Publications by authors named "Philip J Landrigan"

176 Publications

Air pollution and development in Africa: impacts on health, the economy, and human capital.

Lancet Planet Health 2021 Oct;5(10):e681-e688

Global Public Health and the Common Good, Boston College, Chestnut Hill, MA, USA.

Background: Africa is undergoing both an environmental and an epidemiological transition. Household air pollution is the predominant form of air pollution, but it is declining, whereas ambient air pollution is increasing. We aimed to quantify how air pollution is affecting health, human capital, and the economy across Africa, with a particular focus on Ethiopia, Ghana, and Rwanda.

Methods: Data on household and ambient air pollution were from WHO Global Health Observatory, and data on morbidity and mortality were from the 2019 Global Burden of Disease Study. We estimated economic output lost due to air pollution-related disease by country, with use of labour income per worker, adjusted by the probability that a person (of a given age) was working. Losses were expressed in 2019 international dollars and as a proportion of gross domestic product (GDP). We also quantified the contribution of particulate matter (PM) pollution to intelligence quotient (IQ) loss in children younger than 10 years, with use of an exposure-response coefficient based on previously published data.

Findings: Air pollution was responsible for 1·1 million deaths across Africa in 2019. Household air pollution accounted for 697 000 deaths and ambient air pollution for 394 000. Ambient air pollution-related deaths increased from 361 000 in 2015, to 383 000 in 2019, with the greatest increases in the most highly developed countries. The majority of deaths due to ambient air pollution are caused by non-communicable diseases. The loss in economic output in 2019 due to air pollution-related morbidity and mortality was $3·02 billion in Ethiopia (1·16% of GDP), $1·63 billion in Ghana (0·95% of GDP), and $349 million in Rwanda (1·19% of GDP). PM pollution was estimated to be responsible for 1·96 billion lost IQ points in African children in 2019.

Interpretation: Ambient air pollution is increasing across Africa. In the absence of deliberate intervention, it will increase morbidity and mortality, diminish economic productivity, impair human capital formation, and undercut development. Because most African countries are still early in development, they have opportunities to transition rapidly to wind and solar energy, avoiding a reliance on fossil fuel-based economies and minimising pollution.

Funding: UN Environment Programme.
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http://dx.doi.org/10.1016/S2542-5196(21)00201-1DOI Listing
October 2021

It's Time to End Lead Poisoning in the United States.

JAMA Pediatr 2021 Sep 27. Epub 2021 Sep 27.

Department of Neurology, Harvard Medical School, Boston, Massachusetts.

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http://dx.doi.org/10.1001/jamapediatrics.2021.3525DOI Listing
September 2021

Authors' response to Ashley Roberts' letter to the editor on aspartame and cancer.

Environ Health 2021 Sep 21;20(1):107. Epub 2021 Sep 21.

Program for Global Public Health and the Common Good, Boston College, 140 Commonwealth Avenue / Higgins Hall, Suite 648, Chestnut Hill, MA, 02467, USA.

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http://dx.doi.org/10.1186/s12940-021-00789-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8456653PMC
September 2021

Sailors and the Risk of Asbestos-Related Cancer.

Int J Environ Res Public Health 2021 08 9;18(16). Epub 2021 Aug 9.

Collegium Ramazzini, 41012 Carpi, Italy.

Sailors have long been known to experience high rates of injury, disease, and premature death. Many studies have shown asbestos-related diseases among shipyard workers, but few have examined the epidemiology of asbestos-related disease and death among asbestos-exposed sailors serving on ships at sea. Chrysotile and amphibole asbestos were used extensively in ship construction for insulation, joiner bulkhead systems, pipe coverings, boilers, machinery parts, bulkhead panels, and many other uses, and asbestos-containing ships are still in service. Sailors are at high risk of exposure to shipboard asbestos, because unlike shipyard workers and other occupationally exposed groups, sailors both work and live at their worksite, making asbestos standards and permissible exposure limits (PELs). based on an 8-h workday inadequate to protect their health elevated risks of mesothelioma and other asbestos-related cancers have been observed among sailors through epidemiologic studies. We review these studies here.
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http://dx.doi.org/10.3390/ijerph18168417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8394725PMC
August 2021

Commentary: Novel strategies and new tools to curtail the health effects of pesticides.

Environ Health 2021 08 3;20(1):87. Epub 2021 Aug 3.

Gene Expression and Therapy Group, Department of Medical and Molecular Genetics, King's College London, Faculty of Life Sciences and Medicine, Guy's Hospital, London, UK.

Background: Flaws in the science supporting pesticide risk assessment and regulation stand in the way of progress in mitigating the human health impacts of pesticides. Critical problems include the scope of regulatory testing protocols, the near-total focus on pure active ingredients rather than formulated products, lack of publicly accessible information on co-formulants, excessive reliance on industry-supported studies coupled with reticence to incorporate published results in the risk assessment process, and failure to take advantage of new scientific opportunities and advances, e.g. biomonitoring and "omics" technologies.

