May 11th

Population, plastics and prophylactics

By Eugenia Cronin

I was debating whether to write this blog about the small plastic boxes I bought recently to freeze rice, or about global population growth. My dilemma is very neatly summed up in ‘act local, think global’, so surely the answer is to do both!  The question is can I say something at all engaging on either (let alone both) in 400 words? Let’s see.

It seems wrong to start with my habit of freezing leftover rice into portions, so I’ll start with population. I scared myself looking into this. A bit of googling brought me to this website which looks like a great resource. It has some stats that pop up as well as a handy ‘world population’ counter, which was at 7,154,609,605 when I first glanced at it. Then - wait I can’t keep up - seconds later it was 7,154,609,832 – that’s 227 more literally in 20 seconds. I dread to look now. The website points out that this is an uncomfortable issue (see BMJ 2008;337:39575.691343.80). If, like me, you don’t know a lot about this topic, both links are worth a read. One statistic that stays with me is this one: over 200 million women have an unmet need for modern contraception.

Being early for an appointment recently I nipped across the road to a shop that sells all kinds of stuff ‘for the home’, just for a look. I immediately spotted some small colourful plastic boxes. Rice portion size! I thought. Noting happily that they were BPA-free and something else-free, I bought them, and stuffed them into my backpack feeling slightly smug about foregoing the proffered plastic bag. But then I wondered ... using leftover rice is probably a Good Thing; foregoing the one-use-only freezer bag has got to be a Good Thing; but what about these little containers? I am actually replacing plastic with plastic. What should I be considering in this transaction? There is the sourcing/manufacture (sustainable or otherwise), and there must also be the disposal of the waste which eventually – bags or containers – is likely to go into landfill. This is a small dilemma I know, but perhaps typical of the kinds of things we as individuals consider – or need to consider - on a daily basis. 

May 7th

Low Carbon Healthy Lifestyles – Transdisciplinary work?

By Neil Chadborn


Working towards a shared goal, i.e. healthy lifestyle and sustainability, could be described as ‘transdisciplinary’ work. This way of working or researching is often overlooked, because expertise and ‘knowledge’ tend to develop within specialties; in this case, public health and environmental science. Unfortunately disciplines have their drawbacks; research may miss opportunities of ‘cross-fertilisation’ as exemplified by the newspaper article mentioned in my previous blog. Furthermore putting knowledge into practice may be hindered because lifestyles are not arranged in disciplines – we need messages that talk to different facets of our daily life at once. I am involved in an international project that will look at the benefits of transdisciplinary research for human development and sustainability science:

How can we better connect social and environmental sciences to enhance the well-being of people and their environments, especially in the context of poverty?

A challenge for working in a transdisciplinary way can be terminology - because it is mix of several disciplines titles tend to be long and complicated. Also different disciplines may have different meanings for key terms, therefore some meaning can get 'lost in translation'. How do people talk about these links between health and global climate change? We invented the term ‘Low Carbon Healthy Lifestyles’. Twitter users organise around hashtags, which can be an important seed crystal to grow interest and debate. This is the best I’ve found so far: #climatehealth

A great case study of these overlapping issues are the community projects funded by Natural Choices for Health and Wellbeing (Liverpool Primary Care Trust NHS in partnership with Mersey Forest). See my previous blog article.

I have been researching the impact of one of these projects; a therapeutic horticulture project for children. Children and young people from 3 local schools participated in the project, learning about the natural environment as well as benefitting their own wellbeing. I am currently studying how children perceive the gardening project and how they felt it affected their wellbeing. I am particularly interested in how their concepts of nature, ecosystem or sustainability may influence their perceptions of the social world. Are the words and concepts used by the horticultural therapists a critical factor, or is simply being in greenspace therapeutic?

