Health and Environment – What are the issues and impacts

Every year, in the world, there are approximately 13 million deaths due to the environment and 7 million premature deaths due to poor air quality. Cancers, diabetes, chronic respiratory diseases, cardiovascular diseases, obesity… these chronic diseases known as “civilization” have become in a decade one of the main causes of death in Europe. They are also responsible for many years of life lost in good health. As these chronic diseases are not only linked to the genome, the concept of exposome was born in order to study the impact of the environment on health from conception to the end of life of an individual.

Unfortunately, our genes can’t bear all the responsibility in the development of these diseases ; “US” are responsible of this situation or more particularly it is our lifestyle and our environment the guilty ones. Therefore, the study of the exposome allows to better apprehend the impact of pollutants but also life habits on health and to implement targeted prevention actions. With the implementation of prevention actions the environment is the key to a better health ! For example, 40% of cancers in France could be avoided by following the prevention actions.

What do we call non-communicable, civilisation or chronic diseases ?

Non-communicable diseases, diseases of civilization and chronic diseases include long-term diseases that generally evolve slowly and are linked to lifestyle; they cannot be transmitted from one person to another.

Cardiovascular diseases, chronic respiratory diseases, metabolic diseases (diabetes, obesity…), cancers, certain neurodegenerative diseases… are included in these terms. The increasing incidence of these diseases is linked to the increase in life expectancy but this does not explain everything. They are mostly caused by environmental and lifestyle factors.

The environment to which an individual is exposed since conception (exposome) can have a preventive or negative effect on the development of these diseases. A disease can be treated but not necessarily cured, so life expectancy is less impacted than life expectancy in good health*.

A disease can impact daily activities and productivity at work without causing the death of the patient. The costs to society are not negligible. In France, life expectancy in good health is approximately 63.5 years, while life expectancy is 82 years.

It should be noted that in the past, these diseases did not affect developing countries and were the prerogative of the countries of the North. However, with globalization, urbanization and the export of the Western way of life, countries that were previously spared are now affected.

*Life expectancy corresponds to the number of years lived between birth and death of an individual, whereas life expectancy in good health represents the number of years lived in good health only. Thus, the life expectancy in good health is at most equal to the life expectancy.

Causes and consequences of this diseases

• The behaviors at individual scale 

ome factors linked to the lifestyle such as physical activity, diet, Tabasco and alcohol, have a very big influence on the development of chronic diseases. The World Health Organization (WHO) valued thatan increasing physical activity, a healthier diet and smoking cessation would allow to avoid up to 80% of maladies coronariennes, 90% of type 2 diabetes cases and 30% of any cancers. 

The physiological factors including blood pressure, lipidemia and weight … are indicators diseases development risk..

• The socio-economic status

The socio-economic status is also impacting, the inequalities in terms of health matter are an omnipresent and universal phenomenon. In every countries giving data, the early mortality and life expectancy are socially unevenly distributed. At a disadvantage socioeconomic status corresponds to a high mortality and a low life expectancy. The prevention politics must take into account this phenomenon to reduce the inequalities in health matter.

• The physical activity

The physical activity and the sedentary decrease are primordial to reduce the diseases risks. For example, large cohort studies suggest that a regular physical activity leads to a decrease of cancer risk at about 50% for colon cancer and at about 15% for breast cancer.

• A balanced diet

A balanced diet, slightly transformed, composed of fruits, vegetables and legumes is beneficial to prevent civilisation disease development or there complication. A balanced diet allows to preserve the balance of intestinal microbiota and therefore have a protector effect. Studies have shown an alteration of the microbiota in case of obesity, dementia, neurodegenerative diseases, IBD… but without being able to determine if it was a cause or effect of these diseases. To balance the population’s diet would allow to avoid 5.4% of cancers.

