Childhood Cancer & the Environment

Did you know 53% of children under 18 in Maryland live in counties with unhealthy levels of ozone pollution? Or that Maryland was 3.2 degrees Fahrenheit warmer in 2021 than 1970 (compared to the national average of 2.9 degrees)?  There are about 1.4 million children in Maryland, and 12% live in poverty. Poverty is an important
social determinant of health; poverty hurts children and their families. Children of color and young children are disproportionately poor and experience many issues that lead to adverse health outcomes. All children deserve a safe and healthy environment to grow and develop.

This profile highlights key Maryland children’s environmental health indicators, federal support received by the states for environmental health, health equity and climate and health programs, and a spotlight feature on a children’s environmental-health related topical issue.

Continue reading to learn more about environmental hazards, children’s exposures, and children’s health outcomes in Maryland, or click the blue button to download the profile as a PDF.

Key Children’s Environmental Health Indicators for Maryland

What is a Children’s Environmental Health Indicator?

See Indicator References

	Safe Drinking Water: 15.8% of public water utilities had drinking water violations. National average: 31.3%
	Air Quality: 53% of children under age 18 live in counties with unhealthy ozone pollution
	Warming Temperatures: 3.2 degrees F warmer in 2021 than in 1970. National average 2.9 degrees F warmer
	Toxic Chemical Releases: 5.6 million pounds of toxic chemicals were disposed of or released. United States 3.1 billion pounds
	Asthma: 8.2% of children under age 18 have asthma (2019- 2020) Nationwide: 7.5%
	Pediatric Cancer: 174.7 cases of pediatric cancer per 1 million population (2008-2018) Nationwide: 186.5 cases per 1 million
	Blood lead levels: 1.7% of tested children under age 6 have elevated blood lead levels (2018) Nationwide: 2.6%
	Neurodevelopmental Disorders:9.1% of children age 3-17 have ADD or ADHD (2019-2021). Nationwide: 8.9% 3% of children age 3-17  have Autism Spectrum Disorder (2019- 2020) Nationwide: 2.9%

Maryland Spotlight: State Children’s Environmental Health and Protection Advisory Council

Unique to Maryland is its State Children’s Environmental Health and Protection Advisory Council (CEHPAC). The team of 19 rotating interdisciplinary members was established in November 2000 by the General Assembly to ensure that all children can grow up in a safe and healthy environment. It was propelled by the findings that children have preventable exposures to environmental hazards in the places they live, learn, and grow, and are at a greater risk than adults to get exposure to and illness from environmental hazards due to characteristics specific to their developmental stage. Children of color are disproportionately vulnerable to environmental hazards due to systemic racism. CEHPAC identifies pressing environmental hazards in Maryland and recommends solutions to reduce or eliminate children’s exposure to them. The nonpartisan group meets at least six times a year to review and comment on rules, regulations and standards, inform the public about environmental health hazards, advise the General Assembly on relevant legislation, and recommend uniform guidelines for state agencies. CEHPAC addresses issues such as lead hazards, climate change, and school integrated pest management programs, as well as emerging issues relevant to children’s health. This group has been active across multiple administrations and can serve as a model to others for how to adopt a system or structure to intentionally consider children’s environmental health at the state level.

Federal Support to Maryland within the past 5 years

	CDC-funded Lead Poisoning Prevention Program
	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
Children’s environmental health indicators (CEHIs) are measures that can be used to assess environmental hazards, exposures, and their resulting health outcomes in children.  The below criteria are used when determining which indicators to utilize:

• Relevance: 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.
• Representativeness: The indicators as a package should provide a representative picture of children’s health and relation to the environment.
• Traceability: Each indicator should be calculated using an agreed-upon (and published) method and accessible and verifiable data.
• Timeliness: Each indicator should be calculated regularly (at least biennially), with a short lag between the end of the period and publication of the data.
• Data adequacy: The available data needed for the indicator must be sufficiently robust, reliable and valid.
• Universality: Indicators must be comparable across all or very nearly all 50 U.S. states. [/expand]

Indicator Notes and References

Safe Drinking Water

• Reference: Maryland Drinking Water Performance Dashboard. Public Water Systems with Any Violation – Fiscal Year 2021. Enforcement and Compliance History Online (ECHO). U.S. Environmental Protection Agency. Accessed May, 2022.

