Healthy People, Healthy PlanetClimate Change and Chronic Disease:

Common Drivers, Common SolutionsModule 1: Climate ChangeModule 1: Climate ChangeModule 2: Chronic DiseaseModule 2: Chronic DiseaseModule 3: Common Drivers, Module 3: Common Drivers,

Common Solutions Common Solutions

Presented by:Presented by:

Jill Stein, MD Jill Stein, MD Greater Boston Physicians for Social ResponsibilityGreater Boston Physicians for Social Responsibility

With Support from: With Support from: The Boston University Superfund Research ProjectThe Boston University Superfund Research Project

Healthy People, Healthy Planet:Objectives

To inform & empower health To inform & empower health providers to understand, mitigate providers to understand, mitigate & help prevent climate change & & help prevent climate change & chronic disease.chronic disease.

Review key science behind Review key science behind climate change and chronic climate change and chronic disease.disease.

Clarify the major drivers of these Clarify the major drivers of these crises crises –– and how we can fix them.and how we can fix them.

Healthy People, Healthy PlanetClimate 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

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.

Module 3: What We Will CoverModule 3: What We Will Cover

Environmental factors are major determinants of health. Environmental factors are major determinants of health. These include: These include: •• Food system/nutrition and dietFood system/nutrition and diet•• Toxic chemicalsToxic chemicals•• Built environment / physical activityBuilt environment / physical activity•• Socioeconomic stress Socioeconomic stress

A variety of cross cutting A variety of cross cutting solutions dramatically improve solutions dramatically improve human and ecological health.human and ecological health.

Environmental Environmental FactorsFactors

Chronic DiseaseChronic Disease

Altered Altered Biological Biological PathwaysPathways

↑↑ GreenhouseGreenhouseGasesGases

Climate CrisisClimate Crisis

Environment Drives Chronic DiseaseEnvironment Drives Chronic Diseaseandand the Climate Crisisthe Climate Crisis

Food system/DietFood system/DietFossil FuelsFossil FuelsSocioeconomic StressSocioeconomic StressChemicalsChemicalsBuilt Environment/Built Environment/TransportationTransportation

Altered Pathways

Environmental Factors

Environment Drives Chronic Disease

Food System/DietFood System/Diet

Chronic Disease

Novel Nutrients Aggravate Inflammatory Metabolism

Increase risksIncrease riskssaturated and trans fatssaturated and trans fatshigh high glycemicglycemic carbohydratescarbohydrateslack of fruits/vegetables/omega 3slack of fruits/vegetables/omega 3sexcess omega 6s?excess omega 6s?

Reduce risksReduce risksfruits, vegetablesfruits, vegetablesomega 3somega 3slow low glycemicglycemic carbohydratecarbohydrateMediterranean dietMediterranean diet

Influence of Nutritional Factorson Chronic Disease

Insulin signaling

• ↑ blood sugar• ↑ artery disease• ↑ triglycerides

InflammationOxidative

stress

Environmental Factors Disrupt Insulin Signaling, Environmental Factors Disrupt Insulin Signaling, Drive Inflammatory MetabolismDrive Inflammatory Metabolism

Saturated fat

↓anti-oxidants

High GlycemicCarbohydrates

↓Omega-3

Fructose

Compelling LongCompelling Long--Term Benefits of Term Benefits of MediterraneanMediterranean--Type DietType Diet

Clinical intervention studiesClinical intervention studies↓↓ heart attacks, cardiac deathheart attacks, cardiac death & total mortality 70% or more & total mortality 70% or more DeLogerilDeLogeril9494

60%60% ↓↓ cardiac events in CVD patients* cardiac events in CVD patients* OrnishOrnish 9898

~50% ~50% ↓↓ metabolic syndrome metabolic syndrome Esposito 04Esposito 04

39% 39% ↓↓ in CRP in CRP Esposito 04Esposito 04

↓↓insulin resistance insulin resistance Esposito 04Esposito 04

↓↓ weight weight Esposito 04Esposito 04

Prospective observation studiesProspective observation studies80% 80% ↓↓ diabetes diabetes MartinezMartinez--Gonzalez 08Gonzalez 08

2525--30% 30% ↓↓ ParkinsonParkinson’’s disease s disease GaoGao 0707

78% 78% ↓↓ childhood asthma maternal diet childhood asthma maternal diet ChatziChatzi 0808

~31% ~31% ↓↓ allall--cause & cardiovascular mortality, 22% cause & cardiovascular mortality, 22% ↓↓ cancer cancer mortalitymortality SofiSofi 08*08* 73% Alzheimer73% Alzheimer’’s mortalitys mortality ScarmeasScarmeas 0707

*10% low fat, vegetarian diet + exercise, stress reduction

Altered Pathways

Environment Drives Chronic Disease

Environmental Factors

Toxic ChemicalsToxic ChemicalsAir pollution, Some pesticides, Lead Air pollution, Some pesticides, Lead

and other heavy metals, and other heavy metals, Bisphenol ABisphenol A

Chronic Disease

PesticidesParkinsonParkinson’’s Diseases Disease

–– Human studies Human studies --. 24/31 studies show . 24/31 studies show ↑↑ risks for PD. (OR 1.6risks for PD. (OR 1.6--7) 7) Brown 2006

–– Animals Animals -- RRotenone & otenone & paraquatparaquat damagedamage dopaminergicdopaminergic neurons in neurons in striatalstriatal region of brainregion of brain

-- Combinations of Combinations of manebmaneb and and paraquatparaquat; prenatal ; prenatal exposure exposure ““primesprimes”” the brain, increasing adult the brain, increasing adult susceptibility susceptibility Cory-Slechta 2005

Cognitive decline/dementiaCognitive decline/dementia–– Low level fungicides in vineyardsLow level fungicides in vineyards 3.5x poor attention, memory 3.5x poor attention, memory Baldi 2001

–– Occupational exposure associated with 2x risk of developing Occupational exposure associated with 2x risk of developing ADADBaldi 2003

Diabetes, Insulin ResistanceDiabetes, Insulin Resistance Lee 2006, 2007, 2007

–– Some persistent pesticides show strong Some persistent pesticides show strong dosedose--response relation to diabetes,response relation to diabetes,insulin resistance and metabolic syndrome. insulin resistance and metabolic syndrome.

Lead

Cumulative occupational exposureCumulative occupational exposure↑↑ cognitive impairment cognitive impairment Shih 2007

2x risk Parkinson2x risk Parkinson’’s s Coon 2006

Cumulative community exposure Cumulative community exposure ↑cognitive impairment Shih 2006

Up to 15 years cognitive aging Up to 15 years cognitive aging Weisskopf 2004

Animal studies of early life exposureAnimal studies of early life exposurelatelate--life Alzheimerlife Alzheimer’’s markers s markers Basha 2005, Lahiri 2007.

Bisphenol A

Endocrine disruptor, oxidative stressEndocrine disruptor, oxidative stressWidespread human exposure Widespread human exposure –– polycarbonate polycarbonate

plastic, sealants, resins (tin cans)plastic, sealants, resins (tin cans)Fat accumulation & insulin resistance at low levels Fat accumulation & insulin resistance at low levels (animals) (animals) AlansoAlanso--MagdelenaMagdelena 2006, Wada 20072006, Wada 2007

22--33--fold fold ↑↑ Diabetes, Cardiovascular disease Diabetes, Cardiovascular disease Lang 2008Lang 2008

↑↑ liver enzyme abnormalities liver enzyme abnormalities Lang 2008Lang 2008

Insulin signaling

• ↑ blood sugar• ↑ artery disease• ↑ triglycerides

InflammationOxidative

stress

Environmental Factors Disrupt Insulin Signaling, Environmental Factors Disrupt Insulin Signaling, Drive Inflammatory MetabolismDrive Inflammatory Metabolism

EndocrineDisruptors

Saturated fat

High GlycemicCarbohydrates

Air Pollution

↓anti-oxidants

↓Omega-3

Fructose

Altered Pathways

Environment Drives Chronic Disease

Environmental Factors

Built EnvironmentBuilt Environment--Physical ActivityPhysical Activity

Chronic Disease

Health Benefits of Physical ActivityHealth Benefits of Physical Activity

Reduced ongoing levels of oxidative stress and Reduced ongoing levels of oxidative stress and inflammatory burden inflammatory burden Brooks 2008, Brooks 2008, AttipoeAttipoe 20082008

Inversely associated with the risks of Inversely associated with the risks of AlzheimerAlzheimer’’s/dementia and cognitive decline 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

Increasing physical activity at any age improves Increasing physical activity at any age improves physical and emotional wellbeing.physical and emotional wellbeing.

