A Story of Health Wins CDC Communications Award

The National Center for Environmental Health (NCEH) and the Agency for Toxic Substances and Disease Registry (ATSDR) have honored A Story of Health multimedia eBook/continuing education course with an “Excellence in Communications” award.

NCEH and ATSDR are agencies of the Centers for Disease Control and Prevention (CDC). The award was given at the annual NCEH/ATSDR Honor Awards on February 3, 2016, to A Story of Health Team for excellence in communication for the development of a medical education product that highlights the importance of environmental health.

The eBook was designed to harness the power of storytelling to improve environmental health literacy for health professionals, policy makers and health advocates. It was developed by a team from the Collaborative on Health and the Environment (CHE), ATSDR, the Office of Environmental Health Hazard Assessment, California EPA (OEHHA), the Science and Environmental Health Network (SEHN), and the Western States Pediatric Environmental Health Specialty Unit (PEHSU).

sohcoverThe first installment of the eBook, with chapters on asthma, developmental disabilities and childhood leukemia, is available for free download on the CHE website. Health professionals can register for free continuing education credits (CE) through the CDC. A fourth story on infertility and reproductive health is in development.

Your Health: Lead at Home

image of a child running tap waterWith substantial media focus on the tap water situation in Flint, Michigan, and beyond in the last few weeks, many people are concerned about lead levels in their tap water. This concern is well founded, for lead has devastating impacts on our health, and especially on children’s health. There is no amount of lead exposure that is considered safe for children—even the smallest exposures can impact health.

What does lead do? From CHE’s Practice Prevention column on lead:

High levels of lead in children can lead to anemia, stomach and kidney problems, muscle weakness, brain damage and ultimately death. Even very low levels of exposure can affect a child’s mental and physical growth. Studies have linked elevated blood-lead levels in children with reduced intelligence, slowed mental development, attention deficit hyperactivity disorder, increased risk for delinquency and criminal behavior, heightened risk of obesity and delayed onset of puberty.

Lead at home can lurk in several places:

  • plumbing fixtures, from which it leaches into tap water
  • older house paint (manufactured before 1978)
  • paint on some toys, especially imported toys
  • some vinyl products, such as mini-blinds, toys, lunchboxes, purses and bibs
  • soil, especially if the exterior paint on a house contains lead, if the house is located where there was heavy traffic when lead was added to gasoline (prior to 1986), or if the house is located near or downwind from a smelter (either active or decommissioned)
  • some candle wicks, especially in scented candles
  • residues from hobbies such as soldering glass or metal, making bullets or glazing pottery
  • the glaze in some crock pots or crockery dishware, especially imported crockery

Many of the links in the list above provide tips for removing lead or reducing exposures from products. For water, however, CHE passes on advice regarding testing your home’s water from the Cambridge Water Department in Massachusetts. Check with your local water or health department for assistance and recommendations on test kits. A water test should collect water at least two times as described here:

A test should demonstrate a worst case/best case scenario. Worst case is where the tap water is left standing in the plumbing for a period of time and is likely to see if lead is present in the plumbing. Best case is after the tap water in the plumbing has been flushed and is likely to contain extremely low levels or detect no lead at all.

If testing shows that your water at home contains small amounts of lead after water has been left in the pipes overnight, or if you know or suspect that your pipes or water delivery system contain lead, follow this advice from the Massachusetts Executive Office of Energy and Environmental Affairs:

  • In the morning, run the faucet where you normally take your first drink or fill up your coffee pot until the water turns as cold as it’s going to get. This flushes out the water that has been standing in your pipes overnight. If no one is home and using water during the day, do the same thing in the evening.
  • Always used cold tap water for cooking, drinking and preparing baby formula or foods. Hot water dissolves metals faster.
  • At the day’s end, fill a jug with drinking water for later use.
  • Have an electrician check your wiring. Corrosion within your plumbing may be greater when grounding wires from your home’s electrical system are attached.

For those who prefer not to let all that running water simply flow down the drain, capture the day’s first water in a bucket and use it to refill toilet tanks, add it to a filling washing machine, or water landscaping plants (but not edibles).

Children and pregnant women especially need to be protected from lead exposures. As a final protective action, we’ll address another source of lead, also described in CHE’s Practice Prevention column:

Lead can accumulate in the bones and teeth of individuals who are exposed. Women who have been exposed to lead at any time may have enough lead in their bones and teeth to be toxic to their fetuses and babies. During pregnancy or breastfeeding, calcium from the mother provides materials for the child’s developing bones. If the mother does not have a sufficient supply of calcium in her diet, her own bones and teeth may be resorbed to provide calcium. If the mother’s bones and teeth contain lead, this toxic material may also be mobilized from her bones and circulated to the developing child or her breast milk. Pregnant and nursing mothers need to be sure their own calcium intake is adequate.

