>> WELCOME TO EVERYONE.
DEPENDING WHERE YOU'RE JOINING
FROM, GOOD MORNING, GOOD
AFTERNOON, OR GOOD EVENING.
I'M DREW BREMER, MY ABSOLUTE
HONOR AND PLEASURE TO WELCOME
YOU TO THE KICKOFF MEETING FOR
THE AGRICULTURE AND DIET VALUE
ADDED FOR NUTRITION TRANSLATION
AND ADAPTATION IN A GLOBAL
ECOLOGY, OR ADVANTAGE PROJECT.
YOU'LL HEAR MORE ABOUT IT IN A
FEW MINUTES FROM DR. DAN RAIDEN
AND OVER THE NEXT SEVERAL WEEKS,
THE PROJECT IS AN EFFORT TO
BETTER UNDERSTAND THE
INTERSECTION OF FOOD SYSTEMS,
DIET, NUTRITION, AND HEALTH IN A
CHANGING ENVIRONMENT BY
ADDRESSING REALITIES OF CLIMATE
AND ENVIRONMENTAL CHANGE ARE
AFFECTING DIETARY CHOICES,
PATTERNS, RELEVANT ASPECT
RESPECT OF THE FOOD SYSTEM AS
WELL AS IMPLICATIONS FOR
SPECIFIC PUBLIC HEALTH OUTCOMES
OF INTEREST.
SPECIFICALLY, THIS EFFORT SEEKS
TO DETERMINE HOW AN ECOLOGICAL
APPROACH CAN BE APPLIED TO
ASSESS IMPACT OF THESE
RELATIONSHIPS AND HOW TO BEST
TRANSLATE THE EVIDENCE GENERATED
TO SUPPORT DIE TEAR GUIDANCE AND
PROMOTE HEALTH AND PREVENT
DISEASE.
ADVANTAGE IS INTENDED TO AID THE
GLOBAL COMMUNITY IN ADDRESSING
IMPACTS OF CLIMATE AND
ENVIRONMENTAL CHANGE, FOOD
SYSTEMS, NUTRITION AND HEALTH BY
FOCUSING ON EVIDENCE,
SPECIFICALLY WHAT IS KNOWN AND
WHAT IS NOT KNOWN AND HOW GAPS
MIGHT BE ADDRESS AND HOW TO
APPLY EVIDENCE AND SUPPORT A
SUSTAINABLE RESILIENT PROGRAMS
AND POLICIES AND EMPLOY APPROACH
TO ACCOUNT FOR ELEMENTS OF
NUTRITION ECOLOGY TO ACHIEVE
PUBLIC HEALTH GOALS THROUGH
DEVELOPMENT OF CONTEXT SPECIFIC,
EQUITABLE, SAFE, EFFICACIOUS
INTERVENTIONS AND GUIDANCE.
ADVANTAGE WILL ALSO PROVIDE
VALUE ADDED SUPPORT TO THE
AGENCIES AND ORGANIZATIONS THAT
DEVELOP DIETARY GUIDELINES,
RECOMMENDATIONS, POLICIES AND
PROGRAMS.
AS PART OF THIS VERY IMPORTANT
PROJECT THERE WILL BE FIVE
WORKSHOPS, FIRST IS TODAY.
FOCUS ON ON IMPLICATION OF
CLIMATE AND ENVIRONMENTAL CHANGE
ON PRIORITY HEALTH OUTCOMES.
THE NEXT WORKSHOP WILL BE
THURSDAY, APRIL 20, FOCUSED ON
IMPACT OF CLIMATE AND
ENVIRONMENTAL CHANGE, DIETARY
PATTERNS, ATTITUDES, BELIEFS,
CHOICES.
THE THIRD WORKSHOP WILL BE ON
THURSDAY, APRIL 27, FOCUSED ON
IMPACT OF CLIMATE AND
ENVIRONMENTAL CHANGE ON FOOD
SYSTEMS.
THE FOURTH WORKSHOP WILL BE
THURSDAY MAY 11, DEVELOPING
INTEGRATIVE APPROACH TO
UNDERSTAND INTERSECTION OF
CLIMATE AND ENVIRONMENTAL CHANGE
IN FOOD SYSTEMS, NUTRITION AND
HEALTH.
AND THE FIFTH WORKSHOP
ORIGINALLY TUESDAY MAY 16, WILL
NOW BE HELD IN JUNE, TO BE
DETERMINED, ON NEEDS AND
APPROACHES TO TRANSLATION OF
EMERGING EVIDENCE TO SUPPORT
CONTEXT-SPECIFIC, EQUITABLE,
SAFE AND EFFICACIOUS
INTERVENTIONS, DIETARY GUIDANCE,
STANDARDS OF CARE IN A CHANGING
ENVIRONMENT AND WE'LL KEEP THE
REGISTRATION WEBSITE UP TO DATE
AS FINAL DETAILS ARE FLOWN.
I WANT TO RECOGNIZE DR. DAN
RAIDEN FROM EUNICE KENNEDY
SHRIVER INSTITUTE, FEARLESS
LEADER OF THE PROJECT AND DR.
ALLISON STIVER.
THE WORKSHOPS WOULD NOT BE
POSSIBLE WITHOUT DAN, ALLISON,
AND ALLISON'S SPECTACULAR TEAM
FROM THE ACADEMY.
WE'RE GRATEFUL.
I WOULD LIKE TO THANK ALL THE
INDIVIDUALS WHO WORKED
TIRELESSLY BEHIND THE SCENES TO
COORDINATE THESE VIRTUAL
WORKSHOPS, WE'RE ALL USED TO
THESE MEETINGS BY NOW, WE ALSO
KNOW THEY JUST DON'T HAPPEN
WITHOUT A TREMENDOUS AMOUNT OF
LOGISTICAL AND I.T. SUPPORT.
TO THE ENTIRE ADVANTAGE TEAM,
THANK YOU.
FOR THOSE JOINING BY VIDEOCAST,
PLEASE FEEL FREE TO SEND
QUESTIONS AND COMMENTS TO
ADVANTAGE-NICHD@NIH.GOV.
I PROMISED TO KEEP MY REMARKS
SHORT.
IT'S MY PLEASURE AND HONOR TO
INTRODUCE DR. ALISON CERNICH,
DEPUTY DIRECTOR, A TREMENDOUS
LEADER AND HAS BEEN AND
CONTINUES TO BE A TREMENDOUS
ADVOCATE AND CHAMPION FOR
NUTRITION-RELATED RESEARCH
DOMESTICALLY AND GLOBALLY.
WE'RE SO GRATEFUL TO HAVE HER
HERE THIS MORNING.
>> THANKS, DREW.
I WANT TO ECHO MY THANKS FOR
EVERYBODY JOINING US TODAY AND
ADD MY THANKS TO DREW AND DAN
AND ALLISON, NICE TO RECOGNIZE
ANOTHER ALLISON THAT'S SPELLED
RIGHT.
WE HAVE HAD AN AMAZING JOURNEY,
I'VE BEEN WORKING WITH THEM FOR
NUTRITION PROGRAM WAS USAID AS
OFFICE OF NUTRITION RESEARCH
HERE AT NIH.
AND I HAVE LEARNED SO MUCH FROM
THEM AND THE COMMUNITY.
AND SO I WANT TO THANK EVERYONE
INVOLVED IN THE ADVANTAGE
PROJECT AND WELCOME EVERYONE
JOINING TODAY TO THE FIRST OF
ADVANTAGE'S FIVE PUBLIC
MEETINGS.
WE LIVE IN A COMPLEX WORK.
IT STRIKES ME THERE'S AN
INCREASING IMPLICATION OF THE
INTERSECTION OF CLIMATE AND
ENVIRONMENTAL CHANGE, FOOD
SYSTEMS, DIET, NUTRITION AND
HEALTH ACROSS THE LIFE COURSE.
WE REALLY HAVE SEEN MULTIPLE
EFFORTS REFLECTING THE CHANGE OF
EXPERTISE REPRESENTED BY
AGENCIES IN THE U.S. GOVERNMENT,
AND NIH THROUGH OUR SUPPORT OF
THE EXTRAMURAL RESEARCH
COMMUNITY IS PLAYING AN
INCREASINGLY ACTIVE ROLE IN
ADDRESSING THE INTERSECTION OF
THESE FACTORS.
BOTH IN TERMS OF THE IMPACT ON
HUMAN HEALTH AND EFFECTS OF THE
STRUCTURAL COMPONENTS OF SYSTEMS
NEEDED TO DEVELOP AND IMPLEMENT
EVIDENCE-INFORMED GUIDANCE,
PROGRAMS, INTERVENTIONS.
WHETHER IT IS THE ABILITY TO
WITHSTAND THE IMPACT OF
INCREASING VECTOR BORNE DISEASES
AND FOOD BORNE ILLNESS OR
RESILIENCY IN THE FACE OF
CLIMATE-RELATED STRESS OUR
APPRECIATION OF NUTRITION IN
THIS COMPLEX ENVIRONMENT DEMANDS
AN INTEGRATED APPROACH.
WHAT'S GREAT FOR US WE'RE IN AN
ENVIRONMENT HIGHLY CONDUCIVE TO
BETTER UNDERSTAND THESE COMPLEX
RELATIONSHIPS, THERE ARE SO MANY
U.S. GOVERNMENT INITIATIVES
FORMED TO ENGAGE STAKEHOLDER
COMMUNITIES AND DEVELOPMENT OF
EVIDENCE-BASED PROGRAMS,
INTERVENTIONS, RECOMMENDATIONS
TO RESPOND TO THE CHALLENGES
IMPOSED BY CLIMATE ENVIRONMENTAL
CHANGE.
SO THESE INCLUDE INTERAGENCY
CROSS-CUTTING GROUP ON CLIMATE
CHANGE AND HUMAN HEALTH WHICH
HAS A DEDICATED WORK STREAM ON
FOOD SYSTEMS AND NUTRITION
SECURITY SPECIFICALLY ATTEMPTS
TO IDENTIFY INDICATORS OF FOOD
SAFETY AND NUTRITION SECURITY
AND U.S. GOVERNMENT'S GLOBAL
NUTRITION PLAN 2.0, CLIMATE,
HEALTH, AGRICULTURE AND
NUTRITION IN A GLOBAL ECOLOGY,
OR CHANGE.
THE GOAL IS TO COORDINATE
FEDERAL WORK TO ADDRESS IMPACT
OF CLIMATE AND ENVIRONMENTAL
CHANGE ON PROGRAMS AND TO
IDENTIFY AND RESPOND TO THE ROAM
OF NUTRITION IN HEALTH PROMOTION
AND DISEASE PREVENTION.
THESE WILL ISSUE INCLUDE COLLAN
IN THE U.S. COMMUNITY AND GLOBAL
RESEARCH ENTERPRISE.
IN PARALLEL, NIH INITIATIVE
INCLUDES REPRESENTATION FROM
INSTITUTES AND CENTERS AT NIH,
AND REFLECTS THE FILL BREADTH OF
INTEREST AND ACTIVITIES ACROSS
THE NIH COMMUNITY.
THIS EFFORT IS INFORMED BY AN
EXECUTIVE COMMITTEE CONSISTING
OF DIRECTORS FROM MULTIPLE NIH
INSTITUTES INCLUDING OUR OWN
DIRECTOR, DR. DIANA BIANCHI, AND
THIS PROVIDES GUIDANCE AND
DIRECTION AND SETS PRIORITIES TO
ADDRESS CHALLENGES FACING THE
BIOMEDICAL COMMUNITY IN THE
CLIMATE CHANGE SPACE.
WE REALLY SERVE ON THE STEERING
COMMITTEE OF THIS CLIMATE CHANGE
AND HEALTH INITIATIVE AND WE'VE
TRIED TO HELP FOCUS THIS ON THE
DEVELOPMENT OF FRAMEWORK THAT
ADDRESSES MANY CRITICAL
COMPONENTS OF RESEARCH,
ADDRESSING CLIMATE CHANGE AND
HEALTH, INCLUDING STRUCTURAL
ISSUE SUCH AS HEALTH SYSTEMS AND
ENVIRONMENTAL HEALTH QUALITY,
AND WE'VE ALSO ENSURED WE HAVE A
FOCUS ON THE LIFE COURSE
SPECIFICALLY ON DEVELOPMENT.
IN THIS RAPIDLY CHANGING
ENVIRONMENT THAT CONFRONTS OUR
FOOD INTRODUCTION SYSTEM, IT
WILL SHAPE OUR FOOD CHOICES AND
INTERVENTIONS.
THAT BRINGS US TO THE WORKSHOP,
I'M GRATEFUL TO HELP KICK THIS
OFF, FIRST IN THE SERIES OF PART
OF THE AGRICULTURAL AND DIET
VALUE ADDED FOR NUTRITION,
TRANSLATION, ADAPTATION AND
GLOBAL ECOLOGY OR ADVANTAGE
PROJECT.
I THANK NICHD AND ACADEMY FOR
NUTRITION AND DIETETICS.
THE GOAL OF ADVANTAGE IS TO
DETERMINE WHAT WE KNOW AND WHAT
WE DO NOT KNOW ABOUT THESE
CRITICAL ISSUES AND IN DOING SO
DEVELOP AN IMPLEMENTABLE
RESEARCH AGENDA TO ADDRESS THESE
NEEDS.
I EXPRESSION APPRECIATION FOR
SUPPORT OF THIS PROJECT FROM THE
ACADEMY FOR NUTRITION AND
DIETETICS AND OUR PARTNER
AGENCIES THROUGHOUT THE U.S.
GOVERNMENT, AS REFLECTED BY THE
MEMBERSHIP OF OUR SCIENTIFIC
STEERING COMMITTEE.
THANK YOU FOR YOUR SERVICE.
I KNOW WHAT I KNOW ARE VERY BUSY
SCHEDULES.
THE PANEL DISCUSSION WILL START
WITH REFLECTIONs BY MEMBERS OF
THE STEERING COMMITTEE ON THE
CHALLENGES OF CLIMATE AND
ENVIRONMENTAL CHANGES AND VALUE
OF ADVANTAGE TO MEET THEM.
WITH THAT, I WILL HAND IT BACK
TO DRAW AND AGAIN THANK YOU ALL
FOR YOUR PARTICIPATION IN BOTH
THIS AND THE FOLLOWING MEETINGS
AND LOOK FORWARD TO HEARING THE
RESULTS OF THESE CONVERSATIONS.
THANKS, DREW.
>> GREAT, ALISON.
THANK YOU SO MUCH.
I WILL QUICKLY PIVOT AND TURN
THE FLOOR OVER TO DAN.
>> THANK YOU, DR. CERNICH.
PLEASE CONVEY OUR GRATITUDE TO
DR. BIANCHI FOR HER SUPPORT OF
THIS EFFORT.
THANKS TO MY PARTNERS AND
MEMBERS OF THE SCIENTIFIC
STEERING COMMITTEE WHO HELPED
DEVELOP THIS PROJECT.
I'M GOING TO GIVE YOU SOME
BACKGROUND OF WHAT WE'RE TRYING
TO ACCOMPLISH.
NEXT SLIDE.
WE ALL HEAR THE MANTRA OF
EVIDENCE-BASED PROGRAMS AND
POLICIES AND UNDERSTAND NICHD
WHAT OUR ROLE IS IN THAT
CONTINUUM.
OUR ROLE IS THE EVIDENCE
GENERATORS, WE'RE HERE TO
SUPPORT CONSTITUENCY IN THE
EXTRAMURAL COMMUNITY BUT WE ALSO
RECOGNIZE THERE'S A BALANCE
BETWEEN CONDUCT OF BASIC
BIOMEDICAL RESEARCH AND THE
TRANSLATION OF THAT BASIC
BIOMEDICAL RESEARCH TO
ASSESSMENT APPROACHES,
INTERVENTION APPROACHES, AND
STANDARDS OF CARE.
AND SO THAT BALANCE IS REALLY
IMPORTANT.
WE TRY TO BUILD THIS BALANCE
INTO EVERYTHING THAT WE DO WITH
ALL THE PROJECTS THAT WE DO.
NEXT SLIDE.
IT'S IMPORTANT TO HAVE A COMMON
VERNACULAR.
WE'RE GOING TO DEVELOP THAT,
HOPEFULLY TO HELP INFORM THE
CONVERSATIONS ACROSS THE
COMMUNITY.
NEXT SLIDE.
SOME KEY ISSUES WE'RE GOING TO
HEAR ABOUT HERE ARE LISTED HERE.
WE'RE REFERRING TO INTERACTION
OF COMPLEX BIOLOGICAL SYSTEM,
INTERNAL AND EXTERNAL
ENVIRONMENT.
ALL SYSTEMS HAVE AN ECOLOGY.
AND IN ORDER TO BE PRECISE IN
HOW WE ADDRESS THE CHALLENGES
WE'RE FACED WITH, WE FEEL
STRONGLY THAT WE NEED TO TAKE A
MORE ECOLOGICAL APPROACH IN
DOING THINGS.
HEALTH IS THE RESULT OF THAT
ECOLOGY, INCLUDING FOOD
NUTRITION AND PHYSICAL
ENVIRONMENT.
THE NEXT COUPLE SLIDES, I'M NOT
TELLING YOU WHAT THESE TERMS
MEAN BUT IT'S IMPORTANT TO MAKE
A DISTINCTION BETWEEN FOOD AS A
DELIVERY VEHICLE FOR NUTRIENTS
AND BIOLOGIC SUBSTANCES TO
SUPPORT HEALTH.
DIET, THE COMPOSITE OF FOODS AND
BIOLOGICALLY ACTIVE DIETARY
SUBSTANCES.
AND NUTRITIONAL STATUS WHICH IS
A BIOLOGICAL VARIABLE.
WE CONFLATE FOOD AND NUTRITION,
THEY ARE NOT THE SAME.
WE'LL TRY TO MAKE THAT
DISTINCTION CLEAR.
NUTRITIONAL STATUS AS A
BIOLOGICAL VARIABLE IS ACHIEVED
AS A RESULT OF A SERIES OF
PROCESS THAT STARTS WITH
INGESTION BUT INCLUDES MULTIPLE
PROCESSES INTERNALLY, AFFECT AND
ARE AFFECTED BY NUTRITION.
NUTRITION STATUS IS AN INPUT TO
THE BIOLOGICAL SYSTEMS AND
PROCESSES AS WELL AS OUTCOME OF
PERTURBATIONS IN THOSE SYSTEMS.
THE LAST TERM IS ENVIRONMENT.
I DON'T KNOW IF WE ALL USE IT
THE SAME WAY.
NEXT SLIDE.
THIS IS A CARTOON THAT
REPRESENTS OUR HOLISTIC VIEW OF
THE ENVIRONMENT THAT INCLUDES
THE HUMAN BIOLOGY, FOOD,
NUTRITION, LAND, WATER, PHYSICAL
CLIMATE, PHYSICAL SYSTEMS,
SOCIAL, BEHAVIORAL, ECONOMIC
SYSTEMS, ET CETERA.
THESE ARE ALL INTERACTING AND
ARE ALL PART OF THE ENVIRONMENT
THAT WE'LL BE ADDRESSING
THROUGHOUT THIS PROJECT.
NEXT SLIDE.
A CRITICAL ELEMENT IS THE
CONVERSATIONS THAT WE'LL BE
HAVING IS THE FOOD SYSTEMS.
FOOD SYSTEMS WHETHER PLANT,
ANIMAL, MARINE, OR OTHER, ARE
ALL AN ARRAY OF -- REPRESENT
ANOTHER ECOLOGY.
THIS CARTOON REPRESENTS THAT
ECOLOGY.
IT INCLUDES INPUT, THE ROLE OF
HUMANS, ROAM -- ROLE OF THE
ENVIRONMENT, SOCIAL, BEHAVIORAL,
ECONOMIC ENVIRONMENT, ET CETERA.
NEXT SLIDE.
ONE OF THE IMPORTANT ISSUES WITH
REGARD TO THE INTERSECTION THAT
WE'LL BE TALKING ABOUT IS THIS
INTERACTION BETWEEN FOOD SYSTEMS
AND CLIMATE AND ENVIRONMENTAL
CHANGE.
AND THE POINT OF THIS SLIDE HERE
IS THAT IT'S A RECIPROCAL
RELATIONSHIP.
THEY AFFECT OR ARE AFFECTED BY
EACH OTHER.
WE TEND OFTEN TO SEE ONE OF
THESE PERSPECTIVES REPRESENTED
TO THE EXCLUSION OF ANOTHER AND
IT'S IMPORTANT TO RECOGNIZE THAT
THERE IS A RECIPROCAL
RELATIONSHIP.
AND THAT RECIPROCAL RELATIONSHIP
HAS A TEMPORAL COMPONENT TO IT
AS WELL, THAT INCLUDES -- WE
NEED TO BE CLEAR ABOUT WHAT
WE'RE TALKING ABOUT WITH CLIMATE
CHANGE AND YOU'LL HEAR FROM DR.
EBI TODAY ABOUT THE IMPORTANCE
OF RECOGNIZING THAT THERE'S A
DIFFERENCE BETWEEN ACUTE EFFECTS
AND LONG-TERM CHANGES IN WEATHER
AND CLIMATE.
AND IT'S IMPORTANT IN OUR
ANALYSIS AND UNDERSTANDING TO
ACCOUNT FOR DIFFERENCES.
NEXT SLIDE PLEASE.
NEXT.
SO, ON THE RIGHT SIDE OF THE
SLIDE IS THIS VICIOUS CYCLE.
WE'RE ALL AWARE OF WHAT HAPPENS
WHEN YOU HAVE AN IMPAIRED FOOD
SYSTEM.
YOU HAVE LIMITATIONS IN FOOD, IN
NUTRITIONAL QUALITY OF THE FOOD.
THAT HAS AN IMPACT ON HEALTH.
THAT IMPACT ON HEALTH HAS AN
IMPACT ON PERFORMANCE AND IT'S A
NEGATIVE FEEDBACK.
THIS IS BEING IMPACTED BY
CLIMATE AND IS IMPACTING WHAT
WE'RE SEEING IN THE CHANGING
ENVIRONMENT.
NEXT SLIDE.
WHAT WE'RE GOING TO HIGHLIGHT IN
THIS PROJECT I THINK ONE OF THE
THINGS WE'LL HIGHLIGHT IS IT'S
MORE THAN JUST FOOD.
WE HAVE A VERY COMPLEX GLOBAL
HEALTH SCENARIO.
THE TOP LINE IS THE TRADITIONAL
VIEW.
WE FOCUS A LOT OF ENERGY ON
DEALING WITH UNDERNUTRITION.
WE NOW AND WILL HEAR IN WORKING
GROUP 2 NEXT WEEK ABOUT THE
NUTRITION TRANSITION, CHANGING
THE WAY PEOPLE ARE EATING,
TRANSITIONING FROM TRADITIONAL
DIETS TO MORE COMMERCIAL DIETS
WITH PROCESSED FOODS, ET CETERA.
THAT'S LEADING TO ALL SORTS OF
ISSUES INCLUDING DOUBLE BURDEN.
ON THAT BOTTOM ROW YOU SEE THE
FACT THAT WE ALSO HAVE THIS
SITUATION WITH PANDEMIC
INFECTIONS, WHETHER HIV, TB,
MALARIA, COVID, OR THE NEXT NEW
INFECTION, POTENTIAL STATUS
WE'LL HEAR LATER ON TODAY.
AND OF COURSE GROWING PANDEMICS
NON-COMMUNICABLE DISEASES.
IN THE MIDDLE IS RECOGNITION
MUCH OF WHAT IS GOING ON
INTERNALLY, THAT INTERNAL
ECOLOGY FOR ALL THESE THINGS IS
MEDIATED THROUGH THE
RELATIONSHIP TO THE MICROBIOME
AND INFLAMMATORY PROCESS,
CRITICAL COMPONENT OF THE
BIOMEDICAL RESEARCH ENTERPRISE.
AT THE BOTTOM IS RECOGNITION OF
THIS LIFE COURSE, DR. CERNICH
SAID, WE'RE VERY COMMITTED TO
DEVELOPMENTAL ISSUES IN THE LIFE
COURSE.
AND THINGS LIKE DIETARY GUIDANCE
AND RECOMMENDATIONS FOR OTHER
TYPES OF INTERVENTIONS NEED TO
ACCOUNT FOR THE DIFFERENCES
ACROSS THE LIFE COURSE.
WE OF COURSE -- THERE'S
RECOGNITION OF THE DOHaD
HYPOTHESIS, AN IMPORTANT ASPECT
OF RESEARCH ENDEAVOR, TRYING TO
FIGURE OUT WHAT THE IMPACT OF
THOSE EARLY LIFE INSULTS ARE ON
LATER HEALTH OUTCOMES.
NEXT SLIDE PLEASE.
NEXT.
SO WHEN WE PUT THIS TOGETHER,
THIS IS THE NUTRITION ECOLOGY
THAT WE'RE REFERRING TO.
THIS IS THE APPROACH THAT WE'RE
USING.
WE'RE TRYING TO IMPROVE
PRECISION, IMPROVE RIGOR AND
REPRODUCIBILITY OF RESEARCH,
IMPROPER OUR ABILITY TO MAKE --
TO ATTRIBUTE CAUSATION TO THINGS
THAT ARE GOING IN THE
ENVIRONMENT BY RECOGNIZING THE
COMPLEXITY OF THIS ENVIRONMENT
AND FIGURING OUT HOW WAYS TO
DEAL WITH THIS COMPLEXITY.
THIS IS A REPRESENTATION OF THAT
COMPLEXITY.
NEXT SLIDE.
NEXT.
I'M NOT GOING TO SPEND A LOT OF
TIME IN THE NEXT COUPLE SLIDES.
DREW HAS ALREADY REVIEWED THESE.
BUT WHAT I WANT TO EMPHASIZE
HERE IS THAT THIS PROJECT IS NOT
INTENDED TO MAKE DIETARY
GUIDANCE.
IT'S NOT INTENDED TO MAKE
RECOMMENDATIONS OR POLICY.
IT IS INTENDED TO REVIEW THE
EVIDENCE.
AND WE'LL DO THAT BY ENGAGING
THE COMMUNITY IN A
MULTI-DISCIPLINARY EFFORT TO
ADDRESS THE EVIDENCE AS WE FIND
IT NOW, AND IDENTIFY GAPS IN
EVIDENCE, MOVE THE AGENDA
FORWARD, SUPPORT THOSE WHO ARE
MAKING RECOMMENDATIONS, WHO ARE
DOING GUIDANCE.
THIS REALLY IS A PROJECT
INTENDED TO SUPPORT THE
COMMUNITY'S EFFORTS TO ADDRESS
THE ISSUES OF DIET AND HEALTH IN
A CHANGING ENVIRONMENT.
NEXT SLIDE.
NEXT.
DREW ALREADY WENT THROUGH THOSE.
THIS IS JUST THE STRUCTURE OF
THE PROJECT.
WE'VE ORGANIZED THIS PROJECT.
YOU'VE HEARD A LITTLE BIT ABOUT
THIS IN THE EARLIER COMMENTS.
PROJECT IS ORGANIZED BY THE
SECRETARY, LED BY THE STAFF AT
NICHD, DREW AND HIS TEAM.
IT'S ALSO INCLUDING ALISON AND
HER TEAM AT ACADEMY FOR
NUTRITION AND DIETETICS.
EVERY ONE HAS A LEAD MEMBER OF
THE SECRETARY FROM THE A&D TEAM,
WITHOUT THIS NONE OF THIS
HAPPENS.
IN THE BEGINNING OF THE PROJECT,
YOU'LL FLARE A COUPLE MEMBERS OF
THE SCIENTIFIC -- HEAR FROM
MEMBERS OF THE STEERING
COMMITTEE WE ORGANIZED
REPRESENTATIVES FROM AGENCIES
AND STAKEHOLDERS COMMUNITIES
WITH AN INVESTMENT IN THIS
ISSUE, AND TO GET THEIR INPUT
AND HELP US ORGANIZE THINKING
AROUND HOW BEST TO MOVE THIS
PROCESS FORWARD.
THEN THAT FINAL CIRCLE IS
WORKING GROUPS.
I WILL SAY NOW AND SAY
THROUGHOUT THIS PROCESS HOW
GRATEFUL WE ARE FOR ALL OF THE
MEMBERS OF ALL THE WORKING
GROUPS.
WE HAVE FIVE WORKING GROUPS,
BETWEEN FIVE AND EIGHT MEMBERS
IN EACH WORKING GROUP.
AND WE'RE GRATEFUL FOR THEIR
COMMITMENT AND WILLINGNESS TO
TAKE THIS CHALLENGE ON.
NEXT SLIDE.
SO, WE PUT THIS TOGETHER,
CONCEPTUALLY, THIS IS THE
ECOLOGY AND THIS IS HOW WE
OPERATIONALIZED IT.
WE HAVE THREE CORE WORKING
GROUPS THAT ARE GOING TO REALLY
BE FOCUSED ON EXAMINING THE
EVIDENCE AND IDENTIFYING
RESEARCH GAPS.
THOSE THREE GROUPS THAT YOU'LL
HEAR ABOUT TODAY YOU'LL HEAR
FROM THE WORKING GROUP 1, WHICH
IS THE FOCUS ON HEALTH.
NEXT WEEK WORKING GROUP 2
FOCUSED ON DIETARY PATTERNS.
AND THEN WORKING GROUP 3 WILL
FOCUS ON FOOD SYSTEMS.
