Children's Environmental Health Disparities: The Costs and Benefits of Breaking the Cycle

IntroductionThe social determinants of health are the circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics (1).Health inequalities can be defined as differences in health status or in the distribution of health determinants between different population groups. It is important to distinguish between inequality in health and inequity. Some health inequalities are attributable to biological variations or free choice and others are attributable to the external environment and conditions mainly outside the control of the individuals concerned. In the first case it may not be possible to change the health determinants and so the health inequalities are unavoidable. In the second, the uneven distribution may be unnecessary and avoidable as well as unjust and unfair, so that the resulting health inequalities also lead to inequity in health (2).Healthy People 2020 defines a health disparity as "a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion" (3).Healthy People 2020 defines health equity as the "attainment of the highest level of health for all people. Achieving health equity, requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities" (4).The goals of Healthy People 2020 are:* Eliminate preventable disease, disability, injury, and premature death.* Achieve health equity, eliminate disparities, and improve the health of all groups.* Create social and physical environments that promote good health for all.* Promote healthy development and healthy behaviors across every stage of life.They further define environmental determinants of health as follows:* The social environment is the aggregate of social and cultural institutions, norms, patterns, beliefs, and processes that influence the life of an individual or community.* The physical environment, comprising both the natural and built environments, is the structure and function of the environment and how it impacts health.Children who grow up in circumstances of social and economic disadvantage are more likely to experience multiple stressors in their lives, to have less medical, educational and social support systems in place and to also experience environmental threats from a variety of sources in their homes, their day care centers and schools, their recreational areas and their neighborhoods. These threats include environmental toxins such as outdoor and indoor air pollution, pesticides, secondhand tobacco smoke, waterborne contaminates and specific compounds such as lead and mercury. Evidence is accumulating that many medical problems such as asthma, birth defects, and neurodevelopmental disorders may be linked to environmental exposures. Exposures to multiple stressors are also a significant aspect of childhood poverty with far-reaching consequences on biological and psychological regulatory systems resulting in higher incidences of the medical problems which are linked to these exposures (6, 7). We also have evidence of altered brain development in poor children that adversely affects their academic performance and social function (8).In order to capture these multiple factors and their consequences we conceptualized a cycle of environmental health disparities (see Figure 1) and proceeded to develop a program to explore ways to improve environmental conditions and to reduce these health and functional disparities called "Break the cycle. …