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1、Environmental Drivers of Chronic Disease Based on the report Environmental Threats to Healthy Aging by Jill Stein MD, Ted Schettler MD, MPH, Maria Valenti and Ben Rohrer 20102010Greater Boston Physicians for Social Responsibility (www.psr.org/Boston)and The Science and Environmental Health Network (
2、www.sehn.org)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 pathways Environmental factors alter key biological pathways leading to chronic dise
3、aseleading to chronic diseaseuuImportant environmental determinants of health Important environmental determinants of health include:include:- -Food system/nutrition and dietFood system/nutrition and diet- -Toxic chemicalsToxic chemicals- -Built environment / physical activityBuilt environment / phy
4、sical activity- -Psychological & socioeconomic stressPsychological & socioeconomic stressuuExamples of cross cutting solutions for healthy Examples of cross cutting solutions for healthy people & a healthy environmentpeople & a healthy environmentScope & Context of the ProblemuuA century of change i
5、n 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.uuWe are seeing dramatic increases in chronic diseases, We
6、 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. .uuThe over- 65 population will nearly double by 2030 to T
7、he 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 Alzheimers and Parkinsons diseases, amo
8、ng 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 the lifespan. Thus they offer a major prevention opportunityopportunity. .The
9、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 worlds ecosystems: Pervasive spread of synthetic chemicals; air and water pol
10、lution. 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.uuHow we live,
11、 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.
12、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 D
13、iseaseWestern 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 Ch
14、emicalsChemicals Built Environment/Built Environment/ Transportation Transportation InflammationInflammation Disrupted Insulin Disrupted Insulin Signaling Signaling Oxidative StressOxidative Stress Alzheimers Alzheimers ParkinsonsParkinsonsAltered PathwaysAltered PathwaysEnvironmental Environmental
15、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 in 25 yrs 25 yrs http:/www.cdc.gov/chronicdisease/resources/publications/AAG
16、/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.cdc.gov/DDTSTRS/default.aspxuuCardiovascular disease still leading cause of
17、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 syndrome = early signs of other cluster diseases; 35% adults, 55%60 yrs diseas
18、es; 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 of normal aging.uuProgressive impairment of memory and multiple Progressive
19、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 Expected to triple by mid-century to over 13 million. to over 13 million.uuL
20、ikely 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 billion.Parkinsons DiseaseuuProgressive movement disorder that includes tremors, P
21、rogressive 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 and Likely caused by variable combinations of genetic and environmental fact
22、ors. 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 of registries and baseline data on Parkinsons Disease, Due to the lack of regi
23、stries 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 abnormal protein deposits - -chronic inflammationchronic inflammation- -abnorma
24、l 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 continuum, without clearly distinct continuum, without clearly distinct boundarie
25、s in clinical or pathological boundaries in clinical or pathological manifestationsmanifestations Continuum of Age-Associated Cognitive ImpairmentEnvironment Drives Chronic Diseaseuu Early life experiences can influence later-life health Early life experiences can influence later-life health and dis
26、ease. 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 natural pathways which in turn can lead to chronic disease.in turn can lead
27、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, society and ecosystem. ecosystem. Basic PrinciplesToxic exposuresoxidative stres
28、sObesity, hypertension,Cardiovascular disease, diabetesAlzheimers, dementia, ParkinsonsLow birth weightEarly life experiences can influence later-life health, diseaseAging begins at conceptionAging begins at conceptionMultiple Factors Interact to Influence Health & DiseaseMultiple Factors Interact t
29、o Influence Health & DiseasebuiltenvironmentdiseasestressenergychemicalsnutrientsAn ecological health framework considers the individual in the context of family, community, society, and ecosystem.Altered PathwaysEnvironment Drives Chronic DiseaseEnvironmental FactorsInflammationInflammationDisrupte
30、d Insulin SignalingDisrupted Insulin SignalingOxidative StressOxidative StressChronic DiseaseMechanisms of ActionDefined by microscopicDefined by microscopiccharacteristics & laboratory test: characteristics & laboratory test: inflammatory cells & mediatorsinflammatory cells & mediatorsCLASSICAL CON
31、CEPTOF 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 Concept of Inflammation“Atherosclerosis is an “Atherosclerosis is an inflamm
