EnvironmentalDriversofChronicDiseaseBasedonthereportEnvironmentalThreatstoHealthyAgingbyJillSteinMD TedSchettlerMD MPH MariaValentiandBenRohrer2010 GreaterBostonPhysiciansforSocialResponsibility www psr org Boston andTheScienceandEnvironmentalHealthNetwork www sehn org 1 WhatWeWillCover EnvironmentalfactorsarekeydriversofmanycommonchronicdiseasesEnvironmentalfactorsalterkeybiologicalpathwaysleadingtochronicdiseaseImportantenvironmentaldeterminantsofhealthinclude Foodsystem nutritionanddietToxicchemicalsBuiltenvironment physicalactivityPsychological socioeconomicstressExamplesofcrosscuttingsolutionsforhealthypeople ahealthyenvironment 2 Scope ContextoftheProblem Acenturyofchangeinnatural builtandsocialenvironmentshascausedmajorchangesinthepatternsanddistributionofdiseases Weareseeingdramaticincreasesinchronicdiseases andatyoungerages manyofwhich suchasdiabetes arethemselvesriskfactorsfordementia Theover 65populationwillnearlydoubleby2030tomorethan71million sharplyincreasingthenumberofpeopleatriskofchronicdiseasesofaginglikeAlzheimer sandParkinson sdiseases amongothers Environmentalfactorsplayakeyroleinhealthacrossthelifespan Thustheyofferamajorpreventionopportunity 3 TheChangingEnvironmentandDiseasePatterns Duringthepastcentury humanactivityhasalteredvirtuallyallaspectsoftheworld secosystems Pervasivespreadofsyntheticchemicals airandwaterpollution Industrializedfoodsupply Destructionofcriticalnaturalhabitats stressingecosystems Climatechange Howwelive eat work playandsocializehavesubstantiallychanged Builtenvironmentshaveincreasedsocialisolationformanypeople reducedphysicalactivity Growingincomegapincreasesdiseaserisk Diseasesofcivilization obesity diabetes cardiovasculardisease hypertension 4 EnvironmentDrivesChronicDisease WesternDiseaseClusterDiabetesObesityAbnormalLipidsMetabolicSyndromeCardiovascularDisease Foodsystem DietFossilFuelsSocioeconomicStressChemicalsBuiltEnvironment Transportation InflammationDisruptedInsulinSignalingOxidativeStress Alzheimer s Parkinson s AlteredPathways EnvironmentalFactors ChronicDisease 5 ProfoundPublicHealthImpactOfEnvironmentally 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 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 Progressiveimpairmentofmemoryandmultipleothercognitivefunctions severeenoughtointerferewithdailyfunctioning Expectedtotriplebymid centurytoover13million Likelycausedbyvaryingcombinationsofgeneticandenvironmentalfactors AnnualcostsinUSover 150billion 7 Parkinson sDisease Progressivemovementdisorderthatincludestremors stiffness andslowmovement Mayleadtoseveredisability Likelycausedbyvariablecombinationsofgeneticandenvironmentalfactors About50 000newcasesannuallyinUS PrevalenceinUSexpectedtodoubleby2030 DuetothelackofregistriesandbaselinedataonParkinson sDisease thefiguresusedhereareestimates 8 Alzheimer sandParkinson sDiseases Characterizedby abnormalproteindepositschronicinflammationabnormaloxidativestressManyneuroscientistsarebeginningtothinkofsomeneurodegenerativediseasesalongacontinuum withoutclearlydistinctboundariesinclinicalorpathologicalmanifestations 9 ContinuumofAge AssociatedCognitiveImpairment 10 EnvironmentDrivesChronicDisease Earlylifeexperiencescaninfluencelater lifehealthanddisease Multiplefactorsinteracttoinfluencehealth disease Environmentalfactorscanalternaturalpathwayswhichinturncanleadtochronicdisease Anecologicalhealthframeworkconsiderstheindividualinthecontextoffamily community societyandecosystem BasicPrinciples 11 Toxicexposuresoxidativestress Obesity hypertension Cardiovasculardisease diabetes Alzheimer s dementia Parkinson s Lowbirthweight Earlylifeexperiencescaninfluencelater lifehealth disease Agingbeginsatconception 12 MultipleFactorsInteracttoInfluenceHealth Disease builtenvironment disease stress energy chemicals nutrients 13 Anecologicalhealthframeworkconsiderstheindividualinthecontextoffamily community society andecosystem 14 AlteredPathways EnvironmentDrivesChronicDisease EnvironmentalFactors InflammationDisruptedInsulinSignalingOxidativeStress ChronicDisease MechanismsofAction 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