Air Quality

• Indicator Note: In this profile, counties with “unhealthy” ozone pollution are those receiving a grade of D or F for ozone pollution in the American Lung Association’s 2022 State of the Air report. Approximately 706,946 or 53% of Maryland children live in counties where ozone pollution is not monitored or for which there are less than 3 years of data.
• Reference: American Lung Association. 2022 State of the Air. Report card: Maryland. Data from U.S. Environmental Protection Agency’s Air Quality System Accessed May, 2022.

Warming Temperature

• Indicator Note: 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 the hazards driven by warming temperatures, such as heatwaves, droughts, flooding, and many other cascading effects. Climate change causes an increase in the frequency and severity of temperature anomalies, extreme weather, and natural disasters globally.
• Reference: American Warming: NOAA National Centers for Environmental Information. Climate at a Glance: Statewide Time Series, retrieved May 2022. .

Toxic Chemicals

• Indicator Note: 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.
• Reference: Summary of 263 Toxic Release Inventory Facilities in Maryland. Reporting Year 2020. Accessed May, 2022.

Neurodevelopmental Disorders

• Indicator Note: 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 diagnosis or other artifacts fully account for the increased incidences of these conditions. ADHD, ADD and ASD data are for California children aged 3-17 ages.
• Reference:
• ADHD, ADD, and ASD prevalence. 2019-2020 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 May,2022
• Environmental exposures contribute to ADHD/ADD, ASD, and asthma. NIEHS/EPA Children’s Environmental Health and Disease Prevention Research Centers. 2017 Impact Report.

Asthma

• Indicator Note: 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.
• Reference:  Asthma prevalence. 2019-2020 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 May,2022

Pediatric Cancer

• Indicator Note: 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”
• Reference: Maryland Childhood Cancers Incidence. Request for children age 0-19. Age-adjusted rate for 2008-20118. Centers for Disease Control and Prevention. Wide-ranging Online Data for Epidemiologic Research (WONDER). Accessed May, 2022
• President’s Cancer Panel. 2008-2009 Annual Report. Reducing Environmental Cancer Risk. National Cancer Institute, National Institutes of Health.

Blood Lead Levels

• Indicator Note: In 2018, 30.1% of Maryland children under age 6 were tested for blood lead levels (BLLs). Of those tested, 1.7% had a BLL ≥ 5 μg/dL. Often the most vulnerable children are not tested, and not all who are tested get reported, so this is likely an underestimate of the true scope of children’s elevated blood lead in Maryland. 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, the CDC lowered the BLL reference value from 5 to 3.5 μg/dL, but much of the available data still categorizes “elevated” BLLs as being 5 ug/dL or higher.
• Reference:
  • National Childhood Blood Lead Surveillance Data. Centers for Disease Control and Prevention. Accessed May, 2022.
  • Under-testing and Under-reporting of children’s blood lead levels. 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.

Poverty

• Reference:
  • Number of Children in Maryland. U.S. Census Bureau. 2019. Quick Facts Maryland.
  • Percent of Children in Maryland Living in Poverty. The Annie E. Casey Foundation. KIDS COUNT Data Center: Children in poverty (100 percent poverty) in Maryland. 2019.

Federal Support to Maryland

• References:
  • CDC Childhood Lead Poisoning Prevention. Maryland. Accessed September, 2021.
  • ATSDR State Cooperative Agreement Program. APPLETREE map. Accessed on June, 2021.
  • CDC National Asthma Control Program. Accessed June, 2021.
  • CDC Environmental Public Health Tracking Network. Maryland Tracking Program. Accessed June, 2021.
  • CDC State Biomonitoring Programs. Accessed June, 2021.