If you have any concerns about your or your child’s exposure, ask your physician to test blood-lead levels. There is no way to reverse the effects of lead once the damage is done—prevention is key.

Mental Health: A Heightened Recognition of the Role of Toxic Chemicals

written by Elise Miller, EdM

For the first time the American Psychological Association’s (APA) Monitor on Psychology magazine featured a cover story (Oct 2015) on the impact toxic chemicals can have on the developing brain. It makes sense that if chemical exposures can undermine children’s learning capacities, then they might be implicated in mental health problems as well. However, there has been scant research in or recognition of the latter in mainstream psychology. image from the APA articleThe publication of this article suggests that this sector may now be starting to take these concerns more seriously.

One psychologist who has been particularly instrumental in putting these issues on the radar of the APA is Sue Koger, PhD, professor of psychology at Willamette University and co-author of the forthcoming book “Psychology for Sustainability” (Scott, Amel, Koger, & Manning, 2016). In 2003 she attended an “In Harm’s Way” training, led by Ted Schettler, MD, MPH (science director of both the Science and Environmental Health Network and CHE), Maria Valenti (coordinator of CHE’s Healthy Aging Initiative and co-developer of A Story of Health) and Jill Stein, MD. The audience was a mix of physicians, nurses, teachers, and members of advocacy organizations. Dr. Koger was one of a few, if not the only, psychologists participating. After the training, she was inspired to submit an abstract for an oral presentation at the next APA annual meeting. To her knowledge chemical exposures had never been on the agenda. Her abstract was accepted. Subsequently, she, Schettler, and Bernard Weiss, PhD, co-authored a paper on these issues for the American Psychologist in 2005.

During this time, the CHE Mental Health and the Environment Working Group, a sub-working group of CHE’s Learning and Developmental Disabilities Initiative, was formed to provide a forum where emerging research on chemical exposures and mental health concerns could be posted and discussed. The National Association for the Dually Diagnosed (for those with both learning and mental health diagnoses) was a leading participant in these CHE working groups and made sure that at least one session on toxic chemical exposures was on their annual conference agenda for a few years. Other colleagues in various parts of the US spent time working to heighten awareness of these issues in psychology (and even psychiatry) circles in other ways. But for the most part, there hasn’t been a significant uptick in interest as far as we have been able to discern, and CHE’s Mental Health working group has remained only minimally active.

Then late last year, without much fanfare, this issue was spotlighted on the cover of a major magazine for American psychologists. And so it goes in our work. Ideas gain traction in non-linear ways. Strategic planning and other processes need to be in place. Vocal, dedicated champions make a huge difference in getting ideas out. Money certainly helps. But sometimes it’s an unexpected interaction or an unrelated event that crystallizes an idea and makes it palpable to those who may have never considered it before. Often we’ll never know why one idea springs into mainstream consciousness while others that seem equally significant fall flat. But what we do know is that fostering a highly effective learning community and collaborating in forums that bridge multiple perspectives are essential ingredients for social change.

We very much look forward to learning and collaborating more with you in 2016 – in both anticipated and unexpected ways.

Top 10: 4th Quarter 2015

This is the last of CHE’s public quarterly Top 10 lists. We have selected studies and issues that we feel are significant in the field of environmental health, either because of their impact, their implications or their insight. Topics are listed in no particular order. Comments are welcome, as is always true with our blog posts. Corrected in an update 1/6/2016.

  1. Climate change.
    COP21The Paris Agreement from the 21st Conference of Parties (COP21) in Paris is a potentially historic global agreement governing carbon dioxide reduction measures. The agreement still need to be joined by individual countries, and although the reduction targets are considered binding, there is no deadline for determining the targets or any mechanism of enforcement. Regardless, the agreement is considered “a turning point in the struggle to contain global warming” (New York Times).
    Also on the issue of climate, the American Academy of Pediatrics released a statement, Global Climate Change and Children’s Health, stating that “failure to take prompt, substantive action would be an act of injustice to all children.”
  2. The role of extrinsic factors in the development of cancers.
    Nature published an extensive analysis of the roles of intrinsic (genetic) and extrinsic (environmental) contributors to cancer and concluded “that cancer risk is heavily influenced by extrinsic factors.”
  3. Air pollution scope and effects.
    The level of air pollution was recurring news, including Delhi’s levels that “would qualify as a public health emergency”, Beijing’s red alert, and European Environment Agency’s declaration that air pollution is the single biggest environmental health risk in Europe.  Success stories could also be found, as in “The cities that are cleaning up their act.

    Studies of impacts found a slight increase in violent crime in Chicago and more evidence that air pollution in Mexico City is associated with markers in children that are also linked to Alzheimer’s disease when measured later in life. Also, improvements under the Clean Air Act of 1970 have increased earning potentials: “A higher pollution level in the year of birth is associated with lower labor force participation and lower earnings at age 30.”
  4. Diabetes incidence.
    cdcThe US Centers for Disease Control and Prevention (CDC) published data showing that at last the incidence of diabetes has stopped increasing and may be decreasing. However, diabetes is at least two distinct diseases with different etiologies, and so the picture is not as clear as the CDC report implies. CHE’s comments highlight that there is no evidence that type 1 diabetes incidence is declining, while some reports show increasing type 1 diabetes incidence in US children. Increasing evidence over the last several years shows environmental contributors to both types of diabetes.
  5. Hazards of fracking.
    Concerned Health Professionals of New York and Physicians for Social Responsibility published Compendium of Scientific, Medical, and Media Findings Demonstrating Risks and Harms of Fracking (Unconventional Gas and Oil Extraction) highlighting “health risks ranging from air and water pollution to a newly emerging problem: leakage of methane and toxic gases from natural gas compressors, pipelines and other infrastructure.” The ongoing methane leak in California should draw attention to the warnings outlined in this report.
  6. Marine food chain collapse.
    A study published in the Proceedings of the National Academy of Sciences of the United States of America found that the marine food chain is at risk of collapse due to ocean acidification and warming from anthropogenic carbon dioxide emissions. Fish and seafood provide a significant source of protein for much of the world’s human population, as this report highlights, making this an urgent environmental public health concern.
  7. Preventing type 1 diabetes.
    A study published in JAMA Pediatrics found that early probiotic supplementation may reduce the risk of islet autoimmunity in children at the highest genetic risk of type 1 diabetes. This is the first demonstrated preventive intervention associated with decreased levels of antibodies linked to type 1 diabetes and is consistent with an important role of the intestinal microbiome in shaping the developing immune system. CHE has periodically explored the impact of various environmental factors on the microbiome and will continue to follow this rapidly developing field of interest inasmuch as there may be implications for other immune-related disorders as well.
  8. Antibiotic resistance.
    The BBC published an article stating: “The world is on the cusp of a ‘post-antibiotic era’, scientists have warned after finding bacteria resistant to drugs used when all other treatments have failed.” dWarnings of antibiotic resistance date back more than 50 years, but this report is based on a new finding published in The Lancet describing the breach of the last group of antibiotics, polymyxins, by plasmid-mediated resistance and that the resistance can be transferred to neighboring bacteria. It is likely that resistance emerged after overuse of the antibiotic in farm animals. Antibiotic resistant infections in people are rapidly growing in countries around the world with few new pharmaceuticals in the research and development pipeline. Appropriate use and stewardship of antibiotics is not only the responsibility of healthcare providers but also of those using the largest amounts—farmers and ranchers in animal livestock production.
  9. Water fluoridation.
    CochraneAn extensive review by Cochrane, a highly regarded group recognized as representing an international gold standard for high quality, trusted information, concluded that “There is very little contemporary evidence, meeting the review’s inclusion criteria, that has evaluated the effectiveness of water fluoridation for the prevention of caries.” Most studies that met the criteria for review were conducted before 1975 when widespread use of fluoridated toothpaste was initiated. Many studies were at high risk of bias. The authors concluded that water fluoridation resulted in a 35% reduction in decayed, missing, or filled deciduous (baby) teeth and a statistically insignificant 26% reduction in decayed, missing, or filled permanent teeth. The risk of dental fluorosis resulting from fluoride exposure in drinking water at guideline levels varied from 12-40%. This review documents the limited evidence supporting the ongoing practice of fluoridating community drinking water supplies while concerns about safety of the practice continue to grow. An article from The Guardian provides additional commentary on the review.
  10. Lead poisoning.
    We’ve known for millennia that lead is harmful, and yet children are still being exposed in large numbers around the world. Preventable exposures have been highlighted in recent news in Baltimore following Freddie Gray’s life and death and in Flint, Michigan, where the mayor declared a state of emergency December 15th.

We Asked. You Responded. You Can Still Respond: Surveys of CHE’s Working Groups.

During the last quarter of 2015 CHE surveyed our listserv participants about the value of each listserv in their personal and professional lives, also asking for suggestions for improving each listserv. We were pleased to receive many positive comments about the value of CHE listservs, and we were grateful as well for the feedback about how we might improve this core CHE service. Following CHE’s core values of civility and transparency, we share the survey results as of mid December in a spreadsheet. We did not edit typographical errors, but we did remove names of respondents and people identified in comments (other than a few references to group coordinators). Where appropriate, CHE staff have added a few preliminary responses to comments.

