California Children’s Environmental Health - Children's Environmental Health Network

California Children's Environmental Health

California’s dramatic landscapes – from Redwood forests to the peaks of the Sierra Nevada to sprawling deserts and a nearly 900-mile Pacific coastline- have long shaped the state’s identity and economy. Its climate ranges from tundra to desert to snowy mountains, yet California is perhaps most commonly envisioned something akin to the California Dreams series of the 90’s- with the near Mediterranean climate that has inspired the popularity of American farm-to-table dining, Hollywood movie stars, and those in search of life on the beach.

Originally based in mining and agriculture, California’s economy has exploded to become the fourth largest in the entire world, surpassed only by China, Germany, and its own home country of the United States. Perhaps this is no surprise considering the technology, media, and tourism industries alone.

California has also taken aggressive and early action on environmental issues. Key examples of California’s leadership are in their environmental history. California is home to Yosemite, the first publicly protected wilderness area in the United States. In 1885 California became the first state to regulate logging and actively promote reforestation. Later in 1979, they adopted the first energy efficiency standards for appliances. Needless to say, California’s Environmental Protection Agency has a long legacy to uphold.

As tectonic risks continue subsurface, drought and water management issues grow in the rising heat. The state of California has many diverse environments and people to protect. In the profile below, you’ll find a set of key children’s environmental health indicators that illuminate California’s environmental risks, children’s exposures, and emerging trends in child health and development.

Key Children's Environmental Health Indicators for California

Safe Drinking Water:
21% of public water utilities had drinking water violations.
National average: 30%

Air Quality:
89% of children under age 18 live in counties with unhealthy ozone pollution.

Warming Temperatures:
2.7 degrees F warmer in 2020 than in 1970.
National average 2.8 degrees F warmer

Toxic Chemical Releases:
39.2 million pounds of toxic chemicals were disposed of or released.
United States 3.4 billion pounds

Asthma:
7.4% of children under age 18 have asthma (2018- 2019).
Nationwide: 7.7%

Pediatric Cancer:
181 cases of pediatric cancer per 1 million population (2005-2015).
Nationwide: 181 cases per 1 million

Blood Lead Levels:
1.48% of tested children under age 6 have elevated blood lead levels (2018).
Nationwide: 2.6%

Neurodevelopmental Disorders:
5.6% of children age 3-17 have ADD or ADHD (2018-2019).
Nationwide: 8.7%

3.3% of children age 3-17 have Autism Spectrum Disorder (2018- 2019).
Nationwide: 2.9%

California Spotlight: Climate Change and Health Vulnerability Planning Tool

The California Department of Public Health (CDPH) seeks to reduce and prevent adverse and inequitable physical and mental health impacts associated with climate change. With partial funding from the Centers for Disease Control & Prevention’s Climate Ready States and Cities Initiative, the CDPH Climate Change and Health Equity Section and its CalBRACE Project developed Climate Change & Health Vulnerability Indicators for California (CCHVIs) and an online interactive platform to visualize the data, CCHVIz, These tools assist with climate change planning and prioritizing actions to protect people most at risk, including children.

The CCHVIz displays three categories of indicators that influence vulnerability to health impacts of climate change: exposure indicators including heat, air quality,

wildfires, and sea level rise; population sensitivity indicators including children, elderly, poverty, education, outdoor workers, vehicle ownership, linguistic isolation, disability, health insurance, and violent crime rate; and adaptive capacity indicators including air conditioning ownership, tree canopy, and impervious surfaces.

The CCHVIz provides health officials and planners with an online snapshot to compare their county’s indicators to the state average. They can view risk by census tract for specific indicators, such as children under age 5, and their breakdown by race and ethnicity. The tool also plots the intersections of exposure indicators (e.g., ozone concentration) with sensitivity indicators (e.g., population under 5 years of age) to learn where children are susceptible to air pollution, extreme heat, wildfire, or other threats. The CCHVIz is an excellent resource for State and local officials in California to plan to prevent and prepare for climate change-related health impacts to young children, especially children of color and children in under-resourced communities.

