Getting the Questions Right

Elise Miller, MEd
Director

With epigenetics on the cover of Time magazine this week, public awareness of the links between our genes, our environment and our health has never been so widespread. Throughout history, breakthroughs in understanding have been largely shaped and guided by the questions we choose to ask. After World War II, the questions most researchers as well as policymakers in the U.S. were asking focused on how to build infrastructures to catalyze the growth of large-scale industrial processes and products – from pesticides to plastics to pharmaceuticals. The underlying assumption was that we could improve on nature without necessarily understanding or abiding by the natural principles that have allowed life to be nourished and sustained for the previous tens of thousands of years.

In just the last generation, however, new and pressing questions have begun to emerge. For example, why – with the vast availability of food products, abundance of sophisticated technologies, and myriad advances in medicine – are more and more people facing chronic diseases and other health problems in the U.S. as well as experiencing a lower quality of life? Why – if being successful means driving bigger cars and having bigger houses – would we be seeing glaciers melting at unprecedented rates and millions of new climate refugees?

Clearly, we can no longer delude ourselves that ‘improving on nature’ is predicated on disregarding it – and instead, ask how can we work within the systems and imitate the processes that have made this planet life-sustaining to date?

Fortunately, there are more and more researchers and others who are asking just that, and perhaps none more energetically than those in the increasingly robust field of green chemistry. Just a couple weeks ago, Paul Anastas, PhD, who is considered by some ‘the father of green chemistry’, was finally appointed Assistant Administrator of the Office of Research and Development at the EPA. For some years now, he and other colleagues – including many of you – have suggested that a number of the major problems we see today, such as the adverse health consequences of toxic exposures and climate change, are in large part due to not asking the right questions in the first place (or perhaps, as some would argue, there were simply too few people in power asking those essential questions). By contrast, those in green chemistry are urging us to ask a set of principled questions before creating new products and technologies, so that, ultimately, the trajectory of our choices can be as biologically and ecologically benign as possible. 

This month CHE is hosting or co-sponsoring three national/international calls that are intended to help us ask better questions so that our pursuits can be more in keeping with the natural systems in which we have evolved and in which future generations will live. The first is a CHE Café Call with Elizabeth Grossman, author of the recently published book Chasing Molecules, which describes how green chemistry has the potential to not only lead to safer products and materials, but reduce the health impacts of climate change. The next is a CHE Partner call on the potential health impacts of chemicals that can disrupt thyroid dysfunction and how chemical policy reform can help address these concerns. And the third call will be co-sponsored with SeaTrust and IGI and feature two colleagues working at the intersection of climate change and health and attended the recent Copenhagen climate change talks. For more information on these calls and how to register, please view the left-hand column on CHE’s home webpage.

I truly look forward to collaborating with you in the New Year in order to hone our capacity to get the questions right as we work towards a healthier tomorrow.

Changing the Landscape

Elise Miller, MEd
Director

The American Medical Association (AMA) took an unprecedented action yesterday: It unanimously passed a resolution calling for new policies to decrease public exposure to endocrine disrupting chemicals (EDCs) [read more] based on the Endocrine Society’s seminal scientific statement on EDCs published last summer [read the statement]. Both The Endocrine Society Statement and the AMA’s resolution mark an historical turning point for mainstream medical associations. For the first time, tens of thousands of prestigious health professionals are saying in no uncertain terms:

Exposures to many industrial chemicals are contributing to the epidemic of chronic diseases and disabilities, including diabetes, obesity, learning and developmental disorders, infertility and other reproductive health problems. 
  • We have enough science to undertake proactive health measures.
  • The risk to public health is too great to wait any longer. 
  • We need to act now to implement health protective policies and regulations.

Many CHE partners were involved in catalyzing this remarkable action. We now would like to encourage other health-related professional societies to adopt similar resolutons to signal to national leaders and policymakers that fundamental chemical policy reform can no longer be side-lined. In fact, chemical policy reform is not only integral to health care reform, as I suggested in last month’s CHE e-newsletter, but to climate change as well. EPA Administrator Jackson made this point on Monday in her remarks at the American Public Health Association conference. She announced greenhouse gas emission standards for automobiles, a first for the EPA, saying the limits would mean “less harmful pollution that sends people to the hospital with asthma, heart disease, and any number of other conditions.”

In this context, what if we prioritized these same health-focused principles in climate change decisions across the board? That is, in essence, what CHE organizational partners, the Health and Environmental Alliance (HEAL) and Health Care Without Harm (HCWH), are calling for in a new campaign entitled “Prescription for a Healthy Planet.” To date, protecting public health has been essentially left out of the conversation in international talks on climate change. At the upcoming Copenhagen summit in December, however, we have an opportunity to ensure that children’s health and that of other vulnerable populations are prioritized. As stated in the “Prescription”, “a fair and binding international agreement in Copenhagen means: less global warming, less illness, lower healthcare costs, better health for the world population and a healthier planet.” This sounds promising. But right now very little research and discussion has focused on climate change and health.

What we do know is that children will be the most impacted by climate change. Nine percent of American children already suffer from asthma and those attacks will become more numerous and severe with increased air pollution and ozone levels – and of course, the number of children affected in developing countries, where there may be even less regulation on pollutants, will likely be far higher. In addition, we will be faced with increased exposures to industrial chemicals as recently outlined by the World Health Organization. For example, with more extreme storms and floods, there will be greater runoff of chemicals used in urban and agricultural areas into surface and ground waters. With increased drought, non-volatile chemicals and toxic metals will concentrate and rapidly enter groundwater supplies through parched soil when rain finally comes. In addition, global warming will release chemicals currently trapped in glacial ice, and changing weather patterns will move persistent chemicals through water and air streams in ways previously unanticipated. And this doesn’t even begin to describe other concerns about increased infectious diseases and the challenges of whole populations migrating elsewhere because of rising sea water and less fertile land.

