Child Health and the Environment (Medicine)
The study of environmental exposures and children's health goes back to the 19th century, when there were isolated reports of acute effects associated with heavy exposures. However, only in the past several decades have environmental exposures been examined more systematically, with recent studies identifying subtle health effects with lower exposures. A rapidly expanding knowledge base covers a variety of types of environmental exposure in relation to children's health, but until now, people who were interested in this subject had to piece together information from a patchwork of resources. Child Health and the Environment offers a textbook approach to the topic of children's health and environmental exposures for an audience of "professionals and graduate students in public health, pediatrics, environmental health, epidemiology, and toxicology." Risk assessors will also find this book helpful. It offers a broader view than previous books on the subject, such as the well-known, clinically oriented "Green Book" for pediatricians (R.A. Etzel and S.J. Balk, eds. Handbook of Pediatric Environmental Health. Elk Grove, Ill.: American Academy of Pediatrics, 1999). Starting with discussions of the overarching issues, epidemiology and risk assessment, the author illustrates the breadth of this evolving area. Subsequent chapters cover specific exposures (or classes of exposures). Rather than simply reviewing the literature, Wigle places environmental agents in their biologic context, with information about sources and biologic markers of exposure, potential or demonstrated toxic pathways, and genetic susceptibility. He then describes risk-management efforts, including intervention and prevention, which lead logically to discussions of proven outcomes for children's health, unresolved issues and gaps in knowledge, and risk-management issues. All in all, Wigle has done an excellent job of highlighting the facts about a variety of environmental exposures. By weaving in discussions of environmental and regulatory history and public health effects, Wigle has made this book interesting and informative. On a personal note, as an epidemiologist who has spent much of my career working with toxicologists, I believe that an opportunity was missed in this edition. I have witnessed many misunderstandings in the integration of findings from the two disciplines. A side-by-side comparison of the strengths and limitations of epidemiology and toxicology could lead to more informed discussions, collaborations, and assessments. Two items remain on my wish list for future editions. First, I would recommend a more in-depth discussion of critical windows of exposure during prenatal and postnatal development. This topic is discussed briefly, primarily in chapters on specific types of exposure. An overview describing what is currently known about the critical windows for a variety of health effects would be a useful addition. The effect of the misclassification of exposure (when the exposure that is measured does not match the exposure that occurred during the critical window) could be incorporated into the discussion of exposure-response relations. Second, some areas of the book have few or no cited references to original sources, limiting its usefulness as a starting point for additional learning. Indeed, Wigle has begun to address this concern by creating a Web site (as noted in the epilogue) containing supplementary data (http://mclaughlincentre.ca). If it is updated regularly, the Web site will allow the book to be a "living" document. Child Health and the Environment provides a broad view of the topic and is a useful resource for teachers and students who are seeking a comprehensive textbook and for those in the field who want a desk reference. Its usefulness should endure in this rapidly evolving field, given Wigle's efforts to meet the challenge of updating the information in the book through his Web site. (The views expressed in this review are those of the author and do not necessarily represent the views of the U.S. Environmental Protection Agency.)Sherry G. Selevan, Ph.D.Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.