There are ways that tackling climate change can benefit health and wellbeing, however these are often not made explicit. People often consider one or the other, maybe because both health and sustainability are complex topics. I believe bringing these two together, either within global research or local community activities, is a great way to build momentum.
May 7th

Low Carbon Healthy Lifestyles: Goals and challenges shared between health promotion and environmental sustainability

By Neil Chadborn
The science behind the association between health and climate change is building and becoming mainstream. A few years ago a mini-series within the Lancet was dedicated to these issues (Haines et al., 2009). Prof Anthony McMichael, in his recent review (McMichael, 2013), outlines a concept that human-induced change on a global scale has many risks for health of the world’s population. Climate change is one of several examples of these global changes, others being; epidemics of new strains of influenza virus, a decline in seafood stocks, shortages of fresh water and food security (McMichael, 2013).

From a much more local perspective, in the UK, West Midlands Public Health Observatory have calculated the health impacts on the population of the West Midlands of weather events from projected climate change until the end of the century (May, Baiardi, Kara, Raichand, & Eshareturi, 2010). For the Northwest of England, we looked at this from a different angle; looking at disciplines in health (eg. respiratory, cardiovascular, mental wellbeing) and how these may be affected by climate change events (Bates, Chadborn, Jones, & McVeigh, 2011). Partly, the aim of arranging these impacts around the health issue, rather than the climate event, was to gain interest of health professionals and get information across to them.
Sustainable health leaders are emphasising the co-benefits to health of taking action on climate change (mitigation). Cycling rather than driving the car to the shops improves fitness and decreases carbon-footprint. Growing your own vegetables may improve diet and may improve mental wellbeing through time in greenspace; also it can reduce foodmiles and carbon footprint of fertilisers.

A recent newspaper article described how sustainability could learn vital lessons from the experience of health promotion over the years:
Steven Johnson makes a key point; that health promotion has learnt to focus on inequality. Without this focus, well-meaning interventions can exacerbate inequality; the better-off are more able to take advantage of the campaign, and thus improve their health. This is an argument against mass messages, eg TV adverts. Thus advocacy is best at the local level, aiming to reach those suffering from the worst of austerity measures and indifferent consumerism.

Community-based activities are suited to the local context and may be the best way of promoting health and sustainability. I have been studying children’s views of health and climate change using examples of activities that give co-benefits – we coined the term ‘Low Carbon Healthy Lifestyles’(Neil Chadborn, Springett, Gavin, & Dewar, 2011). Young children are often enthusiastic about activities such as cycling and growing vegetables, and show some awareness of the benefits to both health and the environment (NH Chadborn, Gavin, Springett, & Robinson, 2012). Many local organisations facilitate these projects, but often promote either health or environmental benefits. I propose that making explicit links between health and climate change may be beneficial to engaging the public with these activities. Also the shared agenda may strengthen networking between organisations and with schools. I’ll continue this topic in my next blog article.

In this blog I have shown how climate change and health are inextricably linked. While these are global issues, and there is a place for international legislation, we can all take action in our own communities. I believe it’s useful to communicate this explicitly by using phrases such as ‘Low Carbon Healthy Lifestyles’. 

Bates, G., Chadborn, N., Jones, L., & McVeigh, J. (2011). Impact of climate change upon health and health inequalities in the north west of England. Liverpool.
Chadborn, Neil, Springett, J., Gavin, N., & Dewar, S. (2011). Promoting Low Carbon Healthy Lifestyles as new opportunities to tackle obesity and health inequalities. Liverpool.
Chadborn, NH, Gavin, N., Springett, J., & Robinson, J. (2012). “Cycling–exercise or trying to stop pollution”: methods to explore children’s agency in health and climate change. Local Environment, 18(3), 271–288.
Haines, A., McMichael, A. J., Smith, K. R., Roberts, I., Woodcock, J., Markandya, A., Armstrong, B. G., et al. (2009). Public health benefits of strategies to reduce greenhouse-gas emissions: overview and implications for policy makers. Lancet, 374(9707), 2104–14. doi:10.1016/S0140-6736(09)61759-1
May, E., Baiardi, L., Kara, E., Raichand, S., & Eshareturi, C. (2010). Health Effects of Climate Change in the West Midlands: Technical Report. Birmingham.
McMichael, A. J. (2013). Globalization, Climate Change, and Human Health. New England Journal of Medicine, 368, 1335–43.
Apr 30th

Climate Change and Obesity?

