• Local Initiatives
  
• National Actions
  
• Regional Partnerships
  
• International Support
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While the linkages between children and the environment have been acknowledged at the international level, including in Agenda 21 and the 1990 Programme of Action of the World Summit for Children (see box 1), sustained progress can only be made if individuals strive together for concerted action. Governments, the United Nations system, civil society and the private sector need to work together to foster intersectoral cooperation at all levels to promote safe environments for children. If at each level of action, policies and strategies are tailored to specific realities and are designed to complement each other, real and cost-effective synergies will be achieved.

To follow up the information offered in the previous chapters with a call to action, this chapter presents a set of broad recommendations to stimulate discussion and intensify action.

Local Initiatives

Community participation and actions at the local and household level are critical because this is where children’s health and well-being are first and directly influenced by environmental problems. A safe immediate environment for children depends largely on how well communities and families can manage problems, such as a lack of safe drinking water, unsanitary excreta and refuse disposal, smoky indoor air, crowded living spaces and degraded natural resources.

At this level, environmental health interventions must be very specific, concrete and results-oriented. In addition to the examples of possible local initiatives that were included in chapter 3, below are several suggestions that can be taken by communities and those supporting them in local and national governments, regional partnerships, international organizations and civil society.

At the local level there is a need to:

• Build community capacity (namely, municipalities) to sustainably manage local resources, particularly the essential resources of drinking water and fuel wood. In practical terms, community environmental management aimed at preventing diarrhoeal diseases, malaria and acute respiratory infections (ARIs) – three of the primary child killers – involve actions which inhibit, interrupt, and reduce the generation, transmission, and exposure to disease agents. Examples of possible community- and household-level interventions for reducing incidences of these diseases can be found in table 5.
  
• Support community-based environmental care in partnership with local NGOs. Activities such as planting trees, vegetable gardening, protecting water sources, building sanitary latrines, recycling and composting domestic wastes, terracing slopes, etc. can both improve local environmental quality and directly benefit children and families.
  
• Promote hygiene awareness and education for a sustainable future using formal and informal channels. Hygiene education can help family members and children establish hygienic behaviour so as to block or at least reduce harmful environmental agents – particularly biological ones – from entering a child’s body. Environmental education, if tailored to local situations, will increase mothers’ and children’s knowledge and ability to protect themselves from environmental hazards. In rural developing areas where literacy rates are usually low, hygiene education and environmental education can be combined and integrated into literacy efforts.
  
• Increase attention to family-level activities in children’s environmental health projects. In most cases, simple and low-cost options exist for parents to take action aimed at lessening environmental risks to their young children.
  
• Support and build the capacity of parents – both mothers and fathers - in fulfilling their responsibility for providing quality care to their children. Parents should have easy access to up-to-date and correct information on childcare, including children’s environmental health issues. There is a need to ensure that adequate care is provided to disadvantaged children in a family, such as a girl child who often experiences gender discrimination or a disabled child.
  
• Encourage and support children and youth to participate in local environmental management activities, including identifying and monitoring environmental problems and how they relate to livelihoods and taking action to combat specific threats. Environmental education through informal and formal channels can significantly enhance life skills of children. It provides children with environmental knowledge and engenders respect for the world and their role and responsibilities in it (See box 11).

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National Actions

At the national level, the key is to increase understanding of how to mainstream environmental considerations and to recognize and exploit the interlinkages and synergies between environmental issues and child-focused interventions. There is also a need to fill the substantial gaps that exist in the information and thus the understanding of children’s environmental health issues, both through increased and better coordinated research and data collection and through the development and monitoring of indicators to assess progress made in this field.

While many of the recommendations for action at the international and regional levels may also be relevant to national circumstances, certain issues demand specific national level response, for example, to:

• Increase understanding that child health, growth and development depends at least as much on the control of root environmental causes of poor health as on clinical responses to disease. Such understanding should lead to an enhanced preventive aspect in national policies regarding children’s health.
  
• Develop national laws and regulations for the early detection of environmental diseases and increase nations’ capacities to implement and uphold them.
  
• Strengthen intersectoral coordination and cooperation among government departments. Especially, there is a need to reconcile health and environment as prime elements of sustainable development programmes.
  (See box 12)
  
• Put children at the centre of sustainable development agendas. In the context of children’s environmental health, this means that national policy and regulation systems need to take into account the special rights and vulnerabilities of children in terms of environmental risk factors. It also means that government spending on child protection, including environmental safety, should be accorded a high priority. Some specific action points may include:
  
  • Refine current risk assessment methods to better evaluate specific exposure pathways and dose-response characteristics of children when setting protective standards, so as to ensure early detection of diseases;
    
  • Improve monitoring and assessment of children's health and the environment to expand the knowledge base;
    
  • Expand national education curricula to include education for a sustainable future, which integrates environmental and hygiene education.
    