Maryland Spotlight

• References:
  •  Children’s Environmental Health and Protection Advisory Council. About.Accessed May 2022.

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.

Jump to Another State:

Did you know 13.9% of children under 18 in North Carolina have ADHD or ADD (compared to the National average of 8.9%) in 2019-2020? Or that 43% of children under age 18 live in counties that do not monitor ozone pollution? There are 2.3 million children in North Carolina, and approximately 20% of them live in poverty. Poverty is an important social determinant of health; poverty hurts children and their families. Children of color and young children are disproportionately poor and experience many issues that lead to adverse health outcomes. All children deserve a safe and healthy environment to grow and develop.

This profile highlights key North Carolina children’s environmental health indicators, federal support received by the state for environmental health, health equity and climate and health programs, and a spotlight feature in a children’s environmental health-related topical issues.

Continue reading to learn more about environmental hazards, children’s exposures, and children’s health outcomes in North Carolina, or click the blue button to download the profile as a PDF.

Key Children’s Environmental Health Indicators for North Carolina

What is a Children’s Environmental Health Indicator?

See Indicator References

	Safe Drinking Water: 22% of public water utilities had drinking water violations (2020) National average: 31%
	Air Quality: 43% of children under age 18 live in the 68 (out of 100 total) counties that do not monitor ozone pollution (2021)
	Warming Temperatures: 2.5 degrees F warmer in 2020 than in 1970. National average 2.8 degrees F warmer
	Toxic Chemical Releases: 55 million pounds of toxic chemicals were disposed of or released (2020). United States 3.1 billion pounds
	Asthma: 7.1% of children under age 18 have asthma (2018- 2019) Nationwide: 7.7%
	Pediatric Cancer: 172.8 cases of pediatric cancer per 1 million population (2005-2015) Nationwide: 181.0 cases per 1 million
	Blood lead levels: 1.2% of tested children under age 6 have elevated blood lead levels (2018). Nationwide: 2.6%
	Neurodevelopmental Disorders:13.9% of children age 3-17 have ADD or ADHD (2019-2020). Nationwide: 8.9%. 3.2% of children age 3-17  have Autism Spectrum Disorder (2019- 2020) Nationwide: 2.9%

North Carolina Spotlight: 

Research shows that children today will face around three times as many climate disasters as their grandparents did, including wildfires, storms, floods and droughts. Aggressive reductions in greenhouse gas emissions are needed to protect children and future generations from the health effects of these impacts. A 2018 North Carolina executive order established climate and clean energy goals to achieve by 2025, including reducing statewide greenhouse has emissions to 40% below 2005 levels. According to the U.S. Solar Market Insight Report, NC ranks 3rd in the nation for total solar power as  of the end of the first quarter of 2021.

The North Carolina Department of Health and Human Services (DHHS)has listed impacts to children among the top priorities to be addressed in its statewide climate resilience strategy. The state has an Early Childhood Action Plan which outlies a cohesive vision, sets benchmarks for impact by the year 2025, and establishes shared stakeholder accountability to achieve statewide goals for young children from birth through age 8. As of March 2021, the NC DHHS has been working on an addendum to the Early Childhood Action Plan that would focus on assessing and addressing the impacts of climate change on young children through the lens of health equity.

