Title: Reality is a Model: some thoughts
1Reality is a Model some thoughts
- Devra Davis, PhD, MPH
- Center for Environmental Oncology/
- University of Pittsburgh Cancer Institute, Dept.
Epid. - GSPH April 18, 2007
2Public 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
3The 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.
4What is Sustainable Development ??
5What is Sustainable Development?
- Health..expanding the scope to reduce the burden
- Environment
- Development
-
6Infectious 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
7Cross Sectoral Determinants of Health Status
- Energy
- Transport
- Industry
- Household/education
- Access to care
- Socio-economic status
8Population Health Problems Require System-wide
Institutional Responses
- Bioterrorism
- Air and Water Pollution
- Energy Production/Global Warming
- Toxics in Workplace
- Dietary Contaminants
- Poverty/Inequity
- Democide
9Rising 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
10Warming Global Temperature
Source NASA Goddard Space Center
11Michael Deaton, 2007)
12Global 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
13What 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
14Center 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
15Evolution of Object Domains of Environmental
Carcinogenesis
16(No Transcript)
17Fewer 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
18Four Divisions of the Center for Environmental
Oncology
19Major 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
20 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
21 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
22 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
23 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
24Goals
- 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
25Increasing 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
26Identical 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
27As 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
28Differing 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
29Public 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
30Water Temperature
1 year
HIGH
N O R M A L
LOW
311999 was worse
Bleaching data from Peter Glynn