health impacts of the industrialized food system food matters: a clinical education and advocacy...
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Health Impacts of the Industrialized Food System
Food Matters: A Clinical Education and Advocacy Program
Insert Presenter Name and TitleInsert Date and Location of Presentation
Food Matters: A Healthcare Education and Advocacy
Program
To inspire clinicians to:
Provide anticipatory guidance to patients and families about the importance of healthy foods and a healthy food system.
Work within health care facilities to create a healthy food service model that is recognized as integral to a preventive health agenda.
Work within the community at a local, regional and national level to promote policies that support the development of a healthy, accessible, and fair food system.
Clinical advisory group
Clinical curriculum development and • trainings
Nationwide clinical network
Maternal/Child health calendar
Video for waiting rooms, clinics, exam • rooms, community meetings
Healthy Food in Health Care campaign for healthier, more sustainable foodservice
Components of the Food Matters Program
Guiding Rationale An Ecological Health FrameworkThe individual in the context of family, community, society and ecosystem
Healthy food comes from a food system that is
ecologically soundeconomically viable, and
socially responsible.
Guiding Rationale A Food Systems Approach
Interconnections Between Nutrition and Environment
Barilla Centre for Food and Nutritionwww.barillacfn.com
Hospitals and healthcare professionals can be leaders and advocates for a food system that promotes public and environmental health.
Healthcare professionals have credibility, influence, and expertise.
Anti-smoking campaigns can be good models.
Guiding Rationale Healthcare Advocacy
Focus on inputs / outputs Specialization Resource intensiveness Large-scale
Farm as Factory
“The economic reductionism of modern industrial agriculture subjects the farm to the simplification, standardization and abstraction of a factory.”
- James Scott, 1998
HEALTH
SOCIETY
ENVIRONMENT
Chronic diseases (cancer, diabetes, obesity)
Antibiotic resistance & food-borne pathogens
Pesticide exposure (cancer, reproductive, neuro-developmental, and endocrine impacts)
Asthma and respiratory illness
Food injustice (hunger, food deserts)
Local economic decline
Labor issues
Water and air quality
Energy use and GHG emissions
Loss of crop and biological diversity
Soil erosion
Externalities of the Industrialized Food System
Where in the Food System do Health Concerns Exist?
ProductionPesticides, chemical fertilizers, antibiotic and hormone use in meat and dairy production, infectious agents, arsenic, environmental degradation
Processing Increased reliance on imported, unregulated processed foods; melamine; residual mercury; food-borne illness
Packaging / Transportation
Bisphenol A (BPA), phthalates, perfluorochemicals, air quality, food miles, widespread use of plastics leading to large volumes of waste both in landfills and incinerated, environmental degradation
Consumption Fast food, sugar-sweetened beverages, high fructose corn syrup, marketing, obesogens, nutritionally deplete foods
Toxics in the Food System
Pesticides Bisphenol A Phthalates Dioxins
PCBs Metals
lead, mercury, cadmium, manganese
PBDE flame retardants
Critical and Sensitive Windows of Development
Childhood →Periconception Prenatal Postnatal
Blastocyst EmbryoFetus
Infant ChildAdolescent
Environmental ExposuresImmediate & Long Term
Consequences
Based on analysis of representative sample of U.S. population by NHANES 2003-2004. Note, not all women were tested for all
chemicals
Widespread exposure to chemicals with reproductive/developmental toxicity
Body Burden: Pesticide Pollution in Children
www.ewg.org/reports/bodyburden
Pesticide exposure is ubiquitous among pregnant women. Pesticides have been detected in human urine, semen, breast milk, ovarian fluid, cord blood, and amniotic fluid.
Blood from the umbilical cords of 10 infants born in U.S. hospitals in 2004 showed an average of 200 industrial compounds, pollutants, pesticides and other chemicals, including 21 out of the 28 pesticides tested.
