Early Exposures to Toxics
Over the past fifteen years, an expanding body of evidence has implicated the role of environmental exposures on health. Adverse reproductive health outcomes have increased over the last fifty years: childhood cancers, preterm delivery and reduced fecundity, trends that cannot be explained by diagnostic capability or genetics alone.
So, what are mothers and clinicians to do?
I have focused my career on what we call ‘well woman’ healthcare: the concept that our emphasis needs to be preventive, since healthy pregnancies depend on pre-conception health, and 50 percent of pregnancies around the globe are unplanned.
1000 days are the critical period between a woman’s pregnancy and a child’s second birthday, but as an OBGYN I am more likely to discuss the first 1400 because we know that healthy pregnancy outcomes begin months before a woman conceives. Clean air, clean water and healthy food supplies are critical investments.
The developing fetus is particularly susceptible to chemical exposures, due to unique and time-sensitive developmental processes. Risk may be cumulative and reflect multiple types of exposure, but we know that chemicals in pregnant women can cross the placenta; accumulating in the fetus they have long lasting sequelae.
There are around 70-100,000 chemicals in global commerce today, and current regulation of the industry means that research must prove harm before environmental exposures are limited. Contrast this approach with the pharmaceutical industry, where research must prove safety before an exposure can occur. The burden of proof with environmental exposures lies with the public and the health care providers and scientists, rather than with industry.
Of course the expression of disease process is a complex relationship between genetic predisposition, timing of exposure, repetitive exposures, and underlying health, and so the ability to study and to show absolute 'cause and effect' is quite difficult. But a recent study showed that phthalates, which are plasticisers found in skin care products, tubing that feeds infants in the NICU and fast food packaging, are associated with language delay in children exposed prenatally. This is a strong implication of neurodevelopment effects.
We also know that diseases are inequitably distributed within and between countries. There is a higher burden of toxic exposures and adverse health outcomes among indigenous populations in the US, Canada and in low-resource countries around the world. Poor populations carry a disproportionate burden of consequences of exposure to toxic chemicals, whether morbidity, mortality, family impact, or worker productivity.
The World Health Organization (WHO)’s report Inheriting a Sustainable World: Atlas on Children’s Health and the Environment reveals that a large portion of the most common causes of death among children aged 1 month to 5 years - diarrhoea, malaria and pneumonia - are preventable by interventions known to reduce environmental risks, such as access to safe water and clean cooking fuels, heaviest in low and middle-income countries. And, occupational exposures to pesticides in agriculture or workplace solvents impact reproductive health.
So, what are we doing? At FIGO we are focusing on three important areas: Education, Research and Advocacy. Through education we need to reach clinicians, publication, continuing education programs, and to develop training programs that incorporate environmental awareness. It is likely that many individuals are more aware of the impact of the environment on health than are their health care providers!
We are compiling information regarding research centres and products. It is often the case that researchers are not aware of similar programs in other countries.
And finally advocacy, is the most important role for all of us: to advocate for learning, to share the information in our hospitals, communities and with our ministers of health. And to change our world so that the burden of proof of harm gives way to a proof of safety. For every woman, every time, every where.
This speech was given at the Women Engage for a Common Future (WECF) 10th anniversary event. ‘Protecting health from early exposure to toxics: The First 1000 Days of Life’ has been compressed for reading.
Image courtesy of UN Photo / Kibae Park.