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1、慢性病的环境因素分析Stillwatersrundeep.流静水深流静水深,人静心深人静心深Wherethereislife,thereishope。有生命必有希望。有生命必有希望What We Will CoveruuEnvironmental factors are key drivers of many Environmental factors are key drivers of many common chronic diseasescommon chronic diseasesuuEnvironmental factors alter key biological pathway
2、s Environmental factors alter key biological pathways leading to chronic diseaseleading to chronic diseaseuuImportant environmental determinants of health Important environmental determinants of health include:include:- -Food system/nutrition and dietFood system/nutrition and diet- -Toxic chemicalsT
3、oxic chemicals- -Built environment / physical activityBuilt environment / physical activity- -Psychological & socioeconomic stressPsychological & socioeconomic stressuuExamples of cross cutting solutions for healthy Examples of cross cutting solutions for healthy people & a healthy environmentpeople
4、 & a healthy environmentScope & Context of the ProblemuuA 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 distri
5、bution of diseases.uuWe 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 fac
6、tors for dementia. .uuThe 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 r
7、isk of chronic diseases of aging like Alzheimers and Parkinsons diseases, among others. Alzheimers and Parkinsons diseases, among others. uuEnvironmental 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 t
8、he lifespan. Thus they offer a major prevention opportunityopportunity. .The Changing Environment and Disease PatternsuuDuring the past century, human activity has altered During the past century, human activity has altered virtually all aspects of the worlds ecosystems:virtually all aspects of the
9、worlds 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
10、 habitats, stressing ecosystems. Climate change.Climate change.uuHow 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 fo
11、r 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, hy
12、pertension. cardiovascular disease, hypertension.Environment Drives Chronic DiseaseWestern Disease ClusterWestern Disease Cluster Diabetes Diabetes ObesityObesity Abnormal LipidsAbnormal Lipids Metabolic SyndromeMetabolic Syndrome Cardiovascular DiseaseCardiovascular Disease Food system/DietFood sys
13、tem/Diet Fossil FuelsFossil Fuels Socioeconomic StressSocioeconomic Stress ChemicalsChemicals Built Environment/Built Environment/ Transportation Transportation InflammationInflammation Disrupted Insulin Disrupted Insulin Signaling Signaling Oxidative StressOxidative Stress Alzheimers Alzheimers Par
14、kinsonsParkinsonsAltered PathwaysAltered PathwaysEnvironmental Environmental FactorsFactorsChronic Chronic DiseaseDiseaseProfound Public Health Impact Of Environmentally-Driven Western Disease ClusteruuObesity/overweight 2/3 US adults, prevalence x2 in Obesity/overweight 2/3 US adults, prevalence x2
15、 in 25 yrs 25 yrs http:/www.cdc.gov/chronicdisease/resources/publications/AAG/obesity.htmhttp:/www.cdc.gov/chronicdisease/resources/publications/AAG/obesity.htmuuPre/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
16、.cdc.gov/DDTSTRS/default.aspxuuCardiovascular 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 03uuMetabolic syndrome = early signs of other cluster Metabolic s
17、yndrome = early signs of other cluster diseases; 35% adults, 55%60 yrs diseases; 35% adults, 55%60 yrs Ford ES 05uuAlzheimers disease 84 yrs old, 5.3M Alzheimers disease 84 yrs old, 5.3M Alzheimers Assoc.Alzheimers Disease/dementiauuNot an inevitable feature of normal aging.Not an inevitable feature
18、 of normal aging.uuProgressive 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.uuExpected to triple by mid-century
19、 Expected to triple by mid-century to over 13 million. to over 13 million.uuLikely caused by varying Likely caused by varying combinations of genetic and combinations of genetic and environmental factors.environmental factors. uuAnnual costs in US over $150 billion.Annual costs in US over $150 billi
20、on.Parkinsons DiseaseuuProgressive 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.uuLikely caused by variable combinations of genetic
21、 and Likely caused by variable combinations of genetic and environmental factors. environmental factors. uuAbout 50,000 new cases About 50,000 new cases annually in US.* annually in US.*uuPrevalence in US expected to Prevalence in US expected to double by 2030 double by 2030.* .* * Due to the lack o