By Alessandro Demaio

By Alessandro R Demaio, Harvard Medical School and The University of Copenhagen

This is likely to cause controversy, but I am going to draw a line in the sand. We have a number of massive Global Health challenges to address as a society, but to me, there are none more pressing, threatening or crucial to act upon than Climate Change and Non-Communicable Disease (NCDs).


Flickr / Cogdogblog


The BIG Two

At face value, one could be forgiven for seeing these two defining global health challenges as unrelated. Forgiven for thinking of them as separate problems with distinct causes for which we need two groups charged with the implementation of unique solutions.

But take a closer look, and you will realise a few things. These are two massive challenges largely resulting from, and solved by, the same determinants. Also, that the immediate and long-term benefits of addressing one are enormous, dwarfed only by the benefits and co-benefits of addressing both together.

The global health community has a lot to do in the coming decades, with increasingly less. Limited fiscal, human and natural resources available – compounded by austerity and economic conservatism during what could be a lengthy or permanent downturn in government budgets and overseas aid. As a collective, we must look more to opportunities for common progress and gains, and less to siloed initiatives as we have seen in the past few decades. We must seek out social investments which will maximise the benefits returned. One way of doing so, is to look for measures which will solve multiple problems, or address problems which are caused by the same determinants.

We must acknowledge that slicing major challenges into verticalised problems diminishes or precludes opportunities for common progress.

You see, NCDs and Climate Change do in fact share the same causes and largely require the same solutions. Carbon-intensive and labour-conserving lifestyles; highly-processed food requiring large energy inputs; larger portions of meat and higher calorie diets; increasing air pollution… Yet we separate their responses and those commanded with their mitigation. Health is dependent on a healthy environment, both urban and natural.


Flickr / Planeta


The GOOD News.

What’s exciting though, is that given their shared causes and mitigation strategies, by addressing one we will also be addressing the other. By tackling climate change, in addition to bringing the health benefits associated with this alone, we could also bring co-benefits of a reduced burden of chronic disease. By investing in ways to make healthier, less-processed food more affordable we reduce the carbon-intensiveness of our diets but are also likely to see a reduction in diet-related diabetes and heart disease. Providing safe public environments conducive to biking or active living will not only reduce carbon emissions and environmental pollutants, but may also reduce community rates of asthma, lung disease and even cancers.

This idea, or the inter-linked nature of Climate Change and NCDs is not new. But it continues to largely fly under the community radar. A greater awareness could lead to further discussion, engagement, collaborative mitigation and collective action.

For more on global health, explore Translational Global Health, from Alessandro and PLoS.

Alessandro R Demaio does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

The Conversation

This article was originally published at The Conversation. Read the original article.

Apr 29th

The Overlooked Association: Sewage, Climate & Health

By Keith Bell

Have you ever considered poor sanitation as cause of the rickets epidemic in the UK? Experts think it's about sunshine while beaches in the UK are polluted with raw sewage ten times over legal limits. This microbial pollution is also a significant source of carbon dioxide, the "other" global warming. In sanitation issues, we have a powerful intersection of health and environment overlooked by medical experts and nations. Sanitation-challenged India, for example, still believes its rampant diabetes epidemic a matter of diet and exercise.

Let's take a ride into uncharted territory: the inner space of our small intestine. It's the center of all health, directly between our liver and pancreas. The lining of the small intestine is called the most important quarter-inch of the body. It's here where our nutrients are absorbed .  .  . or malabsorbed. Most people believe starvation is a matter of malnutrition, but it's more accurately malabsorption syndrome, meaning it's not necessarily what we eat, but what we can absorb based on intestinal health. Evidence over the past decade is strongly mounting toward the understanding that intestinal health is reliant on balanced flora. Yet even the mighty Human Microbiome Project never ventured into the small intestine.

