Inher iting the World: The Atlas of Children's Health and the Environment Bruce Gordon, Richard Mackay and Eva Rehfuess - World Health Organization

 
Inher iting the World: The Atlas of Children's Health and the Environment Bruce Gordon, Richard Mackay and Eva Rehfuess - World Health Organization
I n h e r i t i n g t h e Wo r l d :
T h e A t l a s o f C h i l d r e n ’s H e a l t h
      a n d t h e E nv i r o n m e n t

  Bruce Gordon, Richard Mackay and Eva Rehfuess
Inher iting the World: The Atlas of Children's Health and the Environment Bruce Gordon, Richard Mackay and Eva Rehfuess - World Health Organization
Inheriting the World: the Atlas of Children’s Health and the Environment © World Health Organization 2004
                                                                                                                                                                                             Contents
                                                   All rights reserved                                                                    Acknowledgements                                                 4
                                                                                                                                          About the Authors                                                6
                                                 First published 2004                                                                     Foreword by
                                               1 3 5 7 9 10 8 6 4 2                                                                       Dr LEE Jong-wook, Director-General, World Health Organization    7

                                                  ISBN 92 4 159156 0
                                                                                                                             Part One     Child Health and Poverty
                                   Produced for the World Health Organization by                                             1            The World’s Forgotten Children                                   8
                                            Myriad Editions Limited
                                                                                                                             2            Two Worlds: Rich and Poor                                       10
                                     6–7 Old Steine, Brighton BN1 1EJ, UK
                                       http://www.MyriadEditions.com                                                         3            Traditional Hazards, New Risks                                  12

                                 Co-ordinated for Myriad Editions by Candida Lacey                                           Part Two     Global Environmental Issues
                                               Edited by Jannet King
                                            Design by Corinne Pearlman                                                       4            Water for All: Making it Happen                                 14
                                        Maps and graphics by Isabelle Lewis                                                  5            Hurry Up in the Toilet: 2.4 Billion are Waiting                 16
                                                                                                                             6            To Fetch a Pail of Water                                        18
                                    WHO Library Cataloguing-in-Publication Data                                              7            Malaria                                                         20

                                                   Gordon, Bruce.                                                            8            Fluoride and Arsenic in Drinking Water                          22
                    Inheriting the world : the atlas of children's health and the environment /                              9            Indoor Smoke: Breaking Down Respiratory Defences                24
Bruce Gordon, Richard Mackay, Eva Rehfuess. 1.Child welfare 2.Infant mortality - trends 3.Environmental health
4.Environmental pollution - adverse effects 5.Forecasting 6.Atlases I.Mackay, Richard. II.Rehfuess, Eva. III.Title           10           Passive Smoking: Children Protest                               26
                           IV.Title: The atlas of children's health and the environment.                                     11           Polluted Cities: The Air Children Breathe                       28
                                                                                                                             12           Child Injuries are Preventable                                  30
                      Publications of the World Health Organization can be obtained from:                                    13           Child Labour: Growing Up Too Quickly                            32
    Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
                  tel: +41 22 791 2476; fax: +41 22 791 4857; email: bookorders@who.int
                                                                                                                             14           Lead: IQ Alert                                                  34
                     Requests for permission to reproduce or translate WHO publications,                                     15           Safe Food: Crucial for Child Development                        36
                               whether for sale or for noncommercial distribution,
                            should be addressed to Publications, at the above address
                                                                                                                             16           Poisoning: Hidden Peril for Children                            38
                              fax: +41 22 791 4806; email: permissions@who.int
                                                                                                                             Part Three   A Look to the Future
The designations employed and the presentation of the material in this publication do not imply the expression of any
                                                                                                                             17           Getting the Lead Out                                            40
    opinion whatsoever on the part of the World Health Organization concerning the legal status of any country,
territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines   18           Healthy Schools: Empowering Children                            42
              on maps represent approximate border lines for which there may not yet be full agreement.                      19           Enjoying the Sun Safely                                         44
 The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or
recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.             20           Climate Change                                                  46
    Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
 The World Health Organization does not warrant that the information contained in this publication is complete and                        Highs and Lows of Environmental Health                          48
                      correct and shall not be liable for any damages incurred as a result of its use.                                    WHO Sub-Regions                                                 49
                 The named authors alone are responsible for the views expressed in this publication.                                     World Data Table                                                50
                                                                                                                                          Sources                                                         58
                                         Printed and bound in Hong Kong
                                                                                                                                          Index                                                           64
                            Produced by Phoenix Offset Limited under the supervision of
                                     Bob Cassels, The Hanway Press, London
Inher iting the World: The Atlas of Children's Health and the Environment Bruce Gordon, Richard Mackay and Eva Rehfuess - World Health Organization
A c k n ow l e d g e m e n t s
We are most grateful to Margaret Chan, Director,             Lorna Fewtrell, Centre for Research into Environment     Michel Thieren, WHO                                        The publishers are grateful to the following
Protection of the Human Environment, WHO, for her              and Health, United Kingdom                             Lana Tomaskovic, WHO                                       organizations and photographers for permission to
vision to produce an atlas on children’s health and the      Chuck Gollmar, WHO                                       Niels Tomijima, WHO                                        reproduce their photographs:
environment. Her support, together with that of              Frank Hagemann, ILO                                      Michael Walsh, United States
Kerstin Leitner, Assistant Director-General, Sustainable     Laurence Haller, WHO                                     Wick Warren, Centers for Disease Control &                 page 8 WHO/H. Bower; 10 Nigel Bruce; 14 WHO/C.
Development and Healthy Environments, WHO, made              Alexander von Hildebrand, WHO-SEARO                        Prevention, United States                                Gaggero; 16 WHO/C. Gaggero; 18 WHO/H.
this atlas possible.                                         Anna Maria Hoffmann, UNESCO                              Martin Weber, WHO                                          Anenden; 19 WHO/P. Virot; 26 WHO; 28 Steve
                                                             Mollie Hogan, WHO                                        Sattar Yoosuf, WHO-SEARO                                   Turner; 30 WHO/H. Anenden; 32 (top) ILO/P.
Special thanks go to the Office of Children's Health         Honorat Hounkpatin, WHO-AFRO                             Maged Younes, WHO                                          Lissac; 32 (bottom) WHO/C. Gaggero; 34 WHO/C.
Protection, United States Environmental Protection           Jose Hueb, WHO                                                                                                      Gaggero; 36 WHO/A. Waak; 38 Donald Cole, with
Agency, for their generous financial contribution            Mie Inoue, WHO                                           International Network to Promote Household Water           thanks to Phil Landrigan, Mount Sinai School of
towards this atlas, and to Judith Mackay, who                Josefa Ippolito-Shepherd, WHO-AMRO                         Treatment and Safe Storage:                              Medicine and with the permission of Donald Cole,
contributed a wealth of experience and inspiration.          Jack Jones, WHO                                          Robert Ainslie, Johns Hopkins University, United States    Associate Professor Public Health Sciences, University
                                                             Michal Krzyzanowski, WHO-EURO                            Mansoor Ali, UNICEF                                        of Toronto; 42 WHO/C. Gaggero; 43 WHO/T. Kelly;
For their creativity, artistic talent and innovative         Philip Landrigan, Mount Sinai School of Medicine,        Greg Allgood, Procter & Gamble, United States              44 The Cancer Council Victoria; 47 WHO; 48 (left)
suggestions in the design and cartography of this atlas,       United States                                          Thomas Clasen, First Water, United States                  ILO/P. Lissac; 48 (middle) WHO/C.Gaggero;
we would like to thank the Myriad Editions team of           Rolaf van Leeuwen, Rijksinstituut voor Volksgezondheid   Camille Dow Baker, Centre for Affordable Water and         48 (right) WHO/C.Gaggero
Candida Lacey, Isabelle Lewis, Jannet King and Corinne         en Milieu, The Netherlands                               Sanitation Technology, Canada
Pearlman.                                                    Matt Livermore, University of East Anglia, United        Sumita Ganguly, UNICEF-India, India                        The publishers are grateful to the following
                                                               Kingdom                                                Willie Grabow, University of Pretoria, South Africa        organizations for supplying maps:
This Atlas could not have been written if not for the        Peter Matz, ILO                                          Stephen Gundry, University of Bristol, United
rich pool of information already available. We extend        Sumi Mehta, WHO                                            Kingdom                                                  Malaria in Africa, page 21
our gratitude to colleagues around the world who             Gerry Moy, WHO                                           Tara Meidl, Centre for Affordable Water and Sanitation     Africa malaria distribution map, theoretical model.
responded to impossible deadlines with data, literature,     Leda Nemer, WHO-EURO                                       Technology, Canada                                       Mapping Malaria Risk in Africa, 2003.
photographs and insightful suggestions. Their                Hisashi Ogawa, WHO-WPRO                                  Adrian Mol, MEDAIR, Madagascar
enthusiastic help and encouragement made this atlas a        Lesley Onyon, WHO                                        Susan Murcott, Massachusetts Institute of Technology,      The sun’s rays, page 44
true collaborative effort. Our heartfelt thanks to all the   Margie Peden, WHO                                          United States                                            Unpublished data from Schmalwieser AW, Institute of
colleagues listed below and to all those we may have         Jenny Pronczuk, WHO                                      Rob Quick, Centers for Disease Control & Prevention,       Medical Physics and Biostatistics, University of
omitted in error.                                            Federico Properzi, WHO                                     United States                                            Veterinary Medicine, Vienna, Austria
                                                             Annette Pruess, WHO                                      Henk van Norden, UNICEF-India, India                       by model calculations described in: Schmalwieser AW
Houssain Abouzaid, WHO-EMRO                                  Thebe Pule, WHO-AFRO                                     Martin Wegelin, EAWAG/SANDEC, Switzerland                  et al., Global validation of a forecast model for
Said Arnaout, WHO-EMRO                                       Sawat Ramaboot, WHO-SEARO                                Giveson Zulu, UNICEF-Zambia, Zambia                        irradiance of the solar, erythemally effective UV
Carmen Audera-Lopez, WHO                                     Vivian Rasmussen, WHO-EURO                                                                                          radiation, Journal of Optical Engineering, 2002,
Hamed Bakir, WHO-EMRO                                        Mike Repacholi, WHO                                      Putting together an atlas on children's health and the     40:3040-3050.
Jamie Bartram, WHO                                           David Rivett, WHO-EURO                                   environment in less than three months has the tendency
Roberto Bertollini, WHO-EURO                                 Colin Roy, Australian Radiation Protection and Nuclear   to take over your life. We are immensely grateful to our   A warming planet, page 46
Tony Blakely, Wellington School of Medicine and                Safety Agency, Australia                               partners and families without whose practical and          Livermore M (University of East Anglia), Campbell-
  Health, New Zealand                                        Yasmin von Schirnding, WHO                               moral support these months would have been difficult.      Lendrum D (WHO). Generated in 2004 based on data
Robert Bos, WHO                                              Jorgen Schlundt, WHO                                                                                                from the Hadley Centre. Climate change observations
Cynthia Boschi-Pinto, WHO                                    Alois Schmalwieser, University of Vienna, Austria                                                                   and predictions. Exeter, UK Meteorological Office,
Diarmid Campbell-Lendrum, WHO                                Gabriele Schöning, European Environment Agency,                                                                     2003.
Richard Carr, WHO                                              Denmark
Carlos Corvalan, WHO                                         Hawa Senkoro, WHO-AFRO
Marlies Craig, Mapping Malaria Risk in Africa, South         Victor Shatalov, Meteorological Synthesizing Centre of
  Africa                                                       EMEP, Russia
Dafina Dalbokova, WHO-EURO                                   Kenji Shibuya, WHO
Gerry Eijkemans, WHO                                         Amr Taha, ILO, Egypt
Anaclaudia Fassa, Universidade Federal de Pelotas,           Joanna Tempowski, WHO
  Brazil                                                     Thomas Teuscher, WHO

4                                                                                                                                                                                                                                      5
Inher iting the World: The Atlas of Children's Health and the Environment Bruce Gordon, Richard Mackay and Eva Rehfuess - World Health Organization
F o r ewo r d
About the authors                                           In the same series:

Bruce Gordon is a member of the Healthy
Environments for Children Alliance Secretariat of
WHO, and a researcher in the area of health and
sustainable development. Prior to joining WHO in
2002, he participated in environmental management
and development studies in Thailand, Vietnam, and
Peru. He was the recipient of a Canadian International
Development Agency Innovative Research Award for
his work in Peru on capacity-building and
environmental management. He has a degree in
Biochemistry from the University of British Columbia,
and a Master’s degree in Environmental Design from
the University of Calgary. His fascination with the links
between poverty, health and the environment continues
to grow.
                                                                                  E  very child has the right to live in a healthy, supportive environment – an environment that encourages growth and
Richard Mackay is an environmental consultant. He                                 development, and protects from disease. Many of the world’s children, however, are exposed to hazards in the very
has a science degree from the University of Cambridge,                            places that should be safest – the home, school and community. Considering that their growing bodies are
UK and a Master’s degree in Environmental                                         particularly sensitive to environmental threats, the final burden of childhood disease is substantial. Every year, more
Management. He has implemented environmental and                                  than three million children die due to unhealthy environments.
safety programmes for the University of Cambridge
and for the business and government sectors. He is a                              The majority of these child deaths are caused by unsafe water, lack of sanitation, indoor air pollution, and
member of the British Institute of Environmental                                  mosquitoes bearing malaria. Other environmental hazards include passive smoking, lead and pesticides, road traffic
Management and Assessment. He is the author of The                                accidents, and global environmental changes.
Atlas of Endangered Species (Penguin USA/Earthscan UK,
2002), also produced by Myriad Editions. He takes a                               Persistent poverty aggravates these environmental threats. The children worst affected are those in the developing
keen interest in environmental protection and ecology,                            world, and the enormous burden of ill-health falling on their youngest citizens constrains the social and economic
including work on the Aride Island Nature Reserve,                                development of these countries.
Seychelles and nature reserves in Britain.
                                                                                  Children are helpless in the face of environmental risks and, all too frequently, adults do not listen to the voices of
Eva Rehfuess, a scientist with WHO’s Department                                   children or act upon their most urgent needs. But we must listen. Children are our most precious resource.
for the Protection of the Human Environment, is                                   Together, now is the time to focus our efforts on combating environmental threats to children’s health and to work
responsible for the agency’s programme on indoor air                              towards a sustainable and brighter future.
pollution, a key environmental risk for childhood
respiratory illness in the developing world. Since
joining the WHO in 2000, she has also managed
activities on topics as diverse as children’s
environmental health indicators and ultraviolet
radiation. She is pursuing a PhD in Epidemiology at
Imperial College London, on the links between
environment, socio-economic factors and child health.                                                                                                                               Dr LEE Jong-wook
She has a Master’s degree in Biological Sciences from                                                                                                                                  Director-General
the University of Oxford. As the recipient of a Robert                                                                                                                         World Health Organization
Bosch Foundation Fellowship in International                                                                                                                                                    Geneva
Relations, she undertook work on sun protection in                                                                                                                                          March 2004
primary schools in the Middle East between 1999
and 2000.