AND WE RECOGNIZE IT'S A VENN
DIAGRAM FOR A REASON.
THESE THINGS OVERLAP AND AFFECT
AND ARE AFFECTED BY EACH OTHER.
OBVIOUSLY OVERLAPPING THAT IS
THE IMPACT OF CLIMATE AND
ENVIRONMENTAL CHANGE.
THE NEXT -- FOURTH WORKING GROUP
IS FOCUSED ON ANALYSIS.
HOW DO WE TAKE THIS EMERGING
EVIDENCE, VERY COMPLICATED
SYSTEMS, AND PUT IT TOGETHER IN
A MEANINGFUL WAY TO ANALYZE
THESE RELATIONSHIPS.
BOTH FROM RESEARCH PERSPECTIVE
AND FROM PERHAPS SURVEILLANCE
PERSPECTIVE.
HOW DO WE INTEGRATE THIS KIND OF
DATA INTO NATIONAL SURVEILLANCE
PROGRAM TO REALLY GET US AN
ANSWER ABOUT WHAT'S GOING ON IN
THE POPULATION.
FINALLY, WORKING GROUP 5 WILL
FOCUS ON THIS ISSUE OF -- THESE
ISSUES OF TRANSLATION AND
IMPLEMENTATION.
ONE OF THE -- WHAT ARE THE CORE
PRINCIPLES AND WHAT'S THE
FRAMEWORK FOR TAKING NEW
EVIDENCE AND INTEGRATING IT INTO
RESEARCH DESIGN AS WELL AS
PROGRAM DEVELOPMENT AND
IMPLEMENTATION.
SO, THAT'S A CRITICAL PIECE OF
WHAT WE'RE DOING AND WE'RE
GRATEFUL.
NEXT SLIDE.
THIS IS A LISTING OF THE FIVE
WORKING GROUPS AND CO-CHAIRS.
THEY ARE ALL LISTED.
TODAY YOU'LL HEAR FROM KRISTIE
EBI.
THESE FOLKS ARE BUSY AND IT'S A
TREMENDOUS PROGRAM.
WE'RE GRATEFUL FOR THE EFFORTS.
THAT'S THE END OF IT.
I WANT TO ISSUE EVERYBODY THE
BEST.
THANK YOU FOR JOINING US.
I THANK WORKING GROUP MEMBERS
FOR BEING HERE.
WE'RE LOOKING FORWARD TO
PRESENTATIONS.
THANK YOU.
>> THANKS, DAN.
FOR THE SAKE OF TIME WE'LL
SEGUE.
WE'RE SUPER APPRECIATIVE OF
THOSE MEMBERS OF OTHER AGENCIES
THAT HAVE TAKEN THEIR TIME TO
PROVIDE INPUT IN DISCUSSIONS AND
WE'LL KICK THINGS OFF WITH CINDY
DAVIS.
TAKE IT AWAY.
>> WAITING FOR MY SLIDES TO
COME UP.
THANK YOU.
THANK YOU FOR GIVING ME THE
OPPORTUNITY TO HIGHLIGHT THE ARS
NATIONAL PROGRAM IN HUMAN
NUTRITION, AND OUR INTEREST IN
THE INTERSECTION OF CLIMATE,
ENVIRONMENTAL CHANGE, FOOD
SYSTEMS, DIET, NUTRITION AND
HEALTH.
NEXT SLIDE PLEASE.
THE MISSION OF OUR PROGRAM IS TO
DEFINE THE ROLE OF FOOD AND
COMPONENTS AND OPTIMIZING HEALTH
THROUGHOUT THE LIFE CYCLE FOR
ALL AMERICANS BY CONDUCTING HIGH
NATIONAL PRIORITY RESEARCH AND
EMPHASIS IS ON RESEARCH.
THAT'S HOW WE INTERSECT WITH
ADVANTAGE.
OUR VISION IS A WELL NOURISHED
AMERICAN MAKE HEALTH PROMOTING
DIETARY CHOICES BASED ON
SCIENTIFIC EVIDENCE, FIVE
PROGRAMMATIC PRIORITIES IN THE
NEXT FIVE YEARS.
BRIDGING THE GAP BETWEEN FOOD
PRODUCTION AND HUMAN HEALTH.
MONITORING FOOD COMPOSITION
NUTRIENT INTAKE, SCIENTIFIC
BASIS FOR DIETARY GUIDANCE,
PRE-VEHICLES OF DIET-RELATED
CHRONIC DECEMBER DISEASE LIFE
STAINING NUTRITION.
ARS STUDIES WHAT PEOPLE CONSUME,
METHODS TO IMPROVE ACCESS,
NUTRIENT REQUIREMENTS FOR ALL
AGE GROUPS AND HOW NUTRITION CAN
MAINTAIN HEALTH IN THE LIFESPAN
AND PREVENT UNIQUE AS DETERMINE
HOW CHANGES AFFECT THE NUTRIENT
CONTENT OF THE AMERICAN DIET,
COMPILATION OF FOOD COMPOSITION
ANALYSIS AND DISSEMINATION AND
DATABASES, AND CONDUCT OF
NATIONALLY REPRESENTED SURVEY OF
HOW MUCH AND WHAT AMERICANS EAT.
NEXT SLIDE PLEASE.
AS I MENTIONED, THE FIRST
COMPONENT IS BRIDGING THE GAP
BETWEEN FOOD PRODUCTION AND
HUMAN HEALTH.
ACCESSIBLE, AFFORDABLE FOODS ARE
THE FOUNDATION.
AGRICULTURE IS THE SOURCE OF
FOOD IN OUR DIETS.
AGRICULTURE IS THE BASIS FOR OUR
NUTRITIONAL STATUS AND
NUTRITIONALLY RELATED HEALTH
STATUS.
AGRICULTURAL POLICIES,
DECISIONS, PROCEDURES AS WELL AS
POST HARVEST PRACTICES AND FOOD
PROCESSING DETERMINE THE TYPES
AND AMOUNTS -- CAN YOU PUT MY
SLIDES BACK UP PLEASE?
I'M NOT SURE -- THE FIRST
PROBLEM THIS COMPONENT ADDRESSES
IS DETERMINING AGRICULTURAL
PRACTICES THAT INFLUENCE
NUTRITIONAL QUALITY AND
COMPOSITION OF FOOD.
ARS SCIENTISTS ARE EXAMINING
EFFECT OF GENETICS, AGRICULTURAL
PRODUCTION, MANAGEMENT,
ENVIRONMENT, PROCESSING ON BOTH
MAGNITUDE AND VARIABILITY OF
NUTRITIONAL COMPOSITION AND
QUALITY OF THE U.S. FOOD SUPPLY.
MANY FACTORS HAVE THE POTENTIAL
TO ALTER FOOD COMPOSITION BUT
THE MAGNITUDE AND VARIABILITY OF
CHANGES NEED TO BE PLACED IN THE
CONTEXT OF AN INTEGRATED AND
COMPLEX FOOD SUPPLY TO DETERMINE
IF AND HOW THEY HAVE MEANINGFUL
EFFECTS ON HUMAN HEALTH.
CHEMICAL AND BIOCHEMICAL
ANALYSIS OF CROPS GROWN UNDER
DIFFERENT GENETIC SOURCES IS
NEEDED AND ANIMAL SOURCES.
STUDIES ARE REQUIRED TO ASSESS
EFFECTS OF ENVIRONMENTAL
VARIABLES INCLUDING CLIMATE,
SOIL, WATER ON THE QUALITY OF
FOODS.
THE SECOND PROBLEM STATEMENT IS
TO CONDUCT MULTI-RESEARCH TO
UNDERSTAND COMPLEX INTERACTIONS
AND IMPACTS ON HUMAN HEALTH.
CONSENSUS IS EMERGING FOOD
SYSTEMS CONTAIN FOUR PRIMARY
INTERACTING AND INTERDEPENDENT
COMPONENTS.
HUMAN NUTRITION AND HEALTH,
PRODUCTION AGRICULTURE AND FOOD
TECHNOLOGY, EFFECTS ON AND BY
THE ENVIRONMENT, AND CONSUMER
CHOICES AND ATTITUDES.
MOREOVER IT IS RECOGNIZED WITHIN
A FOOD SYSTEM ALL COMPONENTS
INTERACT WITH AND HAVE INTENDED
AND UNINTENDED CONSEQUENCES FOR
OTHER COMPONENTS OF THE SYSTEM.
UNDERSTANDING COMPLEX
INTERACTIONS WITHIN THE FOOD
SYSTEMS RELATED TO HUMAN HEALTH
REQUIRES DEVELOPMENT OF
MULTI-DISCIPLINARY TEAMS FROM
ALL SECTORS.
NUTRITION SCIENTISTS NEED TO
DEVELOP PARTNERSHIPS WITH OTHER
SCIENTIFIC DISCIPLINES INCLUDING
ANIMAL, PLANT, SOIL, WATER,
CLIMATE, FOOD TECHNOLOGY, FOOD
SAFETY, SOCIAL SCIENTISTS.
'EM TAMPA
EMPHASIS NEEDS TO BE ON
UNDERSTANDING CONSTRAINS ACROSS
THE SYSTEM FOR EXAMPLE BENEFITS
AND DETRIMENTS OF PLANT-BASED
DIET REQUIRES ASSESSMENT OF
MULTIPLE COMPONENTS COLLEAGUE
EFFECT ON WATER, SOIL, LAND,
CONSUMER EXPECTATIONS, CHANGES
IN CROP ROTATIONS, UTILIZATION
OF GRAZING LANDS, AND
NUTRITIONAL CONSEQUENCES OF NOT
CONSUMING NUTRIENTS OR
COMPONENTS ENRICHED WITH ANIMAL
PRODUCTS.
PRODUCTION PRACTICES THAT MAY
ALTER AVAILABILITY AND INFLUENTS
DIET SELECTION AND QUALITY,
THERE'S A NEED TO DETERMINE
WHETHER THESE INTERACTIONS
RESULT IN ALTERED HUMAN BODY
STORES OR CHANGES IN
PHYSIOLOGICAL VARIABLES.
THERE'S A NEED TO UNDERSTAND HOW
ALTERING AGRICULTURE TO PROMOTE
OPTIMAL HUMAN HEALTH AFFECTS
ECONOMIC AND ENVIRONMENTAL
SUSTAINABILITY.
NEXT SLIDE PLEASE.
FOUNDATIONAL TO CHARACTERIZING
NUTRIENT INTAKE IS A FOCUS OF
THE FDA SINCE THE 19th
CENTURY.
FOODDATA CENTRAL INCLUDES IMPACT
OF PRODUCTION MANAGEMENT,
ENVIRONMENT, PROCESSING ON FOOD
COMPOSITION OF THE FOOD SUPPLY,
THIS IS A FOCUS AREA OF THE
HUMAN NUTRITION PROGRAM WHERE
MORE DATA IS NEEDED.
HOPEFULLY ADVANTAGE WILL
STIMULATE RESEARCH TO FILL THIS
GAP.
THANK YOU FOR GIVING ME THE
OPPORTUNITY TO HIGHLIGHT HOW THE
RESEARCH WITHIN THE PROGRAM FITS
WITHIN ADVANTAGE.
THANK YOU.
>> TREMENDOUS.
THANK YOU AND YOUR ARS
COLLEAGUES AND USDA COLLEAGUES
FOR BEING PART OF THIS PROCESS.
WE TRULY APPRECIATE IT.
NOW I'D LIKE TO TURN THE BATON
OVER TO REAR ADMIRAL PAUL REID,
OFFICE OF ASSISTANT SECRETARY
FOR HEALTH.
>> APPRECIATE THE OPPORTUNITY
TO SHARE OUR THOUGHTS ON THIS
EFFORT FROM PERSPECTIVE OF
OFFICE OF ASSISTANT SECRETARY
FOR HEALTH AND OFFICE OF DISEASE
PREVENTION AND HEALTH PROMOTION
WHICH I OVERSEE.
WE UNDERSTAND THAT
SUSTAINABILITY AND COMPLEX
RELATIONSHIP BETWEEN NUTRITION
AND CLIMATE CHANGE REQUIRES
SPECIFIC EXPERTISE AND DEDICATED
EFFORT TO EVALUATING SCIENCE AND
APPRECIATE THAT NICHD AND THE
ACADEMY ARE LEADING THE EFFORT
TO EXAMINE THIS IMPORTANT
EVIDENCE BASE.
IT GOES WITHOUT SAYING THAT IT
IS A HIGH PRIORITY OF HHS
LEADERSHIP TO ADDRESS CLIMATE
CHANGE ON HEALTH OF AMERICANS
AND ISSUES ARE ALL OBVIOUSLY
CRITICAL, IMPORTANT, BEING
ADDRESSED IN MANY INITIATIVES
ACROSS THE ADMINISTRATION.
IMPORTANT WORK IS ONGOING ON
SUSTAINABLE AGRICULTURE, FOOD
WASTE AND EFFORTS RELATED TO
CLIMATE CHANGE AND INTERSECTION
OF POPULATION HEALTH.
WITHIN THE OFFICE OF THE
ASSISTANT SECRETARY FOR HEALTH
AT HHS, THE NEWLY ESTABLISHED
OFFICE OF CLIMATE CHANGE AND
HEALTH EQUITY IS SPECIFICALLY
FOCUSED ON CLIMATE CHANGE ON
HEALTH OF THE AMERICAN PEOPLE
OUR OFFICE'S RESPONSIBILITY IN
THE LANDSCAPE, AT THE WHITE
HOUSE CONFERENCE ON HUNGER,
NUTRITION AND HEALTH HELD THIS
LAST SEPTEMBER, THE PRESIDENT
SET A GOAL TO END HUNGER,
INCREASE HEALTHY EATING BY 2030
SO FEWER AMERICANS EXPERIENCE
DIET-RELATED DISEASES.
AT THAT CONFERENCE, THE WHITE
HOUSE RELEASED NATIONAL STRATEGY
THAT OUTLINES NUMEROUS ACTIONS
THE FEDERAL GOVERNMENT WILL TAKE
TO ACHIEVE THIS GOAL INCLUDING
ACTIONS TO ENABLE THE
OPPORTUNITIES FOR AMERICANS TO
INCREASE HEALTHY EATING AND
PHYSICAL ACTIVITY.
ROUTINELY WITH INPUT FROM
EXPERTS IN THE FIELD AND PUBLIC
FEEDBACK OUR OFFICE SETS FEDERAL
GUIDELINES ON NUTRITION AND
PHYSICAL ACTIVITY INFORMING
FEDERAL POLICIES AND PROGRAMS TO
PROMOTE HEALTH.
SPECIFICALLY, OUR OFFICE OF
DISEASE PREVENTION AND HEALTH
PROMOTION SERVES AS LEAD FOR
DEVELOPMENT OF THE PHYSICAL
ACTIVITY GUIDELINES FOR UPDATES
TO DIETARY GUIDELINES IN
PARTNERSHIP WITH USDA.
THE NATIONAL STRATEGY ON HUNGER,
NUTRITION AND HEALTH THERE ARE
FIVE PILLARS.
MOST RELEVANT TO THE WORK OF
THIS INITIATIVE IS PILLAR FIVE,
ADDRESSING ENHANCING NUTRITION
AND FOOD SECURITY RESEARCH TO
IMPROVE NUTRITION METRICS, DATA
COLLECTION AND RESEARCH TO
INFORM NUTRITION AND FOOD
SECURITY POLICY PARTICULARLY ON
ISSUES OF EQUITY, ACCESS,
DISPARITIES.
I'LL QUICKLY ADD THE SECOND
PILLAR FOCUSES ON INTEGRATING
NUTRITION AND HEALTH, A LINES
CAN THE KEY STRATEGY.
OUR OFFICE WILL LEAD STRATEGY
REGARDING FOOD AS MEDICINE AS
CALLED FOR IN THE 2023
CONSOLIDATED APPROPRIATIONS ACT
SEEKING TO UNDERSTAND THE
BREADTH, FULL BREADTH OF
EXISTING FOOD AS MEDICINE
STRATEGIES AND DEFINE BEST
PRACTICES TO INFORM FUTURE
FEDERAL POLICY AND INVESTMENTS.
THE THIRD PILLAR OF THE NATIONAL
STRATEGY IS ABOUT EMPOWERING ALL
CONSUMERS TO HAVE ACCESS TO AND
MAKE HEALTHY CHOICES.
WE ALSO SUPPORT THIS IMPORTANT
GOAL THROUGH OUR WORK IN
CO-LEADING ONGOING UPDATE OF
DIETARY GUIDELINES FOR AMERICANS
WITH OUR USDA COLLEAGUES.
AS MANY OF YOU KNOW THE DIETARY
GUIDELINES UPDATED AND RELEASED
EVERY FIVE YEARS SERVE AS
CORNERSTONE OF FEDERAL NUTRITION
POLICY AND NUTRITION EDUCATION
ACTIVITIES.
THEY ARE FOOD-BASED NUTRITION
GUIDELINES DESIGNED TO SUPPORT
DEVELOPMENT OF HEALTHY EATING
PATTERNS.
THE CURRENT EDITION OF THE
DIETARY GUIDELINES PROVIDES
GUIDANCE BY LIFE STAGE FROM
BIRTH THROUGH OLDER ADULTHOOD
INCLUDING RECOMMENDATIONS FOR
PREGNANT AND LACTATING WOMEN.
THE PROCESS TO UPDATE THE NEXT
EDITION OF THE GUIDELINES IS
UNDERWAY AS WE SPEAK.
AS I MENTIONED CO-LED BY ODPHD
AND CENTER FOR NUTRITION AT
USDA.
THE 2025 ADVISORY COMMITTEE WAS
ANNOUNCED IN JANUARY OF THIS
YEAR, TASKED WITH REVIEWING
CURRENT BODY OF EVIDENCE ON DIET
AND HEALTH OUTCOMES ACROSS THE
LIFESPAN.
ALL THE SCIENTIFIC QUESTIONS
DELIBERATED ON WILL BE REVIEWED
WITH HEALTH EQUITY LENS TO
ENSURE THE NEXT EDITION OF THE
DIETARY GUIDELINES IS RELEVANT
TO ALL AMERICANS.
SECOND MEETING OF THE COMMITTEE
IS COMING UP ON MAY 10,
REGISTRATION IS NOW OPEN ON
DIETARY GUIDELINES.GOV AS OF
TODAY I BELIEVE.
IN PARALLEL WITH THE WORK OF THE
SCIENTIFIC ADVISORY COMMITTEE
AND FEDERAL PARTNERS TO DEVELOP
THE NET ITERATION OF GUIDELINES
IS THIS IMPORTANT WORK ON
SUSTAINABILITY.
HHS WILL BE FORMING A SEPARATE
COMMITTEE TO EXAMINE A PROCESS
FRAMEWORK FOR CONSIDERING
INCORPORATING ISSUES OF
SUSTAINABILITY LIKE WHAT WE HOPE
TO LEARN FROM ADVANTAGE INTO THE
DIETARY GUIDELINES PROCESS AS
WELL AS POTENTIALLY HELP INFORM
OTHER FEDERAL NUTRITION POLICIES
AND PROGRAMS.
FINALLY I'D BE REMISS IF I
DIDN'T MENTION THE HALLMARK
PROGRAM, HEALTHY PEOPLE AND ITS
RELEVANCE TO THE WORK WE'RE
DISCUSSING TODAY.
THROUGH HEALTHY PEOPLE ODPHP
WORKS WITH PARTNERS ACROSS THE
FEDERAL GOVERNMENT TO SET
NATIONAL DISEASE PREVENTION
PRIORITIES, SHARE THE LATEST
HEALTH PROMOTION RESEARCH,
COLLABORATE ON STRATEGIES TO
FURTHER THE NATION'S HEALTH
AGENDA.
WE CO-CREATE HEALTHY PEOPLE
EVERY TEN YEARS, HEALTHY PEOPLE
2030 CURRENT ITERATION INCLUDES
MORE THAN 350 EVIDENCE-BASED
MEASURABLE OBJECTIVES WHICH
COVER A WIDE RANGE OF TOPICS IN
WHICH HELP US MEASURE AND TRACK
FACTORS THAT INFLUENCE OUTCOMES.
I'M QUITE CONFIDENT WHAT WE
LEARN FROM THE WORK OF ADVANTAGE
WILL HELP INFORM ALL OF THESE
EFFORTS.
I WANT TO THANK YOU, EVERYBODY
COMMITTED TO THIS EFFORT.
THANK YOU VERY MUCH.
>> PAUL, THANK YOU.
AGAIN, CINDY AND PAUL, WE REALLY
APPRECIATE NOT ONLY YOU
PERSONALLY, WHAT YOU BRING TO
THE TABLE, BUT WHAT YOU BRING
FROM YOUR AGENCIES.
AGAIN, VERY GRATEFUL.
WE'RE GOING GREAT ON TIME.
WE'LL PIVOT WORKING 1 GROUP
CO-CHAIRS AND LET'S LAUNCH
ADVANTAGE.
KRISTIE AND NANCY, TAKE IT AWAY.
>> WE REALLY APPRECIATE ALL THE
COMMENTS FROM EVERYONE, THE
FRAMING WAS VERY HELPFUL.
I'M A PREFER AT THE CENTER FOR
HEALTH AND GLOBAL ENVIRONMENT,
CO-CHAIR WITH NANCY KREBS,
WORKING GROUP 1.
NANCY?
>>GOOD MORNING.
GOOD DAY TO THOSE IN OTHER TIME
ZONES.
IT'S A DELIGHT TO BE HERE.
I WANT TO JUST ADD MY THANKS.
IN THE INTEREST OF TIME I THINK
THE SLIDES THAT DR. EBI IS GOING
TO GO THROUGH WILL REALLY LAY
THE GROUND WORK FOR TODAY'S
SESSION.
BUT JUST TO TAKE A MOMENT TO SAY
WE'LL BE WORKING ON THE
INTERSECTION OF CLIMATE AND
ENVIRONMENT CHANGE WITH EMPHASIS
ON NUTRITION, AND OVERLYING THAT
IS A LIFE COURSE APPROACH.
SO OUR PROGRAM FOR TODAY WILL
HOPEFULLY REFLECT THAT
MULTI-FACTORIAL SECTORAL
APPROACH.
>>I'LL START WITH OUR AGENDA
LAYING OUT WHAT WE'LL COVER IN
THE NEXT COUPLE HOURS SO YOU
HAVE A VISION OF WHERE WE'RE
GOING.
AND WE'RE GOING TO START BY
TALKING ABOUT OUR OBJECTIVES AND
OUR FRAMEWORK.
AND THEN WE'RE GOING TO LAUNCH
INTO A SESSION ON CLIMATE,
HEALTH, NUTRITION.
EACH OF THESE SESSIONS WILL HAVE
A BRIEF DISCUSSION PERIOD.
WE'LL HAVE SOME PRESENTATIONS
AND A BRIEF DISCUSSION PERIOD.
AND WE'LL HAVE A LONGER
DISCUSSION AT THE END THAT WE
REALLY LOOK FORWARD TO YOUR
CONTRIBUTIONS TO.
THIS IS THE WORKING GROUP.
YOU ALREADY SAW NANCY AND ME.
WE'VE GOT RONALD, CARTEEK,
ANDREW, ALEXANDRA.
THESE ARE OBJECTIVES.
WE WANT TO DESCRIBE CURRENT
STATE OF KNOWLEDGE OF IMPACT OF
WEATHER AND CLIMATE ON HEALTH
OUTCOMES OVER THE LIFESPAN.
THINKING IN PARTICULAR ABOUT
PARTICULARLY VULNERABLE GROUPS,
FOR VULNERABILITY FROM THE
HEALTH PERSPECTIVE WE MEAN
SUSCEPTIBILITY, MORE SUSCEPTIBLE
FOR EXAMPLE TO HEAT STRESS AND
THINKING ABOUT PHYSIOLOGIC
FUNCTIONS.
WE'LL COVER THE EVIDENCE BETWEEN
CLIMATE, MALNUTRITION FOR EACH
STAGE, KNOWLEDGE GAPS AND
RESEARCH PRIORITIES.
NONE OF US HAVE DISCLOSURES.
PERHAPS WHEN THERE'S MORE
FUNDING WE MIGHT HAVE SOME
DISCLOSURES BUT WE PROBABLY
WON'T FOR THE FORESEEABLE TIME.
WITH THAT I WANT TO START WITH A
FEW SLIDES ABOUT CLIMATE CHANGE
AND HOW IT IS AFFECTING HEALTH.
THIS AND THE NEXT SLIDE ARE FROM
THE JUST-RELEASED SYNTHESIS
REPORT FROM INTERGOVERNMENTAL
PANEL ON CLIMATE CHANGE.
IT JUST CAME OUT A FEW WEEKS
AGO.
THERE'S A COUPLE HELPFUL
GRAPHICS THAT CAN HELP FRAME HOW
WE'RE GOING TO APPROACH OUR
PARTICULAR CHALLENGE.
THE PANEL A SHOWS OBSERVED
IMPACTS.
CLIMATE CHANGE IS ALREADY
AFFECTING HUMAN HEALTH AND
WELL-BEING.
WE NOW HAVE SPECIFIC STUDIES
THAT SHOW PEOPLE ARE DYING FROM
CLIMATE CHANGE.
THE FOCUS OF THE STUDIES IS ON
HEAT BUT INCREASINGLY THERE WILL
BE MORE STUDIES DOCUMENTING HARM
TODAY FROM MALNUTRITION AND FROM
WILDFIRES IN PARTICULAR.
ALTHOUGH THERE ARE SOME
SUGGESTIONS THAT NOT ONLY DO WE
KNOW THERE'S ASSOCIATIONS
BETWEEN OUR CHANGING CLIMATE,
INCREASES IN FLOODING FOR
EXAMPLE AND MENTAL HEALTH, AND
ONCE IT'S DOCUMENTED FLOODING
EVENTS ARE INDEED ATTRIBUTABLE
TO SOME DEGREE TO CLIMATE CHANGE
WE'LL BE ABLE TO ATTRIBUTE
MENTAL HEALTH OUTCOMES.
YOU'LL HEAR TODAY MORE ABOUT
INFECTIOUS DISEASES.
WE WON'T REALLY TALK MUCH ABOUT
DISPLACEMENT.
WHEN YOU LOOK AT THE OTHER PARTS
OF PANEL A, YOU CAN SEE WATER
AVAILABILITY, FOOD PRODUCTION,
CITY SETTLEMENTS AND
INFRASTRUCTURE, BIODIVERSITY AND
ECOSYSTEMS.
THESE ARE CATEGORIZED IN TERMS
OF WAY MINISTRIES ARE ORGANIZED
WITHIN GOVERNMENT.
OR WHERE YOU HAVE SUBNATIONAL
ELEMENTS LIKE CITIES AND WHAT
HAPPENS WITHIN CITIES.
BUT OF COURSE THESE ARE NOT
INDEPENDENT.
THESE ALL INTERACTION.
AND SO AS DR. RAITEN EMPHASIZED
WE'RE TAKING A SYSTEMS-BASED
APPROACH, WE NEED TO LOOK AT
INTERSECTIONS BETWEEN WATER
AVAILABILITY, WHAT HAPPENS WITH
AGRICULTURE, WHAT THAT MEANS FOR
DIETS AND FINALLY WHAT IT MEANS
FOR NUTRITION.
PANEL B COVERS THE OBSERVED
PHYSICAL CLIMATE CHANGES, AND
EXTENT TO WHICH THERE HAS BEEN
ATTRIBUTION TO CLIMATE CHANGE.
YOU CAN SEE IN THE BOTTOM RIGHT
IT'S VIRTUALLY CERTAIN CLIMATE
CHANGE HAS INCREASED FREQUENCY,
INTENSITY, AND DURATION OF HEAT
EXTREMES.
WE ALSO KNOW VIRTUALLY CERTAIN
THAT CLIMATE CHANGE HAS
AFFECTED pH IN THE UPPER OCEAN
LEADING TO OCEAN ACIDIFICATION.
THERE'S BEEN LOTS OF DISCUSSION
IN THE MEDIA ABOUT SEA LEVEL
RISE, STORM SURGE, WHAT THAT
MEANS FOR COASTAL ZONES.
IN THE U.S. WE'VE SEEN SOME
MASSIVE PRECIPITATION EVENTS
RESULTING IN EXTENSIVE FLOODING.
AND THE FLOODING HAS TO DO NOT
JUST WITH THE CHANGES IN THE
PHYSICAL CLIMATE BUT ALSO OUR
INFRASTRUCTURE.
CHOICES THAT WE'VE MADE IN OUR
CITIES AND HOW OUR CITIES ARE
PLANNED, WHICH IS WHY YOU SEE A
MEDIUM CONFIDENCE IN ISSUES SUCH
AS INCREASES IN COMPOUND
FLOODING.
AGAIN, ON THE SYSTEMS-BASED
APPROACH, ALL OF THESE ISSUES
THEN GO BACK TO THE OBSERVED
IMPACTS LISTED ABOVE, THE
FLOODING AFFECT, AGRICULTURE,
LIVESTOCKS, FISHERIES,
INFECTIOUS DISEASES, ET CETERA.
WE HAVE TO TAKE THE BROADEST
POSSIBLE PICTURE, UNDERSTANDING
THESE UPSTREAM DRIVERS OF HEALTH
AND WELL-BEING.
THE REPORT INCLUDED THIS FIGURE
WHICH VERY MUCH SPEAKS TO THE
THEME OF WHAT WE'RE DOING IN
ADVANTAGE AND WHAT WE'RE GOING
TO BE TALKING ABOUT IN OUR
SPECIFIC WORKING GROUP.