Recommended Actions: Problems in pesticide risk assessment are identified and linked to study design, data, and methodological shortcomings. Steps and strategies are presented that have potential to deepen scientific knowledge of pesticide toxicity, exposures, and risks. We propose four solutions: (1) End near-sole reliance in regulatory decision-making on industry-supported studies by supporting and relying more heavily on independent science, especially for core toxicology studies. The cost of conducting core toxicology studies at labs not affiliated with or funded directly by pesticide registrants should be covered via fees paid by manufacturers to public agencies. (2) Regulators should place more weight on mechanistic data and low-dose studies within the range of contemporary exposures. (3) Regulators, public health agencies, and funders should increase the share of exposure-assessment resources that produce direct measures of concentrations in bodily fluids and tissues. Human biomonitoring is vital in order to quickly identify rising exposures among vulnerable populations including applicators, pregnant women, and children. (4) Scientific tools across disciplines can accelerate progress in risk assessments if integrated more effectively. New genetic and metabolomic markers of adverse health impacts and heritable epigenetic impacts are emerging and should be included more routinely in risk assessment to effectively prevent disease.

Conclusions: Preventing adverse public health outcomes triggered or made worse by exposure to pesticides will require changes in policy and risk assessment procedures, more science free of industry influence, and innovative strategies that blend traditional methods with new tools and mechanistic insights.
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http://dx.doi.org/10.1186/s12940-021-00773-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8330079PMC
August 2021

Aspartame and cancer - new evidence for causation.

Environ Health 2021 04 12;20(1):42. Epub 2021 Apr 12.

Boston College, Chestnut Hill, MA, USA.

Background: Aspartame is one of the world's most widely used artificial sweeteners and is an ingredient in more than 5000 food products globally. A particularly important use is in low-calorie beverages consumed by children and pregnant women. The Ramazzini Institute (RI) reported in 2006 and 2007 that aspartame causes dose-related increases in malignant tumors in multiple organs in rats and mice. Increased cancer risk was seen even at low exposure levels approaching the Acceptable Daily Intake (ADI). Prenatal exposures caused increased malignancies in rodent offspring at lower doses than in adults. These findings generated intense controversy focused on the accuracy of RI's diagnoses of hematopoietic and lymphoid tissue tumors (HLTs). Critics made the claim that pulmonary lesions observed in aspartame-exposed animals were inflammatory lesions caused by Mycoplasma infection rather than malignant neoplasms.

Methods: To address this question, RI subjected all HLTs from aspartame-exposed animals to immunohistochemical analysis using a battery of markers and to morphological reassessment using the most recent Internationally Harmonized Nomenclature and Diagnostic (INHAND) criteria.

Findings: This immunohistochemical and morphological re-evaluation confirmed the original diagnoses of malignancy in 92.3% of cases. Six lesions originally diagnosed as lymphoma (8% of all HLTs) were reclassified: 3 to lymphoid hyperplasia, and 3 to chronic inflammation with fibrosis. There was no evidence of Mycoplasma infection.

Interpretation: These new findings confirm that aspartame is a chemical carcinogen in rodents. They confirm the very worrisome finding that prenatal exposure to aspartame increases cancer risk in rodent offspring. They validate the conclusions of the original RI studies. These findings are of great importance for public health. In light of them, we encourage all national and international public health agencies to urgently reexamine their assessments of aspartame's health risks - especially the risks of prenatal and early postnatal exposures. We call upon food agencies to reassess Acceptable Daily Intake (ADI) levels for aspartame. We note that an Advisory Group to the International Agency for Research on Cancer has recommended high-priority reevaluation of aspartame's carcinogenicity to humans.
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http://dx.doi.org/10.1186/s12940-021-00725-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042911PMC
April 2021

COVID-19 and Health Disparities: Structural Evil Unmasked.

Ann Glob Health 2021 04 1;87(1):34. Epub 2021 Apr 1.

Jesuit Institute, Boston College, US.

Background: Incidence and mortality from COVID-19 are starkly elevated in poor, minority and marginalized communities. These differences reflect longstanding disparities in income, housing, air quality, preexisting health status, legal protections, and access to health care. The COVID-19 pandemic and its economic consequences have made these ancient disparities plainly visible.

Methodology: As scholars in Catholic research universities committed to advancing both scientific knowledge and social justice, we examined these disparities through the lenses of both epidemiology and ethics.

Findings: We see these widening disparities as not only as threats to human health, societal stability, and planetary health, but also as moral wrongs - outward manifestations of unrecognized privilege and greed. They are the concrete consequences of policies that promote structural violence and institutionalize racism.

Recommendations: We encourage governments to take the following three scientific and ethical justified actions to reduce disparities, prevent future pandemics, and advance the common good: (1) Invest in public health systems; (2) Reduce economic inequities by making health care affordable to all; providing education, including early education, to all children; strengthening environmental and occupational safeguards; and creating more just tax structures; (3) Preserve our Common Home, the small blue planet on which we all live.
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http://dx.doi.org/10.5334/aogh.3225DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8015708PMC
April 2021

The interplay between environmental exposures and COVID-19 risks in the health of children.

