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EU bans phthalates in children's toys
Disease surveillance in Canada criticised anadian government’s surveillance of communicable and chronic diseases and injuries has been largely undertaken on an “ad hoc” basis at the risk of public health, claims Auditor-General Denis Desautels. The system is fragmented and fraught with weaknesses, said Desautels in a report to parliament on Nov 30. “The systems were not enabling Health Canada to effectively monitor communicable diseases such as influenza, AIDS, tuberculosis, and food-borne diseases. There are significant gaps in surveillance information on certain chronic diseases such as cancer, diabetes, and heart disease.” Desautels noted that surveillance is primarily the responsibility of Health Canada’s Laboratory Centre for
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Disease Control but that there is no “legislation, policy, or agreement” to link the public-health functions among various levels of government. Similarly, “we found few formal agreements or protocols in place to prevent the entry into Canada of serious communicable diseases and to deal with disease outbreaks and threats to public health. The lack of attention to formalising the way these threats are to be managed places the health of Canadians at undue risk”. Health Canada has responded to Desautels’ report and said that it is now implementing a “food-borne illness outbreak response protocol” and is working to develop a collaborative national health surveillance network.
n Dec 1, after months of debate, the European Union (EU) Product Safety Emergencies Committee approved a ban on the sale of plastic toys made from polyvinyl chloride (PVC) containing phthalates that are aimed at children younger than 3 years. The decision was taken after studies linked phthalate exposure to liver, kidney, and testicular disorders. Phthalates Outlawed are widely used to add flexibility to PVC products. According to a statement by the European Commission (EC), the decision will assure that “all babies in the EU are immediately protected against the risk posed by these products, pending the adoption of a per-
I
manent measure”. But the unanimity of the vote was a surprise because Spain and Britain were expected to vote against the ban. The decision angered the European Council of Plasticisers and Intermediates (ECPI) which stated that “it is in complete contradiction to the views of the CSTEE [EU Scientific Committee for Toxicity, Ecotoxicity and the Environment] and is totally unjustified from a scientific viewpoint”. David Cadogan, the ECPI director, said “there is not a shred of scientific evidence pointing to a risk, let alone a ‘serious and immediate risk’ to children”.
nequalities in the incidence of low-birthweight babies are still striking across all social classes in the UK, and have not reduced in recent years, warns a report by the UK New Policy Institute published on Dec 8. Monitoring Poverty and Social Exclusion 1999 examines the latest trends in health and well-being using 50 indicators. Childhood is a critical and vulnerable stage where socioeconomic circumstances have lasting effects. Inequalities in the incidence of low-birthweight babies correlates with poor health in the first few weeks of life, with death before the age of 2 years, and with ill health in later years. Accidents are the commonest cause of hospital admission among 5–15 year old children. Another indicator of health in children found that deaths among children under 16 years has decreased by one third. But children in lower social classes (classes IV and V) were twice as likely to die as children from higher social groups (classes I, II, and III). Alongside persisting inequalities in health, the report also noted that the number of families and individuals living on low incomes remains close to the record levels reached earlier in the decade. About 14 million people are below a government-recognised “poverty line” including 4·4 million children. And if poverty means illness and early death, health-care policy in the UK was put under further pressure when the report found that between 1995/96 and 1997/98 the number of people on very low incomes increased from 7 to 8 million.
Xavier Bosch
Haroon Ashraf
Wayne Kondro
EU bans phthalates in children’s toys
O
UK policy report paints grim picture of health
Living-related donor liver transplantation approved in Italy n Nov 25, legislation was passed to allow living-related liver transplantation (LRLT) in Italy. The new law waives, for this specific situation, the existing prohibition on destruction of body parts. But the law stipulates that segmental liver grafts from living donors may be donated to relatives only and at no charge. Transplantation of reduced-size livers from living donors was devised “to obviate the shortage of size-matched livers for young children”, says Franco
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2060
Filipponi (Liver Transplant Unit, Pisa, Italy). The technique was then used to treat small adults in countries where living donation was allowed but brain-dead donation precluded. But although LRLT “is important and should be mastered by every liver transplant surgeon”, Filipponi cautions “it is only justified when whole or split livers from brain-dead donors are unavailable”. In central and northern Italy, with donation rates of 18–30 per million
inhabitants, “there is currently no extreme shortage of livers”, says Filipponi, and in areas with lower donation rates, “the priority is to increase brain-dead donations, as demonstrated in the Spanish model”. In LRLT, donors face the risks of major hepatic surgery and the implanted mass may prove insufficient for the recipient, which raises many ethical and medicolegal issues. Bruno Simini
THE LANCET • Vol 354 • December 11, 1999
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Disease Control but that there is no “legislation, policy, or agreement” to link the public-health functions among various levels of government. Similarly, “we found few formal agreements or protocols in place to prevent the entry into Canada of serious communicable diseases and to deal with disease outbreaks and threats to public health. The lack of attention to formalising the way these threats are to be managed places the health of Canadians at undue risk”. Health Canada has responded to Desautels’ report and said that it is now implementing a “food-borne illness outbreak response protocol” and is working to develop a collaborative national health surveillance network.
