Climate Change and Chronic Disease: Common Drivers, Common Solutions

Transcription

1 Healthy People, Healthy Planet Climate Change and Chronic Disease: Common Drivers, Common Solutions Module 1: Climate Change Module 2: Chronic Disease Module 3: Common Drivers, Common Solutions Presented by: Jill Stein, MD Greater Boston Physicians for Social Responsibility With Support from: The Boston University Superfund Research Project

2 Healthy People, Healthy Planet: Objectives To inform & empower health providers to understand, mitigate & help prevent climate change & chronic disease. Review key science behind climate change and chronic disease. Clarify the major drivers of these crises and how we can fix them.

3 Healthy People, Healthy Planet Climate Change and Chronic Disease: Common Drivers, Common Solutions Common Drivers, Common Solutions Module 3 of 3 Jill Stein, MD Greater Boston Physicians for Social Responsibility

4 Module 2: Chronic Disease Review During the past century, human activity has altered virtually all aspects of the world s ecosystems, and changed important determinants of human health. Environmental factors drive the Western disease cluster, a group of illnesses that cluster within western societies and within individuals. These environmentally-driven illnesses are major components of the modern public health burden. The mechanisms linking environmental drivers with disease outcomes include inflammation, oxidative stress, and disrupted insulin signaling.

5 Module 3: What We Will Cover Environmental factors are major determinants of health. These include: Food system/nutrition and diet Toxic chemicals Built environment / physical activity Socioeconomic stress A variety of cross cutting solutions dramatically improve human and ecological health.

6 Environment Drives Chronic Disease and the Climate Crisis Climate Crisis Environmental Factors Food system/diet Fossil Fuels Socioeconomic Stress Chemicals Built Environment/ Transportation Greenhouse Gases Altered Biological Pathways Chronic Disease

7 Environment Drives Chronic Disease Environmental Factors Altered Pathways Chronic Disease Food System/Diet

8 Novel Nutrients Aggravate Inflammatory Metabolism

9 Influence of Nutritional Factors on Chronic Disease Increase risks saturated and trans fats high glycemic carbohydrates lack of fruits/vegetables/omega 3s excess omega 6s? Reduce risks fruits, vegetables omega 3s low glycemic carbohydrate Mediterranean diet

10 Environmental Factors Disrupt Insulin Signaling, Drive Inflammatory Metabolism Saturated fat Omega-3 Inflammation Oxidative stress anti-oxidants Insulin signaling blood sugar artery disease triglycerides High Glycemic Carbohydrates Fructose

11 Compelling Long-Term Benefits of Mediterranean-Type Diet Clinical intervention studies heart attacks, cardiac death & total mortality 70% or more DeLogeril 94 60% cardiac events in CVD patients* Ornish ~50% metabolic syndrome Esposito 04 39% in CRP Esposito 04 insulin resistance Esposito 04 weight Esposito 04 Prospective observation studies 80% diabetes Martinez-Gonzalez % 30% Parkinson s s disease Gao 07 78% childhood asthma maternal diet Chatzi 08 ~31% all-cause & cardiovascular mortality, 22% cancer mortality Sofi 08* 73% Alzheimer s s mortality Scarmeas 07 Ornish 98 *10% low fat, vegetarian diet + exercise, stress reduction

12 Environment Drives Chronic Disease Environmental Factors Altered Pathways Chronic Disease Toxic Chemicals Air pollution, Some pesticides, Lead and other heavy metals, Bisphenol A

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14 Pesticides Parkinson s s Disease Human studies /31 studies show risks for PD. (OR 1.6-7) Animals - Rotenone & paraquat damage damage dopaminergic neurons in striatal region of brain - Combinations of maneb and paraquat; ; prenatal exposure primes the brain, increasing adult susceptibility Cory-Slechta ) Brown 2006 Cognitive decline/dementia Low level fungicides in vineyards 3.5x poor attention, memory Baldi 2001 Occupational exposure associated with 2x risk of developing ADBaldiAD 2003 Diabetes, Insulin Resistance Lee 2006, 2007, 2007 Some persistent pesticides show strong dose-response relation to diabetes, insulin resistance and metabolic syndrome.

15 Lead Cumulative occupational exposure cognitive impairment Shih x risk Parkinson s Coon 2006 Cumulative community exposure cognitive impairment Shih 2006 Up to 15 years cognitive aging Weisskopf 2004 Animal studies of early life exposure late-life life Alzheimer s s markers Basha 2005, Lahiri 2007.

