time of monitoring. Because of these reported
levels, blood lead levels were studied in more
than 900 healthy children in some cities
throughout Pakistan. The overall mean blood
lead levels (micrograms per deciliter) in the
three cities were found to be 22.8 ± 3.30,
19.00 ± 6.48, and 2.30 ± 0.19 (rural site). The
existence of such an alarming environmental
health threat to children in Pakistan has led
to the government’s creation of a National
Environment Action Plan, intended to reduce
poverty and bolster economic growth. As part
of this umbrella program, fuel efficiency projects
aim to reduce at-source emissions of
greenhouse gases and other pollutants by
improving fuel efficiency for transport vehicles
in Pakistan. Lead phaseout programs intended
to provide clean fuel in the country are also
part of this broader action plan (Khwaja 2002).
The India clean-water project. Although
access to drinking water in India has increased
over the past decade, the tremendous adverse
impact of unsafe drinking water on human
health continues. Twenty-one percent of communicable
diseases in India are estimated to be
water related. The highest mortality rate from
diarrhea occurs in children younger than 5
years, and there is an urgent need for focused
interventions to prevent diarrheal disease in
this age group. Despite investments in water
and sanitation infrastructure, many lowincome
communities in India and other developing
countries continue to lack access to safe
drinking water, proper sanitation and sewage
systems, garbage collection networks, and
information and education on healthy hygiene
and sanitation practices. Currently available
strategies and technologies to make water safe
to drink are unaffordable and inaccessible to
most low-income households, particularly
those without a regular piped water supply.
The Safe Water System (SWS), an effective
and inexpensive intervention to provide safe
drinking water, was developed by the U.S.
Centers for Disease Control and Prevention
(CDC) and the Pan American Health
Organization (CDC 2002). The SWS intervention
consists of a) point-of-use treatment of
contaminated water with locally produced
sodium hypochlorite solution, packaged in
locally available bottles with a 5–10 mL cap
that serves as a dosing device; b) safe water storage
in plastic containers with a covered narrow
mouth and a spigot to prevent recontamination;
and c) behavior change techniques,
including social marketing, community mobilization,
and innovative information, education,
and communication.
The WHO has promoted the SWS in
India and Bangladesh in collaboration with the
CDC and is currently partnering with India’s
Population Services International (PSI), India
and Sulabh International Institute of Health
and Hygiene (SIHH; New Delhi, India) to
introduce SWS widely in India. A feasibility
pilot funded by the WHO, to assess SWS’s
potential to reduce diarrheal diseases in lowincome
populations, with a special emphasis
on children younger than 5 years, is currently
underway in eight slum communities in West
Delhi (October 2001 and September 2003).
PSI is also designing and implementing
innovative behavioral change communications
strategies based on qualitative and quantitative
consumer research. PSI is creating demand for
and providing access to sodium hypochlorite
solution and safe water storage containers in
the pilot communities. This demand creation
will be linked to a behavioral change communications
campaign designed to raise awareness
of clean practices around water use and storage,
hygiene, sanitation, and garbage disposal. The
primary audience for key messages will be families
with children younger than 5 years. The
campaign includes the use of mass media and
local, culturally appropriate media. SIHH is
working closely with PSI to train resident community
volunteers (themselves slum residents)
to execute a range of community activities,
including household visits and community
events. Performance-based incentives will be
offered to volunteers to enhance sustainability
(Jafa 2002).
Mercury pollution reduction project.
The United Nations Industrial Development
Organization (UNIDO) is working to reduce
mercury pollution through the implementation
of a global action project that focuses on four
major areas: a) awareness raising and training;
b) reduction of mercury pollution; c) demonstration
of cleaner technology; and d) development
of policies and legislation. The awareness
raising and training components of the project
would provide on-the-job training of cleaner
technologies, and awareness campaigns would
be conducted through workshops and the
media. Reduction of mercury pollution would
use an evidence-based approach based on geochemical
and human monitoring to identify
hot spots. Once hot spots are discovered, measures
to remediate these areas will be formulated.
To demonstrate advantages of cleaner
technology, manufacturers will be made aware
of the cost-effectiveness of alternative techniques,
a databank of technologic requirements
will be established, and microfinancing schemes
will be developed and tested. To improve policies
and legislation, governments will receive
assistance to review current polices and to
develop enforceable standards (Garbe 2002).
International networking. The International
Research and Information Network on
Children’s Health, Environment and Safety
(INCHES) is a global network of people and
organizations interested in promoting the protection
of children from environmental and
safety hazards. INCHES organizers and supporters
believe that promoting children’s
health requires protecting children from
harmful environmental exposures, including
harmful physical, chemical, and biologic
microorganisms and pollutants in water, air,
soil, and food. The president of INCHES, Dr.
Peter van den Hazel, shared lessons in starting
a network with participants of a round table
on Building Partnerships at the Bangkok
conference. He stressed several key aspects,
including the need to consider various fundraising
strategies, human capital needs, engaging
all potential stakeholder groups, and
thinking about how the new network will
grow and operate (national vs. local; membership
vs. open network). INCHES disseminates
information and will initiate research on the
relationship between environmental factors
and child health. News and updates relevant
to children’s environmental health are available
at http://www.inchesnetwork.org/
index.html as the network develops (van den
Hazel 2002; WHO 2002b).
Antismoking campaigns. Environmental
tobacco smoke (ETS) is a major contributor to
indoor air pollution. There is growing concern
worldwide about the effects that ETS has on
children, because their lungs are smaller and
their immune systems are less developed than
those of adults. Data indicate that children
whose fathers smoke are at a 30% higher risk
of suffering from respiratory diseases and middle
ear infections. That risk increases if the
mother is also a smoker. With the support of
the Rockefeller Foundation, the National
Poison Control Center of Malaysia has developed
the Clearinghouse for Tobacco Control
(http://www.ctob.org). The goal of the clearinghouse
is to provide up-to-date information
on the Internet, allowing for interactive communication
between users and the website.
The efforts of this clearinghouse will initially
target the general populace of Southeast Asia,
helping to increase their awareness of the dangers
of smoking and encourage them to proactively
protect children from the ill effects of
ETS. Over time, it is hoped that the clearinghouse’s
efforts will effectively spur policies
intended to curb the health threats of ETS
(Awang and Makalinao 2002). After the
conclusion of the Bangkok conference the
Clearinghouse for Tobacco Control, together
with the Ministry of Health, Malaysia, and the
Southeast Asia Tobacco Control Alliance,
coordinated a regional workshop that was held
in Panang, Malaysia, on 23–26 September
2002, titled “Communicating the Evidence for
Tobacco Control.” Representatives from the
10 Association of Southeast Asian Nations
(ASEAN) countries, including researchers and
advocates, met to discuss four key areas of concern
to curb the tobacco epidemic: smoke-free
areas, advertising and promotion, taxation,
and packaging and labeling (Makalinao IR.
Personal communication).