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The Problem

• A century of change in natural, built and social environments has caused major changes in the patterns and distribution of diseases.
• We are seeing dramatic increases in chronic diseases, and at younger ages, many of which, such as diabetes, are themselves risk factors for dementia.
• The over-65 population will nearly double by 2030 to more than 71 million, sharply increasing the number of people at risk of chronic diseases of aging like Alzheimer’s and Parkinson’s diseases, among others.
• Environmental factors play a key role in health across the lifespan. Thus they offer a major prevention opportunity.

The report Environmental Threats to Healthy Aging explores these factors in depth. A brief preview of some of the issues covered in the report follows. 

Environment Drives Chronic Disease

Research shows that environmental risk factors – including diet, exercise, exposure to environmental chemicals, air pollution, and stress related to social and economic circumstances, across the lifespan – as well as these factors interacting - can play a major role even in people who are genetically predisposed to certain health problems. An ecological approach to healthy aging across the life span that considers the built, food, chemical, psychosocial and socioeconomic environments and their individual as well as interacting influences on health is needed to truly create the conditions for health from fetal life through the end of life.

Environmental Factors >>> Altered Pathways >>> Chronic Disease

This slide illustrates the relationship between environment and chronic disease in graphic form. On the left we see the environmental drivers, and on the right, the chronic diseases. In the middle you'll see listed the main biological mechanisms that link these environmental factors and chronic diseases – inflammation, disrupted insulin signaling and oxidative stress. We refer to these chronic diseases as the "Western Disease Cluster" because they occur in societies that have adopted western lifestyle (usually including diet, inactivity and chemical exposures), and because the diseases tend to co-occur. When industrializing societies start to develop one of these diseases, they generally develop them all. And when individuals develop one of these diseases, they tend to be at increased risk for the others as well.

The diseases of the Western Disease Cluster also cluster together within the condition known as metabolic syndrome. This, by definition, consists of the early stages of the other cluster diseases –  namely increased waste circumference, borderline elevation of blood sugar (without symptoms of diabetes), borderline hypertension (high blood pressure); and abnormal blood lipids – including increased LDL cholesterol and triglycerides, and/or decreased HDL cholesterol. Having any three of the six conditions meets criteria for the diagnosis of metabolic syndrome. Having metabolic syndrome increases the risk of developing frank diabetes by 3.5 – 5 fold, of cardiovascular disease 1.5 – 2 fold, and death from any cause by 1.3 – 1.6 fold. (9,10,11,12) Children with metabolic syndrome are 15 times more likely to have cardiovascular disease as adults.(13)

Interestingly, each disease in the cluster is a known or emerging risk factor for cognitive decline, dementia, and Alzheimer’s disease. Recent studies have found that each of these diseases approximately doubles the risk of dementia, and that the effects were additive. (14, 15)  

Parkinson’s disease is shown separately from the Western disease cluster because it has not been shown as of this time to co-occur with these other diseases. 

Multiple Factors Interact to Influence Health & Disease

This figure illustrates some of the interacting factors in the modern chemical, nutritional, social and built environments that may be contributing to neurodegenerative disease. There are inflammatory nutrients coming from industrial food production, processing and distribution, and diets changing for the worse. There are socioeconomic factors like low income, lack of access to health care, stress and depression. There is exposure to a multitude of environmental toxicants, and a built environment that discourages healthy living.  All of these things promote neuro-inflammation, oxidative stress, and cognitive decline. The vulnerability of a given individual to any of these factors will depend on how these factors interact over time in the “sea of conditions” affecting the individual – including her/his genetic make-up.
 
It also reveals good news ands that there is much that we can do to avoid or delay chronic health problems – as a society, as individuals, and as family members. By adopting an ecological approach to addressing environmental risk factors, particularly cumulative stressors and their health impacts, we can potentially delay the onset or prevent neurodegenerative and other chronic diseases as well as avoid exacerbating the health conditions of those with disabilities.