• Tobacco and alcohol

Tobacco is the first cause of lung cancer. It is also implied in numerous other diseases (cardiovascular, respiratory diseases …). The consumption of alcohol in big quantities (more than 3 glasses per day for men and 2 for women) is responsible of more than 200 diseases and various impairments including hepatic, cardiovascular, neurological complications as well as cancer. Alcohol is the 2nd cause of early deaths in France

Pollution impacts health, it is a fact, but each pollutants don’t have the same action and some of them will only have an effect on the next generation. 

The parameters to take into account to understand the pollution impact on health are :

• The concentration to which an individual is exposed
• The duration of the individual’s exposure to this pollutant
• The life window of the individual (infant, children, adult, womban of childbearing age, pregnant woman, elderly persons…)
• The type of pollutants and its known impacts, (endocrine disruptor, carcinogenic, mutagenic, reprotoxic, toxic…)  

The atmospheric pollution 

The commonly measured pollutants are particulate matter, the ozone, the NOx, Sox,the pollens, the radon, the volatile organic components, the pesticides … In general, these pollutants can be the origin of respiratory diseases or worsening of respiratory pathologies (asthma, BPCO…), they weakened the respiratory tracts on the long term.

Radon is a carcinogen recognized and the 2nd cause after cigarette, lung cancer (9.8% of the cases).

Furthermore, these pollutants are also linked to a worsening or development of cardiovascular diseases (hypertensions, stroke …).

A chronic exposure since childhood can therefore have deleterious effets non negligible on health. This pollution concerns as mush outdoor air pollution (with as principal sources : trafic, industrial sites, wood heating, agriculture…) as indoor air (new furniture, paint, household products, dust, candles, perfumes…)

The endocrine disruptors 

The endocrine disruptors are a special case, they include a very large amount of chemical components that we can find :

• In the air (the pesticides in the air that we breath …)
• In food (chemical treatment, additives, kitchen tool, food packaging…)
• In water (pesticides in water, drug residues…)
• In contact products (cosmetic products, household products…)  

An endocrine disruptor (PE) acts at very low concentrations and disturbs the hormonal system. The PE characterizes itself by not a direct toxic effect, but indirect, via the physiological modifications that they generate ; the life window during exposure has its importance, the exposure of a pregnant woman to PE may have an impact on her baby.

The consequences for the organisme are specific to PE and can be the followings : alteration in reproduction function, malformation of reproductive organs, tumors development in tissues that produce or target hormones (thyroids, breast, testicules, prostate, uterus…), disturbances in the functioning of the thyroid, the development of the nervous system and the cognitive development.

Food risks 

The impact of diet on health is very large and numerous components are at stake. The effects of the various components aren’t all documented and their risk is therefore not recognized on this day. This may concern :

• The pesticides consumed via treated fruits and vegetables -Food additives added in ultra-processed food
• The nanoparticules
• Food inonisation / irradiation (no recognized impact on health)
• Drug residues 

The additives can have various effects on health, going to a hyperactive risk for children to carcinogenicity ; for example the nitrites very present I cold meat are suspected to be carcinogenic. To avoid ultra-processed food is to avoid additive consumption. 

The food ionisation consistes in exposing them to ionizing radiation in order to reduce the number of microorganisms that they contain and unfortunately at the same time the vitamins and amino acids. The indirect effects on health are debating because the treatments lead the formation of components whose harmlessness is still poorly documented. In France, any ionized commodity must bear the mention “treated by ionizing radiations” or “Ionized treated”. In practice, this signage hardly ever appears to the consumer to in the extent where the irradiated ingredients are most likely to be incorporated in prepared dish where they are mixed with others that are not irradiated. The authorized food to be ionized in France are the dried aromatic herbs, spices, poultry meat, shrimps, dry vegetables and fruits, rice flour, the germs and cereal flakes, frog legs and vegetable condiments.

Some foods contain nanoparticules (<100m), coming from some addition of additives, and these particules can passe the intestinal fence generating effects on the organisme still poorly documented. Eating slightly transformed food allows to avoid ingestion of nanoparticules coming from certain added additives. Animal health, in a One Health optic, has its importance since the use of antibiotics in breedings can lead to antibiotic resistance phenomenon, the bacterias become resistant and antibiotics no longer have any effect. Furthermore, it makes you consume antibiotics residues without our knowledge. The diet given to animals has also an impact on consumers, the scandal of the crazy cow is an example. Cattle were nourished with animal flours obtained from animal carcasses and corpse. The disease touching firstly cattle has been transmitted to human during the consumption of infected animal meat. Acting to preserve animal health it is also preserving human health.