16 Bisphenol A Endocrine disruptor, oxidative stress Widespread human exposure polycarbonate plastic, sealants, resins (tin cans) Fat accumulation & insulin resistance at low levels (animals) Alanso-Magdelena 2006, Wada fold Diabetes, Cardiovascular disease Lang 2008 liver enzyme abnormalities Lang 2008

17 Environmental Factors Disrupt Insulin Signaling, Drive Inflammatory Metabolism Saturated fat Omega-3 Inflammation Oxidative stress anti-oxidants Air Pollution Endocrine Disruptors Insulin signaling blood sugar artery disease triglycerides High Glycemic Carbohydrates Fructose

18 Environment Drives Chronic Disease Environmental Factors Altered Pathways Chronic Disease Built Environment- Physical Activity

19 Health Benefits of Physical Activity Increasing physical activity at any age improves physical and emotional wellbeing. Reduced ongoing levels of oxidative stress and inflammatory burden Brooks 2008, Attipoe 2008 Inversely associated with the risks of Alzheimer s/dementia and cognitive decline Rovio 2005 Subjects at risk for AD who walked 150min. per week showed improvements in cognition while the control group showed no net change from baseline at 1.5 yrs. Lautenschlager 2008

20 Green Space Reduces Stress, Mortality, Improves Cognitive Function Shortens post surgical recovery time, reduces need for pain medications. (Ulrich 84) Attention deficits improve after a walk in the park. Effect = methylphenidate. (Taylor 08) Access to green space reduces the effect of poverty on mortality by ~50%. (Mitchell 08)

21 Environmental Factors Disrupt Insulin Signaling, Drive Inflammatory Metabolism Saturated fat Omega-3 Obesity Inflammation Oxidative stress anti-oxidants Inactivity Air Pollution Endocrine Disruptors Insulin signaling blood sugar artery disease triglycerides High Glycemic Carbohydrates Fructose

22 Environment Drives Chronic Disease Environmental Factors Altered Pathways Chronic Disease Socio-economic stress Depression, poverty, inadequate health care, violence

23 Socioeconomic, Psychosocial Stressors Stress, depression risk for CVD, AD Sesso, Kario, Ownby urces.php People with lower SE status are at risk for exposure to multiple enviro hazards damage. Lead + stress cognitive impairment (language, executive function) Glass 2009 Lead + air pollution CV autonomic dysfunction Park 2008

24 Environmental Factors Disrupt Insulin Signaling, Drive Inflammatory Metabolism Saturated fat Omega-3 Stress Obesity Inflammation Oxidative stress anti-oxidants Omega-6 Inactivity Air Pollution Endocrine Disruptors Insulin signaling blood sugar artery disease triglycerides High Glycemic Carbohydrates Fructose

25 Multiple Factors Interact to Influence Health & Disease

26 Solutions for Healthy People & A Healthy Planet

27 Major Illnesses Are Preventable Risks Can Be Profoundly Reduced Personal Level Approaches to Healthy Living Eat healthy whole, fresh, unprocessed, plant based foods Avoid toxicants whenever possible Exercise Be socially engaged

28 Cross-Cutting Cutting Policy Solutions Localized, diversified and sustainable food production Clean, renewable energy air pollution, chemical exposures Mass transit that connects with bike paths and sidewalks can reduce air pollution & obesity Safer substitute programs and green product design toxic exposures, ecosystem & wildlife contamination; job creation Universal health care disease prevention & equitable health care.

29 The Good News: Efforts to Heal the Planet Also Heal the People Local organic food systems Public transportation, bike paths, sidewalks Green jobs, health care, housing, equity Green energy Ecosystem restoration Safe chemicals

30 Summary Novel nutrients and chemical exposures promote inflammation and disrupt insulin signaling. Mediterranean-type diet provides compelling benefits for preventing and in some cases, treating Western Disease cluster illnesses. Physical activity, ecosystem protection/restoration, and socioeconomic equity are also foundations of good health. Key policies for promoting human health also reduce CO2 emissions, sequester atmospheric CO2, and help bring CO2 down to a safe level below 350 ppm. Moving quickly to reduce atmospheric CO2 can help reduce current impacts of climate change and prevent worse consequences currently in the pipeline.

31 Acknowledgements Based on the Report by Greater Boston Physicians for Social Responsibility ( ) and the Science and Environmental Health Network ( authored by Jill Stein MD, Ted Schettler MD, MPH, Maria Valenti & Ben Rohrer Primary author of this presentation: Jill Stein, MD Contributing Authors: Ted Schettler, MD, MPH, Maria Valenti, Maye Thompson, RN, PhD, Marybeth Palmigiano, MPH Illustrations by: : Stephen Burdick Design

32 For more information contact: Greater Boston Physicians for Social Responsibility For additional resources on environmental health and nursing contact: The Environmental Health Nursing Education Collaborative