Environmental Drivers of Chronic Disease Based on the report Environmental Threats to Healthy Aging by Jill Stein MD, Ted Schettler MD, MPH, Maria Valenti

Environmental Environmental Drivers Drivers

of of Chronic DiseaseChronic Disease

Based on the report Environmental Threats to

Healthy Aging

by Jill Stein MD, Ted Schettler MD, MPH,

Maria Valenti and Ben Rohrer

20102010

Greater Boston Physicians for Social Responsibility (www.psr.org/Boston)and

The Science and Environmental Health Network (www.sehn.org)

What We Will CoverWhat We Will Cover

Environmental factors are key drivers of many common Environmental factors are key drivers of many common chronic diseaseschronic diseases

Environmental factors alter key biological pathways Environmental factors alter key biological pathways leading to chronic diseaseleading to chronic disease

Important environmental determinants of health include:Important environmental determinants of health include:- Food system/nutrition and dietFood system/nutrition and diet

- Toxic chemicalsToxic chemicals

- Built environment / physical activityBuilt environment / physical activity

- Psychological & socioeconomic stressPsychological & socioeconomic stress

Examples of cross cutting solutions for healthy people & Examples of cross cutting solutions for healthy people & a healthy environmenta healthy environment

Scope & Context of the ProblemScope & Context of the Problem A century of change in natural, built and social A century of change in natural, built and social

environments has causedenvironments has caused major changes in the major changes in the patterns and distribution of diseases.patterns and distribution of diseases.

We are seeing dramatic increases in chronic diseases, We are seeing dramatic increases in chronic diseases, and at younger ages, many of which, such as diabetes, and at younger ages, many of which, such as diabetes, are themselves risk factors for dementiaare themselves risk factors for dementia..

The over- 65 population will nearly double by 2030 to The over- 65 population will nearly double by 2030 to more than 71 million, sharply increasing the number of more than 71 million, sharply increasing the number of people at risk of chronic diseases of aging like people at risk of chronic diseases of aging like Alzheimer’s and Parkinson’s diseases, among others. Alzheimer’s and Parkinson’s diseases, among others.

Environmental factors play a key role in health across Environmental factors play a key role in health across the lifespan. Thus they offer a major prevention the lifespan. Thus they offer a major prevention opportunityopportunity..

The Changing Environment and The Changing Environment and Disease PatternsDisease Patterns

During the past century, human activity has altered During the past century, human activity has altered virtually all aspects of the world’s ecosystems:virtually all aspects of the world’s ecosystems:

– Pervasive spread of synthetic chemicals; air and water pollution. Pervasive spread of synthetic chemicals; air and water pollution. – Industrialized food supply.Industrialized food supply.– Destruction of critical natural habitats, stressing ecosystems.Destruction of critical natural habitats, stressing ecosystems.– Climate change.Climate change.

How we live, eat, work, play and socialize have How we live, eat, work, play and socialize have substantially changed:substantially changed:

– Built environments have increased social Built environments have increased social isolation for many people; reduced isolation for many people; reduced physical activity.physical activity.– Growing income gap increases disease risk. Growing income gap increases disease risk. – Diseases of civilization - obesity, diabetes, Diseases of civilization - obesity, diabetes, cardiovascular disease, hypertension.cardiovascular disease, hypertension.

Environment Drives Chronic DiseaseEnvironment Drives Chronic Disease

Western Disease ClusterWestern Disease Cluster•Diabetes Diabetes •ObesityObesity•Abnormal LipidsAbnormal Lipids•Metabolic SyndromeMetabolic Syndrome•Cardiovascular DiseaseCardiovascular Disease

•Food system/DietFood system/Diet•Fossil FuelsFossil Fuels•Socioeconomic StressSocioeconomic Stress•ChemicalsChemicals•Built Environment/Built Environment/ TransportationTransportation

•InflammationInflammation•Disrupted Insulin Disrupted Insulin SignalingSignaling•Oxidative StressOxidative Stress

Alzheimer’s Alzheimer’s Parkinson’sParkinson’s

Altered PathwaysAltered Pathways

Environmental Environmental FactorsFactors

Chronic Chronic DiseaseDisease

Profound Public Health Impact Profound Public Health Impact Of Environmentally-Driven Western Of Environmentally-Driven Western

Disease ClusterDisease Cluster

Obesity/overweight – 2/3 US adults, prevalence x2 in Obesity/overweight – 2/3 US adults, prevalence x2 in ~25 yrs ~25 yrs http://www.cdc.gov/chronicdisease/resources/publications/AAG/obesity.htmhttp://www.cdc.gov/chronicdisease/resources/publications/AAG/obesity.htm