Federal Support to North Carolina within the past 5 years

	CDC-funded Climate-Ready States & Cities Initiative
	CDC-Funded Lead Poisoning Prevention Program
	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
Children’s environmental health indicators (CEHIs) are measures that can be used to assess environmental hazards, exposures, and their resulting health outcomes in children. The below criteria are used when determining which indicators to utilize:

• • Relevance: 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.
  • Representativeness: The indicators as a package should provide a representative picture of children’s health and relation to the environment.
  • Traceability: Each indicator should be calculated using an agreed-upon (and published) method and accessible and verifiable data.
  • Timeliness: Each indicator should be calculated regularly (at least biennially), with a short lag between the end of the period and publication of the data.
  • Data adequacy: The available data needed for the indicator must be sufficiently robust, reliable and valid.
  • Universality: Indicators must be comparable across all or very nearly all 50 U.S. states. [/expand]

Indicator Notes and References

Safe Drinking Water

• Reference: North Carolina Drinking Water Performance Dashboard. Public Water Systems with Any Violation – Fiscal Year 2020. Enforcement and Compliance History Online (ECHO). U.S. Environmental Protection Agency.

Air Quality

• Indicator Note: 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. Out of North Carolina’s 100 counties, 68 did not monitor for ozone. Of the 32 counties that monitored, 2 had unhealthy ozone pollution, accounting for 321,520 or 14% of children.
• Reference: Ozone Pollution. American Lung Association. 2021 State of the Air. Report card: North Carolina. Data from U.S. Environmental Protection Agency’s Air Quality System.

[/toggle]
[toggle title=”Warming Temperature”]

• Indicator Note: 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.
• Reference: Warming Temperatures. 2020. Climate at a Glance | National Centers for Environmental Information (NCEI). Statewide Haywood Plots: North Carolina.

Toxic Chemicals

• Indicator Note: 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.
• Reference: Summary of 779 Toxic Release Inventory Facilities in North Carolina. Reporting Year 2020.

Neurodevelopmental Disorders

• Indicator Note: 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 diagnosis or other artifacts fully account for the increased incidences of these conditions. ADHD, ADD and ASD data are for North Carolina children aged 3-17 ages.
• Reference: ADHD, ADD, and ASD prevalence. 2019-2020 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.

Asthma

• Indicator Note: 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.
• Reference: Asthma prevalence. 2018-2019 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.

Pediatric Cancer

• Indicator Note: 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”
• Reference:North Carolina 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).

Blood Lead Levels

• Indicator Note: Often the most vulnerable children are not tested, and not all who are tested get reported, so 1.2% is likely an underestimate of the true scope of children’s elevated blood lead in North Carolina. 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, the CDC lowered the BLL reference value from 5 to 3.5 µg/dL.
• Reference: National Childhood Blood Lead Surveillance Data. 2018. Centers for Disease Control and Prevention..

Poverty

• Reference:
  • Number of Children in North Carolina. U.S. Census Bureau. 2019. Quick Facts North Carolina
  • Percent of Children in North Carolina Living in Poverty. The Annie E. Casey Foundation. 2020 KIDS COUNT Data Book: 2020 State Trends in Child Well-Being: North Carolina.

Federal Support to North Carolina

• References:
  • • Environmental exposures contribute to ADHD/ADD, ASD, and asthma. NIEHS/EPA Children’s Environmental Health and Disease Prevention Research Centers. 2017 Impact Report.
    • 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. 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-funded Climate-Ready States & Cities Initiative. 2021.
    • CDC Childhood Lead Poisoning Prevention. 2019.
    • ATSDR State Cooperative Agreement Program. 2021.

North Carolina Spotlight

• References:
  • Thiery, W., Lange, S., Rogelj, J., Schleussner, C. F., Gudmundsson, L., Seneviratne, S. I., … & Wada, Y. (2021). Intergenerational inequities in exposure to climate extremes. Science, 374(6564), 158-160
  • State of North Carolina Exec. Order No. 80. October 29, 2018.
  • U.S. Solar Market Insight Report 2021 Q2. June 15, 2021. Solar Energy Industries Association.
  • North Carolina Early Childhood Action Plan. 2019. North Carolina Department of Health and Human Services.

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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.