Newly formed compounds 

Newly formed compounds are usually let behind however their impact is reel. A newly formed compound is a component that forms itself during the transformation of the product concerned.

To cook food at high temperature and weak humidity (chips, fried, bread, cakes …) leads to acrylamide formation (réaction de Maillard) but acrylamide is ranked as a probable carcinogenic by the CIRC.

As far at that goes, the meat (mostly fatty meat) cooked on the grill and somewhat a little bit charred (black residue) ingest heterocyclic amines (HCA) and polycyclic aromatic hydrocarbures (PAH) that are cancer-gene substances.

Furan is a volatil component which is formed during refining of vegetables oils. The newly formed compounds aren’t mentioned on the product’s packaging, only prevention actions at informative aim can allow the consumers to identified the recognized health risks of these substances.  

Microbiote intestinal

The consequences of diseases or behaviors come above the development of a pathology. For example, in the case of an unbalanced diet or obesity or IBD (Chronic Inflammatory Bowel Disease) the intestinal microbiota is altered : causes or consequences of these diseases or behaviors it is not decided ! But what is known is an imbalance in a microbiota can impact immunity, the digestion, the metabolism and the neurological functions.

• The epigenetic

The environment, and more generally our expositions and habits, can generate epigenetic modifications that are transmissible at the descent. Unlike the DNA genetic code the epigenetic modifications sont reversible.

The epigenetic modifications are induced by the environment at large. These signals, including the ones linked to our behaviors (diet, smoking, stress…), can conduct to modifications in the expression of our genes, without affecting their sequence. The phenomenon may be transient, but there are epigenetic perennial modifications, that persist when the signal that induced them disappears.

The precautionary principle and the general decrease of the pollution are necessary to prevent the diseases mostly in the case where the environmental causes and their impacts are still poorly documented 

Pediatric cancers

An anormal high number of pediatric cancers has been outnumbered at St-Pazanne a little town in Loire-Altlantic. 9 children have been affected by cancer since December 2015. The causes of such important quantity of cancers linked one of the environmental causes. ARS has therefore launched extensive investigations (water analysis, air quality, radon, radiations, electromagnetic waves …). Despite the searches and measures of numerous environmental factors no probative element explaining these cancers has been determine to this day.

Children born without arms in Loire-Atlantic, Morbihan and Ain 

The census of a few suspected cases of armless, handless new born (excess cases in a same geographical zone), interrogating on this rare malformation, to undetermined causes. One thing is certain, this type of malformation is not genetic origin hence the research of environmental causes. The investigations are led on toxics like the exposure to some positives. The results aren’t published yet.

Lubrizol fires 

The Lubrizol fires is in a particular pollution context since the population has been exposed, on the short term and will be on the long term, to pollutants (dioxine, furans, PCB, PAH, metal elements, fine particles, flame retardant phthalates…). On the short term the exposition to high concentrations could drive to acute symptoms like cough, difficulty breathing, tearing, digestive problem, feeling dizzy …

The sanitary impacts on the long term need soil contamination analyzes, food products, and the air quality. The objectif which is to take sanitary measures to reduce the health risks on human and animal health (in the case of breeding). The vegetal productions declared unsuitable to consumption after the soot fallout have been destroyed. The required sanitary measures to preserve health can be taken as the results of the analyzes

Covid-19

Epidemics like Covid-19 are also linked to environment even if it is indirect. Civilisation diseases are comorbidity causes in this epidemic (obesity, respiratory diseases, cardiovascular diseases, diabetes …). Furthermore, it has been shown that the air pollution (on the long term) played on the virulence ; the persons that are subjected to a chronic exposure to air pollution have a respiratory system more weakened (inflammation) and were more impacted in the case where they contracted the virus. A letter implying more than 250 international scientists calls WHO to recognize that the virus can stay in the air a few hours after an infected person has passed and that this may be a transmission mode to investigate and not to neglect. Therefore, the rule for a good indoor air quality that consists in ventilating regularly closed spaces takes all of its sens. 