Environ Health 2021 03 26;20(1):34. Epub 2021 Mar 26.

Superfund Research Program, National Institute of Environmental Health Sciences, 530 Davis Drive, Durham, NC, 27709, USA.

Background: An unusual feature of SARS-Cov-2 infection and the COVID-19 pandemic is that children are less severely affected than adults. This is especially paradoxical given the epidemiological links between poor air quality and increased COVID-19 severity in adults and that children are generally more vulnerable than adults to the adverse consequences of air pollution.

Objectives: To identify gaps in knowledge about the factors that protect children from severe SARS-Cov-2 infection even in the face of air pollution, and to develop a transdisciplinary research strategy to address these gaps.

Methods: An international group of researchers interested in children's environmental health was invited to identify knowledge gaps and to develop research questions to close these gaps.

Discussion: Key research questions identified include: what are the effects of SAR-Cov-2 infection during pregnancy on the developing fetus and child; what is the impact of age at infection and genetic susceptibility on disease severity; why do some children with COVID-19 infection develop toxic shock and Kawasaki-like symptoms; what are the impacts of toxic environmental exposures including poor air quality, chemical and metal exposures on innate immunity, especially in the respiratory epithelium; what is the possible role of a "dirty" environment in conveying protection - an example of the "hygiene hypothesis"; and what are the long term health effects of SARS-Cov-2 infection in early life.

Conclusion: A concerted research effort by a multidisciplinary team of scientists is needed to understand the links between environmental exposures, especially air pollution and COVID-19. We call for specific research funding to encourage basic and clinical research to understand if/why exposure to environmental factors is associated with more severe disease, why children appear to be protected, and how innate immune responses may be involved. Lessons learned about SARS-Cov-2 infection in our children will help us to understand and reduce disease severity in adults, the opposite of the usual scenario.
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http://dx.doi.org/10.1186/s12940-021-00716-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7996114PMC
March 2021

Human Health and Ocean Pollution.

Ann Glob Health 2020 12 3;86(1):151. Epub 2020 Dec 3.

Nigerian Institute for Medical Research, Lagos, NG.

Background: Pollution - unwanted waste released to air, water, and land by human activity - is the largest environmental cause of disease in the world today. It is responsible for an estimated nine million premature deaths per year, enormous economic losses, erosion of human capital, and degradation of ecosystems. Ocean pollution is an important, but insufficiently recognized and inadequately controlled component of global pollution. It poses serious threats to human health and well-being. The nature and magnitude of these impacts are only beginning to be understood.

Goals: (1) Broadly examine the known and potential impacts of ocean pollution on human health. (2) Inform policy makers, government leaders, international organizations, civil society, and the global public of these threats. (3) Propose priorities for interventions to control and prevent pollution of the seas and safeguard human health.

Methods: Topic-focused reviews that examine the effects of ocean pollution on human health, identify gaps in knowledge, project future trends, and offer evidence-based guidance for effective intervention.

Environmental Findings: Pollution of the oceans is widespread, worsening, and in most countries poorly controlled. It is a complex mixture of toxic metals, plastics, manufactured chemicals, petroleum, urban and industrial wastes, pesticides, fertilizers, pharmaceutical chemicals, agricultural runoff, and sewage. More than 80% arises from land-based sources. It reaches the oceans through rivers, runoff, atmospheric deposition and direct discharges. It is often heaviest near the coasts and most highly concentrated along the coasts of low- and middle-income countries. Plastic is a rapidly increasing and highly visible component of ocean pollution, and an estimated 10 million metric tons of plastic waste enter the seas each year. Mercury is the metal pollutant of greatest concern in the oceans; it is released from two main sources - coal combustion and small-scale gold mining. Global spread of industrialized agriculture with increasing use of chemical fertilizer leads to extension of Harmful Algal Blooms (HABs) to previously unaffected regions. Chemical pollutants are ubiquitous and contaminate seas and marine organisms from the high Arctic to the abyssal depths.

Ecosystem Findings: Ocean pollution has multiple negative impacts on marine ecosystems, and these impacts are exacerbated by global climate change. Petroleum-based pollutants reduce photosynthesis in marine microorganisms that generate oxygen. Increasing absorption of carbon dioxide into the seas causes ocean acidification, which destroys coral reefs, impairs shellfish development, dissolves calcium-containing microorganisms at the base of the marine food web, and increases the toxicity of some pollutants. Plastic pollution threatens marine mammals, fish, and seabirds and accumulates in large mid-ocean gyres. It breaks down into microplastic and nanoplastic particles containing multiple manufactured chemicals that can enter the tissues of marine organisms, including species consumed by humans. Industrial releases, runoff, and sewage increase frequency and severity of HABs, bacterial pollution, and anti-microbial resistance. Pollution and sea surface warming are triggering poleward migration of dangerous pathogens such as the species. Industrial discharges, pharmaceutical wastes, pesticides, and sewage contribute to global declines in fish stocks.