Did you know 48% of Minnesota’s children live in counties that do not monitor ozone pollution levels?  Or that while the national average temperature increase since 1970 is 2.8 degrees F, Minnesota’s temperature increase is 3.3 degrees F? There are 1.3 million children in Minnesota, and approximately 11% of them live in poverty. Poverty is an important social determinant of health; poverty hurts children and their families. Children of color and young children are disproportionately poor and experience many issues that lead to adverse health outcomes. All children deserve a safe and healthy environment to grow and develop.

This profile highlights key Minnesota children’s environmental health indicators, federal support received by the state for environmental health, health equity, and climate and health programs, and a spotlight feature on a children’s environmental health-related topical issue.

Continue reading to learn more about environmental hazards, children’s exposures, and children’s health outcomes in Minnesota, or click the blue button to download the profile as a PDF.

Key Children’s Environmental Health Indicators for Minnesota

What is a Children’s Environmental Health Indicator?

See Indicator References

	Safe Drinking Water: 3% of public water utilities had drinking water violations (2020). National average: 31%
	Air Quality: 48% of children under age 18 live in the 72 (out of 87 total) counties that do not monitor ozone pollution (2021).
	Warming Temperatures: 3.3 degrees F warmer in 2020 than in 1970. National average 2.8 degrees F warmer
	Toxic Chemical Releases: 20.4 million pounds of toxic chemicals were disposed of or released (2020). United States 3.1 billion pounds
	Asthma: 7% of children under age 18 have asthma (2018- 2019) Nationwide: 7.7%
	Pediatric Cancer: 185.7 cases of pediatric cancer per 1 million population (2005-2015) Nationwide: 181.0 cases per 1 million
	Blood lead levels: 1.4% of tested children under age 6 have elevated blood lead levels (2018) Nationwide: 2.6%
	Neurodevelopmental Disorders:6.8% of children age 3-17 have ADD or ADHD (2019-2020). Nationwide: 8.9%. 2.7% of children age 3-17  have Autism Spectrum Disorder (2019- 2020) Nationwide: 2.9%

Minnesota Spotlight: Minnesota Department of Health Drinking Water Guidance

Minnesota is one of only a few states that develops its own drinking water guidance in addition to existing EPA standards. State law specifies that the guidance must adequately protect the health of infants and children. To this end, the Minnesota Department of Health (MDH) has developed drinking water guidance that considers developmental “windows of sensitivity” to toxicants as well as periods of high exposure.

The state is particularly aggressive in its monitoring of per and poly-fluoroalkyl substances (PFAS), a class of persistent chemicals that pose significant health risks. MDH toxicologists uniquely consider placental transfer and transfer through formula-feeding and breastmilk in their risk assessment of PFAS in water sources.

MDH has a long-term goal of sampling all community water systems in the state for PFAS. Under this goal, MDH aims to cover 90% of CWS customers under its PFAS monitoring program by 2025. They will also sample noncommunity water systems in areas that are most vulnerable to PFAS contamination to address the highest potential public health risks.

Federal Support to Minnesota within the past 5 years

	CDC-Funded Lead Poisoning Prevention Program
	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
Children’s environmental health indicators (CEHIs) are measures that can be used to assess environmental hazards, exposures, and their resulting health outcomes in children.  The below criteria are used when determining which indicators to utilize:

• • Relevance: 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.
  • Representativeness: The indicators as a package should provide a representative picture of children’s health and relation to the environment.
  • Traceability: Each indicator should be calculated using an agreed-upon (and published) method and accessible and verifiable data.
  • Timeliness: Each indicator should be calculated regularly (at least biennially), with a short lag between the end of the period and publication of the data.
  • Data adequacy: The available data needed for the indicator must be sufficiently robust, reliable and valid.
  • Universality: Indicators must be comparable across all or very nearly all 50 U.S. states. [/expand]

Indicator Notes and References

Safe Drinking Water

• Reference: Minnesota Drinking Water Performance Dashboard. Public Water Systems with Any Violation – Fiscal Year 2020. Enforcement and Compliance History Online (ECHO). U.S. Environmental Protection Agency.

