Environmental pollution, health, and development: a Lancet-Global Alliance on Health and Pollution-Icahn School of Medicine at Mount Sinai Commission

Artisanal gold mining in Kakamega and Vihiga counties, Kenya: potential human exposure and health risk

Artisanal and small-scale gold mining (ASGM) represents 20% of gold supply and 90% of gold mining workforce globally, which operates in highly informal setups. Pollutants from mined ores and chemicals introduced during gold processing pose occupational and inadvertent health risks to the extent that has not been well elucidated in Africa. Trace and major elements were analysed using inductively coupled plasma mass spectrometry in soil, sediment and water samples from 19 ASGM villages in Kakamega and Vihiga counties. Associated health risks for residents and ASGM workers were assessed. This paper focuses on As, Cd, Cr, Hg, Ni and Pb for which 96% of soil samples from mining and ore processing sites had As concentrations up to 7937 times higher than the US EPA 12 mg kg-1 standard for residential soils. Soil Cr, Hg and Ni concentrations in 98%, 49% and 68% of the samples exceeded respective USEPA and CCME standards, with 1-72% bioaccessibility. Twenty-five percentage of community drinking water sources were higher than the WHO 10 µg L-1 drinking water guideline. Pollution indices indicated significant enrichment and pollution of soils, sediment and water in decreasing order of As > Cr > Hg > Ni > Pb > Cd. The study revealed increased risks of non-cancer health effects (98.6) and cancer in adults (4.93 × 10-2) and children (1.75 × 10-1). The findings will help environment managers and public health authorities better understand the potential health risks in ASGM and support evidence-based interventions in ASGM processes, industrial hygiene and formulation of public health policy to protect residents and ASGM workers' health in Kenya.

Maternal exposure to air pollution alters energy balance transiently according to gender and changes gut microbiota

Introduction

The timing of maternal exposure to air pollution is crucial to define metabolic changes in the offspring. Here we aimed to determine the most critical period of maternal exposure to particulate matter (PM_2.5) that impairs offspring's energy metabolism and gut microbiota composition.

Methods

Unexposed female and male C57BL/6J mice were mated. PM_2.5 or filtered air (FA) exposure occurred only in gestation (PM_2.5/FA) or lactation (FA/PM_2.5). We studied the offspring of both genders.

Results

PM_2.5 exposure during gestation increased body weight (BW) at birth and from weaning to young in male adulthood. Leptin levels, food intake, Agrp, and Npy levels in the hypothalamus were also increased in young male offspring. Ikbke, Tnf increased in male PM_2.5/FA. Males from FA/PM_2.5 group were protected from these phenotypes showing higher O₂ consumption and Ucp1 in the brown adipose tissue. In female offspring, we did not see changes in BW at weaning. However, adult females from PM_2.5/FA displayed higher BW and leptin levels, despite increased energy expenditure and thermogenesis. This group showed a slight increase in food intake. In female offspring from FA/PM_2.5, BW, and leptin levels were elevated. This group displayed higher energy expenditure and a mild increase in food intake. To determine if maternal exposure to PM_2.5 could affect the offspring's gut microbiota, we analyzed alpha diversity by Shannon and Simpson indexes and beta diversity by the Linear Discriminant Analysis (LDA) in offspring at 30 weeks. Unlike males, exposure during gestation led to higher adiposity and leptin maintenance in female offspring at this age. Gestation exposure was associated with decreased alpha diversity in the gut microbiota in both genders.

Discussion

Our data support that exposure to air pollution during gestation is more harmful to metabolism than exposure during lactation. Male offspring had an unfavorable metabolic phenotype at a young age. However, at an older age, only females kept more adiposity. Ultimately, our data highlight the importance of controlling air pollution, especially during gestation.