32、atory 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 artery diseaseartery disease triglyceridestriglyceridesInsulin Insulin signaling
33、signaling blood sugarblood sugar artery diseaseartery disease triglyceridestriglyceridesInflammationInflammationOxidative Oxidative stressstressDisrupted Insulin Signaling = Inflammatory MetabolismAltered PathwaysAltered PathwaysEnvironment Drives Chronic DiseaseEnvironmental Environmental FactorsFa
34、ctorsChronic 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 percentage of calories from fat) and intake of vitamins E and C (mg/d). Data
35、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 & Pharma
36、cotherapy 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 down quickly during digestion, rapidly releasing glucose (sugar) into the bl
37、oodstream.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 SaturatedSaturatedFoodFood PerishablePerishable Durable Durable Increased in Increased inSyste
38、mSystemShort 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 animalsanimalsImmuneImmuneAnti-inflammatoryAnti-inflammatory InflammatoryInflammatory & & Inflamma
39、toryInflammatoryProperties Properties Anti-inflammatoryAnti-inflammatory EvolutionaryEvolutionary Recent markedRecent marked Recent markedRecent marked Recent markedRecent markedContextContextdeclinedecline increase increase increaseincreaseOmega-3, (Omega-6) Insulin Insulin signalingsignaling blood
40、 sugarblood sugar artery diseaseartery disease triglyceridestriglyceridesInflammationInflammationOxidative Oxidative stressstressNovel Nutrients Disrupt Insulin Signaling, Novel Nutrients Disrupt Insulin Signaling, Drive Inflammatory MetabolismDrive Inflammatory MetabolismSaturated fatAntioxidants H
41、igh Glycemic CarbohydratesFructose uuIncrease 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?uuReduce risksReduce
42、 risks - -fruits, vegetablesfruits, vegetables- -omega 3somega 3s- -low glycemic carbohydrateslow glycemic carbohydrates- -Mediterranean dietMediterranean dietInfluence of Nutritionon Chronic Disease Benefits of Mediterranean-Type Diet on Chronic Disease RiskClinical intervention studiesClinical int
43、ervention 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* Ornish 98Ornish 98uu50% 50% metabolic syndrome metabolic syndrome Esposito 04Espos
44、ito 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% diabetes diabetes Martinez-Gonzalez 08Martinez-Gonzalez 08uu31% 31% all-cau
45、se & 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 07Scarmeas 07uu25-30% Parkinsons disease 25-30% Parkinsons disease Gao 07Gao 07uu78%
46、 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 0.9
47、1 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 th
48、ese 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 mortal
49、ity 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 higher levels of vitamins, minerals and phytochemicals minerals and phytochemicals
50、 (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 concentrations of polyphenols and antioxidants in 75% of the matched antioxidants in
51、 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 to pesticides Altered PathwaysAltered PathwaysEnvironment Drives Chronic Dis
52、easeEnvironmental Environmental FactorsFactorsChronic Chronic DiseaseDiseaseToxic ChemicalsAir 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 DisruptorsLeadC
53、umulative occupational exposureCumulative occupational exposureuu cognitive impairment cognitive impairment Shih 2007Shih 2007uu2x risk Parkinsons 2x risk Parkinsons Coon 2006Coon 2006Cumulative community exposure Cumulative community exposure uu cognitive impairment cognitive impairment Shih 2006Sh
54、ih 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 Alzheimers markers Basha 2005, Lahiri 2007Basha 2005, Lahiri 2007 PesticidesuuParkinso
55、ns 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 & paraquatdamage dopaminergic neurons in damage dopaminergic neurons in striatal region of b
56、rain 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 2005uuCognitive decline/d
57、ementiaCognitive 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 develo
58、ping 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 insulin resistance dose-response relation to insulin resistance and metabolic
59、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 disruptor, oxidative stress. Endocrine disruptor, oxidative stress.uu Causes fat acc
60、umulation & 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 disease. Cardiovascular disease. Lang Lang 20082008uu 2-fold 2-fold Insulin Re
61、sistance. Insulin Resistance. Lang 2008Lang 2008 Bisphenol A polycarbonateInsulin Insulin signalingsignaling blood sugarblood sugar artery diseaseartery disease triglyceridestriglyceridesInflammationInflammationOxidative Oxidative stressstressEnvironmental Factors Disrupt Insulin Signaling, Environm
62、ental Factors Disrupt Insulin Signaling, Drive Inflammatory MetabolismDrive Inflammatory MetabolismEndocrine Disruptors -BPA, dioxins, PCBs, some pesticides Saturated fatHigh Glycemic CarbohydratesAir PollutionAntioxidants Omega-3 Fructose SomePesticidesLead, other heavy metalsAltered PathwaysAltere