22、f registries and baseline data on Parkinsons Disease, Due to the lack of registries and baseline data on Parkinsons Disease, the figures used here are estimates.the figures used here are estimates. Alzheimers and Parkinsons DiseasesuuCharacterized by:Characterized by: - -abnormal protein deposits ab
23、normal protein deposits - -chronic inflammationchronic inflammation- -abnormal oxidative stressabnormal oxidative stressuuMany neuroscientists are beginning to think Many neuroscientists are beginning to think of some neurodegenerative diseases along a of some neurodegenerative diseases along a cont
24、inuum, without clearly distinct continuum, without clearly distinct boundaries in clinical or pathological boundaries in clinical or pathological manifestationsmanifestations Continuum of Age-Associated Cognitive ImpairmentEnvironment Drives Chronic Diseaseuu Early life experiences can influence lat
25、er-life health Early life experiences can influence later-life health and disease. and disease.uu Multiple factors interact to influence health & disease. Multiple factors interact to influence health & disease.uu Environmental factors can alter natural pathways which Environmental factors can alter
26、 natural pathways which in turn can lead to chronic disease.in turn can lead to chronic disease.uu 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, soc
27、iety and ecosystem. ecosystem. Basic PrinciplesToxic exposuresoxidative stressObesity, hypertension,Cardiovascular disease, diabetesAlzheimers, dementia, ParkinsonsLow birth weightEarly life experiences can influence later-life health, diseaseAging begins at conceptionAging begins at conceptionMulti
28、ple Factors Interact to Influence Health & DiseaseMultiple Factors Interact to Influence Health & DiseasebuiltenvironmentdiseasestressenergychemicalsnutrientsAn ecological health framework considers the individual in the context of family, community, society, and ecosystem.Altered PathwaysEnvironmen
29、t Drives Chronic DiseaseEnvironmental FactorsInflammationInflammationDisrupted Insulin SignalingDisrupted Insulin SignalingOxidative StressOxidative StressChronic DiseaseMechanisms of ActionDefined by microscopicDefined by microscopiccharacteristics & laboratory test: characteristics & laboratory te
30、st: inflammatory cells & mediatorsinflammatory cells & mediatorsCLASSICAL CONCEPTOF INFLAMMATIONDefined 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
31、 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 = Normal MetabolismInsulin Insulin signalingsignaling blood sugarblood sugar art
32、ery diseaseartery disease triglyceridestriglyceridesInsulin Insulin signalingsignaling blood sugarblood sugar artery diseaseartery disease triglyceridestriglyceridesInflammationInflammationOxidative Oxidative stressstressDisrupted Insulin Signaling = Inflammatory MetabolismAltered PathwaysAltered Pa
33、thwaysEnvironment Drives Chronic DiseaseEnvironmental Environmental FactorsFactorsChronic Chronic DiseaseDiseaseFood System/Diet Novel Nutrients Are Pervasive, Promote Inflammatory MetabolismWhats “Novel” in the Western Diet?“Hypothetical scheme of fat, fatty acid (6, 3, trans and total) intake (as
34、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 importanc
35、e of the ratio of omega-6/omega-3 essential fatty acids. Biomedicine & Pharmacotherapy 56 (2002) 365-379.Years% of calories from fatmg/dayHigh Glycemic Carbohydrates Increase the Risk of Chronic DiseaseHigh glycemic carbohydrates break down quickly during digestion, High glycemic carbohydrates break
36、 down quickly during digestion, rapidly releasing glucose (sugar) into the bloodstream.rapidly releasing glucose (sugar) into the bloodstream. Plasma Insulin,mg/dlTime, minsINSULINEMIC RESPONSELow glycemic foodHigh glycemic foodProperties of Fatty AcidsOmega-3Omega-3 Omega-6Omega-6 SaturatedSaturate
37、dFoodFood PerishablePerishable Durable Durable Increased in Increased inSystemSystemShort 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 animalsanimalsImmuneI
38、mmuneAnti-inflammatoryAnti-inflammatory InflammatoryInflammatory & & InflammatoryInflammatoryProperties Properties Anti-inflammatoryAnti-inflammatory EvolutionaryEvolutionary Recent markedRecent marked Recent markedRecent marked Recent markedRecent markedContextContextdeclinedecline increase increas