Environmental Regulation and Chronic Conditions: Evidence from China's Air Pollution Prevention and Control Action Plan

In January 2013, a dense haze covered 1.4 million kilometers of China and affected more than 800 million people. Air pollution in China had become a serious threat to the daily lives of people. The State Council of China enacted the "Air Pollution Prevention and Control Action Plan" (APPCAP) in 2013 to lower the particulate matter (PM) level. Between 2013 and 2017, each administrative division established its own environmental preservation strategy in accordance with the APPCAP. We examined the effects of the nationwide air pollution control policy, APPCAP, on chronic health conditions among adults using a nationally representative survey, CFPS, conducted in 2012, 2014, and 2016. We applied a difference-in-differences model, using the time gap when each administrative division implemented the APPCAP. We found that the APPCAP significantly reduced doctor-diagnosed chronic conditions of the respiratory and circulatory systems in the last six months. In respiratory diseases and circulatory system diseases, the treatment effect of the APPCAP was a 34.6% and 11.5% reduction in the sample mean, respectively. The poorest socioeconomic groups and the elderly benefited the most. The stronger the goal, the more positive the effects were on health; the longer the policy intervention, the better the health outcomes were.

Going green: decreasing medical waste in a paediatric intensive care unit in the United States

The healthcare industry generates significant waste and carbon emissions that negatively impact the environment. Intensive care units (ICU) are a major contributor to the production of waste, due to patient complexity and needs requiring extensive equipment, cleaning practices and pre-emptive supplies. To quantify the extent of the problem, health care professionals collected all unused medical supplies destined to be discarded over three one-week periods in a paediatric intensive care unit, weighed the items, and created an inventory. This article argues for greener hospital standards and provides a specific example of a project framework to reduce disposable waste with the hope that others can embark on similar initiatives for a more ethical and sustainable future for hospitals. Healthcare facilities must not just meet short-sighted safety standards of the now. In order to be a virtuous organization, one must consider all implications of daily decisions, including disposable supplies and cleaning.

Application of metabolomics to characterize environmental pollutant toxicity and disease risks

The increased incidence of non-communicable human diseases may be attributed, at least partially, to exposures to toxic chemicals such as persistent organic pollutants (POPs), air pollutants and heavy metals. Given the high mortality and morbidity of pollutant exposure associated diseases, a better understanding of the related mechanisms of toxicity and impacts on the endogenous host metabolism are needed. The metabolome represents the collection of the intermediates and end products of cellular processes, and is the most proximal reporter of the body's response to environmental exposures and pathological processes. Metabolomics is a powerful tool for studying how organisms interact with their environment and how these interactions shape diseases related to pollutant exposure. This mini review discusses potential biological mechanisms that link pollutant exposure to metabolic disturbances and chronic human diseases, with a focus on recent studies that demonstrate the application of metabolomics as a tool to elucidate biochemical modes of actions of various environmental pollutants. In addition, classes of metabolites that have been shown to be modulated by multiple environmental pollutants will be discussed with an emphasis on their use as potential early biomarkers of disease risks. Taken together, metabolomics is a useful and versatile tool for characterizing the disease risks and mechanisms associated with various environmental pollutants.

Advancing science in rapidly changing environments: opportunities for the Central and Eastern European Conference on Health and the Environment to connect to other networks

The Central and Eastern Europe region is faced with longstanding environmental health problems as well as emerging health threats from pollution caused by the region's recent period of rapid industrialization. As researchers in the region continue to work to address these problems, they could find unique approaches by increasing collaborations between biomedical and non-biomedical scientists and by more closely following the Superfund Research Program model of pursuing basic research, then connecting with stakeholders in the region to share and apply new knowledge. To build upon and leverage research in the region, researchers and stakeholders should work to formalize the bi-annual meeting of the Central and Eastern European Conference on Health and the Environment into a more cohesive organization and make efforts to connect to broader global networks that aim to spread research results and applications around the world. By taking these steps to connect to the broader world of environmental health research, the CEE region stakeholders can reduce pollution-related disease, minimize costs of hazardous waste remediation, and help grow the economy in their region.

