“The Paramount Health Challenge for Humans in the 21st Century”

I had the privilege recently of introducing William Balistreri as the keynote speaker for the Georgia AAP Nutrition Symposium.  Dr. Balistreri is a personal hero for me; someone I admire greatly.  Hopefully, if he reads this, he will forgive me for forgetting to mention in my introduction that he also is a Lacrosse coach for one of his grandchildren’s team.

He gave a tour de force presentation on the global challenge of obesity.  In addition, he discussed undernutrition, endobariatrics, gastroenteritis, climate change and even food waste; 40% of U.S. food is thrown away. In Finland, there is a ‘Grocery Store Happy Hour‘ for distribution of reduced cost/free groceries which may help reduce food waste.  In general, I try to condense what I read or hear –that was pretty much impossible with this lecture which was packed with information based on the latest research as well as information dating back to the 5th Century BC/Plato.  What follows are some of my favorite slides.

Here is a link to the full talk: WHAT’S HOT in Pediatric Gastroenterology? Global Nutrition Lecture (10-10-19)

Two Articles received the most attention:

  1. LANCET Commission on Global Syndemic (Obesity, Undernuturition, and Climate Change)
  2. EAT- LANCET Commission on Healthy Diets

What Can Be Done?

Additional References:

A recent book (not discussed in lecture) provides related information. “We Are The Weather” by Jonathan Foer, was reviewed this past weekend in the NY Times: Meat is Murder: “[This book] has a point, and that is to persuade us to eat fewer animal products. Foer makes the case that, for Americans and citizens of other voracious meat-eating countries, this is the most important individual change we can make to reduce our carbon footprints.” However, the reviewer, Mark Bittman, states that “we’re not good at making positive decisions about our future. And we’re really not good at denying ourselves cheap pleasures like cheeseburgers.”  He advocates for stronger laws, government leadership, and pricing the products to account for their true costs in terms of their contributions to climate change, public health, and environmental degradation.

Related blog posts:

 

 

The Health Consequences of Climate Change

A recent review article, “The Imperative for Climate Action to Protect Health,” (A Haines, K Ebi. NEJM 2019; 380: 263-73, and commentary 209-11) explains why many brilliant minds are so concerned about our climate.

What is happening to our climate:

  • “Climate change is already adversely affecting human health…if no additional actions are taken, then over the coming decades, substantial increases in morbidity and mortality are expected.”
  • “August 2018 was the 406th straight month during which global mean temperatures were above the long-term mean.”
  • “Carbon dioxide (the primary greenhouse gas) have risen from approximately 280 ppm in preindustrial times to approximately 410 ppm today. Carbon dioxide remains in the atmosphere for centuries, with about 20% persisting for more than 1000 years.”
  • “The global mean temperature is currently increasing at a rate of 0.2 degrees C per decade owing to past and continuing emissions.”

Health Consequenes:

  • Major climate events including heat waves, floods, rising sea levels, droughts and storms with their immediate and long-term effects of health: heat-related illnesses, fatalities, injuries, and mental health effects
  • Worsened air quality: asthma and COPD exaccerbations, worsened cardiovascular outcomes
  • Water-borne illnesses due to effects on water quality: cholera, campylobacter infection, algae blooms, cryptosporidium, leptospirosis are some examples
  • Disruption of food supply and safety –heat can interfere with soil moisture and crop yield: malnutrition
  • Proliferation of vector-related illnesses: zika virus, dengue, lyme disease, malaria to name a few
  • Social: flooding and heat are likely to lead to social upheaval, mass migration, and violent conflicts

Even if all of the goals of the Paris Agreement were honored by all of the signatories, “it would not be sufficient to limit warming to 2 degree C above preindustrial levels…[it] would be expected to result in a temperature increase of approximately 3.2 degree C by the year 2100, relative to the preindustrial period.”

The authors cite estimates that mitigating adverse climate effects could prevent more than 175,000 premature deaths and 22,000 fewer deaths annually by 2030.

The associated commentary link the recent destructive California wildfires to climate change.  They note that “tackling this challenge may feel overwhelming.” Working on this can include both individual lifestyle actions and institutional efforts.

Individual actions:

  • Walking/cycling more
  • Eating less meat
  • Reducing food waste
  • Conserving energy

Institutional actions:

  • Health care system accounts for 1/10th of greenhouse gas emissions and health systems need to work on cutting their emissions
  • Health care institutions can invest/divest in industries who are helping and harming efforts to limit fossil fuel consumption

Resources:

From review article by Haines and Ebi:  “Health professionals have leading roles to play in addressing climate change. They can support health systems in developing effective adaptation to reduce the health risks of climate change, promote healthy behaviors and policies with low environmental impact.”

My take: Interestingly, the issue of delay in addressing problems is discussed in an unrelated commentary (NEJM 2019; 380: 118-9) related to denial.  For the author, she was attempting to deny the possibility that her father had ALS.  At the end, she quotes Elisabeth Kubler-Ross: “Denial helps us to pace our feelings of grief. There is a grace in denial.  It is nature’s way of letting in only as much as we can handle.”  Clearly, much of the world remains in denial of the necessitiy to address climate change.

Related blog post:

Badwater Basin, Death Valley -salt-covered dried up basin

Science in a Hyperpartisan Age

Two recent commentaries (L Rosenbaum. NEJM 2017; 376: 1607–09; DJ Hunter et al. NEJM 2017; 376: 1605–7) discuss the intersection of science and politics.

Some key points from the first commentary:

  • “When doubt is wrapped up in one’s cultural identity or powerful emotions, facts often not only fail to persuade, but may further entrench skepticism.”  This is referred to as “biased assimilation.”
  • People with “higher levels of science comprehension are actually also the most adept at dismissing evidence that challenges their beliefs.”  Liberals, “for instance, are far more likely than conservatives to dismiss science suggesting that genetically modified foods are safe.”
  • “It’s easy to forget that most scientific facts, and related policies, don’t induce tribalism. You don’t see partisan battles over treatment for myocardial infarction.”
  • Dan Kahan, an expert on the way emotion and identity affect our interpretation of scientific facts says that our president “is our science communication environment polluter in chief.”  Such polluters “cunningly incite cultural battles that ultimately heighten distrust of science.”
  • For vaccine skeptics, if criticized, will try to elicit a backlash against the “academic elite.”

The second commentary focuses on the issue of climate change.  Key points:

  • “Average temperatures have increased by 1.3 to 1.9 degrees F over the past century…and increases have accelerated in recent years…the three hottest years recorded in the U.S. were 2012, 2015, and 2016.”
  • Summer heat waves increase mortality, worsen mosquito-related diseases, jeopardize crop production, increase ozone which worsens lung function, and contribute to forest fires.  Increases in “extreme heat leads to more aggression and violence.”
  • Climate change increases severe storms like hurricanes and cause indirect effects like waterborne-disease outbreaks.
  • The authors advocate for the CDC’s Building Resilience against Climate Effects (BRACE) (https://cdc.gov/climateandhealth/)
  • “U.S. leadership is critical to global action. Jobs in the renewable energy sector…already outnumber those in power generation from coal, natural gas, and oil combined.”
  • “Climate change has become unnecessarily politicized.” Tools for discussing this topic: http://climateforhealth.org/lets-talk -1 hour webinar available and links to specific ways to make an impact.

My take:  While I concede that I am not an expert on this topic, it is clear that climate change is having effects on population health and there are ways to reduce the future impact. Please don’t call me an elitist.