63、d PathwaysEnvironment Drives Chronic DiseaseEnvironmental Environmental FactorsFactorsChronic Chronic DiseaseDiseaseBuilt EnvironmentPhysical ActivityHealth Benefits of Physical ActivityuuReduced ongoing levels of oxidative Reduced ongoing levels of oxidative stress and inflammatory burden. stress a
64、nd 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. cognitive decline. Rovio 2005Rovio 2005uuSubjects at risk for AD who walked 150
65、 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 Lautensch
66、lager 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 GardensuuFarmers MarketsuuRails to TrailsLivable Communities Enhance Healthy AgingC
67、uba- 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% F
68、ranco 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 Solutions:The Cuba ExampleGreen Space Reduces Stress, Mortality, Improves Cogni
69、tiveReduces 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 84uuAttention deficits improve Attention deficits improve after a walk in the park. afte
70、r 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%. 50%. Mitchell 08Insulin Insulin signalingsignaling blood sugarblood sugar a
71、rtery diseaseartery disease triglyceridestriglyceridesInflammationInflammationOxidative Oxidative stressstressEnvironmental Factors Disrupt Insulin Signaling, Environmental Factors Disrupt Insulin Signaling, Drive Inflammatory MetabolismDrive Inflammatory MetabolismObesityEndocrine Disruptors -BPA,
72、dioxins, PCBs, some pesticides InactivitySaturated fatHigh Glycemic CarbohydratesAir PollutionAntioxidants Omega-3 Fructose Lead, other heavy metalsSomePesticidesAltered PathwaysAltered PathwaysEnvironment Drives Chronic DiseaseEnvironmental Environmental FactorsFactorsChronic Chronic DiseaseDisease
73、Socio-Economic StressDepression, poverty, violence, Depression, poverty, violence, inadequate health careinadequate health careSocioeconomic, Psychosocial StressorsuuStress, depressionStress, depression risk for risk for CVD, ADCVD, AD Sesso, Kario, OwnbySesso, Kario, OwnbyuuPeople with lower SE sta
74、tus 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
75、 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 have cohesion, sidewalks, or safety limit their exercise and have an increased
76、 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 artery diseaseartery disease triglyceridestriglyceridesInflammationInflammation
77、Oxidative Oxidative stressstressEnvironmental Factors Disrupt Insulin Signaling, Environmental Factors Disrupt Insulin Signaling, Drive Inflammatory MetabolismDrive Inflammatory MetabolismObesityEndocrine Disruptors -BPA, dioxins, PCBs, some pesticides InactivitySaturated fatHigh Glycemic Carbohydra
78、tesAir PollutionAntioxidants Omega-3 Fructose Lead, other heavy metalsSomePesticidesStressMultiple Factors Interact to Influence Health & DiseaseEnvironmental Environmental FactorsFactorsChronic DiseaseChronic Disease Altered Altered Biological Biological PathwaysPathways Greenhouse Greenhouse Gases
79、 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 irrigation, refugees, food refugees, food insecurity/starvation,insecurity/starvati
80、on,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 Risks Personal Level “Approaches to Healthy Living”Personal Level “Approaches
81、 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 Exercise uu Be socially engaged Be socially engaged uuL Localized, diversified ando
82、calized, diversified and sustainable food production sustainable food production uuClean, renewable energyClean, renewable energy air pollution, chemical air pollution, chemical exposuresexposuresuuMass transit Mass transit that connects with bike paths and sidewalksthat connects with bike paths and
83、 sidewalks can can reducereduce air pollution & obesityair pollution & obesityuuChemical regulatory reformChemical regulatory reformuu“Safer substitute” “Safer substitute” programs and programs and green product design green product design toxic exposures, ecosystem, wildlife contamination; job crea
84、tiontoxic exposures, ecosystem, wildlife contamination; job creationuuUniversal health careUniversal health care disease prevention & equitable health disease prevention & equitable health care.care.Major Illnesses Are PreventablePolicy Initiatives to Profoundly Reduce RisksMajor Illnesses Are Preve
85、ntablePolicy 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 be directed toward programs and practices that provide sufficient nutritious,
86、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 th
87、e 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 an
88、d 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 facilitiesfacilitiesAcknowledgementsBased on the Report by Greater Boston Physicians for Social
89、 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 Network (www.sehn.orgwww.sehn.org) authored by ) authored by Jill Stein Jill
90、 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 Stein MD, Ted Schettler MD, MPHMD, MPHContributing Authors: Contributing Auth
91、ors: 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 is granted to use this presentation or individual slides with Permission is gr
92、anted 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 presentatio
93、n 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
