The primary finding of this study is that the environmental legal framework in Mexico is not yet linked with the growing body of evidence regarding both the biological and social vulnerabilities of children to environmental hazards. Similar challenges in modifying legislation to protect children have been reported in US and Canada [35
]. To our knowledge, this is the first assessment of the environmental policy and children's health conducted in Mexico. While our considerations focus on Mexico, the methodology applied in this case study may be appropriate also in regard to other countries to examine adequacy of policy instruments to protect children from environmental hazards.
The study was conducted immediately at the end of the Vicente Fox administration (2000-2006), which came to power after defeating the ruling party (the Institutional Revolutionary Party, or PRI, had remained in power for the preceding 70 years), while creating great expectations for governmental reform. Our investigation showed that even today, there is no coherent policy, and new challenges exist in the current era of financial constraints and government downsizing. We identified a series of communication barriers between researchers and policy decision makers, built upon institutional culture and mutual mistrust. On the one hand, most research groups restrict their role to knowledge production, while focusing only on publication of results, rather than translational advocacy; the majority of public officials involved in policy making process, on the other hand, tend to disregard scientific evidence regarding both the high prevalence and increasing incidence of pediatric diseases associated with environmental exposures. Not surprisingly, for example, no laws addressing housing conditions were found, despite the fact that young children spend most of their lives indoors.
Furthermore, advocacy has had a weak impact, if any, on health protection measures in part because children's environmental health is not on the radar screen of many Mexico's NGOs. Mexico is not, however, totally devoid of non-governmental groups or community groups that are concerned about children's environmental health issues. The Commission for Environmental Cooperation has awarded a number of grants through its North American Fund for Environmental Cooperation to organizations that demonstrate sensitivity to children's health and the environment, such as the Instituto de Culturas Nativas de Baja California and the Instituto de la Naturaleza y la Sociedad de Oaxaca [63
Lack of information about environmental risk factors represents a major barrier for many families and communities. Of paramount importance is informing communities of concern about approaches to minimize hazards from a growing list of environmental contaminants. In addition to increasing efforts by nongovernmental organizations to communicate about children's environmental health issues, the press is giving increasing attention to risks posed by chemical exposures and children, such as those experienced by San Quintin farmworker families in Baja California Norte [64
]. Major conferences in Latin America have also served to highlight the need to focus on children's health and the environment. This includes a meeting of Health and Environment Ministers of the Americas, which met in Mar del Plata, Argentina on 16-17 June 2005. We do not dispute that NGOs and governmental agencies are not working to improve awareness of these issues, but do suggest that serious gaps in knowledge persist and merit further intervention.
As with any qualitative research study, there are important caveats to be made. Our systematic review endeavored to be as complete as possible, though we may have omitted sources of information that may underreport to some degree the scope of governance instruments and policies intended to protect children from environmental hazards. Indeed, our interview process is based upon a small number of responses and respondent bias, as well as concern about confidentiality of responses, may have limited the depth with which certain respondents commented. Nonetheless, together these two data sources provide insights never before obtained about a developing country amidst significant industrialization and increasing scientific understanding of the impact of environmental hazards on children's lives. Despite these limitations, our results strongly suggest that significant gaps remain in the system developed to protect children from environmental hazards in a country that is likely to experience increases in scope of industrialization and potentially hazardous environmental exposures.
The challenge Mexico faces in the future is to design policies that specifically protect children against environmental exposures. A systematic review of US state policies has identified a series of model environmental regulations that can be used to prevent neurodevelopmental disabilities and asthma in children [65
]. These include: reductions in mercury emissions from coal-fired power plants, bans on smoking in public places, incentives for implementation of integrated pest management (IPM), limits on arsenic contamination in drinking water, limits on diesel vehicle idling, and requirements to reduce volatile organic compound use in household products. While these model policies may require some modification for use in the Mexican national context, they do serve as bases for the implementation of proactive measures to limit harmful exposures.
