Keynote Address: The Environment and Our Health

During the Keynote Address at the 2018 AAAAI Annual Meeting, Linda Birnbaum, PhD, DABT, ATS, of the National Institute of Environmental Health Sciences (NIEHS; part of the National Institutes of Health [NIH]), discussed the interactions between the environment and health. She was the recipient of the AAAAI Foundation and Dr. William and Judith H. Busse Lectureship: Investing Together in Our Future award.

NIEHS is one of 27 research institutes comprising the NIH and is headquartered in North Carolina. The organization’s mission is to discover how the environment affects people in order to promote healthier lives. Dr. Birnbaum noted that NIEHS, unlike other NIH agencies, has a focus on prevention, rather than treatment and cures.

The environment is more than just the biosphere; other chemical-based components interact with the environment, including prescription drugs, cosmetics, food, electronics, agriculture, and more.

The exposome can be defined as the measure of all the exposures of an individual in a lifetime and how those exposures relate to health. New tools are necessary to monitor exposure, she said, noting that we can use biomonitoring or untargeted metabolomics to begin with a “top-down” approach. “It’s time to deal with complex mixtures,” said Dr. Birnbaum.

With climate change, there has been a rapid increase in diseases, including asthma. A 2016 report from the World Health Organization said 23% of all global deaths are linked to the environment, representing about 12.6 million deaths per year; 8.2 million deaths caused by the environment are due to non-communicable diseases, and most are attributed to air pollution. It is believed that climate change contributes to more than 100 disease and injury types, and children and older adults are at the highest risk.

The impact of climate change leads to air pollution, severe weather, extreme heat, environmental degradation, decreased water and food supply, decreased water quality, increasing allergies, and changes in vector diseases.

A 2017 Lancet Commission by Landrigan et at reported 9 million pollution-related deaths worldwide, with the greatest burden of pollution-related deaths (92%) in low- and middle-income countries. Welfare losses due to pollution is estimated at $4.6 trillion per year, or 6.2% of the global domestic product (GDP). However, a follow-up paper by Grandjean and Bellanger published in Environmental Health in 2017 said these numbers were conservative, estimating that chemical exposures cost >10% of the global GDP.

“Global is local—pollution doesn’t stay where it starts,” said Dr. Birnbaum, noting that air pollution in China can reach the western United States in about four days.

While there is a greater understanding of outdoor exposures (e.g., agriculture, vehicle, industrial, and ozone), indoor exposures (e.g., combustion, biologic, vapors) are just as important. “What goes on outdoor comes in,” and vice versa, she said. There’s a newer understanding that a lot of household products—such as cleaners, pesticides, and personal care products—are now major contributors to indoor and outdoor pollution. Most people spend 90% of time indoors, and many indoor pollutants are unregulated.

There is the emerging issue of serious weather events, as we have observed an uptick in wildfires and severe storms. “We recognize that if we’re going to better deal with climate change and disaster events, we need to be prepared,” she said. The Rapid Acquisition of Pre- and Post-Incident Disaster Data (RAPIDD) study is a protocol intended to minimize the time needed to begin collecting health data and biological samples from disaster response workers who may be exposed to environmental contaminants. RAPIDD includes documents and procedures needed to create a registry of workers. The program is focused on improving disaster response, reducing health impacts, and preventing future harm through:

• Timely and integrated collection of health and environmental data
• Creating a national network of transdisciplinary researchers
• Broad inclusion of public health, academia, and community stakeholders for input and expertise
• Training researchers on data collection questionnaires, protocols, guidance, and safety issues.

With the data from RAPIDD to date, nearly 400 new tools have been developed.

Dr. Birnbaum also mentioned that studies show reducing carbon dioxide, methane, and other greenhouse gases can improve mortality. In addition, more active forms of transportation help in other ways by reducing cardiovascular disease and diabetes.

“This is not just an environmental issue, but a moral issue of life and death,” Dr. Birnbaum concluded.

Presentation 2701: Global Environmental Change and Our Health