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1、EnvironmentalDriversofChronicDiseaseBasedonthereportEnvironmentalThreatstoHealthyAgingbyJillSteinMD TedSchettlerMD MPH MariaValentiandBenRohrer2010 GreaterBostonPhysiciansforSocialResponsibility www psr org Boston andTheScienceandEnvironmentalHealthNetwork www sehn org 1 WhatWeWillCover Environmenta
2、lfactorsarekeydriversofmanycommonchronicdiseasesEnvironmentalfactorsalterkeybiologicalpathwaysleadingtochronicdiseaseImportantenvironmentaldeterminantsofhealthinclude Foodsystem nutritionanddietToxicchemicalsBuiltenvironment physicalactivityPsychological socioeconomicstressExamplesofcrosscuttingsolu
3、tionsforhealthypeople ahealthyenvironment 2 Scope ContextoftheProblem Acenturyofchangeinnatural builtandsocialenvironmentshascausedmajorchangesinthepatternsanddistributionofdiseases Weareseeingdramaticincreasesinchronicdiseases andatyoungerages manyofwhich suchasdiabetes arethemselvesriskfactorsford
4、ementia Theover 65populationwillnearlydoubleby2030tomorethan71million sharplyincreasingthenumberofpeopleatriskofchronicdiseasesofaginglikeAlzheimer sandParkinson sdiseases amongothers Environmentalfactorsplayakeyroleinhealthacrossthelifespan Thustheyofferamajorpreventionopportunity 3 TheChangingEnvi
5、ronmentandDiseasePatterns Duringthepastcentury humanactivityhasalteredvirtuallyallaspectsoftheworld secosystems Pervasivespreadofsyntheticchemicals airandwaterpollution Industrializedfoodsupply Destructionofcriticalnaturalhabitats stressingecosystems Climatechange Howwelive eat work playandsocialize
6、havesubstantiallychanged Builtenvironmentshaveincreasedsocialisolationformanypeople reducedphysicalactivity Growingincomegapincreasesdiseaserisk Diseasesofcivilization obesity diabetes cardiovasculardisease hypertension 4 EnvironmentDrivesChronicDisease WesternDiseaseClusterDiabetesObesityAbnormalLi
7、pidsMetabolicSyndromeCardiovascularDisease Foodsystem DietFossilFuelsSocioeconomicStressChemicalsBuiltEnvironment Transportation InflammationDisruptedInsulinSignalingOxidativeStress Alzheimer s Parkinson s AlteredPathways EnvironmentalFactors ChronicDisease 5 ProfoundPublicHealthImpactOfEnvironmenta
8、lly DrivenWesternDiseaseCluster Obesity overweight 2 3USadults prevalencex2in 25yrshttp www cdc gov chronicdisease resources publications AAG obesity htmPre Diabetes 40 USadults prevalenceDM x2over20yrsCowie09 http apps nccd cdc gov DDTSTRS default aspxCardiovasculardisease stillleadingcauseofdeath
9、Hypertensionincreasing http www cdc gov nchs FASTATS lcod htm Hajjar03Metabolicsyndrome earlysignsofotherclusterdiseases 35 adults 55 60yrsFordES05Alzheimer sdisease 84yrsold 5 3MAlzheimer sAssoc 6 Alzheimer sDisease dementia Notaninevitablefeatureofnormalaging Progressiveimpairmentofmemoryandmultip
10、leothercognitivefunctions severeenoughtointerferewithdailyfunctioning Expectedtotriplebymid centurytoover13million Likelycausedbyvaryingcombinationsofgeneticandenvironmentalfactors AnnualcostsinUSover 150billion 7 Parkinson sDisease Progressivemovementdisorderthatincludestremors stiffness andslowmov
11、ement Mayleadtoseveredisability Likelycausedbyvariablecombinationsofgeneticandenvironmentalfactors About50 000newcasesannuallyinUS PrevalenceinUSexpectedtodoubleby2030 DuetothelackofregistriesandbaselinedataonParkinson sDisease thefiguresusedhereareestimates 8 Alzheimer sandParkinson sDiseases Chara
12、cterizedby abnormalproteindepositschronicinflammationabnormaloxidativestressManyneuroscientistsarebeginningtothinkofsomeneurodegenerativediseasesalongacontinuum withoutclearlydistinctboundariesinclinicalorpathologicalmanifestations 9 ContinuumofAge AssociatedCognitiveImpairment 10 EnvironmentDrivesC
13、hronicDisease Earlylifeexperiencescaninfluencelater lifehealthanddisease Multiplefactorsinteracttoinfluencehealth disease Environmentalfactorscanalternaturalpathwayswhichinturncanleadtochronicdisease Anecologicalhealthframeworkconsiderstheindividualinthecontextoffamily community societyandecosystem
14、BasicPrinciples 11 Toxicexposuresoxidativestress Obesity hypertension Cardiovasculardisease diabetes Alzheimer s dementia Parkinson s Lowbirthweight Earlylifeexperiencescaninfluencelater lifehealth disease Agingbeginsatconception 12 MultipleFactorsInteracttoInfluenceHealth Disease builtenvironment d
15、isease stress energy chemicals nutrients 13 Anecologicalhealthframeworkconsiderstheindividualinthecontextoffamily community society andecosystem 14 AlteredPathways EnvironmentDrivesChronicDisease EnvironmentalFactors InflammationDisruptedInsulinSignalingOxidativeStress ChronicDisease MechanismsofAct
16、ion 15 Definedbymicroscopiccharacteristics laboratorytest inflammatorycells mediators CLASSICALCONCEPTOFINFLAMMATION Definedbyappearance Calor dolor rubor tumor Heat pain redness swelling TheNewConceptofInflammation Atherosclerosisisaninflammatorydisease 2 Ross Russell Atherosclerosis AnInflammatoryDisease NEJM1999 340 2 115 126 16 17 InsulinSignaling NormalMetabolism 18 DisruptedInsulinSignaling InflammatoryMetabolism 19 AlteredPathways EnvironmentDrivesChronicDisease EnvironmentalFactors Chron
