慢性病的环境因素分析.ppt

EnvironmentalDriversofChronicDiseaseBasedonthereportEnvironmentalThreatstoHealthyAgingbyJillSteinMD,TedSchettlerMD,MPH,MariaValentiandBenRohrer2019,GreaterBostonPhysiciansforSocialResponsibility(/Boston)andTheScienceandEnvironmentalHealthNetwork(),WhatWeWillCover,EnvironmentalfactorsarekeydriversofmanycommonchronicdiseasesEnvironmentalfactorsalterkeybiologicalpathwaysleadingtochronicdiseaseImportantenvironmentaldeterminantsofhealthinclude:Foodsystem/nutritionanddietToxicchemicalsBuiltenvironment/physicalactivityPsychologicalairandwaterpollution.Industrializedfoodsupply.Destructionofcriticalnaturalhabitats,stressingecosystems.Climatechange.Howwelive,eat,work,playandsocializehavesubstantiallychanged:Builtenvironmentshaveincreasedsocialisolationformanypeople;reducedphysicalactivity.Growingincomegapincreasesdiseaserisk.Diseasesofcivilization-obesity,diabetes,cardiovasculardisease,hypertension.,EnvironmentDrivesChronicDisease,WesternDiseaseClusterDiabetesObesityAbnormalLipidsMetabolicSyndromeCardiovascularDisease,Foodsystem/DietFossilFuelsSocioeconomicStressChemicalsBuiltEnvironment/Transportation,InflammationDisruptedInsulinSignalingOxidativeStress,Alzheimers,Parkinsons,AlteredPathways,EnvironmentalFactors,ChronicDisease,ProfoundPublicHealthImpactOfEnvironmentally-DrivenWesternDiseaseCluster,Obesity/overweight2/3USadults,/chronicdisease/resources/publications/AAG/obesity.htmPre/Diabetes40%USadults,prevalenceDMx2over20yrsCowie09,/DDTSTRS/default.aspxCardiovasculardiseasestillleadingcauseofdeath.H/nchs/FASTATS/lcod.htm,Hajjar03Metabolicsyndrome=earlysignsofotherclusterdiseases;35%adults,55%60yrsFordES05Alzheimersdisease84yrsold,5.3MAlzheimersAssoc.,AlzheimersDisease/dementia,Notaninevitablefeatureofnormalaging.Progressiveimpairmentofmemoryandmultipleothercognitivefunctions,severeenoughtointerferewithdailyfunctioning.Expectedtotriplebymid-centurytoover13million.Likelycausedbyvaryingcombinationsofgeneticandenvironmentalfactors.AnnualcostsinUSover$150billion.,ParkinsonsDisease,Progressivemovementdisorderthatincludestremors,stiffness,andslowmovement.Mayleadtoseveredisability.Likelycausedbyvariablecombinationsofgeneticandenvironmentalfactors.About50,000newcasesannuallyinUS.*PrevalenceinUSexpectedtodoubleby2030.*,*DuetothelackofregistriesandbaselinedataonParkinsonsDisease,thefiguresusedhereareestimates.,AlzheimersandParkinsonsDiseases,Characterizedby:abnormalproteindepositschronicinflammationabnormaloxidativestressManyneuroscientistsarebeginningtothinkofsomeneurodegenerativediseasesalongacontinuum,withoutclearlydistinctboundariesinclinicalorpathologicalmanifestations,ContinuumofAge-AssociatedCognitiveImpairment,EnvironmentDrivesChronicDisease,Earlylifeexperiencescaninfluencelater-lifehealthanddisease.Multiplefactorsinteracttoinfluencehealth115-126.,InsulinSignaling=NormalMetabolism,DisruptedInsulinSignaling=InflammatoryMetabolism,AlteredPathways,EnvironmentDrivesChronicDisease,EnvironmentalFactors,ChronicDisease,FoodSystem/Diet,NovelNutrientsArePervasive,PromoteInflammatoryMetabolism,Whats“Novel”intheWesternDiet?,“Hypotheticalschemeoffat,fattyacid(6,3,transandtotal)intake(aspercentageofcaloriesfromfat)andintakeofvitaminsEandC(mg/d).Datawereextrapolatedfromcross-sectionalanalysesofcontemporaryhunter-gathererpopulationsandfromlongitudinalobservationsandtheirputativechangesduringthepreceding100years75.”FromAPSimopoulos,Theimportanceoftheratioofomega-6/omega-3essentialfattyacids.BiomedicineSept.19,2019,SustainableFood&TransportationSolutions:TheCubaExample,GreenSpaceReducesStress,Mortality,ImprovesCognitiveFunction,Shortenspostsurgicalrecoverytime,reducesneedforpainmedications.Ulrich84Attentiondeficitsimproveafterawalkinthepark.Effect=methylphenidate.Taylor08Accesstogreenspacereducestheeffectofpovertyonmortalityby50%.Mitchell08,EnvironmentalFactorsDisruptInsulinSignaling,DriveInflammatoryMetabolism,Obesity,EndocrineDisruptors-BPA,dioxins,PCBs,somepesticides,Inactivity,Saturatedfat,HighGlycemicCarbohydrates,AirPollution,Antioxidants,Lead,otherheavymetals,SomePesticides,AlteredPathways,EnvironmentDrivesChronicDisease,EnvironmentalFactors,ChronicDisease,Socio-EconomicStress,Depression,poverty,violence,inadequatehealthcare,Socioeconomic,PsychosocialStressors,Stress,depressionriskforCVD,ADSesso,Kario,OwnbyPeoplewithlowerSEstatusareatriskforexposuretomultipleenvironmentalhazardsdamage.Lead+stresscognitiveimpairmentGlass2009Lead+airpollutionCVautonomicdysfunctionPark2019,Peoplewholiveinneighborhoodsthatlacksocialcohesion,sidewalks,orsafetylimittheirexerciseandhaveanincreasedriskofdepressionandpossiblyobesity.BerkeEM07,MolnarBE04,EffectsoftheBuiltEnvironmentonHealth,EnvironmentalFactorsDisruptInsulinSignaling,DriveInflammatoryMetabolism,Obesity,EndocrineDisruptors-BPA,dioxins,PCBs,somepesticides,Inactivity,Saturatedfat,HighGlycemicCarbohydrates,AirPollution,Antioxidants,Lead,otherheavymetals,SomePesticides,Stress,MultipleFactorsInteracttoInfluenceHealth&Disease,EnvironmentalFactors,ChronicDisease,AlteredBiologicalPathways,GreenhouseGases,ClimateCrisisHeat,drought,storms,fires,icesheetinstability,sealevelrise,lossofglacialirrigation,refugees,foodinsecurity/starvation,tropicaldiseases,EnvironmentalFactorsDriveChronicDiseaseandtheClimateCrisis,SolutionsforHealthyPeople&AHealthyPlanet,MajorIllnessesArePreventablePersonalActionstoProfoundlyReduceRisks,PersonalLevel“ApproachestoHealthyLiving”,Eathealthywhole,fresh,unprocessed,plantbasedfoodsAvoidtoxicantswheneverpossibleExerciseBesociallyengaged,Localized,diversifiedandsustainablefoodproductionClean,renewableenergyairpollution,chemicalexposuresMasstransitthatconnectswithbikepathsandsidewalkscanreduceairpollutionjobcreationUniversalhealthcarediseaseprevention&equitablehealthcare.,MajorIllnessesArePreventablePolicyInitiativestoProfoundlyReduceRisks,MajorIllnessesArePreventablePolicyInitiativestoProfoundlyReduceRisks,ExamplesofSpecificInitiatives:NutritionReformagriculturalsubsidiestobedirectedtowardprogramsandpracticesthatprovidesufficientnutritious,sustainablyproducedfoodandrestoreecosystemsthathavebeendegradedbyagriculturalactivities.ToxicChemicalsReformthenationalToxicSubstancesControlActtoincludephaseoutofpersistent,bioaccumulative,orhighlytoxicchemicals.Activity/NatureIncorporateindoorandoutdoorgreenspacesandexerciseareasintodesignsofnursinghomesandassistedlivingfacilities,Acknowledgements,BasedontheReportbyGreaterBostonPhysiciansforSocialResponsibility(/boston)andtheScienceandEnvironmentalHeal