• Develop functional voluntary partnerships between communities, schoolteachers, environmental and public health NGOs, scientific and academic communities, and local and national governments. Partnering with civil society helps to ensure success through sharing of information and follow-up activities.
  
• Empower and educate health/environment professionals to ensure a better recognition of environmental health problems affecting children. Incorporate children’s environmental health issues into the teaching curricula of medical and clinical toxicology university courses.
  
• Give special policy attention to disadvantaged children, who are generally closer and more vulnerable to environmental hazards. These children may include girls, working children, homeless children, orphans, disabled children, children displaced by armed conflicts, children living in extreme poverty, children of urban slums, children affected by HIV/AIDS, and children caught in violence, sexual abuse or drug use.
  

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Regional Partnerships

Most of the recommendations put forth in the next section for the international level also apply at the regional level. There are, however, two points that retain specific regional relevance, which are highlighted below. At the regional level there is a need to:

• Develop coordinated regional approaches to children’s environmental health issues. Nations in a particular region often face similar environmental threats and many are both multi-causal and transboundary in nature. Likewise, children from countries within a region often face similar social and economic situations. Therefore, countries can benefit substantially from regional consultations and collaboration where they can exchange ideas and best practices and replicate measures to effectively mitigate environmental threats to the health of their populations. Regional consultations are also vital to fashion policy responses to specific environmental threats that are plaguing a particular area beyond any one national border (see box 13).
  
• Pay special attention to regional priority environmental problems that most afflict children of the region. Children of different regions often face unique environmental threats, which should not be neglected while dealing with high-profile global issues. The lack of safe drinking water and basic sanitation facilities, for instance, is perhaps the most dismal environmental condition endured by the majority of Asian and African children.
  

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International Support

In the past decade, several international agreements (see box 1) have recognized the link between children’s well-being and the protection of the environment. Despite this, there is a need to bring children’s environmental health, growth, and development issues to the forefront of the international agenda and translate these declarations into concrete action (see box 14). At the international level there is a need to, among other things:

• Ensure that children’s rights as well as their special vulnerabilities are systematically taken into account in discussions and negotiations on environmental issues. Such recognition needs to generate more specific policy decisions and actions directed to children’s particular needs.
  
• Fully recognize the important role of environmental protection in child survival, development and protection. Global efforts for children need to adopt the concept of protecting the child’s environment and to strengthen and integrate into their child-related programmes appropriate environmental interventions that will improve a child’s immediate environment.
  
• Further develop international environmental law that will safeguard children’s health, growth and development from environmental risk factors. The existing and rapidly expanding body of international environmental conventions and protocols play a key role in addressing the most pressing global environmental challenges, which threaten human health including that of children. Commitments need to be honoured and implementation needs to be accelerated.
  
• Employ a precautionary approach in dealing with environmental issues, as this will widely be in the best interest of children and future generations. A lack of full scientific certainty should not be used as a reason for postponing cost-effective measures to prevent environmental degradation.
  
• Develop and build consensus on children’s environmental health indicators. Just as basic economic indicators have been instrumental to Governments in estimating and steering the functioning of national and world economies, we need effective and user-friendly indicators to monitor and protect children from environmental health threats. Actions to protect children from environmental hazards will be, at the best, arbitrary and unsystematic until a core set of good indicators can be widely adopted. Since indicators receive media attention, they can also play a crucial role in bringing the public’s focus to the issue. Most importantly, such indicators will provide a sound basis for children’s environmental health policies.
  
• Encourage and promote national investment in early childhood care, including the improvement of home, school and community environments. The quality of the environment exerts a powerful influence on whether a child will survive his or her first years. Therefore, improving the local environmental conditions can be effective in reducing childhood malnutrition and disease and can ultimately break the inter-generational transmission of poverty.
  
• Raise awareness of various stakeholders and children’s environmental health, growth and development issues. This will involve efforts to:
  
  • Disseminate concise information to decision-makers and all those caring for children, which can help to stimulate feasible actions at all levels to reduce child exposure to environmental pollutants.
    
  • Promote, support and coordinate research, monitoring and assessment with regard to children’s special vulnerabilities to environmental degradation, in order to yield the required information for effective decision-making (at each level of competence). The knowledge gaps related to children’s environmental health are substantial.
    
  • Coordinate existing efforts and initiatives that specifically address children’s environmental health issues, creating coherent networks for action. Establish active partnerships among the various stakeholder groups: Governments, civil society (i.e.: non-governmental organizations, foundations, private institutions, community groups, universities, research centres, etc.) media and international organizations.

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