n Dec 1, after months of debate, the European Union (EU) Product Safety Emergencies Committee approved a ban on the sale of plastic toys made from polyvinyl chloride (PVC) containing phthalates that are aimed at children younger than 3 years. The decision was taken after studies linked phthalate exposure to liver, kidney, and testicular disorders. Phthalates Outlawed are widely used to add flexibility to PVC products. According to a statement by the European Commission (EC), the decision will assure that “all babies in the EU are immediately protected against the risk posed by these products, pending the adoption of a per-
I
manent measure”. But the unanimity of the vote was a surprise because Spain and Britain were expected to vote against the ban. The decision angered the European Council of Plasticisers and Intermediates (ECPI) which stated that “it is in complete contradiction to the views of the CSTEE [EU Scientific Committee for Toxicity, Ecotoxicity and the Environment] and is totally unjustified from a scientific viewpoint”. David Cadogan, the ECPI director, said “there is not a shred of scientific evidence pointing to a risk, let alone a ‘serious and immediate risk’ to children”.
nequalities in the incidence of low-birthweight babies are still striking across all social classes in the UK, and have not reduced in recent years, warns a report by the UK New Policy Institute published on Dec 8. Monitoring Poverty and Social Exclusion 1999 examines the latest trends in health and well-being using 50 indicators. Childhood is a critical and vulnerable stage where socioeconomic circumstances have lasting effects. Inequalities in the incidence of low-birthweight babies correlates with poor health in the first few weeks of life, with death before the age of 2 years, and with ill health in later years. Accidents are the commonest cause of hospital admission among 5–15 year old children. Another indicator of health in children found that deaths among children under 16 years has decreased by one third. But children in lower social classes (classes IV and V) were twice as likely to die as children from higher social groups (classes I, II, and III). Alongside persisting inequalities in health, the report also noted that the number of families and individuals living on low incomes remains close to the record levels reached earlier in the decade. About 14 million people are below a government-recognised “poverty line” including 4·4 million children. And if poverty means illness and early death, health-care policy in the UK was put under further pressure when the report found that between 1995/96 and 1997/98 the number of people on very low incomes increased from 7 to 8 million.
Xavier Bosch
Haroon Ashraf
Wayne Kondro
EU bans phthalates in children’s toys
O
UK policy report paints grim picture of health
Living-related donor liver transplantation approved in Italy n Nov 25, legislation was passed to allow living-related liver transplantation (LRLT) in Italy. The new law waives, for this specific situation, the existing prohibition on destruction of body parts. But the law stipulates that segmental liver grafts from living donors may be donated to relatives only and at no charge. Transplantation of reduced-size livers from living donors was devised “to obviate the shortage of size-matched livers for young children”, says Franco
O
2060
Filipponi (Liver Transplant Unit, Pisa, Italy). The technique was then used to treat small adults in countries where living donation was allowed but brain-dead donation precluded. But although LRLT “is important and should be mastered by every liver transplant surgeon”, Filipponi cautions “it is only justified when whole or split livers from brain-dead donors are unavailable”. In central and northern Italy, with donation rates of 18–30 per million
inhabitants, “there is currently no extreme shortage of livers”, says Filipponi, and in areas with lower donation rates, “the priority is to increase brain-dead donations, as demonstrated in the Spanish model”. In LRLT, donors face the risks of major hepatic surgery and the implanted mass may prove insufficient for the recipient, which raises many ethical and medicolegal issues. Bruno Simini
THE LANCET • Vol 354 • December 11, 1999