2.2 Overview of the methodology and process

2.2 Overview of the methodology and process

The proposed list of CEHIs is the result of systematic scientific literature analysis as well as substantial expert and stakeholder input. the United States Centers for Disease Control and Prevention (US CDC), and UNICEF gave us a basis for assembling our initial list of CEH measures (for more information on the desktop research process, please refer to Annex A). Next,

local and international experts suggested less traditional indicators to provide novel insights into associations between environmental hazards and health. We also used contextual socioeconomic measures to evaluate the relationship among indicators and explore ecologic associations. This led to a list of 80 measures (Annex B) that we prioritized for the next step.

The project partners then ranked the 80 measures and identified relevant indicators to represent each measure (Annex C). Next, we consulted about the ranked indicators with national specialists using the Delphi methode of consensus development (Annex D). Finally, we consulted one-on-one with local topical experts to discuss specific indicators (Annex E).

Figure 3: Overview of CEHI development and prioritization

Desktop research

Consultations with project stakeholders Internal ranking exercise

External consultations Literature review 2nd internal ranking exercise

Final prioritized list

Seminal CEHI articles and reports, including by leading authorities (e.g., WHO, U.N., U.S. CDC).

70 Measures

Additions of indicators about climate, soil contamination, pesticide, children’s overweight and children’s screen time.

80 Measures

By UNICEF, Vital Strategies and NIEH, China CDC.

50 Indicators

Using the Delphi method of consensus development and one-on-one interviews with local specialists. Review of 7,527 published investigations of children’s environmental exposures and health outcomes.

54 Indicators

57 Indicators

By UNICEF; Vital Strategies; NIEH, China CDC; PRCEE, MEE. Exclusion of lowest-scoring and duplicate indicators.

47 Indicators

By UNICEF, Vital Strategies and NIEH, China CDC. Top 22 indicators prioritized as core indicators for China.

22 Indicators

While there are hundreds of environmental health indicators that can be measured, we endeavored to create an initial list of 20-30 priority indicators that can be used to guide policy and outreach. These core CEHIs are intended to emphasize actionable environmental health risks to children and provide a proof-of-concept for further indicator development.

As depicted in Figure 3, we conducted several rounds of development, review and evaluation to produce the list of indicators. From November 2019 to January 2020, we conducted formative desktop research about seminal reports, peer-reviewed journal articles and grey literature on CEHIs. Three seminal reports on children’s environmental health from the World Health Organization (WHO),