IF YOU'RE NOT FAMILIAR WITH
THESE, THESE ARE THE WARMING
STRIPES, CLIMATE STRIPES THAT
SHOW GLOBAL TEMPERATURE CHANGE
ABOVE WHAT WAS OBSERVED IN 1850
TO 1900.
DARKER THE COLOR, HIGHER THE
TEMPERATURE CHANGE.
FROM 2020 GOING FORWARD, THESE
ARE PROJECTIONS BASED ON
EMISSION SCENARIOS, HOW MUCH
GREENHOUSE GASES WILL BE OH OF
ADMITTED INTO THE ATMOSPHERE
WITH FIVE SCENARIOS USED TO
BRACKE THE RANGE OF FUTURE
UNCERTAINTIES.
LOW EMISSIONS IS A WORLD AIMING
TO SUSTAINABLE DEVELOPMENT.
TRYING TO KEEP WARMING BELOW 2
DEGREES CELSIUS, AIMING TO 1.5
DEGREES UP TO VERY HIGH
EMISSIONS, THIS IS A WORLD WHERE
THERE ARE VERY HIGH CHALLENGES
TO ADAPTATION AND MITIGATION,
AND SO YOU CAN SEE QUITE EXTREME
WARMING UP TO 4 DEGREES C ABOVE
PRE-INDUSTRIAL IN THE VERY HIGH.
THE SLIDE SHOWS YOU WHAT IT
MEANS FOR US, WHAT IT MEANS FOR
THE HUMAN POPULATIONS.
AT THE BOTTOM YOU SEE PEOPLE
BORN IN 1950, EXPERIENCED A
SMALL AMOUNT OF TEMPERATURE
CHANGE BUT NOT MUCH.
AND AS THEY ARE NOW GETTING INTO
THE PERIOD OF BEING OLDER
ADULTS, THEY ARE STARTING TO
EXPERIENCE HIGHER TEMPERATURES.
BUT CHILDREN BORN IN 1980 ARE
STARTING TO EXPERIENCE THESE
TEMPERATURES IN THEIR MIDDLE
YEARS.
AND THIS IS GOING TO AFFECT
THEIR LIFE COURSE BECAUSE THEY
ARE GOING TO HAVE MORE
SIGNIFICANT EXPOSURES TO HIGH
TEMPERATURES, MORE FLOODING
EVENTS, THE KINDS OF CLIMATE
IMPACTS I MENTIONED ON THE
PREVIOUS SLIDE.
AND THEN CHILDREN BORN TODAY
WILL HAVE MUCH MORE EXTREME
EXPOSURES.
AND SO WHEN WE THINK ABOUT LIFE
SOURCE AND HEALTH, WE THINK
ABOUT WHAT HAPPENS OVER THE
COURSE OF OUR LIFETIMES, AND WE
HAVE TO ADD INTO THIS, AS DR.
RAITEN SET, THINKING ABOUT OUR
GLOBAL ENVIRONMENT, WHAT IS THE
EXPERIENCE OF US INDIVIDUALLY
AND COLLECTIVELY, AS WE GO INTO
A MUCH WARMER AND VERY DIFFERENT
FUTURE.
IN TERMS OF HEALTH, AN IMPORTANT
FRAMING FROM THE
INTERGOVERNMENTAL PANEL ON
CLIMATE CHANGE, WE THINK NOT
JUST ABOUT THE CLIMATE.
THE TOP ROW SHOWS CHANGES THAT
ARE OCCURRING WITH INCREASING
GREEN HOUSE GAS EMISSIONS,
INCREASE IN TEMPERATURE, SEA
LEVEL RISE.
THOSE INTERACT WITH A BROAD
RANGE OF DEMOGRAPHIC,
SOCIOENVIRONMENT, ENVIRONMENTAL
AND OTHER FACTORS.
TOGETHER THAT INTERACTION
DETERMINES THE MAGNITUDE AND
PATTERN OF RISKS.
THE SLIDE LISTS A SHORT LIST OF
SOME OF THESE OTHER FACTORS, AND
WE NEED TO UNDERSTAND THESE
BECAUSE CLIMATE CHANGE IS
UNEVEN.
WE DO HAVE THE CHANGE AND GLOBAL
MEAN SURFACE TEMPERATURE BUT
WHAT HAPPENS AT LOCAL SCALE
DIFFERS QUITE A BIT.
AND SO EXPOSURES VARY FROM PLACE
TO PLACE.
ALSO, BECAUSE OF THE
INTERACTIONS THAT ULTIMATELY
DETERMINE WHAT WE'RE GOING TO
OBSERVE, WE NEED TO UNDERSTAND
THE UNDERLYING SUSCEPTIBILITY OF
POPULATIONS AND WE NEED TO
UNDERSTAND THE CAPACITY OF OUR
SYSTEMS TO MANAGE THESE SHIFTS
IN THE MAGNITUDE AND PATTERN OF
RISKS.
AND TOGETHER THOSE THEN
INFLUENCE EXPOSURE PATHWAYS THAT
ARE WHAT ARE TYPICALLY STUDIED
IN HEALTH.
ON THE LEFT EXTREME WEATHER
EVENT TO THE RIGHT WHETHER WE'VE
GOT SOCIAL FACTORS THAT
INFLUENCE, FOR EXAMPLE,
MIGRATION AND CONFLICT.
THE EXAMPLES OF HEALTH OUTCOMES
ARE INDEED THAT.
JUST EXAMPLES.
THERE ARE LITERALLY HUNDREDS OF
CLIMATE SENSITIVE HEALTH
OUTCOMES.
WE CATEGORIZE THINGS FOR
PARTICULAR REASONS.
SO THE LIST OF HEALTH OUTCOMES
IS CATEGORIZED BY EXPOSURE
PATHWAYS, BUT AGAIN THESE ARE
NOT INDEPENDENT OF EACH OTHER.
WE KNOW THAT UNDER NUTRITION IN
CHILDREN MAKES CHILDREN
SUSCEPTIBLE TO MALARIA AND TO
DIARRHEAL DISEASE, MAKING
CHILDREN MORE SUSCEPTIBLE TO
ADVERSE CONSEQUENCES OF
UNDERNUTRITION SO THERE ARE
INTENSE INTERACTIONS ACROSS
THESE EXPOSURE PATHWAYS.
AND WE'RE GOING TOUCH ON SOME OF
THOSE IN ADVANTAGE JUST TO MAKE
SURE THAT THE READERS TAKE INTO
ACCOUNT THE SYSTEMS-BASED
THINKING, SO THAT WE DON'T
UNINTENTIONALLY MISINFORM BY
STOVE PIPING ISSUES WHEN THEY
ARE IN FACT NOT INDEPENDENT.
THANK YOU VERY MUCH FOR
LISTENING.
AND ALEXA, ON TO YOU.
DO YOU WANT TO CONTROL THE
SLIDES?
>>I CAN SHARE THE SLIDES.
>> PERFECT.
>>OKAY.
ARE YOU SEEING MY SLIDES?
AWESOME.
THANK YOU, DR. EBI, FOR THE
OVERVIEW ON CLIMATE CHANGE AND
HEALTH.
I'M ALEXA BELLOWS, DOING A BRIEF
OVERVIEW ON NUTRITION AND HEALTH
AS I'M SURE MANY OF YOU ARE
FAMILIAR WITH THIS TOPIC
ALREADY.
SO GLOBALLY THE PREVALENCE OF
MALNUTRITION IS CONTINUING TO
INCREASE.
AND I WANT TO SAY GLOBAL AND
NATIONAL ESTIMATES DO HIDE
SIGNIFICANT DISPARITIES IN
NUTRITIONAL STATUS ACROSS
POPULATIONS.
BUT WE KNOW PREVALENCE CONTINUES
TO BE HIGH PARTICULARLY IN RURAL
AREAS OF SUB-SAHARAN AFRICA AND
SOUTH ASIA, OVERWEIGHT AND
OBESITY PREVALENCE RISING IN ALL
REGIONS OF THE WORLD.
YOU CAN SEE 150 MILLION CHILDREN
ARE STUNTED, 45 MILLION CHILDREN
WASTED, 35 MILLION OVERWEIGHT,
700 MILLION AFFECTED BY OBESITY.
WE'RE NOT A TRACK TO MEET
TARGETS BY 2025.
WE'RE OFF COURSE.
WE'RE OFF COURSE RELATED TO
REDUCING DIET RELATED
NON-COMMUNICABLE DISEASES.
AND FOR THE WORKING GROUP AS
KRISTI AND NANCY MENTIONED WE'LL
TAKE A LIFE COURSE PERSPECTIVE,
IMPACTING IMMEDIATE AND
LONG-TERM HEALTH OUTCOMES.
THIS GRAPHIC DOES A NICE JOB OF
HIGHLIGHTING HOW THE
UNDERNUTRITION AND OVERNUTRITION
AT LIFE STAGES CAN IMPACT
HEALTH.
FOR EXAMPLE IN INFANCY, CHRONIC
UNDERNUTRITION CAN LEAD TO
HIGHER MORTALITY, IMPAIRED
MENTAL HEALTH, INCREASED RISK OF
POOR HEALTH OUTCOMES DURING
ADULTHOOD.
AND ANOTHER EXAMPLE WOULD BE
MALNUTRITION AND PREGNANCY WHICH
CAN RESULT IN INCREASED HEALTH
RISK FOR MOTHER AND CHILD
HIGHLIGHTING THIS
INTERGENERATIONAL EFFECT OF
NUTRITION.
THE GOAL FOR WORKING GROUP 1 IS
TO INCORPORATE THE EFFECT OF
CLIMATE CHANGE INTO THIS LIFE
COURSE PERSPECTIVE FOR NUTRITION
AS WELL.
AND AT THE MOMENT MOST
CONCEPTUAL FRAMEWORKS
INCORPORATE CLIMATE CHANGE AS A
DISTAL CAUSE FOR MALNUTRITION,
SO ON THIS SLIDE WE HAVE THE
W.H.O. CONCEPTUAL FRAMEWORK FOR
THE DOUBLE BURDEN OF
MALNUTRITION, WHICH WAS UPDATED
FROM UNICEF FRAMEWORK FOR
UNDERNUTRITION.
WE SEE AT THE BOTTOM IN BLUE
THAT CLIMATE CHANGE IS INCLUDED
HERE AS ONE OF THE BASIC CAUSES
AT THE SOCIETAL LEVEL.
SO FOR WORKING GROUP 1 WE'RE
WORKING ON A CONCEPTUAL
FRAMEWORK, A DRAFT TO HIGHLIGHT
PATHWAYS THEY INTERACT.
PATHWAY 1 IN BLUE SHOWS CLIMATE
AND ENVIRONMENTAL CHANGE
IMPACTING FOOD SYSTEMS RESULTING
IN CHANGES IN DIETARY INTAKE,
NUTRITIONAL STATUS, AND HEALTH.
IN THE SECOND PATHWAY, THE
PURPLE ARROW, SHOWS CLIMATE AND
ENVIRONMENTAL CHANGE DIRECTLY
IMPACTING HEALTH AND SEVERITY OF
IMPACTS MAY BE MODIFIED BY
INDIVIDUALS' STATUS.
EXAMPLE MIGHT BE IMPACTING
HEALTH EFFECTS OF EXTREME HEAT.
AND I ALSO WANT TO POINT OUT WE
HAVE A DOUBLE ARROW HIGHLIGHTING
THAT HEALTH ALSO IMPACTS
NUTRITIONAL STATUS AS WELL.
AND SO THIS IS A VERY BASIC
CONCEPTUAL FRAMEWORK WE PUT
TOGETHER TO HELP US START
THINKING THROUGH THE DIFFERENT
PATHWAYS THAT CLIMATE AND
ENVIRONMENTAL CHANGE IMPACT
HEALTH.
AND WORKING GROUPS 2 AND 3 WILL
FOCUS ON CLIMATE AND
ENVIRONMENTAL CHANGES IMPACT ON
THE FOOD SYSTEMS AND DIETS.
FOR WORKING GROUP 1 WE'RE GOING
TO FOCUS ON THE DOWNSTREAM END
OF THIS FRAMEWORK.
WE PLAN TO LOOK AT HOW CHANGES
IN DIET ESTIMATED FROM WORKING
GROUP 2 WILL IMPACT NUTRITIONAL
STATUS AND THEREFORE HEALTH.
BUT ALSO HOW NUTRITIONAL STATUS
MODIFIES DIRECT IMPACT OF
CLIMATE CHANGE ON LET.
THAT'S ALL THAT WE HAVE PREPARED
FOR THIS SESSION.
DO WE WANT TO LEAVE OUT THIS
CONCEPTUAL FRAMEWORK FOR THE
DISCUSSION PART?
>> THANK YOU, DR. BELLOWS.
SURE, WE CAN LEAVE THAT UP.
>> OKAY.
>> NANCY, DID YOU WANT TO
MODERATE THE DISCUSSION?
>> WELL, YES.
THAT WOULD BE GREAT.
I WONDER IF ANYONE HAS ANY
KICKOFF QUESTIONS FOR OUR
PROPOSED FRAMEWORK HERE,
ANYTHING COMES TO MIND FROM OUR
WORKING GROUP OR OTHER WORKING
GROUP MEMBERS IN ATTENDANCE?
>> I CAN START WITH A
DISCUSSION POINT AS PART OF THE
WORKING GROUP.
>> GREAT.
>> ONE OF THE THINGS I THINK
WHEN I WAS FIRST WORKING WITH
SOME OTHER MEMBERS OF OUR
WORKING GROUP IS WE WERE
FOCUSING ON PATHWAY 1, THAT WAS
THROUGH MY OWN BIAS, I'VE
THOUGHT OF NUTRITION AND FOOD
SYSTEMS, WHERE THE FOCUS OF MY
WORK HAS BEEN.
LEARNING FROM OTHERS IN THE
WORKING GROUP.
SECOND PATHWAY OF NUTRITIONAL
STATUS MODIFYING, DIRECT IMPACTS
OF CLIMATE CHANGE ON HEALTH,
SOMETHING THAT WAS NEW TO THINK
ABOUT, REALLY INTERESTING AND
JUST THE LOOP THAT GOES BACK AS
WELL.
THAT WE'LL BE EXPERIENCING.
>> YES.
THANK YOU.
AND I'LL JUST ADD TO THAT THAT I
WANT TO SORT OF REHIGHLIGHT WHAT
DR. EBI SAID ABOUT THE
POPULATION STATISTICS ARE SO
HIGH LEVEL THAT THEY REALLY
DON'T GET AT SOME OF THE
SUBQUESTIONS AND VULNERABILITIES
AND INEQUALITIES IN HOW THESE
SYSTEM CHANGES AFFECT
INDIVIDUALS AND SUBGROUPS
DIFFERENTLY, THAT ADDRESSES YOUR
POINT THERE, ALEXA, IN TERMS OF
NUTRITIONAL STATUS, IT'S NOT AN
EQUAL PLAYING FIELD.
>> THERE'S AN ESTIMATE FROM
UNICEF THAT ABOUT 1 BILLION
CHILDREN ARE BEING AFFECTED BY
CLIMATE CHANGE.
WE KNOW CHILDREN ARE
PARTICULARLY AFFECTED BY THE
KINDS OF CHANGES ONGOING.
AN ESTIMATE FROM THE WORLD
HEALTH ORGANIZATION A FEW YEARS
AGO WAS 85% OF HEALTH RISKS IN
CLIMATE CHANGE ARE IN CHILDREN.
BUT AS YOU HEARD FROM BOTH OF
OUR PRESENTATIONS THIS IS GOING
TO SHIFT OVER THE LIFE COURSE,
THAT CHILDREN WILL CONTINUE TO
BE PARTICULARLY AFFECTED BUT ALL
OF US ARE BEING AFFECTED BY
CHANGING CLIMATE.
AS WE'RE SEEING SHIFTS IN, FOR
EXAMPLE, EXPOSURE TO HEAT
STRESS, THERE'S GOING TO BE
CONSEQUENCES FOR OLDER ADULTS AS
WELL BECAUSE HEAT STRESS IS --
PRIMARILY AFFECTS CHILDREN,
OLDER ADULTS, OUTDOOR WORKERS,
PREGNANT WOMEN.
THERE ARE POSSIBILITIES THEN
THAT THERE COULD BE BROADER
CONSEQUENCES ACROSS THE LIFE
COURSE.
WE'VE GOT SOMETHING IN CHAT.
>>DO YOU WANT TO VERBALIZE YOUR
MESSAGE?
>> I'M A MEMBER OF WORKING
GROUP 5, FOCUSING ON METHODS AND
METRICS.
LOTS OF TIE-INS BETWEEN THE
DIFFERENT GROUPS.
GREAT TO HEAR FROM YOU AND SEE
THIS FRAMEWORK .
I SUPPOSE WITH EVERY FRAMEWORK
THERE'S MORE ARROWS THAT COULD
BE ADDED, INFINITE NUMBER OF
ARROWS.
THERE'S IMPACTS OF FOOD SECURITY
ON HEALTH AS WELL AS IMPACTS OF
FOOD SYSTEMS ON HEALTH THAT
AREN'T NECESSARILY MEDIATED.
FOOD INSECURITY CAN IMPACT
MENTAL HEALTH, ORAL HEALTH AMONG
CHILDREN, OR FOR FOOD SYSTEMS,
OCCUPATIONAL HEALTH RISKS, FARM
WORKERS THAT DIRECTLY IMPACT
HEALTH, NOT NECESSARILY MEDIATED
BY NUTRITIONAL STATUS, THINGS TO
CONSIDER.
I KNOW THERE'S ALWAYS AN
INFINITE NUMBER OF ARROWS THAT
COULD BE ADDED.
>> YES.
THANK YOU.
>> ANY OTHER THOUGHTS OR
REACTIONS?
>> I'LL ADD TO THAT I AGREE
THERE CAN BE AN INFINITE NUMBER
OF ARROWS.
IT DOES BECOME A CHALLENGE HOW
YOU DO ANY KIND OF GRAPHIC WHEN
YOU'RE TALKING ABOUT SYSTEMS
THAT ARE FUNDAMENTALLY
INTERCONNECTED.
WE'RE ALSO GOING TO ACROSS ALL
OF THE WORKING GROUPS HAVE
EXTENSIVE COVERAGE ABOUT HOW
LIMITED OUR KNOWLEDGE IS.
AND NOTE THAT THERE'S LOTS OF
CONNECTIONS THAT WE UNDERSTAND
FROM FIRST PRINCIPLES BUT WE MAY
NOT UNDERSTAND HOW CLIMATE AND
GLOBAL ENVIRONMENTAL CHANGE
COULD INTERACT WITH THOSE.
THERE'S BEEN RELATIVELY LITTLE
RESEARCH IN THE SPACE, AND SO
WE'LL BE FINDING LOTS OF
OPPORTUNITIES FOR FURTHER
RESEARCH TO IDENTIFY KEY ISSUES
THAT ARE IMPORTANT FOR POLICY
MAKING.
>> YES.
>> CHRIS?
>>YES?
>> I RAISED MY HAND.
SO, I JUST WANT TO REEMPHASIZE
THE POINT WITH REGARD TO THE
VERNACULAR WE'RE USING.
NUTRITION IS THE GLUE THAT TIES
FOOD SYSTEMS TO HEALTH.
SO YOU HAVE FOOD, A DELIVERY
VEHICLE.
FOOD SYSTEMS PROVIDE FOOD.
BUT NUTRITION IS A BIOLOGICAL
VARIABLE THAT CONNECTS TO
HEALTH.
I THINK IT'S REALLY IMPORTANT
FOR US TO MAINTAIN VIGILANCE
ABOUT THAT BECAUSE OTHERWISE
WE'RE MISSING A CRITICAL PIECE
HERE.
FOOD IS NOT NUTRITION.
NUTRITION IS NOT FOOD.
THEY ARE OBVIOUSLY RELATED.
AND ALONG THOSE LINES IN YOUR
EFFORTS WE HAVEN'T TALKED ABOUT
THIS YET, BUT HOW MIGHT YOU
INTEGRATE AND MAYBE THIS IS
SOMETHING THAT WORKING GROUP 4
COULD CHIME IN ON AS WELL,
INTEGRATE ASSESSMENT OF
NUTRITIONAL STATUS, BOTH
SURVEILLANCE AND CLINICAL
ASSESSMENT, INDIVIDUAL CARE, TO
ADDRESS THIS INTERSECTION.
>> THANK YOU, DAN.
THAT'S REALLY HELPFUL.
I'LL ADD THAT OF COURSE
AGRICULTURE IS NOT FOOD SECURITY
EITHER.
AND SO WE DO HAVE TO BE MINDFUL
OF HOW WE FRAME THE QUESTIONS
THAT WE'RE ADDRESSING.
AND YOU'RE ABSOLUTELY RIGHT.
ONE OF THE OTHER WORKING GROUPS
IS GOING TO BE TALKING ABOUT THE
CONSEQUENCES OF HIGHER
CONCENTRATIONS OF CARBON DIOXIDE
IN THE ATMOSPHERE AND NUTRIENTAL
DENSITY OF FOOD, THINKING ABOUT
HOW WE MEASURE NUTRITIONAL
STATUS AND THINK ABOUT WHAT
KINDS OF SURVEYS WE NEED GOING
FORWARD AS WE -- FROM WHAT WE
KNOW FROM EXPERIMENTS, THE
NUTRIENT DENSITY IS ALTERING OUR
FOOD, HOW THAT AFFECTS
WELL-BEING.
>> I'D LIKE TO JUST ADD TO THIS
AND NOT NECESSARILY ADD ARROWS
BUT I THINK THAT THE WAY THE
CURRENT FRAMEWORK IS SET UP SORT
OF DOES REINFORCE WHAT I THINK
DAN WAS TRYING TO COUNTER OR
BROADEN OUR THINKING ABOUT IS
THAT NUTRITIONAL STATUS IS NOT
ONLY SUPPLY SIDE ECONOMICS, IF
YOU WILL, THE ENVIRONMENT IS
DEFINITELY GOING TO BE AFFECTS
HOW FOOD IS UTILIZED,
NUTRITIONAL AND METABOLIC
STATUS, ALL OF THAT.
AND THEN THAT THEN THEREFORE
INTERACTS WITH REQUIREMENTS AND
HEALTH STATUS AND SO ON.
SO WE QUICKLY GET INTO THE
COMPLEXITY BUT THIS IS WHAT
WE'RE HERE FOR.
>> EXACTLY RIGHT.
>> WE HAVE TIME FOR ANOTHER
COMMENT OR QUESTION.
THIS IS GREAT TO HAVE THIS
INTERACTION, ESPECIALLY FROM THE
OTHER WORKING GROUPS.
>> ANYBODY FROM WORKING GROUP 4
HERE?
I DON'T THINK SO.
I KNOW THE CHAIRS ARE CONFLICTED
TODAY.
WORKING GROUP 5?
GOING ONCE?
>> WE CAN ALWAYS MOVE TO THE
NEXT SET OF --
>> I WAS GOING TO SAY WE'RE
ALWAYS HAPPY TO HAVE EXTRA TIME.
DR. KLEINMAN IS NEXT TO TALK
ABOUT NUCLEAR ENERGY, WAS THAT
IT, RON?
INFECTIOUS DISEASE.
RON KLEINMAN, WELCOME.
>> THANK YOU, NANCY.
YES, I'M NOT -- YES, I'M NOT
GOING TO TALK ABOUT NUCLEAR
ENERGY.
BUT WHAT I HELP TO DO IN THE
SHORT PRESENTATION IS ADD A FEW
MORE ARROWS AND BUILD ON WHAT
NANCY, KRIS, AND ALEXA HAVE JUST
TALKED ABOUT BY RELATING
INFECTIOUS DISEASE, NUTRITION
AND CLIMATE TO ONE ANOTHER.
NEXT SLIDE PLEASE.
I'D LIKE TO START WITH THIS
FRAMEWORK THAT DAN RAITEN
PRESENTED IN HIS INTRODUCTION TO
THE ADVANTAGE PROJECT WITH A FEW
MODIFICATIONS.
IT'S QUITE CLEAR THAT INFECTIOUS
IMPACTS ON HEALTH ARE
INTERRELATED WITH THE IMPACTS ON
HEALTH OF NUTRITIONAL STATUS.
AND THAT BOTH OF THESE ARE
SIGNIFICANTLY INFLUENCED BY
WEATHER, CLIMATE, CLIMATE
CHANGE, AND ENVIRONMENT OVER THE
COURSE OF A LIFETIME.
NEXT SLIDE PLEASE.
THIS IS FURTHER DESCRIBED IN
THIS NEXT GRAPHIC IN WHICH I
PRESENTED SOME OF THE OTHER
MEDIATORS IMPACTED BY CLIMATE ON
HEALTH ULTIMATELY.
AND THIS INCLUDES FOOD AND
NUTRITION SECURITY, AND FOOD
SAFETY, AND OVER THE COURSE OF A
LIFETIME PHYSIOLOGY AND THE
CHANGES IN PHYSIOLOGY THAT
OCCUR, CHANGES IN DIETS AND
DIETARY PATTERNS, AS WELL AS
FOOD -- DEVELOPING FOOD AND
AGRICULTURAL SYSTEMS.
SO, IN THIS NEXT FEW MINUTES,
I'M GOING TO BRIEFLY TOUCH ON
WEATHER AND CLIMATE IMPACTS ON
INFECTIONS.
THEN BRIEFLY MOVE ON TO
NUTRITION, NUTRITIONAL STATUS
AND HOST DEFENSE.
AND THEN END WITH A BRIEF
DISCUSSION OF A CASE AND ITS
IMPACT WITH REGARD TO CHOLERA.
SO THE NEXT SLIDE PLEASE.
IT'S BEEN KNOWN FOR SOME TIME
THAT WEATHER PATTERNS INFLUENCE
THE PATHWAYS OF INFECTIOUS
DISEASE TRANSMISSION.
THESE PATTERNS INCLUDE ALL OF
THOSE ON THE LEFT SIDE OF THE
SLIDE FROM WARMING DOWN TO SEA
LEVEL CHANGES.
ALL OF THESE IMPACT ALL OF THE
PATHWAYS OF INFECTIOUS DISEASE
TRANSMISSION, INCLUDING VECTOR,
WATER, AIR, AND FOOD, ALONG WITH
DIRECT CONTACT.
AND THESE PATHWAYS OF
TRANSMISSION IMPACT INFECTIONS
FROM HUNDREDS OF DIFFERENT
DISEASES, IN ALL CATEGORIES OF
INFECTION, AFFECTING HUMANS,
PLANTS, AS WELL AS ANIMALS.
NEXT SLIDE PLEASE.
THE CDC POINTED OUT THE INCREASE
TO DISEASE THREATS THAT OCCURRED
OVER THE PAST TWO DECADES FROM
VECTOR-BORNE DISEASE, FOR
EXAMPLE ILLNESS FROM MOSQUITOES,
TICK, FLEA BITES MORE THAN
DOUBLED OVER THE PAST TWO
DECADES, WITH A NUMBER OF NEW
DISORDERS, DISEASES, SPREAD BY
MOSQUITOES AND TICKS THAT WERE
INTRODUCED INTO THE U.S. DURING
THIS PERIOD.
FURTHERMORE THE GEOGRAPHIC RANGE
OF THESE VECTOR-BORNE DISEASES
LAST EXPANDED SIGNIFICANTLY
INCLUDING LYME DISEASE AND OTHER
TICK-BORNE ILLNESSES SUCH A
SAPLASMOSIS AND SPOTTED FEVER.
LONGER AND WARMER SUMMERS HAVE
FAVORED MOSQUITOS IN A
SIGNIFICANT WAY WITH HOTTER
SUMMERS, FOR EXAMPLE, WEST NILE
VIRUS, AND THE LIST OF THESE
CONDITIONS OBSERVED TO INCREASE
OVER THE PAST TWO DECADES IS ON
THE RIGHT SIDE OF THE SLIDE, AND
IT GOES FROM A-W, IF WE WANTED
TO INCLUDE ZIKA IN IT IT WOULD
GO FROM A-Z.
NEXT SLIDE PLEASE.
IN ADDITION TO THE INFECTIONS
THEMSELVES, THERE ARE SOME
UNEXPECTED MANIFESTATIONS AS
MCFADDEN ET AL. POINT YOU HAD
OUT IN THIS PAPER, INCREASE IN
TEMPERATURE OF 10 DEGREES
CENTIGRADE ACROSS REGIONS OF THE
UNITED STATES WAS SIGNIFICANTLY
ASSOCIATED WITH INCREASE IN
ANTIBIOTIC RESISTANCE TO SEVERAL
VERY IMPORTANT PATHOGENS,
INCLUDING E. COLI, KLEBSIELLA,
STAPH AUREUS.
NEXT SLIDE PLEASE.
IN ADDITION TO THE INFECTIONS
THEMSELVES, CLIMATE CHANGE HAS A
PROFOUND EFFECT AND CAN HAVE A
PROFOUND EFFECT ON FOOD SAFETY.
IN PART AS A RESULT OF CHANGES
IN THE GROWTH PATTERN OF
PATHOGENS, THEIR ABILITY TO
SURVIVE AND THEIR CHANGES IN
THEIR VIRULENCE OVER TIME, IN
RESPONSE TO CLIMATE, AND CLIMATE
CHANGE, AND WORKING THROUGH
CONTAMINATION OF CROPS BY FECES
DUE TO FLOODING OR HIGH LEVELS
OF RAINFALL, AND ON THE OPPOSITE
RIGHT-HAND SIDE OF THE SLIDE
LIKELY ALSO DUE TO WATER
SCARCITY DURING DROUGHTS WHICH
CAN ADVERSELY AFFECT HYGIENE AND
SANITATION.