Air Quality

• Indicator Note: 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. Out of Minnesota’s 87 counties, 72 did not monitor for ozone. None of the 15 counties that monitored had unhealthy ozone pollution.
• Reference: Ozone Pollution. American Lung Association. 2021 State of the Air. Report card: Minnesota. Data from U.S. Environmental Protection Agency’s Air Quality System.

Warming Temperature

• Indicator Note: 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.
• Reference: AMERICAN WARMING: The Fastest-Warming Cities and States in the U.S. 2020. Climate Central. Data from National Centers for Environmental Information, National Oceanic Toxic Chemicals”]

• Indicator Note: 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.
• Reference: Summary of 509 Toxic Release Inventory Facilities in Minnesota. Reporting Year 2020.

Neurodevelopmental Disorders

• Indicator Note: 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 diagnosis or other artifacts fully account for the increased incidences of these conditions. ADHD, ADD and ASD data are for Minnesota children aged 3-17 ages.
• Reference: ADHD, ADD, and ASD prevalence. 2019-2020 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 October 28, 2019.

Asthma

• Indicator Note: 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.
• Reference: Asthma prevalence. 2018-2019 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 October 28, 2019.

Pediatric Cancer

• Indicator Note: 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”
• Reference: Minnesota 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).

Blood Lead Levels

• Indicator Note: In 2017, 21.9% of Minnesota children under age 6 were tested for blood lead levels (BLLs). Of those tested, 0.6% had a BLL>= 5 µg/dL. Often the most vulnerable children are not tested, and not all who are tested get reported, so 0.6% is likely an underestimate of the true scope of children’s elevated blood lead in Minnesota. 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, the CDC lowered the BLL reference value from 5 to 3.5 µg/dL.
• Reference: National Childhood Blood Lead Surveillance Data. Minnesota (2018). Centers for Disease Control and Prevention.

Poverty

• Reference:
  • Number of Children in Minnesota. U.S. Census Bureau. 2019. Quick Facts Minnesota.
  • Percent of Children in Minnesota Living in Poverty. The Annie E. Casey Foundation. 2019 KIDS COUNT Data Book: 2019 State Trends in Child Well-Being: Minnesota

Federal Support to Minnesota

• References:
  • CDC Climate & Health Program. Minnesota (2019).
  • CDC Childhood Lead Poisoning Prevention. Minnesota (2019). 
  • ATSDR State Cooperative Agreement Program. APPLETREE map (2021).
  • CDC National Asthma Control Program. 2020.
  • CDC Environmental Public Health Tracking Network. Minnesota Tracking Program (2020).
  • CDC State Biomonitoring Programs. 2019

Minnesota Spotlight

• References:
  • Minnesota Guidance Values and Standards for Contaminants in Drinking Water. Minnesota Department of Health. 2020.
  • Minnesota State Law. Health Standards. 2021 Minnesota Statutes. Office of the Revisor of Statutes. Minnesota Legislature.
  • Minnesota Risk Assessment. Focus on Chronic Exposure for Deriving Drinking Water Guidance Underestimates Potential Risk to Infants. Helen Goeden. Int J Environ Res Public Health. 2018 Mar; 15(3): 512. 
  • Minnesota PFAS water guidance. A transgenerational toxicokinetic model and its use in derivation of Minnesota PFOA water guidance.Goeden HM, Greene CW, Jacobus JA. J Expo Sci Environ Epidemiol. 2019 Mar;29(2):183-195. [/toggle]
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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.

Did you know 50% of children under 18 in Michigan live in counties with unhealthy levels of ozone pollution? Or that 9.1% of children under age 18 had asthma (compared to the National average of 7.7%) in 2018-2019? There are 2.1 million children in Michigan, and approximately 18% of them live in poverty. Poverty is an important social determinant of health; poverty hurts children and their families. Children of color and young children are disproportionately poor and experience many issues that lead to adverse health outcomes. All children deserve a safe and healthy environment to grow and develop.