Pre/Diabetes – 40% US adults, prevalence DM ~x2 Pre/Diabetes – 40% US adults, prevalence DM ~x2 over 20 yrsover 20 yrs Cowie 09, http://apps.nccd.cdc.gov/DDTSTRS/default.aspx

Cardiovascular disease – still leading cause of death. Cardiovascular disease – still leading cause of death. Hypertension increasing. Hypertension increasing. http://www.cdc.gov/nchs/FASTATS/lcod.htm, Hajjar 03

Metabolic syndrome = early signs of other cluster Metabolic syndrome = early signs of other cluster diseases; 35% adults, ~55%>60 yrs diseases; 35% adults, ~55%>60 yrs Ford ES 05

Alzheimer’s disease – ½ >84 yrs old, 5.3M Alzheimer’s disease – ½ >84 yrs old, 5.3M Alzheimer’s Assoc.

Alzheimer’s Disease/dementiaAlzheimer’s Disease/dementia

Not an inevitable feature of normal aging.Not an inevitable feature of normal aging.

Progressive impairment of memory and multiple Progressive impairment of memory and multiple other cognitive functions, severe enough to interfere other cognitive functions, severe enough to interfere with daily functioning.with daily functioning.

Expected to triple by mid-century Expected to triple by mid-century to over 13 million.to over 13 million.

Likely caused by varying Likely caused by varying combinations of genetic and combinations of genetic and environmental factors.environmental factors.

Annual costs in US over $150 billion.Annual costs in US over $150 billion.

Parkinson’s DiseaseParkinson’s Disease

Progressive movement disorder that includes tremors, Progressive movement disorder that includes tremors, stiffness, and slow movement. May lead to severe stiffness, and slow movement. May lead to severe disability.disability.

Likely caused by variable combinations of genetic and Likely caused by variable combinations of genetic and environmental factors. environmental factors.

About 50,000 new cases About 50,000 new cases annually in US.*annually in US.*

Prevalence in US expected to Prevalence in US expected to double by 2030double by 2030.*.*

** Due to the lack of registries and baseline data on Parkinson’s Disease, Due to the lack of registries and baseline data on Parkinson’s Disease, the figures used here are estimates.the figures used here are estimates.

Alzheimer’s and Parkinson’s Alzheimer’s and Parkinson’s DiseasesDiseases

Characterized by:Characterized by: - abnormal protein deposits abnormal protein deposits - chronic inflammationchronic inflammation- abnormal oxidative stressabnormal oxidative stress

Many neuroscientists are beginning to think Many neuroscientists are beginning to think of some neurodegenerative diseases along a of some neurodegenerative diseases along a continuum, without clearly distinct continuum, without clearly distinct boundaries in clinical or pathological boundaries in clinical or pathological manifestationsmanifestations

Continuum of Age-Associated Continuum of Age-Associated Cognitive ImpairmentCognitive Impairment

Environment Drives Chronic Disease

Early life experiences can influence later-life health Early life experiences can influence later-life health and disease.and disease.

Multiple factors interact to influence health & disease.Multiple factors interact to influence health & disease.

Environmental factors can alter natural pathways which Environmental factors can alter natural pathways which

in turn can lead to chronic disease.in turn can lead to chronic disease.

An ecological health framework considers the individual An ecological health framework considers the individual in the context of family, community, society and in the context of family, community, society and ecosystem.ecosystem.

Basic PrinciplesBasic Principles

Toxic exposuresoxidative

stress

Obesity, hypertension,Cardiovascular disease,

diabetesAlzheimer’s,

dementia, Parkinson’s

Low birth weight

Early life experiences can influence Early life experiences can influence later-life health, diseaselater-life health, disease

Aging begins at conceptionAging begins at conception

Multiple Factors Interact to Influence Health & DiseaseMultiple Factors Interact to Influence Health & Disease

builtenvironme

ntdisease stress

energychemicals

nutrients

An ecological health framework considers An ecological health framework considers the individual in the context of family, the individual in the context of family, community, society, and ecosystem.community, society, and ecosystem.

