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Health risks from toxic pollution
Editorial
Amit Bhargava/Corbis
Health risks from toxic pollution
For more on the report see http://www.worstpolluted.org/ files/FileUpload/files/2012%20 WorstPolluted.pdf
In its annual report The World’s Worst Pollution Problems, released on Oct 24, the New York based Blacksmith Institute together with Green Cross Switzerland attempted for the first time to estimate the burden of disease attributed to toxic pollution from industrial sites in low-income and middle-income countries. Excluding indoor and carbon-related air pollution and arsenic in groundwater, and only including pollutants with quantifiable health outcomes that are given disability weights by WHO, the report estimates that about 125 million people are at risk from toxic pollution across 49 countries with an estimated impact of 17·15 million disability-adjusted life years. These estimates are based on 2600 investigated sites in countries that are safe to visit and are very likely to be an underestimate. The substances included are lead, chromium, mercury, and asbestos. The top ten industrial sources responsible for their estimated effect on health are: lead-acid battery recycling, lead smelting, mining and ore processing, tanneries, industrial and municipal dump sites, industrial estates, artisanal gold mining, product and chemical
manufacturing, and the dye industry. The particular vulnerability of children to these substances, and the fact that many of these sites are within or close to densely populated areas, make it especially important to highlight this neglected area of health risk, which is likely to increase with rapid industrialisation and development in low-income and middle-income countries. Whereas developed countries have oversight bodies, such as the Environmental Protection Agency (EPA) in the USA, to regulate and educate, developing countries often have lack of oversight, no or poor regulation, and limited understanding of potential health effects. The Blacksmith Institute works with local authorities and countries’ Ministries of Health on educational activities, remedial solutions, and preventive efforts, and highlights individual success stories in its report. These are laudable efforts but to make a real difference much more is needed. The international health community needs to tackle hazardous substance pollution with the same urgency as other health threats to achieve healthy and sustainable development worldwide. ■ The Lancet
Understanding self-harm
See Comment page 1536 See Articles page 1568
For the Talking Self-harm report see http://www.cellogroup.com/ pdfs/talking_self_harm.pdf For Moran and colleagues’ study see Articles Lancet 2012; 379: 236–43 For the linked Comment see Lancet 2012; 379: 198–99
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Self-harm is shrouded in stigma, secrecy, and embarrassment, and as such is an issue that many people feel uncomfortable discussing. According to new research from Cello’s Talking Taboos initiative, in partnership with the YoungMinds charity, increased communication between young people who self-harm, parents, and professionals is urgently needed. The study shows clear gaps in knowledge and awareness about why young people self-harm, and provides recommendations for how specific groups can help. One in 12 children and young people self-harm, and in the past 10 years, inpatient admissions for this population have increased by 68%. In this issue of The Lancet, Helen Bergen and colleagues show that physical health and life expectancy are severely compromised in people who self-harm. The Article, which presents findings for 30 950 individuals, shows that patients have a greater risk of death from any cause than do the general population. Notably, of the 6% of patients who died, deaths from natural causes were two
or more times higher than expected. This finding should alert health professionals to patients’ physical needs, and is a call for integrated services for physical and mental care. Cello’s recommendations include programmes for schools to build emotional resilience of children, targeted resources for parents, and training modules for health-care professionals. Paul Moran and colleagues noted that most people who self-harm will discontinue the practice with increasing age; however, support through this period is crucial. Furthermore, as discussed in a linked Comment, subgroups should be identified to remove the ingrained idea that self-harm inevitably leads to suicide, which could further prevent parents and professionals from broaching the topic. People want to help, but feel that they are poorly equipped to do so; therefore, increased training and education will increase understanding, so that people who self-harm won’t be afraid to speak, and health professionals won’t be afraid to listen. ■ The Lancet www.thelancet.com Vol 380 November 3, 2012
Amit Bhargava/Corbis
Health risks from toxic pollution
For more on the report see http://www.worstpolluted.org/ files/FileUpload/files/2012%20 WorstPolluted.pdf
In its annual report The World’s Worst Pollution Problems, released on Oct 24, the New York based Blacksmith Institute together with Green Cross Switzerland attempted for the first time to estimate the burden of disease attributed to toxic pollution from industrial sites in low-income and middle-income countries. Excluding indoor and carbon-related air pollution and arsenic in groundwater, and only including pollutants with quantifiable health outcomes that are given disability weights by WHO, the report estimates that about 125 million people are at risk from toxic pollution across 49 countries with an estimated impact of 17·15 million disability-adjusted life years. These estimates are based on 2600 investigated sites in countries that are safe to visit and are very likely to be an underestimate. The substances included are lead, chromium, mercury, and asbestos. The top ten industrial sources responsible for their estimated effect on health are: lead-acid battery recycling, lead smelting, mining and ore processing, tanneries, industrial and municipal dump sites, industrial estates, artisanal gold mining, product and chemical
manufacturing, and the dye industry. The particular vulnerability of children to these substances, and the fact that many of these sites are within or close to densely populated areas, make it especially important to highlight this neglected area of health risk, which is likely to increase with rapid industrialisation and development in low-income and middle-income countries. Whereas developed countries have oversight bodies, such as the Environmental Protection Agency (EPA) in the USA, to regulate and educate, developing countries often have lack of oversight, no or poor regulation, and limited understanding of potential health effects. The Blacksmith Institute works with local authorities and countries’ Ministries of Health on educational activities, remedial solutions, and preventive efforts, and highlights individual success stories in its report. These are laudable efforts but to make a real difference much more is needed. The international health community needs to tackle hazardous substance pollution with the same urgency as other health threats to achieve healthy and sustainable development worldwide. ■ The Lancet
Understanding self-harm
See Comment page 1536 See Articles page 1568
For the Talking Self-harm report see http://www.cellogroup.com/ pdfs/talking_self_harm.pdf For Moran and colleagues’ study see Articles Lancet 2012; 379: 236–43 For the linked Comment see Lancet 2012; 379: 198–99
1532
Self-harm is shrouded in stigma, secrecy, and embarrassment, and as such is an issue that many people feel uncomfortable discussing. According to new research from Cello’s Talking Taboos initiative, in partnership with the YoungMinds charity, increased communication between young people who self-harm, parents, and professionals is urgently needed. The study shows clear gaps in knowledge and awareness about why young people self-harm, and provides recommendations for how specific groups can help. One in 12 children and young people self-harm, and in the past 10 years, inpatient admissions for this population have increased by 68%. In this issue of The Lancet, Helen Bergen and colleagues show that physical health and life expectancy are severely compromised in people who self-harm. The Article, which presents findings for 30 950 individuals, shows that patients have a greater risk of death from any cause than do the general population. Notably, of the 6% of patients who died, deaths from natural causes were two
or more times higher than expected. This finding should alert health professionals to patients’ physical needs, and is a call for integrated services for physical and mental care. Cello’s recommendations include programmes for schools to build emotional resilience of children, targeted resources for parents, and training modules for health-care professionals. Paul Moran and colleagues noted that most people who self-harm will discontinue the practice with increasing age; however, support through this period is crucial. Furthermore, as discussed in a linked Comment, subgroups should be identified to remove the ingrained idea that self-harm inevitably leads to suicide, which could further prevent parents and professionals from broaching the topic. People want to help, but feel that they are poorly equipped to do so; therefore, increased training and education will increase understanding, so that people who self-harm won’t be afraid to speak, and health professionals won’t be afraid to listen. ■ The Lancet www.thelancet.com Vol 380 November 3, 2012