This profile highlights key Michigan children’s environmental health indicators, federal support received by the state for environmental health, health equity and climate and health programs, and a spotlight feature in a children’s environmental health-related topical issues.

Continue reading to learn more about environmental hazards, children’s exposures, and children’s health outcomes in Michigan, or click the blue button to download the profile as a PDF.

Key Children’s Environmental Health Indicators for Michigan

What is a Children’s Environmental Health Indicator?

See Indicator References

	Safe Drinking Water: 24% of public water utilities had drinking water violations (2020) National average: 31%
	Air Quality: 50% of children under age 18 live in counties with unhealthy ozone pollution (2021)
	Warming Temperatures: 2.9 degrees F warmer in 2020 than in 1970. National average 2.8 degrees F warmer
	Toxic Chemical Releases: 61.9 million pounds of toxic chemicals were disposed of or released (2020). United States 3.1 billion pounds
	Asthma: 9.1% of children under age 18 have asthma (2018- 2019) Nationwide: 7.7%
	Pediatric Cancer: 184.8 cases of pediatric cancer per 1 million population (2005-2015) Nationwide: 181.0 cases per 1 million
	Blood lead levels: 4% of tested children under age 6 have elevated blood lead levels (2016). Nationwide: 3.8%
	Neurodevelopmental Disorders:9.7% of children age 3-17 have ADD or ADHD (2019-2020). Nationwide: 8.9%. 2.6% of children age 3-17  have Autism Spectrum Disorder (2019- 2020) Nationwide: 2.9%

Michigan Spotlight: Michigan PFAS Action Response Team (MPART)

Contamination of drinking water by per- and polyfluoroalkyl substances (PFA) has been a high-visibility issue in Michigan and across the country over the past few years. PFAS are a group of highly toxic persistent chemicals and a significant public health concern. Although the EPA anticipates issuing PFAS regulation in Fall 2023, there are currently no federal regulations in place for PFAS in drinking water. A 2021 report found that Michigan has among the most PFAS-contaminated water sites in the country. However, the high number of confirmed sites is at least partly attributed to MI’s aggressive search for PFAS contamination.

Since 2017, the state has acted to protect its drinking water via the Michigan PFAS Action Response Team (MPART), a multi-agency collaboration. MPART actions that have successfully reduced statewide exposure include the provisioning of alternative water sources and the regulation of PFAS discharges into drinking water supplies, While the state drinking water standards only apply to public water supplies, MPART actions that have successfully reduced statewide exposure include the provisioning of alternative water sources and the regulation of PFAS discharges into drinking water supplies. While the state drinking water standards only apply to public water supplies, MPART investigators also assist private well owners by testing wells in areas with known PFAS contamination, providing educational information about PFAS, and helping those with tainted well water to consider solutions. Michigan is one of only 16 states to set enforceable standards for certain PFAS substances in drinking water. These standards are stricter than the EPA’s for current unenforceable health advisory levels.

Federal Support to Michigan within the past 5 years

	CDC-funded Climate-Ready States & Cities Initiative
	CDC-Funded Lead Poisoning Prevention Program
	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 (click to expand):”]
Children’s environmental health indicators (CEHIs) are measures that can be used to assess environmental hazards, exposures, and their resulting health outcomes in children.  The below criteria are used when determining which indicators to utilize:

• • Relevance: 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.
  • Representativeness: The indicators as a package should provide a representative picture of children’s health and relation to the environment.
  • Traceability: Each indicator should be calculated using an agreed-upon (and published) method and accessible and verifiable data.
  • Timeliness: Each indicator should be calculated regularly (at least biennially), with a short lag between the end of the period and publication of the data.
  • Data adequacy: The available data needed for the indicator must be sufficiently robust, reliable and valid.
  • Universality: Indicators must be comparable across all or very nearly all 50 U.S. states. [/expand]

Indicator Notes and References

Safe Drinking Water

• Reference: Michigan Drinking Water Performance Dashboard. Public Water Systems with Any Violation – Fiscal Year 2020. Enforcement and Compliance History Online (ECHO). U.S. Environmental Protection Agency.

