The first in a series of reports on the impact of the environment on children's health surveys children of North America. The study focuses on three broad areas: asthma and respiratory illness, exposure to lead and other toxins, and waterborne diseases.

Erica Phipps coordinated the project for the Commission for Environmental Cooperation, an agency created by the North American Free Trade Agreement, or NAFTA. "What we found is that even in relatively developed countries of North America, children are being affected by the environment," she says.

For example, asthma rates in North America are four times greater than 20 years ago. Roughly one child in 10 is affected. The report says children exposed to air pollution - ranging from noxious auto emissions to tobacco smoke - are at greater risk of asthma, infant death syndrome and pneumonia.

Phipps says levels of lead in human blood samples showed improvement in all three nations, largely due to the phase-out of leaded gasoline. But she says children are still exposed to lead from paint in older houses.

Of the three countries, children in rural Mexico face the greatest health risks overall. "Sixty three percent of people in rural areas still lack sewage services. And in terms of water quality, 32 percent of those in Mexico still lack access to safe water," she says.

Phipps says it is important to continue to document how environmental degradation affects children. "For me that is a compelling reason for governments, citizens, businesses to step up our efforts to cut back on air pollution, to use mass transit to get out of our cars, to find innovative ways of generating products and generating energy that don't impact on the environment," she says. "We need to do better if we are going to protect the health of our children."

Phipps expects the report to serve as a baseline for continued research in North America and as a template for studies in other regions of the world. Pilot projects led by the World Health Organization are underway in Africa, Europe, Latin America, the Caribbean and the Eastern Mediterranean.