All of this is to say that the AMA and myriad other health professional societies in the US and abroad are essential to figuring out solutions to this thorny nexus of pressing public health issues, namely: chemical policy reform, health care reform and the impact of climate change on human health. Through ongoing efforts to translate the best available science for lay audiences and to incubate strategic health-focused initiatives, I have no doubt CHE partners can continue to change the landscape in which these major decisions – decisions affecting all of us and future generations – are made.

CHE’s Letter to President-Elect Obama

Dear President-Elect Obama:

We write as Partners in the Collaborative on Health and the Environment, a national and international partnership dedicated to protecting the health of our families and communities. Our 3000 Partners include patient group representatives, health professionals, scientists, government officials, environmental health advocates, and citizens from over 48 states and 45 countries.

We provide a respected nonpartisan forum where informed, thoughtful, civil dialogue on health and the environment takes place. We share your dedication to civility and to listening to each other. By our founding mandate, we are prohibited from speaking for all CHE Partners. But we are permitted to convey the shared understanding that has emerged for many of us from six years of intensive dialogue on the implications of the revolution in environmental health sciences for safeguarding human health.

Mr. President, there has been a revolution in environmental health sciences over the past decade. New technologies, new scientific research, and new paradigms of human health and disease have revolutionized our understanding of human health. Indisputably, we face an epidemic of chronic diseases and disorders. Cancer, heart disease, diabetes, metabolic syndrome, obesity, asthma, allergies, learning and developmental disabilities, infertility, neurodegenerative diseases, autoimmune diseases, and many other serious diseases and disorders are epidemic in our time.

There are three core insights from the revolution in environmental health sciences. First, most of these diseases are multifactorial in origin. Second, many begin during fetal and early childhood development. And third, most include among their causes exposures to chemical contaminants, particularly those that persist and bioaccumulate. These contaminants interact with genetic inheritance, gene expression, nutrition, stress, socioeconomic status, and much, much more. We call this the complexity model, or ecological model, of human health. You can call it a multifactorial model just as well. Whatever we call it, few scientists disagree with its main outlines.

The implications of these three core insights from the environmental health science revolution are profound. They bear directly on your administration’s plans for health care reform.

Mr. President, you know our health care system is broken. You want to fix it. You have spoken eloquently of the need to prevent disease. The question we face is HOW to prevent the diseases that are bankrupting our health care system and imposing enormous costs on our economy — to say nothing of their cost in human suffering.

Mr. President, the simple truth is that REAL health promotion and disease prevention requires a national commitment to making our inner and outer environments less toxic and stressful — and richer in nutrients and resilience factors. That is what the multifactorial or ecological model of human health ineluctably implies. What this means is that most of the major policy issues you face — the economy, climate change, health care reform, school reform, food and agriculture and much more — are ultimately your real health promotion and disease prevention policies.

You know that the global financial crisis is unquestionably the single greatest immediate stressor on human health. But to what degree do you recognize how important it is that your policies reduce income disparities, which are the single strongest predictor of disparities in health outcomes? If you want to reduce health care costs, the single most powerful lever to do that is to reduce income disparities and enhance buffers against the stresses of income disparities. The MacArthur Network on Socioeconomic Status and Health is a respected source on this point.

Likewise, you know that climate change is a potentially overwhelming stressor on human health. So your green energy program is not only an economic, national security and environmental priority, as you have said. It is also one of your most important health programs. But to what degree do you recognize that green energy must be accompanied by a commitment to green chemistry and green materials?

Mr. President, it is vital to understand that your chemical management policy will have a profound impact on our health. This is the area in which CHE Partners have the greatest expertise. Chemical contaminants are major contributors to many of the chronic disease epidemics we face. Green energy is necessary but not sufficient to sustaining our health. Green energy, green chemistry, and green materials are all vital components of a health policy that recognizes the implications of the environmental health science revolution and the ecological or multifactorial model of human health.

Beyond green energy, green chemistry and green materials, many of us also share a view that your administration needs to be aware of the health threats of new and emerging technologies. There is increasing concern about the health effects of disrupted electromagnetic fields, biotechnologies and nanotechnologies. Again and again, we have failed to test new technologies for health and safety adequately before loosing them on our citizens and the world.

We cannot expect you to address all of these questions at once, Mr. President. So let us leave you with this summary. Universal health care will fail — it will be far too expensive to sustain — if it is not accompanied by a commitment to real health promotion and disease prevention. The green economy you are committed to creating can only be truly green if it includes green energy, green chemistry, and green materials. That is the path to a just and sustainable country and a just and sustainable world.

Thank you for listening, Mr. President. We wish you well,

Michael Lerner, PhD
Founding CHE Partner

Steve Heilig, MPH
Director of Public Health and Education, San Francisco Medical Society

Génon K. Jensen, MA
Executive Director, Health & Environment Alliance

Philip R. Lee, MD
Chairman, CHE
Professor and Chancellor Emeritus, University of California, San Francisco
Professor of Medicine Emeritus, Stanford University
Former United States Assistant Secretary of Health and Human Services

Elise Miller, MEd
Executive Director, Institute for Children’s Environmental Health

Ted Schettler, MD, MPH
Science Director, Science and Environmental Health Network

Lisette van Vliet, PhD
Toxics Policy Advisor, Health & Environment Alliance