Environmental Health Will Be Very Private

Raghu G. Mirmira, MD, PhD

Earth Day 2022 has come — and gone. Gone, for the day has passed, and for many, so has the message. Earth Day is a call to action not just for a day but for a lifetime.

If you reflect on the horrific global events we’ve witnessed in recent years — catastrophic floods, wildfires, extreme heat waves, melting polar ice caps — you may think that governments need to act, and hopefully this world’s Greta Thunbergs or the Paris Agreement will eventually have an impact. .

Beyond these more obvious consequences of climate change, there are environmental effects on our everyday health. As healthcare providers, we see these effects every day in the work we do, but we may not recognize them—perhaps because we are often trained to see them as a consequence of people’s lifestyles, as a genetic predisposition, or perhaps simply as bad luck.

We are in the midst of a new era in healthcare where we must consider more than just the biological determinants of disease. Our community, personal behavior, psychological factors, and environmental exposures are arguably the most burdensome factors for disease risk and health care accessibility.

Environmental Exposure Is Not Easy To Measure

At the University of Chicago Institute of Translational Medicine, these other determinants of health are collectively referred to as “socio.” The problem with sociomes – and environmental exposures in particular – is that, unlike the biological determinants of disease, it has no easily measurable measure, sometimes its contribution is questionable to disease, and can be so ingrained in society that it may not be obvious (think poisoning leads).

Unfortunately, even when we are aware of the contribution of socioeconomics to a disease, we often ignore it because it is not easily modifiable. The environment is a very famous one because we take it as a fact of life and assume that there is little that one person can do. But when you think about any disease, you realize that the data make a convincing case that personal and environmental health are closely linked.

Obesity and reduced physical activity affect the environment

Obesity is, by all measures, an epidemic. According to the Centers for Disease Control and Prevention, obesity affects more than 40% of the US population. The consequences of obesity include diabetes, cardiovascular disease, and cancer, as well as worse COVID-19 outcomes.

In this context lies the health disparity in underserved populations, which face a disproportionate burden of obesity. In particular, the lack of availability of healthy foods in many underserved communities leads to the provision of inexpensive and calorie-dense alternatives (and, yes, calories do matter when it comes to obesity).

Agricultural practices that focus on the production of heavily processed foods account for a third of global greenhouse gas emissions. The increasing appetite for meat, for example, underlies the worldwide trend of deforestation to make room for cattle ranching and is undeniably the impetus for the continued loss of the Amazonian biome.

Of course, obesity is not only driven by food consumption and food choices. Reduction of physical activity resulting from the use of motorized vehicles, in particular, reduces energy expenditure at the expense of increasing greenhouse gas emissions. In one study, it was shown that cycling to work just 1 day per week can reduce a person’s greenhouse gas emissions by more than 65% — and cycling to work can have the same effect as periods of specific exercise on weight loss and obesity. A win-win.

Environmentally Related Disturbances

Various other diseases are also closely related to the environment. Particulate matter measuring 2.5 microns or less (known as PM2.5) is often used as a quantitative measure of environmental air pollution. Probably everyone knows that exacerbation of lung diseases such as asthma is closely related to the prevalence of PM2.5 in the atmosphere.

But what’s underappreciated are abnormalities or other flaws that we don’t usually associate with the environment. For example, vitamin D deficiency is closely related to PM2.5 exposure. And, relevant to the ongoing pandemic, vitamin D deficiency is associated with more severe COVID-19. Other disorders associated with PM2.5 levels include low birth weight (and did you know that low birth weight is a risk factor for obesity in adulthood?), thyroid disorders, infertility (think about diminishing global fertility rates), and certain types of cancer.

So where does this relationship between health and the environment leave us? The magnitude of the influence of the environment on health is enough to make you feel personal futility. It’s a justifiable feeling. As a health-conscious individual, imagine you are doing your part by reducing your own carbon footprint — for your own health, if not for others.

If you are a healthcare provider, take a few minutes to talk to your patients about the benefits of reducing their carbon footprint. It’s quite simple. How about walking or cycling to work 1 day a week, or only working from home once a week? We’ve already seen the global impact of work-at-home policies introduced during the pandemic — a stark reduction in global PMIs2.5 — so we know it works, but on a personal level you know you’re doing your part (not to mention the health benefits of walking or cycling).

Also, while no one is asking you to be vegan, think about reducing your meat and dairy intake; a diet that meets World Health Organization recommendations is estimated to reduce greenhouse gas emissions by 17%.

How about utilizing non-traditional protein sources (cultivated meat and insect-based supplements)? These alternatives may not sound appropriate today, but perceptions change over time. Some of these interventions are easier for some people than others, and we need to pay attention to culture and socioeconomic status. But there are always similarities, and framing environmental concerns around personal health often comes to an agreement. So, as we reflect on Earth Day 2022, the theme “investing in our planet” is as much about our health today as it is about our planet’s future.

Raghu Mirmira, MD, PhD, is a professor of medicine at the University of Chicago and director of the Translational Research Center, which focuses on transferring basic concepts of health from the laboratory to the clinic. He is one of the leading NIH-funded diabetes and obesity researchers in the United States and the author of more than 170 scientific articles on insulin production and its effects on organ systems. Follow Raghu on Twitter: @rmirmira

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