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 2010,Greater Boston Physicians for Social Responsibility (www.psr.org/Boston) and The Science and Environmental Health Network (www.sehn.org),What We Will Cover,Environmental factors are key drivers of many common chronic diseases Environmental factors alter key biological pathways leading to chronic disease Important environmental determinants of health include: Food system/nutrition and diet Toxic chemicals Built environment / physical activity Psychological & socioeconomic stress Examples of cross cutting solutions for healthy people & a healthy environment,Scope & Context of the Problem,A century of change in natural, built and social environments has caused major changes in the patterns and distribution of diseases. We are seeing dramatic increases in chronic diseases, and at younger ages, many of which, such as diabetes, are themselves risk factors for dementia. The over- 65 population will nearly double by 2030 to more than 71 million, sharply increasing the number of people at risk of chronic diseases of aging like Alzheimers and Parkinsons diseases, among others. Environmental factors play a key role in health across the lifespan. Thus they offer a major prevention opportunity.,The Changing Environment and Disease Patterns,During the past century, human activity has altered virtually all aspects of the worlds ecosystems: Pervasive spread of synthetic chemicals; air and water pollution. Industrialized food supply. Destruction of critical natural habitats, stressing ecosystems. Climate change. How we live, eat, work, play and socialize have substantially changed: Built environments have increased social isolation for many people; reduced physical activity. Growing income gap increases disease risk. Diseases of civilization - obesity, diabetes, cardiovascular disease, hypertension.,Environment Drives Chronic Disease,Western Disease Cluster Diabetes Obesity Abnormal Lipids Metabolic Syndrome Cardiovascular Disease,Food system/Diet Fossil Fuels Socioeconomic Stress Chemicals Built Environment/ Transportation,Inflammation Disrupted Insulin Signaling Oxidative Stress,Alzheimers,Parkinsons,Altered Pathways,Environmental Factors,Chronic Disease,Profound Public Health Impact Of Environmentally-Driven Western Disease Cluster,Obesity/overweight 2/3 US adults, prevalence x2 in 25 yrs http:/www.cdc.gov/chronicdisease/resources/publications/AAG/obesity.htm Pre/Diabetes 40% US adults, prevalence DM x2 over 20 yrs Cowie 09, http:/apps.nccd.cdc.gov/DDTSTRS/default.aspx Cardiovascular disease still leading cause of death. Hypertension increasing. http:/www.cdc.gov/nchs/FASTATS/lcod.htm, Hajjar 03 Metabolic syndrome = early signs of other cluster diseases; 35% adults, 55%60 yrs Ford ES 05 Alzheimers disease 84 yrs old, 5.3M Alzheimers Assoc.,Alzheimers Disease/dementia,Not an inevitable feature of normal aging. Progressive impairment of memory and multiple other cognitive functions, severe enough to interfere with daily functioning. Expected to triple by mid-century to over 13 million. Likely caused by varying combinations of genetic and environmental factors. Annual costs in US over $150 billion.,Parkinsons Disease,Progressive movement disorder that includes tremors, stiffness, and slow movement. May lead to severe disability. Likely caused by variable combinations of genetic and environmental factors. About 50,000 new cases annually in US.* Prevalence in US expected to double by 2030.*,* Due to the lack of registries and baseline data on Parkinsons Disease, the figures used here are estimates.,Alzheimers and Parkinsons Diseases,Characterized by: abnormal protein deposits chronic inflammation abnormal oxidative stress Many neuroscientists are beginning to think of some neurodegenerative diseases along a continuum, without clearly distinct boundaries in clinical or pathological manifestations,Continuum of Age-Associated Cognitive Impairment,Environment Drives Chronic Disease,Early life experiences can influence later-life health and disease. Multiple factors interact to influence health & disease. Environmental factors can alter natural pathways which in turn can lead to chronic disease. An ecological health framework considers the individual in the context of family, community, society and ecosystem.,Basic Principles,Toxic exposures oxidative stress,Obesity, hypertension, Cardiovascular disease, diabetes,Alzheimers, dementia, Parkinsons,Low birth weight,Early life experiences can influence later-life health, disease,Aging begins at conception,Multiple Factors Interact to Influence Health & Disease,built environment,disease,stress,energy,chemicals,nutrients,An ecological health framework considers the individual in the context of family, community, society, and ecosystem.,Altered Pathways,Environment Drives Chronic Disease,