Federal Support to California Within the Past Five Years

CDC-funded Lead Poisoning Prevention Program
CDC-funded Climate-Ready States & Cities Initiative
ATSDR State Cooperative Agreement Program
CDC National Asthma Control Program
CDC-funded Environmental Public Health Tracking Program
CDC State Biomonitoring Cooperative Agreement Program

Children's Environmental Health Indicators Selection Criteria

Each headline indicator should be a clear, understandable indicator of children’s environmental health, with broad relevance for a range of audiences at the state level – with relevance to the national level.

The indicators as a package should provide a representative picture of children’s health and relation to the environment.

Each indicator should be calculated using an agreed-upon (and published) method and accessible and verifiable data.

Each indicator should be calculated regularly (at least biennially), with a short lag between the end of the period and publication of the data.

The available data needed for the indicator must be sufficiently robust, reliable and valid.

Indicators must be comparable across all or very nearly all 50 U.S. states

Indicator Notes and References

Number of Children in California

U.S. Census Bureau. 2018. Quick Facts California.

Percent of Children in California Living in Poverty

The Annie E. Casey Foundation. 2019 KIDS COUNT Data Book: 2019 State Trends in Child Well-Being: California.

California Drinking Water Performance Dashboard

Public Water Systems with Any Violation – Fiscal Year 2019. Enforcement and Compliance History Online (ECHO). U.S. Environmental Protection Agency. Accessed on March 25, 2020.

Ozone Pollution

In this fact sheet, counties with “unhealthy” ozone pollution are those receiving a grade of D or F for ozone pollution in the American Lung Association’s 2021 State of the Air report. Approximately 43,082 California children live in counties where ozone pollution is not monitored or for which there is less than 3 years of data.

American Lung Association. 2020 State of the Air. Report card: California. Data from U.S. Environmental Protection Agency’s Air Quality System. Accessed on April 21, 2020.

American Warming

Warming matters — it drives most of the hazards associated with climate change such as extreme weather, heat days, droughts, and heavy downpours. Children are more vulnerable to harm from extreme heat and to the other cascading effects of warming temperatures.

The Fastest-Warming Cities and States in the U.S. April 17, 2019. Climate Central. Data from National Centers for Environmental Information, National Oceanic and Atmospheric Association. Accessed on October 28, 2019

Toxic Release Inventory

EPA’s Toxics Release Inventory (TRI) tracks the management of certain toxic chemicals that may pose a threat to human health and the environment. Certain industrial facilities in the U.S. must report annually how much of each chemical is disposed of or released on- and off-site. Many of these chemicals are known carcinogens, developmental toxicants, and neurotoxicants, such as arsenic, lead, and mercury, that adversely impact children’s health.

Summary of 263 Toxic Release Inventory Facilities in California. Reporting Year 2018. Accessed on April 28, 2020.

Neurodevelopmental Notes

Mounting scientific research links environmental exposures with risk of Attention-Deficit Hyperactivity Disorder (ADHD), Attention-Deficit Disorder (ADD), and Autism Spectrum Disorder (ASD). Neither genetics nor changing diagnoses or other artifacts fully account for the increased incidences of these conditions. ADHD, ADD, and ASD data are for California children aged 3-17 years.

ADHD, ADD, and ASD prevalence

2017-2018 National Survey of Children’s Health. Title V Maternal and Child Health Services Block Grant National Performance and Outcome Measures. Prevalence of current ADD or ADHD, age 3-17 years; and Prevalence of current Autism or Autism Spectrum Disorder (ASD), age 3-17 years. Data Resource Center for Child and Adolescent Health. Maternal and Child Health Bureau, Health Resources and Services Administration. Accessed on March 25,2020.