6                                                                                                                                                                                                           7
Inher iting the World: The Atlas of Children's Health and the Environment Bruce Gordon, Richard Mackay and Eva Rehfuess - World Health Organization
01 The World’s Forgotten Children CYAN MAGENTA YELLOW BLACK

                                                                                                                                                                                                                                                                                                                         Child mortality rate
                                     1           The World’s Forgotten                                                                                                                         ICELAND
                                                                                                                                                                                                                                                                          FINLAND                                        Under-five mortality rate per 1000 live births

                                                 Children                                                                                                                                                                               NORWAY
                                                                                                                                                                                                                                                           SWEDEN

                                                                                                                                                                                                                                                                         ESTONIA
                                                                                                                                                                                                                                                                                          RUSSIAN
                                                                                                                                                                                                                                                                                                                         2000

                                                                                                                                                                                                                                                                                                                                      over 175                           11 – 25
                                                                                                                                                                                                                                                                                                                                                                                                    Beacons of hope

      Aiko is safely delivered in Kumamoto,                                                                                                                                                                          UNITED                                               LATVIA            FED.                                                                                                              greatest improvement
                                                                                                         Today, 35% of Africa’s children are                                                                        KINGDOM
    Japan, and can expect to live about 85                                                                                                                                                                                                   DENMARK               LITHUANIA
                                                                                                                                                                                                                                                                                                                                      101 – 175                          10 and under                         in child mortality rate
   years. At the same time, Mariam comes
                                                                                                         at higher risk of death than they                                                               IRELAND
                                                                                                                                                                                                                                                                                                                                                                                                              1970–2000
into this world in one of the poorest areas                                                              were ten years ago.                                                                                                         NETH.                                      BELARUS
                                                                                                                                                                                                                                              GERMANY
                                                                                                                                                                                                                                                                  POLAND                                                              26 – 100                           no data
          of Freetown, Sierra Leone. She is                                                                                                                                                                                BELGIUM
                                                                                                                                                                                                                                                          CZECH             UKRAINE
   underweight and vitamin-deficient, and                                                                                                                                                                                                                 REPUBLIC SLOVAKIA
                                                                                                                                                                                                                                     LUX.                                                  REP.
     has a 30% chance of dying before her                                                                                                                                                                                                             AUSTRIA     HUNGARY
                                                                                                                                                                                                                                                                            ROMANIA
                                                                                                                                                                                                                                                                                    MOLDOVA
                                                                                                                                                                                                                           FRANCE      SWITZ.                     BOSNIA &
                               fifth birthday.                                                                                                                                                                                                       SLOVENIA
                                                                                                                                                                                                                                                                  HERZEGOVINA
                                                                                                                                                                                                                                         S. MARINO
                                                                                                                                                                                                                                                        CROATIA         SERBIA & BULGARIA                                    RUSSIAN FEDERATION
                                                                                                                                                                                                                                                                       MONTENEGRO
                                                                                                                                                                                                                                                       ITALY

O                                                                                                                                                                                                                   ANDORRA            MONACO
       ver 10 million children                                                                                                                                                                                                                                   ALBANIA
                                                                                                                                                                                                                                                                             FYR MACEDONIA
       under five die every year –                                                                            C A N A D A                                                                     PORTUGAL
                                                                                                                                                                                                                 SPAIN

                                                                                                                                                                                                                                                                            GREECE
98 per cent of them in developing                                                                                                                                                                                                                                                                                 KAZAKHSTAN
                                                                                                                                                                                                                                                               MALTA
countries. Widespread                                                                                                                                                                                                                                                                                                                                MONGOLIA

malnutrition hampers children’s                                                                                                                                                                                                                                            GEORGIA                                        KYRGYZSTAN
                                                                                                                                                                                                                                                                                                                                                                                                    DPR
                                                                                                                                                                                                                                                                                                                                                                                                    KOREA
                                                                                                                                                                                                                                                                                                     UZBEKISTAN                                                                                                   JAPAN
growth and development, opening                                                                                                                                                                                                                                TURKEY
                                                                                                                                                                                                                                                                                      AZERBAIJAN
                                                                                                                                                                                                                                                                                    ARMENIA    TURKMENISTAN
                                                                                                                                                                                                                                                                                                                         TAJIKISTAN
the door to the biggest killers of                                         U S A                                                                                                                                                                            CYPRUS      SYRIAN ARAB
                                                                                                                                                                                                                                                                                          ISL . RE P.
                                                                                                                                                                                                                                                                                                                                                                                                    REP.
                                                                                                                                                                                                                           TUNISIA                                      REPUBLIC                                                                              C H I N A                             KOREA
children under five: perinatal                                                                                                                                                                MOROCCO                                                    LEBANON
                                                                                                                                                                                                                                                           ISRAEL                IRAQ       IRA N                AFGHANISTAN
                                                                                                                                                                                                                                                                        JORDAN
diseases, pneumonia, diarrhoea,                                                                                                                                                                                                                                                            KUWAIT
                                                                                                                                                                                                                                                                                                                       PAKISTAN                      BHUTAN
                                                                                                                                                                                                                                                                                                                                                                                                                              MARSHALL ISLANDS
                                                                                                                                                                                                                                                                                                                                                                                                                                   KIRIBATI
                                                                                                      BAHAMAS                                                                                                   ALGERIA            LIBYAN                                               BAHRAIN
and malaria. This presents a sharp                                MEXICO
                                                                                            CUBA                                                                                                                                    ARAB                                                          QATAR
                                                                                                                                                                                                                                                                                                                                            NEPAL
                                                                                                                                                                                                                                 JAMAHIRIYA              EGYPT                                                                                                                                                                  NAURU
contrast to the situation in the                                                                              DOMINICAN                                                                                                                                                                   SAUDI
                                                                                                                                                                                                                                                                                                   UAE
                                                                                                                                                                                                                                                                                                                                       INDIA        BANGLADESH                                                                            TUVALU
                                                                                                              REP.                                                                                                                                                                                                                                                        LAO
industrialized world, where junk                                                   BELIZE
                                                                                          JAMAICA
                                                                                                      HAITI                                                                    MAURITANIA
                                                                                                                                                                                                                                                                                          ARABIA
                                                                                                                                                                                                                                                                                                          OMAN
                                                                                                                                                                                                                                                                                                                                                              MYANMAR
                                                                                                                                                                                                                                                                                                                                                                          PDR
                                                                                                                                                                                                                                                                                                                                                                                   VIET NAM
                                                                                                                                                                                                                                                                                                                                                                                                                                           SAMOA      COOK
                                                                                                                                                                                                                                                                                                                                                                                                                                                   ISLANDS
                                                                     GUATEMALA       HONDURAS
                                                                                                      ST KITTS & NEVIS      ANTIGUA & BARBUDA                                                            MALI                                                                                                                                                                                                                     FIJI
food and a sedentary lifestyle have                                   EL SALVADOR            ST VINCENT & GRENADINES
                                                                                                                            DOMINICA                          CAPE VERDE
                                                                                                                                                                               SENEGAL                                   NIGER
                                                                                                                                                                                                                                        CHAD                                ERITREA      YEMEN
                                                                                                                                                                                                                                                                                                                                                                        THAILAND                                    VANUATU
                                                                                                                           ST LUCIA                                        GAMBIA                                                                                                                                                                                                                   PHILIPPINES                          TONGA NIUE
                                                                                  NICARAGUA                                                                                                                                                            SUDAN
triggered an unprecedented                                                                                    GRENADA
                                                                                                                              BARBADOS
                                                                                                                                                                   GUINEA-BISSAU
                                                                                                                                                                                                    BURKINA
                                                                                                                                                                                                      FASO                                                                            DJIBOUTI
                                                                                                                                                                                                                                                                                                                                                                             CAMBODIA
                                                                              COSTA RICA                                    TRINIDAD & TOBAGO                                       GUINEA
epidemic of obesity in children,

                                                                                                                                                                                                            BENIN
                                                                                                           VENEZUELA                                                                                                NIGERIA

                                                                                                                                                                                                          GHANA
                                                                                                                                                                                                           TOGO
                                                                                      PANAMA                               GUYANA                                                              CÔTE                                                                                                                                              SRI LANKA
                                                                                                                                                                            SIERRA LEONE                                              CENTRAL AFRICAN                      ETHIOPIA                                      MALDIVES                                                                                         PALAU
leading to diabetes and heart                                                                      COLOMBIA
                                                                                                                               SURINAME
                                                                                                                                                                                    LIBERIA
                                                                                                                                                                                              D’IVOIRE
                                                                                                                                                                                                                                         REPUBLIC
                                                                                                                                                                                                                                                                                                                                                                                      BRUNEI DAR.

                                                                                                                                                                                                             EQUATORIAL CAMEROON                                                        SOMALIA
disease in adult life.                                                                                                                                                                                          GUINEA                                            UGANDA
                                                                                                                                                                                                                                                                                                                                                                                MALAYSIA
                                                                                                                                                                                                                                                                                                                                                                                                                                             MICRONESIA,
                                                                                                                                                                                                                                                                           KENYA                                                                                                SINGAPORE                                                    FED. STATES OF
                                                                                     ECUADOR                                                                                                                SAO TOME
                                                                                                                                                                                                                           GABON
                                                                                                                                                                                                                                                                                                          SEYCHELLES
The last three decades have                                                                                                                                                                                 & PRINCIPE
                                                                                                                                                                                                                              CONGO
                                                                                                                                                                                                                                              DEM. REP.
                                                                                                                                                                                                                                               CONGO
                                                                                                                                                                                                                                                                RWANDA
                                                                                                                                                                                                                                                                BURUNDI
witnessed an impressive decline in                                                             PERU                                                                                                                                                               UNITED REP.
                                                                                                                                                                                                                                                                                                                                                                                              I N D O N E S I A
                                                                                                                                                                                                                                                                                                                                                                                                                                               PAPUA
                                                                                                                                                                                                                                                                                                                                                                                                                                                NEW
                                                                                                                                                                                                                                                                  TANZANIA
child mortality, from 17 million a                                                                                           BRAZIL                                                                                                ANGOLA                                           COMOROS
                                                                                                                                                                                                                                                                                                                                                                                                                                               GUINEA         SOLOMON
                                                                                                                                                                                                                                                                                                                                                                                                                                                              ISLANDS
                                                                                                                                                                                                                                                                                                                                                                                                                  TIMOR-LESTE
year in the 1970s. Yet these gains
                                                           "It is not enough                                                                                                                                                                         ZAMBIA
                                                                                                                                                                                                                                                                       MALAWI

have not been enjoyed                            to prepare our children for the world;                          BOLIVIA                                                                                                                                                              MADAGASCAR
                                                                                                                                                                                                                                                           ZIMBABWE                                       MAURITIUS
everywhere. In some countries of                    we must also prepare the world                                                                                                                                                 NAMIBIA
                                                                                                                                                                                                                                                BOTSWANA
sub-Saharan Africa, child                                   for our children.”                                              PARAGUAY
                                                                                                                                                                                                                                                                  MOZAMBIQUE

                                                       Luis J. Rodriguez (1954– )                                                                                                                                                                                                                                  US$ 17 billion
mortality is rising as wars and the                                                                         CHILE                                                                                                                                               SWAZILAND
                                                                                                                                                                                                                                                                                                                                                                                                             A USTR A LIA
                                                                                                                                                                                                                                              SOUTH
ravage of the AIDS epidemic                                                                                                                                                                                                                   AFRICA       LESOTHO

undermine the medical, social and                                                                                                   URUGUAY

economic structures of society.                                                                                           ARGENTINA

At the turn of the century, the
world joined together in the fight                                                                                                                                                                                                     The price of life                                                                                                                                                                                                NEW
                                                                                                                                                                                                                                                                                                                                                                                                                                                    ZEALAND
against poverty, and committed
itself to the Millennium                         The biggest killers of children under five
Development Goals, adopted by                                                                                                                                                                                                                                                                                                                                           US$ 7.5 billion
                                                 Main causes of child mortality
the United Nations in 2000. “To                  2002
reduce by two-thirds the                                                                                                               Diarrhoea 15%
                                                                Acute respiratory
under-five mortality rate between                                infection 18%
1990 and 2015” may be the most                                                                                                                   Malaria 11%
ambitious of these goals.
                                                                                                   Deaths associated
                                                                                                   with malnutrition:                                Measles 5%
                                                                                                         54%                                                                                                                                                                                        Annual expenditure on pet food                       Annual cost of scaling-up vaccination,
                                                                      Other                                                                        Human Immunodeficiency                                                                                                                                                                                       malaria prevention and
                                                                                                                                                                                                                                                                                                     in North America and Europe
                                                                      24%                                                                          Virus (HIV) 4%                                                                                                                                                                                            essential treatment to reach
                                                                                                                                                                                                                                                                                                                1998
                                                                                                                                                Perinatal diseases                                                                                                                                                                                        every child in the developing world
8                                                                                                                                               (within 7 days of birth)                                                                                                                                                                                                  2001                                                                          9
                                                                                                                                                23%
Inher iting the World: The Atlas of Children's Health and the Environment Bruce Gordon, Richard Mackay and Eva Rehfuess - World Health Organization
02 Two Worlds: Rich and Poor CYAN MAGENTA YELLOW BLACK

                                                                                                                                                                                                                                                                                                                                                   The rich…
                                 2           Two Worlds: Rich and Poor                                                                                                                                                                                                                                                                             Percentage of people living on more than two dollars a day
                                                                                                                                                                                                                                                                                                                                                   who use solid fuel for cooking
                                                                                                                                                                                                                                                                                                                                                   2004
                                                                                                                                                                                                                                                                                                                                                   by WHO sub-region
         “We are all responsible for all.”
          Fyodor Dostoevsky (1821–1881)
                                                                                                                                                                                                                                                                                                                                                               51% – 75%                                            25% and under

P    overty is the single biggest
     threat to children’s health.
Poor children are more likely to                                                                                                                                                                                                                   POLAND
                                                                                                                                                                                                                                                              EST.
                                                                                                                                                                                                                                                          LATVIA
                                                                                                                                                                                                                                                           LITH.
                                                                                                                                                                                                                                                                 BELARUS
                                                                                                                                                                                                                                                                                                  RUSSIAN FEDERATION

                                                                                                                                                                                                                                                                                               KAZAKHSTAN
                                                                                                                                                                                                                                                                                                                                                               26% – 50%                                            no data

                                                                                                                                                                                                                                                                   UKRAINE
die as infants, and are sick more                                                                                                                                                                                                                          SL.
                                                                                                                                                                                                                                                          HUN ROM. REP.
                                                                                                                                                                                                                                                                                                                                                  MONGOLIA
                                                                                                                                                                                                                                                                      MOLDOVA
                                                                                                                                                                                                                                                           S. &
often and more seriously than                                                                                                                                                                                                                          B-H M. BUL.
                                                                                                                                                                                                                                                                              GEORGIA
                                                                                                                                                                                                                                                                                      AZERBAIJAN
                                                                                                                                                                                                                                                                                                 UZBEKISTAN KYRGYZSTAN
                                                                                                                                                                                                                                                                                                                                                                                   DPR
                                                                                                                                                                                                                                                                                                                                                                                   KOREA
                                                                                                                                                                                                                                                        ALB.
                                                                                                                                                                                                                                                                        TURKEY                                                                                                     REP.
better-off children.                                                                                                                                                                                                                                          FYR
                                                                                                                                                                                                                                                              MAC.               ARMENIA
                                                                                                                                                                                                                                                                                            TURKMEN.      TAJIKISTAN
                                                                                                                                                                                                                                                                                                                                                       C H I N A
                                                                                                                                                                                                                                                                                                                                                                                   KOREA
                                                                                                                                                                                                                                                                                                                   AFGHANISTAN
                                                                                                                                                                                                                                                                                           IRAQ
                                                                                                                                                                                                                  MOROCCO
The poor and the marginalized –                                                                                                                                                                                                                                                                                       PAKISTAN                    BHUTAN
                                                                                                                                                                                                                                                                                                                                                                                               MARSHALL
                                                                                                                                                                                                                                                                                                                                                                                                ISLANDS
                                                                                                                                      BAHAMAS                                                                                       ALGERIA                                                                                               NEPAL
especially children – often bear                                                                  MEXICO
                                                                                                                                                                                                                                                                        EGYPT                                                                                                                  NAURU
                                                                                                                                                                                                                                                                                                                                                                                                       KIRIBATI
                                                                                                                                                                                                                                                                                                                                                                                                            TOKELAU
                                                                                                                                                                                                                                                                                                                                     INDIA     BANGLADESH
the brunt of environmental                                                                                               JAMAICA HAITI DOMINICAN REP.
                                                                                                                    BELIZE                     ANTIGUA & BARBUDA                                      MAURITANIA                                                                                                                                    MYANMAR
                                                                                                                                                                                                                                                                                                                                                                LAO
                                                                                                                                                                                                                                                                                                                                                                PDR VIET NAM
                                                                                                                                                                                                                                                                                                                                                                                                    TUVALU       SAMOA
                                                                                                                                                                                                                                                                                                                                                                                                                      COOK
                                                                                                  GUATEMALA          HONDURAS ST KITTS & NEVIS                                                                               MALI                                                                                                                                                                                  ISLANDS
degradation. Yet, because of their                                                                 EL SALVADOR
                                                                                                                  NICARAGUA
                                                                                                                            ST VINCENT & GRENADINES
                                                                                                                                                              DOMINICA
                                                                                                                                                             ST LUCIA
                                                                                                                                                                                    CAPE VERDE
                                                                                                                                                                                                    SENEGAL
                                                                                                                                                                                               GAMBIA                     BURKINA
                                                                                                                                                                                                                                           NIGER
                                                                                                                                                                                                                                                         CHAD          SUDAN
                                                                                                                                                                                                                                                                                     ERITREA YEMEN                                                                               PHILIPPINES VANUATU
                                                                                                                                                                                                                                                                                                                                                                                                              TONGA
                                                                                                                                            GRENADA              BARBADOS                                                                                                                                                                                          CAMBODIA                                 FIJI       NIUE
vulnerability, children are the                                                                               COSTA RICA                                     TRINIDAD & TOBAGO
                                                                                                                                                                                         GUINEA-BISSAU
                                                                                                                                                                                                        GUINEA
                                                                                                                                                                                                                           FASO                                                              DJIBOUTI