AND ALL OF THIS LEADING TO FOOD
SCARCITY CAN CAUSE DIETARY
SHIFTS TOWARDS MORE UNSAFE
FOODS.
NEXT SLIDE PLEASE.
IN THIS PAPER FROM CANADA, THEY
HAVE POINTED OUT POTENTIAL
IMPACT OF ALMOST ALL OF THE
COMMON FOOD-BORNE DISEASES OVER
THE COMING YEARS, AS A RESULT OF
CLIMATE CHANGES.
THE LIST IS QUITE EXTENSIVE.
AND VIRTUALLY ALL OF THEM
POTENTIALLY HAVE SOME IMPACT
OCCURRING AS A RESULT -- ON THE
ILLNESSES THEMSELVES, AS A
RESULT OF CLIMATE AND CLIMATE
CHANGE.
NEXT SLIDE.
THE RELATIONSHIP THEN BETWEEN
INFECTION AND MALNUTRITION, THE
SYNERGY DESCRIBED MORE THAN 50
YEARS AGO, ESSENTIALLY SAYS THAT
INFECTION LEADS TO MALNUTRITION
IN MANY CASES, PARTICULARLY IN
VULNERABLE POPULATIONS, AND
MALNUTRITION INCREASES THE RISK
OF AND FROM INFECTIONS.
AND SO INFECTIONS POTENTIALLY
LEAD TO DECREASED NUTRIENT
INTAKE, MALABSORPTION, INCREASED
CATABOLISM, AND MALNUTRITION
THEN LEADS TO DEFICIENCIES IN
HOST RESPONSE TO INFECTION
THROUGH IMPAIRED IMMUNE FUNCTION
AND IMPAIRED BARRIER PROTECTION
AGAINST THOSE INFECTIONS.
NEXT SLIDE PLEASE.
SOME OF THE SPECIFIC NUTRITIONAL
DEFICIENCIES THAT AFFECT IMMUNE
RESPONSE HAVE ALSO BEEN WELL
DESCRIBED OVER THE PAST SEVERAL
DECADES.
AND I THINK MOST OF US ARE
FAMILIAR WITH THESE PATHWAYS.
VITAMIN A IS PERHAPS ONE OF THE
MOST WELL-KNOWN DEFICIENCIES
RELATED TO RESISTANCE TO MEASLES
AND MORTALITY AS WELL AS
MORBIDITY FROM MEASLES, AND IN
ADDITION TO ACUTE DIARRHEA.
BUT ALL OF THESE HAVE BEEN
LINKED TO SERIOUS AND
COMPROMISED RESPONSES TO
INFECTIONS.
NEXT SLIDE PLEASE.
AS HAS BEEN POINTED OUT, THE
VULNERABLE POPULATIONS ARE THOSE
AT THE PRESENT TIME IN LOW --
MOST VULNERABLE POPULATIONS ARE
CURRENTLY THOSE WHO LIVE IN LOW
AND MIDDLE INCOME COUNTRIES,
EXPANDING OVER TIME TO AFFECT
THE ENTIRE GLOBE.
WE KNOW THE PREVALENCE OF
STUNTING IN CHILDREN HAS
SIGNIFICANTLY DECREASED OVER THE
PAST DECADE, GLOBALLY, BUT
REMAINS STUBBORNLY HIGHLY
PREVALENT IN AFRICA,
PARTICULARLY SUB-SAHARAN AFRICA,
AND ASIA, SOUTHEAST ASIA, WITH
LEVELS BETWEEN 20 AND 60%.
AND NEXT SLIDE.
ONE CAN COMPLETELY OVERLAY THIS
MAP OF PREVALENCE OF VITAMIN A
DEFICIENCY IN YOUNG CHILDREN
WITH THAT MAP OF STUNTING, AND
THE SAME THING WITH MAPS FOR
ZINC DEFICIENCY, IODINE
DEFICIENCY, IRON, AND OTHER
MACRO AND MICRO NUTRIENT
DEFICIENCIES.
NEXT SLIDE.
AND SO I WANT TO CONCLUDE THEN
BY TALKING ABOUT -- BRIEFLY
ABOUT CHOLERA, A BELLWETHER FOR
THE IMPACT OF CLIMATE CHANGE ON
HEALTH.
CURRENTLY, THERE 3 MILLION CASES
OF DIARRHEA AND 100,000 DEATHS
ANNUALLY CAUSED BY VIBRIO
CHOLERA.
IT OCCURS IN SPORADIC FORM,
ENDEMIC AREAS, PRIMARILY IN
YOUNG CHILDREN WHO LACK IMMUNITY
AND THEN IN THE EPIDEMICKING I
N -- EPIDEMICS IN MAN-MADE AND
NATURAL DISASTERS, FOR EXAMPLE
IN YEMEN AND SYRIA OVER THE PAST
SEVERAL YEARS.
IN 2017 THE W.H.O. INITIATED A
CAMPAIGN TO REDUCE CHOLERA
DEATHS BY 90%, BY 2030.
WITH IMPROVED SANITATION AND
VACCINES.
BUT CLIMATE CHANGE POSES A VERY
SIGNIFICANT EXISTENTIAL THREAT
TO THIS GOAL.
NEXT SLIDE.
THE REASON FOR THIS IS THAT
VIBRIOS THRIVE UNDER THE
CONDITIONS OF CLIMATE CHANGE
THAT WE ARE EXPERIENCING NOW AND
WILL CONTINUE TO EXPERIENCE
GOING FORWARD, DEPENDING ON OUR
RESPONSE TO THESE CHANGES.
INCREASED OCEAN SURFACE
TEMPERATURE, ACIDITY, SEA LEVEL
RISE, CHANGES IN SALINITY AND
CHANGES IN PRECIPITATION ALL
INCREASE THE GROWTH OF VIBRIOS
SPECIES AND HORIZONTAL GENE
TRANSFER IN THESE SPECIES,
LEADING TO NOT ONLY INCREASED
RISK FOR CHOLERA FROM VIBRIOS,
BUT AS WELL NON-VIBRIO SPECIES
SUCH AS VULNIFICANS AND
INCREASED ANTIBIOTIC RESISTANCE
WHICH I MENTIONED BEFORE.
BANGLADESH REPRESENTS AN AREA OF
THE GLOBE WHERE THIS
RELATIONSHIP BETWEEN CLIMATE,
HEALTH, AND ENDEMIC CHOLERA IS
MOST ACTIVELY DEMONSTRATED, EVEN
RIGHT NOW.
AND IN ENDEMIC AREAS, CLIMATE
DATA PREDICTS INCIDENCE OF
CHOLERA, AND THIS INCLUDES
RAINFALL, WATER SURFACE
TEMPERATURE, AND SALINITY.
AND MODELING THE IMPACT OF
CHANGE IN THESE PREDICTORS IN
BANGLADESH SUGGESTS A COUNTRY
THAT IS UNDER ENORMOUS THREAT
FROM CHOLERA.
AND WITHOUT INTERVENTION, A
SUBSTANTIAL INCREASE IN CHOLERA
IS PREDICTED IN EVERY DISTRICT
IN BANGLADESH OVER THE NEXT 30
YEARS, ESPECIALLY IN LOW-LYING
COASTAL AREAS.
SO, WITH THAT I'M GOING TO
CONCLUDE WITH THE NEXT SLIDE.
WHICH RETURNS TO THE FRAMEWORK
THAT I BEGAN WITH.
AND REEMPHASIZES THE
INTERRELATIONSHIP BETWEEN
CLIMATE, CLIMATE CHANGE, AND
ENVIRONMENTAL CHANGE ON
NUTRITIONAL STATUS AND THE RISK
FROM UNDER AND OVERNUTRITION AND
INFECTIOUS DISEASES OVER THE
LIFE COURSE, AND I LOOK FORWARD
TO WORKING WITH COLLEAGUES ON
WORK GROUP 1, IDENTIFYING THE
EVIDENCE THAT CURRENTLY EXISTS
TO ESTABLISH THESE
INTERRELATIONSHIPS AS WELL AS TO
IDENTIFYING THE RESEARCH GAPS
FOR STUDIES THAT STILL NEED TO
BE CONDUCTED TO FURTHER
DEMONSTRATE CAUSAL RELATIONSHIPS
BETWEEN THESE OUTCOMES.
WITH THAT, I'LL END.
THANK YOU.
>> THANK YOU FOR AN EXCELLENT
OVERVIEW, VERY COMPLEX TOPIC.
IN ADDITION TO COMMENTS YOU MADE
I'D LIKE TO UNDERSCORE SOMETHING
THAT'S INCREASING CONCERN IN THE
CLIMATE CHANGE COMMUNITY, WHAT
WE CALL COMPOUNDING AND
CASCADING RISKS.
YOU ILLUSTRATED THAT THROUGHOUT
THAT WE NEED TO STOP THINKING
ABOUT JUST THE FLOODING EVENT
BUT NEED TO MOVE ON TO THINKING
ABOUT THE CONSEQUENCES OF
FLOODING FOR MENTAL HEALTH,
INFECTIOUS DISEASE, TO THINK
ACROSS COMPLEXITY OF WHAT
HAPPENS WHEN OUR ENVIRONMENT
FURTHER CHANGES SO WE'RE BETTER
PREPARED.
IT'S NOT JUST TO UNDERSTAND FOR
UNDERSTANDING'S SAKE BUT
UNDERSTAND TO TAKE EFFECTIVE
ACTION.
>> ABSOLUTELY.
>> NANCY?
>>I WOULD POINT OUT THAT MY
BACKGROUND HERE IS THE VIEW FROM
OUR HOUSE TO THE COAST OF MAINE,
AND SO WE ACTUALLY -- AND THE
GULF OF MAINE IS THE
FASTEST-WARMING OCEAN IN THE
WORLD I BELIEVE.
AND WHILE THE TIDE IS OUT IN
THIS SLIDE, WHEN IT COMES IN WE
APPRECIATE EXACTLY WHAT'S MEANT
BY RISING TIDES AND THREATS.
SO JUST WANTED TO ADD THAT IN.
NANCY?
THANKS.
THAT .
>> I HABIT HEARD THOSE FIGURES
FOR THE CHOLERA IN -- HADN'T
HEARD THAT FOR CHOLERA AND
BANGLADESH.
HAVE YOU RUN INTO EXAMPLES OF
HOW NUTRITIONAL STATUS INTERACTS
WITH THE -- YOU KNOW, RESPONSE
TO CHOLERA INFECTIONS, EITHER IN
BANGLADESH, BUT ELSEWHERE AS
WELL.
BANGLADESH HAS BEEN ONE OF THE
LEADING COUNTRIES IN REALLY
ADDRESSING MICRONUTRIENT
DEFICIENCY, ESPECIALLY IN YOUNG
CHILDREN.
AND SO ARE THERE ANY DATA TO
SUGGEST THIS COULD ALTER THE
RESPONSE OR RESILIENCE OF
POPULATIONS?
>> YEAH, I MEAN, THE IDDRB IN
BANGLADESH HAS CERTAINLY TAKEN
THE LEAD IN IDENTIFYING THE --
WHAT HAPPENS WHEN YOU ARE
MALNOURISHED AND TRYING TO
RECOVER FROM CHOLERA.
THAT'S WELL ESTABLISHED.
WHAT'S LESS WELL ESTABLISHED IS
NUTRITIONAL MITIGATION.
FRANKLY, THAT IS AN AREA THAT IS
BEING ACTIVELY PURSUED, BUT THE
BIGGEST IMPACT IS GOING TO COME
WITH VACCINES, EFFECTIVE
VACCINES, AND BEING ABLE TO
DISTRIBUTE THOSE IN A WAY THAT
REACHES ALL OF THOSE VULNERABLE
CHILDREN AND ADULTS.
>> ADULTS, RIGHT.
>> YEAH.
>> I THINK THAT'S WHERE THE
PAYLOAD IS ACTUALLY.
>> YEAH.
THANKS.
>> THAT WAS EXCELLENT.
WE'LL HAVE MORE TIME AT THE END
FOR DISCUSSION.
SHOULD WE MOVE ON TO DR. BUNDY?
THANK YOU FOR JOINING FROM THE
U.K.
>> THANK YOU VERY MUCH,
KRISTIE.
WE'VE SPOKEN BUT WE HAVEN'T MET.
THIS IS PART OF THE LEGACY OF
THE PANDEMIC.
SO THANK YOU FOR THIS
OPPORTUNITY TO SPEAK ON CLIMATE
CHANGE IN THE NEXT 7,000 DAYS OF
CHILD DEVELOPMENT.
I WAS ASKED TO SPEAK REALLY ON
BEHALF OF ANOTHER GROUP WITHIN
THE NIH THAT'S LOOKING AT THESE
MODERN DAY ISSUES, AND THIS IS A
GROUP CALLED BOND-KIDS,
BIOMARKERS OF NUTRITIONAL
DEVELOPMENT, FOCUSING ON
SCHOOL-AGE CHILDREN AND
ADOLESCENTS.
I'M GOING TO BE -- I REALLY
ENJOYED DR. KLEINMAN'S
PRESENTATION.
I'M GOING TO BE MUCH MORE
TALKING ABOUT SOME ACTIONS THAT
ARE ONGOING AND SOME LEVELS OF
UNDERSTANDING THAT ARE PERHAPS
DIFFERENT ABOUT SCHOOL-AGE
CHILDREN.
SO, I'M GOING TO TALK ABOUT THE
FIRST 8,000 DAYS OF LIFE, UP TO
SORT OF THE EARLY 20s.
I'M GOING TO TALK ABOUT WHAT
GOVERNMENTS ARE DOING TO ACT ON
THIS, WHAT RESEARCH IS BEING
INITIATED, HOW THAT'S NOW
LOOKING AT CLIMATE, AND REALLY
HOW OUR GOVERNMENT'S REACTING.
WHAT IS THEIR LEVEL OF INTEREST.
ARE THEY GOING TO TAKE UP THESE
IDEAS AND MOVE WITH THEM?
SO, HERE'S -- LET'S START WITH A
FOCUS ON THE FIRST 8,000 DAYS OF
LIFE, THE THOUSAND DAYS WE'RE SO
USED TO TALKING ABOUT FOR
NUTRITIONAL PERSPECTIVE, ALSO
THE NEXT 7,000 DAYS THROUGH
SCHOOL AGE AND INTO ADOLESCENCE.
MANY OF US DURING THE FIRST DAYS
OF THE COVID EPIDEMIC WERE
SUFFICIENTLY DISTRACTED NOT TO
NOTICE ONE STRANGE THING THAT
HAPPENED TO THE WORLD IN 2020
WAS THE AVERAGE AGE OF A PERSON
IN THE WORLD NOW EXCEEDED FOR
THE FIRST TIME 30 YEARS OF AGE.
IN SOME PARTS OF THE WORLD AS WE
RECOGNIZE, THAT'S A MUCH HIGHER
AGE.
IN BRITAIN AND THE STATES, THE
AVERAGE AGE OF A PERSON IS NOW
IN THEIR 40s.
IN OTHER PARTS OF THE WORLD,
THINKING, THE AVERAGE AGE OF
SOME POPULATIONS, NIGER OR CHAD,
IS AROUND 15 OR 16 YEARS OF AGE.
IN OTHER WORDS, HALF THE
POPULATION ARE CHILDREN.
AND THESE TWO DEMOGRAPHIC
PYRAMIDS ARE JUST TO REEMPHASIZE
THE POINT, WHAT IS THE GROUP WE
ARE TALKING ABOUT?
ON THE LEFT WE'VE GOT THE
SUB-SAHARAN AFRICAN POPULATION,
ON THE RIGHT EUROPEAN AND NORTH
AMERICAN POPULATION BY AGE AND
SEX, STRIKINGLY DIFFERENT
DISTRIBUTIONS.
IF WE LOOK AT THE RIGHT, WE CAN
SEE IN THOSE RICH NORTHERN
COUNTRIES SOMETHING LIKE LESS
THAN 7% OF THE COUNTRY, OF THE
POPULATION, ARE THOSE SCHOOL-AGE
CHILDREN AND ADOLESCENTS.
BUT WE ALSO RECOGNIZE THAT THAT
7% IS GOING TO HAVE TO BE THE
EARNERS OF TOMORROW.
THOSE ARE OUR FUTURE.
THAT'S THE HUMAN CAPITAL WE'LL
TAKE FORWARD TO SUPPORT THE VERY
LARGE BURDEN OF DEPENDENT
POPULATIONS THAT ARE GROWING
THERE, WHEREAS IF WE LOOK AT THE
AFRICAN SITUATION WE CAN SEE
VERY DIFFERENT.
THERE ARE VERY LARGE VERY
SUBSTANTIAL PROPORTIONS OF THE
POPULATION SCHOOL AGE CHILDREN
AND ADOLESCENTS AND CARRY FOR
THEM, ALSO VITALLY IMPORTANT,
PRETTY WELL THE TOTAL OF THE
POPULATION.
SO WE'RE SEEING A VERY DIFFERENT
BUT EQUALLY IMPORTANT REASONS
FOR FOCUSING ON THOSE NEXT 7,000
DAYS.
AND WHEN THE NEXT SLIDE PLEASE,
WHEN THE BOND-KIDS INITIATIVE OF
NIH WAS LAUNCHED AND STARTED
LOOKING AT THE DATA, THEIR
WORKING GROUP 1 FOCUSED ON
BIOLOGY CAME UP WITH SOME OF
THESE RESULTS, ASSEMBLED SOME
IMPORTANT INDICATORS HERE.
SO, LET'S LOOK AT THIS GRAPH,
TOTAL ENERGY EXPENDITURE BY AGE,
ISOTOPIC MEASURES, SO THAT'S THE
FIRST TIME WE'VE BEEN ABLE TO
LOOK AT HUNDREDS OF THOUSANDS OF
PEOPLE IN TERMS OF ENERGY
EXPENDITURE.
REALLY LOOK ACROSS AN AGE RANGE.
WHAT WE SEE, WE SEE BETWEEN 20
AND 60 YEARS OF AGE, NOMINAL
WORKING ADULT AGE RANGE, STABLE
LEVELS OF ENERGY EXPENDITURE.
THEY CONTINUE PRETTY WELL AFTER
62.
UP TO THAT 20, WE CAN SEE THE
PICTURE IS NOT HOW WE TENDED TO
THINK OF IT IN NUTRITION.
WE SEE THIS PEAK VERY EARLY ON
IN THE FIRST THOUSAND DAYS BUT
WE CAN ALSO SEE THAT ENERGY
DEMANDS REMAINED HIGH THROUGHOUT
INTO THE 20s.
SO, MESSAGE THEN, THE FIRST
THOUSAND DAYS VERY IMPORTANT
NUTRITIONALLY.
WE KNOW ALL THAT.
THAT'S AN OLD STORY.
BUT NOW WE'RE SEEING SOMETHING
MORE IMPORTANT HAPPENING THAT WE
SEE THE NEXT 7,000 DAYS, SCHOOL
AGE AND ADOLESCENTS, ALSO
IMPORTANT NUTRITIONALLY.
THE BOND-KIDS PROJECT IN FACT IS
MAKING THAT A SPECIFIC MESSAGE
OF A DIFFERENT WAY OF THINKING
OF THE DEMOGRAPHICS OF
POPULATIONS FROM A NUTRITIONAL
PERSPECTIVE.
AND IF I HAVE THE NEXT SLIDE
PLEASE, THIS IMPLIES THINKING IN
TERMS OF INTERVENTIONS FIRST
THOUSAND DAYS WE'RE USED TO THAT
MATERNAL INTRAUTERINE, INFANT
DEVELOPMENT, ALL INTERVENTIONS
REQUIRED THERE, BUT WE'RE ALSO
NOW SAYING THAT THOSE
INVESTMENTS NEED TO ALSO
CONTINUE THROUGH THE NEXT 7,000
DAYS, TO MAINTAIN THOSE EARLY
GAINS, TO ALLOW FOR CATCH-UP,
ALSO TO SUPPORT CHILDREN DURING
VULNERABLE PHASES OF, FOR
EXAMPLE, BRAIN DEVELOPMENT
DURING ADOLESCENCE.
CERTAINLY ALSO THE VULNERABLE
PHASES DURING PUBERTY.
BUT THE BIG MESSAGE, THE BIG
MESSAGE HERE IS THE NEED TO
SUPPORT CHILDREN THROUGHOUT THE
FIRST 8,000 DAYS OF THEIR LIFE.
AND WE RECOGNIZE, IF WE TAKE A
STAND BACK AND TAKE A VIEW
BEYOND NUTRITION, THOSE NEXT
7,000 DAYS OF SCHOOL AGE AND
ADOLESCENT DAYS ARE AGES WHEN WE
TEACH OUR CHILDREN.
THAT'S WHEN CHILDREN, WE INVEST
IN THE EDUCATION OF SCHOOL AGE
CHILDREN AND ADOLESCENTS,
LEADING INTO ADULTHOOD.
WHEN COUNTRY CREATES HUMAN
CAPITAL IT'S INVESTING HEAVILY
IN EDUCATION DURING THAT PHASE
AND WHAT WE'RE ARGUING NOW THAT
THERE NEEDS TO BE EQUIVALENT
INVESTMENT IN THE WELL-BEING OF
CHILDREN DURING THOSE AGES WHEN
THEY ARE BEING EDUCATED.
SO IF I COULD HAVE THE NEXT
SLIDE AND THE NEXT ONE PLEASE.
NEXT SLIDE.
AND THE MESSAGE THAT I
PARTICULARLY THEN WANT TO TALK
ABOUT IS WHAT ARE COUNTRIES
DOING DURING THOSE 7,000 DAYS,
THE NEXT 7,000 DAYS.
THE ANSWER IS THAT SCHOOL HEALTH
AND NUTRITION PROGRAMS ARE IN
PLACE, AND IN PARTICULAR SCHOOL
MEALS PROGRAMS ARE IN PLACE.
IF WE LOOK AT THE GRAPH ON THE
LEFT HERE, JANUARY 2020, THIS IS
JUST -- THESE ARE DATA FROM
BEFORE THE COVID PANDEMIC, SOME
388 MILLION SCHOOL CHILDREN WERE
BEING FED EVERY DAY, AT SCHOOL.
THAT'S APPROXIMATELY 1 IN 2 OF
ALL PRIMARY SCHOOL CHILDREN WERE
BEING FED.
AND SOMEWHERE OVER 95% OF THOSE
CHILDREN WERE ALSO RECEIVING
HEALTH INTERVENTIONS, MANY OF
THEM WERE OF COURSE
NUTRITIONALLY SENSITIVE LIKE
DEWORMING, FOR EXAMPLE.
SO, A VERY SUBSTANTIAL COVERAGE
WORLDWIDE OF INVESTMENT IN
CHILDREN IN THOSE EARLY -- IN
THE NEXT 7,000 DAYS.
AND IF I CAN GO TO THE PREVIOUS
SLIDE PLEASE, WHAT WE SEE HERE
IS WHO IS PAYING FOR THESE
INTERVENTIONS.
THIS IS QUITE STRIKING.
SO THAT IN HISTOGRAM ON THE LEFT
WE CAN SEE THAT OVER THE LAST 10
YEARS THERE'S BEEN ACTUALLY A
SUSTAINED GROWTH IN THESE
PROGRAMS.
BUT THROUGHOUT THAT PERIOD, MORE
THAN 98% OF THE COSTS HAVE BEEN
MET FROM DOMESTIC FUNDS.
THE OTHER HISTOGRAMS SHOW IT'S
ONLY REALLY IN THE LOWEST INCOME
COUNTRIES THAT THERE'S RELIANCE
ON EXTERNAL FUNDS FOR THESE
PROGRAMS.
MOST OF THE SCHOOL MEALS AND
SCHOOL HEALTH PROGRAMS ARE
DOMESTICALLY FUNDED.
AND THE HISTOGRAM -- SORRY, THE
PIECHART ON THE RIGHT SHOWS IT'S
AN INDUSTRY THAT'S WORTH
SOMETHING LIKE $40 BILLION A
YEAR, BUT ONLY ABOUT .$3 BILLION
COMES FROM EXTERNAL SOURCES.
THIS IS OFTEN A SURPRISE TO HOW
PEOPLE THINK THAT SCHOOL MEALS
PROGRAMS WORK GLOBALLY.
THEIR ESSENTIALLY DOMESTICALLY
FUNDED GOVERNMENT-LED PROGRAMS.
GO BACK TO THE -- THANK YOU VERY
MUCH.
JANUARY 2020, MORE CHILDREN
LOOKED AFTER THROUGH THEIR
SCHOOL SYSTEMS MORE CHILDREN IN
THE 7,000 DAYS AREA THAN EVER IN
THE HISTORY OF THE WORLD.
THEN BY APRIL 2020, WITH THE
ARRIVAL OF COVID, THE DECISION
WAS MADE TO CLOSE SCHOOLS
WORLDWIDE.
SO 199 COUNTRIES CLOSED SCHOOLS
WITH CATASTROPHIC CONSEQUENCES
FOR THE CHILDREN.
OVERNIGHT OF COURSE THEY LOST
THE ACCESS TO EDUCATION IN SOME
COUNTRIES, RICHER COUNTRIES THAT
WASN'T MUCH OF A CHALLENGE
BECAUSE THERE WERE OPPORTUNITIES
ONLINE.
NOT TOO MUCH OF A CHALLENGE, BUT
OF COURSE IN OUR RICH COUNTRIES
WE'VE HEARD NOTHING -- ABOUT
NOTHING MORE THAN DAMAGE DOWN TO
OUR -- DONE TO OUR CHILDREN
DAMAGED BY THAT PROCESS.
IMAGINE THE REST OF THE WORLD,
FOR EXAMPLE IN AFRICA 10% OF
CHILDREN HAVE ACCESS TO ONLINE
EDUCATION.
IN SOME COUNTRIES WE'RE SEEING
THE SCHOOLS REMAINED CLOSED FOR
3 YEARS, ONLY JUST NOW BEGINNING
TO OPEN.
SO WE'VE SEEN DISASTROUS
CONSEQUENCES OF PARTICULARLY
SCHOOL GIRLS, BECOMING FIRST
WIVES, SCHOOL GIRLS ALSO
BECOMING MOTHERS, SCHOOL BOYS
BECOMING LABOR, SO ON.
IT'S BEEN -- ALL THE LAST THREE
SOCIAL CONSEQUENCES HAVE PROVEN
LARGELY IRREVERSIBLE, MOST OF
THOSE CHILDREN HAVE NEVER GONE
BACK TO SCHOOL.
SO, WE SEE THIS CONSEQUENCE.
WE THEN SAW A VERY STRONG
REACTION FROM THE COUNTRIES.
NEXT SLIDE PLEASE.
WE SAW COUNTRIES COMING FORWARD
TO REACT TO THIS.
SO JUST SOME EXAMPLES HERE,
FINLAND, WHICH DIDN'T CLOSE ITS
SCHOOLS, AND WHICH HAS RELIED ON
UNIVERSAL SCHOOL FEEDING
PROGRAMS FOR THE LAST 75 YEARS
SINCE THE SECOND WORLD WAR AND
SEES THEM AS THE KEY FACTOR IN
ITS INTERNATIONAL DEVELOPMENT,
HAS LOBBIED STRONGLY FOR
REBUILDING OF THESE PROGRAMS.
BUT TWO EXAMPLES FURTHER OVER,
EMMANUEL MACRON FROM FRANCE AND
PRESIDENT PAUL KAGAMA FROM
RWANDA, ESSENTIALLY TWEETING THE
SAME MESSAGE THAT THIS IS A
REALLY IMPORTANT ISSUE THAT
LOOKING A OUR SCHOOL CHILDREN,
THE WELL-BEING OF OUR SCHOOL
CHILDREN IS CRUCIAL TO THE
DEVELOPMENT OF THE NATIONS.
IF I HAVE THE NEXT SLIDE PLEASE,
THE REACTION TO THIS HAS BEEN
CREATION OF A SCHOOL MEALS
COALITION, SCHOOL MEALS
COALITION BUT REALLY ABOUT
SCHOOL HEALTH AND NUTRITION.
BUT MEALS THE MOST VISIBLE
ASPECT OF THIS.
78 COUNTRIES REPRESENTING 55% OF
GLOBAL POPULATION HAVE JOINED
THE SCHOOL MEALS COALITION AT
THE LEVEL OF HEAD OF STATE OR
PRIME MINISTER, SO HAS BEEN A
STRONG DRIVING FORCE.
NEXT SLIDE PLEASE.
AND THIS AGGREGATION OF 78
COUNTRIES HAS HAPPENED IN LESS
THAN A YEAR.
I JUST WANT TO CONTRAST THAT
WITH SCALING UP NUTRITION, SUN,
SUPPORTING 65 COUNTRIES AFTER 12
YEARS, OR GLOBAL FINANCING 75
COUNTRIES OVER SEVEN YEARS.
THE COALITION DEVELOPED ITS OWN
INTERNAL MOMENTUM.
IT'S ALSO STAKEHOLDERS THAT HAVE
GOT BEHIND THIS AND ARE
SUPPORTING THIS AGENDA.
IF I COULD -- YES, THE GOALS OF
THE COALITION ARE VERY CLEAR.