Altered Pathways


Environmental Factors

InflammationInflammationDisrupted Insulin SignalingDisrupted Insulin Signaling

Oxidative StressOxidative Stress

Chronic Disease

Mechanisms of ActionMechanisms of Action

Defined by microscopicDefined by microscopiccharacteristics & laboratory test: characteristics & laboratory test: inflammatory cells & mediatorsinflammatory cells & mediators

CLASSICAL CONCEPT

OF INFLAMMATION

Defined by appearance. Defined by appearance. ““Calor, dolor, rubor, tumor.” Calor, dolor, rubor, tumor.”

Heat, pain, redness, swelling.Heat, pain, redness, swelling.

The New Concept of InflammationThe New Concept of Inflammation

““Atherosclerosis is an Atherosclerosis is an inflammatory disease.”inflammatory disease.”

(2) Ross, Russell. Atherosclerosis – An Inflammatory Disease. NEJM 1999, 340(2); 115-126.

Insulin Signaling = Insulin Signaling = Normal MetabolismNormal Metabolism

Insulin Insulin signalingsignaling

•↓ blood sugarblood sugar•↓↓ artery diseaseartery disease•↓↓ triglyceridestriglycerides


• ↑ blood sugarblood sugar• ↑↑ artery diseaseartery disease• ↑↑ triglyceridestriglycerides

InflammationInflammationOxidative Oxidative

stressstress

Disrupted Insulin Signaling = Disrupted Insulin Signaling = Inflammatory MetabolismInflammatory Metabolism





Food System/DietFood System/Diet

Novel Nutrients Are Pervasive, Novel Nutrients Are Pervasive,

Promote Inflammatory MetabolismPromote Inflammatory Metabolism

What’s “Novel” in the Western Diet?What’s “Novel” in the Western Diet?

“Hypothetical scheme of fat, fatty acid (ω6, ω3, trans and total) intake (as percentage of calories from fat) and intake of vitamins E and C (mg/d). Data were extrapolated from cross-sectional analyses of contemporary hunter-gatherer populations and from longitudinal observations and their putative changes during the preceding 100 years [75].” From AP Simopoulos, The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomedicine & Pharmacotherapy 56 (2002) 365-379.

Years

% o

f ca

lori

es f

rom

fat

mg

/day

High Glycemic Carbohydrates High Glycemic Carbohydrates Increase the Risk of Chronic Increase the Risk of Chronic

DiseaseDiseaseHigh glycemic carbohydrates break down quickly during digestion, High glycemic carbohydrates break down quickly during digestion,

rapidly releasing glucose (sugar) into the bloodstream.rapidly releasing glucose (sugar) into the bloodstream.

Δ P

lasm

a In

suli

n,m

g/d

l

Time, mins

INSULINEMIC RESPONSE

Low glycemic food

High glycemic food

Properties of Fatty AcidsProperties of Fatty Acids

Omega-3Omega-3 Omega-6Omega-6 SaturatedSaturated

FoodFood PerishablePerishable Durable Durable Increased in Increased inSystemSystem Short shelf lifeShort shelf life Processed foods factory farmed Processed foods factory farmed

Increased in Increased in Long shelf life animals Long shelf life animals pasture- fed pasture- fed

animalsanimals

ImmuneImmune Anti-inflammatoryAnti-inflammatory InflammatoryInflammatory & & InflammatoryInflammatoryProperties Properties Anti-inflammatoryAnti-inflammatory

EvolutionaryEvolutionary Recent markedRecent marked Recent markedRecent marked Recent Recent markedmarked

ContextContext declinedecline increase increase increaseincrease

↓Omega-3, (↑Omega-6)




stressstress

Novel Nutrients Disrupt Insulin Signaling, Novel Nutrients Disrupt Insulin Signaling, Drive Inflammatory MetabolismDrive Inflammatory Metabolism

Saturated fat

↓Antioxidants

High Glycemic Carbohydrates

Fructose

Increase risksIncrease risks - saturated and trans fatssaturated and trans fats- high glycemic carbohydrateshigh glycemic carbohydrates- lack of fruits/vegetables/omega 3slack of fruits/vegetables/omega 3s- excess omega 6s?excess omega 6s?

