Exploring and Building Models

In recognition of CHE’s 10th anniversary, colleagues who have been particularly instrumental to shaping CHE this past decade will be invited to write an introduction. This month’s introduction is by Ted Schettler, MD, MPH, CHE Science Director, Science Director of the Science and Environmental Health Network, and Coordinator of CHE’s Science Working Group.

Beginning a decade ago, CHE formed working groups with interests in specific aspects of environmental health science. Most were organized around health outcomes, since individuals and organizations frequently focus on a specific disease or disorder, often for very personal reasons, and it seemed logical to build on that structure.

Periodically, however, we come up against the limits of our taxonomies. For example, naming the diabetes-obesity spectrum working group was challenging from the beginning-it was once known as the metabolic syndrome working group—because of the common co-occurrence of insulin resistance, type 2 diabetes, obesity, cardiovascular disease, and lipid abnormalities, not only in individuals but also in populations. Moreover, midlife diabetes and obesity are themselves risk factors for cognitive decline, dementia, and certain kinds of cancer. But, since these conditions are so commonly mixed together, what is the disease? Does our routine use of the International Classification of Diseases coding system hinder our ability to see patterns and identify common environmental threads that create the conditions giving rise to the diseases of our time?

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