This microbial balance, or homeostasis, is the driver for all health, physical and mental. Have you heard of the gut-brain connection? The major gut diseases such as Celiac, ulcerative colitis, IBD and Crohn's are all associated with mental illness. Let's put it this way: sanitation is sanity.

The problem is most people still believe our water-based sanitation systems, flushing toilets, are an improvement. Modern sanitation has been voted the most important medical advance in the history of science. But it's now obsolete, guided by obsolete law. We purposely multiply the wrong kinds of microbes in the name of sanitation. It's time to end mixing our waste with water. The technology, activated sludge, was born in Manchester, UK, 1913. It was great in its first 50 years to lower deaths by acute illness. But we've traded that for something far more ominous: chronic, long-term non-communicable disease, NCDs which are now the global health focus.

It will take generations to reverse the damage if we focus on real sanitation. The problem is now generational, a matter of microbial predisposition via placental transmission. For example, malaria is no longer just about mosquitoes as babies are now born carrying the parasite. The immune system keeps it in check until something such as routine vaccination tips the balance. There are no studies regarding vaccination effect on flora; all focus is on adjuvants such as mercury and aluminum toxicity. Collateral damage to flora by vaccination remains unknown.

Poor sanitation is the driving force behind global non-communicable diseases (NCDs) such as diabetes, cancer, autism, heart and lung disease. But this has been completely overlooked by the United Nations where the General Assembly held its first meeting on health in a decade in 2011. The last such meeting was 2001 on AIDS. In 2011, the focus was NCDs, yet sanitation was not on the agenda, a lost opportunity. The World Bank still builds wastewater treatment plants while UNICEF builds polluting pit latrines. What's really needed is to promote dry compost toilet technology.

This is not new information. The world's first physician, Hippocrates, stated "death begins in the colon." Yet we disregard intestinal health at every turn, polluting water and soil, abusing antibiotics and routine vaccination. Sadly, children are now born imbalanced where vaccines given within 12 hours of birth add insult to injury, tipping the balance further in the wrong direction. We're now born predisposed to obesity, diabetes, autism, Alzheimer's, cancer, anorexia and rickets. All NCDs can be explained by flora imbalance beginning in the gut. Many studies show gut dysbiosis using new molecular DNA detection technology called microarray. Yet modern science still holds belief the fetal gastrointestinal tract is sterile without a lick of evidence. But truth is being revealed as what was once thought sterile is actually teeming with life. This includes the brain, also reliant on balanced flora. Amniotic fluid, urine, eyeballs, meconium and breast milk all not sterile and were never meant to be sterile.

In the UK, there is a rickets epidemic thought to be a matter of sunshine. Lack of sun exposure is only part of the rickets equation. Vitamin D deficiency is likely caused by imbalanced flora. I
t's not a matter of absorption via diet, though it's interesting that mushrooms exposed to sunlight become vitamin D bombs. Diet is important because it can shift flora in the right direction. But vitamin D experts promoting sunshine and supplements are missing the microbial target. Flora such as fungi produce the precursors of vitamin D biosynthesis, ergosterol, and they also probably consume it leading to deficiency. Bacteria produce enzymes responsible for vitamin D degradation, methyltransferase. Peer-reviewed papers reveal bacteria dysregulate vitamin D receptors. Vitamin D is an important rallying point for improved sanitation because it's responsible for calcium absorption where intracellular calcium activates the immune system to balance flora. Intracellular calcium is also needed to mineralize bone, the problem in rickets. The problem in England hasn't been seen since the 19th century when sanitation was abysmal. London still has an overflowing Victorian sewer system. Refined carbohydrate diets, poor sanitation, vaccination and antibiotic abuse create a perfect storm for rickets, obesity, diabetes and autism via shifting flora.

Microbes are affected by light. I believe UV-microbe interaction is the reason we're able to make vitamin D via skin. But like diet, light is secondary to flora. We have polluted the world's microbiome, shifting the balance. We need to retain and repair what we have to prevent these environmental health problems. This means the end of mixing waste with water, the ultimate in non-kosher.