Reduce risksReduce risks - fruits, vegetablesfruits, vegetables- omega 3somega 3s- low glycemic carbohydrateslow glycemic carbohydrates- Mediterranean dietMediterranean diet

Influence of NutritionInfluence of Nutritionon Chronic Diseaseon Chronic Disease

Benefits of Mediterranean-Type Diet Benefits of Mediterranean-Type Diet on Chronic Disease Riskon Chronic Disease Risk

Clinical intervention studiesClinical intervention studies 70% 70% ↓ heart attacks, cardiac death↓ heart attacks, cardiac death & total mortality & total mortality DeLogeril 94DeLogeril 94

60%60% ↓ cardiac events in CVD patients* ↓ cardiac events in CVD patients* Ornish 98Ornish 98

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

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

↓↓insulin resistance insulin resistance Esposito 04Esposito 04

↓ ↓ weight weight Esposito 04Esposito 04

Prospective observation studiesProspective observation studies 80% 80% ↓ ↓ diabetes diabetes Martinez-Gonzalez 08Martinez-Gonzalez 08

~31% ~31% ↓ ↓ all-cause & cardiovascular mortality, 22% ↓ cancer all-cause & cardiovascular mortality, 22% ↓ cancer mortality**mortality**calculated from Sofi 08calculated from Sofi 08 73% Alzheimer’s mortality73% Alzheimer’s mortality Scarmeas 07Scarmeas 07

25-30% ↓ Parkinson’s disease 25-30% ↓ Parkinson’s disease Gao 07Gao 07

78% 78% ↓↓ childhood asthma maternal diet childhood asthma maternal diet Chatzi 08Chatzi 08

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

**For every 2 point increase in adherence (on a 9 point scale), risk reductions were observed of 0.91 for all cause mortality, 0.91 for CV mortality, 0.94 for occurrence **For every 2 point increase in adherence (on a 9 point scale), risk reductions were observed of 0.91 for all cause mortality, 0.91 for CV mortality, 0.94 for occurrence and mortality from neoplasm. To convey the implications of these findings, we have applied the risk reductions across a 9 point adherence scale to yield a calculated and mortality from neoplasm. To convey the implications of these findings, we have applied the risk reductions across a 9 point adherence scale to yield a calculated ~31% ~31% ↓ ↓ all-cause & CV mortality and a 22% ↓ in cancer mortality.all-cause & CV mortality and a 22% ↓ in cancer mortality.

Benefits ofBenefits of Sustainably-Produced Food Sustainably-Produced Food

Nutritional benefits:Nutritional benefits:Generally higher levels of vitamins, Generally higher levels of vitamins, minerals and phytochemicals minerals and phytochemicals (often dependent on soil quality)(often dependent on soil quality)

Higher Omega-3 contentHigher Omega-3 content

Organic samples contained higher Organic samples contained higher concentrations of polyphenols and concentrations of polyphenols and antioxidants in 75% of the matched antioxidants in 75% of the matched pairs representing those nutrientspairs representing those nutrients

Benefits for farm workers and Benefits for farm workers and communities: communities: Reduced exposure to pesticidesReduced exposure to pesticides





Toxic ChemicalsToxic Chemicals

Air pollution, Lead and other heavy metals, Air pollution, Lead and other heavy metals, some Pesticides,some Pesticides,

Bisphenol A and other Endocrine DisruptorsBisphenol A and other Endocrine Disruptors

LeadLead

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

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

Cumulative community exposure Cumulative community exposure ↑↑cognitive impairment cognitive impairment Shih 2006Shih 2006

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

Animal studies of early life exposureAnimal studies of early life exposure Late-life Alzheimer’s markers Late-life Alzheimer’s markers Basha 2005, Lahiri 2007Basha 2005, Lahiri 2007

PesticidesPesticides Parkinson’s DiseaseParkinson’s Disease

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

– Animals - Rotenone & paraquatAnimals - Rotenone & paraquatdamage dopaminergic neurons in damage dopaminergic neurons in striatal region of brain striatal region of brain Uversky VN 2004

- Combinations of maneb and paraquat; prenatal - Combinations of maneb and paraquat; prenatal exposure “primes” the brain, increasing adult exposure “primes” 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 in men associated with 2x risk of Occupational exposure in men associated with 2x risk of

developing AD developing AD Baldi 2003

Insulin Resistance, metabolic syndromeInsulin Resistance, metabolic syndrome Lee 2006, 2007, 2007

– Some persistent pesticides show strong Some persistent pesticides show strong dose-response relation to insulin resistance dose-response relation to insulin resistance

and metabolic syndrome. and metabolic syndrome.

Found in polycarbonate plastic, Found in polycarbonate plastic, resins, sealants.resins, sealants.

Exposures are nearly ubiquitous.Exposures are nearly ubiquitous.

Endocrine disruptor, oxidative stress.Endocrine disruptor, oxidative stress.

