PPPrrrooofffiiillleee ooofff CCChhhiiillldddrrreeennn’’’sss EEEnnnvvviiirrrooonnnmmmeeennntttaaalll HHHeeeaaalllttthhh iiinnn AAArrrgggeeennntttiiinnnaaa Asociación Argentina de Médicos por el Medio Ambiente . HHeeaalltthh PPrrooffiillee PPrrooffiillee ooff CChhiillddrreenn’’ss EEnnvviirroonnmmeennttaall HHeeaalltthh iinn AArrggeennttiinnaa Researched and Prepared by: The Profile of Children’s Environmental Health in Shelley Callaghan, Canadian Institute of Child Health Argentina is a joint publication of the Ministry of Lilian Corra, Asociación Argentina de Médicos por el Health of Argentina, Society of Pediatrics of Medio Ambiente Argentina, Asociación Argentina de Médicos por el Louise Hanvey, Canadian Institute of Child Health Medio Ambiente and the Canadian Institute of Child Mariana Leoni, Asociación Argentina de Médicos por Health. The publication is available in Spanish and el Medio Ambiente English. Verónica Monti, Asociación Argentina de Médicos por el Medio Ambiente The English version of the Profile of Children’s Environmental Health in Argentinahas been adapted Printing: Bifronte S.R.L. (Spanish Edition) from the Spanish Original Version, 2007 Editing: León Goldstein (Spanish Edition) Design: Guillermo Falciani Electronic copies of the Profile of Children’s Development of Statistical Graphics: Lorena Grinberg Environmental Health in Argentinamay be obtained Spanish Editing: Liliana Cheren in Spanish and English from: English Editing: Janice Sonnen, Canadian Institute Asociación Argentina de Médicos por el Medio of Child Health Ambiente (AAMMA) website: www.aamma.org and from: Program/project/activity undertaken with the finan- Canadian Institute of Child Health (CICH) website: cial support of the Government of Canada provided http://www.cich.ca/project_safeenvironment.html through the Canadian International Development Agency (CIDA). Copyright © 2007 Programme/projet/activité réalisé avec l’appui finan- cier du gouvernement du Canada agissant par l’en- Readers are free to reprint parts of this publication as tremise de l’Agence canadienne de développement background for conferences, seminars and other international (ACDI). activities related to education, information sharing and policy development, providing they provide the appropriate credit to this publication. Citation for editorial copy for newsprint, radio and television is permitted. Photos Courtesy of: AAMMA Printed in Argentina Ricardo Ceppi Lilian Corra Esta Publicación esta también disponible en español Edmundo Ferretti con el titulo Perfil de la Salud Ambiental de la Niñez Horacio Forlano en la Argentina: Perfil SANA 2007. Martín Gómez Ålzaga Mariana Leoni This publication does not necessarily reflect the Sofia Lomazzi perspective and opinions of the Ministry of Health of Ronald Lovelace Argentina, the funders or individuals who collabora- Verónica Monti ted in the process. All photographs have been included with permission. 2 HHeeaalltthh PPrrooffiillee 22000077 Profile of Children’s Environmental Health in Argentina Asociación Argentina de Médicos por el Medio Ambiente Table of Contents Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 Message from Ministry of Health of Argentina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Message from Asociación Argentina de Médicos por el Medio Ambiente . . . . . . . . . .9 Message from the Canadian Institute of Child Health . . . . . . . . . . . . . . . . . . . . . . . .10 Message from Society of Argentine Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 Message from the World Health Organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 General Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Chapter 1 – Context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25 Chapter 2 – Children’s health and the environment . . . . . . . . . . . . . . . . . . . . . . . . .61 Chapter 3 – Environmental exposures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117 Chapter 4 – Actions for the protection of health and the environment . . . . . . . . . .153 Chapter 5 – Linking context, health outcomes, environmental exposure and action indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .195 Chapter 6 – Considerations and Recommendations . . . . . . . . . . . . . . . . . . . . . . . .215 Appendix A – Tools and resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .223 Appendix B – Processes, conventions and declarations . . . . . . . . . . . . . . . . . . . . . . .263 Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .288 4 Acknowledgements The Ministry of Health of Argentina, Asociación Argentina de Médicos por el Medio Ambiente and the Canadian Institute of Child Health above all would like to recog- nize the support provided by the Canadian government through the Canadian International Development Agency (CIDA). Without this support and cooperation it would not have been possible to produce the Profile of Children’s Environmental Health in Argentina. The Ministry of Health of Argentina, Asociación Argentina de Médicos por el Medio Ambiente and the Canadian Institute of Child Health would also like to recognize the hard work and commitment from the many individuals and institutions who shared their experience and vision in the development of this document. by providing data and offering technical support: • National Secretariat of Determinants of Health and Sanitary Relationships, Ministry of Health of Argentina • Coordinating Unit of Health and Environment, Ministry of Health of Argentina • Unit of Health and Environment, Secretariat of Environment and Sustainable Development, Chief of Cabinet of the Presidency of Argentina • National Bureau of Maternal and Child Health, Ministry of Health of Argentina • National Bureau of Promotion and Protection