Microbial overgrowth in the body leads to a condition called metabolic acidosis associated with all disease. Microbes both produce and absorb carbon dioxide leading to high acid blood. Because of this high prevalence of acidosis, alkalizing our bodies is a major health trend. There's an inverse relationship, however, between gut-brain pH and overall body pH, meaning we need a high acid gut-brain to have a healthy alkaline body. Small intestinal bacterial overgrowth (SIBO) leads to a low acid gut. This leads to a cascade of problems known as metabolic syndrome including mental health challenges.

Acidosis is a warming, low oxygen condition where microbes produce toxins. The same dynamic in our bodies takes place in bodies of water known as ocean acidification. It's the "other" global warming based on sewage pollution and livestock waste entering water supply. These nutrients polluting water supply cause explosive microbial overgrowth such as algae blooms belching carbon dioxide. Algae absorb carbon dioxide from air pollution, but they also compound it in water. This is a significant, overlooked cause of global warming and rising seas.

Consider your body as a walking brewery where sugars and starch change the balance. That's where diet is important. But the diet we're feeding our rivers, lakes and oceans is raw and poorly treated sewage.
Wastewater treatment plants purposely multiply the wrong kinds of microbes in the name of sanitation causing further imbalance. Things like ciliate protozoan cysts, worm ova and clostridium spores laugh at chlorine used in municipal drinking water treatment. Ciliates, also known as "free-swimmers" are multiplied to lower bacterial counts (that's what they eat), making sludge legal for disposal. But these ciliates are likely entering our bodies, one example of creating imbalance as they rapidly consume commensal bacteria allowing yeast overgrowth. Bacteria would normally control fungi.

Even dolphins now have diabetes per recent studies. How interesting that gastric bypass surgery rapidly halts diabetes via removal of infected duodenum, the first section of small intestine after the stomach.

My hometown of Chicago is being sued for sending its sewage down the mighty Mississippi River into the Gulf of Mexico. This leads to an acidic, toxic, low oxygen Dead Zone where female fish develop testes.

Hormonal aspects of this pollution are barely on the map. All steroid hormones are derived from cholesterol and its metabolite, coprostanol, excreted from everyone's intestines, the subject of my next blog post. After that we'll explore gene-microbe interaction where poor sanitation and health choices lead to genetic mutation from which there is no return.

Supporting links may be found in these photo comments:
Ocean Acidification:
Rickets and Vitamin D Deficiency:
Our Bodies Are Ecosystems like bodies of water:
Sanitation Is Sanity:
Apr 29th

Why I love my bike!

By charlotte holm-hansen

Denmark is usually thought, as a very green, environmental and sustainable society, and the image of a typical Dane, I would imagine, would be on a bicycle. Indeed that is very true when it comes to the major cities, such as Copenhagen, Aarhus and Odense, and it’s suburban areas, but the rest of the country is lacking behind. The infrastructure is indeed very different from the cities; with longer distances so of course a challenge. This means that in the countryside (majority of Denmark) – EVERYONE has a car, there are almost no carpooling possibilities, and the public transport is less frequent, expensive and just not being used by the community.

In the center of one of the major cities, obesity is rare, the general urban population is fit, in good health, and that is partly because of the bike ride to and from the office, but of course many other factors play a role. Even though the social inequalities are less than in most countries, there is still major differences in all aspects of life, including supply of goods. The other day I was an hour outside of Copenhagen, and went into a supermarket to pick up lunch, and the difference in supply was so striking, that I almost couldn’t believe it. Usually salads would be easily available, but here the only possible lunch was something from the deli, where basically everything was fried, consisting of meat, or if I preferred - a pizza or a kebab. I had a look around, and the whole foundation of the supermarket was different, of course it’s supply and demand, but can the demand really be so different? The greens department was much smaller, and the area with coolers and ready-made food, was much larger, there were tons of soda, and I have never seen such a big area with candy. Even in the dairy section, the majority of the yoghurts where the unhealthy ones, with a lot of added sugar and so on. It all made me think about Ian Roberts book “The Energy Glut”, and how we don’t have to carry our own food home, and thereby can take home much larger quantities than needed.