FIRST GOAL IS TO RESTORE THE
COVERAGE THAT THERE WAS IN 2020
TO RESTORE IT BEFORE 2023.
SECONDLY, REACH THE 73 MILLION
CHILDREN WHO WERE NOT EVEN
REACHED IN 2020.
AND FINALLY, TO RAISE THE
QUALITY OF SCHOOL HEALTH AND
NUTRITION PROGRAMS.
HERE'S THE ISSUE WHERE BOND-KIDS
AND I WOULD SUGGEST ADVANTAGE
CAN REALLY PLAY AN IMPORTANT
ROLE IN ADDRESSING WHAT ARE THE
KEY COMPONENTS.
WELL, THE NEXT DEVELOPMENT FROM
THE SCHOOL MEALS COALITION WAS
TO DEVELOP A RESEARCH CONSORTIUM
TO TAKE THESE IDEAS FORWARD.
SO LET'S HEAR FROM GORDON BROWN
ABOUT THIS ONE.
WE'RE NOT HEARING SOUND I THINK.
THE RESEARCH CONSORTIUM --
SORRY, RESEARCH COALITION,
SCHOOL MEALS COALITION,
DETERMINED ITS FIRST ACTION
SHOULD BE TO INITIATE A RESEARCH
CONSORTIUM.
IS THE SOUND WORKING NOW?
>>A SACRED INJUNCTION IN EVERY
RELIGIOUS FAITH.
IF WE'RE TO BE THE FIRST
GENERATION IN HISTORY TO ACHIEVE
TWO GREAT HUMANITARIAN GOALS,
ENDING EXTREME POVERTY, GETTING
EVERY CHILD INTO SCHOOL AND
LEARNING, THEN EVERY SINGLE
CHILD MUST HAVE THE OPPORTUNITY
TO ACCESS WHAT IS PERHAPS THE
MOST IMPACTFUL AND EFFECTIVE
SAFETY NET TO SUPPORT CHILDREN,
HEALTHY MEALS EVERY DAY IN
SCHOOL.
IN LOW- AND MIDDLE-INCOME
COUNTRIES EVERY DOLLAR YIELDS
NINE DOLLARS IN RETURNS.
SINCE THE START OF THE PANDEMIC,
MORE THAN 39 BILLION IN-SCHOOL
MEALS HAVE BEEN MISSED, 379
MILLION CHILDREN HAVE BEEN
SUDDENLY DEPRIVED OF THE MAIN
AND SOMETIMES ONLY MEAL OF THE
DAY, A SILENT TRAGEDY FOR
CHILDREN'S NUTRITION THAT WILL
COME BACK TO HAUNT US.
EVEN BEFORE THE PANDEMIC,
DESPITE 388 MILLION STUDENTS
RECEIVING MEALS IN 161
COUNTRIES, 73 MILLION OF THE
MOST VULNERABLE GIRLS AND BOYS
IN 60 LOWER INCOME COUNTRIES
WERE NOT REACHED.
TO REPAIR THIS WE NEED TO
MOBILIZE $2 BILLION IN AID,
RESTORE PROGRAMS FOR CHILDREN BY
2022 AND ENSURE THE 73 MILLION
ADDITIONAL CHILDREN LEFT OUT ARE
NOW FED.
WE WILL NEED THE SUPPORT OF THE
GLOBAL COALITION FOR SCHOOL
FEEDING AS IT BRINGS TOGETHER
ALL WHO CAN CONTRIBUTE AND NEW
RESEARCH CONSORTIUM WILL BE
WORKING WITH DEDICATED TASK
FORCE UNDER THE EDUCATION FORUM
I CO-CHAIR, AND IT WILL MAP THE
AVAILABLE GLOBAL FINANCING FOR
HEALTH PROGRAMS AND WILL DEVELOP
A FINANCING AND DELIVERY PLAN SO
THAT INSTEAD OF DEVELOPING ONLY
SOME POTENTIAL OF SOME CHILDREN
IN SOME COUNTRIES, WE NURTURE
AND FEED ALL OF THE POTENTIAL OF
ALL CHILDREN IN ALL COUNTRIES.
>>SO THAT'S GORDON BROWN,
EX-PRIME MINISTER OF THE U.K.
ALSO SPEAKING THERE AS THE
CO-CHAIR OF THE GLOBAL EDUCATION
COMMISSION.
THE POINT I WANT TO EMPHASIZE
HERE, THIS IS THE EDUCATION
WORLD ALSO RECOGNIZING THE
IMPORTANCE OF WELL-BEING IN
SCHOOL AGE CHILDREN AND
ADOLESCENTS, CRITICALITY FOR
DEVELOPMENT.
AS HE SAID, THE PURPOSE OF THIS
LAUNCH THAT HE WAS DISCUSSING
WAS THE CREATION OF THE RESEARCH
SIDE.
AND THE AFRICAN UNION
DEVELOPMENT AGENCY WORKED WITH
US TO CREATE THIS NEW RESEARCH
CONSORTIUM.
NEXT SLIDE PLEASE.
AND THE GOAL OF THE CONSORTIUM,
THIS IS WHERE WE START TO COME
BACK TO OUR CLIMATE ISSUES, WAS
TO GENERATE EVIDENCE ON THE
VALUE OF SCHOOL MEALS, SCHOOL
HEALTH AND NUTRITION, AND TO DO
THAT FOR THE POLICYMAKERS AND
PARLIAMENTARIANS FROM THE 78
COUNTRIES THAT SUPPORT THE
SCHOOL MEALS COALITION.
SO THIS IS VERY MUCH RESEARCH
FOR A PURPOSE, MISSION-DRIVEN
RESEARCH.
NEXT SLIDE PLEASE.
THIS IS THE STRUCTURE OF THE
RESEARCH CONSORTIUM.
SO THE BOSS , THE LEADERSHIP OF
ALL OF THIS, IS THE 78 NATIONAL
GOVERNMENTS.
A SMALL SECRETARIAT SET UP IN
LONDON AT THE LONDON SCHOOL OF
HYGIENE AND TROPICAL MEDICINE,
HELPS COORDINATE THE REAL POWER
IN THE RESEARCH CONSORTIUM, A
SERIES OF COMMUNITIES OF
PRACTICE ADDRESSING A RANGE OF
TOPICS, SIX OF THEM LINED UP
THERE.
LET ME BRIEFLY MENTION THE NEXT
SLIDE WHAT THOSE CONSORTIA --
WHAT THOSE RESEARCH GROUPS ARE
CONCERNED ARE.
THESE ARE THE COMMUNITIES OF
PRACTICE.
IMPACTING EVIDENCE, UNDERTAKING
SYSTEMATIC REVIEWS OF THIS
PROCESS, IT'S WORTH EMPHASIZING
EACH OF THE COMMUNITIES OF
PRACTICE IS GLOBAL IN ITS
MEMBERSHIP AND SPECIFICALLY
GLOBAL IN ITS THOUGHT
LEADERSHIP.
ANALYTICS AND METRICS, VALUE FOR
MONEY, ALSO LOOKING AT SOME
IMPACTS SPECIFICALLY ON
LEARNING.
THE GOOD EXAMPLES WHICH CREATES
CASE STUDIES, PURSUING CASE
STUDIES FOR ALL 78 COUNTRIES, SO
TO LEARN WHAT ARE THE BEST
PRACTICES, NUTRITION MEASUREMENT
GROUP WHICH IS WHERE BOND-KIDS
CAME INTO THE PICTURE.
AND LED ON NUTRITION.
AND SO IMPORTANTLY SHOWED THE
WAY FORWARD IN THAT AREA,
IMPORTANCE OF THE NEXT 7,000
DAYS.
I'M GOING TO TALK ABOUT THE DIET
AND FOOD SYSTEMS SPECIFICALLY
NOW JUST TO MENTION AT THE END
WE ALSO HAVE AN EARLY CAREER
RESEARCH GROUP, VERY KEEN TO
ENCOURAGE YOUNGER SCIENTISTS
INTO LOOKING AT SCHOOL AGE
CHILDREN AND ADOLESCENT
NUTRITION.
LET'S TALK ABOUT THE DIET AND
FOOD SYSTEMS.
IN THIS A THIS IS A COMMUNITY OF
PRACTICE ESTABLISHED IN RESPONSE
TO COUNTRY DEMAND GOING ON FOR A
YEAR NOW.
WHAT BECAME APPARENT THROUGH THE
WORK OF BOND-KIDS WAS NOT ONLY
DO WE NEED TO THINK ABOUT
NUTRITION, WE NEED TO THINK
ABOUT THE MENUS IN SCHOOLS, DIET
THAT SUPPORTS, AND HOW THAT'S
SUPPORTED BY FOOD SYSTEMS.
SO, WITH A FOCUS ON DIET, ON
FOOD SOVEREIGNTY, AGRO
BIODIVERSITY AND CLIMATE
RESPONSIVENESS IN ADDRESSING
SCHOOL MEALS, PARTICULARLY
THROUGH THE HOMEGROWN SCHOOL
MEALS ACTIVITIES THAT ARE BEING
ADOPTED SO STRONGLY IN AFRICA.
AND FOOD SYSTEMS, THIS IS THE
YELLOW BOX HERE, WHY FOOD
SYSTEMS?
BECAUSE WE SEE THESE AS --
COUNTRIES SEE THESE AS A FAST
TRACK TO SUBSTANTIAL CHANGE.
OPERATING AT SCHOOL, OVER $40
BILLION WORTH OF BUSINESS A
YEAR, FEEDING SOME 400 MILLION
CHILDREN.
AND THEY HAVE LIFELONG AND
COMMUNITY-WIDE INFLUENCES, THEY
CAN ESTABLISH DIETARY
PREFERENCES, AND MOST
IMPORTANTLY BECAUSE THESE ARE
GENERALLY GOVERNMENT LED, LEVERS
OF POLICY CHANGE ARE RELATIVELY
IN HAND, THERE TO BE MOVED.
SO, ALL OF THAT SUGGESTED STRONG
NEED TO LOOK AT NEW COMMUNITY OF
PRACTICE IN FOOD SYSTEMS, AND
WITHIN THAT, NEXT SLIDE PLEASE,
TO THINK ABOUT FOOD SYSTEMS AND
THE ENVIRONMENT.
AND SO ONE OF THE ISSUES THE
CURRENT FOOD SYSTEMS ARE
ENVIRONMENTALLY UNSUSTAINABLE.
THEY ARE MAJOR DRIVERS OF
CLIMATE CHANGE.
THEY ARE MAJOR DRIVERS OF
ENVIRONMENTAL DEGRADATION.
AND THAT THE FOOD SYSTEMS BY AND
LARGE FAILED TO DELIVER HEALTHY
AND NUTRITIOUS DIETS.
AND WE SEE DIETARY RISKS ARE A
LEADING RISK FACTOR FOR
PREMATURE MORTALITY GLOBALLY.
PREVALENCE OF OVERWEIGHT AND
OBESITY IN PARTICULAR, WHICH ARE
ON THE INCREASE, EVEN WHILE
UNDERNUTRITION IS A PROBLEM.
HEALTHY DIETS ARE UNAFFORDABLE
FOR THE WORLD'S POOR.
WE SEE FOOD SYSTEMS AS VITALLY
IMPORTANT FOR ALL OF THOSE
REASONS.
NEXT SLIDE PLEASE.
AT THE SAME TIME WE SEE SCHOOL
MEALS CAN BE PART OF THE
SOLUTION.
SO, SCHOOL MEALS IF WELL PLANNED
CAN PROVIDE THE HEALTH AND DIET
AT AFFORDABLE COST.
AND THEY ACT AT DIFFERENT LEVELS
OF IMPACT ON HEALTH AND
NUTRITIONAL IMPACTS FOR THE
PUPIL, SUSTAINABLE IMPACTS TO
SOCIETY, AND COST IMPACTS FOR
SCHOOLS AND PARENTS AND TO
SOCIETY.
AND HERE WE'RE TALKING ABOUT IN
TERMS OF FOOD SYSTEMS IMPROVED
FOOD SOVEREIGNTY, AND THE
EXAMPLE I THINK OF NEPAL, FROM
HAVING THREE MAIN CROPS
SUPPLYING ITS SCHOOL MEALS
PROGRAMS TO 18 I THINK IS A
GREAT EXAMPLE, CREATION OF
SHORTER FOOD CHAINS AND
HOMEGROWN SCHOOL FOOD.
AND HOW THESE IMPACTS ARE
SUSTAINABLE, CONTINUING HOME
SUSTAINED DURING THE LIFE COURSE
AND TAKEN UP PIE PARENTS AND
TEACHERS AND OTHERS.
ALREADY WE KNOW THE CHILDREN
ALONE REPRESENT SOMETHING LIKE
400 MILLION DAILY.
NEXT SLIDE PLEASE.
AS A RESULT OF THIS, WE'RE
EMBARKING ON CREATING A WHITE
PAPER ON CLIMATE SMART SCHOOL
MEALS.
THIS IS BEING LED BY SYLVIA
PASTORENO FROM OUR SIDE FROM,
SIDE OF THE RESEARCH CONSORTIUM.
WE'VE INVITED BY ONE OF THE
MEMBER STATES OF THE COALITION,
UAE, TO DEVELOP A WHITE PAPER ON
CLIMATE SMART SCHOOL MEALS,
WE'RE TAKING THAT PAPER TO OUR
MINISTERIAL MEETING IN PARIS
THIS YEAR, CHAIRED BY PRESIDENT
MACRON, TO WHICH THE 78
MINISTERS WILL BE INVITED.
AND ON THE BASIS OF THEIR
DECISION, TO MOVE THAT PAPER
THEN ON TO COP 28 IN DUBAI IN
NOVEMBER, ENSURING SOME OF THE
COUNTRIES, SOME OF THE SCHOOL
MEAL COALITION COUNTRIES
FORMALLY ADOPT THESE PERHAPS AND
ALLOW FOR TRACKING OF WHAT ARE
THE REALTIME BENEFITS.
TO GET TO THIS WE'RE UNDERTAKING
AN ANALYSIS LED BY MARCO
SPRINGMAN ON ACTIONABLE POLICY
RECOMMENDATION ALSO BASED ON
MODELING INDICATIONS FROM
NUTRITIONAL ANALYSIS AND COST OF
DIET.
SO ALL OF THOSE PIECES ARE IN
PLACE AS WE ARE NOW MOVING
FORWARD DRAFT THAT WHITE PAPER.
SO THAT'S WHERE WE'VE GOT TO.
IN FINISHING, I WANT TO SAY ONE
OF THE QUESTIONS WE ALL ASK, WE
ASK OURSELVES, IS WILL
GOVERNMENTS ACTUALLY TAKE THIS
ON?
WILL GOVERNMENTS MOVE ON THIS?
HOW INTERESTED ARE THE
GOVERNMENTS?
I WANTED TO FINISH ON TWO
EXAMPLES THAT I THINK ARE QUITE
ENCOURAGING.
THE FIRST IS THREE COUNTRIES
WHICH HAVE MADE A DECISION SINCE
2020 TO GO AHEAD WITH
SIGNIFICANT INVESTMENT IN THE
NUTRITION AND SUPPORT AND HEALTH
OF THEIR SCHOOL AGE CHILDREN AND
ADOLESCENTS.
THESE ARE NOT THE RICHEST
COUNTRIES IN THE WORLD.
BENIN DECIDED TO INVEST $270
MILLION OVER THE NEXT FIVE
YEARS.
THEIR COVERAGE HAS RISEN FROM
30% IN 2020 TO 75% NOW WITH 100%
EXPECTED IN TWO YEARS' TIME.
KENYA EMBARKING ON SIMILAR
PROGRAM.
RWANDA ALSO HAS INCREASED ITS
NATIONAL BUDGET.
IT'S MOVING UP TO $8 IN 2020 TO
$80 MILLION IN 2022, INCREASED
COVERAGE FROM 660,000 CHILDREN
TO 3.8 MILLION PUPILS THIS YEAR.
IT'S ALREADY VERY DRAMATICALLY
INCREASED ITS COVERAGE.
FINALLY THIS IS NOT JUST A FEW
COUNTRIES, HERE IS THE LATEST
DATA ON THE NUMBERS OF CHILDREN
BEING SUPPORTED BY SCHOOL MEALS
PROGRAMS.
THIS IS FROM WORLD FOOD PROGRAMS
2022 DATA ANALYSIS, DATA I
SHOWED BEFORE FROM THE 2020
ANALYSIS.
AND WHAT THIS SHOWS IS THE
NUMBER OF CHILDREN NOW BEING FED
IS AROUND 418 MILLION, WHICH IS
UP FROM 388 MILLION TWO YEARS
AGO.
SO, IN ONE SENSE, THE GOAL,
FIRST GOAL OF THE SCHOOL MEALS
COALITION IS BEING MET.
COUNTRIES REOPENED SCHOOLS, PUT
IN PLACE PROGRAMS THAT ACHIEVED
WHAT THEY ACHIEVED IN 2020 BUT
ACTUALLY EXCEEDED.
OF COURSE, THERE'S A DOWN SIDE
TO THIS STORY.
THAT OF COURSE IS THE COUNTRIES
THAT NEED TO DO THIS THE MOST
ARE THE ONES THAT HAVE BEEN
LEAST ABLE TO RESPOND.
THIS IS VERY ENCOURAGING.
OVER JUST A TWO-YEAR PERIOD
WE'RE SEEING A REAL REACTION
FROM THE COUNTRIES, A REAL
INTEREST, AND THIS IS A REAL
INTEREST THAT EXTENDS TO
HOMEGROWN SCHOOL FEEDING AS A
SOURCE OF FOOD FOR THESE
PROGRAMS.
HOW CAN WE LEARN BETTER TO MAKE
THESE HOMEGROWN SCHOOL MEALS
MUCH MORE CLIMATE RESPONSIVE IS
EXACTLY WHERE WE'RE GOING WITH
THE WHITE PAPER.
SO THANK YOU.
THAT'S THE MESSAGE THAT I WANTED
TO SHARE WITH YOU TODAY.
>> THANK YOU.
THAT WAS PERFECT, AS USUAL.
DON IS AN INSPIRATIONAL PARTNER.
THE EXPANSIVE PRESENTATION
COVERED A LOT OF ISSUES THAT ARE
GOING TO BE COVERED BY THE
LARGER COMMUNITY, IT IS -- WHAT
HE'S PRESENTED EXEMPLIFIES
IMPORTANCE OF ECOLOGICAL
APPROACH.
HE MENTIONED THE BOND-KIDS
PROJECT.
THERE MAY BE A WAY TO INTEGRATE
THE 7,000 DAYS INTO WHAT WORKING
GROUP 1 IS DOING, SPECIFICALLY
AS RELATES TO THE INTERSECTION
OF CLIMATE AND FOOD SYSTEMS.
THE ECOLOGY IS CLEARLY
REPRESENTING WHAT DON PRESENTED
HERE TODAY IN TERMS OF THE
BIOLOGY, INTERSECTION OF THE
FOOD SYSTEMS, IMPACT ON
PROGRAMS.
FUNDAMENTALLY THE REASON WE NEED
SCHOOL MEAL PROGRAMS IS BECAUSE
KIDS ARE IN FACT FOOD INSECURE,
NUTRITION INSECURE.
AND MALNOURISHED AND THESE
PROGRAMS ARE HELPING AMELIORATE
BUT BEING IMPACTED BY CHANGING
CLIMATE.
WE'LL WORK TOGETHER TO MAKE SURE
THIS IS INTEGRATED, THE TWO
PROJECTS.
>> THANK YOU.
>> I WANT ECHO MY THANKS, DON.
ALWAYS GREAT TO SEE YOU.
THANK YOU.
>> THANK YOU, DREW.
MUCH APPRECIATED.
>> YES, THANK YOU.
I'M NOT SURE IF I'M MODERATING
BUT I'LL JUMP IN AND ASK IF
ANYONE HAS QUESTIONS, BUT I WANT
TO -- YOU TOUCHED ON SO MANY
ASPECTS OF WHAT WE'VE BEEN
THINKING ABOUT AND REALLY HOW
IMPORTANT SCHOOL PROGRAMS ARE,
EVEN THOUGH A SMALLER PERCENTAGE
OF YOUNG CHILDREN IN OUR
COUNTRY, THE SCHOOL PROGRAM IN
THE U.S. IS CLEARLY AN IMPORTANT
DRIVER OF LOTS OF DIFFERENT
IMPLICATIONS.
HEALTH AND OTHERWISE.
DOES ANYONE HAVE QUESTIONS?
COMMENTS?
>> IF I MAY, THANK YOU FOR THIS
PROMISING AND GOOD NEWS TALK.
I WONDERED, HOW LONG STAYING IN
SCHOOL INFLUENCES NUTRITIONAL
ACCESS AND HOW THAT IS ACROSS
SOCIAL STRATA AND FIT INTO THIS
APPROACH?
>> SURE, THAT'S A VERY
IMPORTANT QUESTION.
AND A SLIGHTLY COMPLICATED ONE.
LET ME SAY WHAT WAS THE GREAT
ACHIEVEMENT OF THE MILLENIUM
DEVELOPMENT GOALS?
IT WAS GETTING KIDS TO GO TO
SCHOOL.
THAT WAS THE NUMBER ONE SUCCESS
STORY THAT CAME FROM THE
MILLENIUM DEVELOPMENT GOALS.
NOW, WHAT DID THEY DO WHEN THEY
GOT TO SCHOOL?
THAT'S STILL A PROBLEM BECAUSE
THE LEARNING DIDN'T NECESSARILY
RISE WITH THE ATTENDANCE.
SO, BUT THE IDEA THAT CHILDREN
GO TO PRIMARY SCHOOL IS NOW WELL
EMBEDDED.
THAT'S NOW -- FOR THOSE WHO HAVE
NOT BEEN FOLLOWING THE EDUCATION
STORY CLOSELY, THAT'S THE GOOD
NEWS FROM THE EDUCATION STORY.
CHILDREN DO NOW BY AND LARGE
ATTEND PRIMARY SCHOOL THROUGHOUT
THE WORLD.
THEY DON'T NECESSARILY LEARN
WELL WHILE THERE.
THAT'S ANOTHER CHALLENGE.
AND SO THE PUSH NOW IS TO GET
CHILDREN TO ATTEND SECONDARY
SCHOOL, BECAUSE THAT'S THE
ADOLESCENT AREA.
VITALLY IMPORTANT IN TERMS OF
ACHIEVING A FULL EDUCATION
OUTCOME AND ACHIEVING REAL HUMAN
CAPITAL, HEALTHY CHILDREN
ACHIEVE WHAT THEY CAN IN THEIR
LIVES.
SO THAT'S A DYNAMIC.
AND ACTUALLY ONE OF THE REASONS
WHY SCHOOL MEALS AND PROGRAMS
LIKE THAT ARE SO SUPPORTED BY
COUNTRIES AND LET'S REALIZE IT'S
THE COUNTRIES THAT ARE
SUPPORTING THEM.
THAT'S THE MOST STRIKING FINDING
I THINK.
THE COUNTRIES, WHY ARE THEY
SUPPORTING THEM?
BECAUSE THEY KNOW IF THEY
PROVIDE SUPPORTS AT SCHOOL
CHILDREN GO TO SCHOOL.
THIS IS PART OF -- IN OTHER
WORDS YOUR QUESTION, A GREAT
ONE, IS ACTUALLY AN INTERACTIVE
QUESTION.
DOESN'T SCHOOL -- DON'T SCHOOL
MEALS ALSO ENSURE THAT CHILDREN
GO TO SCHOOL, GET AN EDUCATION,
AND CONTRIBUTE TO THEIR
COUNTRY'S HUMAN CAPITAL.
THE ANSWER IS YES.
THESE PARTS OF NEED TO COME
TOGETHER.
SO YOU'RE ABSOLUTELY RIGHT THERE
ARE CERTAINLY AREAS IN THE WORLD
WHERE NOT ENOUGH CHILDREN GO TO
SCHOOL, PARTICULARLY NOT ENOUGH
GIRLS, BUT FIXING THAT SHOULD BE
PART OF THE SOLUTION.
I WASN'T SUGGESTING THAT THIS
WAS THE SOLUTION TO NUTRITION IN
THESE GROUPS BUT I DO THINK IT'S
PART OF THE SOLUTION TO
NUTRITION IN THESE GROUPS.
>> ALEXA?
>> HI.
THANK YOU FOR THAT GREAT
PRESENTATION.
I HAD A QUESTION ABOUT SCHOOL
MEALS AND WE SAW DURING COVID
WHEN SCHOOLS SHUT DOWN THAT IT
HIGHLIGHTED HOW IMPORTANT THESE
SCHOOL MEALS WERE TO NUTRITION
AND FOOD SECURITY STATUS FOR SO
MANY CHILDREN ESPECIALLY IN THE
U.S. WHERE I LIVED DURING THE
LOCKDOWNS.
WE HAVE CLIMATE CHANGE.
WE'RE GOING TO EXPECT IN MANY
PARTS OF THE WORLD GREATER
DISRUPTION, PARTICULARLY AROUND
WEATHER, THAT MIGHT AFFECT THE
STUDENTS' ABILITY TO GO TO
SCHOOL.
HAS THERE BEEN TALK ABOUT HOW TO
STILL PROVIDE MEALS WHEN SCHOOLS
CAN'T OPEN?
>> SO GREAT QUESTION.
I THINK IT'S ALMOST THE REVERSE
IS THE DISCUSSION, THE
DISCUSSION IS SHOULD WE AS
COUNTRIES HAVE CLOSED THESE
SCHOOLS IN THE FIRST PLACE?
WAS THAT ACTUALLY RATIONAL?
IT HAS BEEN DISASTROUS.
IT'S BEEN REALLY DESTRUCTIVE.
AND I THINK THE GENERAL VIEW IS
THAT ARE THIS SHOULD REALLY ONLY
BE THE LAST RESORT, THAT KEEPING
SCHOOLS OPEN, MAKING THE SCHOOLS
KEY TO SUPPORTING CHILDREN IN
THOSE AGE GROUPS, BECAUSE
FRANKLY IN MANY SOCIETIES IT IS
THE SCHOOL -- THE SCHOOL IS THE
ONLY INSTITUTION SUPPORTING
THOSE AGE GROUPS, THAT THAT'S
SOMETHING WE ACTUALLY NEED TO
GIVE FAR MORE EMPHASIS TO.
I TRAINED AS AN EPIDEMIOLOGIST.
EPIDEMIOLOGISTS SAID SHUTTING
SCHOOLS SEEMED LIKE A CHEAP WAY
OF REDUCING TRANSMISSION.
IT'S WHAT WE'VE DONE FOR YEARS
WITH MANY EARLY CHILDHOOD
INFECTIONS, RIGHT?
THAT SEEMED LIKE A SIMPLE AND
LOW IMPACT, LOW COST THING TO
DO.
IT TURNED OUT TO BE A
DISASTROUSLY BAD THING TO DO.
THE WORLD BANK IS ANALYZING THE
2008 FOOD AND FINANCIAL CRISIS
THAT BECAME A RECESSION IN2010.
AND SHOWING THAT THEN
GOVERNMENTS LOOKED TO AIDS
PROGRAMS TO EXPAND SCHOOL MEALS
PROGRAMS.
THEIR REACTION, GOVERNMENT
REACTION IN 2008, WAS NOT TO
CLOSE SCHOOLS BUT TO ACTUALLY
EXPAND THE ROLE OF THEIR SCHOOLS
IN SUPPORTING CHILDREN.
AND MAYBE IN 2020 WE SHOULD HAVE
PAID MORE ATTENTION TO DOING
THAT RATHER THAN THE COMPLETE
OPPOSITE.
I DON'T KNOW IF THAT ANSWERS
YOUR ACTUAL QUESTION.
>> YES, THAT MAKES SENSE.
I WAS MORE THINKING ABOUT
WEATHER DISRUPTION, I'M FROM
FLORIDA, FORT LAUDERDALE, WHICH
CLOSED ITS SCHOOLS TODAY AND
GREW UP WITH HURRICANES.
WE WERE OUT OF SCHOOL FOR
SOMETIMES A COUPLE WEEKS.
I HAD THE PRIVILEGE OF NOT
NEEDING TO WORRY ABOUT WHERE MY
MEALS CAME FROM DURING THAT TIME
BUT WITH MY KNOWLEDGE OF FOOD
SECURITY I'M NOW THINKING MORE
ABOUT WHEN WE DO HAVE THESE
DISRUPTIONS, WE'RE SEEING MORE
FREQUENTLY, SCHOOLS CLOSE FOR
SAFETY AS WELL.
YEAH, I'VE BEEN THINKING ABOUT
THAT A LITTLE BIT.
>> INTERESTING.
>> DAN, HOW ABOUT WE GIVE YOU
THE LAST QUESTION?
>> THANK YOU.
I JUST THINK IT'S -- GETTING
BACK TO THE BOND-KIDS PROJECT
AND OUR MOTIVATION FOR DOING
THAT, THE RELEVANCE TO THE
ADVANTAGE PROJECT, SCHOOL MEALS
PROGRAMS ARE MORE THAN JUST AN
INCENTIVE TO GET KIDS TO GO TO
SCHOOL.
THEY REALLY ARE, AS DON
HIGHLIGHTED, OVER AND OVER
AGAIN, ABOUT THE CHILD'S HEALTH.
AND HOW DO YOU MEASURE THAT?