While identification of model policies is a useful first step, the social will must also exist to implement them. In the United States and Europe, progress towards protecting children from environmental risk factors has emerged out of a joint effort of academic researchers, government officials and advocates in translating knowledge from theory to population impact. While a WHO Collaborating Center in Children's Environmental Health does exist at the University of San Luis Potosi, resources need to be established across other parts Mexico to ensure effective dissemination of knowledge about environmental risk factors across this large and geographically dispersed population. One model for the effective dissemination of knowledge about environmental risk factors is the establishment of regionalized Pediatric Environmental Health Specialty Units (PEHSU) where researchers and clinicians work together to identify, study and remediate local population concerns.
Indeed, one PEHSU was established at the National Institute of Public Health and Children's Hospital of Morelos with support from the EPA (2001 to 2008) in concert with the CEC trilateral program on children and environment, but has subsequently had its stream of funding terminated. Before its termination, this PEHSU built an impressive track record of communication locally and nationally about a host of hazards, ranging from water contamination to unhealthy food. Government officials should recognize this track record of success and must devote additional resources to children's environmental health in Mexico. Further fiscal support for clinical and research facilities is needed to document burden of environmentally-mediated diseases in Mexican children and identify preventable risk factors for intervention by policy makers, communities and clinicians. While competing public health priorities exist, expanding efforts in children's health beyond the prevention of infectious illnesses would stem the tide of an increasing epidemic of chronic disease in Mexican children [5
Even if resources are established to study, prevent and treat diseases of environmental origin, improving communication between the research and advocacy communities was identified as a major concern across many of the interviews. Whether or not PEHSUs are reestablished in Mexico, researchers should establish more collaborative modes of communication with the government officials and the advocacy community to ensure effective and appropriate translation of research findings. This can easily be done in a manner that does not compromise scientific integrity.
Strong concerns were raised about threats of economic development as a barrier to proactive protection of children from environmental hazards. Perceptions can cloud reality, especially when economic progress is primal in the minds and hearts of government officials. Examples from the systematic review of US states [65
] include many initiatives that do not come at a cost to economic progress. These include widespread use of integrated pest management, which in Ecuador, reduced pesticide applications and lowered the overall amount of pesticides needed. The IPM fields yielded as many or more potatoes but production costs decreased from USD$104/ton potatoes produced to USD$80/ton, while neurological effects among farmers and their families decreased [68
]. Examples like these must be communicated along with the economic benefits associated with reduced disease and disability among children when proactive regulation is instituted to limit toxic environmental exposures. Removal of lead in gasoline is likely to have resulted in similar economic benefits in Mexico to that achieved in the United States, where annual economic productivity of each birth cohort increased by $110-319 billion [32
We were surprised that international treaties did not support ongoing efforts to improve children's environmental health in Mexico. Indeed, as NAFTA continues to open trade across North America, children in all three countries will be exposed to contaminants in products made in any one of them. While gaps do remain in US policy with regard to children and protecting them from environmental hazards [65
], our review identified opportunities for US leadership that would be of mutual benefit to Mexican and US children. It is important to recognize the ongoing effort of the Commission for Environmental Cooperation (CEC), a trinational organization that has partnered with each North American government to issue a first report on children's health and the environment [69
]. We would encourage CEC to include policy outcomes in future reports, and ensure effective communication of successful initiatives and lessons learned in policy initiatives to protect children.
As Mexico moves through the twenty-first century, concerns regarding environmental exposures loom globally. In 2020, the developing world will account for 33% of world chemical demand and 31% of production, compared with 23% and 21% respectively in 1995 [70
]. It is equally imperative to develop and implement policies across industrializing countries and less developed nations around the globe to protect the health of our children now and in the future. As Mexico and other countries emerge as developed economies, industrialization is likely to result in broader and greater exposures to industrial chemicals. If regulatory efforts are not taken to limit environmental exposures that are known or suspected to be hazardous, industrialization could result in increases in environmental exposure to toxic chemicals which have been linked to epidemics of chronic conditions in the United States and other developed countries [31
]. Children are arguably a country's greatest natural resource, and policies to protect children from environmental hazards can have great long-term benefits, given their greater future years of productive life. Mexico, like other countries, will continue to wrestle with decisions to distribute resources towards improvement of public health of its entire population rather than focus those resources on children and other vulnerable populations. However, many policy options to improve protections of children would not require governmental resources, and yield economic benefits many times over for decades to come.