Child Health and the Environment. Donald T Wigle. Oxford: Oxford University Press, 2003, pp. 396, (HB)  37.50 ISBN: 0-19-513559-8.

Children all over the world are exposed to multiple low-level environmental contaminants beginning in utero, and yet surprisingly little is known about the proportions of adverse health outcomes attributable to these exposures. The foetus and infant is particularly vulnerable to environmental contaminants because of rapid body growth and development, relatively high exposures related to diet and behaviour, differences in physiology and metabolism in comparison to adults, and immature detoxification systems. In this review of the environmental health issues for children Don Wigle critically assesses the epidemiological and biological evidence supporting causal relationships between early exposures and subsequent adverse health outcomes, and addresses the risk management issues for children. The author is an experienced environmental epidemiologist from the Institute of Population Health at the University of Ottawa who has advised the Canadian government on environmental hazards, and although there is an inevitable North American bias in the literature review and the approach to public health, the book is well written in an accessible style and should be of interest to a wide audience. The first three chapters provide an overview of environmental health issues for children, the role of environmental epidemiology, and the principles of risk assessment and child health protection. Together these chapters provide an excellent overview for the student, but some topics (such as developmental neurotoxicity and reproductive toxicity) are covered relatively superficially. Subsequent chapters deal in more detail with the main environmental hazards in groups, starting with heavy metals, reviewing dioxins, polychlorinated biphenyls and pesticides, hormonally active agents, the effects of radiation, and concluding with air and water exposures. The evidence is critically appraised and each chapter concludes with a useful summary of the proven child health outcomes, the unresolved issues and knowledge gaps and the risk management issues. The amount of evidence reviewed and the space given to each topic varies widely, and reflects the concerns of the environmental epidemiologist from the developed industrialized world—for example a whole chapter of 27 pages is devoted to the effects of lead, whilst the much bigger topic of water-borne hazards is covered more superficially in a chapter of 31 pages. I would have liked more on the potential effects of climate change on child health, but recognize that the evidence at this stage may be lacking. Two consistent calls throughout the book are for more specific epidemiological research that incorporates biomarkers of exposure and susceptibility with sufficient size to control for potential confounders, and for the continual tracking of levels of environmental contaminants. The concluding chapter is an excellent overview of the current state of knowledge of the environmental threats to child health, and contains five useful tables summarizing the strength of evidence of causality as sufficient, limited, or inadequate. Much of the evidence comes from inadvertent exposures in pregnancy or childhood before the risks were appreciated, and the clear conclusion is that a precautionary approach has to be adopted. The author concludes that, for almost all potential hazards, existing knowledge does not permit estimation of attributable risk. The overriding difficulty is in quantifying the health risks of low-level environmental exposure, especially at critical periods in early development or over long periods in childhood. Child Health and the Environment provides a comprehensive review of a big subject area in a well-referenced but easy to digest format: it will be useful for paediatricians, epidemiologists, and those interested in public health policy. The book is supported by a useful website at the McLaughlin Centre for Population Health Risk Assessment at the University of Ottowa: http://www.mclaughlincentre.ca

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