Human Health Findings: Methylmercury and PCBs are the ocean pollutants whose human health effects are best understood. Exposures of infants to these pollutants through maternal consumption of contaminated seafood can damage developing brains, reduce IQ and increase children's risks for autism, ADHD and learning disorders. Adult exposures to methylmercury increase risks for cardiovascular disease and dementia. Manufactured chemicals - phthalates, bisphenol A, flame retardants, and perfluorinated chemicals, many of them released into the seas from plastic waste - can disrupt endocrine signaling, reduce male fertility, damage the nervous system, and increase risk of cancer. HABs produce potent toxins that accumulate in fish and shellfish. When ingested, these toxins can cause severe neurological impairment and rapid death. HAB toxins can also become airborne and cause respiratory disease. Pathogenic marine bacteria cause gastrointestinal diseases and deep wound infections. With climate change and increasing pollution, risk is high that infections, including cholera, will increase in frequency and extend to new areas. All of the health impacts of ocean pollution fall disproportionately on vulnerable populations in the Global South - environmental injustice on a planetary scale.

Conclusions: Ocean pollution is a global problem. It arises from multiple sources and crosses national boundaries. It is the consequence of reckless, shortsighted, and unsustainable exploitation of the earth's resources. It endangers marine ecosystems. It impedes the production of atmospheric oxygen. Its threats to human health are great and growing, but still incompletely understood. Its economic costs are only beginning to be counted.Ocean pollution can be prevented. Like all forms of pollution, ocean pollution can be controlled by deploying data-driven strategies based on law, policy, technology, and enforcement that target priority pollution sources. Many countries have used these tools to control air and water pollution and are now applying them to ocean pollution. Successes achieved to date demonstrate that broader control is feasible. Heavily polluted harbors have been cleaned, estuaries rejuvenated, and coral reefs restored.Prevention of ocean pollution creates many benefits. It boosts economies, increases tourism, helps restore fisheries, and improves human health and well-being. It advances the Sustainable Development Goals (SDG). These benefits will last for centuries.

Recommendations: World leaders who recognize the gravity of ocean pollution, acknowledge its growing dangers, engage civil society and the global public, and take bold, evidence-based action to stop pollution at source will be critical to preventing ocean pollution and safeguarding human health.Prevention of pollution from land-based sources is key. Eliminating coal combustion and banning all uses of mercury will reduce mercury pollution. Bans on single-use plastic and better management of plastic waste reduce plastic pollution. Bans on persistent organic pollutants (POPs) have reduced pollution by PCBs and DDT. Control of industrial discharges, treatment of sewage, and reduced applications of fertilizers have mitigated coastal pollution and are reducing frequency of HABs. National, regional and international marine pollution control programs that are adequately funded and backed by strong enforcement have been shown to be effective. Robust monitoring is essential to track progress.Further interventions that hold great promise include wide-scale transition to renewable fuels; transition to a circular economy that creates little waste and focuses on equity rather than on endless growth; embracing the principles of green chemistry; and building scientific capacity in all countries.Designation of Marine Protected Areas (MPAs) will safeguard critical ecosystems, protect vulnerable fish stocks, and enhance human health and well-being. Creation of MPAs is an important manifestation of national and international commitment to protecting the health of the seas.
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http://dx.doi.org/10.5334/aogh.2831DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731724PMC
December 2020

Commentary: Epidemiology, economics and the path to clean energy.

Int J Epidemiol 2021 01;49(6):1896-1898

Harvard Medical School, Boston, MA, USA.

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http://dx.doi.org/10.1093/ije/dyaa224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7825938PMC
January 2021

COVID-19 and clean air: an opportunity for radical change.

Lancet Planet Health 2020 10;4(10):e447-e449

University of Global Health Equity, Kigali, Rwanda.

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http://dx.doi.org/10.1016/S2542-5196(20)30201-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7541046PMC
October 2020

Severe dioxin-like compound (DLC) contamination in e-waste recycling areas: An under-recognized threat to local health.

Environ Int 2020 06 18;139:105731. Epub 2020 Apr 18.

Guangdong Key Laboratory of Environmental Pollution and Health, School of Environment, Jinan University, China. Electronic address:

Electrical and electronic waste (e-waste) burning and recycling activities have become one of the main emission sources of dioxin-like compounds (DLCs). Workers involved in e-waste recycling operations and residents living near e-waste recycling sites (EWRS) are exposed to high levels of DLCs. Epidemiological and experimental in vivo studies have reported a range of interconnected responses in multiple systems with DLC exposure. However, due to the compositional complexity of DLCs and difficulties in assessing mixture effects of the complex mixture of e-waste-related contaminants, there are few studies concerning human health outcomes related to DLC exposure at informal EWRS. In this paper, we have reviewed the environmental levels and body burdens of DLCs at EWRS and compared them with the levels reported to be associated with observable adverse effects to assess the health risks of DLC exposure at EWRS. In general, DLC concentrations at EWRS of many countries have been decreasing in recent years due to stricter regulations on e-waste recycling activities, but the contamination status is still severe. Comparison with available data from industrial sites and well-known highly DLC contaminated areas shows that high levels of DLCs derived from crude e-waste recycling processes lead to elevated body burdens. The DLC levels in human blood and breast milk at EWRS are higher than those reported in some epidemiological studies that are related to various health impacts. The estimated total daily intakes of DLCs for people in EWRS far exceed the WHO recommended total daily intake limit. It can be inferred that people living in EWRS with high DLC contamination have higher health risks. Therefore, more well-designed epidemiological studies are urgently needed to focus on the health effects of DLC pollution in EWRS. Continuous monitoring of the temporal trends of DLC levels in EWRS after actions is of highest importance.
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http://dx.doi.org/10.1016/j.envint.2020.105731DOI Listing
June 2020

