Our Undeniable Human Experiment

written by Elise Miller, EdM
Director

Last week was “National Public Health Week,” an initiative of the American Public Health Association (APHA). The organizers posted an infographic highlighting some disturbing statistics about the health of Americans, including how poorly the US does overall relative to other developed countries (and even some developing ones). While this is not new news, the graphics are well-designed and the facts are well worth restating:
HeathiestNation

  • the US ranks 34th in life expectancy
  • inequities, such as less access to nutritious food, healthy communities, good education, etc., are far higher in the US than other high-income countries and have the greatest impact on people of color
  • though nearly 50% of Americans suffer from preventable, chronic disease, only 3% of health care spending is on prevention
  • and so forth….

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From Puzzle to Mystery: More Data Isn’t Enough to Address Public Health Problems

Elise Miller, MEd
Director

Malcolm Gladwell describes the difference between a puzzle and a mystery in one of his essays entitled “Open Secrets” from his recent book What the Dog Saw. He suggests that when you’re trying to work out a puzzle, you simply need to collect more information in order to uncover what is hidden or obscured—and thus solve the puzzle. Figuring out a mystery, however, is more complex. Often more information is not useful, and even counterproductive, because it muddies the waters, according to Gladwell. Instead, what is often needed is a better, smarter analysis of information already available and the ability to take effective action based on that analysis. Gladwell uses examples such as Enron, World War II, Watergate and Al Qaeda to demonstrate how puzzles and mysteries are distinct and therefore need different responses.

I think this distinction is useful to apply to the environmental health field as well. Over the years, many of us (including yours truly) have viewed environmental health related concerns as puzzles to figure out. By this, I mean we have sought more information—more facts, graphs, methodologies, and so forth, believing that if we could just bring more data to light, we would solve the puzzle and improve public health. This method has worked to a certain point. For example, with increasingly sophisticated scientific tools over the last century, what were considered “safe” thresholds of exposures to lead and mercury have dropped and dropped to the point where many researchers think that any exposure to these heavy metals can have some negative impact on neurodevelopment.

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Obesity and Related Health Conditions: A Call for Primary Prevention Strategies

Elise Miller, MEd
Director

This month is the first-ever National Childhood Obesity Awareness Month. The fact we even have to raise awareness on this debilitating condition is a sad reflection on the current health of our society, particularly our children’s. Even sadder yet is the fact that obesity is associated with a number of other diseases on the rise in younger and younger populations, including diabetes and metabolic syndrome. Nonetheless, children are being sent off for the new school year to try to learn, while continuing to eat foods infused with trans-fats, pesticides and agricultural antibiotics, to imbibe drinks from cans lined with BPA plastic (an endocrine disrupting chemical and likely obesogen – see CHE’s letter to First Lady Michelle Obama), and to sit for hours without adequate recess in classrooms known to have poor ventilation and mold. Not a pretty picture, I know. But I have a 5-year-old starting kindergarten at a public school this week, and believe me, all of these issues are very much on my mind. No doubt many of you as well as countless other parents, grandparents, aunts, uncles and anyone who cares about children’s health and society’s future share these concerns.

Fortunately, a number of innovative thinkers and colleagues in different fields are trying to press for systemic ways to reduce the alarming increase in chronic diseases and disabilities and the resulting escalation in health care costs. Below I list a few events being held this month that are intended to highlight primary prevention and some promising public health interventions. Also feel free to check our online calendar for other webinars, conferences and workshops you may find of interest.

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Trying to Take the Long View

Steve Heilig, MPH
CHE Director of Public Health & Education

“Patience is a virtue” is wise counsel in many arenas, including both science and politics. But as 2010 speeds along, much of the American public and media seem consumed by a sense of impatience, if not disappointment, that concerns regarding health care reform, climate change, the economy and other large-scale issues have not moved more quickly towards a positive resolution over this past year. Some of that frustration is of course not only understandable, but appropriate. However, with the scope of problems facing our nation and the world, one year is hardly a fair passage of time to expect fundamental shifts in perspective and direction. Sometimes in our broad field of work a long view is not only justified, but essential.

For a bit of a reality check in CHE’s realm, take a look at the reflections of Dr. Linda Birnbaum, who in the new NIEHS newsletter reflects on her first year as director of that crucial federal agency. CHE partners will soon have the opportunity to hear from, and talk with, Dr. Birnbaum directly.