                                                                                                                                                                                                                                BENIN
                                                                                                                                           VENEZUELA

                                                                                                                                                                                                                              GHANA
                                                                                                                                                                                                                                         NIGERIA

                                                                                                                                                                                                                               TOGO

                                                                                                                                                                                                                                                                                                       LIA
                                                                                                                     PANAMA                              GUYANA                                                    CÔTE                           CENTRAL
                                                                                                                                                                                              SIERRA LEONE

                                                                                                                                                                                                                                                                                                   MA
                                                                                                                                                                                                                                                                                     ETHIOPIA
very group that can least afford to                                                                                               COLOMBIA                                                              LIBERIA
                                                                                                                                                                                                                  D’IVOIRE                      AFRICAN REP.
                                                                                                                                                                                                                                                                                                                        MALDIVES                                                                 PALAU

                                                                                                                                                                                                                                                                                                  SO
                                                                                                                                                                                                                              EQUATORIAL CAMEROON                              UGANDA
                                                                                                                                                                                                                                                                                                                                                                   MALAYSIA
be exposed to environmental                                                                                         ECUADOR
                                                                                                                                                                                                                                  GUINEA
                                                                                                                                                                                                                                          GABON                                    KENYA
                                                                                                                                                                                                                                                                                                                                                                                                                      MICRONESIA,
                                                                                                                                                                                                                                                                                                                                                                                                                      FED. STATES OF
                                                                                                                                                                                                                              SAO TOME              DEM. REP.                 RWANDA                           SEYCHELLES
hazards. They are not “little                                                                                                                                                                                                 & PRINCIPE    CONGO    CONGO                    BURUNDI
                                                                                                                                                                                                                                                                                                                                                                                                                      PAPUA
                                                                                                                               PERU                                                                                                                                             UNITED REP.                                                                                                                            NEW
adults”: they breathe more air,                                                                                                                              BRAZIL                                                                                    ANGOLA
                                                                                                                                                                                                                                                                                TANZANIA
                                                                                                                                                                                                                                                                                          COMOROS
                                                                                                                                                                                                                                                                                                                                                                                                                      GUINEA    SOLOMON
                                                                                                                                                                                                                                                                                                                                                                                                                                ISLANDS
consume more food, and drink                                                                                                                                                                                                                                         ZAMBIA
                                                                                                                                                                                                                                                                                  MALAWI
                                                                                                                                                                                                                                                                                  MADAGASCAR
more water in proportion to their                                                                                                                  BOLIVIA
                                                                                                                                                                                                                                                       NAMIBIA
                                                                                                                                                                                                                                                                    ZIMBABWE                MAURITIUS
                                                                                                                                                                                                                                                              BOTSWANA
weight. Children’s behaviour                                                                                                               CHILE          PARAGUAY
                                                                                                                                                                                                                                                                        MOZAMBIQUE

further puts them at risk. Their                                                                                                                                                                                                                              SOUTH
                                                                                                                                                                                                                                                                              SWAZILAND

                                                                                                                                                                                                                                                              AFRICA      LESOTHO
life takes place closer to the                                                                                                                                       URUGUAY

ground and young children                                                                                                                                ARGENTINA                                                                                Households on higher incomes mostly use electricity or gas for cooking.
frequently put their fingers in                                                                                                                                                                                                      Those on lower incomes are more likely to use polluting solid fuels, such as dung, wood and coal.
their mouths.                                                                                                                                                                                                                        As a result, children living in these households suffer disproportionately from the adverse health
                                                                                                                                                                                                                                                                        effects of indoor smoke (map 9).
Exposure to environmental risks is
one of the reasons for poor
                                                                                                                                                                                                                                                                                            RUSSIAN FEDERATION
children being worse off than their                                                                                                                                                                                                                    EST.
                                                                                                                                                                                                                                                   LATVIA
wealthier peers. In developing                                                                                                                                                                                                                      LITH.

                                                         Every year                                                                                                                                                                             POLAND      BELARUS
countries, environmental risks are                  smoke from burning                                                                                                                                                                                  SL.   UKRAINE
                                                                                                                                                                                                                                                                                                       KAZAKHSTAN
                                                                                                                                                                                                                                                                                                                                              MONGOLIA
                                                                                                                                                                                                                                                       HUN ROM. REP.
compounded in the poorest                         solid fuels in the home                                                                                                                                                                        B-H        BUL.
                                                                                                                                                                                                                                                                MOLDOVA
                                                                                                                                                                                                                                                                                 GEORGIA
                                                                                                                                                                                                                                                                                                                                                                               DPR
                                                                                                                                                                                                                                                                                                             UZBEKISTAN KYRGYZSTAN                                             KOREA
settlements, where housing is                    kills one million children                                                                                                                                                                        ALB. FYR                            AZERBAIJAN
                                                                                                                                                                                                                                                                       T U R K E Y ARMENIA   TURKMEN.                TAJIKISTAN                                                REP.
                                                                                                                                                                                                                                                        MAC.                                                                                                                   KOREA
                                                       under five years.                                                                                                                                                                                                                                                                           C H I N A
inadequate, water and sanitation                                                                                                                                                                                                                                                    IRAQ
                                                                                                                                                                                                                                                                                                               AFGHANISTAN
                                                                                                                                                                                                              MOROCCO
are lacking, garbage collection is                                                                                                BAHAMAS                                                                                    ALGERIA
                                                                                                                                                                                                                                                                                                                  PAKISTAN
                                                                                                                                                                                                                                                                                                                                      NEPAL
                                                                                                                                                                                                                                                                                                                                              BHUTAN
                                                                                                                                                                                                                                                                                                                                                                                           MARSHALL
                                                                                                                                                                                                                                                                                                                                                                                            ISLANDS
                                                                                                                                                                                                                                                                                                                                                                                                   KIRIBATI
non-existent, and smoke fouls                                                                  MEXICO
                                                                                                                                                                                                                                                                   EGYPT
                                                                                                                                                                                                                                                                                                                                          BANGLADESH
                                                                                                                                                                                                                                                                                                                                                                                           NAURU
                                                                                                                                                                                                                                                                                                                                                                                                        TOKELAU
                                                                                                                         JAMAICA HAITI    DOMINICAN REP.                                                                                                                                                                          INDIA
indoor air. In rich countries,                                                                                  BELIZE                             ANTIGUA & BARBUDA                             MAURITANIA
                                                                                                                                                                                                                     MALI
                                                                                                                                                                                                                                                                                                                                                MYANMAR
                                                                                                                                                                                                                                                                                                                                                            LAO
                                                                                                                                                                                                                                                                                                                                                            PDR VIET NAM
                                                                                                                                                                                                                                                                                                                                                                                             TUVALU       SAMOA
                                                                                                                                                                                                                                                                                                                                                                                                               COOK
                                                                                               GUATEMALA         HONDURAS ST KITTS & NEVIS                                       CAPE VERDE                                                                                                                                                                                   PHILIPPINES VANUATU
                                                                                                                                                                                                                                                                                                                                                                                                            ISLANDS
                                                                                                                                                                                                                                        NIGER
low-income or minority                                                                          EL SALVADOR          ST VINCENT & GRENADINES
                                                                                                              NICARAGUA                  GRENADA
                                                                                                                                                        DOMINICA
                                                                                                                                                     ST LUCIA
                                                                                                                                                         BARBADOS
                                                                                                                                                                                                SENEGAL
                                                                                                                                                                                           GAMBIA                 BURKINA                           CHAD          SUDAN
                                                                                                                                                                                                                                                                                 ERITREA YEMEN
                                                                                                                                                                                                                                                                                                                                                               CAMBODIA
                                                                                                                                                                                                                                                                                                                                                                                                       TONGA

                                                                                                                                                                                     GUINEA-BISSAU                 FASO                                                                                                                                                                              FIJI          NIUE
                                                                                                                                                                                                                                                                                       DJIBOUTI
neighbourhoods are sometimes                                                                            COSTA RICA                                    TRINIDAD & TOBAGO                             GUINEA

                                                                                                                                                                                                                           BENIN
                                                                                                                                     VENEZUELA                                                                                       NIGERIA

                                                                                                                                                                                                                         GHANA
                                                                                                                                                                                                                          TOGO
                                                                                                               PANAMA                                GUYANA                                                    CÔTE                          CENTRAL
                                                                                                                                                                                          SIERRA LEONE                                                                           ETHIOPIA                           MALDIVES                                                                 PALAU
                                                                                                                                                                                                              D’IVOIRE
disproportionately located near                                                                                             COLOMBIA                    SURINAME                                    LIBERIA                               AFRICAN REP.
                                                                                                                                                                                                                         EQUATORIAL CAMEROON                                        SOMALIA                                                                    MALAYSIA
                                                                                                                                                                                                                                                                         UGANDA
                                                                                                                                                                                                                             GUINEA
hazardous waste sites or polluting                                                                              ECUADOR                                                                                                  SAO TOME GABON
                                                                                                                                                                                                                                              DEM. REP.                 RWANDA
                                                                                                                                                                                                                                                                              KENYA
                                                                                                                                                                                                                                                                                                        SEYCHELLES
                                                                                                                                                                                                                                                                                                                                                                                                               MICRONESIA,
                                                                                                                                                                                                                                                                                                                                                                                                               FED. STATES OF
                                                                                                                                                                                                                         & PRINCIPE   CONGO
industries.                                                                                                                                                                                                                                    CONGO                    BURUNDI
                                                                                                                                                                                                                                                                                                                                                                                                                   PAPUA
                                                  …and the poor                                                            PERU
                                                                                                                                                      BRAZIL                                                                                    ANGOLA
                                                                                                                                                                                                                                                                          UNITED REP.
                                                                                                                                                                                                                                                                          TANZANIA
                                                                                                                                                                                                                                                                                    COMOROS
                                                                                                                                                                                                                                                                                                                                                                                                                    NEW
                                                                                                                                                                                                                                                                                                                                                                                                                   GUINEA   SOLOMON
A rising income gap between the                                                                                                                                                                                                                                             MALAWI
                                                                                                                                                                                                                                                                                                                                                                                                                            ISLANDS

rich and the poor within countries                Percentage of people living on less than one dollar a day                                                                                                                                                   ZAMBIA
                                                                                                                                                                                                                                                                                       MADAGASCAR
                                                                                                                                            BOLIVIA                                                                                                           ZIMBABWE                           MAURITIUS
                                                  who use solid fuel for cooking                                                                                                                                                                 NAMIBIA
around the world means that                                                                                                                                                                                                                             BOTSWANA MOZAMBIQUE
                                                  2004                                                                               CHILE            PARAGUAY

millions of children may be                       by WHO sub-region                                                                                                                                                                                                      SWAZILAND
                                                                                                                                                                                                                                                         SOUTH
excluded from the health benefits                                                                                                                                URUGUAY
                                                                                                                                                                                                                                                         AFRICA        LESOTHO

of emerging prosperity.                                   over 75%                 26% – 50%
                                                                                                                                                    ARGENTINA

                                                          51% – 75%                no data
10                                                                                                                                                                                                                                                                                                                                                                                                                                        11
Inher iting the World: The Atlas of Children's Health and the Environment Bruce Gordon, Richard Mackay and Eva Rehfuess - World Health Organization
03 Traditional Hazards, New Risks CYAN MAGENTA YELLOW BLACK

                                                                                                            Environmental health risks
                                 3           Traditional Hazards,                                           Sized according to significance of risk

                                             New Risks                                                      2002 by WHO sub-region

  “The problems we have today cannot be                                                                                         lack of safe water,                                    lead and other
   solved by thinking the way we thought                                                                                        sanitation and hygiene                                 hazardous chemicals
                  when we created them.”
               Albert Einstein (1879–1955)                                                                                      indoor air pollution                                   malaria and other
                                                                                                                                from solid fuel use                                    vector-borne diseases

C     hildren today live in an
      environment that is vastly
different from that of a few
                                                                                                                                urban outdoor
                                                                                                                                air pollution
                                                                                                                                                                                       child injuries

generations ago. Global challenges                                                                          This simplified overview illustrates how certain environmental risks differ in magnitude between WHO sub-
include industrialization, rapid                                                                            regions. It does not account for the often large variation between countries within a given region, nor is it a
urban population growth, the                                                                                comprehensive summary of all environmental risks to children’s health.
unsustainable consumption of
natural resources, the increasing
production and use of chemicals,
and the movement of hazardous
wastes across national borders.
Homes, schools, streets and fields
– the settings where children live,
learn, play and work – all present
environmental hazards. Yet,
children born into different
countries, cities or rural areas,
and even different
neighbourhoods, face risks that
may be poles apart.
As countries develop, many of the
most serious “basic risks” to child
health gradually vanish with
improvements in water and
sanitation, hygiene and cleaner
fuels for cooking. Their decline,
however, is accompanied by an
increase in “modern risks”.
Industrialization brings with it an
increase in road traffic, air
pollution, and the use of
chemicals that infiltrate the air                                                 Environmental health risk transition
children breathe and the food
                                                                                                                                                            Summary of risks
they eat.                                                                                                                                                   by income
It is too early to judge the exact                                                significance of risk                                                      2004
                                                 Each year over three million
impact of “emerging risks”, such                children die from illnesses and                                                                                      basic risks: lack of safe water, sanitation
as endocrine disruptors and global                other conditions caused by                                                                                         and hygiene, indoor air pollution,
warming. These add to the                           environmental hazards.                                                                                           vector-borne diseases, hazards that cause
challenges we must confront to                                                                                                                                       accidents and injuries
safeguard our children’s health
                                                                                                                                                                     modern risks: unsafe use of
and future.                                                                                                                                                          chemicals, environmental degradation

                                                                                                                                                                     emerging risks: climate change, ozone
                                                                                      Low-income         Middle-income              High-income                      depletion, persistent organic pollutants,
                                                                                      populations         populations               industrialized                   endocrine disruptors
                                                                                       in poverty         in transition               societies
12                                                                                                                                                                                                                            13
Inher iting the World: The Atlas of Children's Health and the Environment Bruce Gordon, Richard Mackay and Eva Rehfuess - World Health Organization
04 Water for All CYAN MAGENTA YELLOW BLACK

                                                                                                                                                                                                                                                                                                            Water supplies
                                4          Water for All:                                                                                                                                                                                                        FINLAND                                    Percentage of households with access to an improved water supply

                                           Making it Happen                                                                                                                                                                     NORWAY
                                                                                                                                                                                                                                                   SWEDEN

                                                                                                                                                                                                                                                                ESTONIA
                                                                                                                                                                                                                                                                                 RUSSIAN
                                                                                                                                                                                                                                                                                                            2000 or latest available data
                                                                                                                                                                                                                                                                                                            An improved water supply is defined according to the type
         “By means of water we give life                                                                                                                                                                      UNITED                                                               FED.                     of technology (piped drinking water, protected well or
                                                                                                                                                                                                             KINGDOM
                        to everything.”                                                                                                                                                                                              DENMARK                                                                spring, rainwater), the distance from the source (available
                                  Koran                                                                                                                                                                                                                                                                     within 1 km of the home) and water quantity
                                                                                                                                                                                                                             NETH.                                    BELARUS
                                                                                                                                                                                                                                                                                                            (at least 20 litres per day).
                                                                                                                                                                                                                                                                                                                                                                                           Striving ahead

W        ater is the essence of life
         and human dignity. As a
fundamental human right
                                                                                                                                                                                                                               SWITZ.
                                                                                                                                                                                                                                             AUSTRIA
                                                                                                                                                                                                                                            SLOVENIA
                                                                                                                                                                                                                                                             SLOVAKIA
                                                                                                                                                                                                                                                                          UKRAINE

                                                                                                                                                                                                                                                                      ROMANIA
                                                                                                                                                                                                                                                                                   REP.
                                                                                                                                                                                                                                                                                   MOLDOVA
                                                                                                                                                                                                                                                                                                                         over 95%

                                                                                                                                                                                                                                                                                                                         81% – 95%
                                                                                                                                                                                                                                                                                                                                                           41% – 60%

                                                                                                                                                                                                                                                                                                                                                           40% and under
                                                                                                                                                                                                                                                                                                                                                                                                   multiple projects on
                                                                                                                                                                                                                                                                                                                                                                                                   household water
                                                                                                                                                                                                                                                                                                                                                                                                   management are
                                                                                                                                                                                                                                                             SERBIA & BULGARIA
“sufficient, safe, acceptable,                                                                                                          C ANAD A                                                                                                            MONTENEGRO
                                                                                                                                                                                                                                                                                                                                                           no data                                 underway
                                                                                                                                                                                                             ANDORRA           MONACO
                                                                                                                                                                                                                                                       ALBANIA                                                           61% – 80%
physically accessible and                                                                                                                                                                                                                                                                                                                                                                          2004
affordable water for personal and
domestic uses” is vital for all.                                                                                                                                                                                                                    MALTA                                                                RUSSIAN FEDERATION
Governments are responsible for
ensuring that this human right is          The United Nations proclaimed the years 2005 to 2015
                                                                                                                                              Halving the proportion                                                                                                                                 KAZAKHSTAN
                                           as the Decade of Water for Life.
progressively fulfilled. As a result                                                                                                       of people without access to                                                                                                                                                                 MONGOLIA

of their action, in collaboration                                                                                                          a safe water supply by 2015                                                                                                                                                                                                             DPR
                                                                                                                                          requires connecting 125 000                                                                                            GEORGIA                       UZBEKISTAN    KYRGYZSTAN                                                            KOREA
with partners, 900 million more                                           U S A
                                                                                                                                         people every day and sustaining                                                                             TURKEY
                                                                                                                                                                                                                                                                                AZERBAIJAN
                                                                                                                                                                                                                                                                                                                                                                                   REP.
                                                                                                                                                                                                                                                                                                            TAJIKISTAN                                                             KOREA
people gained access to an                                                                                                                     existing connections.                                                                               CYPRUS       SYRIAN ARAB
                                                                                                                                                                                                                   TUNISIA                                      REPUBLIC                                                                        C H I N A
improved water supply during                                                                                                                                                             MOROCCO
                                                                                                                                                                                                                                                  LEBANON
                                                                                                                                                                                                                                                                         IRAQ         ISL . RE P.
                                                                                                                                                                                                                                                                                                     AFGHANISTAN

the 1990s.                                                                                                                                                                                                                                     WEST BANK
                                                                                                                                                                                                                                                AND GAZA
                                                                                                                                                                                                                                                                JORDAN                  IRA N
                                                                                                                                                                                                                                                                                                         PAKISTAN                      BHUTAN                                                                        KIRIBATI
                                                                                                       BAHAMAS                                                                                           ALGERIA           LIBYAN                                                                                             NEPAL
                                                                                                                                                                                                                            ARAB
Yet 1.1 billion people in rural                                 MEXICO                         CUBA
                                                                                                                                                                                                                         JAMAHIRIYA             EGYPT
                                                                                                                                                                                                                                                                                                                                      BANGLADESH                                                            TUVALU        SAMOA
areas and urban slums still rely on                                                                           DOMINICAN
                                                                                                                                                                                                                                                                          SAUDI ARABIA                                    INDIA
                                                                                          JAMAICA             REP.                                                                                                                                                                                                                              MYANMAR     LAO
                                                                                                        HAITI                                                                                                                                                                                                                                                                                                                      COOK
                                                                                    BELIZE                                                                                                                                                                                                                                                                  PDR                                                                 ISLANDS
                                                                                                                                                                         MAURITANIA                                                                                                          OMAN
unsafe drinking water from                                                           HONDURAS
                                                                                                        ST KITTS & NEVIS      ANTIGUA & BARBUDA
                                                                                                                                                          CAPE VERDE
                                                                                                                                                                                                  MALI                                                                                                                                                               VIET NAM
                                                                                                                                                                                                                                                                                                                                                                                                  VANUATU
                                                                                                                                                                                                                                                                                                                                                                                                                 FIJI       NIUE
                                                                                                            ST VINCENT
                                                                                                                             DOMINICA                                      SENEGAL                              NIGER                                              ERITREA       YEMEN
                                                                                                                                                                                                                                                                                                                                                          THAILAND
rivers, lakes and open wells.                            GUATEMALA   EL SALVADOR
                                                                                   NICARAGUA             & GRENADINES
                                                                                                                             ST LUCIA
                                                                                                                                BARBADOS
                                                                                                                                                                       GAMBIA                                                   CHAD
                                                                                                                                                                                                                                                SUDAN                                                                                                             CAMBODIA          PHILIPPINES                         TONGA
                                                                                                                                                                                             BURKINA
Children, in particular, suffer                                              COSTA RICA
                                                                                                              GRENADA
                                                                                                                             TRINIDAD & TOBAGO
                                                                                                                                                               GUINEA-BISSAU                   FASO                                                                        DJIBOUTI

                                                                                                                                                                                                     BENIN
                                                                                                                                                                           GUINEA                            NIGERIA
                                                                                                            VENEZUELA

                                                                                                                                                                                                   GHANA
                                                                                                                                                                                                    TOGO
                                                                                      PANAMA
from water-related illnesses. Each                                                              COLOMBIA
                                                                                                                             GUYANA
                                                                                                                                 SURINAME
                                                                                                                                                                        SIERRA LEONE    CÔTE
                                                                                                                                                                                       D’IVOIRE                                  CENTRAL                          ETHIOPIA                                   MALDIVES
                                                                                                                                                                                                                                                                                                                                  SRI LANKA
                                                                                                                                                                                                                                                                                                                                                                                                        PALAU
                                                                                                                                                                                                                             AFRICAN REPUBLIC
episode of diarrhoea sets back a                                                                                                                                                                      EQUATORIAL CAMEROON
                                                                                                                                                                                                                                                                                                                                                              MALAYSIA

                                                                                                                                                                                                         GUINEA                                         UGANDA
                                                                                                                                                                                                                                                                                                                                                       SINGAPORE
child’s growth by lowering their                                                     ECUADOR                                                                                                                       GABON
                                                                                                                                                                                                                                                                  KENYA
                                                                                                                                                                                                                                                       RWANDA
appetite and reducing their                                                                                                                                                                                            CONGO
                                                                                                                                                                                                                                      DEM. REP.
                                                                                                                                                                                                                                       CONGO           BURUNDI
calorie and nutrient uptake.                                                                    PERU                                                                                                                                                    UNITED REP.
                                                                                                                                                                                                                                                        TANZANIA
                                                                                                                                                                                                                                                                                                                                                                                I N D O N E S I A                               PAPUA
                                                                                                                                                                                                                                                                                                                                                                                                                                 NEW
Persistent diarrhoea and severe                                                                                               BRAZIL                                                                                       ANGOLA                                          COMOROS
                                                                                                                                                                                                                                                                                                                                                                                                                                GUINEA     SOLOMON
                                                                                                                                                                                                                                                                                                                                                                                                                                           ISLANDS
diseases, such as typhoid and                                                                                                                                                                                                                               MALAWI

dysentery, jeopardize children’s              Health effects                                                                                                                                                                               ZAMBIA
                                                                                                                                                                                                                                                                             MADAGASCAR
                                                                                                                                                                                                                                                  ZIMBABWE                                   MAURITIUS
healthy development. Every year,              Intestinal diseases caused                                           BOLIVIA                                                                                                 NAMIBIA
                                                                                                                                                                                                                                        BOTSWANA
nearly 2 million children do not              by unsafe drinking water:                                     CHILE            PARAGUAY
                                                                                                                                                                                                                                                        MOZAMBIQUE

survive this struggle.                        • Diarrhoea                                                                                                                                                                                                                                                                                                                                    A USTR A LIA
                                                                                                                                                                                                                                                                                                                                  627
                                              • Cholera                                                                                                                                                                               SOUTH
                                                                                                                                                                                                                                      AFRICA      LESOTHO
Continued progress towards                    • Dysentery                                                                            URUGUAY
providing everyone with access to             • Typhoid                                                                    ARGENTINA                                                               Preventing diarrhoea                                                                                                                                                         539
protected wells and, ultimately,              • Guinea worm
piped water supplies will radically           Hygiene- and sanitation-related                                                                                                                      Annual number of deaths of children under five years
                                              diseases (map 5)                                                                                                                                     2002                                                                                                                                       434
reduce childhood illness. In the                                                                                                                                                                                                                                                                                                                                                                                                         NEW
                                                                                                                                                                                                   thousands                                                                                                                                                                                                                       ZEALAND
meantime, disinfection and                                                                                                                                                                                                                                                                                                                                                              370
filtration at home are simple and                                                                                                                                                                             from diarrhoea
cheap measures that make an                                                                                                                                                                                   that would be averted by piped water supply and sanitation
                                           • Water is essential for hygiene, especially for hand-washing after defecation (map 5)
immediate difference to the lives
                                                                                                                                                                                                              that would be averted                                                        226
of the worst affected.                     • Pools and marshes are breeding sites for malaria-carrying mosquitoes (map 7)                                                                                     by household water treatment

                                           • Arsenic and high levels of fluoride in drinking water cause severe illness (map 8)                                                                                                                                                                     148
                                                                                                                                                                                                                                                                                                                                                    114
                                           • Children and women often spend many hours collecting water (map 6)
                                                                                                                                                                                                                                      45                    4                                               15
                                                                                                                                                                                                                                                  30                                                                                                                                              33
                                           • During daily water collection, children face the risk of drowning and injuries (map 12)
14                                                                                                                                                                                                                                    Latin America                               Eastern Mediterranean                                       Africa                             South-East Asia                                   15
Inher iting the World: The Atlas of Children's Health and the Environment Bruce Gordon, Richard Mackay and Eva Rehfuess - World Health Organization
05 TOILET/sanitation CYAN MAGENTA YELLOW BLACK

                    !                                                                                                                                                                                                                                                                            Meagre sanitation
                 Highly
                Neglected
                  Issue
                                  5           Hurry Up in the Toilet:                                                                                                                                                                                FINLAND
                                                                                                                                                                                                                                                                                                 Percentage of households without access to improved sanitation

                                              2.4 Billion are Waiting                                                                                                                                                                  SWEDEN
                                                                                                                                                                                                                                                                                                 2000 or latest available data
                                                                                                                                                                                                                                                                                                 Improved sanitation facilities include flush toilets and pit latrines, if they are not shared
                                                                                                                                                                                                   UNITED                                                                                        between households and provide privacy.
      “Are we to decide the importance of                                                                                                                                                         KINGDOM
       issues by asking how fashionable or
    glamorous they are? Or by asking how                                                                                                                                                                                                                                                                      over 75%                           6% – 25%
                                                                                                                                                                                                                 NETH.
         seriously they affect how many?”
                    Nelson Mandela (1918– )                                                                                                                                                                                                                                                                   51% – 75%                          5% and under
                                                                                                                                                                                                                                                             UKRAINE
                                                                                                                                                                                                                                                SLOVAKIA
                                                                                                                                                                                                                                                                     REP.
                                                                                                                                                                                                                                            HUNGARY                  MOLDOVA
                                                                                                                                                                                                                                                                                                              26% – 50%                          no data
I
                                                                                                                                                                                                                                 AUSTRIA                 ROMANIA
   magine a life without a clean,                                                                                                                                                                                  SWITZ.       SLOVENIA

   private place to defecate and                                                                                                                                                                                                                 SERBIA & BULGARIA
                                                                                                                                                                                                                                                MONTENEGRO
                                                                                                                                                                                                                   MONACO
urinate: the embarrassment of                                                                                             CANADA
                                                                                                                                                                                                  ANDORRA
                                                                                                                                                                                                                                           ALBANIA

going to the toilet in an
abandoned plot or on the open
                                                                                                                                                                                                                                                                                         KAZAKHSTAN
street and, for girls, the fear of                                                                                                                                                                                                      MALTA                                                                                MONGOLIA

assault at night.                                                                                                                                                                                                                                                                                                                                                         DPR
                                                                                                                                                                                                                                                     GEORGIA                        UZBEKISTAN    KYRGYZSTAN                                                              KOREA
                                                                                                                                                                                                                                                                  AZERBAIJAN
This is the reality of life for a                                                                                                                                                                                                        TURKEY
                                                                                                                                                                                                                                                                                                 TAJIKISTAN
                                                                                                                                                                                                                                                                                                                                                                         REP.
                                                                                                                                                                                                                                                                                                                                                                         KOREA
staggering 2.4 billion people,                                         U S A
                                                                                                                                                                                                       TUNISIA
                                                                                                                                                                                                                                     CYPRUS      SYRIAN ARAB
                                                                                                                                                                                                                                                 REPUBLIC
                                                                                                                                                                                                                                                                                          AFGHANISTAN
                                                                                                                                                                                                                                                                                                                                      C H I N A
                                                                                                                                                                            MOROCCO                                                LEBANON
most of whom live in extreme                                                                                                                                                                                                                               IRAQ            ISL . RE P.
                                                                                                                                                                                                                                                                             IRA N
                                                                                                                                                                                                                                  WEST BANK       JORDAN
poverty in Africa and Asia.                                                                        BAHAMAS                                                                                ALGERIA                LIBYAN
                                                                                                                                                                                                                                   AND GAZA                                                   PAKISTAN
                                                                                                                                                                                                                                                                                                                    NEPAL
                                                                                                                                                                                                                                                                                                                             BHUTAN                                                                        KIRIBATI