39、e increaseincreaseOmega-3, (Omega-6) Insulin Insulin signalingsignaling blood sugarblood sugar artery diseaseartery disease triglyceridestriglyceridesInflammationInflammationOxidative Oxidative stressstressNovel Nutrients Disrupt Insulin Signaling, Novel Nutrients Disrupt Insulin Signaling, Drive In
40、flammatory MetabolismDrive Inflammatory MetabolismSaturated fatAntioxidants High Glycemic CarbohydratesFructose uuIncrease risksIncrease risks - -saturated and trans fatssaturated and trans fats- -high glycemic carbohydrateshigh glycemic carbohydrates- -lack of fruits/vegetables/omega 3slack of frui
41、ts/vegetables/omega 3s- -excess omega 6s?excess omega 6s?uuReduce risksReduce risks - -fruits, vegetablesfruits, vegetables- -omega 3somega 3s- -low glycemic carbohydrateslow glycemic carbohydrates- -Mediterranean dietMediterranean dietInfluence of Nutritionon Chronic Disease Benefits of Mediterrane
42、an-Type Diet on Chronic Disease RiskClinical intervention studiesClinical intervention studiesuu70% 70% heart attacks, cardiac death heart attacks, cardiac death & total mortality & total mortality DeLogeril 94DeLogeril 94uu60%60% cardiac events in CVD patients* cardiac events in CVD patients* Ornis
43、h 98Ornish 98uu50% 50% metabolic syndrome metabolic syndrome Esposito 04Esposito 04uu39% in CRP 39% in CRP Esposito 04Esposito 04uuinsulin resistance insulin resistance Esposito 04Esposito 04uu weight weight Esposito 04Esposito 04Prospective observation studiesProspective observation studiesuu80% 80
44、% diabetes diabetes Martinez-Gonzalez 08Martinez-Gonzalez 08uu31% 31% all-cause & cardiovascular mortality, 22% cancer all-cause & cardiovascular mortality, 22% cancer mortality*mortality*calculated from Sofi 08calculated from Sofi 08 73% Alzheimers mortality73% Alzheimers mortality Scarmeas 07Scarm
45、eas 07uu25-30% Parkinsons disease 25-30% Parkinsons disease Gao 07Gao 07uu78% 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 inc
46、rease 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
47、 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
48、a 9 point adherence scale to yield a calculated 31% 31% all-cause & CV mortality and a 22% all-cause & CV mortality and a 22% in cancer mortality. in cancer mortality.Benefits of Sustainably-Produced FoodNutritional benefits:Nutritional benefits:uuGenerally higher levels of vitamins, Generally highe
49、r levels of vitamins, minerals and phytochemicals minerals and phytochemicals (often dependent on soil quality)(often dependent on soil quality) uuHigher Omega-3 contentHigher Omega-3 contentuuOrganic samples contained higher Organic samples contained higher concentrations of polyphenols and concent
50、rations 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: uuReduced exposure to pesticidesReduced exposure
51、 to pesticides Altered PathwaysAltered PathwaysEnvironment Drives Chronic DiseaseEnvironmental Environmental FactorsFactorsChronic Chronic DiseaseDiseaseToxic ChemicalsAir pollution, Lead and other heavy metals, Air pollution, Lead and other heavy metals, some Pesticides,some Pesticides,Bisphenol A
52、and other Endocrine DisruptorsBisphenol A and other Endocrine DisruptorsLeadCumulative occupational exposureCumulative occupational exposureuu cognitive impairment cognitive impairment Shih 2007Shih 2007uu2x risk Parkinsons 2x risk Parkinsons Coon 2006Coon 2006Cumulative community exposure Cumulativ
53、e community exposure uu cognitive impairment cognitive impairment Shih 2006Shih 2006uuUp to 15 years cognitive aging Up to 15 years cognitive aging Weisskopf 2004Weisskopf 2004Animal studies of early life exposureAnimal studies of early life exposureuuLate-life Alzheimers markers Late-life Alzheimer
54、s markers Basha 2005, Lahiri 2007Basha 2005, Lahiri 2007 PesticidesuuParkinsons DiseaseParkinsons 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 - RAnimals - Rotenone & paraquatotenone & paraquatdamag
55、e 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, increasi
56、ng adult susceptibility susceptibility Cory-Slechta 2005uuCognitive 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