Beyond NIEHS activity, also peruse this mopnth’s newsletter for a number of new scientific and policy developments of note. Though it is hard to see signs of progress and hope in the seeming torrent of bad news, we applaud the extraordinary contributions that so many colleagues are making to improve public health for the long term. Some of the reports, meetings, activities and working groups listed in this newsletter offer ways to engage in a variety of ways. We hope you will find something of real interest to you and join us in our collective efforts.

Common Sense Steps

Frieda Slavin

Science is rarely certain about anything, and certainly not about most links between environmental exposures and health effects in people. Nonetheless, the evidence showing links to health grows ever stronger as research progresses and becomes ever-more sophisticated:

  • Scientists have generated compelling laboratory evidence revealing adverse effects in animals at low levels of exposure, affecting animal endpoints that are relevant to cancer, birth defects, reproductive effects, immune system dysfunctions, respiratory problems, learning and behavior problems, etc.
  • They have demonstrated that many of the underlying mechanisms causing those effects in animals are similar, if not identical, to human mechanisms.
  • They have documented human exposures to chemicals at levels that produce harm of many types in animals.
  • And they have identified trends in human health and disability that can be predicted on the basis of the above.

But establishing scientific certainty of harm to people is elusive at best and in many cases likely to be impossible before countless people would be affected adversely. After all, epidemiology can only establish harm after an epidemic has occurred. Purposefully carrying out controlled experiments on people is considered, appropriately, unethical. And thus we are left with the plethora of uncontrolled, largely unmonitored experiments currently underway because of ubiquitous exposure.

Given these limitations, and given that our current regulatory system is unlikely to strengthen exposure standards absent much firmer proof, what is a person, or a parent, or a family, to do?

Much good, practical advice is available on the web and in print. Some of the best places to turn for practical advice are listed below. In addition to pointing toward these resources, on this page we will highlight a few old themes (“constants”) and then focus on new issues that are emerging from recent research and analysis.

One general point: As you make choices about products to buy, things to do, food to eat, places to go, bear in mind that government standards for regulating environmental threats to health are at best a bare minimum and at worst completely inadequate and health threatening. So what you choose to do should always at least live up to those standards.

This is because government regulations represent a compromise negotiated between advocates for public health and parties, usually companies or trade associations, with an economic interest in protecting their access to the market. The playing field in which the negotiation takes place is strongly biased in favor of the vested interests, who have succeeded over several decades of lobbying to put in place evidentiary standards for proof of harm that make it very difficult to prevent marketing of new products, or removal of old, even in the face of compelling evidence of plausible harm. Decades of experience reinforce that conclusion.

Constants:

  • Smoking harms adults, children and the developing fetus. It’s not just the irritation of the smoke itself, it’s also compounds added to the tobacco, the paper and the filter that make their way into your lungs and your bloodstream. Rules #1-3: don’t smoke; don’t inflict second-hand smoke on someone else; and don’t allow smokers to share their second-hand smoke with you or your family, especially your young children.
  • The fetus is remarkably sensitive to alcohol. Avoid alcoholic beverages during pregnancy. Otherwise impacts can last a lifetime.
  • Ozone damages developing lungs. While studies have shown for some time that ozone can trigger asthmatic attacks, the latest research even implicates ozone in the actual causation of asthma itself. When ozone levels rise and local governments issue air pollution warnings, pay attention. Some local newspapers carry regular ozone notices. They are worth reading and heeding.
  • Pollutants in some fish can damage the fetus, undermining development of disease resistance and cognitive development. Heed fish advisories posted by public health agencies.
    New York State Dept of Health: Health Advisories on Chemicals in Fish
  • Some plastics leach biologically-active materials into food with which they come into contact, particularly when heated. If you must use plastic, at least don’t microwave food in it.

 


Web and print resources

The Children’s Health Environmental Coalition’s HealtheHouse: an interactive resource for parents to learn about simple and effective steps they can take to protect their baby from environmental harm within the home.

The GreenGuide’s product reports: “a one-stop, reliable and easy-to-use shoppers’ guide so that you can make wiser, more conscientious shopping decisions.” Reports available include “flea control,” “insect repellant” and “household cleaning supplies.”

Raising Healthy Children in A Toxic World, a book by Philip Landrigan, Herbert Needleman and Mary Landrigan.

The Resource Guide on Children’s Environmental Health, by the Children’s Environmental Health Network.

Cleaning for Health: Products and Practices for a Safer Indoor Environment, an excellent and thorough review of cleaning products by Inform, Inc.

The Healthy School Network: ways to reduce exposures at school.

The Healthy Building Network: steps to reduce exposures via better selection of building materials and hospital equipment.

A number of organizations offer solid information about ways to reduce pesticide use. Among them: