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

written by Elise Miller, EdM
Director 

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,

Elise

CHE Partner Forum: Call for Ideas and Comments

Dear CHE Partners,

We want your ideas! We’re in the process of evaluating various aspects of CHE’s services and initiatives and generating potential new ones. Given we are indeed a collaborative partnership, your innovative suggestions as to what CHE might do (within our mission, below) to address gaps or needs you see in the environmental health field would be genuinely welcome.

To facilitate this, we’re opening this Partner Idea Forum, a platform where you can offer your ideas. This one is interactive in that you can see, respond to and build on other partners’ suggestions.

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The Faraway Nearby

written by Elise Miller, EdM
Director

Rebecca Solnit, in her book The Faraway Nearby, evokes Georgia O’Keeffe’s closing line in letters she sent to friends after she moved from New York to New Mexico—as well as her painting by the same title. In Solnit’s volume, gaining greater intimacy with one’s own inner topography is generated by traveling huge distances geographically, philosophically, and historically through her lyrical prose. In O’Keeffe’s painting, the stark articulation of an imagined and distant realm brings us closer in touch with our own mortality, embedded in each breath we take.

And in the kaleidoscope of our every day lives, we are absorbed one moment by the horrors that immigrants are experiencing as they flee persecution and violence in their homelands, and in the next, by the heart-wrenching sobs of our own child slighted by her best friend.

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A Story of Health: Something for Everyone

written by Elise Miller, MEd
Director 

We all know there are multiple contributors to health and disease, but let’s say you want to figure out what the latest science says on environmental links to, say, asthma? Or learning disabilities? Or childhood leukemia? Pretty daunting, isn’t it? Which websites have the most evidence-based science? Which articles are accessible without paying a subscription or membership fee? What do those research findings mean for your patients, your family, and community? And many other pressing questions. Most health care professionals can’t begin to keep up with the emerging scientific literature, much less the rest of us.

cover of A Story of HealthFortunately, A Story of Health is a brilliant, innovative new resource that can help you find out how various environments interact with our genes to influence health across the lifespan. Based on the latest peer-reviewed research, it’s more than a bunch of scientific facts thrown together with fancy graphics. It’s a story, or really—multiple, interactive, and interconnected stories that touch us and teach us not only about risk factors for disease, but how to prevent disease and promote health and resilience.

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Thank You for Supporting CHE

Dear CHE Colleagues,

“A good start lasts a lifetime.” That’s what Linda Birnbaum’s mother told her when Birnbaum was growing up. Now Dr. Linda Birnbaum is Director of the National Institute of Environmental Health Sciences and works tirelessly to ensure we all get a good start in life by reducing exposures to toxic chemicals during the prenatal period and on through adolescence—in fact, across the entire lifespan.

And that’s what CHE does too. Prevention is at the heart of our work. We know that there are many contributors to a healthy start in life—socioeconomic, psychosocial, gene-environment interactions, nutrition, and so forth. But what is most often left out of the priority list of many excellent programs designed to protect children’s health are chemical contaminants. This means we’re not giving the next generation the greatest possible chance at reaching their fullest potential. By integrating this critical piece, CHE is creating a ‘win-win’ for children, families, and communities.

Over this past year, the audio-recordings of our exceptional conference calls on the emerging environmental health science have been downloaded 90,000 times, reaching people concerned with these issues around the world. Our Toxicant and Disease Database continues to be utilized and lauded by those in the federal government as well as researchers, health professionals, and laypeople alike. Our resources on environmental contributors to diabetes/obesity, infertility, cancer, and learning disabilities are consistently accessed on our website. Our publications, such as the “CHE issue” of San Francisco Medicine, the journal of the San Francisco Medical Society, offer useful analyses on cutting edge research and its implications for clinical practice and policy.
With your generous donation, we will continue to educate and motivate tens of thousands of scientists, health professionals, health affected groups and concerned citizens across the globe who want to improve public health in their respective countries and local communities. With your generous donation, we will continue our efforts to ensure that all children get the best start possible so that they can enjoy healthy, long and productive lives and see their children, grandchildren and even great grandchildren grow and thrive.

With gratitude and warmest wishes for the holidays,

Elise Miller, MEd
Director

P.S. Remember: Donating to CHE is an investment in your children’s and grandchildren’s health—and future.

A Beacon of Light Is Only as Strong as Its Source

written by Elise Miller, MEd
CHE Director

We can no longer relegate social and environmental determinants of health to the sidelines, while deeply investing in pharmaceuticals and gene therapies. Instead, we must work to minimize exposures—from toxic chemicals to psychosocial stress—starting in the womb. By providing this expanded frame for addressing chronic disease and disability, CHE is helping us reimagine and ignite new ways to improve population health for generations to come.

– Philip R. Lee, MD
Former United States Assistant Secretary of Health
Chancellor Emeritus, University of California, San Francisco
Professor Emeritus, Stanford University

As 2013 comes to a close, Dr. Phil Lee, CHE’s founding chair, continues to inspire us. Given his renowned leadership and expertise in public health over the decades, he remains a beacon of light as stormy economic and political forces often obscure scientific evidence and common sense, further undermining our capacity to protect our most vulnerable populations from environmental health insults.

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Interview with Dr. Jeanne Conry

interview by Karin Gunther Russ
Coordinator of CHE’s Fertility and Reproductive Health Working Group

Dr. Jeanne Conry of American Congress of Obstetricians and Gynecologists
Roseville, California

Congratulations on receiving the Pacific Southwest EPA’s award for Children’s Environmental Health! What first brought you into environmental health work?

I had been working on preconception health care since 1998 when the American College of Obstetricians and Gynecologists, District IX (California) collaborated with the March of Dimes efforts to create guidelines on preconception health to meet Healthy People 2000 goals. The same group of professionals got together as a preconception health council in mid 2000. Reducing preconceptional exposure to chemicals was not part of the plan at the time.

Dr. Hani Atrash from the CDC was at the preconception health council, and connected me with Dr. Tracey Woodruff at the UCSF Program on Reproductive Health and the Environment (PRHE). Tracey came to the group and started doing her talks, and I knew we had to address environmental exposures and reproductive health.

What is your primary mission in your work?

Currently, physicians are not used to incorporating the results of environmental health studies into their clinical practice. More and more research is showing that chemicals and other environmental factors are negatively impacting fertility, pregnancy and fetal development. Clinicians need to be able to access that information, but in a practical way.

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Spotlight on Fertility and Reproductive Health Work at CHE

Karin Russ, MS, RN, CHE’s Fertility and  Reproductive Health Working Group Coordinator

Years ago,  I  was a nurse caring for a patient who had just had her sixth miscarriage. She was, as one might expect, emotionally  devastated and searching for answers as to why this might have  happened. At the time, some potential physiological causes  were examined, but environmental factors were not  considered.

As CHE celebrates its 10th  anniversary, significant progress has been made toward  educating professionals and the public on environmental  contributors to infertility, early pregnancy loss, and impacts on the developing fetus. Since CHE’s early years, the Fertility and Reproductive Health Working Group  has sought to bring  attention to the growing body of research linking environmental factors to problems with reproductive health. In  the male, many environmental agents are associated with decreased sperm quality and increased risk of prostate cancer.  Women are more susceptible to endometriosis, polycystic ovary  disease, and problems with in vitro fertilization following exposure to some environmental chemicals. A substantial body  of scientific literature demonstrates the crucial nature of  fetal environmental exposures on developmental origins of  adult health and disease.

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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