In Denmark we face the inequalities in health with health promotion, education and frightening campaigns, but is that really the best way to deal with these challenges? At the end of the day it’s an environmental problem, and I would argue an exacerbater of underlying social conditions, but the question is how do we make the connection clear to our politicians?

Apr 26th

Healthy Planet, Healthy Hospitals, Healthy People

By Alejandra Livschitz
Gary Cohen

In the age of climate change, the health sector finds itself on the front lines, confronting and adapting to a changing landscape and shifting burden of disease. By working to reduce carbon pollution in the atmosphere, while developing forward looking adaptation strategies, we can protect human health, saving lives and money. Indeed, the health sector can play a leadership role in developing and modeling climate solutions for the rest of society.

In an article published by Forbes, HCWH Founder and President, Gary Cohen, discusses the connection between health care and climate change, the need for hospitals to model the transition to a post-fossil fuel economy and become leading climate advocates. Read the article here.

Read the 'Healthy Hospitals, Healthy Planet, Healthy People' report, which was put together by the WHO and Healthcare Without Harm, here.

If you are interested in being informed on the latest developments, trends, resources and events around the world, sign up to receive HCWH Climate and Health News Service.
Apr 25th

UK Carbon emissions have been going down?

By Hugh Montgomery
Not really.  They have been rising!
Apr 16th

A new website to help visualise the health effects of climate change

By Climate and Health Council is a great new site summarising evidence the impacts of climate change on health in 4 domains - heat, UV, pollens and air pollution - in a visual and interactive way. These aren't the only important areas within which climate change impacts health by any means, but they are all relevant

The science behind these statistics is explained in much greater depth - along with other threats such as infections and emergencies, like dengue and drought -in the Atlas of Health and Climate from whose 'emerging environmental threats' section they are derived.  This is a joint report by the World Health Organisation (WHO) and the World Meteorological Organisation (WMO) - video here.
Apr 16th

Coal and Health

By Hugh Montgomery
'Control-Click' to open links..

Coal Combustion Poses Serious Risks to Human Health, Review Finds

Source HCWH and UIC

A new scientific review, Scientific Evidence of Health Effects from Coal Use in Energy Generation, has been released by researchers from the School of Public Health at the University of Illinois at Chicago (UIC). The pollutants generated from coal combustion have profound effects on the health of local communities but can also travel long distances, affecting communities remote from power plants, according to the review. This scientific literature review is a new initiative of the Health Care Research Collaborative based at UIC and carried out in conjunction with Health Care Without Harm, and is part of a project to evaluate the health impacts and healthcare costs of energy generation choices across a number of countries.  download report

India: New Study Finds Emissions from Coal Plants Cause High Mortality and Diseases

source Urban Emissions

Emissions from coal-fired power plants are taking a heavy toll on human life across large parts of India. In 2011-2012, coal emissions resulted in 80,000 to 115,000 premature deaths and more than 20 million asthma cases from exposure to a total PM10 (particulate matter) pollution. Titled Coal Kills — An Assessment of Death and Disease caused by India's dirtiest energy source, by Urban and Greenpeace India, with support from Conservation Action Trust (CAT), the study says emissions from coal-fired power are responsible for a large mortality and morbidity burden on human health. download

Europe: How is Coal Pollution Making Us Sick?

source HEAL

A new report launched by the European NGO, Health and Environment Alliance (HEAL) aims to provide an overview of the scientific evidence of how air pollution impacts health in Europe and how emissions from coal power plants are implicated in this. It presents the first-ever economic assessment of the health costs associated with air pollution from coal power plants in Europe as well as testimonies from leading health advocates, medical experts and policy makers on why they are concerned about coal. The report develops recommendations for policy-makers and the health community on how to address the unpaid health bill and ensure that it is taken into account in future energy decisions.  download report