In the coming weeks and months we will be evaluating the feedback we received. As we decide on changes or refinements to the listservs we will be communicating with our partners. Additionally, we invite further comments on this post and survey results.

We thank all those CHE Partners who completed the surveys (some of you who are subscribed to several listservs even completed several of them—thank you!). We value your feedback.

In gratitude for your continued collaboration with CHE, and all your efforts to make this world a healthier place for all,
The CHE team

See the survey results.

Type 1 Still on the Rise in US Kids

written by Sarah Howard
Coordinator of the Diabetes-Obesity Spectrum Working Group

Sarah HowardYou may have seen the recent articles about the CDC data that found that type 2 diabetes incidence has recently started to decline in the US (e.g., New diabetes cases, at long last, begin to fall in the United States). That New York Times article notes that, “Type 1 diabetes, often diagnosed in childhood and adolescence and not usually associated with excess body weight, was also included in the data.”

Well, there has been a lot of talk about CDC data relating to type 1 diabetes. While it is technically true that type 1 diabetes is “included” in the CDC numbers, the CDC data do not tell us anything about type 1 diabetes. Since type 2 makes up about 90-95% of diabetes cases in the US, and the CDC does not distinguish between type 1 and type 2 diabetes, the CDC data do not tell us if type 1 is increasing or not.

A new Medpage Today article notes that a new study finds that type 1 prevalence increased between 2002-2013 in US children: Type 1 diabetes prevalence on the rise in kids: group complains about reports that lump type 1 together with type 2 (See the study: Prevalence of diabetes and diabetic nephropathy in a large US commercially insured pediatric population, 2002–2013.)

Type 2 in children increased until 2006 and then began to fall. Thus the two types do not show the same pattern in the population, and should not be lumped together.

This study also finds that diabetic nephropathy is also increasing in children, starting at age 12.

Other data, from the SEARCH for Diabetes in Youth study, also continue to find type 1 increasing in US children.

And almost no one is looking at type 1 incidence in US adults.

NHANES also does not distinguish between type 1 and type 2 diabetes, making it difficult for researchers to analyze whether or not chemicals play a role in type 1 diabetes. Type 1 diabetes is an autoimmune disease that often is diagnosed during childhood. Type 2 diabetes is associated with insulin resistance and obesity. We cannot assume that these separate processes have identical or even similar responses to chemical or other environmental exposures.

Type 1 diabetes incidence in children is increasing in at least 61 countries/regions worldwide. To see these studies or more on diabetes incidence/prevalence in the US and around the world, see Diabetes Incidence and Historical Trends

Thin Places: Providing Space to Explore the Complexity of Health and the Environment

written by Elise Miller, EdM

Thin Places, a book written by Ann Armbrecht, an anthropologist friend who completed her doctoral research in northeastern Nepal in the 1990s, explores what it means for people to live close to the land–and how that, in turn, fosters greater intimacy with every other relationship in our lives and shapes our sense of home. In the tribal region Armbrecht studied, the people seemed to live with a stronger sense of connection to the natural world and to community. The conceptual walls often imposed by Western cultures between humans and the environment seemed thinner for those in this region–more permeable and multi-faceted.

Whether we choose to recognize it or not,  the fact is we all live in thin places. Forward thinking segments of industrialized world now acknowledge that the boundaries and distinctions we have defined over centuries, whether between academic departments or cultural norms or forms of healing, are not so neatly segregated. Instead, what contributes to our health and well-being is far more complex and nuanced than we ever imagined. This of course raises more questions than answers. We can no longer retreat into our polarized perspectives. With emerging information and insights, we are instead forced to question our assumptions again and again.

Yet there are few forums where open discussion on these complex issues and concerns can take place. This is why CHE is valued by so many around the world. CHE insists on civil, constructive, non-polarizing conversations on our highly regarded teleconferences and our multiple listservs. The vast majority of responses to our recent surveys indicate that CHE’s services would be sorely missed if they were no longer available. Many indicated that CHE is deeply important to them–it enriches their professional and personal lives in ways that no other organization in the environmental health sector does.

In other words, CHE is a place where you can talk about thin places. The places that are not so clearly defined, but essential to ponder regularly with colleagues if we are to have a healthier future.

Your support now will ensure that these critical conversations continue to take place so that we can collectively implement the most effective, well-informed, and prevention-oriented strategies possible. We recognize there are many organizations worthy and deserving of your support, but given what CHE uniquely provides in the environmental health field, please make a tax-deductible gift to CHE today.

Warmest wishes for the holidays and deep gratitude for your partnership in this effort,