continuing education for health care professionals.¹⁰

Pediatric Environmental Health Specialty Units

In 1998, the ATSDR's Office of Children's Health and the Association of Occupational and Environmental Clinics formed three Pediatric Environmental Health Specialty Units (PEHSUs) in Boston, Seattle, and New York. The goal of the program was to "promote children's health by encouraging medical specialists with environmental expertise to work collaboratively with pediatricians to develop pediatric environmental medical expertise and to improve the ability of locally practicing health care providers and parents to access this expertise."¹¹ By 2001, the EPA had become a partner in the program and the number of units had expanded.¹¹ The units focus on medical education and training, outreach, and clinical evaluation of children potentially affected by exposure to harmful environmental contaminants.¹¹ The PEHSUs are improving access to clinical environmental health services and facilitating national referral networks. In 2001, the PEHSUs evaluated 907 children, received 30,581 calls, and trained more than 16,275 health professionals.¹² MDH staff refer some callers to the PEHSU in our region, the Great Lakes Center for Children's Environmental Health, which has proven to be a great resource for health providers and parents. MDH sponsored a seminar on the PEHSUs in 2002.

Links to each PEHSU

Region 1: New England PEHSU
Region 2: Mount Sinai Pediatric Environmental Health Unit
Region 3: Mid-Atlantic Center for Children's Health and the Environment
Region 4: SE Pediatric Environmental Health Specialty Unit, Nell Hodgson Woodruff School of Nursing (emory.edu) | Pediatric Environmental Health Specialty Unit, PEHSU
Region 5: Great Lakes Center for Children's Environmental Health, Cook County Hospital
Region 6: The Southwest Center for Pediatric Environmental Health
Region 7: MidAmerica PEHSU, Environmental Health Specialty Unit
Region 8: Rocky Mountain Regional PEHSU
Region 9: University of California (San Francisco and Irvine) PEHSU
Region 10: Northwest PEHSU, University of Washington

Centers for Children's Environmental Health and Disease Research

In response to Executive Order 13,045, the EPA, the CDC, and the NIEHS developed a program to give grants to Centers around the country developed with the purpose of "[promoting] translation of basic research findings into applied intervention and prevention methods."¹³ The first request for applications for grant proposals was put forth in 1998 and outlined two areas of scientific focus: respiratory disease and growth and development. In the first round of grants, eight Centers were established. Each Center was awarded $1 million per year for 5 years.¹⁴

Four Centers focus on respiratory disease:

Center for Childhood Asthma at the University of Iowa
Southern California Environmental Health Sciences Center
Center for Childhood Asthma in the Urban Environment at Johns Hopkins University
Research Centers: Michigan Center for the Environment and Children’s Health

There are four Centers studying growth and development:

Columbia University Center for Children's Environmental Health
Children's Environmental Health and Disease Prevention Research Center at Icahn School of Medicine at Mount Sinai
Center for Child Environmental Health Risks Research at the University of Washington
Center for the Health Assessment of Mothers and Children of Salinas at the University of California, Berkeley

In addition to the scientific research occurring at each of the Centers, there are also important community-based intervention projects. There are a number of approaches being used by the various Centers, but a central feature is the collaboration between community members and the researchers. Community education, health fairs, fact sheets, bilingual materials, school-based interventions, and individual education are examples of intervention approaches.

In 2001, the EPA, the CDC, and the NIEHS decided to expand the program to include four additional Centers. The desired focus of the new Centers was research on developmental disabilities (especially autism); cognitive, motor, sensory, and behavioral impairments in children; and the exposures that are putting children at risk for these disorders.

The four Centers focusing on developmental disabilities are:

The National Children's Study¹⁵

The proposal for a longitudinal cohort study on how environmental factors affect child health and development was first put forth in 1998 by the President's Task Force on Environmental Health Risks and Safety Risks to Children. The Children's Health Act of 2000 (PDF) directed the National Institute on Child Health and Development (NICHD), along with the EPA and a consortium of federal agencies, to carry out the National Children's Study. As planned, the National Children's Study will collect data on a cohort of approximately 100,000 children if funded. Pregnant mothers will be recruited and their children will be followed through age 21.

In addition to a central coordinating facility, approximately 40-50 centers nationwide will participate in the study. Key core hypotheses will include: 1) prenatal/early childhood exposures increase the risk of neurodevelopmental disorders; 2) prenatal/early childhood exposures influence asthma incidence and severity; and 3) individual, family, and community factors affect incidence, severity, and outcome of injuries. Data collection for most participants up to age 21 will be complete in 2030. The outcome of the study will hopefully be an immense increase in our knowledge about how environmental factors affect child health and development.

Professional Societies

There are a number of scientific societies that have sponsored meetings and presentations on children's environmental health issues. MDH scientists regularly participate in such meetings and read children's environmental health research in the societies' journals. Examples of these professional societies include Society for Risk Analysis, International Society for Exposure Analysis, International Society for Environmental Epidemiology, and Society of Toxicology.

International Initiatives

U.S. organizations are taking an active role in some international organizations' initiatives on children's environmental health. In addition, other countries are also addressing children's environmental health concerns. For more information on international organizations and initiatives, please visit the links below.

World Health Organization, Healthy Environments for Children
Commission for Environmental Cooperation
European Union, European Environment Agency, (search for "children")

References

¹Executive Order 13,045: Protection of Children from Environmental Health Risks and Safety Risks, Sec. 3-303.

²Environmental Protection Agency, Office of Children's Health Protection, accessed 6/23/03.

³Children's environmental health and safety inventory of research (CHEHSIR). Environmental Health Perspectives 107¹¹, November 1999.

⁴Environmental Protection Agency. The EPA Children's Environmental Health Yearbook, EPA 100-R-98-100, June 1998, 2.

⁵Browner, CM (EPA Administrator). Proposals for Environmental Regulatory Reform Colloquium: Environmental Regulatory Reform 15 Pace Envtl. L. Rev. 45, Winter 1997.

⁶Environmental Protection Agency, Office of Children's Health Protection, accessed 6/23/03.

⁷Environmental Protection Agency. The EPA Children's Environmental Health Yearbook Supplement, EPA-100-R-00-0018, August, 2000, 10.

⁸Schmidt, CW. A growth spurt in children's health laws. Environmental Health Perspectives 109⁶, June 2001.

⁹Agency for Toxic Substances and Disease Registry, accessed 1/28/03.

¹⁰Agency for Toxic Substances and Disease Registry. "Public Health and the Environment." Volume 1, No. 1/2, Fall 2002.

¹¹Agency for Toxic Substances and Disease Registry, accessed 3/26/02.

¹²Agency for Toxic Substances and Disease Registry. "Public Health and the Environment." Volume 1, No. 1/2, Fall 2002.

¹³National Institute for Environmental Health Sciences, Division of Extramural Research and Training, Centers for Children's Environmental Health and Disease Prevention Research, accessed 3/24/02.

¹⁴Wakefield, J. New centers to focus on autism and other developmental disorders. Environmental Health Perspectives 110¹, January 2002.

¹⁵Presentation by C Kimmel of the Environmental Protection Agency at the Minnesota Department of Health, February 5, 2002.

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