HOW DO YOU MEASURE THE IMPACT OF
THESE PROGRAMS ON THE CHILD'S
HEALTH AND WHAT DOMAINS SHOULD
WE LOOK AT, WHAT SYSTEMS SHOULD
WE BE LOOKING AT? ?
HOW DO YOU ASSESS THE IMPACT OF
THESE PROGRAMS?
IT'S MORE THAN KIDS NOT BEING
ABLE TO LEARN, NOT HAVING ACCESS
TO LEARN.
ITS HAD AN IMPACT ON THEIR
HEALTH AND PERHAPS SOME OF THE
DATA THAT WILL BE EMERGING WILL
START LOOKING AT INCREASE IN
PREVALENCE OF INFECTIOUS
DISEASE, IS THERE AN INCREASE IN
OTHER AT VERSE HEALTH OUTCOMES?
I THINK THAT BRINGS IT BACK TO
THE ISSUE HERE OF WHAT IS THE
HEALTH IMPACT OF THIS
INTERSECTION OF CLIMATE,
NUTRITION, FOOD SYSTEMS AND
PROGRAMS LIKE SCHOOL MEAL
PROGRAMS.
THANKS AGAIN, DON.
>> YES.
THANK YOU.
I SAW DREW PROPOSED KEEPING OUR
20-MINUTE BREAK.
I WAS GOING TO SPLIT THE
DIFFERENCE AND SAY 15.
LET'S GO WITH THE 20 AND WE'LL
TAKE THAT.
DON, I DON'T KNOW IF YOU CAN
CONTINUE WITH US.
IT'S LATE WHERE YOU ARE.
I'M GUESSING IT IS.
YOU'RE WELCOME TO CONTINUE TO
JOIN OUR GROUP.
BUT THANK YOU SO MUCH FOR YOUR
TALK.
IT WAS WONDERFUL.
>> WELL, THANK YOU, NANCY.
>>EVERYONE, LET'S TAKE A
20-MINUTE BREAK.
SO THAT GETS US BACK HERE AT 10
MINUTES TO THE HOUR.
THANK YOU.
>> SOUND GREAT.
THANKS.
>> THANK YOU FOR COMING BACK.
WE HAVE A FEW MORE MOMENTS
BEFORE MY CLOCK SAYS IT'S TEN
TO.
LOOKS LIKE EVERYBODY'S BACK
ONLINE.
WE MIGHT AS WELL GET STARTED.
I'M DELIGHTED TO INTRODUCE DR.
SHANKAR, MATERNAL HEALTH,
LACTATION, CLIMATE AND HEALTH.
LOOK FORWARD TO YOUR
PRESENTATION.
>> THANK YOU, DR. EBI.
THANK YOU TO DREW, DAN, ALISON
AND CO-CHAIRS FOR ABLY LEADING
THIS GROUP.
I'M GOING TO GO BACK AFTER THE
WONDERFUL TALK FROM DR. BUNDY
AND REWIND TO THE FIRST THOUSAND
DAYS.
AND TALK ABOUT WHAT WE KNOW
ABOUT CLIMATE IMPACTS DURING THE
PREGNANCY AND EARLY LIFE.
WE'VE SEEN THIS SCHEMATIC IN
SEVERAL VERSIONS, IN MANY
PREVIOUS TALKS.
THE FEW OF US WHO MAYBE JOINED
LATER, WE'RE IN WORKING GROUP 1
INTERESTED IN THIS INTERACTION
OF THE HEALTH OUTCOMES BETWEEN
CLIMATE CHANGE AND NUTRITION,
I'LL FOCUS ON PREGNANCY AND
EARLY LIFE.
BROADLY AS WE'VE HEARD DR. EBI
DISCUSS THIS, EFFECTS OF CLIMATE
ARE DIRECT AND INDIRECT, AND
DATA, PRECIPITATION EVENTS,
FLOODING ARE THE PREDOMINANT
ONES.
I'M TRYING TO IN THIS GRAPHIC
SUMMARIZE THE EXISTING EVIDENCE
FROM THESE EXPOSURES,
CLIMATE-RELATED EXPOSURES,
ESPECIALLY IN PREGNANCY AND
OUTCOMES STUDIED.
SIZE OF THE ARROWS REPRESENTS
PREDOMINANCE OF LIMIT --
LITERATURE IN EACH AREA,
DOMINATED BY HEAT AND AIR
POLLUTION.
MOST OF THE OUTCOMES THAT HAVE
BEEN STUDIED IN GESTATIONAL
LENGTH, PREECLAMPSIA, OUTCOMES
SUCH AS PRE-TERM BIRTH AND
STILLBIRTH, MOSTLY STUDIED IN
THE LITERATURE.
IT'S GOING TO BE HARD TO
SUMMARIZE A LOT OF THIS DATA, IN
THE SHORT TEN MINUTES.
THERE HAVE BEEN SEVERAL
META-ANALYSES AND SYSTEMATIC
ANNUAL -- ANALYSES IN THE
CONTEXT OF PREGNANCY, STRONG
EVIDENCE FOR EFFECTS OF HEAT TO
HAVE DETRIMENTAL EFFECTS ON
SEVERAL OUTCOMES, NOTED IN MANY
PARTS OF THE WORLD INCLUDING THE
U.S., IN LARGE SCHEMATIC
ANALYSES, PROJECTION STUDIES
SUGGESTED THAT BOTH SOUTH ASIA
AND MIDDLE EAST AND NORTH AFRICA
REGION ARE GOING TO BE
ESPECIALLY SUSCEPTIBLE IN FUTURE
TO EFFECTS OF HEAT ON PREGNANCY
OUTCOMES.
HERE IS MORE SPECIFIC
INFORMATION IN THIS CONTEXT.
LARGE META ANALYSES A COUPLE
YEARS AGO IN THE U.S. INCLUDING
32 MILLION BIRTHS SHOWED RISK OF
BOTH PRE-TERM BIRTH, LOW BIRTH
WEIGHT AND STILLBIRTH WAS
INCREASED IN 9 OUT OF 10 STUDIES
IN A LOOKED AT HEAT, ALMOST 85%
LOOKED AT AIR POLLUTION.
AND SPECIFIC METRIC OF AIR
QUALITY, THIS IS THE ABUNDANCE
OF PARTICULATE MATTER AROUND
2.5-MICRON RANGE,ING PM2.5 IN
LITERATURE, ABUNDANCE OF AIR
POLLUTANT IS ASSOCIATED WITH A
LOT OF NEGATIVE OUTCOMES.
MUCH MORE COMPREHENSIVE
META-ANALYSIS WORLDWIDE LOOKING
AT HEAT STRESS AND EXTREME HEAT
EXPOSURE IN PREGNANCY WAS DONE,
CLEARLY SHOWED 70 STUDIES OUT OF
WHICH 7 WERE IN LOW- AND
MIDDLE-INCOME COUNTRIES,
DOMINANCE OF DATA CAME FROM
HIGH-INCOME COUNTRIES, SHOWED
RISK OF PRE-TERM BIRTH AND
STILLBIRTH, LOW BIRTH WEIGHT
INCREASES AS TEMPERATURE
EXPOSURE IN PREGNANCY INCREASES.
THERE WERE LOTS OF CAVEATS TO
OBSERVATIONS, PRIMARILY
HETEROGENEITY IN DEFINING
TEMPERATURES, METHODS USED TO
DEVELOP, WINDOWS TO EXAMINE, AND
ONLY 7 OUT OF THE 70 STUDIES
WERE DONE IN LOW- AND
MIDDLE-INCOME COUNTRIES AND EVEN
MANY OF THESE WERE IN MIDDLE
INCOME COUNTRIES.
SO REALLY WE'RE MISSING A LOT OF
DATA WHERE EXPOSURE IS LARGEST.
THERE WAS VERY ALSO INCLUSION OF
MATERNAL NUTRITIONAL STATUS AND
FEW ANALYSES THAT INCLUDED
SUBANALYSES BASED ON MATERNAL
NUTRITION.
THIS IS AN IMPORTANT COMPONENT
OF WHAT WE'RE TRYING TO
UNDERSTAND.
WE'VE BEEN TRYING TO
UNDERSTAND -- IMPLICIT AMONG THE
PREDISPOSITION AMONG LOW- AND
MIDDLE-INCOME COUNTRIES WE HEARD
SEVERAL SPEAKERS TALK ABOUT
MATERNAL NUTRITION STATUS
PERHAPS PLAYS AN IMPORTANT ROLE
IN MODIFYING THIS RELATIONSHIP
BETWEEN ENVIRONMENTAL STRESSORS
AND OUTCOMES.
WE'VE BEEN INTERESTED IN THIS
QUESTION, WE'VE LEVERAGED ONE
DATASET FROM PAKISTAN, WHICH
RANKS HIGHLY IN THE CLIMATE --
CHILDREN'S CLIMATE RISK INDEX,
LOOKING AT WOMEN WHO WERE FROM A
STUDY CALLED WOMEN FIRST FROM
NICHD AND GATES FOUNDATION,
WOMEN WERE RANDOMIZED TO
MULTIPLE MICRONUTRIENT
SUPPLEMENTATION, BEFORE
CONCEPTION, DURING PREGNANCY, OR
RECEIVED CONTROL OR NO
INTERVENTION.
COMPARING EFFECTS OF HEAT AMONG
THE THREE GROUPS PROVIDED US THE
BALANCE BETWEEN UNDERSTANDING
INTERACTIONS BETWEEN
PRE-CONCEPTION MATERNAL
NUTRITION AND EFFECTS OF HEAT
STRESS.
IN THIS ANALYSIS IT WAS OBVIOUS
THAT THE CHILD'S BIRTH LENGTH
WAS NEGATIVELY ASSOCIATED WITH
HEAT EXPOSURE IN FIRST
TRIMESTER, WHETHER HEAT EXPOSURE
WAS CONTINUOUS OUTCOME EXPOSURE
OR A CATEGORICAL EXPOSURE.
HIGH DAYS OF HEAT STRESS LET TO
SMALLER LENGTH BABIES AT BIRTH.
WHAT WAS NOTABLE WAS THAT THIS
EFFECT OF HEAT STRESS WAS
ACTUALLY OBSERVED ONLY IN THE
WOMEN WHO DID NOT RECEIVE
NUTRITIONAL SUPPLEMENTATION
SUGGESTING PROVIDING OR
IMPROVING MATERNAL NUTRITION
PRIOR TO PREGNANCY OR PRIOR TO
THE HEAT EXPOSURE PERIOD
ACTUALLY MITIGATED.
THIS IS ONE OF THE FEW STUDIES
MATERNAL NUTRITION HAS BEEN
EXAMINED AS A FACTOR.
WE SAW THAT AS AN EXAMPLE WHERE
NUTRITION WAS A MODIFIER FOR
CLIMATE STRESSORS BUT THERE
EXISTS EVIDENCE WHERE NUTRITION
ITSELF IS AN OUTPUT, MATERNAL
NUTRITION ITSELF IS AFFECTED BY
CLIMATE STRESSORS AND IN THIS
CASE IT'S ANEMIA AND PM2.5
LEVELS IN INDIA WITH A HIGH
PREVALENCE OF ANEMIA, HALF WOMEN
OF PRODUCTION AGE HAVE SOME
LEVEL OF ANEMIA, ONE OF THE
WORST AIR QUALITIES IN THE WORLD
WHERE LEVELS OF PM2.5 EXCEEDS BY
SEVERAL LEVELS OF MAGNITUDE.
THIS IS 80% OF WOMEN IN DARK
SHADES OF BROWN.
THIS GRAPH AT THE BOTTOM SHOWS
PROBABILITY OF HAVING ANEMIA AS
AIR QUALITY DECREASES.
AS PM2.5 INCREASES, PROBABILITY
OF A PERSON BEING DIAGNOSED WITH
ANEMIA CHANGES SUBSTANTIALLY.
THIS ANALYSIS DID PROJECTIONS,
LOOKING AT WHAT WOULD HAPPEN IF
INDIA STARTED TO MEET SOME OF
ITS AIR QUALITY TARGETS OR CLEAN
AIR TARGETS.
IF IT REALLY MET THE WORLD
HEALTH ORGANIZATION GUIDELINE
FOR QUALITY WOULD SIGNIFICANTLY
DECREASE ANEMIA PREVALENCE, OVER
186 DISTRICTS WOULD FALL BELOW
THE TARGET OF 35% SUGGESTING
NEXUS OF MATERNAL NUTRITION,
RESPONSE TO NUTRITIONAL
INTERVENTIONS AND HEALTH
OUTCOMES IS ACTUALLY STRONG.
WE KNOW PREGNANCY HAS A LOT OF
CHANGES AND TO REALLY UNDERSTAND
THE NUTS AND BOLTS OF VARIABLES,
WE NEED PHYSIOLOGICAL
UNDERSTANDING.
WE KNOW THAT HEAT HAS IMPACT ON
PHYSIOLOGY ESPECIALLY IN
PREGNANCY, AND PREGNANCY IS
ASSOCIATED WITH ITS OWN SET OF
PHYSIOLOGICAL CHANGES INCLUDING
LOWERING OF CORE BODY
TEMPERATURE, INCREASE IN PLASMA
VOLUME DEFENDING AGAINST EFFECTS
OF HEAT, NICELY SUMMARIZED IN
THIS SCHEMATIC PUBLISHED IN "THE
LANCET" A FEW YEARS AGO.
AND EFFECTS ARE SYSTEMIC.
CHANGE CARDIO OUTPUT, BLOOD
PERFUSION TO THE TRUNK, MANY
ENDOCRINE CHANGES INCLUDING
ENDOTOXEMIA DUE TO CHANGES IN
GUT PERMEABILITY, LEADING TO
CHANGES IN BLOOD FLOW, OXIDATIVE
STRESS, ENDOTOXEMIA, IMPACTING
HEALTH OUTCOMES IN PREGNANCY.
ONE GAP HAS BEEN MEASURING IN
PHYSIOLOGICAL STATES EFFECTS OF
HEAT STRESS ON THE PLACENTA AND
PLACENTAL FUNCTION.
I WANT TO HIGHLIGHT THESE PAPERS
FROM THE LONDON SCHOOL OF
HYGIENE AND TROPICAL MEDICINE
WHERE WOMEN IN GAMBIA HAD
BEEN -- PHYSIOLOGIC OUTCOMES IN
THIS COHORT HAS BEEN MEASURED
USING DOPPLER UMBILICAL THAT CAN
MEASURE TRUE CORD BLOOD VELOCITY
AND UTERINE HEART RESISTANCE,
IMPORTANT MEASURES OF PLACEBO
CERTAINLY BLOOD FLOW AND DELIVER
Y
TO THE FETUS.
A PHYSIOLOGICAL MEASURE OF
THERMAL STRESS WAS MEASURED,
PRETTY EVIDENT AS TEMPERATURES
GO UP, THE ARTERY RESISTANCE
GOES UP.
AND FETAL STRESS MEASURED BY
HEART RATE GOES UP.
EVEN IN CONDITIONS IN NOT
EXTREME HEAT STRESS THERE'S A
STRONG PHYSIOLOGIC RESPONSE IN
PREGNANCY OF THE MOTHER AND
FETUS.
WE KNOW THIS IS RELEVANT BECAUSE
ALMOST 750 MILLION KIDS LIVE IN
AREAS THROUGHOUT THE WORLD THAT
HAVE VERY HIGH NUMBER OF HEAT
DAYS.
THIS WAS REALLY ELEGANTLY
HIGHLIGHTED IN THE REPORT BY THE
UNICEF WHICH WAS APTLY NAMED
COLDEST YEAR OF THE REST OF
THEIR LIVES.
BY 2050 IT'S PROJECTED UNDER ANY
WARMING SCENARIO ALMOST ALL KIDS
ON THE PLANET ARE GOING TO BE
EXPOSED TO GREATER HEAT STRESS
THAN NOW.
THIS IS CERTAINLY AN URGENT
ISSUE.
THERE ARE LONG-TERM IMPACTS OF
BOTH HEAT AND OTHER
ENVIRONMENTAL EXPOSURES ON
INFANTS AND CHILDREN.
THE MOST STUDY AMONG THESE IS
HIGH AMBIENT TEMPERATURE,
ASSOCIATED WITH GROWTH ALTERING,
STUNTING, OCCURRENCE OF WASTING
AND STUNTING, SHOWN TO HAPPEN IN
SUB-SAHARAN AFRICA AND SOUTH
ASIAN CONTINENT IN LARGE STUDIES
INVOLVING HUNDREDS OF THOUSANDS
OF CHILDREN IN THE FIVE YEAR
RANGE AND THEN OTHER STUDIES OUT
OF CHINA HAVE SUGGESTED THAT
EXTREME TEMPERATURES IN
PREGNANCY AND MEASURES OF AIR
POLLUTION CAN CAUSE LONG-TERM
NEURODEVELOPMENTAL AND OTHER
IMMUNOLOGIC CHANGES.
ONE IMPORTANT STUDY POINTED TO
THE CHANGES IN PRECIPITATION
PATTERNS AS MEASURED BY THIS
INDEX.
WHAT YOU SEE IN THE GRAPH AS
PRECIPITATION BECOMES TOO WET OR
TOO DRY, IT CHANGES THE HEIGHT Z
SCORES OF THE CHILDREN
SUGGESTING THAT OBVIOUSLY
PRECIPITATION PATTERNS STILL
HAVE AN IMPACT ON THE GROWTH OF
CHILDREN.
AND THIS COULD BE MEDIATED
THROUGH MANY FACTORS AND TWO
IMPORTANT FACTORS RELEVANT FOR
ADVANTAGE WERE NUTRITIONAL
DIVERSITY OF AGRICULTURE AND
RELATED FACTORS THAT MODERATED
THE ASSOCIATION.
SUGGESTING AGAIN THE NEXUS
BETWEEN CLIMATE VARIABLES SUCH
AS PRECIPITATION AND THEN HEALTH
OUTCOMES IN CHILDREN.
THERE'S ALSO RELATIONSHIP
OBSERVED BETWEEN PM 2.5 LEVELS
AND ANEMIA, AND HEMOGLOBIN
VALUES IN CHILDREN, SEEN WITH
PREGNANT WOMEN, AND SHE'S --
THESE DATA COME FROM INDIA,
NATIONAL HEALTH SURVEY, DISTRICT
LEVEL AND INDIVIDUAL LEVEL DATA.
THESE GRAPHS ARE TELLING FOR
THEMSELVES, HEMOGLOBIN VALUES
PLUMMET AS AIR QUALITY
DECREASES, INCREASING THE ODDS
OF HAVING ANEMIA.
THE PHASE DURING LACTATION IS
ANOTHER IMPORTANT COMPONENT
WHERE CLIMATE VARIABLES COULD
AFFECT CONTINUUM OF MATERNAL
CHILD NUTRITION, AND FROM THE
WOMEN FIRST TRIAL SUGGEST THERE
SEASONAL VARIATIONS IN MILK
ENERGY ACKNOWLEDGE MILK FAT,
ASSOCIATE THE WITH TEMPERATURE
FLUCTUATIONS.
AND FINALLY, IT'S IMPORTANT TO
KNOW THAT FOR A LONG TIME WE'VE
KNOWN LACTATION IS SUSCEPTIBLE
TO HEAT STRESS FROM BOTH ANIMALS
AND AGRICULTURAL ANIMALS, AND
THERE'S A REALLY INTERESTING
ANALYSIS OUT OF COLORADO
SUGGESTING ANALYSIS OF OVER
13,000 COWS, MAPPING CLIMATE
DATA, AND SHOWING THERE IS
ACTUALLY A HUGE EFFECT OF HEAT
AND POLLUTION ON MILK
PRODUCTION.
BUT MUCH, MUCH LESS IS KNOWN
ABOUT BREASTFEEDING PRACTICES
AND MILK QUALITY AND COMPOSITION
IN HUMANS, CONTINUES TO BE AN
IMPORTANT AREA.
THERE'S A NEW PAPER RECENTLY
PUBLISHED LOOKING AT AROUND 800
WOMEN IN BURKINA FASO AND
TEMPERATURES AS EXPOSURE
VARIABLE SUGGESTING A
SIGNIFICANT DECREASE IN
BREASTFEEDING WITH INCREASED
AMBIENT TEMPERATURE, BUT THIS
WAS MOST PROMINENT IN OLDER KIDS
RATHER THAN YOUNGER KIDS.
SO THIS SEEMS TO BE AN OPEN
QUESTION ON THE IMPACTS OF THIS.
SO FINALLY I WANT TO LEAVE US
WITH SOME SUMMARY QUESTIONS THAT
EMERGED FROM THIS VIEW, WHICH IS
IN MOST STUDIES LOOKING AT
CLIMATE AND HEALTH NUTRITIONAL
STATUS REMAINS AN UNMEASURED
VARIABLE.
HEAT STRESS AND AIR POLLUTIONS
FORM THE PREDOMINANCE OF
EVIDENCE LINKING CLIMATE
VARIABLES AND CLIMATE EXPOSURES
AND HEALTH.
AND MOST STUDIES ASSOCIATE AND
DIRECT ATTRIBUTION TO A SINGLE
CLIMATE-RELATED EVENT REMAINS
CHALLENGING AND THIS SHOULD BE
AN IMPORTANT POINT OF OUR
DISCUSSION.
FINALLY, CONTEXT MATTERS A LOT
BECAUSE IN EVERY CASE WHERE
CLIMATE IMPACTS HAVE IMPACTED
HEALTH THERE ARE NICHES.
AND MOSTLY THE POSTPARTUM PERIOD
AND PREGNANCY HAVE BEEN
UNDERSTUDIED.
I'LL STOP AND LEAVE TIME FOR
DISCUSSION.
>> EXCELLENT REVIEW OF THE
KNOWLEDGE GAPS IN THIS AREA.
REALLY APPRECIATE THAT.
WE'RE RUNNING BEHIND SO WE'LL
MOVE TO DR. CHANG IN A MOMENT
AND COME BACK.
FIRST SET OF QUESTIONS WHEN WE
DID Q&A WILL BE TO YOU.
REALLY APPRECIATE THAT
COMPREHENSIVE REVIEW.
THE COMMENT ON THE ATTRIBUTION
THERE'S QUITE A BIT OF WORK
GOING ON IN TERMS OF ATTRIBUTION
IN THE HEALTH SECTOR AND HOW WE
DO THAT.
THERE'S SOME PAPERS THAT ARE
UNDER REVIEW AT THE MOMENT,
HOPEFULLY WILL SHED LIGHT ON
THAT IMPORTANT QUESTION.
THANK YOU VERY MUCH.
I'M SURE PEOPLE WILL WANT YOUR
SLIDES.
THAT WAS REALLY GREAT.
ANDY, DO YOU WANT TO COME UP
NEXT?
ARE YOU READY?
ARE YOU GOING TO SHARE YOUR
SLIDES?
>> YES.
I CAN DO THAT.
THAT WAS INCREDIBLE, I FEEL
INTIMIDATED GOING AFTER HIM.
I'LL DO MY BEST.
ALL RIGHT.
LET'S DO A QUICK SHARE.
CAN EVERYBODY SEE THE SLIDES?
>>YES.
>> PERFECT.
WELL, GOOD MORNING, EVERYBODY.
THANK YOU SO MUCH FOR STAYING
LONG ENOUGH TO SEE MY PORTION AT
THE END AND I HOPE I WON'T
DISAPPOINT.
ANDY CHANG, CARDIOLOGIST,
POSTDOCTORAL RESEARCH FELLOW
WITH CARDIOVASCULAR INSTITUTE AT
STANFORD.
ALSO WORKING ON A DOCTORATE
DEGREE IN EPIDEMIOLOGY AS WELL
CONCURRENTLY AT STANFORD.
I'M GOING TO TALK ABOUT THE
CLIMATE MEDIATED HEALTH CONCERNS
FOR OUR MIDDLE AGED AND OLDER
AGED ADULTS, AND AS YOU CAN
IMAGINE IT'S A BROAD TOPIC.
I APOLOGIZE I WON'T BE ABLE TO
GO INTO MUCH GRANULARITY ON SOME
CONCEPTS.
BUT ALSO NOTE THAT AS A
CARDIOLOGIST, AND GIVEN MY
PATIENT POPULATION, THERE WILL
BE A LITTLE BIT OF A BIAS
TOWARDS CARDIOVASCULAR DISEASE
AND OLDER ADULTS IN THIS TALK.
I WILL DO MY BEST TO REMAIN AS
UNBIASED AS POSSIBLE.
I DID WANT TO MENTION A COUPLE
DISCLOSURES AS DR. EBI MENTIONED
AT THE BEGINNING I DON'T HAVE
COMMERCIAL CONFLICTS OF INTEREST
BUT PAID BY THE U.S. FEDERAL
GOVERNMENT FOR MY CLINICAL WORK.
SO, CONTINUING ON THE LIFE
COURSE, A LITTLE BIT OF A JUMP
FROM 18 TO THE 40s, BUT
THERE'S PHENOMENON IN THE MIDDLE
AND OLDER AGE GROUPS, WE'RE
TALKING ABOUT THE 40s TO 60s
FOR THE MIDDLE AGES, 60s PLUS
FOR OLD, MOLECULAR, CELLULAR,
TISSUE-LEVEL CHANGES.
THERE ARE A LOT OF EXTERNAL AND
INTERNAL CONTRIBUTIONS, THINGS
LIKE UV LIGHT, DNA STRESS,
OXIDATIVE STRESS, WHICH INTERACT
WITH UNDERLYING GENETIC
SUSCEPTIBILITIES, INFLUENCING A
HOST OF GENETIC AND
CELLULAR-LEVEL PROCESSES THAT
ULTIMATELY LEAD TO THIS
PHENOTYPIC PHENOMENON THAT WE
CALL AGING.
AND WON'T GO INTO MUCH DEPTH BUT
THIS REVIEW BY LOPEZ ET AL. IN
"CELL" IN 2013 DOES A GOOD JOB
SUMMARIZING NINE DOMAINS, DEBATE
IF THERE'S A 10th OR 11th,
LIKE DECREASED ABILITY TO REPAIR
DNA, LOSS OF TELOMERES,
EPIGENETIC CHANGES ASSOCIATED
WITH AGING, CHRONIC
INFLAMMATION, CELLS THEMSELVES
IN A VACUUM WILL ALSO GROW OLD
OVER TIME.
THAT'S A CELLULAR SENESCENCE.
WE LOSE ABILITY TO MAINTAIN OUR
PROTEIN STRUCTURES.
MITOCHONDRIA WHICH HAVE NO DNA
REPAIR MECHANISMS OF THEIR OWN
GRADUALLY ACCUMULATE ADDITIONAL
MUTATIONS AND WILL EXHIBIT
DYSFUNCTION.
CELLS STOP TALKING TO EACH
OTHER, SO EFFICIENT EFFICIENTLE
AND WE'RE BORN WITH A RESERVE OF
STEM CELLS AND BURN THROUGH OR
USE UP A GOOD CHUNK OF THEM.
A LOT OF THESE PROCESSES WORK
TOGETHER, CERTAINLY WITH
NUTRITION AS WELL AS THE
ENVIRONMENT, TO INFLUENCE HUMAN
DISEASE.
AND WHAT'S INTERESTING IS THAT
THESE CHANGES ARE ALSO AS I
MENTIONED ASSOCIATED NOT JUST IN
VITRO AND ANIMAL MODELS BUT WITH
POPULATION-LEVEL CHANGES AND
INCIDENCE AND PREVALENCE, VERY
IMPORTANT HIGH MORBIDITY, HIGH
MORTALITY CONDITIONS.
I LEAK THIS GRAPH FROM THE
NATIONAL CANCER INSTITUTE'S SEER
EXPLORER WEBSITE, IF YOU HAVEN'T
HAD A CHANCE TO LOOK AT THAT
IT'S A FUN WAY TO PLAY WITH DATA
VISUALIZATIONS.
WHAT THIS SHOWS IS FOR ALL
CANCER SITES COMBINED THE
INCIDENCE THAT THERE'S THIS
INFLECTION POINT THAT HAPPENS IN
THE 40s THAT CONTINUES ON
THROUGHOUT THE COURSE OF THE
HUMAN LIFE IN TERMS OF ALL
CAUSES OF CANCERS.
INDEED THE SAME SHAPE, YOU CAN
SEE FOR WHOLE HOST OF CHRONIC
DISEASES, SUCH AS ARTHRITIS,
HEART DISEASE, COPD, LUNG
DISEASES, AS WELL AS DIABETES, I
REALLY LIKE THIS GRAPH IN
PARTICULAR BECAUSE IT ALSO SHOWS
THAT NOT ALL DISEASES ARE
NECESSARILY DISEASES OF AGING.
SO HARRIS AND THE AUTHORS AND
THIS TEXT BOOK CHAPTER INCLUDE
ASTHMA AS A DISEASE
DISPROPORTIONATELY AFFECTING
YOUNGER INDIVIDUALS AND STAYS
THE SAME OR MAY TAIL OFF INTO
OLDER AGES.
AGING IS A UNIQUE PHENOMENON
THAT SHOULD BE CONSIDERED TO BE
DISTINCT AND NOT A MAGNIFICATION
OF DISEASES EARLIER IN LIFE THAT
CONTINUE ON THROUGHOUT THE LIFE
COURSE.
AND WHY IS THIS IMPORTANT?
WELL, AS OF FOUR YEARS AGO
ALMOST 3/4 OF A BILLION PEOPLE
IN THE WORLD WERE OVER 65.
