Healthy children in living healthy environments are essential for our future. However, every day children are exposed to a range of environmental hazards in their physical, built and social environment that may adversely affect their health. Progress towards meeting the eight United Nations Millennium Development Goals has been accompanied by a substantial change in the global pattern of disease with a significant shift towards chronic non-communicable diseases (NCDs). Globally, early childhood deaths have declined, but years lived with disability have increased over the 20 years 1990-2010: cardiovascular disease by 17·7%; chronic respiratory disease by 8·5%; neurological conditions by 12·2%; diabetes by 30·0%; and mental and behavioural disorders by 5·0%. There is increasing recognition that many chronic diseases are initiated in early life but measuring exposures and outcomes in early life is challenging. Improving both exposure assessments and health outcomes will be a key focus of CHEP research over the next 5 years.

WHO estimates that around one quarter of the global burden of disease has an environmental contribution. In children, the fraction is higher, with approximately 36% in children 0-4 years old and 34% in children 0-14 years old attributed to environmental factors. This is likely an underestimate as many environmental factors were not included in these estimates. Given the growing evidence of the early life origins of disease, environmental exposures during childhood play a huge role in how we develop illness throughout our lives, influencing everything from normal growth and development, to asthma, heart disease and cancer. Research into the causes of childhood illness is therefore incomplete without investigating the early life environmental contribution to disease.

The major contributions to the burden of disease for Australian children come from mental disorders (23%), respiratory diseases, primarily asthma (18%) and neonatal conditions (16%). These are all disorders recognized to have a major environmental contribution, however, the contribution that the environment makes to childhood disease has not been reported in Australia. The response of the public health establishment to the challenges facing children is sub-optimal. Few jurisdictions specifically account for the special vulnerability of children when setting exposure standards. There is little or no requirement to demonstrate that new technologies or chemicals are safe for children before they are introduced into the marketplace. Manufactured nanoparticles are currently in use, including in products specifically designed for children, such as sunscreens and burns dressings. There is concern that flame retardants may be harmful, based on their chemical structure, yet they are used on children’s sleepwear without demonstrating their safety. More research is needed to inform public policy.