                                                                                         CUBA
Inadequate sanitation in the home                             MEXICO
                                                                                                                                                                                                                  ARAB
                                                                                                                                                                                                               JAMAHIRIYA          EGYPT
                                                                                                                                                                                                                                                                                                                                                                                                  TUVALU
and in public places erodes human                                                     JAMAICA
                                                                                                           DOMINICAN
                                                                                                           REP.
                                                                                                                                                                                                                                                           SAUDI ARABIA                                        INDIA        BANGLADESH
                                                                                                                                                                                                                                                                                                                                      MYANMAR     LAO
                                                                                                                                                                                                                                                                                                                                                                                                                      SAMOA
                                                                                                   HAITI                                                                                                                                                                                                                                          PDR                                                                      COOK
                                                                                                                                                              MAURITANIA
dignity, undermines                                              GUATEMALA
                                                                                 BELIZE
                                                                                   HONDURAS
                                                                                                   ST KITTS & NEVIS      ANTIGUA & BARBUDA                                             MALI
                                                                                                                                                                                                                                                                                 OMAN                                                                      VIET NAM
                                                                                                                                                                                                                                                                                                                                                                                        VANUATU
                                                                                                                                                                                                                                                                                                                                                                                                       FIJI             ISLANDS
                                                                                                                         DOMINICA            CAPE VERDE                                              NIGER                                                                                                                                      THAILAND
development, and causes disease.                                  EL SALVADOR
                                                                               NICARAGUA
                                                                                          ST VINCENT & GRENADINES
                                                                                                                        ST LUCIA
                                                                                                                                                              SENEGAL
                                                                                                                                                          GAMBIA                                                   CHAD
                                                                                                                                                                                                                                                      ERITREA      YEMEN
                                                                                                                                                                                                                                                                                                                                                                          PHILIPPINES                                 NIUE
                                                                                                                           BARBADOS                                               BURKINA                                          SUDAN                                                                                                             CAMBODIA
                                                                                          NETH. ANTILLES GRENADA                                  GUINEA-BISSAU                     FASO
                                                                           COSTA RICA                                    TRINIDAD & TOBAGO                                                                                                                      DJIBOUTI
Putting fingers into their mouth                                                                                                                                   GUINEA                          NIGERIA

                                                                                                                                                                                          BENIN
                                                                                                        VENEZUELA

                                                                                                                                                                                        GHANA
                                                                                                                                                                                         TOGO
                                                                                   PANAMA                               GUYANA                                               CÔTE                                                                                                                                       SRI LANKA
                                                                                                                                                           SIERRA LEONE                                                                              ETHIOPIA
puts young children most at risk                                                                COLOMBIA
                                                                                                                            SURINAME                                        D’IVOIRE                                  CENTRAL
                                                                                                                                                                                                                  AFRICAN REPUBLIC
                                                                                                                                                                                                                                                                                                  MALDIVES                                                                                    PALAU

of catching diarrhoea. For                                                                                                                                                                 EQUATORIAL CAMEROON
                                                                                                                                                                                              GUINEA                                       UGANDA
                                                                                                                                                                                                                                                                                                                                                SINGAPORE
families, preventing faecal-oral                                                 ECUADOR                                                                                                               GABON
                                                                                                                                                                                                                                         RWANDA
                                                                                                                                                                                                                                                     KENYA
                                                                                                                                                                                                                         DEM. REP.
contamination depends on proper                                                                                                                                                                                           CONGO          BURUNDI
                                                                                            PERU                                                                                                                                           UNITED REP.                                                      Every minute                                                                                              PAPUA
hygiene, and disposing of                                                                                                                                                                                                                  TANZANIA
                                                                                                                                                                                                                                                                                                  1.1 million litres of raw sewage
                                                                                                                                                                                                                                                                                                                                                                      I N D O N E S I A                                NEW
                                                                                                                                                                                                                                                                                                                                                                                                                      GUINEA
                                                                                                                          BRAZIL                                                                                                                                                                                                                                                                                                  SOLOMON
children’s faeces safely. The                                                                                                                                                                                  ANGOLA                                        COMOROS
                                                                                                                                                                                                                                                                                                 are dumped into the Ganges river.                                                                                                ISLANDS

availability of sufficient water                                                                                                                                                                                               ZAMBIA
                                                                                                                                                                                                                                                MALAWI                                               The same story is repeated
enables both children and adults                                                                              BOLIVIA                                                                                                                                           MADAGASCAR                           in rivers, lakes and oceans
                                                                                                                                                                                                                                     ZIMBABWE                                     MAURITIUS
                                                                                                                                                                                                                                                                                                          around the world.
to wash their hands before meals                                                                                                                                                                               NAMIBIA
                                                                                                                                                                                                                            BOTSWANA
                                                                                                                                                                                                                                            MOZAMBIQUE
                                                                                                                         PARAGUAY
and after defecating. Simple hand-                                                                      CHILE

washing could save up to one                                                                                                                                                                                                                                                                                                                                                       A USTR A LIA
                                                                                                                                                                                                                         SOUTH
million lives every year.                               One gram of faeces                                                                                                                                               AFRICA      LESOTHO
                                                  may contain 10 million viruses,                                                URUGUAY

Realizing the Millennium                           1 million bacteria, a thousand                                      ARGENTINA                                                                                                                                                                                   100%
                                                           parasite cysts
Development Goal of halving the                      and a hundred worm eggs.                                                                                                           Sewerage services
proportion of people without                                                                                                                                                                                                                                                                                                                                                                 86%
access to sanitation by 2015                                                                                                                                                            2000
would still leave almost a quarter                                                                                                                                                                  percentage of population with a flush toilet
                                                                                                                                                                                                    connected to a sewer
of humanity without a basic                                                                                                                                                                                                                                                                                                                                65%
                                                                                                                                                                                                    percentage of urban wastewater that is not treated
latrine. Hopes of achieving even
this modest goal are fading fast.              Health effects                                                                                                                           A sewerage connection is an effective
                                                                                                                                                                                        system for removing human faeces from                                                                                                                                                49%
                                               Diseases caused by inadequate sanitation                                                                                                 a household. However, sewage is
                                               and hygiene:                                                                                                                             frequently discharged, untreated, into
                                               • Intestinal worms (including                                                                                                            rivers, lakes and oceans, where it
                                                  ascariasis, trichuriasis and hookworm)                                                                                                contaminates food and water supplies,
                                               • Schistosomiasis                                                                                                                        causing illness, in particular among the                                                                                                         18%
                                               • Trachoma                                                                                                                               poor. Even in industrialized countries not                                                                    13%
                                               Intestinal diseases (map 4)                                                                                                              all sewage is treated. This dilemma will
                                                                                                                                                                                        continue to plague the sewerage debate.                                                                                Africa                             Asia                        Latin America
                                                                                                                                                                                                                                                                                                                                                                               & Caribbean
16                                                                                                                                                                                                                                                                                                                                                                                                                           17
Inher iting the World: The Atlas of Children's Health and the Environment Bruce Gordon, Richard Mackay and Eva Rehfuess - World Health Organization
06 To Fetch a Pail of Water CYAN MAGENTA YELLOW BLACK

                                                                                                                                                                                                                                       A heavy burden
                                     6           To Fetch a Pail of Water                                                                                                                                                              Percentage of people who must travel
                                                                                                                                                                                                                                       more than half an hour
                                                                                                                                                                                                                                       to fetch water and return home
                                                                                                                                                                                                                                       2001 or latest available data
      A mother and her children take turns
       trekking 14 km to the nearest water
                                                                                                                                                                                                                                              over 50%
    source. The journey is exhausting. They
each carry a bucket weighing up to 20 kg,
     causing backache and, over the years,
                                                                                                                                                                                                                                              26% – 50%
      spinal injury. Some women have been
        picked on by men; others have been                                                                                                                                                                                                    25% and over
attacked by stray dogs or bitten by snakes.
 Water is so hard to come by that there is                                                                                                                                                                                                    no data
               barely sufficient for drinking.

F    etching water prevents
     mothers from looking after
their children and generating
household income. The time
children spend carrying heavy
buckets, queuing at the water
source or being sick with
diarrhoea could be spent in school
or on other productive tasks. In                                                                                                                                MOROCCO
urban slums, paying hefty sums of
money to a water vendor may be
the only way to obtain drinking
                                                                                                                    Time ticking away                                                                                          EGYPT
water at all.
With scarcely enough water to                                                                                     Average number of hours
quench children’s thirst, even less                                                                                           per household
                                                                                                                          spent each month                                   MALI
remains for hand-washing. Dirty,
                                                                                                               on essential water collection    SENEGAL                                         NIGER         CHAD
insufficient water causes                                                                                      2001 or latest available data
diarrhoea and other intestinal                                                                                                                                           BURKINA
diseases in children: the worst hit                                                                                                                                        FASO
                                                                                                                                                       GUINEA

                                                                                                                                                                                      BENIN
families often have no access to                                                                                                                                                              NIGERIA

                                                                                                                                                                              GHANA
                                                                                                                                                                   CÔTE
medical care and are least able to                                                                                                                                D’IVOIRE                                      CENTRAL                      ETHIOPIA
pay for the cost of treatment,                        25
                                                                                                                                                                                                            AFRICAN REPUBLIC
such as oral rehydration salts.                                                                                                                                                                  CAMEROON
                                                                                                                                                                                                                                    UGANDA
Difficulty in obtaining water                                                                                                                                                                                                                KENYA
causes disease, and denies families                                                                                                                                                                                               RWANDA
opportunities for education and
income generation, perpetuating
poverty.                                                                                                                                                                                                                               UNITED REP.
                                                                                                                                                                                                                                       TANZANIA
                                                                                                                                                        Halving the proportion of
                                                                        12                                                                            Africans without access to an
                                                                                                                                                  improved water supply and improved                                                      MALAWI
                                                                                                                                                sanitation would save US$ 1.2 billion in                                ZAMBIA
                                                                                          8                8                                   health treatment costs. Universal access for
                                                                                                                                                   Africans to a piped water supply and
                                                                                                                                                                                                                               ZIMBABWE                 MADAGASCAR
                                                                                                                            5                      sewerage connection in their homes
                                                                                                                                                        would save US$ 6.4 billion.                     NAMIBIA
                                                                                                                                                                                                                                    MOZAMBIQUE

                                                    Pakistan           India           Nepal          Philippines       Indonesia
                                                    Time spent on water collection represents time lost to household and national                                                                                  SOUTH
                                                    economies. Every month, the Indian economy misses out on over 100 million                                                                                      AFRICA
                                                    working days in this way. With its large population, Asia loses more time than
18                                                  any other continent.                                                                                                                                                                                                      19
7 malaria CYAN MAGENTA YELLOW BLACK

                                                                                                                                                                                                Malaria in Africa
                            7         Malaria                                                                                                                                                   Suitability of climate conditions for the transmission of malaria
                                                                                                                                                                                                2004
                                                                                                                                                                                                       climate suitable,            Africa bears the overwhelming burden
                                                                                                                                                                                                       malaria endemic              of malaria. It is home to the deadliest
T    he name “mal aria” was
     coined in Italy, as people
believed that “bad air” brought
                                      Malaria around the world
                                      2004
                                                                                                                                                                                                                                    form of the malaria parasite and to
                                                                                                                                                                                                                                    climatic conditions where mosquitoes
                                                                                                                                                                                                                                    flourish. Local environmental
about the disease. In truth, the                                                                                                                                                                                                    conditions, such as wetlands and
cause of malaria is a parasite                malaria transmission occurs                                                                                                                                                           drainage patterns, also influence the
transmitted from person to                                                                                                                                                                                                          abundance of mosquitoes.
                                              limited risk                                                                                                                                                                          Consequently, dams and irrigation
person through the bite of the
female Anopheles mosquito.                    no malaria                                                                                                                                                                            schemes must be carefully planned
                                                                                                                                                                                                       climate unsuitable,          and managed in order to reduce
The environment is a key                                                                                                                                                                               malaria absent               opportunities for mosquitoes to breed.
determinant of the spread of
malaria – the deadliest of all the
vector-borne diseases. Malaria
flourishes within a certain
temperature range and altitude,
where favourable rainfall patterns
and humidity prevail, and where
animal or human blood is
available. Any clean standing
water provides a potential
breeding site for mosquitoes.
Ninety per cent of the at least one
million deaths a year from malaria
occur in Africa, mostly among
young children. Malaria also
hampers children's education:
because they miss school when ill,                                                                                                   978 661
and because severe episodes of
the disease may cause permanent
neurological damage. Malaria has                                                                                                                          Child deaths from malaria
been estimated to cost Africa                                                                                                                                   Annual deaths from malaria
more than US$ 12 billion every                                                                                                                                  of children under five years
year in lost GDP. The disease                                                                                                                                                          2002
could be controlled for a fraction                                                                                                                                           by WHO region
                                      Other vector-borne diseases
of that sum.
                                      Schistosomiasis        Flat worms, whose life cycle partly takes place in freshwater snails,
Preventive measures, such as                                 burrow through the skin. 200 million people, many of them children,
insecticide-treated bed nets, stop                           are currently infected with schistomiasis.
mosquitoes biting children.
Drugs, such as chloroquine, are       Japanese               This is a virus transmitted by mosquitoes in Asia. 90% of the cases
available, but drug resistance        encephalitis           occur in children under five years.
means that new remedies are
                                      Leishmaniasis          Transmitted by sand flies, this parasite causes skin lesions and
urgently being sought. Malaria is                            damage to internal organs. It killed 59 000 people in 2001.
one of the major public health
challenges undermining                Dengue fever           Mosquitoes transmit the virus, which kills more than 10 000
development. Long-term                                       children every year.
solutions are needed to stop an                                                                                                                  57 877     51 059
African child dying every             Lymphatic              Worms lodging in the lymphatic system can cause deformations in                                             9443         1266        44
                                      filariasis             children as young as 12 years.
30 seconds.                                                                                                                          Africa    South-East   Eastern    Western         The      Europe
                                                                                                                                                  Asia    Mediterranean Pacific      Americas

20                                                                                                                                                                                                                                                                       21
8 Fluoride and Arsenic in Drinking Water CYAN MAGENTA YELLOW BLACK

                                                                                                                                                                                                                                                                                                                     Fluorosis
                                    8           Fluoride and Arsenic                                                                                                                                                                                                                                                 2004 or latest available data

                                                in Drinking Water                                                                                                                                                                                                                                                             cases of dental or skeletal fluorosis reported

   In Kachariadih village, India, a group of                                                                                                                                                                                                                                                                                  no data
  children with limbs twisted out of shape
  hobble forward with the help of walking
      sticks. They grin with embarrassment
         because they cannot run like other                                                                                   CANADA                                                                 NORWAY

    children their age — fluoride poisoning
                    has crippled their limbs.
                                                                                                                                                                                                        GERMANY

M      illions of children are
       exposed to excessive
amounts of fluoride through
                                                                                                                    U     S     A
                                                                                                                                                                                            SPAIN

                                                                                                                                                                                                                                                                                                       CHINA
                                                                                                                                                                                                                                                                                                                              JAPAN

                                                                                                                                                                                                                               ISRAEL
drinking water contaminated from                                                                                                                                                                                                                                       PAKISTAN
natural geological sources. In                                                                                  MEXICO                                                                                                                                                                                                                      There are 2 million cases
China, the burning of fluoride-                                                                                                                                                                                                                  SAUDI ARABIA                       INDIA                                                     of skeletal fluorosis
                                                                                                                                                                                                                                                                                                                                                    in China.
rich coal adds to the problem.                                                                                                                                            SENEGAL                       NIGER
                                                                                                                                                                                                                             SUDAN
                                                                                                                                                                                                                                             ERITREA                                                      THAILAND

Small amounts of fluoride are                                                                                                                                                                        NIGERIA
                                                                                                                                                                                                                                                                                           SRI LANKA
                                                                                                                                                                                                                                             ETHIOPIA
good for teeth; it is added to
                                                                                                                                                                                                                                    UGANDA
toothpaste and, in some countries,                                                                                                                                                                                                      KENYA

to drinking water. At higher
                                                              “The dose makes the poison.”                                                                                                                                              UNITED REP.
                                                                                                                                                                                                                                        TANZANIA
doses, it destroys teeth and                                      Paracelsus, physician                                                                          BRAZIL

accumulates in bones, leading to                                      (1493–1541)
crippling skeletal damage. With
their bodies still growing, children
are most at risk.                                                                                                                                                                                                     SOUTH
                                                                                                                                                                                                                      AFRICA