BY 2050 THAT WILL DOUBLE, 1 IN 6
PEOPLE GLOBALLY CONSIDERED OLDER
ADULTS.
AND THIS IS PARTICULARLY
RELEVANT AS WE SAW IN DR. EBI'S
PRESENTATION BEFORE, BY 2050
THAT'S A LOT OF INDIVIDUALS WHO
ARE NOT OLDER ADULTS RIGHT NOW
CONSIDERED TO BE YOUNG AND
PERHAPS MAY NOT BE THINKING
ABOUT THESE ISSUES.
OLDER ADULTS WILL COMPRISE NOT
JUST A LARGER ABSOLUTE NUMBER OF
INDIVIDUALS BUT A LARGER
PROPORTION OF INDIVIDUALS THAN
WE ARE CURRENTLY HAVING IN OUR
SOCIETY.
AND THAT'S NOT JUST A PROBLEM IN
THE WEALTHY COUNTRIES BUT AN
ISSUE IN LOW- AND MIDDLE-INCOME
COUNTRIES TOO AS THEY ARE
EXPERIENCING A DEMOGRAPHIC
TRANSITION.
UNFORTUNATELY, FORTUNATELY THAT
MEANS LIFE EXPECTANCIES ARE
INCREASING BUT UNFORTUNATELY
THAT'S ASSOCIATED WITH A NUMBER
OF CHANGES THAT ARE LEADING TO
THIS ATHEROGENIC, OBESOGENIC
CHRONIC DISEASE-GENERATING
ENVIRONMENT.
AND IT SHOULD BE NO -- SHOULDN'T
BE A SURPRISE TO ANYONE ON THIS
CALL THAT INCLUDES CHEAP
PROCESSED FOODS, INCREASE IN
WHITE COLLAR WORK, URBAN LIVING,
REDUCED PHYSICAL ACTIVITY,
OVERALL PER CAPITA INCOME IS
GREAT BUT UNFORTUNATELY CAN LEAD
TO INCREASED MALADAPTIVE
BEHAVIORS LIKE ALCOHOL AND
TOBACCO USE.
IN ADDITION THERE'S INCREASED
LOCAL POLLUTION, WHETHER AIR
POLLUTION, TOXIC EXPOSURES FROM
INDUSTRIALIZATION OR SOUND AND
LIGHT POLLUTION AS WELL TOO.
THIS GRAPH WAS FROM DR. BELLOWS'
TALK EARLIER.
OUR PATHWAY NUMBER 1 ON THE LEFT
SIDE OF THIS FIGURE I THINK WILL
ALLOW OUR COLLEAGUES AND WORKING
GROUP TO FLESH THAT OUT SO WE'L
FOCUS ON THE RIGHT SIDE, CLIMATE
AND ENVIRONMENTAL CHANGE EFFECTS
ON HEALTH AND PERHAPS A FEW
COMMENTS AT THE END ABOUT HOW
NUTRITION STATUS SHOULD BE
EXAMINED AND HOW THIS FITS IN.
SO MOVING TO OLDER ADULTS A LOT
OF CLIMATE EFFECTS ARE
CONCENTRATED HERE, ONE OF THE
BIGGEST -- TWO BIGGEST ISSUES AS
WAS MENTIONED EARLIER ARE AIR
POLLUTION AND HEAT STRESSES.
AIR POLLUTION, WE'LL HAVE
INCREASES NOT JUST IN GROUND
LEVEL AIR POLLUTION IN GENERAL
BUT ALSO AN INCREASE IN REGIONAL
WILDFIRE EVENTS, POLLEN SEASONS
WILL BE LONGER AND MORE SEVERE,
DUST STORMS IN AREAS THAT ARE
PRE-DISPOSED.
AND OVERALL THAT LEADS TO 7
MILLION PREMATURE DEATHS
GLOBALLY EACH YEAR, AIR
POLLUTION IS THE SINGLE LARGEST
ENVIRONMENTAL CONTRIBUTOR TO
HUMAN HEALTH.
AND UNSURPRISINGLY ABOUT HALF OF
THOSE DEATHS, 7 MILLION DEATHS,
ARE INDIVIDUALS OVER 65.
AND HALF ARE ATTRIBUTABLE TO
CARDIOVASCULAR DISEASES AS WELL
AS STROKE.
AND CHRONIC LUNG DISEASE SUCH AS
COPD ARE NOT FAR BEHIND.
THERE'S QUITE A FEW
META-ANALYSES AND SYSTEMATIC
REVIEWS THAT DISCUSSED THAT, NOT
JUST SHORT TERM BUT LONG-TERM
EFFECTS FROM AIR POLLUTION.
BOTH EXPOSURES HAVE BEEN LINKED
TO NOT JUST ASTHMA AND COPD
EXACERBATION BUT HEART ATTACK,
HEART FAILURE, DECOMPENSATIONS,
CARDIAC ARREST AS WELL AS STROKE
FROM A WIDE VARIETY OF DIFFERENT
AIR POLLUTION EXPOSURES WITH PM
2.57 OR CARBON MONOXIDE OR
NITROGEN DIOXIDE, ET CETERA.
ALSO RELEVANT TO OLDER ADULTS,
LONG-TERM AIR POLLUTION EXPOSURE
IS ASSOCIATED WITH MALIGNANCY,
PARTICULARLY LUNG CANCER, ALSO
DEMENTIA, OSTEOPOROSIS AND
FRAILTY.
THESE CHRONIC CONDITIONS ARE
ALSO IMPORTANT NOT JUST BECAUSE
AIR POLLUTION ITSELF CAN BE A
RISK FACTOR FOR DEVELOPMENT OF
THESE CONDITIONS BUT HAVING
PREEXISTING CARDIOVASCULAR
DISEASE OR FRAILTY STATUS OR
DEMENTIA ACTUALLY INCREASES RISK
OF SUFFERING FROM NOT JUST
EXACERBATION BUT RELATED
CONDITION FROM AIR POLLUTION
EXPOSURE AS WELL TOO.
MOVING TO EXTREME HEAT, HEAT
WAVES, A NUMBER OF LARGE
MULTI-NATIONAL ANALYSES SUGGEST
THAT GLOBAL GENERAL TEMPERATURE
INCREASES HAVE BEEN LINKED TO
INCREASE IN CARDIOVASCULAR
MORTALITIES.
BUT LOOKING SPECIFICALLY AT
EXTREME HEAT WAVES, DEPENDING
HOW YOU DEFINE IT, STILL
RESPONSIBLE FOR QUITE A FEW
DEATHS, MAYBE 2,000 OR SO A YEAR
IN THE UNITED STATES.
BUT IT DOESN'T CAPTURE THE FACT
THAT PARTICULARLY SEVERE HEAT
WAVES CAN REALLY CLAIM QUITE A
FEW LIVES IN A SHORT AMOUNT OF
TIME.
FOR EXAMPLE EUROPEAN HEAT WAVE
IN 2003 WHICH WAS PARTICULARLY
BAD FOR FRANCE HAS BEEN
ASSOCIATED WITH AN ESTIMATED
70,000 FATALITIES, MAKING THEM
MORE DANGEROUS THAN OTHER VERY
HIGH PROFILE NATURAL DISASTERS
COMBINED.
UNSURPRISINGLY MAJORITY OF
DEATHS IN INDIVIDUALS WHO LIVED
THROUGH THESE EXPERIENCES,
SUCCUMBED TO THESE EXPERIENCES,
WERE IN ADULTS OVER 65, AND WHAT
I FOUND INTERESTING AS A
CARDIOLOGIST CAUSE OF DEATH
DURING HEAT WAVES AND SPIKES IS
LARGELY CARDIOVASCULAR IN
NATURE.
AND JUST TO GIVE AN EXAMPLE IN
THE 1990s WHEN WE HAD MAJOR
HEAT WAVES GO THROUGH THE U.S.
MIDWEST, IF YOU LOOK BACK AT THE
MORTALITY STATISTICS, MINORITY
OF THEM ARE DIRECTLY ATTRIBUTED
TO HEAT STROKE OR HEAT
WAVE-RELATED CODED CAUSES, AND
THAT QUITE A FEW, MAJORITY IN
FACT, EITHER LIST CARDIOVASCULAR
DISEASE AS CONTRIBUTING FACTOR
OR AS ACTUAL CAUSE OF DEATH
ITSELF.
AND I'M SURE PART OF THAT HAS TO
DO WITH THE WAY WE CODE HEAT
INJURY THAT THERE'S VERY
SPECIFIC DEFINITIONS SUCH AS,
YOU KNOW, A CORE BODY
TEMPERATURE OVER X, BUT
NEVERTHELESS I THINK THIS
SUGGESTS THERE IS INVOLVEMENT OF
THE HEART AND CARDIOVASCULAR
SYSTEM IN A LOT OF THESE
MORTALITIES.
AND TO GIVE AN EXAMPLE OF SOME
BIOCHEMICAL EVIDENCE IN SUPPORT
OF THIS, THERE ARE A NUMBER OF
ANALYSES THAT SUGGEST THAT
HIGHER SERUM TROPONIN LEVELS IN
THE BLOOD TREMENDOUS, A MARKER
OF CARDIAC INDUSTRY OR STRESS IS
AN INDEPENDENT RISK FACTOR FOR
POOR OUTCOME FROM HEAT-RELATED
INJURIES.
BRIEFLY, I DID WANT TO MENTION
NATURAL DISASTER, WHETHER
HURRICANES, FLOODING, TORNADOES,
WINTER STORMS, BLIZZARDS.
AGAIN, THEY ARE TRAGICALLY
ILLUSTRATIVE OF THE FACT THAT
WITHIN HURRICANE KATRINA OVER
HALF -- NEARLY HALF MORTALITIES
IN ADULTS OVER 75 YEARS OF AGE.
WHAT'S INTERESTING WHEN WE LOOK
AT HURRICANES AND HURRICANE
SEASONS, THERE'S USUALLY A BUMP
IN MYOCARDIAL INFARCTIONS THAT
FOLLOW THESE EVENTS, SOMETIMES
ELEVATIONS PERSIST FOR YEARS,
THERE HAVE BEEN ANALYSES
FOLLOWING KATRINA LOOK LOOKING3
TO 10 YEARS MEDICAL CENTERS
REPORTING ELEVATED LEVELS, NOT
JUST EFFECT OF ACUTE HURRICANE
EVENT BUT PROBABLY THE EMOTIONAL
AND MENTAL STRESS THAT RESULTS
FROM SUCH A SEVERE INCIDENT CAN
REALLY AFFECT YOUR HEALTH GOING
FOR YEARS AFTER THESE EVENTS.
AND THEN ADDITIONALLY SOME GREAT
ANALYSES FROM BACK IN THE
1970s, SHOWN CLEAR INCREASES
IN RISK OF ISCHEMIC HEART
DISEASE RELATED DEATHS AND
HOSPITALIZATIONS FOLLOWING
SNOWSTORMS.
SOMETHING THAT REQUIRES MORE
ATTENTION COMING TO LIGHT IS
JUST HOW BAD THE MENTAL HEALTH
EFFECTS OF THESE NATURAL
DISASTERS ARE.
WE DO KNOW OLDER ADULTS ARE
PARTICULARLY SENSITIVE TO
AMENDMENT CRISES FROM NOT JUST
THE DISASTERS BUT EVACUATIONS
AND CERTAIN GROUPS OF
INDIVIDUALS SUCH AS INDIGENOUS
PEOPLES, ELDERS, ARE ESPECIALLY
DISPROPORTIONATELY AFFECTED BY
EVACUATIONS AS WELL AS DISASTERS
THEMSELVES.
BRIEFLY, SOMETHING EMERGING IS
DISCUSSION OF SEA LEVEL RISE,
THERE'S NOT A LOT OF DATA
CONNECTING ACTUAL HEART HEALTH
OUTCOMES ASSOCIATED, BUT THERE'S
A DISTURBING TREND IN COASTAL
REGIONS THAT SOME PLACES, MOST
OF THE DATA IS COMING OUT OF
BANGLADESH, BUT GROUND WATER
ENCROACHMENT BY SEA WATER FROM
RISING SEA LEVELS.
AND THAT WILL INCREASE SALINITY
WHICH WE'LL HAVE TO WAIT AND SEE
WHAT THAT HAS IMPLICATIONS ON IN
TERMS OF HYPERTENSION, OVERALL
SODIUM INTAKE ON COASTAL
POPULATIONS.
FINALLY EPIDEMIC AND PANDEMIC
DISEASE WILL BE WORSENED, WE
HEARD FROM DR. KLEINMAN.
PARTICULARLY NURSING HOMES WERE
GROUND ZERO IN THE INITIAL
OUTBREAK OF COVID-19.
I DON'T THINK IT REQUIRES
ADDITIONAL DISCUSSION ABOUT HOW
IMPORTANT IT WILL BE TO CONSIDER
OLDER ADULTS IN FUTURE PANDEMIC
OR EPIDEMIC DISEASES THAT MAY
HAVE CLIMATE CONNECTIONS.
I WANTED TO DRILL DOWN INTO WHY
OLDER ADULTS ARE PHYSIOLOGICALLY
AND SOCIOLOGICALLY VULNERABLE TO
HAZARDS.
LOOKING FROM A BODY SYSTEMS
PERSPECTIVE, AS I MENTIONED
BEFORE, DEMENTIA IS NOT ONLY A
RISK FACTOR BUT ALSO END RESULT
FOR INJURY FROM THINGS LIKE AIR
POLLUTION EXPOSURE AND TOXIC AIR
POLLUTION EXPOSURE.
THE HEART IS INTERESTING BECAUSE
IT'S SO VERY INVOLVED IN THE
BODY'S RESPONSE TO EXTREME HEAT.
AND SO WITH THE AGING PROCESS
YOU SEE THERE'S A DECREASE IN
MYOCARDIAL CONTRACTILITY, THE
HEART DOES NOT PUMP AS IT USED
TO, ABILITY DECREASES, BUT ALSO
ABILITY TO INCREASE HEART RATE
CAN BE HIGHER METABOLIC DEMANDS
DURING DEHYDRATION, HEAT STRESS,
ALSO BLUNTED OVER TIME.
OLDER ADULTS ARE MORE LIKELY TO
HAVE COMORBIDITIES LIKE RENAL
DISEASE OR HEART FAILURE
NECESSITATING BEING ON
MEDICATIONS LIKE DIURETICS AND
BETA BLOCKERS PREDISPOSING TO
DEHYDRATION BUT DESIGNED TO
BLUNT THE VERY INCREASE IN
CARDIAC SQUEEZE AS WELL AS HEART
RATE THAT THE BODY NEEDS TO RELY
ON IN TIMES OF HEAT STRESS AND
DEHYDRATION IN ORDER TO MAINTAIN
ADEQUATE BLOOD PRESSURE.
AND SO WHAT'S INTERESTING IS
THAT THERE'S A HOST OF PROCESSES
THAT LEAD TO INCREASED HEART
STRESS, BUT ALSO ISCHEMIA, AND
PUMP FUNCTION THAT CAN SPIRAL
QUICKLY OUT OF CONTROL INTO
FRANK CARDIOVASCULAR SHOCK IN
THESE EVENTS.
THE LUNGS ARE VERY IMPORTANT
BECAUSE THE PULMONARY VASCULAR
INTERFACE IS THE -- INTERFACE
FOR AIR POLLUTION INHALATION
EXPOSURE BEFORE IT HAS PASSES
THROUGH THE BLOODSTREAM INTO
ORGANS.
WITH AGING THERE'S A VARIETY OF
ISSUES THAT IMPAIR THAT
PULMONARY VASCULAR BARRIER
FUNCTION LIKE LOSS OF THE
PROGENITOR CELLS AND LOSS OF THE
EXTRACELLULAR MATRIX COMPRISING
THAT BARRIER FUNCTION SO YOU SEE
THERE'S ADDITIONAL
SUSCEPTIBILITY TO INHALED TOXINS
AND DELAYED RECOVERY FROM
INHALATION EXPOSURE.
NEXT, SKIN IS IMPORTANT BECAUSE
THE THERMO RECEPTORS THAT TELL
THE BODY LET'S KICK COMPENSATORY
MEASURES ARE DECREASED,
REDISTRIBUTION OF SWEAT GLANDS
IN TERMS OF WHERE THEY ARE AND
HOW ACTIVE THEY ARE, AND THAT
TENDS TO RELIEVE THE CORE OF THE
BODY WHERE A LOT OF HEAT
DISSIPATION NEEDS TO OCCUR SO
YOU HAVE REDUCE THE EVAPORATIVE
COOLING EEFFICIENCY.
NEXT KIDNEYS AND GUT, THE BODY
ACTUALLY REDIRECTS BLOOD FROM
THE VASCULATURE, INTERNAL
STRUCTURES LIKE GUT AND KIDNEYS
TO THE SKIN IN HEAT STRESS IN
ORDER TO FACILITATE PASSIVE
COOLING BY BRINGING BLOOD TO THE
SURFACE TO ALLOW IT TO COOL.
WITH AGING DECREASE IN THAT
ABILITY TO REDIRECT BLOOD FLOW
AND BASICALLY ACTIVATE OUR HEAT
SYNC FEATURES.
FINALLY, DR. KLEINMAN MENTIONED
IMMUNE SYSTEM AND CLIMATE
EFFECTS, BUT AGING IS ASSOCIATED
WITH THIS CONCEPT OF
IMMUNOSENESCENCE, THAT HAS TWO
CONSEQUENCES.
FIRST IS THAT OLDER ADULTS ARE
LESS LIKELY TO BE ABLE TO MOUNT
A ROBUST IMMUNE REACTION TO
INFECTIOUS AGENTS BUT ALSO TO
VACCINES, AND ON THE FLIP SIDE
WE HAVE DYSREGULATION AND
AUTOIMMUNITY ON THE FLIP SIDE
WHICH LEADS TO THE PHENOMENON I
MENTIONED CALLED IMMUNE AGING
AND SO THAT PROCESS OF CHRONIC
INFLAMMATION IN THE BODY CAN
ALSO LEAD TO THINGS LIKE
ATHEROSCLEROSIS, A DOUBLE WHAMMY
ON THE SPECTRUM.
SOCIAL VULNERABILITIES, A LOT
ARE LIVING ON FIXED INCOMES,
CANNOT DEAL WITH ACUTE FINANCIAL
STRESS AS WELL AS YOUNGER
ADULTS.
SOCIAL ISOLATION, OLDER ADULTS
IF NOT INSTITUTIONALIZED ARE
MORE LIKELY TO LIVE BY
THEMSELVES LEADING TO DECREASE
IN MOBILITY AND TRANSPORTATION
RESOURCES.
I DON'T HAVE TO ELABORATE TO LET
YOU KNOW INSTITUTIONALIZED
ELDERS ARE PARTICULARLY
CONSTRAINED WHETHER DUE TO
FRAILTY OR NEURODEGENERATIVE
CONDITIONS BUT EVEN INDEPENDENT
LIVING OLDER ADULTS ARE LESS
LIKELY TO DRIVE THEMSELVES,
WHETHER THEY DON'T OWN A CAR OR
LOST THEIR LICENSE OR SIMPLY
DON'T HAVE ACCESS TO THE SOCIAL
NETWORK NECESSARY FOR RAPID
TRANSPORTATION RESOURCES.
AND THEN UNFORTUNATELY OLDER
ADULTS SOMETIMES LESS ABLE AND
WILLING TO EVACUATE IN DISASTERS
WHICH SOME WAS REFLECTED IN THE
HIGH MORTALITY IN THIS
POPULATION DURING HURRICANE
EVENTS, LESS LIKELY TO LIVE IN
AIR CONDITIONED HOMES, HELPFUL
IN WILDFIRE EVENTS, HIGH HAIR
POLLUTION DAYS OR TIMES OF HEAT
STRESS.
EVEN INDIVIDUALS WHO DO LIVE IN
HOMES WITH AIR CONDITIONING
UNITS, THERE'S A TENDENCY TO BE
LESS LIKELY TO USE THEM WITH
ADVANCING AGE, QUALITATIVE
RESEARCH SUGGESTS THAT'S DUE TO
FINANCIAL BARRIERS TO THEIR USE,
WHICH I MENTIONED EARLIER AS
WELL TOO.
I DID WANT TO END BY MENTIONING
THAT NUTRITION DOES PLAY A VERY
IMPORTANT ROLE IN THIS ACCESS
AND THINK SOMETHING I'D LOVE TO
HEAR MORE FROM THE OTHER WORKING
GROUPS AND WHAT WE WOULD LIKE TO
FLESH OUT IN WORKING GROUP 1 AS
A RESULT HOW THESE THREE FACTORS
NOW INTERSECT AND SO THE FIRST
BEING HOW CLIMATE AFFECTS
NUTRITION-RELATED HEALTH
CONDITIONS IN OLDER ADULTS WHICH
AGAIN A LOT OF THAT WORK WILL BE
ASSESSED IT BY WORKING GROUP 2 I
ASSUME.
SPECIFICALLY LOOKING AT HOW
NUTRITION INFLUENCES OUR
VULNERABILITY TO CLIMATE
MEDIATED HAZARDS, PARTICULAR
AREAS ARE BARRIER FUNCTIONS,
PULMONARY VASCULATURE,
PHYSIOLOGIC REACTION TO EXTREME
HEAT, WHAT NUTRITION MEANS
DEMENTIA IN CLIMATE-MEDIATED
INSULTS, WHAT NUTRITION AND
TUMORGENESIS MEANS FOR CANCER,
BONE HEALTH, IMMUNE SYSTEM,
FINALLY SPECIFIC DIETARY TOXINS
THAT ARE KNOWN TO BE TOXIC TO
THE HEART AND BRAIN AND OTHER
ORGANS SUCH AS HEAVY METALS,
ENDOCRINE DISRUPTORS, WHAT THAT
HAS IN TERMS OF CLIMATE AND
AGING-RELATED DISEASE
RELATIONSHIP.
SO, WITH THAT, I GUESS WE WILL
OPEN UP FOR QUESTIONS.
>> THANK YOU VERY MUCH.
THAT'S AN IMPRESSIVE RESEARCH
AGENDA SUGGESTING FUNDERS WILL
BE BUSY FOR QUITE SOME TIME
TRYING TO FILL IN THE GAPS THAT
YOU LISTED.
THANK YOU, ANDY, AND WAS LISTED
IN THE EARLIER PRESENTATIONS.
WEIGH POSTPONED QUESTIONS FOR
KARTIK AND WE HAVE QUESTIONS FOR
ANDY.
NANCY, DID YOU WANT TO MODERATE
THAT?
>>I CAN JUST OPEN THE FLOOR.
WE CAN GO BACK AND FORTH WITH
QUESTIONS, BUT THANK YOU BOTH.
I CAN'T IMAGINE THERE ARE NO
QUESTIONS.
>> JEAN?
>>MICHIGAN STATE UNIVERSITY.
I'M ALSO A PART OF WORK GROUP 2
SO I'M REALLY IN AWE OF ALL THAT
YOU'VE DONE WITH THIS WORK GROUP
ALREADY.
AND DR. SHANKA, I WANTED TO
COMMENT ON YOUR PRESENTATION.
I'M A PRINCIPAL INVESTIGATOR OF
ONE OF THE ECHO COHORTS, SO FOR
PEOPLE WHO MIGHT NOT KNOW, ECHO
IS NIH'S PROJECT ENVIRONMENTAL
INFLUENCE ON CHILD HEALTH
OUTCOMES.
THEY ARE JUST TO START A SECOND
FUNDING CYCLE.
7-YEAR FUNDING CYCLE.
I FEEL LIKE I HOPE THAT ALL OF
WHAT YOU SAID WILL GO STRAIGHT
TO THE ECHO LEADERSHIP BECAUSE
IT INFORMS SOPPING WE CAN --
SOMETHING WE COULD IN THE U.S.
INFORMED BY THE INSIGHT YOU HAVE
INTERNATIONALLY THROUGH THE ECHO
PROGRAM WHICH HAS 69 COHORTS
ACROSS THE U.S. AT THIS TIME.
AND I THINK WE CAN REALLY LOOK
AT SOME IMPORTANT INTERACTIONS
BETWEEN NUTRITION AND CLIMATE.
THANK YOU SO MUCH.
>> THANK YOU FOR THE COMMENT.
IN THE SHORT TIME I DIDN'T MAKE
THESE CONNECTIONS BUT WITHIN THE
U.S. A LOT OF THE DATA FROM AIR
POLLUTION AND OTHER
ENVIRONMENTAL CONTAMINANTS HAS
COME FROM THE ECHO COHORT FOR
SUBANALYSES OF SEVERAL STUDIES
THAT ARE PART OF THE ECHO
COHORT, BUT AS FAR AS I KNOW A
LOT OF THE CLIMATE VARIABLES
SEEM TO BE BEHIND IN TERMS OF
THE MORE TRADITIONAL
ENVIRONMENTAL POLLUTANTS,
METALS, SO ON AND SO FORTH, THE
ONES THAT HAVE BEEN STUDIED.
EXPOSURE TO SOME OF THESE IS
ALSO GOING TO BE INCREASED WITH
ADVANCING CLIMATE CHANGE.
THANK YOU FOR THAT COMMENT.
>> ANDY, I'D LIKE TO ASK YOU,
YOU SAID THERE WEREN'T MANY
NUTRITION INTERVENTIONS OR DATA
GATHERED ON THE COHORTS YOU
DESCRIBED.
BUT WHAT'S YOUR GUT FEELING
ABOUT IF YOU COULD TEST
SOMETHING IN TERMS OF NUTRITION
AND RISK FACTORS, AGAIN THE
MULTI-SYSTEM EFFECTS, WHERE
WOULD YOU START?
IMPROVED BMIs, MACRONUTRIENTS,
OR IMPROVED -- LIKE EVERYBODY ON
MACRONUTRIENTS OR IMPROVED
DIETS, WHAT COMES TO MIND?
>>YOU MENTIONED EXACTLY WHAT IT
IS I THINK IT'S GOING TO BE
MACRONUTRIENTS.
THE BIG THREE THAT I USUALLY
THINK ABOUT CARDIOVASCULAR RISK
FACTORS, SO WE'RE TALKING
HYPERTENSION, BLOOD SUGAR IN
FORM OF DIABETES AND
HYPERLIPIDEMIA.
A LOT HAVE STRONG LINKS TO
CARBOHYDRATES AS WELL AS
CONSUMPTION OF CERTAIN PROTEINS
SUCH AS RED MEAT AND DAIRY.
WE HAVE LONG KNOWN THESE THINGS.
UNFORTUNATELY, MAYBE FORTUNATELY
FOR US, THERE'S BIDIRECTIONAL
IMPACT, FOR INSTANCE RED MEAT
FOR THE CLIMATE, CARDIOVASCULAR
DISEASE.
REALLY IT'S GOT TO BE THE
MACROMACROS, SUGAR, PROTEINS,
FATS REALLY.
>> I'LL JUST SAY I WOULDN'T
DISMISS MICRO NUTRIENTS BUT THAT
SEEMS FAR TO START WITH MACROS.
GREAT COMMENT.
>>IF I COULD INTERRUPT I'D LIKE
TO ADD TO THAT.
WE KNOW CARBON DIOXIDE IS
AFFECTING NUTRIENT DENSITY, NOT
RESEARCH OF WHAT THAT MEANS FOR
THE OBESITY EPIDEMIC.
WHEN WE LOOK AT MEAT
ALTERNATIVES AT THIS MOMENT
THOSE MEAT ALTERNATIVES ARE
FOCUSING ON PROTEIN CONTENT BUT
NOT MICRONUTRIENTS.
SWITCHING TO THESE ALTERNATIVES
IN TERMS OF WHAT 1.5 BILLION
WOMEN WHO HAVE IRON DEFICIENCY
ANEMIA AND THINKING FORWARD
ABOUT THE CHALLENGES WE'RE GOING
TO FACE AS WE TRANSITION TO MORE
SUSTAINABLE FOOD SYSTEM THAT
TAKES INTO ACCOUNT ITS
CONTRIBUTION TO CLIMATE CHANGE,
BUT THEN ALSO HOW IT COMES BACK
TO NUTRITION, AND I'M SURE DAN
HAS HIS HAND UP FOR JUST THAT
REASON.
>> YOU'RE STILL ON MUTE.
THERE WE GO.
>> THERE IS WORK BEING DONE ON
MEAT ALTERNATIVES, AND I THINK
WORKING GROUP 3 WILL FOCUS ON
SOME OF THAT.
I THINK THAT'S IMPORTANT.
THE QUESTION I HAD FOR THE
GROUP, THE CONTEXT OF THE
PROJECT, OUR GOAL HERE IS TO
MAKE A CASE FOR WHY THIS
INTERSECTION OF HEALTH AND
NUTRITION NEEDS TO BE INTEGRATED
INTO THE DELIBERATION OF
GUIDANCE RECOMMENDATIONS ET
CETERA, HOW CAN WE POSITION
THIS, ARE THERE DATA WE CAN
EXPLORE FOR WHAT HAPPENS WHEN
YOU DON'T INTEGRATE THESE
THINGS?
I'M JUST WONDERING IF WE CAN
COVER THAT SOMEHOW IN THE GROUP.
I'M HAPPY TO HEAR FROM OTHER
WORKING GROUP MEMBERS AS WELL,
FROM OTHER WORKING GROUPS AS
WELL AS THIS ONE.
>> I GUESS I WOULD JUST SAY
THAT WE HAVE WHAT YOU JUST
DESCRIBED IS WHAT HAPPENS WHEN
WE DON'T ACCOUNT FOR IT.