Probabilistic estimates of prenatal lead exposure at 195 toxic hotspots in low- and middle-income countries.

Environ Res 2020 04 15;183:109251. Epub 2020 Feb 15.

Pure Earth, 475 Riverside Drive, Suite 860, New York, NY, 10115, USA; Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue NW, Washington, DC, 20052, USA; Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.

Background: Prior estimates of pediatric lead-related disease burden in low- and middle-income countries (LMICs) used population estimates of maternal blood lead levels (BLLs). This approach may underestimate fetal BLLs by not considering potentially high prenatal lead exposure from toxic hotspots OBJECTIVES: We developed a probabilistic approach to using the Adult Lead Methodology (ALM) to estimate fetal BLLs from prenatal exposure to lead-contaminated soil at hotspots in the Toxic Site Identification Program (TSIP).

Methods: We created distributions for each ALM parameter using published literature and extracted soil lead measurements from the TSIP database. Each iteration of the probabilistic ALM randomly selected values from the input distributions to generate a site-specific fetal BLL estimate. For each site, we ran 5000 model iterations, producing a site-specific fetal BLL distribution.

Results: 195 TSIP sites, in 33 LMICs, met our study inclusion criteria; an estimated 820,000 women of childbearing age are at risk for lead exposure at these sites. The predicted geometric means (GM) for site-specific fetal BLLs ranged from 3.3 μg/dL to 534 μg/dL, and 98% of sites had estimated GM fetal BLLs >5 μg/dL, the current reference level of the United States Centers for Disease Control and Prevention (CDC), while 11 sites had estimated GM fetal BLLs above the CDC chelation threshold of 45 μg/dL.

Discussion: The TSIP soil lead data and this probabilistic approach to the ALM show that pregnant women living near TSIP sites may have BLLs that put their fetus at risk for neurologic damage and other sequelae, underscoring the need for interventions to reduce lead exposure at toxic hotspots.
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http://dx.doi.org/10.1016/j.envres.2020.109251DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176741PMC
April 2020

The False Promise of Natural Gas.

N Engl J Med 2020 Jan 4;382(2):104-107. Epub 2019 Dec 4.

From the Program in Global Public Health and the Common Good and the Global Observatory on Pollution and Health, Boston College, Chestnut Hill (P.J.L.) and Lundberg Health Advocates, Newton (B.E.L.) - both in Massachusetts; and the Wellcome Trust, London (H.F.).

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http://dx.doi.org/10.1056/NEJMp1913663DOI Listing
January 2020

Improving and Expanding Estimates of the Global Burden of Disease Due to Environmental Health Risk Factors.

Environ Health Perspect 2019 10 18;127(10):105001. Epub 2019 Oct 18.

Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA.

Background: The Global Burden of Disease (GBD) study, coordinated by the Institute for Health Metrics and Evaluation (IHME), produces influential, data-driven estimates of the burden of disease and premature death due to major risk factors. Expanded quantification of disease due to environmental health (EH) risk factors, including climate change, will enhance accuracy of GBD estimates, which will contribute to developing cost-effective policies that promote prevention and achieving Sustainable Development Goals.

Objectives: We review key aspects of the GBD for the EH community and introduce the Global Burden of Disease-Pollution and Health Initiative (GBD-PHI), which aims to work with IHME and the GBD study to improve estimates of disease burden attributable to EH risk factors and to develop an innovative approach to estimating climate-related disease burden-both current and projected.

Methods: We discuss strategies for improving GBD quantification of specific EH risk factors, including air pollution, lead, and climate change. We highlight key methodological challenges, including new EH risk factors, notably evidence rating and global exposure assessment.

Discussion: A number of issues present challenges to the scope and accuracy of current GBD estimates for EH risk factors. For air pollution, minimal data exist on the exposure-risk relationships associated with high levels of pollution; epidemiological studies in high pollution regions should be a research priority. For lead, the GBD's current methods do not fully account for lead's impact on neurodevelopment; innovative methods to account for subclinical effects are needed. Decisions on inclusion of additional EH risk-outcome pairs need to be guided by findings of systematic reviews, the size of exposed populations, feasibility of global exposure estimates, and predicted trends in exposures and diseases. Neurotoxicants, endocrine-disrupting chemicals, and climate-related factors should be high priorities for incorporation into upcoming iterations of the GBD study. Enhancing the scope and methods will improve the GBD's estimates and better guide prevention policy. https://doi.org/10.1289/EHP5496.
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http://dx.doi.org/10.1289/EHP5496DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6867191PMC
October 2019

Satellite images and machine learning can identify remote communities to facilitate access to health services.