Air Quality

• Indicator Note: 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 566,278 or 26% of Michigan children live in counties where ozone pollution is not monitored for which there is less than 3 years of data.
• Reference: Ozone Pollution. American Lung Association. 2021 State of the Air Report Card: Michigan. Data from U.S. Environmental Protection Agency’s Air Quality System.

Warming Temperature

• Indicator Note: 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.
• Reference: Warming Temperatures. Climate at a Glance | National Centers for Environmental Information (NCEI). Statewide Haywood Plots: Michigan (2020).

Toxic Chemicals

• Indicator Note: 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.
• Reference: Summary of 759 Toxic Release Inventory Facilities in Michigan. Reporting Year 2020.

Neurodevelopmental Disorders

• Indicator Note: 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 diagnosis or other artifacts fully account for the increased incidences of these conditions. ADHD, ADD and ASD data are for Michigan children aged 3-17 ages.
• Reference: ADHD, ADD, and ASD prevalence. 2019-2020 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. Environmental exposures contribute to ADHD/ADD, ASD, and asthma. NIEHS/EPA Children’s Environmental Health and Disease Prevention Research Centers. 2017 Impact Report.

Asthma

• Indicator Note: 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.
• Reference: 2018-2019 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.

Pediatric Cancer

• Indicator Note: 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”
• Reference: Michigan 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).President’s Cancer Panel. 2008-2009 Annual Report. Reducing Environmental Cancer Risk. National Cancer Institute, National Institutes of Health.

Blood Lead Levels

• Indicator Note: In 2016, 21% of Michigan children under age 6 were tested for blood lead levels (BLLs). Of those tested, 4.0% had a BLL>= 5 µg/dL. Often the most vulnerable children are not tested, and not all who are tested get reported, so 4.0% is likely an underestimate of the true scope of children’s elevated blood lead in Michigan. 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, the CDC lowered the BLL reference value from 5 to 3.5 µg/dL.
• Reference: National Childhood Blood Lead Surveillance Data. 2016. Centers for Disease Control and Prevention. Under-testing and under-reporting of children’s blood lead levels. 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. Blood Lead Reference Value. 2021. Centers for Disease Control and Prevention.

Poverty

• Reference: Number of Children in Michigan. U.S. Census Bureau. 2019. Quick Facts Michigan.,
  • Percent of Children in Michigan Living in Poverty. The Annie E. Casey Foundation: 2019 Kids COUNT Data Center.

Federal Support to Michigan

• References:
  • CDC-funded Climate-Ready States & Cities Initiative. 2021.
  • CDC Childhood Lead Poisoning Prevention. 2019.
  • ATSDR State Cooperative Agreement Program. 2021.
  • CDC National Asthma Control Program. 2020.
  • CDC Environmental Public Health Tracking Network. 2020.
  • CDC State Biomonitoring Programs. 2019.

Michigan Spotlight

• References:
  • PFAS Contamination in the U.S. Environmental Working Group. 2021.
  • PFAS Project Lab. Northeastern University Social Science Environmental Health Research Institute. 2020.
  • PFAS Strategic Roadmap: EPA’s Commitments to Action 2021-2024. United States Environmental Protection Agency. 2021.
  • PFAS Response: Taking Action, Protecting Michigan. 2021. Michigan.gov. 
  • Emergency Responses. 2021. Michigan PFAS Action Response Team. Michigan.gov. 
  • State-by-State Regulation of PFAS Substances in Drinking Water. 2021. BCLP Law.
    Michigan’s new PFAS rules: 5 things to know. Bridge Michigan. (2021).

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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.