Causes fat accumulation & insulin Causes fat accumulation & insulin resistance at low levels (animals). resistance at low levels (animals). Alanso-Magdelena 2006, Wada 2007Alanso-Magdelena 2006, Wada 2007

3-fold 3-fold ↑↑ Cardiovascular disease. Cardiovascular disease. Lang 2008Lang 2008

2-fold 2-fold ↑↑ Insulin Resistance. Insulin Resistance. Lang 2008Lang 2008

Bisphenol ABisphenol A

polycarbonate




stressstress

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

Endocrine Disruptors -BPA, dioxins, PCBs, some pesticides

Saturated fat


Air Pollution

↓Antioxidants

↓Omega-3

Fructose

SomePesticides

Lead, other heavy metals





Built EnvironmentBuilt EnvironmentPhysical ActivityPhysical Activity

Health Benefits of Physical ActivityHealth Benefits of Physical Activity

Reduced ongoing levels of oxidative Reduced ongoing levels of oxidative

stress and inflammatory burden. stress and inflammatory burden. Brooks 2008, Attipoe 2008Brooks 2008, Attipoe 2008

Inversely associated with the Inversely associated with the

risks of Alzheimer’s/dementia and risks of Alzheimer’s/dementia and cognitive decline. cognitive decline. Rovio 2005Rovio 2005

Subjects at risk for AD who walked 150 min. per Subjects at risk for AD who walked 150 min. per week showed improvements in cognition while the week showed improvements in cognition while the control group showed no net change from baseline control group showed no net change from baseline at 1.5 yrs. at 1.5 yrs. Lautenschlager Lautenschlager 20082008

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

Walkable Cities Projects Walkable Cities Projects Community GardensCommunity Gardens Farmer’s MarketsFarmer’s Markets Rails to TrailsRails to Trails

Livable Communities Enhance Healthy AgingLivable Communities Enhance Healthy Aging

Cuba- lost fossil fuelsCuba- lost fossil fuels

↑↑biking, walking, local plant-based food biking, walking, local plant-based food ↑↑physical activityphysical activity 50%50%↓↓obesity 50% obesity 50% ↓↓mortality: DM 51%, CVD 35%, stroke 20%, all cause 18% mortality: DM 51%, CVD 35%, stroke 20%, all cause 18%

Franco M et al. Impact of Energy Intake, Physical Activity, and Population-wide Weight Loss on Cardiovascular Disease and Diabetes Mortality in Cuba, 1980-2005. AJE 166, 12; Sept. 19, 2007

Sustainable Food & Transportation Solutions:

The Cuba Example

Green SpaceGreen Space Reduces Stress, Mortality, Improves CognitiveReduces 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 ‘84

Attention deficits improve Attention deficits improve after a walk in the park. after a walk in the park. Effect = methylphenidate. Effect = methylphenidate.

Taylor ’08

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




stressstress


Obesity


Inactivity

Saturated fat


Air Pollution

↓Antioxidants

↓Omega-3

Fructose


SomePesticides





Socio-Economic Socio-Economic StressStress

Depression, poverty, violence, Depression, poverty, violence, inadequate health careinadequate health care

Socioeconomic, Psychosocial StressorsSocioeconomic, Psychosocial Stressors

Stress, depressionStress, depression risk for risk for CVD, ADCVD, AD Sesso, Kario, OwnbySesso, Kario, Ownby

People with lower SE status are at People with lower SE status are at risk for exposure to multiple risk for exposure to multiple environmental hazardsenvironmental hazards ↑↑damagedamage..

– Lead + stress Lead + stress ↑↑cognitive impairment cognitive impairment Glass 2009Glass 2009

– Lead + air pollution Lead + air pollution ↑↑CV autonomic CV autonomic dysfunction dysfunction Park 2008Park 2008

People who live in neighborhoods that lack social People who live in neighborhoods that lack social cohesion, sidewalks, or safety limit their exercise and have cohesion, sidewalks, or safety limit their exercise and have an increased risk of depression and possibly obesityan increased risk of depression and possibly obesity..

