Environmental Health in Early Childhood: Q&A with Dr. Philip Landrigan

This blog is the fourth in our five-part series on philanthropic strategies for preventing and reducing childhood exposure to harmful chemicals. To learn more, see our corresponding funder brief, Ensure a Healthy Start.

Philip J. Landrigan, MD, MSc, is a pediatrician, epidemiologist and a leader in the field of children’s environmental health. Dr. Landrigan is a graduate of Harvard Medical School and of the London School of Hygiene & Tropical Medicine. He serves as Dean for Global Health in the Icahn School of Medicine at Mount Sinai.   He is a member of the National Academy of Medicine.

Dr. Landrigan’s landmark studies in the early 1970s of children exposed to lead were among the first to show that lead can cause brain damage to children at levels too low to cause clinically evident signs and symptoms – a phenomenon now termed “subclinical toxicity.” This work was critical in persuading the U.S. Environmental Protection Agency (EPA) to remove lead from gasoline and paint, actions that resulted in a 95% decline in lead poisoning in US children. Dr. Landrigan led the 1993 National Academy of Science report on Pesticides in the Diets of Infants and Children that provided the blueprint for the Food Quality Protection Act of 1996, the major law governing pesticide use in the US, and the only federal environmental law that contains explicit provisions for the protection of children’s health. Most recently Dr. Landrigan has joined with Richard Fuller of the Blacksmith Institute to create a new Lancet Commission on Pollution, Health and Global Development.

Center: We hear a lot about the First Thousand Days. Why is this so important?

Donors need to know that environmental exposures during the 9 months of pregnancy and in the first two years after birth – the time period that has come to be known as the First Thousand Days – can have powerful impacts on health and development in childhood.  Early human development is a time of enormous sensitivity. Additionally, we now know that environmental exposures during the First Thousand Days can have impacts that extend far beyond childhood and also influence health and disease across the human life span, even to extreme old age.

Positive environmental exposures during the First Thousand Days – exposures to loving parents, to good nutrition and to a positively stimulating environment will make babies stronger, healthier and more resilient.  Healthy cities, healthy communities, healthy schools and early intervention programs such as Head Start have all been documented to enhance the likelihood that children will lead productive lives with reduced risk of illness.

Center: What happens if babies experience negative exposures in the First Thousand Days?

By contrast babies who are exposed in the womb and in infancy to toxic environmental hazards such as lead, pesticides and air pollution; babies who are exposed to psychosocial stress and violence; and babies who are poorly nourished are at increased risk in childhood for developmental disorders such as dyslexia, ADHD and autism, as well as for obesity and asthma.  And beyond childhood these children are at increased risk for lifelong reductions in intelligence and for diabetes, cardiovascular disease and cancer.

The biology underlying these observations is that during the First Thousand Days, children’s organ systems – their brains, nervous systems, immune system and reproductive organs – are all growing and developing incredibly rapidly.  These developmental processes are extraordinarily complex and they are highly sensitive to the environments around them. There exist “windows of vulnerability” during these early developmental periods when exposures to even very low levels of toxic chemicals or other environmental hazards can cause serious damage within the cells of an infant’s body, a process  termed “fetal programming”. Once established, fetal programming can persist lifelong, can become manifest at any point in the lifespan, even after many years or decades and thus can influence health and disease from early infancy to extreme old age.

It is critically important for donors to support programs that provide infants and children with positive early environments and protect them against environmental hazards. And it is important also for donors to continue to support research on the links between early environments and children’s health because there is much that we do not yet know and that we need to know if we are better to protect our children.

Center: What is the economic dimension to this conversation?

Diseases caused in children by toxic exposures in the environment have been estimated to cost the United States $76 billion every year.[1] Prevention will therefore yield economic as well as health benefits.

Center: Many suggest a moral dimension to this conversation as well. Can you elaborate?

Yes. There also is a moral dimension to this issue. Children in the highly vulnerable early stages of life have no ability to fight back against harmful exposures in the environment. Many faith traditions want to protect our environment and our most vulnerable, and this issue appeals to them. Limiting harmful chemical exposure to the least among us is a moral imperative that cuts across the usual political battle lines. We all have children.

Center: What is the most common myth about children’s environmental health that you’d like to dispel?

Many people think we’ve made great progress to protect our kids against environmental hazards – and we have.  Our air is cleaner, our drinking water is safer, and we can now swim in many formerly polluted lakes and rivers. But one area in which we have failed badly is that we have no rational chemical policy in this country. Specifically, we have no policy in the United States requiring that chemicals be tested for safety before they come to market. The result is that no more than half of the 85,000 consumer chemicals on the market in the US have undergone only minimal safety testing and fewer than 20% have been tested for their potential developmental toxicity, their ability to disrupt early development in infants and children.

Center: Why do you think we’ve made so little progress?

The problem underlying this failure is that TSCA, the Toxic Substances Control Act, the federal statute that is supposed to regulate chemicals is broken and obsolete. TSCA does not keep harmful chemicals off the market or require any kind of safety testing. The consequence is that untested new chemicals continue to come to market, to become widely used in consumer products and to contaminate the environment.  Then only belatedly after years of use and exposure do we find that some of these chemicals cause great harm to human health and the environment.  DDT and PCBs were early examples.  More current examples include brominated flame retardants, phthalates, Bisphenol A and perfluorinated compounds.

Donors need to support groups who are working against great economic odds to reform chemical policy in the United States.

Center:  Can you share an example of how coalitions (funders, researchers, advocates) have helped prevent and reduce exposure to harmful chemicals?

I first began studying the effects of lead on children’s brains in the 1970’s. I became involved in exposures, particularly in smelting states (like Colorado) where whole towns had chronic exposures and permanent negative life outcomes for children, such as eroded IQs. Since then I’ve been involved with many efforts that have made significant progress to protect children’s health. For example, I (alongside funders and advocates) was centrally involved in getting lead out of gasoline. Since the 1990’s, the IQ of every child born has gone up 5 points, and we’ve increased our economic output by billions of dollars as we have grown up a new generation of highly intelligent and economically productive, lead-free children. If we muster our political will to reform chemical policy in this country, we can do this again.

Center: How can impact-focused funders best help going forward?

Going forward, I think the push for chemical safety legislation is more likely to succeed at the state and even the county level. California recently passed state legislation that will ban brominated flame retardants. Vermont, Massachusetts and Connecticut have passed legislation that will require labeling of genetically modified food.   Connecticut and Suffolk County, New York have been register receipts that contain Bisphenol A.

Donors can get involved in their communities and states to help drive state-level legislation and reform. Your Funder Brief mentions Safer Chemicals, Healthy Families, which is involved in this important work; another example is the Environmental Working Group. The journal, Environmental Health Perspectives is also a great resource for parents and funders to learn more.

For more on how funders can help prevent and reduce childhood exposure to harmful chemicals, see our funder brief, Ensure a Healthy Start.


[1] Trasande, L., & Liu, Y. (2011). Reducing the staggering costs of environmental disease in children, estimated at $76.6 billion in 2008. Health Affairs30(5), 863-870.