Determination of Benzopyrene-Induced Lung Inflammatory and Cytotoxic Injury in a Chemical Gradient-Integrated Microfluidic Bronchial Epithelium System

Environmental pollution is one of the largest sources responsible for human diseases and premature death worldwide. However, the methodological development of a spatiotemporally controllable and high-throughput investigation of the environmental pollution-induced biological injury events is still being explored. In this study, we describe a chemical gradient generator-aided microfluidic cell system for the dynamic study of representative environmental pollutant-induced bronchial epithelium injury in a throughput manner. We demonstrated the stability and reliability of operation-optimized microfluidic system for precise and long-term chemical gradient production. We also performed a microenvironment-controlled microfluidic bronchial epithelium construction with high viability and structure integration. Moreover, on-chip investigation of bronchial epithelium injury by benzopyrene stimulation with various concentrations can be carried out in the single device. The varying bronchial inflammatory and cytotoxic responses were temporally monitored and measured based on the well-established system. The benzopyrene directionally led the bronchial epithelium to present observable cell shrinkage, cytoskeleton disintegration, Caspase-3 activation, overproduction of reactive oxygen species, and various inflammatory cytokine (TNF-α, IL-6, and IL-8) secretion, suggesting its significant inflammatory and cytotoxic effects on respiratory system. We believe the microfluidic advancement has potential applications in the fields of environmental monitoring, tissue engineering, and pharmaceutical development.

Cardiovascular Disease as a Result of the Interactions Between Obesity, Climate Change, and Inflammation: The COCCI Syndemic

Obesity and climate change conspire to create an environment in which subclinical vascular inflammation leads to progressive atherosclerosis, which contributes to the number 1 cause of global mortality: cardiovascular disease. The syndemic model requires 2 or more diseases or contributors to disease (such as obesity and climate change) clustering within a specific population in addition to the associated societal and social factors, ultimately creating an environment supportive of a greater adverse interaction. This article explores the syndemic of obesity and climate change as a driver for cardiovascular disease.

Mitigation of air pollution by greenness: A narrative review

Air pollution represents one of the world's most important environmental health risks, being associated with an increased rate of multiple diseases (mainly cardiopulmonary) and of premature deaths. A number of actions have been suggested and implemented to mitigate the deleterious health effects of air pollution. Accordingly, recent research has attempted to estimate the beneficial effect of exposure to greenness on human health. In this narrative review, we summarize and review the current literature on the favourable association between greenness and human health in both the outdoor and indoor environments. The potential mechanisms underlying this benefit will be also addressed.

Health Care Expenditures Associated With Pollution: Exploratory Methods and Findings

BACKGROUND

The research done for this paper is part of the background analysis undertaken to support the work of the Global Commission on Pollution, Health and Development, an initiative of The Lancet, the Global Alliance on Health and Pollution, and the Icahn School of Medicine at Mount Sinai. The paper expands on areas where the current literature has gaps in knowledge related to the health care cost of pollution.

OBJECTIVES

This study aims to generate an initial estimate of total tangible health care expenditure attributable to man-made pollution affecting air, soil and water.

METHODS

We use two methodologies to establish an upper and lower bounds for pollution related health expenditure. Key data points in both models include (a) burden-of-disease (BoD) at the national level in different countries attributable to pollution; and (b) the total cost of health care at the national level in different countries using standard national health accounts expenditure data.

FINDINGS

Depending on which determinist model we apply, annual expenditures range from US$630 billion (upper bound) to US$240 billion (lower bound) or approximately three to nine percent of global spending on health care in 2013 (the reference year for the analysis). Although only 14 percent of global total for pollution related health care spending is in lower- and middle-income countries (LMICs) in our primary (lower bound) model, the relative share of spending for pollution related illness is substantial, especially in very low-income countries. Cancer, chronic respiratory and cardio/cerebrovascular illnesses account for the largest health care spending items linked to pollution even in LMICs.

CONCLUSIONS

These conditions have historically received less attention by national governments, international public health organizations and development/financial agencies than infectious disease and maternal/child health sectors. Other studies posit that intangible costs associated with environmental pollution include lower productivity and reduced income - components which our models do not attempt to capture. The financial and health impacts are substantial even when we exclude intangible costs, yet it is likely that in many LMICs poor households simply forgo medical treatment and lose household income as a result of man-made environmental degradation.

RECOMMENDATIONS

When evaluating the value of public health or environmental programs which prevent or limit pollution-related illness, policy makers should consider the health benefits, the tangible cost offsets (estimated in our models) and the opportunity costs.

Air quality and acute myocardial infarction in adults during the 2016 Hangzhou G20 summit

To fulfill its commitment to a successful Hangzhou G20 summit (4 to 5 September 2016), the Chinese government implemented a series of measures to improve the air quality in Hangzhou. We report findings on air quality and acute myocardial infarction (AMI) hospital admissions in adults during the Hangzhou G20 summit. Three study periods were defined. The first period was pre-G20 (28 July to 27 August: limited restrictions on industrial emissions). The second period was G20 (28 August to 6 September) when there were further restrictions on industrial emissions and increased transportation restrictions. The third period was post-G20 (7 September to 6 October) when restrictions were relaxed again. The mean number of AMI admissions per day was, respectively, 8.2 during G20, 13.3 during pre-G20, and 15.1 during post-G20. We used time-series Poisson regression models to estimate the relative risk (RR) for AMI associated with pollution levels. Our results suggest that the air quality improvement can reduce the number of hospital admissions for AMI.

A Systematic Review of Children's Environmental Health in Brazil

In the region of the Americas, approximately 100,000 children under the age of 5 years die each year due to environmental hazards. Brazil, due to its large size and wide range of environmental challenges, presents numerous hazards to children's health. The aim of this study was to systematically review the scientific literature that describes children's exposures to environmental pollutants in Brazil and their effects on Brazilian children's health. A systematic review of the scientific literature was performed without language restrictions and time of publication (years). The literature search was conducted in the following key resources: PubMed (MEDLINE), Scopus and Web of Science with the MeSH Terms: Environmental exposure AND Brazil (filters: Human, Child [birth to 18 years] and Affiliation Author). The Virtual Health Library was also employed to access the databases Scielo and Lilacs. The search strategy was [DeCS Terms]: Child OR adolescent AND Environmental exposure AND Brazil. Health effects in children associated with exposure to environmental pollutants in Brazil were reported in 74 studies, during the period between 1995 and 2015. The most frequently cited effect was hospital admission for respiratory causes including wheezing, asthma, and pneumonia among children living in areas with high concentrations of air pollutants. A broad spectrum of other health effects possibly linked to pollutants also was found such as prematurity, low birth weight, congenital abnormality (cryptorchidism, hypospadia, micropenis), poor performance in tests of psychomotor and mental development, and behavioral problems. Exposure to pesticides in utero and postnatally was associated with a high risk for leukemia in children <2 years old. These results show that there is a need in Brazil for stricter monitoring of pollutant emissions and for health surveillance programs especially among vulnerable populations such as pregnant women and young children.

Slum Upgrading and Health Equity

Informal settlement upgrading is widely recognized for enhancing shelter and promoting economic development, yet its potential to improve health equity is usually overlooked. Almost one in seven people on the planet are expected to reside in urban informal settlements, or slums, by 2030. Slum upgrading is the process of delivering place-based environmental and social improvements to the urban poor, including land tenure, housing, infrastructure, employment, health services and political and social inclusion. The processes and products of slum upgrading can address multiple environmental determinants of health. This paper reviewed urban slum upgrading evaluations from cities across Asia, Africa and Latin America and found that few captured the multiple health benefits of upgrading. With the Sustainable Development Goals (SDGs) focused on improving well-being for billions of city-dwellers, slum upgrading should be viewed as a key strategy to promote health, equitable development and reduce climate change vulnerabilities. We conclude with suggestions for how slum upgrading might more explicitly capture its health benefits, such as through the use of health impact assessment (HIA) and adopting an urban health in all policies (HiAP) framework. Urban slum upgrading must be more explicitly designed, implemented and evaluated to capture its multiple global environmental health benefits.