57、 Occupational exposure in men associated with 2x risk of developing AD developing AD Baldi 2003uuInsulin Resistance, metabolic syndromeInsulin Resistance, metabolic syndrome Lee 2006, 2007, 2007 Some persistent pesticides show strong Some persistent pesticides show strong dose-response relation to i
58、nsulin resistance dose-response relation to insulin resistance and metabolic syndrome. and metabolic syndrome. uu Found in polycarbonate plastic, Found in polycarbonate plastic, resins, sealants.resins, sealants.uu Exposures are nearly ubiquitous. Exposures are nearly ubiquitous.uu Endocrine disrupt
59、or, oxidative stress. Endocrine disruptor, oxidative stress.uu 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 2007uu 3-fold 3-fold Cardiovascular d
60、isease. Cardiovascular disease. Lang Lang 20082008uu 2-fold 2-fold Insulin Resistance. Insulin Resistance. Lang 2008Lang 2008 Bisphenol A polycarbonateInsulin Insulin signalingsignaling blood sugarblood sugar artery diseaseartery disease triglyceridestriglyceridesInflammationInflammationOxidative Ox
61、idative stressstressEnvironmental Factors Disrupt Insulin Signaling, Environmental Factors Disrupt Insulin Signaling, Drive Inflammatory MetabolismDrive Inflammatory MetabolismEndocrine Disruptors -BPA, dioxins, PCBs, some pesticides Saturated fatHigh Glycemic CarbohydratesAir PollutionAntioxidants
62、Omega-3 Fructose SomePesticidesLead, other heavy metalsAltered PathwaysAltered PathwaysEnvironment Drives Chronic DiseaseEnvironmental Environmental FactorsFactorsChronic Chronic DiseaseDiseaseBuilt EnvironmentPhysical ActivityHealth Benefits of Physical ActivityuuReduced ongoing levels of oxidative
63、 Reduced ongoing levels of oxidative stress and inflammatory burden. stress and inflammatory burden. Brooks 2008, Attipoe 2008Brooks 2008, Attipoe 2008uuInversely associated with the Inversely associated with the risks of Alzheimers/dementia and risks of Alzheimers/dementia and cognitive decline. co
64、gnitive decline. Rovio 2005Rovio 2005uuSubjects 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
65、 no net change from baseline at 1.5 yrs. at 1.5 yrs. Lautenschlager Lautenschlager 20082008Increasing physical activity at any age improves Increasing physical activity at any age improves physical and emotional wellbeing.physical and emotional wellbeing.uuWalkable Cities Projects uuCommunity Garden
66、suuFarmers MarketsuuRails to TrailsLivable Communities Enhance Healthy AgingCuba- 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%, stro
67、ke 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, 2007Sustainable Food & Transportation So
68、lutions:The Cuba ExampleGreen Space Reduces Stress, Mortality, Improves CognitiveReduces Stress, Mortality, Improves Cognitive FunctionuuShortens post surgical Shortens post surgical recovery time, reduces recovery time, reduces need for pain medications.need for pain medications. Ulrich 84uuAttenti
69、on deficits improve Attention deficits improve after a walk in the park. after a walk in the park. Effect = methylphenidate. Effect = methylphenidate. Taylor 08uuAccess to green spaceAccess to green space reduces the effect of reduces the effect of poverty on mortality by poverty on mortality by 50%
70、. 50%. Mitchell 08Insulin Insulin signalingsignaling blood sugarblood sugar artery diseaseartery disease triglyceridestriglyceridesInflammationInflammationOxidative Oxidative stressstressEnvironmental Factors Disrupt Insulin Signaling, Environmental Factors Disrupt Insulin Signaling, Drive Inflammat
71、ory MetabolismDrive Inflammatory MetabolismObesityEndocrine Disruptors -BPA, dioxins, PCBs, some pesticides InactivitySaturated fatHigh Glycemic CarbohydratesAir PollutionAntioxidants Omega-3 Fructose Lead, other heavy metalsSomePesticidesAltered PathwaysAltered PathwaysEnvironment Drives Chronic Di
72、seaseEnvironmental Environmental FactorsFactorsChronic Chronic DiseaseDiseaseSocio-Economic StressDepression, poverty, violence, Depression, poverty, violence, inadequate health careinadequate health careSocioeconomic, Psychosocial StressorsuuStress, depressionStress, depression risk for risk for CV
73、D, ADCVD, AD Sesso, Kario, OwnbySesso, Kario, OwnbyuuPeople 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
74、 impairment Glass 2009Glass 2009 Lead + air pollution Lead + air pollution CV autonomic CV autonomic dysfunction dysfunction Park 2008Park 2008People who live in neighborhoods that lack social People who live in neighborhoods that lack social cohesion, sidewalks, or safety limit their exercise and h