Asthma prevalence

A wealth of research links exposure to poor outdoor air quality, including high concentrations of ground-level ozone, with the exacerbation of children’s respiratory illnesses, including asthma. Several studies link it with the onset of childhood asthma.

2017-2018 National Survey of Children’s Health. Title V Maternal and Child Health Services Block Grant National Performance and Outcome Measures. Prevalence of current asthma, age 0-17 years. Data Resource Center for Child and Adolescent Health. Maternal and Child Health Bureau, Health Resources and Services Administration. Accessed on March 25,2020.

California Childhood Cancers Incidence

Request for children age 0-19. Age-adjusted rate for 2005-2015. Centers for Disease Control and Prevention. Wide-ranging Online Data for Epidemiologic Research (WONDER). Accessed on March 25, 2020.

National Childhood Blood Lead Surveillance Data

Centers for Disease Control and Prevention. Accessed on March 25, 2020

Environmental exposures contribute to ADHD/ADD, ASD, and asthma

NIEHS/EPA Children’s Environmental Health and Disease Prevention Research Centers. 2017 Impact Report.

Pediatric Cancer Indicator Notes

Although cancer in children is rare, the rate of pediatric cancer has been increasing since the 1970s. It is the leading disease-related cause of death past infancy in U.S. children. Neither genetics nor improved diagnostic techniques can explain the increased rate.

According to the President’s Cancer Panel’s 2008-2009 Annual Report, “the true burden of environmentally induced cancer has been grossly underestimated.”

President's Cancer Panel

2008-2009 Annual Report. Reducing Environmental Cancer Risk. National Cancer Institute, National Institutes of Health.

Under-testing and Under-reporting of children's blood lead levels

CA 2018 BLL data is from the California Department of Public Health, and the 2018 Nationwide BLL is from CDC’s NCEH website. Often the most vulnerable children are not tested, and not all who are tested get reported, so these values are likely an underestimate of the true scope of children’s elevated BLL in California. There is no safe level of lead exposure for children. A potent neurotoxicant, lead reduces IQ and impairs other cognitive, behavioral, and developmental functions. In 2021 CDC lowered the BLL reference value from 5 to 3.5 μg/dL.

Assessing Child Lead Poisoning Case Ascertainment in the US, 1999–2010. Eric M. Roberts, Daniel Madrigal, Jhaqueline Valle, Galatea King and Linda Kite. Pediatrics April 2017, e20164266; DOI: https://doi.org/10.1542/peds.2016-4266.

CDC Childhood Lead Poisoning Prevention

California. Accessed on March 25, 2020.

ATSDR State Cooperative Agreement Program

APPLETREE map. Accessed on March 25, 2020.

CDC National Asthma Control Program

Accessed on March 25, 2020.

CDC Environmental Public Health Tracking Network

Arizona Tracking Program. Accessed on March 25, 2020.

CDC State Biomonitoring Program

Accessed on March 25, 2020.

State Spotlight Reference

Accessed on March 25, 2020.

All children deserve and need a safe and healthy environment to grow and develop. They need clean air to breathe, safe water to drink, nutritious food to eat, and healthy places in which to live, learn, and play. Early exposure to harmful agents can lead to acute and chronic adverse outcomes. Infants and children are especially vulnerable to environmental exposures because they breathe, eat and drink more, in proportion to their body size, than do adults, and because their bodies and brains are still developing.

A blueprint for Protecting Children’s Environmental Health Network set out to identify a set of CEHIs that can be used to provide an understanding of children’s environmental health at the state level. Through this process, CEHN found that robust, valid, and regularly updated state level data–that are comparable across most states–were not readily accessible. States need adequate funding and capacity to collect and make accessible reliable CEHI data in order to set goals and track progress towards improving children’s health.

Children are our future – society has a moral obligation to protect them. Exposure to environmental hazards can and must be prevented. Prevention requires strong environmental regulations, fully funded and supportive public and environmental health programs and a robust workforce.