J Am Med Inform Assoc 2019 08;26(8-9):806-812

Department of Health Systems Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Objective: Community health systems operating in remote areas require accurate information about where people live to efficiently provide services across large regions. We sought to determine whether a machine learning analyses of satellite imagery can be used to map remote communities to facilitate service delivery and planning.

Materials And Methods: We developed a method for mapping communities using a deep learning approach that excels at detecting objects within images. We trained an algorithm to detect individual buildings, then examined building clusters to identify groupings suggestive of communities. The approach was validated in southeastern Liberia, by comparing algorithmically generated results with community location data collected manually by enumerators and community health workers.

Results: The deep learning approach achieved 86.47% positive predictive value and 79.49% sensitivity with respect to individual building detection. The approach identified 75.67% (n = 451) of communities registered through the community enumeration process, and identified an additional 167 potential communities not previously registered. Several instances of false positives and false negatives were identified.

Discussion: Analysis of satellite images is a promising solution for mapping remote communities rapidly, and with relatively low costs. Further research is needed to determine whether the communities identified algorithmically, but not registered in the manual enumeration process, are currently inhabited.

Conclusions: To our knowledge, this study represents the first effort to apply image recognition algorithms to rural healthcare delivery. Results suggest that these methods have the potential to enhance community health worker scale-up efforts in underserved remote communities.
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http://dx.doi.org/10.1093/jamia/ocz111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7647253PMC
August 2019

Five national academies call for global compact on air pollution and health.

Lancet 2019 Jul 17;394(10192):23. Epub 2019 Jun 17.

Philip Landrigan Schiller Institute for Integrated Science and Society, Boston College, Chestnut Hill, MA, USA.

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http://dx.doi.org/10.1016/S0140-6736(19)31417-5DOI Listing
July 2019

A Most Reckless Proposal - A Plan to Continue Asbestos Use in the United States.

N Engl J Med 2019 Aug 10;381(7):598-600. Epub 2019 Jul 10.

From the Program in Global Public Health and the Common Good and the Global Observatory on Pollution and Health, Boston College, Chestnut Hill, MA (P.J.L.); and the Rollins School of Public Health, Emory University, Atlanta (R.A.L.). Dr. Landrigan and Dr. Lemen are former senior officials of the National Institute for Occupational Safety and Health, where Dr. Lemen served as deputy director. Dr. Lemen is a retired assistant surgeon general, U.S. Public Health Service.

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http://dx.doi.org/10.1056/NEJMp1906207DOI Listing
August 2019

Assessment of Environmental Sustainability and Corporate Social Responsibility Reporting by Large Health Care Organizations.

JAMA Netw Open 2018 08 3;1(4):e180975. Epub 2018 Aug 3.

Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York.

Importance: Sustainability practices by large corporations are increasingly important to reduce the environmental and social impacts of the business enterprise. The health care industry represents 18% of the US economy, employs more people than any other economic sector, and is responsible for 10% of US carbon emissions. The engagement of large health care delivery organizations in reporting sustainability efforts has not been previously assessed.

Objective: To evaluate sustainability reporting by large US health care delivery organizations compared with reporting trends in all other economic sectors.

Design, Setting, And Participants: Cohort study of 49 large health care organizations (HCOs) by inclusion on one of the following lists in 2015 or 2016: Fortune 500, S&P (Standard & Poor) 500, Forbes 100 Largest Charities, Becker's Hospital Review of largest HCOs, and 24/7 Wall St's largest state employers. Each HCO was analyzed for sustainability reporting by reviewing the main corporate website, Google search, and search of publicly available databases. The percentage of sustainability reporting by HCOs on each list was compared with the percentage of sustainability reporting by all corporations on each list as obtained from public reports and publicly available databases. Data analysis was conducted in January 2018.

Main Outcomes And Measures: The percentages of large health care corporations and other corporations publicly reporting sustainability information.

Results: Forty-nine large for-profit and nonprofit US HCOs were analyzed (10 appeared on >1 list but were analyzed only once) appearing on the Fortune 500 (8 [16%]), S&P 500 (3 [6%]), Forbes 100 Largest Charities (8 [16%]), largest state employers (14 [29%]), largest for-profit HCOs (11 [22%]), and largest nonprofit HCOs (17 [35%]) by facilities owned for sustainability reporting. Among them, 4 of 8 (50%) on the Fortune 500, 1 of 3 (33%) on the S&P 500, and 6 of all 49 health care corporations (12%) published a sustainability report compared with 389 of 500 (78%) on the Fortune 500 and 410 of 500 (82%) on the S&P 500 reporting by all economic sectors.

