Notes on Engineering Health, February 2021: Climate and Health

Jonathan Friedlander, PhD
Geoffrey W. Smith

Jonathan Friedlander, PhD & Geoffrey W. Smith

February 28, 2021

Alarm would certainly be a reasonable reaction to the challenges posed by climate change (cf., David Wallace-Wells in his now infamous New York Magazine article). The obvious truth is that the effects of a warming climate can already be felt today, and the consequences for the healthcare industry need to be addressed quickly, as things are bound to get worse especially for the most vulnerable among us.

Measuring the effects of climate change and pollution on health is hard but the consensus is that they are overwhelmingly negative. To understand the ramifications of a worsening climate crisis, it is useful to make a distinction between the impact on health and on healthcare delivery. Adding to the voices of the World Health Organization, the Centers for Disease Control and Prevention, and the US Federal government to name a few, The New England Journal of Medicine published a remarkable guide to the climate crisis and its impact on health laying out dozens of studies (all published by the journal) showing effects in nearly every medical specialty. The most fragile populations, such as children, pregnant people, and the elderly, are unsurprisingly the most at risk from extreme weather and rising heat.

The NEJM guide also outlines the danger of a shifting climate on care delivery, especially around cost, utilization, and disruption of care. Many examples from the guide detail the disruptions in care delivery stemming from extreme events such as Hurricane Sandy in NYC or Hurricane Maria in Puerto Rico. Although the circumstances, wealth, and populations were vastly different in the two occurrences, important lessons about how to better prepare and how to build a more resilient system can be drawn from both. A more recent example is what happened in Texas over the last week. Not only did the cold wave endanger patients locally through power outages, but it disturbed vaccine distribution throughout the US, highlighting once more the weaknesses of an infrastructure built in and for another age.

Two recent publications also highlight the scale and ingenuity of studies required to accurately measure and address negative effects of different parts of the climate change problem such as air pollution. In the first publication from 2017, the authors conducted a nationwide cohort study involving all Medicare beneficiaries from 2000 through 2012 — a population of 61 million, with 460 million person-years of follow-up. This monumental undertaking found that health was negatively impacted by exposure to small particles and ozone at concentrations even below current national standards, with the burden falling more heavily among self-identified racial minorities and people with low income. The second publication from last month aimed at developing a method to identify epigenetic markers of prenatal exposure to air pollution.

The otherworldly images from Perseverance on the surface of Mars this week provide an important reminder of the uniqueness of the habitability of the planet we call home, and the need to protect it and all of us on it from the continued encroachment of climate change.

Jonathan Friedlander, PhD & Geoffrey W. Smith

First Five
First Five is our list of essential media for the month which will span a range of content including scientific papers, books, podcasts, and video. For our full list of interesting media in health and science, updated regularly, follow us on Twitter or Instagram.

1/ Medicine For Each of Us
The era of individualized medicine is beginning to become a reality and FDA has issued draft guidance addressing submission processes for certain hyper-specialized treatments.
(Endpoint News)

While tailored therapies are appealing, we need to also guard against being overwhelmed by the “incidentalome” arising out of our increased usage of genome-scale screening tests as part of our drive to treat each patient as an N of 1.

2/ All Virus, All The Time
While we may all be fed up with the overwhelming impact of the COVID virus on our lives, certain other parts of the viral world hold out the hope of a new class of therapeutics.
(The New Yorker)

3/ Nutrition Nutrition Nutrition Nutrition
The myriad and complicated ways that nutrition impacts health continues to drive new findings which seem to have particularly caught the attention of the folks at Nature:
– Changes triggered by obesity help to give tumour cells the upper hand in the struggle for nutrients. (Nature)
– Western diet is one of the major causes underlying diabetes, and the microbes residing in the gut playing a critical role in mediating the effects of diet. Here the authors utilize network analysis to discover two species of Lactobacilli decreased by western diet, which improve glucose metabolism and restore of hepatic mitochondria in mice. (Nature Communications)
– In mice, oral tolerance to food antigens can break down after enteric infection, and this leads to food-induced pain resembling irritable bowel syndrome in humans. (Nature)
– Increasing compositional uniqueness of the gut microbiome, and corresponding changes in microbial metabolites in the blood, are identified as a signature of healthy ageing in humans. (Nature Metabolism)

4/ When I’m Sixty-Four
Even at a young age, the Beatles knew growing old isn’t all that easy. But, it turns out that exercise (Nature Communications) helps with metabolism and controlling inflammation aids cognition (Nature) in the aged and aging. And, eating chocolate may in fact be on the list of must do’s
(Scientific Reports)

5/ Just Bonkers
We are living in a time of incredible technology…
(Nature Communications)

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