Like fluoride, arsenic is widely
distributed throughout the earth's                                                                                                                                                                                                                                                                                                              NEW
                                                                                                                                                                                                                                                                                                                                            ZEALAND
crust, and is present in almost all
waters in very small amounts. In
                                                                                                                                                                                                                                                                                              Some estimates suggest
certain areas, however, there are                                                                                                                                                                                                                                                             arsenic in drinking water
dangerous levels of this toxin in                                                                                                                                                                                                                                                               will cause 200 000 to
children’s drinking water. The                  Arsenicosis                                                                                                                                                                                                                                        270 000 deaths
                                                                                                                                                                                                                                                                                                    from cancer in
most tragic example is                          2004 or latest available data                                                                                                                                                                                                                     Bangladesh alone.
Bangladesh, where thousands of
wells are causing a mass poisoning                         elevated levels of arsenic (over 50 µg/l) reported in water
of the population. Unsafe wells                                                                                                                                                                                                                                                                                      Arsenic poisoning in Bangladesh
are marked with red paint,                                 ill-health has been reported due to arsenic-contaminated water                                                                                                                                                                        Sylhet

warning people that this water is                                                                                                                                                   Hawabganj                BANGLADESH                                                                                              Percentage of boreholes tested
                                                                                                                                                                                            Rajshashi                                                                                                                where arsenic levels are
not for drinking.                                                                                                                                                                                         Natore                                                                Habiganj
                                                                                                                                                                                                                                                                                           Moulvibazar
                                                                                                                                                                                                                                                                                                                     above 50 micrograms per litre (µg/l)
                                                                                                                                                                                                                                                                                                                     1999
                                                    C A N A D A                                      FINLAND
                                                                                                                                                                                                                    Pabna

                                                                                                                                                                                                                                                                            ria
Health effects

                                                                                                                                                                                                                                                                          ba
                                                                                                                                                                                                                                                 Dhaka                                                               The provisional WHO guideline value for arsenic

                                                                                                                                                                                                                                                                        an
                                                                                                                                                                                                          Kushtia

                                                                                                                                                                                                                                                                      m
                                                                                                                                                                                                                                                                       j
                                                                                                                                                                                          Meherpur
                                                                                                                                                                                                                                                                                                                     in drinking water is set at 10 µg/l

                                                                                                                                                                                                                                                                    an
                                                                                                                                                                                                                                  Manikganj

                                                                                                                                                                                                                                                                   ah
                                                                                                                                                                                                                                                                ng

                                                                                                                                                                                                                                                                Br
                                                                                                                                                                                                                       Rajbari

                                                                                                                                                                                                                                                           ya
                                                   U S A                                                                                                                                                                                        Dhaka
Fluorosis

                                                                                                                                                                                                                                                           ra
                                                                                                                                                                                                                                                          Na
                                                                                                                                                                                                Chuadanga

                                                                                                                                                                                                               ah
                                                                                              HUNGARY ROMANIA                                                                                                                                    Munshiganj                                                                 75% and over

                                                                                                                                                                                                             aid
• Tooth discoloration and decay                                                                                                              C H I N A                                                                           Faridpur                            Cornilla

                                                                                                                                                                                                         en
                                                                                                                                                                                                                    Magura

                                                                                                                                                                                                        Jh
                                                                                                                         PAKISTAN   NEPAL
• Crippling skeletal damage                                                                                                                                                                                                                  Shariatpur
                                                                                                                                                                                                                                                        Chandpur
                                                MEXICO                                                                         INDIA
                                                                                                                                            MYANMAR                                                                                      Madaripur                                                                          50% – 74%
                                                                                                                                                      VIET NAM                                            Jessore       Narail
                                                                                                                                                                                                                                 Gopalganj
Arsenicosis                                                                                                                         BANGLADESH        CAMBODIA                                                                                                 Lakshmipur         Feni
                                                                                                                                                                                                                                                                                                                            25% – 49%
                                                                                                                                                                                                                                                Barisal
• Skin pigmentation changes and skin                                                                                                         THAILAND
                                                                                                                                                                                                                                        Pirojpur
                                                                                                                                                                                                                                                                       Noakhali

  thickening (hyperkeratosis)                                                                                                                                                                                       Khulna                  Jhalakati                                                                       under 25%
                                                           PERU                                                                                                                                         Satkhira             Bagerhat
• Cancer of the skin, lungs, bladder                                                                                                                                                                                                                                                       Chittagong
  and kidney                                                              BOLIVIA
                                                                                                                                                                                                                                                                                                                            no data
                                                                  CHILE

                                                                          ARGENTINA

                                                                                                                                                                                                                                                                                                 Cox’s

22                                                                                                                                                                                                                                                                                               Bazar
                                                                                                                                                                                                                                                                                                                                                                               23
09 Indoor Smoke CYAN MAGENTA YELLOW BLACK

                   !                                                                                                                                                                                                                                                    Cooking with solid fuel
                Highly
               Neglected
                 Issue
                                9        Indoor Smoke: Breaking
                                                              g                                                                                                              ICELAND
                                                                                                                                                                                   D
                                                                                                                                                                                                                                     FIN
                                                                                                                                                                                                                                       NLAND                            Percentage of households

                                         Down Respiratory Defences                                                                                                                                              NORWAY
                                                                                                                                                                                                                NO
                                                                                                                                                                                                                            SWEDEN
                                                                                                                                                                                                                                EN

                                                                                                                                                                                                                                     ESTON
                                                                                                                                                                                                                                       TO
                                                                                                                                                                                                                                        ONIA
                                                                                                                                                                                                                                                    RUSSIAN
                                                                                                                                                                                                                                                                        using solid fuel for cooking
                                                                                                                                                                                                                                                                        2000 or latest available data
                                                                                                                                                                                               UNITED
                                                                                                                                                                                               UNITE

C                                                                                                                                                                                                                                    LATVIA
                                                                                                                                                                                                                                     LA               FED.
     ooking is central to our                                                                                                                                                                 KI
                                                                                                                                                                                              KINGDO
                                                                                                                                                                                              KINGDOM
                                                                                                                                                                                                                 DENMARK
                                                                                                                                                                                                                    MARK
                                                                                                                                                                                                                       K
                                                                                                                                                                                                                                                                               over 75%                  25% and under
                                                                                                                                                                                                                                 LITHUA
                                                                                                                                                                                                                                      ANIA
     lives, yet the very act of                                                                                                                                                   IRELA
                                                                                                                                                                                    ELAND
                                                                                                                                                                                                                                                                               51% – 75%                 no data
cooking is a threat to children’s
health and well-being.                                                                                                                                                                                                                                                         26% – 50%
                                                                                                                                                                                                                                                                A

Half of the world’s population
rely on solid fuels, such as dung,                                  C A N A D A                                                                                                                                                                                            RUSSIAN FEDERATION
wood, crop waste or coal to meet
their most basic energy needs. In                                                                                                                                                           PAIN

most developing countries, these
fuels are burned in open fires or
rudimentary stoves that give off                           U S A                                                                                                                                                                                                                                                               DPR
                                                                                                                                                                                                                                                                                                                               D
                                                                                                                                                                                                                                                                                                                               K
                                                                                                                                                                                                                                                                                                                               KOREA
                                                                                                                                                                                                                                                                                                                                              JAPAN
                                                                                                                                                                                                                                                                                                                                               APA
black smoke. Children, often                                                                                                                                                                                                                                                                                                   REP.
                                                                                                                                                                                                                                                                                                                               KOREA
                                                                                                                                                                                                                                                                                                                                OREA
carried on their mother’s back
                                                                                                                                                                                                                                                                                                         A
during cooking, are most                                                                                                                                                                             TU
                                                                                                                                                                                                      UNISIA               LE

exposed. The indoor smoke
                                                                                        BAHAMAS                                                                                           LGERIA             LIBYAN
inhaled gives rise to pneumonia                   MEXICO
                                                                                                                                                                                                              ARAB                               BAHRAIN    Q                                                                                     MARSHALL       KIRIBATI
                                                                                                                                                                                                           JAMAHIRIYA      EGYPT                                                                                                                   ISLANDS
                                                                                                                                                                                                                                                                U
and other respiratory infections –                                              CUBA           DOMINICAN                                                                                                                                                                                                                                         NAURU
                                                                                               RE
                                                                                               REP.                                                                                                                                            SAUDI ARABIA
the biggest killer of children                                          ZE
                                                                             JAMAICA
                                                                                   A
                                                                                         HAITI
                                                                                            TI
                                                                                                                                                               MAURITTANIA
                                                                                                                                                                                                                                                                                                                                                       TUVALU

                                                     GU                 NDURAS
                                                                        N D
                                                                                         ST KITTS & NEVIS    ANTIGUA & BARBUDA                                                    MALI
under five years of age. Indoor air                   EL SALVADOR
                                                                                                             DOMINICA
                                                                                                            ST LUCIA
                                                                                                                                             CAPE VERDE
                                                                                                                                                                 SENE
                                                                                                                                                                   NEGAL                           NIGER                               ERIT
                                                                                                                                                                                                                                         ITREA      YEMEN                                                                                                     FIJI
                                                                                                                                                                                                                                                                                                                                                                       SAMOA
                                                                                                                                                                                                                                                                                                                                                                           NIUE
                                                                    NICARA
                                                                    NIC                                                                                   GA                                                                                                                                                                    PHILIPPINES
                                                                                                                                                                                                                                                                                                                                   LIPPINE
pollution is responsible for nearly                                                                            BARBADOS
                                                                                                                                                   GUINEA-
                                                                                                                                                                                                                            UDAN                                                                                                                 VANUATU
                                                                                                                                                                                                                                                                                                                                                                     TONGA
                                                                                                                                                                                                                                                                                                                                                                                 COOK
                                                                                                                                                                                                                                                                                                                                                                              ISLANDS
                                                              COSTA RICA
                                                                      CA                                    TRINIDAD & TOBAGO
half of the more than 2 million                                        PA                                   UYANA
                                                                                                            U                                                                                                                         ETHI                                                SRI LANKA
                                                                                                                                                                                                                                                                                                                                                      PALAU
deaths each year that are caused                                                   COLOMB
                                                                                                               SURINAME
                                                                                                               SUR
                                                                                                                 RI
                                                                                                                 R
                                                                                                                                                                                                                                                                               MALDIVES
                                                                                                                                                                                                                                                                                                                        DAR.

by acute respiratory infections.                                                                                                                                                       EQU                                                        SOMAL
                                                                                                                                                                                                                                                    MALIA                                                    MALAYSIA
                                                                                                                                                                                                                                                                                                                                                                         MICRONESIA,
                                                                                                                                                                                                                                         YA                                                             SINGAPORE
                                                                                                                                                                                                                                                                                                         INGAPORE                                                        FED. STATES OF
                                                                      ECUAD
                                                                          DOR                                                                                                          SAO
Good ventilation and improved                                                                                                                                                          & PR

cooking stoves can dramatically                                                  PERU                                                                                                                                                                                                                                 I N D O N E S I A
                                                                                                                                                                                                                                                                                                                                                                             PAPUA
                                                                                                                                                                                                                                                                                                                                                                              NEW
                                                                                                                                                                                                                                                                                                                                                                                  A

reduce children’s exposure to                                                                                   BRAZIL                                                                                                                                                                                                                                                       GUINEA
                                                                                                                                                                                                                                                                                                                                                                              UIN         SOLOMON
                                                                                                                                                                                                                                                                                                                                                                                          I LA
                                                                                                                                                                                                                                                                                                                                                                                          ISLANDS
                                                                                                                                                                                                           A
smoke. Ultimately, making the
transition to gas and electricity                                                                                                                                                                                                                MADAGASC
                                                                                                                                                                                                                                                                    S
will save lives and reduce the                                                                                                                                                                             NA

physical toll on women and                                                                                                                                                                                                               UE

children from gathering wood,                                                                                                                                                                                                                                                                                                            A USTR A LIA
freeing time for education and
development.
This problem has been largely                                                                                                                                                            Smoky homes
ignored by policy-makers.                      The Energy Ladder
                                                                                                                                     Electricity                                         Typical 24-hour mean concentration                                                                                                                                                           NEW
                                               Increasing cleanliness,                                                                                                                   of particulate matter of                                                                                                                                                               ZEALAND
                                                                                                                                                                                                                                                                                                                                                                                      D

                                               efficiency,                                                                                                                               less than 10 micrometres
Health effects                                                                                                              petroleum gas,
                                               convenience                                                                  ural gas                                                     in diameter (PM10)
Established effects:                                                                                                                                                                     early 2000s
• Pneumonia and other respiratory infections                                                                Kerosene                                                                     micrograms per cubic metre
• Chronic obstructive pulmonary disease                                                                                                                                                  (µg/m3)
  (including bronchitis, emphysema)
                                                                                           Charcoal, coal
Suspected effects:
• Tuberculosis
                                                                                   Wood                                                                                                  European Union standard 50
• Cataracts
• Asthma
• Low birth weight                                          Crop waste, dung
• Middle ear infection (otitis media)                                                                                           Increasing prosperity
                                                                                                                                                                                                                                                      Hut with an open fire          Bangkok roadside          Berlin city centre
24                                                                                                                                                                                                                                                                                                                                                                              25
10 Passive Smoking CYAN MAGENTA YELLOW BLACK

                                                                                                                                                                                                                                                                                         Children’s voices
                              10               Passive Smoking:                                                                                                                                                                                                                          Percentage of students aged 13–15 years                          Framework Convention

                                               Children Protest                                                                                                                                                                    SWEDEN
                                                                                                                                                                                                                                                     ESTONIA
                                                                                                                                                                                                                                                                                         who want bans on smoking in public places
                                                                                                                                                                                                                                                                                         1999–2003
                                                                                                                                                                                                                                                                                                                                                          on Tobacco Control

                                                                                                                                                                                                                                                                                                                                                                  first five countries
“Child abuse doesn’t have to mean broken                                                                                                                                                                                                             LATVIA
                                                                                                                                                                                                                                                                                                over 75%                       no data                            to ratify convention
          bones and black and blue marks.
       Young growing tissues are far more                                                                                                                                                                                                                                                      51% – 75%                       sub-national data
                                                                                                                                                                                                                                            POLAND
  vulnerable to carcinogens than those of                                                                                                                                                                                                                                                                                      available only
  adults. Knowingly subjecting children to                                                                                                                                                                                           CZECH
  respiratory tract disease is child abuse.”                                                                                                                                                                                         REPUBLIC SLOVAKIA
                                                                                                                                                                                                                                                       UKRAINE                                 26% – 50%
         Dr. William Cahan, Memorial Sloan                                                                                                                                                                                     SLOVENIA       BOSNIA &
         Kettering Cancer Center, USA, 1993                                                                                                                                                                                                   HERZEGOVINA
                                                                                                                                                                                                                                  CROATIA
                                                                                                                                                                                                                                                   SERBIA &
                                                                                                                                                                                                                                                  MONTENEGRO BULGARIA                      RUSSIAN FEDERATION