Conclusions And Relevance: The health care delivery sector lags behind other US economic sectors in sustainability reporting. Publicly reporting sustainability activities would provide HCOs with an incentive to quantify and reduce their environmental impacts, lower costs, and protect human health.
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http://dx.doi.org/10.1001/jamanetworkopen.2018.0975DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6324268PMC
August 2018

Building Capacity in Pediatric Environmental Health: The Academic Pediatric Association's Professional Development Program.

Acad Pediatr 2019 May - Jun;19(4):421-427. Epub 2019 Jan 9.

Icahn School of Medicine at Mount Sinai (PJ Landrigan, J Forman, M Galvez, G Halevi, and RO Wright), New York, NY.

Background: Environmental exposures contribute to multiple diseases in children; yet, few pediatricians have training in pediatric environmental health (PEH), and few academic health centers have PEH expertise. To build national capacity in PEH, the Academic Pediatric Association (APA) launched a professional development program that since 2002 has encouraged the establishment of post-residency/post-doctoral training programs, supported a special interest group, and convened an annual mentored retreat for PEH trainees.

Objective: Describe the APA's professional development program in PEH and assess its impact by tracking careers of former trainees.

Methods: Careers were tracked through interviews with trainees and program directors supplemented by searches of institutional websites. Publication listings were obtained through PubMed. Publication impact was assessed using bibliometric and altmetric measures. Grant histories were accessed through the National Institutes of Health RePORTER project. Information on advocacy work was obtained through interviews with program directors.

Results: Fifty-five trainees (36 physicians and 19 health scientists) completed PEH training and attended the APA retreat between 2002 and 2017. Forty-one (75%) are pursuing academic careers, 11 are associate or full professors, 11 are practicing general pediatrics or a pediatric subspecialty, 2 are Centers for Disease Control and Prevention epidemiologists, and 1 is a data scientist. Forty-two former trainees (76%) listed "environment" or "environmental" in their job titles or on their websites. Former trainees have published 632 scientific papers. These papers have been cited 3094times, have a relative citation ratio of 2.97, and have been read or viewed 1,274,388times. Twenty-one former trainees have been awarded 43 National Institutes of Health grants. Trainees have developed education and advocacy skills by teaching medical students and residents, presenting grand rounds, preparing policy papers, presenting legislative testimony, and making presentations to public audiences.

Conclusions: The APA's professional development program has contributed to the expansion of national capacity in PEH. Former trainees are populating the field, generating new knowledge, and moving into leadership positions.
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http://dx.doi.org/10.1016/j.acap.2019.01.001DOI Listing
May 2020

It's time to consider pollution in NCD prevention.

Lancet 2018 11;392(10158):1625-1626

Global Public Health Program, Schiller Institute for Integrated Science and Society, Boston College, Chestnut Hill, MA 02467, USA. Electronic address:

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http://dx.doi.org/10.1016/S0140-6736(18)32200-1DOI Listing
November 2018

Building New York State Centers of Excellence in Children's Environmental Health: A Replicable Model in a Time of Uncertainty.

Am J Public Health 2019 01 29;109(1):108-112. Epub 2018 Nov 29.

Maida Galvez, Geoffrey Collins, Joel Forman, Perry Sheffield, Lauren Zajac, and Philip J. Landrigan are with the Department of Pediatrics and the Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY. Robert W. Amler and Allen Dozor are with the Department of Pediatrics and the School of Health Science & Practice, New York Medical College, Valhalla. Evonne Kaplan-Liss is with the Texas Christian University and University of North Texas Health Science Center School of Medicine, Fort Worth. Danielle Laraque-Arena is with the Department of Pediatrics, Upstate Medical University, Syracuse, NY. Ruth Lawrence and Richard Miller are with the Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY. Karen Miller is with the Huntington Breast Cancer Action Coalition, Huntington, NY.

Public health programs may be seriously affected in periods of federal retrenchment. During these times, state-based strategies provide an alternate pathway for advancing public health.A 12-year campaign to secure state support for a network of Centers of Excellence in Children's Environmental Health (CEH) promoting health of children across New York State is described. It was driven by rising rates of asthma, birth defects, developmental disorders, and other noncommunicable diseases in children; growing evidence associating hazardous environmental exposures with these conditions; and recognition that federal resources in CEH are insufficient.Critical campaign elements were (1) formation of a statewide coalition of academic health centers, health care providers, public health officials, community advocates, and other stakeholders; (2) bipartisan collaborations with legislative champions and government leaders; (3) assessment of the burden of developmental disorders and noncommunicable diseases associated with environmental exposures among children; (4) maps documenting the presence of environmental hazards in every county statewide; (5) iterative charting of a changing political landscape; and (6) persistence. The 2017 award of a 5-year, $10 million contract to establish Centers of Excellence in CEH demonstrates the value of this statewide strategy.
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http://dx.doi.org/10.2105/AJPH.2018.304742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301385PMC
January 2019

New Initiative aims at expanding Global Burden of Disease estimates for pollution and climate.

Lancet Planet Health 2018 10;2(10):e415-e416

Department of Health Metrics Science, School of Medicine, University of Washington, Seattle, WA 98195, USA.

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http://dx.doi.org/10.1016/S2542-5196(18)30189-XDOI Listing
October 2018

Pollution and children's health.

