Reality is a Model: some thoughts

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Reality is a Model some thoughts

• Devra Davis, PhD, MPH
• Center for Environmental Oncology/
• University of Pittsburgh Cancer Institute, Dept.
  Epid.
• GSPH April 18, 2007

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Public Health is a negative

• When it is at its best, nothing happens there
  are no epidemics, food and water are safe to
  consume, the citizens are well informed regarding
  personal habits that affect their health,
  children are immunized, the air is breathable,
  factories obey workers safety standards, there is
  little class-based disparity in disease or life
  expectancy, and few members of the citizenry go
  untreated. . . .
• Laurie Garrett, Betrayal of Trust, 2000

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The Medical Model Health care treats disease
Does not prevent it. Pasteurs dying words
Remember the host
In some countries we know how many mothers each
year have diabetes, how many get prenatal
care, but not how many fathers work in hazardous
jobs, or how many parents drink polluted
water, breathe dirty air, or work or live near
toxic materials.
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What is Sustainable Development ??
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What is Sustainable Development?

• Health..expanding the scope to reduce the burden
• Environment
• Development

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Infectious Disease Declined in 1800s due to
environmental improvements

• Prior to introduction of vaccines
• Before widespread use of antibiotics
• Tied with cleaner development
• air and water
• safer workplaces and housing

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Cross Sectoral Determinants of Health Status

• Energy
• Transport
• Industry
• Household/education
• Access to care
• Socio-economic status

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Population Health Problems Require System-wide
Institutional Responses

• Bioterrorism
• Air and Water Pollution
• Energy Production/Global Warming
• Toxics in Workplace
• Dietary Contaminants
• Poverty/Inequity
• Democide

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Rising Energy Use
6,000
24,000

• Urban air pollution
• Climate change

MILLION TONS OF OIL EQUIVALENT
MILLION TONS OF CARBON DIOXIDE
3,500
14,000
1970
1995
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Warming Global Temperature
Source NASA Goddard Space Center
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Michael Deaton, 2007)
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Global Impact of Fossil Fuels on Public Health
(The LANCET, 1997)
Fossil Fuel Consumption
Air Pollutants
CONCENTRATIONS OF PARTICULATE MATTER
8 MILLION DEATHS between 20002020 due to
excessive fossil fuel use
Human Exposures
Public HealthImpacts
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What is Environmental Oncology?

• Clinical oncology detects and treats disease
• Environmental oncology seeks to identify causes
  of disease in order to prevent occurrence and
  recurrence
• Measures develops biomarkers of exposure,
  susceptibility and early onset of disease
• To predict and prevent cancer

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Center for Environmental Oncology Mission
Statement

• Provide a state-of-the-art, medical center-based,
  cross-disciplinary approach to identify
  controllable or avoidable causes of cancer linked
  with the environment
• Create and assess interventions that inform,
  educate and change individual and institutional
  behaviors

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Evolution of Object Domains of Environmental
Carcinogenesis
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(No Transcript)
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Fewer than 1 in 10 cases of breast cancer arises
in women with germline mutations
Reasons why environment is a cause of cancer
National Cancer Institute
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Four Divisions of the Center for Environmental
Oncology
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Major Divisions Of Center for Environmental
Oncology
Basic Research
Molecular, Environmental and Clinical Epidemiology
Maryann Donovan
Evelyn Talbott/Joel Weissfeld
Clinical studies and patterns and trends of
disease tied with environmental factors
Provides scientific evidence on biomarkers of
environmental carcinogenesis
Environmental Assessment and Monitoring and
Control
Community and Professional Education and Public
Policy
Dan Volz/Marcia Barr
Sharon McDermott
Develops institutional protocols for monitoring
and control of pollutants for hospital and
community
Communicates links between the environment and
cancer and develops policies to reduce cancer
risk for individuals and institutions
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Basic Research in Environmental Oncology

• Conduct in vitro and in vivo studies of
  cancer-causing and cancer-preventing agents
• Develop genetic, hormonal and other molecular
  markers of carcinogenic risk
• Evaluate the role of prenatal and other early
  windows of vulnerability

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Molecular, Environmental, and Clinical
Epidemiology

• Assess nutritional and other cancer preventive
  agents
• Develop novel, clinical/biological markers of
  cancer risk
• Pilot test the use of automated core
  questionnaires of occupational, environmental,
  behavioral, medical and familial risk factors
• Provide innovative analyses of geographic and
  other trends in cancer in the community

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Environmental Assessment Monitoring and
Control

• Develop cutting edge methods for measuring
  pollutants
• Assess workplace, community and other cancer
  hazards in the hospital and local environments
• Devise cost effective systems for toxics
  reduction, cleaning, maintenance, energy and
  recovery
• Create systems for monitoring progress

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Outreach and Public Policy Program
Development

• Develop scientifically supported and needs-
  assessed multi-media education programs for
  target audiences on the environment and cancer,
  including documentary films and websites
• Explore and develop policy innovations, including
  novel ways to pay for prevention-based services
  and local and state incentive systems

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Goals

• Hospital as model for healthy practices regarding
  toxins, energy, exercise and nutrition
• Educate and train health professionals and
  communities regarding healthy hospitals
• Dynamic interactive analysis of public health,
  economic and other policy impacts of proposed
  interventions

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Increasing Efficiency of Tertiary Health Care
should lead to Primary Prevention

• Reducing footprint of health care
• improved design
• better operations
• Less toxic products technologies
• Estimated financial savings and health benefits
• Public health, economic and ecological savings

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Identical twins dont have identical chromosomal
banding patterns
Chromosome 1
Chromosome 3
3 year old twins
Chromosome 12
Fraga, Mario F., et al. (2005) Proc Natl Acad Sci
USA 10210604-10609.
Chromosome 17
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As identical twins age, their chromosomes look
less similar
Chromosome 1
Chromosome 3
Chromosome 12
50 year old twins
Chromosome 17
PhotoMaryellen Mark, Ned Fred Mitchell
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Differing Workplace Exposures For African
Americans

• 12.7 of the U.S. population
• 20 of non-private household cleaning and
  building service occupations
• 29 of textile pressing machine operators
• 20 of laundering and dry-cleaning machine
  operators
• 30 of bus drivers
• 30 of barbers

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Public Health is a negative

• When it is at its best, nothing happens there
  are no epidemics, food and water are safe to
  consume, the citizens are well informed regarding
  personal habits that affect their health,
  children are immunized, the air is breathable,
  factories obey workers safety standards, there is
  little class-based disparity in disease or life
  expectancy, and few members of the citizenry go
  untreated. . . .
• Laurie Garrett, Betrayal of Trust, 2000

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Water Temperature
1 year
HIGH
N O R M A L
LOW
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1999 was worse
Bleaching data from Peter Glynn