These few current examples show at what point the environment and health are linked and this more or less directly. We can also note that the routes of exposure are multiples (ingestion, inhalation, contact) juste like the effects and that the impacts can be visible at long or less long term. 

Social responsability

Changing the behaviors can only be at individual scale, indeed the collectivities, governments and the industrials mus also get involved.

Within the framework of projects on a European scale are financed, it is the case of H2020 (Horizon 2020) program and the new “Europe Horizon” program that allow the emergence of projects on the study of the exposome at big scale (cohort of 32 000 mother-daughter pairs for the projet HELIX for example). It is therefore possible via these studies to do the link between exposome and asthma or exposome and cancer  and this while studying the individual’s exposure since their growth in-utero.

The concept of exposome is also part of the French law since  the term has been integrated in the 1rst article of the public health law adopted in April 2015 by the National Assembly. The 1rst axe of the PNSE 4 (Plan National Santé Environnement) est basé sur la notion d’exposome « is based on the notion of exposome “Better know the exposures and the environmental effects on population health”. 

After the study the actions must follow. The actions can be can be as prevention for individuals but mostly they should be at national level, or collectivities/ industrials. For example, to reduce the pollution linked to trafic and by the same occasion the lack of physical activity. The development of cycle paths and bike stations in town is a solution. Furthermore, the industrials must also continu their re-composition of food products efforts. For example, reducing the number of additives, the fats of low nutritional quality, salt and sugar added without substituting the sugars by intense sweeteners or by ingredients containing sugars (such as musts, concentrated fruit juice, honey, etc.).

Public powers can act : 

• By limiting the disponilility of nutritional quality products poor in automatic distribution and particularly on all education and teaching places. 
• By making mandatory the disponilility of manufactured product composition data… 
• By thinking of the establishment of targeted regulatory measures on the principal sugar, salt, saturated fat, added additives, in order to act in a controlled scheduled, on the number of concerned products and the level of contents of addiction decrease. 

At the municipal or company level, the canteens must continue their efforts to propose biological products and vegetarian meals. The society has its part of responsibility in the development of civilisation diseases and the cause of this spread could rely only on individual responsibility. To start with actions at community scale has shown its efficiency in projects led on American towns (Albert Lea, Minnesota ; Beach Cities, California…).

At a more localized scale the indoor air quality surveillance (IAQ) is mandatory in maternity and elementary schools also in nurseries since 1rst January 2018, and in leisure centers, colleges and high-schools since the 1rst January 2020. Environmental and sensibilisation actions also allows to establish a virtuous circle between health and environment since environment influences human health but the human generally impact their environment. Each action must be thought in a “One Health” optical that is to say “one health only” therefore regrouping human, environmental and animal health. 

Individual actions (legend of the suricate

Some actions to preserve health can already be taken at the individual level and have a significant impact. Avoid smoking, protect yourself from UV rays, include vegetables and fibers in your diet, be physically active, limit your alcohol consumption to one or two drinks, reduce your stress… Small preventive actions held on the long term rather than big changes on the short term are better to preserve your health.

Human interventions alter the capacity of ecosystem in providing their goods (ex. pure water, food, Pharmaceutical goods, etc.) and services (ex.purification of the air, water and soils, the sequestration of pollutants, etc.). The disturbance of the ecosystem can have repercussions on one’s health in many ways and according to a complex sequence.  The establishment of a virtuous circle human-environment and environment-human is the challenge to take-up to be able to respond to tomorrow’s problem namely the emergence of virus, antibiotic resistance, the increase of chronicle diseases, the loss and transformation of some nutriments (for example the gluten which the digestibility has diminished) in food… 

Meersens analyze the quality of your environment

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