T     he burning of tobacco
      produces a cocktail of
dangerous chemicals. Almost half
                                                                                                                                                                                                                                                         FYR MACEDONIA

the world’s children (about 700                                                                                                                                                                                                           MALTA

million) are exposed to smoke
                                                                                                                                                                                                                                                      GEORGIA
from burning tobacco and exhaled
smoke at home. Environmental                                                                                                                                                                                                                       SYRIAN ARAB
                                                                                                                                                                                                                                                                                                                      C H I N A
tobacco smoke has particularly                                                                                                                                                                                                                     REPUBLIC
                                                                                                                                                                                                                                                                         ISL . RE P.
                                                                                                                                                                                                                                                                           IRA N
harmful effects on foetuses and                                                                                                                                                                                                   WEST BANK
                                                                                                                                                                                                                                   AND GAZA
                                                                                                                                                                                                                                                    JORDAN

young children, causing                                             MEXICO
                                                                                                                    BAHAMAS                                                                                        LIBYAN
                                                                                                                                                                                                                    ARAB
                                                                                                                                                                                                                                                                                                       NEPAL

                                                                                                                                                                                                                 JAMAHIRIYA
respiratory infections and other                                                                        CUBA
                                                                                                                           HAITI
                                                                                                                                                                                                                                                                                                 INDIA
illness.                                                                                              JAMAICA                                ANTIGUA & BARBUDA
                                                                                                                                                                                                                                                                               OMAN
                                                                                                                                                                                                                                                                                                                              LAO
                                                                                                                                                                                                                                                                                                                              PDR
                                                                                                                                               MONTSERRAT (UK)                                                                                                                                                                      VIET NAM
                                                                         GUATEMALA                                      ST KITTS & NEVIS
                                                                                                HONDURAS
                                                                                                                                               DOMINICA
Children do not choose to inhale                                           EL SALVADOR                   ST VINCENT & GRENADINES             ST LUCIA
                                                                                                                                                                                   SENEGAL                                                                       YEMEN
                                                                                                                                                                                                                                                                                                                                                    PHILIPPINES
                                                                                                                                                                                                                                                                                                                                                                          FIJI

                                                                                                                        GRENADA                  BARBADOS                                                                                                                                                                                                                           COOK
a mix of over 4000 chemicals,                                                           COSTA RICA                                            TRINIDAD & TOBAGO
                                                                                                                                                                                                       NIGERIA
                                                                                                                                                                                                                                                                                                                               CAMBODIA                                          ISLANDS

                                                                                                                                                                                               BENIN
                                                                                                                           VENEZUELA
including carcinogens. In fact,

                                                                                                                                                                                             GHANA
                                                                                                                                                                                              TOGO
                                                                                                  PANAMA                                     GUYANA                                                                                                                                                      SRI LANKA
                                                                                                                                                 SURINAME                                                                                             ETHIOPIA
the majority of children
                                                                                                                                                                                                                                             UGANDA
worldwide urge people to stop
smoking in public places. At
                                                                                                                                                                                                                                                                            SEYCHELLES
home, it is the responsibility of                                                                          PERU                                                                                                                                                                                                                                I N D O N E S I A
parents to protect their children                                                                                                             BRAZIL
and stop smoking. Media                                                                                                                                                                                                                           MALAWI
                                                                                                                                                                                                                                 ZAMBIA
campaigns, combined with
                                                                                                                                   BOLIVIA
smoking restrictions in public                                                                                                                                                                                                        ZIMBABWE

                                                                                                                                                                                                                              BOTSWANA
places and the workplace, can                                                                                               CHILE             PARAGUAY
                                                                                                                                                                                                                                             MOZAMBIQUE

help make homes tobacco-free.
Other tobacco control measures                                                                                                                                                                                           SOUTH
                                                                                                                                                                                                                         AFRICA       LESOTHO
include taxation, bans on tobacco                                                                                                                    URUGUAY

advertising and health warnings                                                                                                            ARGENTINA
                                                                                                                                                                                                                                                                                                                     BRAIN
on cigarette packs. The                                                                                                                                                                                                                                                                                              • Possible association with
Framework Convention on                                                                                                                                                                                                          Health effects on children                                                            brain tumours and long-term
Tobacco Control, an international                                                                                                                                                                                                                                                                                      mental effects
treaty instigated by WHO, is                                                                                                                                                                                                                  • Increased risk of sudden
currently in the process of                                                                                                                                                                                                                                                                                          EARS
                                                                                                                                                                                                                                                  infant death syndrome
                                                                                                                                                                                                                                                                                                                     • Middle ear infections
signature and ratification.                                                                                                                                                                                                                                                                                            (chronic otitis media)
                                                           58%                                             58%                                                                                                                                                   HEART
Children whose parents and                                                                                                     50%                 Exposure in the home                                                                      • Adverse effect on oxygen
                                                                                                                                                                                                                                                                                                                     LUNGS
friends smoke are more likely to                                       47%                                                                                                                                                                          uptake and arteries
                                                                                                                                                                                                                                                                                                                     • Respiratory diseases
become addicted themselves;                     41%                                                                                                Percentage of children exposed to                                                                                                                                   (including bronchitis and
                                                                                           36%                                                     tobacco smoke in the home                                                                                      BLOOD
250 million children alive today                                                                                                                                                                                                                                                                                       pneumonia)
                                                                                                                                                                                                                                             • Possible association with
will be killed by tobacco if                                                                                                                       1999–2003                                                                                                                                                         • Asthma induction and
                                                                                                                                                                                                                                                              lymphoma
                                                                                                                                                   by WHO region                                                                                                                                                       exacerbation
                                                                        Mediterranean

current consumption trends                                                                                                                                                                                                                                                                                           • Chronic respiratory symptoms
                                                                                                           South-East

continue.                                                                                                                                                                                                                                                    BURNS
                                                                                                                                                                                                                                                                                                                       (wheezing, coughing,
                                                Americas

                                                                                                                              Western

                                                                                                                                                                                                                                     • From fires caused by tobacco
                                                                        Eastern
                                                           Europe

                                                                                                                              Pacific

                                                                                                                                                                                                                                                                                                                       breathlessness)
                                                                                             Africa

                                                                                                           Asia
                                                The

                                                                                                                                                                                                                                                                                                                     • Decreased lung function
26                                                                                                                                                                                                                                                                                                                                                                                 27
11 Polluted cities CYAN MAGENTA YELLOW BLACK

                                                                                                                                                                                 ICELAND
                                                                                                                                                                                                                                                                                                                                                         Dirty air: the silent killer
                             11               Polluted Cities:
                                                                                                                                                                                                                                                                                                              Oulu
                                                                                                                                                                                                                                                                                                              FINLAND
                                                                                                                                                                                                                                                                                                                  Kuopio
                                                                                                                                                                                                                                                                                                                                                         Average concentration of small particles (PM10)

                                              The Air Children Breathe                                                                                                                                                                                      NORWAY
                                                                                                                                                                                                                                                                                SWEDEN
                                                                                                                                                                                                                                                                                                                  Helsinki
                                                                                                                                                                                                                                                                                                                   Tallinn
                                                                                                                                                                                                                                                                                                                                                         in outdoor urban air by WHO sub-region
                                                                                                                                                                                                                                                                                                                                                         2000
                                                                                                                                                                                                                                                                                                                                                         micrograms per cubic metre (µg/m3)
        “The widespread exposure of large                                                                                                                                                                        UNITED                                                                                   ESTONIA
numbers of children to heavily polluted air                                                                                                                                                                                                                                     Gothenburg                                    RUSSIAN
                                                                                                                                                                                                                KINGDOM
                                                                                                                                                                                                                                                                                                         LATVIA                 FED.                                  over 25
 in developing countries has skyrocketed.”                                                                                                                                                                            Glasgow
             World Resources Institute 1999                                                                                                                                                                                                              DENMARK                   Malmo            LITHUANIA
                                                                                                                                                                                                                                                                                                                                                                      21 – 25                           11 – 15
                                                                                                                                                                                                    Dublin                        Leeds
                                                                                                                                                                                                                                                                      Hamburg

P    ower plants, factories and
     vehicles spew out harmful
gases and small particles that can
                                                                                                                                                                                                IRELAND
                                                                                                                                                                                                             Birmingham
                                                                                                                                                                                                                                    London

                                                                                                                                                                                                                                   Brussels
                                                                                                                                                                                                                                                  NETH.
                                                                                                                                                                                                                                                    Amsterdam
                                                                                                                                                                                                                                                  Rotterdam
                                                                                                                                                                                                                                                      GERMANY Prague
                                                                                                                                                                                                                                                                              POLAND
                                                                                                                                                                                                                                                                             Lodz
                                                                                                                                                                                                                                                                            Berlin
                                                                                                                                                                                                                                                                                Wroclaw
                                                                                                                                                                                                                                                                                          Warsaw

                                                                                                                                                                                                                                                                                       Krakow
                                                                                                                                                                                                                                                                                                    BELARUS

                                                                                                                                                                                                                                                                                                            UKRAINE
                                                                                                                                                                                                                                                                                                                                                                      16 – 20
                                                                                                                                                                                                                                                                                                                                                         Average concentration of small particles (PM10)
                                                                                                                                                                                                                                                                                                                                                                                                        no data

                                                                                                                                                                                                                                       BELGIUM
                                                                                                                                                                                                                                                LUX.                         Brno                                                                        in selected European cities
penetrate deep into children’s                                                                                                                                                                                          Brest
                                                                                                                                                                                                                                                       Stuttgart CZECH REP.      SLOVAKIA   Kosice
                                                                                                                                                                                                                                                                                                                                                         2001
                                                                                                                                                                                                                                                                                  Bratislava                  REP.
                                                                                                                                                                                                                                                                         Linz
lungs. In strong sunlight, oxides of                                                                                                                                                                                                  Paris Metz      Munich
                                                                                                                                                                                                                                                                           Graz HUNGARY
                                                                                                                                                                                                                                                                                                              MOLDOVA                                    micrograms per cubic metre (µg/m3)
                                                                                                                                                                                                                                                               AUSTRIA
nitrogen from vehicle exhaust                                                                                                                                                                                                      FRANCE      SWITZ.
                                                                                                                                                                                                                                                        Zurich
                                                                                                                                                                                                                                                              SLOVENIA    Ljubljana               ROMANIA
                                                                                                                                                                                                                                                                                                                                                                      over 30
                                                                                                                                                                                                                                                 Brescia
fumes form ozone at ground level,                                                                                                                                                                                                                    Modena         CROATIA    B-H
                                                                                                                                                                                                                                                                                        SERBIA &
                                                                                                                                                                                                                                                                                                           Ruse
                                                                                                                                                                                                                                                                Florence             MONTENEGRO                                                                       21 – 30
which can trigger asthma attacks.                                                                                                                                                                                      Burgos                    Toulon                                            BULGARIA    Burgas
                                                                                                                                                                                                                                                                                 Rome                    FYR MACEDONIA                                                20 and under
                                                                                                                                                                                                                                                                                               ALBANIA
Air pollution does not respect                                                                                                                                                        PORTUGAL                         Guadalajara                                                ITALY                                                                  PM10 refers to particles less than 10 micrometres in
                                                                                                                                                                                                                                                                                                              Thessaloniki
national borders. Heavy metals                                                                                                                                                                            SPAIN                                                                                                                                          diameter, which can penetrate deep into the lungs
                                                                                                                                                                                               Lisbon                      Albacete
and persistent organic pollutants                                                                                                                                                                                                                                                                              Athens                                    and cause adverse health effects. The European
                                                                                                                                                                                                                                                                                 Palermo                  GREECE                                         Union standard for 24-hour mean PM10 levels is set
are carried by winds,                                                                                                                                                                                                                                                                                                                                    at 50 µg/m3, not to be exceeded more than 35 days
contaminating water and soil far                                              C A N A D A                                                                                                                                                                                            MALTA                                                               per year.
from their origin. In the late
                                                                                                                                                                                                                                                                                                                   RUSSIAN FEDERATION
1990s, forest fires, mainly in
Indonesia, caused a haze of smoke
to hang for months over                                                                                                                                                                             see inset
                                                                                                                                                                                                                                                                                      KAZAKHSTAN
                                                                                                                                                                                                                                                                                                                                      MONGOLIA
neighbouring South-East Asian
                                                                                                                                                                                                                                                                                                                                                                                      DPR
countries. Schools and                                                U S A                                                                                                                                                                               GEORGIA
                                                                                                                                                                                                                                                                       AZERBAIJAN
                                                                                                                                                                                                                                                                                      UZBEKISTAN      KYRGYZSTAN                                                                      KOREA
                                                                                                                                                                                                                                                                                                                                                                                                     JAPAN
kindergartens were forced to                                                                                                                                                                                                                          TURKEY         ARMENIA    TURKMENISTAN
                                                                                                                                                                                                                                                                                                     TAJIKISTAN
                                                                                                                                                                                                                                                                                                                                                                                      REP.
                                                                                                                                                                                                                                                                                                                                                                                      KOREA
close, while local hospitals                                                                                                                                                                                                               CYPRUS       SYRIAN ARAB
                                                                                                                                                                                                                                                        REPUBLIC                                                                               C H I N A
                                                                                                                                                                                                                                        LEBANON                                                AFGHANISTAN
                                                                                                                                                                                                             TUNISIA
reported large numbers of haze-                                                                                                                                                 MOROCCO                                                   ISRAEL                 IRAQ           ISL . RE P.
                                                                                                                                                                                                                                                                                  IRA N
                                                                                                                                                                                                                                      WEST BANK         JORDAN
related illnesses in young                                                                        BAHAMAS                                                                                    ALGERIA                LIBYAN
                                                                                                                                                                                                                                       AND GAZA                           KUWAIT                   PAKISTAN
                                                                                                                                                                                                                                                                                                                             NEPAL
                                                                                                                                                                                                                                                                                                                                      BHUTAN

                                                                                                                                                                                                                     ARAB
children.                                                    MEXICO                                                                                                                                               JAMAHIRIYA
                                                                                                                                                                                                                                                                     BAHRAIN    QATAR
                                                                                                                                                                                                                                                                                  UAE
                                                                                                                                                                                                                                                                                                                                                                                                           MARSHALL
                                                                                                                                                                                                                                                                                                                                                                                                            ISLANDS
                                                                                                                                                                                                                                                                                                                                                                                                                        KIRIBATI
                                                                                                                                                                                                                                                                                                                                                                                                                                 TOKELAU
                                                                                                                                                                                                                                          EGYPT
                                                                                        CUBA              DOMINICAN                                                                                                                                                                                                  INDIA           BANGLADESH                                                           NAURU
                                                                                                                                                                                                                                                                  SAUDI ARABIA
The Great London Smog of 1952                                                  BELIZE
                                                                                     JAMAICA
                                                                                                   HAITI
                                                                                                          REP.
                                                                                                                                                            MAURITANIA                                                                                                                OMAN
                                                                                                                                                                                                                                                                                                                                               MYANMAR     LAO
                                                                                                                                                                                                                                                                                                                                                           PDR
                                                                                                                                                                                                                                                                                                                                                                    VIET NAM
                                                                                                                                                                                                                                                                                                                                                                                                               TUVALU

                                                                                                   ST KITTS & NEVIS       ANTIGUA & BARBUDA                                           MALI
focused the world’s attention on                                GUATEMALA       HONDURAS
                                                                                                                         DOMINICA             CAPE VERDE
                                                                                                                                                               SENEGAL                                   NIGER                                             ERITREA      YEMEN
                                                                                                                                                                                                                                                                                                                                                         THAILAND
                                                                                                                                                                                                                                                                                                                                                                                                                      FIJI
                                                                                                                                                                                                                                                                                                                                                                                                                               SAMOA
                                                                                                                                                                                                                                                                                                                                                                                                                                     NIUE
                                                                EL SALVADOR             ST VINCENT & GRENADINES         ST LUCIA                                                                                         CHAD
                                                                                                                                                           GAMBIA                                                                                                                                                                                                                      PHILIPPINES
the problem of air pollution, and                                             NICARAGUA
                                                                                                       GRENADA              BARBADOS
                                                                                                                                                   GUINEA-BISSAU
                                                                                                                                                                                     BURKINA
                                                                                                                                                                                      FASO
                                                                                                                                                                                                                                        SUDAN
                                                                                                                                                                                                                                                                                                                                                              CAMBODIA                                    VANUATU
                                                                                                                                                                                                                                                                                                                                                                                                                             TONGA
                                                                                                                                                                                                                                                                                                                                                                                                                                         COOK
                                                                                                                                                                                                                                                                                                                                                                                                                                      ISLANDS
                                                                        COSTA RICA                                      TRINIDAD & TOBAGO                                                                                                                            DJIBOUTI
since then there has been a