Green SpaceReduces Stress, Mortality, Improves Cognitive Function

Shortens post surgical Shortens post surgical recovery time, reduces recovery time, reduces need for pain medications.need for pain medications.(Ulrich (Ulrich ‘‘84)84)

Attention deficits improve Attention deficits improve after a walk in the park. after a walk in the park. Effect = methylphenidate. Effect = methylphenidate. (Taylor (Taylor ’’08)08)

Access to green spaceAccess to green spacereduces the effect of reduces the effect of poverty on mortality by poverty on mortality by ~50%.~50%.(Mitchell (Mitchell ‘‘08)08)

Insulin signaling

• ↑ blood sugar• ↑ artery disease• ↑ triglycerides

InflammationOxidative

stress

Environmental Factors Disrupt Insulin Signaling, Environmental Factors Disrupt Insulin Signaling, Drive Inflammatory MetabolismDrive Inflammatory Metabolism

Obesity

EndocrineDisruptors

Inactivity

Saturated fat

High GlycemicCarbohydrates

Air Pollution

↓anti-oxidants

↓Omega-3

Fructose

Altered Pathways

Environment Drives Chronic DiseaseEnvironmental Factors

Chronic Disease

SocioSocio--economiceconomicstressstress

Depression, poverty, Depression, poverty, inadequate health care, inadequate health care,

violenceviolence

Socioeconomic, Psychosocial Stressors

Stress, depression risk for CVD, AD Sesso, Kario, Ownby

People with lower SE status are at risk for exposure to multiple envirohazards ↑damage.

– Lead + stress ↑cognitive impairment (language, executive function) Glass 2009

– Lead + air pollution ↑CV autonomic dysfunction Park 2008

http://www.unnaturalcauses.org/resources.php

Insulin signaling

• ↑ blood sugar• ↑ artery disease• ↑ triglycerides

InflammationOxidative

stress

Environmental Factors Disrupt Insulin Signaling, Environmental Factors Disrupt Insulin Signaling, Drive Inflammatory MetabolismDrive Inflammatory Metabolism

Obesity

EndocrineDisruptors

Inactivity

Stress

Saturated fat

↑Omega-6

High GlycemicCarbohydrates

Air Pollution

↓Omega-3

Fructose

↓anti-oxidants

Multiple Multiple Factors Factors

Interact to Interact to Influence Influence

Health Health & &

DiseaseDisease

SolutionsSolutionsforfor

Healthy People & A Healthy PlanetHealthy People & A Healthy Planet

Major Illnesses Are PreventableMajor Illnesses Are PreventableRisks Can Be Profoundly ReducedRisks Can Be Profoundly Reduced

Personal Level Personal Level –– ““Approaches to Healthy LivingApproaches to Healthy Living””

Eat healthy Eat healthy –– whole, fresh, unprocessed, plant based whole, fresh, unprocessed, plant based foodsfoodsAvoid toxicants whenever possibleAvoid toxicants whenever possible

Exercise Exercise

BBe socially engagedsocially engaged

CrossCross--Cutting Policy SolutionsCutting Policy Solutions

LLocalized, diversified andocalized, diversified and sustainable food productionsustainable food productionClean, renewable energyClean, renewable energy ↓↓ air pollution, chemical air pollution, chemical exposuresexposuresMass transitMass transit that connects with bike paths and sidewalksthat connects with bike paths and sidewalks can can reducereduce air pollution & obesityair pollution & obesity

““Safer substituteSafer substitute”” programs and programs and green product design green product design ↓↓toxic exposures, ecosystem & wildlife contamination; toxic exposures, ecosystem & wildlife contamination; job creationjob creation

Universal health careUniversal health care disease prevention disease prevention & equitable health care.& equitable health care.

The Good News: Efforts to Heal the Planet Also Heal the People

Local organic food systemsLocal organic food systemsPublic transportation, bike paths, sidewalksPublic transportation, bike paths, sidewalksGreen jobs, health care, housing, equityGreen jobs, health care, housing, equityGreen energyGreen energy

Ecosystem restorationEcosystem restorationSafe chemicalsSafe chemicals

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.

AcknowledgementsAcknowledgements

Based on the Report by Greater Boston Physicians for Based on the Report by Greater Boston Physicians for Social Responsibility (Social Responsibility (www.psr.org/bostonwww.psr.org/boston) and the ) and the Science and Environmental Health Network Science and Environmental Health Network ((www.sehn.orgwww.sehn.org) authored by ) authored by Jill Stein MD, Ted Schettler Jill Stein MD, Ted Schettler MD, MPH, Maria Valenti & Ben RohrerMD, MPH, Maria Valenti & Ben Rohrer

Primary author of this presentation: Primary author of this presentation: Jill Stein, MDJill Stein, MD

Contributing Authors: Contributing Authors: Ted Schettler, MD, MPH, Maria Ted Schettler, MD, MPH, Maria Valenti, Maye Thompson, RN, PhD, Marybeth Valenti, Maye Thompson, RN, PhD, Marybeth Palmigiano, MPHPalmigiano, MPH

Illustrations byIllustrations by: Stephen Burdick Design: Stephen Burdick Design

For more information contact:Greater Boston

Physicians for Social Responsibilitywww.psr.org/boston

For additional resources on environmental health and nursing contact:

The Environmental Health Nursing Education Collaborative

www.ehnursing.org