Berke EM 07, Molnar BE 04

Effects of the Built Environment on HealthEffects of the Built Environment on Health




stressstress


Obesity


Inactivity

Saturated fat


Air Pollution

↓Antioxidants

↓Omega-3

Fructose


SomePesticides

Stress

Multiple Multiple Factors Factors

Interact to Interact to Influence Influence

Health Health & &

DiseaseDisease

Environmental Environmental Factors Factors

Chronic DiseaseChronic Disease

Altered Altered Biological Biological PathwaysPathways

↑↑ GreenhouseGreenhouse GasesGases

Climate CrisisClimate Crisis

Heat, drought, storms, Heat, drought, storms, fires, ice sheet fires, ice sheet instability, sea level rise, instability, sea level rise, loss of glacial irrigation, loss of glacial irrigation, refugees, food refugees, food insecurity/starvation,insecurity/starvation,tropical diseasestropical diseases

Environmental Factors Drive Chronic Environmental Factors Drive Chronic Disease Disease andand the Climate Crisis the Climate Crisis

SolutionsSolutions forfor

Healthy People & A Healthy PlanetHealthy People & A Healthy Planet

Major Illnesses Are PreventableMajor Illnesses Are PreventablePersonal Actions to Profoundly Reduce RisksPersonal Actions to Profoundly Reduce Risks

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

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

Exercise Exercise

Be socially engagedBe socially engaged

Localized, diversified andLocalized, diversified and sustainable food production sustainable food production Clean, renewable energyClean, renewable energy ↓↓ air pollution, chemical air pollution, chemical

exposuresexposures Mass transit Mass transit that connects with bike paths and sidewalksthat connects with bike paths and sidewalks can can

reducereduce air pollution & obesityair pollution & obesity

Chemical regulatory reformChemical regulatory reform ““Safer substitute” Safer substitute” programs and programs and green product design green product design ↓↓

toxic exposures, ecosystem, wildlife contamination; job creationtoxic exposures, ecosystem, wildlife contamination; job creation Universal health careUniversal health care disease prevention & equitable health disease prevention & equitable health

care.care.

Major Illnesses Are PreventableMajor Illnesses Are PreventablePolicy Initiatives to Profoundly Reduce RisksPolicy Initiatives to Profoundly Reduce Risks

Major Illnesses Are PreventableMajor Illnesses Are PreventablePolicy Initiatives to Profoundly Reduce RisksPolicy Initiatives to Profoundly Reduce Risks

Examples of Specific Initiatives:Examples of Specific Initiatives:

Nutrition Nutrition – – Reform agricultural subsidies to be directed toward Reform agricultural subsidies to be directed toward programs and practices that provide sufficient nutritious, sustainably programs and practices that provide sufficient nutritious, sustainably produced food and restore ecosystems that have been degraded by produced food and restore ecosystems that have been degraded by agricultural activities.agricultural activities.

Toxic ChemicalsToxic Chemicals – – Reform the national Toxic Substances Reform the national Toxic Substances Control Act to include phase out of persistent, bioaccumulative, or Control Act to include phase out of persistent, bioaccumulative, or highly toxic chemicals.highly toxic chemicals.

Activity/NatureActivity/Nature – – Incorporate indoor and outdoor green spaces Incorporate indoor and outdoor green spaces and exercise areas into designs of nursing homes and assisted living and exercise areas into designs of nursing homes and assisted living facilitiesfacilities

AcknowledgementsAcknowledgements

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

Primary authors of this presentation: Primary authors of this presentation: Jill Stein MD, Ted Schettler Jill Stein MD, Ted Schettler MD, MPHMD, MPH

Contributing Authors: Contributing Authors: Maye Thompson RN, PhD, Marybeth Maye Thompson RN, PhD, Marybeth Palmigiano MPH, Maria Valenti. Palmigiano MPH, Maria Valenti.

Illustrations byIllustrations by: Stephen Burdick Design: Stephen Burdick Design

Permission is granted to use this presentation or individual slides with Permission is granted to use this presentation or individual slides with proper acknowledgement and cited as from proper acknowledgement and cited as from Environmental Threats to Environmental Threats to Healthy AgingHealthy Aging by Stein, Schettler et al. by Stein, Schettler et al. The authors of the The authors of the presentation do not authorize changes, and are not presentation do not authorize changes, and are not responsible for the accuracy of material if changes have been responsible for the accuracy of material if changes have been made.made.

For more information contact:For more information contact:

Greater Boston Greater Boston

Physicians for Social ResponsibilityPhysicians for Social Responsibility

www.psr.org/Bostonwww.psr.org/Boston

[email protected]@igc.org

Additional Additional ReferencesReferences

For Mediterranean Diet SlideFor Mediterranean Diet Slide 2828

Additional Additional NotesNotes

What’s Novel in the Western Diet?What’s Novel in the Western Diet?

Slide 22Slide 22

Documents

Environmental Drivers of Chronic Disease Based on the report Environmental Threats to Healthy Aging by Jill Stein MD, Ted Schettler MD, MPH, Maria Valenti