YOU KNOW, WE HAVE ALL THESE GAPS
IN KNOWLEDGE, BUT YOU'VE RAISED
AN IMPORTANT POINT.
>>AN EXAMPLE, WE HAVE THE W.H.
TARGETS, ANEMIA, STUNTING, ET
CETERA, WE'RE NOT DOING A GREAT
JOB OF MEETING BUT THEY DON'T
INCLUDE CONSIDERATION OF
CLIMATE.
BUT THERE ARE DATA TO INDICATE
THAT I THINK WE'VE HEARD DATA
TODAY TO INDICATE WHY THAT'S
IMPORTANT.
I WANT TO HIGHLIGHT THAT IS AS A
POINTS OF EMPHASIS FOR THE
REPORT, WE HAVE TARGETS THAT
WE'RE TRYING TO MEET, HERE IS
WHY THIS NEEDS TO BE INTEGRATED.
ANEMIA IS A PERFECT CASE IN
POINT.
WE HEAR ABOUT IT ALL THE TIME.
IT'S A MULTI-DIMENSIONAL
DISEASE, NOT JUST NUTRITIONAL.
WE DON'T ADDRESS ITS IT AND HAT
INCLUDE THE THE INTERSECTION OF
CLIMATE.
IF WE WANT TO TIE IT TOGETHER,
TAKE MALARIA, RON DISCUSSED
INFECTIOUS DISEASES, IF YOU LOOK
AT MALARIA AND RELATIONSHIP TO
IRON, A SCENARIO IS CREATED THAT
MAKES FOR A COMPLICATED SET OF
ISSUES THAT WE NEED TO HIGHLIGHT
HERE.
SO, FOR EXAMPLE, IF WE ASSUME
MALARIA IS RELATED TO IRON
STATUS, AND IRON PHYSIOLOGY,
WHICH IT OBVIOUSLY IS, THERE'S
ASSUMPTION IT'S RELATED TO IRON
DEFICIENCY, OR IRON NUTRITION,
WHICH IT MAY OR MAY NOT BE.
IN AREAS WHAT MALARIA IS ENDEMIC
IRON DEFICIENCY IS ALSO ENDEMIC.
WE'RE LEFT WITH WHAT TO DO IN
THAT CONTEXT, GIVE IRON
SUPPLEMENTATION WHERE KRIS IS
POINTING OUT AND WE'LL HEAR FROM
WORKING GROUP 2 THAT QUALITY OF
THE DIETS AND BEING DECREASED AS
A RESULT OF GREENHOUSE GAS
EMISSION, EXPECTATIONS ABOUT
DIET ARE GOING TO BE REDUCED.
IRON SUPPLEMENTATION MAY NOT BE
SAFE IN THE CONTEXT OF MALARIA,
AND INFECTIOUS DISEASES, MAKES
FOR A CONUNDRUM WITH REGARD TO
INTERVENTION, TAKING THAT
APPROACH WILL BE IMPORTANT, NOT
JUST PRESENTING THE CASE FOR
NUTRITION BEING IMPORTANT, IN
THE COURSE OF THE LIFESTYLE
CYCLE OR ANY DISEASE BUT ALSO
CHALLENGES ABOUT MAKING
DECISIONS WHAT INTERVENTION
MIGHT BE BEST ON A GIVEN
CIRCUMSTANCE.
WORKING GROUP 2 WILL BE DEALING
WITH CHOICE, ISSUES AROUND
CHOICE, DIETARY PATTERNS, AND
WORKING GROUP 3 WILL BE DEALING
WITH CHOICES AS RELATES TO
PRODUCTION-RELATED ISSUES AND
WORKING GROUP 5 WILL HAVE TO
ADDRESS IT IN SOME WAY BUT THIS
IT WILL BE IMPORTANT FOR THIS
GROUP TO PUT IT IN CONTEXT.
I'LL STOP RAMBLING.
>>YOU RAISED A CASE FOR
EXAMPLES TO HIGHLIGHT WHAT
YOU'RE DESCRIBING.
THERE'S MANY THAT WE COULD DO.
>> EXACTLY.
THANK YOU.
>> ALEXANDRA?
ALEXA, SORRY.
>> ANDY, YOUR TALK WAS
INTERESTING.
I MYSELF DON'T HAVE A LOT OF
EXPERIENCE LOOKING AT DATA FOR
ORDINARY ADULTS BUT WAS
WONDERING AS WE'RE THINKING
ABOUT THIS LIFE COURSE
PERSPECTIVE, WHEN DO YOU THINK
THE BEST TIME TO INTERVENE TO
IMPROVE NUTRITIONAL STATUS FOR
ELDERLY, IS IT BEFORE YOU ENTER
A CERTAIN AGE?
OR LIKE CAN WE BE INTERVENING
DURING THAT PART OF THE LIFE
COURSE?
I WAS WONDERING IF YOU HAD ANY
THOUGHTS.
>> I MEAN, THE COPOUT ANSWER IS
BOTH.
I THINK THE IMPLIED ANSWER TO
YOUR QUESTION BASED ON YOUR
STATEMENT I THINK IS TRUE, THE
BIGGEST BANG FOR YOUR BUCK
HAPPENS EARLIER IN LIFE BECAUSE
A LOT OF CONDITIONS ARE THE AS A
RESULT, END RESULT, OF CHRONIC
LONG-TERM, THEY CALL IT
MARINATION, PICKLING EFFECT FOR
HIGH SUGARS OVER TIME.
THE EARLIER YOU INTERVENE THE
BETTER, FOR LIPIDS AND DIABETES,
TRYING TO MORE AGGRESSIVELY DEAL
WITH IT EARLIER.
WE'RE PUTTING PEOPLE ON STATINS
AND BLOOD PRESSURE MEDICATIONS
EARLIER.
I DON'T THINK THERE CAN BE AN
EARLY ENOUGH, BUT THE EARLIER
THAT WE DO PUT THESE INTO EFFECT
THE BETTER HEALTH EFFECTS WE'LL
SEE IN THE LONG RUN.
I WILL SAY THAT THERE IS A POINT
WE MAY START TO WONDER IF WE'RE
ACTUALLY PAST A CERTAIN POINT ON
THE CURVE SO I DO SOME RESEARCH
LOOKING AT SYNCOPE, VERY
AGGRESSIVE BLOOD PRESSURE
CONTROL AT EXTREME AGES MAY NOT
BE SUPER BENEFICIAL BECAUSE
WE'RE DEALING WITH A LOT OF
COMPETING RISKS FOR MORTALITY AT
THE END, BUT IF YOU'RE REALLY
AGGRESSIVELY DRIVING BLOOD
PRESSURE DOWN YOU HAVE SYNCOPE,
LOSING CONSCIOUSNESS, FALLING, A
GREATER SOURCE OF POTENTIAL
TRAUMA AND DEATH.
THE ANSWER IS CAN'T INTERVENE
EARLY ENOUGH BUT THERE'S A POINT
IN LIFE MAYBE SOMEWHERE IN THE
'80s WHERE PERHAPS MAYBE WE
SHOULD BE BACKING OFF AND JUST
LETTING IT BE WHAT IT IS.
>> THANK YOU.
THAT ALSO BRINGS BACK TO DAN'S
POINT OF WHAT HAPPENS IF YOU I
DON'T INTEGRATE NUTRITION AND
CLIMATE AND HEALTH, IS WE'RE
SEEING A POPULATIONS THAT ARE
AGING, DON'T ADDRESS IT NOW, I
THINK IT'S GOING TO BE MUCH
HARDER TO ADDRESS IN THE FUTURE.
>> I MEAN, THERE'S SOME -- WHEN
I SAY YOU CAN'T START EARLY
ENOUGH, I MEAN THERE'S TRAGIC
DATA FROM THE DUTCH FAMINE IN
1944, NAZIS BLOCKADE THE THE
ENTIRE COUNTRY TO PUNISH THEM
FOR A RAIL STRIKE.
PEOPLE WHO ARE IN UTERO DURING
THIS 12-WEEK EXTREME FAMINE
LATER WOULD GO ON TO HAVE 2 1/2
TIMES HIGHER ODDS OF HEART
ATTACKS AND DIABETES LATER ON IN
LIFE.
SO IT STARTS IN UTERO.
YOU CAN'T START EARLY ENOUGH.
>> I THINK I WANTED TO MAKE A
COUPLE POINTS.
TO DAN'S POINT, WHICH IS WE
THINK ABOUT NUTRITIONAL
REQUIREMENTS AND INTAKE AND LIFE
STAGES TO BE DIFFERENT.
AND THOSE TO IMPACT PERSONAL
REQUIREMENT.
BUT -- AND IN THE CONTEXT OF
CLIMATE CHANGING NUTRITION
REQUIREMENTS, IT'S REALLY ABOUT
CONTEXT, RIGHT?
IN SOME CONTEXTS WHERE, SAY, THE
AIR IS REALLY, REALLY, REALLY
BAD THAT IMPACT MAY BE MUCH
GREATER THAN THE KIND OF
INFLUENCES PERHAPS IN THE LARGER
U.S. POPULATION, MAYBE
LOCALIZED, SAY, WILDFIRE SETTING
MIGHT GET A LOT OF EXPOSURE TO
PM2.5 BUT WHEN ALL THE AIR YOU
BREATHE IS BAD THE CONTEXT IS
VERY DIFFERENT.
WE'VE GOT TO FRAME THIS IN TERMS
OF CONTEXT.
THAT WAS ONE OF THE KIND OF
POINTS THAT MAYBE WE SHOULD
DISCUSS.
SECONDLY WE WERE TALKING ABOUT
WHAT DIETARY THINGS WE WOULD USE
FOR INTERVENTION.
AND TYPICALLY WE THINK ABOUT
GOOD THINGS YOU CAN GIVE PEOPLE
TO IMPROVE NUTRITION BUT WE HAVE
TO LOOK AT FOOD SYSTEM AND THINK
ABOUT BAD THINGS, BUT THINGS
THAT MIGHT IMPACT, SAY, THE
EXAMPLE THAT'S INTERESTING,
FRUCTOSE, HYDRATION, WHETHER IN
COUNTRIES WHERE THERE'S A LOT OF
FRUCTOSE EASILY AVAILABLE, KIDS
CONSUME IT A LOT, SUSCEPTIBLE TO
HEAT STRESS AND DISEASE, THERE'S
THE WHOLE ANGLE ABOUT LOOKING
INTO OUR FOOD SYSTEM AND
THINKING ABOUT VERY PREVALENT
MODERATELY GOOD FOODS.
THOSE WERE TWO POINTS I REALLY
THOUGHT --
>> I REALLY LIKED THE
PERSPECTIVE FROM DON ABOUT HOW
THE SCHOOL LUNCH PROGRAMS WERE
CHANGING LOCAL AGRICULTURE AND
FOOD SUPPLY, I DON'T KNOW IF
THAT CAN BE BUILT INTO A LONGER
BROADER CHANGE IN DIETARY
PATTERNS BUT MAYBE WORK GROUP 2
OR 3 WILL TAKE THAT ON.
ARE YOU OKAY IF WE OPEN TO OTHER
PARTICIPANTS ON THE WEBINAR?
>> OH, ABSOLUTELY.
>> I FOR GOT WHO IS GOING TO
BE -- THE QUESTIONS FROM THE
AUDIENCE WENT TO AN E-MAIL
ADDRESS SOMEONE IS GOING TO --
>>DREW IS IN CHARGE OF THAT.
>>I'M MONITORING THAT.
WE'VE NOT HAD A LOT OF TRAFFIC
COME IN BUT I DO, FOR THOSE ON
THE VIDEOCAST, PLEASE FEEL FREE
TO SEND COMMENTS AND QUESTIONS.
WE'LL TRY TO ADDRESS THEM IN
REAL TIME WITH OUR PANELISTS AND
WORKING GROUP MEMBERS BUT THEY
ALSO WILL BE ARCHIVED.
AS THESE GROUPS CONTINUE WITH
THEIR CHARGE OF PUTTING TOGETHER
REPORTS AND OUTPUTS, IT'S SUPER
HELPFUL TO HAVE INPUT FROM THE
COMMUNITY.
>> COULD I ASK WORKING GROUP
MEMBERS TO TURN ON YOUR VIDEO
AND THEN WHILE WE'RE WAITING FOR
QUESTIONS TO COME IN, I'D LIKE
TO OFFER THE OPPORTUNITY FOR ANY
OF THE WORKING GROUP MEMBERS TO
ASK QUESTIONS OF EACH OVER.
THESE ARE GREAT PRESENTATIONS.
IF THERE ARE ISSUES THAT CAME UP
IN WHAT YOU HEARD IF YOU WOULD
LIKE TO ASK ANY QUESTIONS.
APOLOGIES, I HAVE SOMEBODY
BANGING IN THE BACKGROUND SO
I'LL BE ON MUTE EXCEPT WHEN
SPEAKING.
>> SO I HAVE A GENERAL QUESTION
ABOUT ATTRIBUTION AND I WANT TO
LEARN MORE ABOUT WHAT WE CAN
TRULY -- I THINK WE HAVE THIS IN
OUR VOCABULARY CLIMATE DOES
THIS, CLIMATE DOES THAT, BUT
REALLY IN TERMS OF ATTRIBUTION,
MAYBE IT'S SOMETHING WE COULD
LEARN.
>> THIS IS A WELL-DEVELOPED
FIELD IN CLIMATE SCIENCE.
DEVELOPED OVER THE LAST COUPLE
DECADES.
AND THERE WAS AN EXPERT MEETING
ON THIS TOPIC, I DON'T KNOW,
ABOUT 2006, 2007, SOMETHING LIKE
THAT.
PART OF THEIR METHODS ARE QUITE
FAMILIAR TO THOSE OF US IN
HEALTH BECAUSE THEY COME
STRAIGHT FROM HOW WE THINK ABOUT
ATTRIBUTION IN HEALTH.
IN HEALTH ATTRIBUTION IS
PRIMARILY A TWO-STAGE PROCESS.
FIRST YOU HAVE ATTRIBUTION TO
WHATEVER WEATHER VARIABLES OR
WEATHER EVENTS YOU'RE INTERESTED
IN.
SO MOSTLY ATTRIBUTION IS AROUND
HEAT.
I LIVE IN THE PACIFIC NORTHWEST,
THE HEAT TOMORROW.
ACROSS OREGON, WASHINGTON,
BRITISH COLUMBIA THERE WAS 800
EXCESS DEATHS.
WE CAN SAY THEY WERE DUE TO
CLIMATE CHANGE.
THERE WAS A HEAT WAVE THAT HAD A
RETURN PERIOD OF 1 IN 3 MILLION
YEARS, WHICH I STILL HAVE REALLY
HARD TIME CONCEPTUALIZING.
IN SCANDINAVIA OVER 700 EXCESS
DEATHS, FROM CLIMATE CHANGE.
MORE COMPLICATED WHEN YOU THINK
ABOUT THE HEAT WAVE IN EUROPE IN
2003, CLIMATE CHANGE MADE IT
MUCH MORE LIKELY, INCREASED
LIKELIHOOD OF THE SEVERITY OF
THAT EVENT, INTENSITY OF THAT
EVENT BY ABOUT THREE-QUARTERS.
AND THERE IS NOT YET A CONSENSUS
IN THE HEALTH SECTOR HOW DO WE
PARTITION OUT HOW MANY, 70,000
EXCESS DEATHS, DOO WE LOOK AT
THREE-QUARTERS, ABOVE A CERTAIN
TEMPERATURE TAKE THAT?
WELLCOME TRUST IS QUITE
INTERESTED IN THIS, WELL COME
--
WELLCOME TRUST IS GOING TO FUND
RESEARCH OVER THE NEXT DECADE,
AREAS WE'RE INTERESTED IN TO
ADVANCE THE METHODS BEYOND HEAT
TO VECTOR BORNE DISEASES AND
OTHER ISSUES.
>> IF I COULD ADD TO THAT,
YOU'RE RAISING A COUPLE POINTS,
REALLY IMPORTANT POINTS.
ONE IS INDICATORS.
WHAT DO WE NEED TO INTEGRATE
INTO OUR CURRENT SYSTEMS FOR
SURVEILLANCE?
THERE ARE SYSTEMS THAT ARE
SURVEILLING IMPACT OF CERTAIN
ASPECTS OF THE CLIMATE ON
CERTAIN ASPECTS OF THE FOOD
SYSTEM BUT NOT INTEGRATING
HEALTH.
OR THERE MAY BE SOME LOOKING AT
HEALTH, ASPECTS OF CLIMATE BUT
NOT INTEGRATING FOOD SYSTEMS.
SO THIS IS AN IMPORTANT ISSUE.
WORKING GROUP 4 IS GOING TO BE
THE FOCAL POINT.
YOU CAN RAISE THESE ISSUES,
WHERE THE NEEDS ARE.
WORKING GROUP 4 IS REALLY
FOCUSING ON ANALYTICAL
FRAMEWORKS FOR LOOKING AT
COMPLEX SYSTEMS.
BOTH IN TERMS OF RESEARCH DESIGN
BUT ALSO PERHAPS AS IT RELATES
TO PUBLIC HEALTH SURVEILLANCE.
IT'S REALLY AT THE CORE OF WHAT
WE'RE TRYING TO ACCOMPLISH HERE,
HOW DO YOU INTEGRATE THESE
THINGS INTO WHAT'S GOING ON SO
THAT WE CAN ATTRIBUTE WHAT'S
REALLY HAPPENING TO WHAT'S
REALLY GOING ON.
ALSO I'LL ADD THAT WE MENTIONED
EARLY ON IN THE PRESENTATION
TODAY THAT THERE'S A NUMBER OF
GOVERNMENT -- U.S. GOVERNMENTAL
EFFORTS THAT ARE ONGOING, ONE OF
WHICH IS INTERGOVERNMENTAL
COMMITTEE ON CLIMATE CHANGE AND
HEALTH, THERE'S A WORK STREAM
THAT'S SPECIFICALLY DEVOTED TO
FOOD SAFETY AND NUTRITION
SECURITY.
IT'S LED BY SHEILA FLESHHACKER
AND OTHERS.
THERE'S A SPECIFIC ACTIVITY
FOCUSED ON INDICATORS, AND
INTERESTINGLY THE CASE STUDY
THAT IT STARTED WITH IS VIBRIO.
THERE'S A LOT GOING ON, BUT THE
POINT OF WHAT WE'RE DOING HERE
IS THAT IT HASN'T INCLUDED
NUTRITION.
IT HAS DONE SOME STUFF ON FOOD
SYSTEMS BUT HASN'T DONE
NUTRITION, CERTAINTY HAS NOT
DONE NUTRITION AS IT INTERSECTS,
THE BIDIRECTIONAL WAY WE'RE
TALKING HERE.
>> IF I COULD ADD TO THAT ONE
OF MY ROLES THROUGHOUT THIS
PROCESS IS TO MAKE SURE WE'RE
ALL ACCURATE TALKING ABOUT
WEATHER, CLIMATE VARIABILITY,
AND CLIMATE CHANGE BECAUSE THEY
ARE ALL PART OF THE CONTINUUM.
THEY ARE DIFFERENT PARTS OF THE
CONTINUUM.
THERE SEEMS TO BE CONFUSION IN
THE HEALTH SECTOR, ALTHOUGH
WE'RE COMFORTABLE WITH UV.
VARIOUS CATEGORIES OF UV ON A
CONTINUUM BUT WE DON'T CONFUSE
UVA FROM UVB.
AND THERE'S LOTS OF CONFUSION
UNFORTUNATELY IN THE LITERATURE
BETWEEN WHAT'S WEATHER AND
WHAT'S CLIMATE.
>>IN YOUR REPORT, KRIS, WHAT
YOU PRESENTED TODAY WILL BE
GREAT AS AN INTRODUCTION.
THE WHOLE ISSUE EVER VERNACULAR
IS CRITICAL TO WHAT WE'RE TRYING
TO DO HERE.
SO IT'S IMPORTANT TO MAKE
THOSE -- HIGHLIGHT ISSUES, IN
YOUR REPORT, THROUGHOUT THE
OTHER REPORTS, MAKE SURE WE'RE
ALL TALKING ABOUT THE SAME THING
ACROSS ALL REPORTS, AND
CERTAINLY IN THE PROJECT SUMMARY
THE SECRETARIAT WILL DRAFT WE'LL
MAKE SURE TO INTRODUCE THIS
ISSUE OF VERNACULAR.
>> THANK YOU.
>>ONE OF THE THINGS WE HAVEN'T
TOUCHED ON MUCH, ALTHOUGH ANDY
AND KARTIK ALLUDED TO THIS,
EFFECT OF CLIMATE CHANGE ON THE
GENOME ITSELF.
AND FUNCTIONING OF THE GENOME,
BOTH KARTIK DID IT AT EARLIER
STAGES, ANDY AT LATER STAGES,
BUT AS YOU MENTIONED, KRIS,
THERE'S A CONTINUUM OF CHANGE
AND INFLUENCE, THE DEGREE TO
WHICH THAT'S OPERATING
THROUGHOUT LIFE.
AND THE REVERSIBILITY OF ALL OF
THAT.
I THINK, YOU KNOW, REALLY THEY
ARE INTERESTING QUESTIONS.
IT WOULD BE GOOD FOR US TO AT
LEAST IDENTIFY THE RESEARCH GAPS
HERE BECAUSE I THINK THEY ARE
PRETTY WIDE.
BUT THE A LEAST TO BRING THAT
UP.
>>THAT'S A GOOD POINT.
THERE'S STUDIES ON FRUIT FLIES
SHOWING WITH WARMER TEMPERATURES
THEY ARE EVOLVING A LOT FASTER.
GOES STRAIGHT TO INFECTIOUS
DISEASES, WHAT IT'S GOING TO
MEAN IF OUR VECTORS ARE EVOLVING
FASTER THAN WE'RE ABLE TO MANAGE
SHIFTS IN THE GEOGRAPHIC RANGE,
IN SEASONALITY.
WE'RE NOT DOING GREAT FOR SOME
INFECTIOUS DISEASES RIGHT NOW.
IT'S GOING TO BE EVEN MORE
CHALLENGING AS THEY EVOLVE MORE
QUICKLY.
>> JUST TO ADD ONE POINT TO
THAT.
I INTERPRETED INTERPRETED COMMS
TO EPIGENOME OF THE INDIVIDUAL.
OBVIOUSLY CHANGES TO GENOME OF
VECTORS, DISEASE-CAUSING
PATHOGENS, BUT ALMOST WITH
CERTAINTY THINGS THAT CHANGE
ABOUT SCIENCE HAVE BEEN SHOWN TO
BE ASSOCIATED WITH PERSISTENT
CHANGES IN THE EPIGENOME.
THE LEVEL OF CHANGE OR EFFECT
SIZE WHERE WE HAVE LOW BIRTH
WEIGHT, WE'RE ALMOST CERTAINLY
TALKING ABOUT LONG-TERM
DOHaD-TYPE EFFECTS.
>> THAT'S WHAT I MEANT BY
FUNCTIONALITY.
WHAT IS CONTROLLING GENETIC
EXPRESSION?
ABSOLUTELY THE EPIGENOME IS
WHERE IT'S LOCATED.
>>INTERESTING TOO, TO IDENTIFY
NATURAL EXPERIMENTS.
THERE'S A FASCINATING STUDY
PUBLISHED YEARS AGO WHICH YOU
MAY OF BE AWARE OF, MASSIVING G
--
MASSIVE MIGRATION IN ITALY FROM
THE SOUTH TO THE NORTH.
THOSE BORN IN THE SOUTH HAD
LOWER HEAT-RELATED MORTALITY,
PRESUMABLY IT'S SOMETHING
EPIGENETIC THAT STAYS THROUGHOUT
OUR LIVES.
THERE HASN'T BEEN OTHER
FOLLOW-UP EXPERIMENTS.
THINKING ABOUT WHERE IT'S
POSSIBLE TO DO SOME KINDS OF
COMPARISONS WOULD BE REALLY
VALUABLE.
SO, I DON'T HAVE ANY SUGGESTIONS
FOR THOSE STUDIES BUT I HOPE
SOMEBODY'S GOT SOME IDEAS WHERE
TO LOOK.
WE'VE GOT THREE MINUTES LEFT.
ARE THERE ANY QUESTIONS, DREW,
YOU HAVE FROM THE E-MAILS THAT
YOU'D LIKE TO POSE TO US?
>> I SEE A TOOLS HANDOUT,
THERE'S BEEN NOT MUCH TRAFFIC ON
THE E-MAIL BUT A TOOL.
>> I'M A PROFESSOR AT THE
UNIVERSITY OF ILLINOIS.
I DON'T HAVE MUCH EXPERIENCE OR
MY BACKGROUND IS NOT IN HEALTH
SECTOR, BUT I'M JUST
UNDERSTANDING THE IMPACTS OF THE
NUTRIENTS MICRO AND MACRO ON THE
CLIMATE CHANGE.
SO FAR I'VE HEARD IN THIS GROUP
DISCUSSION HOW THE HUMANS ARE
BEING IMPACTED BY CLIMATE CHANGE
BUT IT'S ALSO THE OTHER WAY
AROUND, THAT FOOD SECTOR, SOURCE
OF THE MACRONUTRIENT OR MICRO
NUTRIENT, IS ALSO DRIVING
CLIMATE CHANGE.
THAT'S WHAT WE STUDY IN OUR
RESEARCH GROUP.
IN FACT, OUR STUDY SUGGESTS THAT
ABOUT 35% OF THE EMISSIONS
COMPOUND, FOOD SECTOR, BUT IT IS
ALSO WE NEED TO TRANSFORM HOW
THE FOOD SECTOR IS BEING
ACTUALLY PRODUCED, PROCESSED, AS
WELL AS CONSUMED.
AT THE SAME TIME THIS QUESTION
HAS BEEN RAISED MANY TIMES THAT
PERHAPS WE SHOULD SWITCH TO THE
PLANT-BASED DIET RATHER THAN
ANIMAL BASED, SO HEALTH OF THE
HUMANS BEING PART OF THIS
EQUATION, WONDERING IF THERE'S
ANY INTEREST IN THIS GROUP ABOUT
UNDERSTANDING LINKAGE BETWEEN
THE TWO IN THE BEGINNING OF THE
TALK THAT YOU'RE INTERESTED IN
THE SYSTEM-BASED APPROACH OR
INTEGRATED APPROACH SO I BELIEVE
THERE WILL BE SOME KIND OF
INTERACTION BETWEEN IMPACT OF
CLIMATE CHANGE OF THE HEALTH BUT
ALSO AT THE SAME TIME HOW
NUTRIENTS AND MACRONUTRIENTS AND
MICRO NUTRIENTS IMPACT THE
CLIMATE CHANGE.
>> LETS MAKE THAT QUICK.
WE HAVE A WHOLE WORKING GROUP
THAT'S DEVOTED TO THAT.
THOSE ISSUES ARE GOING TO BE
INTEGRATED INTO ALL THE REPORTS.
SO WE APPRECIATE THE COMMENT.
HIGHLIGHTING THE COMPLEXITY OF
THESE INTERACTIONS.
DOES ANYBODY ELSE HAVE ANY OTHER
QUESTIONS?
>> I DON'T HAVE A QUESTION BUT
BEFORE WE GO I WANT TO THANK
LISA MALONEY, REALLY CRITICAL
FOR HELPING US PULL ALL OF THIS
TOGETHER.
AND APOLOGIES, WE DIDN'T
SPECIFICALLY CALL HER OUT AT THE
BEGINNING.
AND THEN THANKS TO YOU, DAN, AND
TO EVERYONE ELSE FOR MAKING THIS
HAPPEN.
IT'S BEEN REALLY, REALLY
INTERESTING.
>> THANK YOU, EVERYONE.
I WANT TO ECHO A SHOUT OUT TO
LISA.
WE MENTIONED THE TEAM IS
INTEGRAL TO THIS.
LISA IS ONE OF OUR PARTNERS,
EACH OF THE WORKING GROUPS HAS
SOMEONE TO SUPPORT THEIR
EFFORTS.
YOU'LL MEET THEM ALL IN THE
COURSE OF THESE WORKSHOPS.
DREW?
>>I WANT TO THANK -- EXPRESS
GRATITUDE AND THANKS FOR
EVERYONE.
I WILL LET YOU KNOW THAT MY
DAUGHTER HAS BEEN HOME ON SPRING
BREAK, YOU'RED -- YOU'RE
EDUCATING US AND THE NEXT
GENERATION OF INVESTIGATORS.
DAD, THAT'S COOL STUFF!
HIGH PRAISE FROM A 10-YEAR-OLD.
TO DAN'S POINT THE TEAM IS
FANTASTIC.
I WANT TO CALL OUT OUR NICHD
SUPPORT TEAM BECAUSE THEY ARE
BEYOND FANTASTIC.
I INVITE YOU BACK NEXT THURSDAY
FOR THE NEXT WORKING GROUP.
I WISH EVERYONE AN ENJOYABLE
FRIDAY.
A GREAT WEEKEND.
WITH THAT --
>>THIS IS ALL RECORDED,
AVAILABLE TO YOU AT ANY TIME,
THE ADVANTAGE TEAM.
WE'LL HAVE A WRITTEN RECORDING
OF THIS AS WELL, A TEXT
RECORDING AS WELL. SO YOU'LL HAE
THAT AT YOUR DISPOSAL AS WELL AS
POWER POINTS.
>> THANKS, EVERYBODY.