75、ave 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 04Effects of the Built Environment on HealthInsulin Insulin signalingsignaling blood sugarblood sugar ar
76、tery diseaseartery disease triglyceridestriglyceridesInflammationInflammationOxidative Oxidative stressstressEnvironmental Factors Disrupt Insulin Signaling, Environmental Factors Disrupt Insulin Signaling, Drive Inflammatory MetabolismDrive Inflammatory MetabolismObesityEndocrine Disruptors -BPA, d
77、ioxins, PCBs, some pesticides InactivitySaturated fatHigh Glycemic CarbohydratesAir PollutionAntioxidants Omega-3 Fructose Lead, other heavy metalsSomePesticidesStressMultiple Factors Interact to Influence Health & DiseaseEnvironmental Environmental FactorsFactorsChronic DiseaseChronic Disease Alter
78、ed Altered Biological Biological PathwaysPathways Greenhouse Greenhouse Gases GasesClimate 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 irriga
79、tion, refugees, food refugees, food insecurity/starvation,insecurity/starvation,tropical diseasestropical diseases Environmental Factors Drive Chronic Disease and the Climate Crisis Solutions forforHealthy People & A Healthy PlanetMajor Illnesses Are PreventablePersonal Actions to Profoundly Reduce
80、Risks Personal Level “Approaches to Healthy Living”Personal Level “Approaches to Healthy Living”uu Eat healthy whole, fresh, unprocessed, plant based Eat healthy whole, fresh, unprocessed, plant based foods foodsuu Avoid toxicants whenever possible Avoid toxicants whenever possibleuu Exercise Exerci
81、se uu Be socially engaged Be socially engaged uuL Localized, diversified andocalized, diversified and sustainable food production sustainable food production uuClean, renewable energyClean, renewable energy air pollution, chemical air pollution, chemical exposuresexposuresuuMass transit Mass transit
82、 that connects with bike paths and sidewalksthat connects with bike paths and sidewalks can can reducereduce air pollution & obesityair pollution & obesityuuChemical regulatory reformChemical regulatory reformuu“Safer substitute” “Safer substitute” programs and programs and green product design gree
83、n product design toxic exposures, ecosystem, wildlife contamination; job creationtoxic exposures, ecosystem, wildlife contamination; job creationuuUniversal health careUniversal health care disease prevention & equitable health disease prevention & equitable health care.care.Major Illnesses Are Prev
84、entablePolicy Initiatives to Profoundly Reduce RisksMajor Illnesses Are PreventablePolicy Initiatives to Profoundly Reduce RisksExamples of Specific Initiatives:Examples of Specific Initiatives:Nutrition Nutrition Reform agricultural subsidies to be directed toward Reform agricultural subsidies to b
85、e 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
86、 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
87、.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 facilitiesfaciliti
88、esAcknowledgementsBased on the Report by Greater Boston Physicians for Social Based on the Report by Greater Boston Physicians for Social Responsibility (Responsibility (www.psr.org/bostonwww.psr.org/boston) and the Science and ) and the Science and Environmental Health Network (Environmental Health
89、 Network (www.sehn.orgwww.sehn.org) authored by ) authored by Jill Stein Jill Stein MD, Ted Schettler MD, MPH, Maria Valenti & Ben RohrerMD, Ted Schettler MD, MPH, Maria Valenti & Ben RohrerPrimary authors of this presentation: Primary authors of this presentation: Jill Stein MD, Ted Schettler Jill
90、Stein MD, Ted Schettler MD, MPHMD, MPHContributing 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 DesignPermission i
91、s 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 Stei
92、n, Schettler et al. by Stein, Schettler et al. The authors of the presentation The authors of the presentation do not authorize changes, and are not responsible for the accuracy of do not authorize changes, and are not responsible for the accuracy of material if changes have been made.material if changes have been made.For more information contact:Greater Boston Physicians for Social Responsibilitywww.psr.org/Bostonpsrmaboigc.orgAdditional ReferencesFor Mediterranean Diet Slide 28Additional NotesWhats Novel in the Western Diet?Slide 22