Environmental Exposures and Cardiovascular Disease: A Challenge for Health and Development in Low- and Middle-Income Countries

Environmental exposures in low- and middle-income countries lie at the intersection of increased economic development and the rising public health burden of cardiovascular disease. Increasing evidence suggests an association of exposure to ambient air pollution, household air pollution from biomass fuel, lead, arsenic, and cadmium with multiple cardiovascular disease outcomes, including hypertension, coronary heart disease, stroke, and cardiovascular mortality. Although populations in low- and middle-income countries are disproportionately exposed to environmental pollution, evidence linking these exposures to cardiovascular disease is derived from populations in high-income countries. More research is needed to further characterize the extent of environmental exposures.

The history, geography, and sociology of slums and the health problems of people who live in slums

Massive slums have become major features of cities in many low-income and middle-income countries. Here, in the first in a Series of two papers, we discuss why slums are unhealthy places with especially high risks of infection and injury. We show that children are especially vulnerable, and that the combination of malnutrition and recurrent diarrhoea leads to stunted growth and longer-term effects on cognitive development. We find that the scientific literature on slum health is underdeveloped in comparison to urban health, and poverty and health. This shortcoming is important because health is affected by factors arising from the shared physical and social environment, which have effects beyond those of poverty alone. In the second paper we will consider what can be done to improve health and make recommendations for the development of slum health as a field of study.

Mortality benefits of vigorous air quality improvement interventions during the periods of APEC Blue and Parade Blue in Beijing, China

Vigorous air pollution control measures were implemented during the 2014 Asia-Pacific Economic Cooperation and a large-scale military parade (described here as "APEC Blue" and "Parade Blue" periods) in Beijing, China. A natural experiment was conducted in a health impact assessment framework to estimate the number of deaths attributable to PM_2.5, using concentration-response functions derived from previous studies conducted in Beijing, combined with the differences in PM_2.5 concentrations between intervention and reference periods. Substantial reductions in daily PM_2.5 concentrations were observed during both intervention periods. Using the same dates from the prior year as a reference, daily PM_2.5 concentration decreased from 98.57 μg/m³ to 47.53 μg/m³ during "APEC Blue", and from 59.15 μg/m³ to 17.07 μg/m³ during the "Parade Blue". We estimated that 39-63 all-cause deaths (21-51 cardiovascular, 6-13 respiratory deaths) have been prevented during the APEC period; and 41-65 deaths (22-52 cardiovascular, 6-13 respiratory deaths) have been prevented during the Parade period. This study shows that substantial mortality reductions could be achieved by implementing stringent air pollution mitigation measures.

Environmental Pollution: An Under-recognized Threat to Children's Health, Especially in Low- and Middle-Income Countries

Exposures to environmental pollutants during windows of developmental vulnerability in early life can cause disease and death in infancy and childhood as well as chronic, non-communicable diseases that may manifest at any point across the life span. Patterns of pollution and pollution-related disease change as countries move through economic development. Environmental pollution is now recognized as a major cause of morbidity and mortality in low- and middle-income countries (LMICs). According to the World Health Organization, pollution is responsible for 8.9 million deaths around the world each year; of these, 94% (8.4 million) are in LMICs. Toxic chemical pollution is growing into a major threat to children's health in LMICs. The disease and disability caused by environmental pollution have great economic costs, and these costs can undercut trajectories of national development. To combat pollution, improved programs of public health and environmental protection are needed in countries at every level of development. Pollution control strategies and technologies that have been developed in high-income countries must now be transferred to LMICs to assist these emerging economies to avoid the mistakes of the past. A new international clearinghouse is needed to define and track the health effects of pollution, quantify the economic costs of these effects, and direct much needed attention to environmental pollution as a risk factor for disease.