of Health, Ministry of Health of Argentina • National Program of Children’s Environmental Health, National Bureau of Maternal and Child Health, Ministry of Health of Argentina • National Program of Environmental Health, National Bureau of Maternal and Child Health, Ministry of Health of Argentina • National Unit of Chemical Substances and Products, Secretariat of Environment and Sustainable Development, Chief of Cabinet of the Presidency of Argentina • National Bureau of Epidemiology, Ministry of Health of Argentina • National Bureau of Statistics and Health Information, Ministry of Health of Argentina • National Institute of Respiratory Diseases ‘Dr. Emilio Coni’ (Spanish acronym INER) 5 • National Bureau of Environmental and Social Impacts, Secretariat of Environment and Sustainable Development, Chief of Cabinet of the Presidency of Argentina • Ministry of Labour, Employment and Social Security of Argentina • National Sanitary Service, Agro and Food Quality (Spanish acronym SENASA) • National Bureau of Press and Communication, Ministry of Health of Argentina • Argentinean Union of Rural and Dock Workers (Spanish acronym UATRE) • Health Canada • University of Ottawa, Canada • Memorial University of Newfoundland, Canada • Sub-commission of Child Health and Environment, Society of Argentine Pediatrics, (Spanish acronym SAP) • Argentinean Toxicological Society (Spanish acronym ATA) • Kaleidos Foundation, Cancer Registry of Argentina (Spanish acronym ROHA) • Pan American Health Organization (PAHO) / World Health Organization (WHO) by providing guidance and external review: Sergio Arias, Daniel Beltramino, Ricardo Benítez, Connie Berry, Juan Carlos Bossio, Osvaldo Canziani, Yue Chen, Ernesto De Titto, Luis Roberto Escoto, Edmundo Ferretti, María Angélica Flores, Susana García, Paul Glover, LorenzoGonzález Videla, Pablo Issaly, Flavio Landra, Argelia Lenardon, Linda Longerich, Doria Loria, Patricia Maccagno, Élida Marconi, Robin Moore-Orr, James C. Orr, Adela Penna, Julia Piñero, Nick Previsich, Jenny Pronczuk, Atilio Savino, Graciela Sfasciotti, Janice Sonnen, AnaSperanza. Finally, we would like to recognize the efforts of the Project Team: Lilian Corra, Louise Hanvey, Shelley Callaghan and Verónica Monti for coordinating the project, researching and writing the document; Mariana Leoni, Diana Carrero and Carolina Sánchez, for providing research and on-going administrative support; Regina De la Campa and Mariana Leoni for their assistance with translation, and to Javier Agramunt for his role in the administration and development of this project. 6 MESSAGE FROM THE MINISTRY OF HEALTH OF ARGENTINA It is very gratifying to be able to introduce the Profile of Children’s Environmental Health in Argentina due to its contribution to improve public health in the country. This work highlights the convergence of two factors that do not always come together: • the use of existing information and its systematization, a relevant fact that makes an important contribution to the decision-making process and to the quality of the decisions themselves, and • the international cooperation that allows, through financial support, the collabora- tive work of Non-Governmental Organizations and the Argentinean Government, another element that characterizes its success. These two factors came together in 2005, at the precise moment when Argentina assumed true regional leadership on the problems of environmental health and agreed to guide the Secretariat of the Initiative of the Health and Environment Ministers of the Americas (HEMA). The following international meetings of HEMA (Washington/1995, Ottawa/2002, Mar de la Plata/2005) created not only a sustainable political framework but also a course of actions defined by consensus that included Children’s Environmental Health. This regional process was reflected in our country by a series of decisions sup- ported by the same vision of integration: the creation of the Ministry of Health and Environment (May/03), National Health Plan, consensus of the National Health Councils (COFESA) and Environment (COFEMA) to develop a National Health and Environment Initiative (2005), creation of the Pediatric Environmental Health Units (UPAs) and, more recently, the creation of the National Secretariat of Determinants of Health and Sanitary Relationships, Ministry of Health of Argentina (October/07), as well as creation of the Intergovernmental Commission of Environmental and Worker’s Health (CISAT) in the framework of Mercosur and Associate States, just to mention some relevant examples. About 5 years ago, Argentina went through the greatest economic crisis of its contem- porary history. Today, the country has seen 52 consecutive months of economic growth and unemployment has fallen below the two digit level, resulting in a reduc- tion of poverty. At the same time child mortality and the mortality of children under 5years of age decreased by 23% and 20%, respectively. 7 The country’s economic and health frameworks are developing favorably. This under- lines the importance of health as a determinant of development, in this sense, to gen- erate major growth of the economy. The challenges that Argentina assumed when establishing its Millennium Development Goals require strengthening the path and making the process sustainable. The Profile clearly demonstrates where our country is in terms of Children’s Environmental Health, but also clearly sets out the work that remains to be done. In this sense then, to give Children’s Environmental Health priority is a strategic course of development that allows for the creation of a better future with equity and social justice. Atilio Savino National Secretariat of Determinants of Health and Sanitary Relationships Ministry of Health of Argentina 8