                                                                                                                                                                                            BENIN
                                                                                                       VENEZUELA
                                                                                                                                                                GUINEA          CÔTE                 NIGERIA

                                                                                                                                                                                          GHANA
                                                                                                                                                                                           TOGO
                                                                                 PANAMA                                 GUYANA                                                                                                                                                                                                  SRI LANKA
                                                                                                                                                            SIERRA LEONE       D’IVOIRE                                     CENTRAL                        ETHIOPIA
marked improvement in air                                                                   COLOMBIA
                                                                                                                            SURINAME
                                                                                                                                                                     LIBERIA                                           AFRICAN REPUBLIC
                                                                                                                                                                                                                                                                                                     MALDIVES                                                           BRUNEI DAR.
                                                                                                                                                                                                                                                                                                                                                                                                             PALAU

quality in developed countries.                                                                                                                                                              EQUATORIAL CAMEROON                                                      SOMALIA                                                                                    MALAYSIA
                                                                                                                                                                                                GUINEA                                           UGANDA
                                                                                                                                                                                                                                                                                                                                                                                                                                MICRONESIA,
Nevertheless, every year outdoor                                                ECUADOR                                                                                                     SAO TOME
                                                                                                                                                                                                           GABON
                                                                                                                                                                                                                                DEM. REP.
                                                                                                                                                                                                                                                          KENYA
                                                                                                                                                                                                                                                                                  SEYCHELLES
                                                                                                                                                                                                                                                                                                                                                         SINGAPORE                                                              FED. STATES OF
                                                                                                                                                                                                                                               RWANDA
                                                                                                                                                                                            & PRINCIPE
air pollution is responsible for the                                                                                                                                                                          CONGO              CONGO
                                                                                                                                                                                                                                               BURUNDI
                                                                                                                                                                                                                                                                                                                                                                                                                                     PAPUA
death of hundreds of children in                                                           PERU                                                                                                                                                       UNITED REP.                                                                                                              I N D O N E S I A                                      NEW
                                                                                                                                                                                                                                                      TANZANIA                                                                                                                                                                       GUINEA
                                                                                                                         BRAZIL                                                                                                                                                                                                                                                                                                                  SOLOMON
Europe, and of more than 24 000                                                                                                                                                                                        ANGOLA
                                                                                                                                                                                                                                                                    COMOROS
                                                                                                                                                                                                                                                                                                                                                                                                     TIMOR-LESTE                                 ISLANDS

globally.                                                                                                                                                                                                                            ZAMBIA
                                                                                                                                                                                                                                                      MALAWI
                                                                                                                                                                                                                                                                                                                   The entire bus fleet
                                                                                                                                                                                                                                                                     MADAGASCAR
Industrial growth and rapid
                                                                                                              BOLIVIA
                                                                                                                                                                                                                                            ZIMBABWE                                   MAURITIUS              of New Delhi has converted to
                                                                                                                                                                                                                   NAMIBIA
                                                                                                                                                                                                                                 BOTSWANA                                                                     compressed natural gas to ease
urbanization aggravate the                                                                             CHILE            PARAGUAY
                                                                                                                                                                                                                                                 MOZAMBIQUE
                                                                                                                                                                                                                                                                                                               the city’s infamous pea-soup
problem, with the pressure felt                                                                                                                                                                                                                                                                                             smog.                                                               A USTR A LIA
most acutely in the megacities of              Health effects on children                                                                                                                                                    SOUTH
                                                                                                                                                                                                                                               SWAZILAND

                                                                                                                                                                                                                             AFRICA         LESOTHO
the developing world. Use of                   • Pneumonia and other lower
                                                                                                                                URUGUAY

cleaner fuels and technologies,                  respiratory infections                                               ARGENTINA

refined motor engines, and public              • Asthma
transport are crucial in ensuring              • Low birth weight
                                                                                                                                                                                                                                                                                                                                                                                                                                       NEW
that children breathe clean air.                                                                                                                                                                                                                                                                                                                                                                                                ZEALAND

28                                                                                                                                                                                                                                                                                                                                                                                                                                      29
12 Child Injuries CYAN MAGENTA YELLOW BLACK

                                                                                                                                                                                                                                                                                                Dying on the roads
                             12               Child Injuries                                                                                                              ICELAND
                                                                                                                                                                                                                                                    FINLAND                                     Deaths due to road traffic accidents of children aged 0–14 years

                                              are Preventable                                                                                                                                                       NORWAY
                                                                                                                                                                                                                                       SWEDEN

                                                                                                                                                                                                                                                   ESTONIA
                                                                                                                                                                                                                                                                      RUSSIAN
                                                                                                                                                                                                                                                                                                per 100 000
                                                                                                                                                                                                                                                                                                2002
                                                                                                                                                                                                                                                                                                by WHO sub-region
                                                                                                                                                                                                 UNITED                                             LATVIA              FED.
 Emeka slipped while drawing water from                                                                                                                                                         KINGDOM
                                                                                                                                                                                                                         DENMARK                LITHUANIA
  the river near her village in Nigeria and                                                                                                                                                                                                                                                                  20.0 and over                         2.5 – 4.9
                                                                                                                                                                                     IRELAND
                 did not return home . . .                                                                                                                                                                       NETH.                                      BELARUS
                                                                                                                                                                                                                                            POLAND
                                                                                                                                                                                                       BELGIUM            GERMANY
                                                                                                                                                                                                                                      CZECH
                                                                                                                                                                                                                                                                                                             10.0 – 19.9                           under 2.5
                                                                                                                                                                                                                                                        UKRAINE

D
                                                                                                                                                                                                                                      REPUBLIC SLOVAKIA
       rowning is the most                                                                                                                                                                                       LUX.                                                  REP.
                                                                                                                                                                                                                                  AUSTRIA HUNGARY                      MOLDOVA                               5.0 – 9.9                             no data
       common cause of injuries                                                                                                                                                                        FRANCE      SWITZ.       SLOVENIA           ROMANIA
                                                                                                                                                                                                                                 CROATIA B-H SERBIA &
for infants, killing approximately                                  C A N A D A                                                                                                                                                             MONTENEGRO BULGARIA
                                                                                                                                                                                                                                 ITALY                                                                 RUSSIAN FEDERATION
60 000 children under five every                                                                                                                                          PORTUGAL
                                                                                                                                                                                                                                         ALBANIA
                                                                                                                                                                                                                                                   FYR MACEDONIA
                                                                                                                                                                                             SPAIN
year and leaving roughly the same
                                                                                                                                                                                                                                                      GREECE
number permanently disabled.                                                                                                                                                                                                                                                         KAZAKHSTAN
                                                                                                                                                                                                                                        MALTA
Children also suffer burns from                             U S A
                                                                                                                                                                                                                                                                                                                              MONGOLIA

open fires and kerosene stoves,                                                                                                                                                                                                                      GEORGIA                     UZBEKISTAN      KYRGYZSTAN
                                                                                                                                                                                                                                                                                                                                                                               DPR
                                                                                                                                                                                                                                                                                                                                                                               KOREA
                                                                                                                                                                                                                                                                                                                                                                                              JAPAN
                                                                                                                                                                                                                                                                  AZERBAIJAN
and are injured in falls at home, at                                                                               Deaths from road accidents                                                                                            TURKEY                 ARMENIA    TURKMENISTAN
                                                                                                                                                                                                                                                                                                TAJIKISTAN
                                                                                                                                                                                                                                                                                                                                                                               REP.
                                                                                                                                                                                                                                                                                                                                                                               KOREA
school and at playgrounds.                                                                                         are projected to rise by 65%                                                                                        CYPRUS      SYRIAN ARAB
                                                                                                                                                                                                                                                                                                                                       C H I N A
                                                                                                                                                                                                                                                   REPUBLIC
                                                                                                                        by 2020, mostly in                                                             TUNISIA                      LEBANON
                                                                                                                                                                                                                                      ISRAEL                               ISL . RE P.
                                                                                                                                                                                                                                                                                         AFGHANISTAN
                                                                                                                                                                          MOROCCO                                                                            IRAQ
In older children, however, the                                                                                        developing countries.                                                                                       WEST BANK       JORDAN                    IRA N
                                                                                                                                                                                                                                    AND GAZA                          KUWAIT                  PAKISTAN                        BHUTAN
                                                                                        BAHAMAS                                                                                             ALGERIA            LIBYAN
overriding cause of injuries is                                                                                                                                                                                 ARAB                                            BAHRAIN     QATAR
                                                                                                                                                                                                                                                                                                                     NEPAL
                                                                                                                                                                                                                                                                                                                                                                                                   MARSHALL     KIRIBATI
                                                   MEXICO                                                                                                                                                    JAMAHIRIYA                                                                                                                                                                             ISLANDS
                                                                                                                                                                                                                                                                                                                                                                                                                         TOKELAU
road traffic accidents, killing                                               CUBA              DOMINICAN
                                                                                                                                                                                                                                      EGYPT                                   UAE
                                                                                                                                                                                                                                                                                                              INDIA          BANGLADESH                                                           NAURU
                                                                                                REP.                                                                                                                                                         SAUDI ARABIA                                                                           LAO
approximately 180 000 children                                       BELIZE
                                                                           JAMAICA
                                                                                         HAITI                ANTIGUA & BARBUDA
                                                                                                                                                       MAURITANIA                                                                                                                OMAN
                                                                                                                                                                                                                                                                                                                                       MYANMAR
                                                                                                                                                                                                                                                                                                                                                    PDR
                                                                                                                                                                                                                                                                                                                                                             VIET NAM
                                                                                                                                                                                                                                                                                                                                                                                                       TUVALU

                                                      GUATEMALA       HONDURAS           ST KITTS & NEVIS                                                                            MALI                                                                                                                                                                                                                              SAMOA
under 15 each year. Children are                      EL SALVADOR               ST VINCENT & GRENADINES
                                                                                                               DOMINICA
                                                                                                              ST LUCIA
                                                                                                                                         CAPE VERDE
                                                                                                                                                          SENEGAL                                    NIGER                                            ERITREA       YEMEN
                                                                                                                                                                                                                                                                                                                                                  THAILAND
                                                                                                                                                                                                                                                                                                                                                                                                              FIJI         NIUE
                                                                    NICARAGUA                                                                         GAMBIA                                                                        SUDAN                                                                                                                                       PHILIPPINES
                                                                                                                                                                                                                   CHAD
rarely the cause of road traffic                                                               GRENADA            BARBADOS
                                                                                                                                              GUINEA-BISSAU
                                                                                                                                                                               BURKINA
                                                                                                                                                                                FASO                                                                            DJIBOUTI
                                                                                                                                                                                                                                                                                                                                                       CAMBODIA
                                                                                                                                                                                                                                                                                                                                                                                                  VANUATU
                                                                                                                                                                                                                                                                                                                                                                                                                     TONGA
                                                                                                                                                                                                                                                                                                                                                                                                                                 COOK
                                                                                                                                                                                                                                                                                                                                                                                                                              ISLANDS
                                                              COSTA RICA                                      TRINIDAD & TOBAGO

                                                                                                                                                                                        BENIN
                                                                                                                                                         GUINEA                                 NIGERIA
accidents but suffer as pedestrians,                                                         VENEZUELA

                                                                                                                                                                                      GHANA
                                                                                                                                                                                       TOGO
                                                                       PANAMA                                 GUYANA                                                       CÔTE                                                                                                                                          SRI LANKA
                                                                                                                  SURINAME                             SIERRA LEONE       D’IVOIRE                                   CENTRAL                         ETHIOPIA                                   MALDIVES                                                                                              PALAU
                                                                                                                                                                                                                                                                                                                                                                 BRUNEI DAR.
cyclists and passengers. Boys,                                                     COLOMBIA                                                                     LIBERIA                                          AFRICAN REPUBLIC

                                                                                                                                                                                         EQUATORIAL CAMEROON                                                     SOMALIA                                                                                  MALAYSIA
often given greater freedom to                                                                                                                                                              GUINEA                                         UGANDA
                                                                                                                                                                                                                                                                                                                                                  SINGAPORE
                                                                                                                                                                                                                                                                                                                                                                                                                         MICRONESIA,
                                                                                                                                                                                                                                                     KENYA                                                                                                                                                               FED. STATES OF
                                                                      ECUADOR                                                                                                                          GABON
roam, are more likely to be                                                                                                                                                             SAO TOME                          DEM. REP.      RWANDA                                  SEYCHELLES
                                                                                                                                                                                        & PRINCIPE        CONGO            CONGO         BURUNDI
injured than girls.                                                              PERU                                                                                                                                                          UNITED REP.
                                                                                                                                                                                                                                                                                                                                                                                                                             PAPUA
                                                                                                                                                                                                                                                                                                                                                                        I N D O N E S I A                                     NEW
                                                                                                                                                                                                                                               TANZANIA
                                                                                                               BRAZIL                                                                                                                                                                                                                                                                                                        GUINEA       SOLOMON
Injuries are unnecessary and                                                                                                                                                                                   ANGOLA                                         COMOROS
                                                                                                                                                                                                                                                                                                                                                                                              TIMOR-LESTE                                 ISLANDS

avoidable. The use of seatbelts                                                                                                                                                                                                ZAMBIA
                                                                                                                                                                                                                                                 MALAWI

and child car seats, and the                                                                        BOLIVIA
                                                                                                                                                                                                                                      ZIMBABWE
                                                                                                                                                                                                                                                                MADAGASCAR
                                                                                                                                                                                                                                                                                  MAURITIUS

wearing of helmets are essential                                                                                                                                                                               NAMIBIA
                                                                                                                                                                                                                            BOTSWANA
                                                                                                                                                                                                                                            MOZAMBIQUE
                                                                                                               PARAGUAY
                                                                                             CHILE
to prevent the death of child
                                                                                                                                                                                                                                                                                                                                                                                         A USTR A LIA
passengers or cyclists. Traffic                                                                                                                                                                                           SOUTH
                                                                                                                                                                                                                                          SWAZILAND

                                                                                                                                                                                                                          AFRICA      LESOTHO
measures such as checking vehicle                                                                                     URUGUAY

roadworthiness, enforcing speed                                                                             ARGENTINA
                                                                                                                                                                                                                                                                             How children are injured
limits and prosecuting drunk                                                                                                                                                                                                                                                 Causes of deaths worldwide
drivers are particularly important                                                                                                                                                              111 559                                                                      due to unintentional injuries
                                                                                                                                                                                                                                                                                                                                                                                                                                      NEW
in developing countries, where                                                                                                                                                                                                                                               for children under 15 years                                                                                                                        ZEALAND

roads tend to be poorly                                                                                                                                                                                                                                                      2002
                                                                                                                                                                                                                                            89 955
maintained and the number of
vehicles is growing rapidly.                                                                                                                                                                                        71 261

Injuries from road traffic                                                                                                                                                                                                                                          55 104
accidents already cost developing
countries US$ 65 billion a year –                                                                                                                                                                                                                                                                        39 969
                                                                                                                                                                                                                                                                                         34 238
more than the annual amount of
development assistance they                                                                                                                                                                                                                                                                                                  22 294                                     19 818
                                                                                                                                                                                                                                                                                                                                              14 713                                     15 797
receive.

                                                                                                                                                                                                boys        girls                                boys     girls                           boys               girls             boys               girls                  boys      girls
30                                                                                                                                                                                           Road traffic accidents                                 Drowning                                       Fires                                  Falls                            Poisonings                                           31
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