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Journal Issue: Children with Disabilities Volume 22 Number 1 Spring 2012

Prevention of Disability in Children: Elevating the Role of Environment
Stephen A. Rauch Bruce P. Lanphear


Americans have an unwavering belief that advances in biomedical technology and medical care will solve their health problems. With few exceptions, however, the best these can achieve is enhanced treatment of existing diseases or disabilities. It would be far better to prevent disabilities from developing in the first place. For most clinicians, "prevention" usually occurs in a clinical setting and seeks to identify signs, symptoms, or risk factors for a disability in an individual child. In contrast, a strategy that focused on prevention would concentrate on reducing environmental influences that put entire populations at risk. Identifying, and either eliminating or controlling, widespread exposures to modifiable environmental risk factors that incrementally increase the prevalence of disability in a population is the key to preventing many disorders in children and adults.

In this article, we examine the emerging evidence showing that many prevalent disabilities of childhood have their roots in environmental influences, and we make a case for devoting more attention to societal or population-level interventions. These interventions would rely less on medical and genetic technology and more on recommendations, policies, and regulations that would reduce children's exposure to ubiquitous environmental risks. Such interventions are likely to be highly controversial, require long-term investments as well as shifts in societal thinking, and have less well-defined outcomes than individual medical treatments. But in the long run, they could prevent many of the disabilities that currently afflict millions of children and adults.