Solutions for Healthy People and a Healthy Planet 

Major Illnesses Are Preventable: Personal Actions to Reduce Risks

Personal-level approaches to healthy living:

• Eat healthy – whole, fresh, unprocessed, plant-based foods
• Avoid toxicants whenever possible
• Exercise
• Be socially engaged

Major Illnesses Are Preventable: Policy Initiatives to Profoundly Reduce Risks

• Localized, diversified and sustainable food production
• Clean, renewable energy leads to lower air pollution, chemical exposures
• Mass transit that connects with bike paths and sidewalks can reduce air pollution & obesity
• Chemical regulatory reform
• “Safer substitute” programs and green product design leads to lower toxic exposures, ecosystem, wildlife contamination; job creation
• Universal health care leads to disease prevention & equitable health care

Examples of Specific Initiatives

Nutrition – Reform agricultural subsidies to be directed toward programs and practices that provide sufficient nutritious, sustainably-produced food and restore ecosystems that have been degraded by agricultural activities.

Toxic Chemicals – Reform the national Toxic Substances Control Act to include phase out of persistent, bioaccumulative, or highly toxic chemicals.

Activity/Nature – Incorporate indoor and outdoor green spaces and exercise areas into designs of nursing homes and assisted living facilities.
 

EPA's Kathy Sykes, Dr. Jill Stein, and Dr. Danny George
after speaking at APHA session on healthy communities for aging.

References

(1) Hotu S, Carter B, Watson PD, Cutfield WS, Cundy T. Increasing prevalence of type 2 diabetes in adolescents. J Paediatr Child Health. 2004 Apr;40(4):201-4.

(2) http://www.cdc.gov/obesity/data/trends.html Accessed 5/28/10

(3)  Short KR, Blackett PR, Gardner AW, Copeland KC. Vascular health in children and adolescents: effects of obesity and diabetes. Vasc Health Risk Manag. 2009;5:973-90. Epub 2009 Nov 16.

(4) Gupta R, Misra A, Vikram NK, Kondal D, Gupta SS, Agrawal A, Pandey RM. Younger age of escalation of cardiovascular risk factors in Asian Indian subjects. BMC Cardiovasc Disord. 2009 Jul 5;9:28.

(5) Hebert LE, Scherr PA, Bienias JL, Bennett DA, Evans DA.  Alzheimer disease in the US population: prevalence estimates using the 2000 census. Arch Neurol. 2003; Aug; 60(8):1119-22.

(6) World Health Organization. Neurological disorders: public health challenges. Geneva, Switzerland. February 2007. Available at: http://www.who.int/mental_health/neurology/neurodiso/en/index.html. Accessed 3/20/07.

(7) Dorsey ER, Constantinescu R, Thompson JP, et al. Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030. Neurology 2007; 68: 384-386.

(8) U.S. Dept. of Health and Human services, Administration on Aging. http://www.aoa.gov/AoARoot/(S(f5rz34zowqggwq55wtokl0f4))/Aging_Statistics/index.aspx. Accessed 5/28/10

(9) Ford ES; Li C; Sattar N  Metabolic syndrome and incident diabetes: current state of the evidence. Diabetes Care. 2008 Sep;31(9):1898-1904. Epub 2008 Jun 30.

(10) Gami AS et al. Metabolic syndrome and risk of incident cardiovascular events and death: a systematic review and meta-analysis of longitudinal studies. J Am Coll Cardiol. 2007 Jan 30;49(4):403-14. Epub 2007 Jan 12.

(11) Galassi A; Reynolds K; He J  Metabolic syndrome and risk of cardiovascular disease: a meta-analysis. Am J Med. 2006 Oct;119(10):812-9.

(12) Ford ES Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. AU Diabetes Care 2005 Jul;28(7):1769-78.

(13) Morrison JA, Friedman LA, Gray-McGuire C. Metabolic syndrome in childhood predicts adult cardiovascular disease 25 years later: the Princeton Lipid Research Clinics Follow-up Study. Pediatrics. 2007 Aug;120(2):340-5.

(14) Biessels GJ, Risk of dementia in diabetes mellitus: a systematic review. Lancet Neurol. 2006 Jan; 5(1):64-74.

(15) Kivipelto M, Obesity and vascular risk factors at midlife and the risk of dementia and Alzheimer disease. Arch Neurol. 2005 Oct; 62(10):1556-60.