Sci Total Environ 2019 Feb 2;650(Pt 2):2389-2394. Epub 2018 Oct 2.

University Hospital Munich, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, WHO Collaborating Centre for Occupational Health, Unit Global Environmental Health, Ziemssenstr. 1, D-80336 Munich, Germany; Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT (University for Health Sciences, Medical Informatics and Technology), Hall i.T., Austria.

Findings: The Lancet Commission on Pollution and Health found that pollution - air, water, soil, and chemical pollution - was responsible in 2016 for 940,000 deaths in children worldwide, two-thirds of them in children under the age of 5. Pollution is inequitably distributed, and the overwhelming majority of pollution-related deaths in children occurred in low- and middle-income countries (LMICs). Most were due to respiratory and gastrointestinal diseases caused by polluted air and water. Pollution is linked also to multiple non-communicable diseases (NCDs) in children including low birth weight, asthma, cancer and neurodevelopmental disorders, and these diseases are on the rise. The full impact of pollution, especially chemical pollution on the global burden of pediatric disease is not yet known, but almost certainly is undercounted because patterns of chemical exposure are not well charted and the potential toxicity of many chemical pollutants has not been characterized. The list of pediatric NCDs attributed to pollution will likely expand as the health effects of newer chemical pollutants are better defined and additional associations between pollution and disease are discovered.

Conclusion: Pollution prevention presents a major, largely unexploited opportunity to improve children's health and prevent NCDs, especially in LMICs. Failure to incorporate pollution prevention into NCD control programs is a major missed opportunity for disease prevention.
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http://dx.doi.org/10.1016/j.scitotenv.2018.09.375DOI Listing
February 2019

Pollution and Global Health – An Agenda for Prevention.

Environ Health Perspect 2018 08 6;126(8):084501. Epub 2018 Aug 6.

Division of Extramural Research and Training, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA.

Summary: Pollution is a major, overlooked, global health threat that was responsible in 2015 for an estimated 9 million deaths and great economic losses. To end neglect of pollution and advance prevention of pollution-related disease, we formed the Commission on Pollution and Health. Despite recent gains in understanding of pollution and its health effects, this Commission noted that large gaps in knowledge remain. To close these gaps and guide prevention, the Commission made research recommendations and proposed creation of a Global Observatory on Pollution and Health. We posit that successful pollution research will be translational and based on transdisciplinary collaborations among exposure science, epidemiology, data science, engineering, health policy, and economics. We envision that the Global Observatory on Pollution and Health will be a multinational consortium based at Boston College and the Harvard T.H. Chan School of Public Health that will aggregate, geocode, and archive data on pollution and pollution-related disease; analyze these data to discern trends, geographic patterns, and opportunities for intervention; and make its findings available to policymakers, the media, and the global public to catalyze research, inform policy, and assist cities and countries to target pollution, track progress, and save lives. https://doi.org/10.1289/EHP3141.
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http://dx.doi.org/10.1289/EHP3141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6108842PMC
August 2018

Air pollution and the kidney-implications for control of non-communicable diseases.

Lancet Planet Health 2017 Oct 5;1(7):e261-e262. Epub 2017 Oct 5.

Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA. Electronic address:

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http://dx.doi.org/10.1016/S2542-5196(17)30120-1DOI Listing
October 2017

The need for independent research on the health effects of glyphosate-based herbicides.

Environ Health 2018 05 29;17(1):51. Epub 2018 May 29.

Cesare Maltoni Cancer Research Center Ramazzini Institute, Via Saliceto, 3, 40010, Bentivoglio, Bologna, Italy.

Background: Glyphosate, formulated as Roundup, is the world's most widely used herbicide. Glyphosate is used extensively on genetically modified (GM) food crops designed to tolerate the herbicide, and global use is increasing rapidly. Two recent reviews of glyphosate's health hazards report conflicting results. An independent review by the International Agency for Research on Cancer (IARC) found that glyphosate is a "probable human carcinogen". A review by the European Food Safety Agency (EFSA) found no evidence of carcinogenic hazard. These differing findings have produced regulatory uncertainty.

Regulatory Actions: Reflecting this regulatory uncertainty, the European Commission on November 27 2017, extended authorization for glyphosate for another 5 years, while the European Parliament opposed this decision and issued a call that pesticide approvals be based on peer-reviewed studies by independent scientists rather than on the current system that relies on proprietary industry studies.

Ramazzini Institute Response: The Ramazzini Institute has initiated a pilot study of glyphosate's health hazards that will be followed by an integrated experimental research project. This evaluation will be independent of industry support and entirely sponsored by worldwide crowdfunding. The aim of the Ramazzini Institute project is to explore comprehensively the effects of exposures to glyphosate-based herbicides at current real-world levels on several toxicological endpoints, including carcinogenicity, long-term toxicity, neurotoxicity, endocrine disrupting effects, prenatal developmental toxicity, the microbiome and multi-generational effects.
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http://dx.doi.org/10.1186/s12940-018-0392-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5972398PMC
May 2018
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