Our Chemical Environment
Over 85,000 synthetic chemicals in production 3,800 high production volume; used in quantities
> 1 million lbs/yr ~900 active pesticide ingredients (EPA) ~ 3,000 in food processing (FDA)
Toxic Substances Control Act of 1976 (TSCA) Health data exists for < 10% of chemicals on the
market 62,000 ‘grandfathered’ in Potential for endocrine disruption is not
assessed
Cumulative exposures matter Risk assessment and safety standards
use a 1-chemical-at-a-time approach
Toxicity / vulnerable periods of development
Bioconcentration
Persistence
Persistent Bioaccumulative Toxicants (PBT’s)
MercuryPBDEsDioxins
PCBsPesticides
DDT Heptachlor Dieldrin Chlordane
Cumulative Exposures Add Up
~ 40% of US children may have OP pesticide levels greater than benchmarks for neurological impacts
Payne-Sturges D, Cohen J, Castorina R, et al. Evaluating cumulative organophosphorus pesticide body burden of children: a national case study. Environ Sci Technol. 2009 Oct 15;43(20):7924-30.
Carcinogenic Pesticide Use in California
CA Department of Pesticide Regulation Pesticide Use Reports, 2008. Mapped by CA Environmental Health Investigations Branch.
Pesticides and Cancer
Occupational exposure and cancer Organophosphate Pesticides – NHL, Leukemia Arsenical Pesticides – Lung, Skin cancer Triazine herbicides – Ovary
Epidemiologic studies associate pesticide exposure with cancer in children
Leukemia, neuroblastoma, Wilms' tumor, soft-tissue sarcoma, Ewing's sarcoma, non-Hodgkin's lymphoma, and cancers of the brain, colorectum, and testes
Non-Cancer Adverse Health Effects Prenatal Exposure to Organophosphate Pesticides
Decreased Bayley MDI and PDI scores at 36 months
(Rauh et al Pediatrics 2006)
Greater likelihood of behavioral issues on CBCL (Rauh et al Pediatrics 2006)
Abnormal primitive newborn reflexes (Brazelton NBAS) (Engel et al. Am J of Epid 2007)
Decreased birth weight and length (Whyatt et al. EHP 2004)
Smaller Head Circumference (Berkowitz et al. EHP 2004)
Decreased Bayley MDI at 24 mo. (Eskanazi et al, EHP 2007)
Effects of Preconception and Prenatal Exposure
Eskenazi B et al. Basic Clin. Pharmacol. Toxicol. 2008.
more…
OP Exposure in Children and ADHD
1139 children ages 8 – 15 (NHANES)Examined Urinary OP metabolites
Diagnosis of ADHD by DISC-IV or Med use
10-fold ↑ in urinary DMAP associated with an adjusted OR of 1.55 (1.14 – 2.10) for ADHD
Children with dimethyl thiophosphate > median had OR of 1.93 (1.23 - 3.02) for ADHD compared with children with ND levels
Bouchard et al. Pediatrics, 125(6), 2010
25
Agri-chemicals in surface water and birth defects in the United States
Winchester et al. Acta Paediatr. 2009 April; 98(4): 664–669
Effects of Adult Male Pesticide Exposure
Sterility Altered semen quality Prostate cancer
Women
Hauser R. Semin Reprod Med. 2006; Swan SH. Semin Reprod Med. 2006;Diamanti-Kandarakis E et al. Endo Rev 20099
Effects of Postnatal Female Pesticide Exposure
Men WomenMen Age at puberty and menarche
Menstrual and ovarian function
Fertility and fecundity
Menopause Breast cancer
Mendola P, Messer LC, Rappazzo K.. Fertil Steril. 2008;Diamanti-Kandarakis E et al. Endo Rev 2009
Farm Workers and Pesticides
↑ rates of many cancers & respiratory illness
Mills and Kwong 2001, Linaker and Smedley 2002, Zahm 1997
↑ rates of birth defects & childhood leukemia
Wigle et al. 2009, Van Maele-Fabry et al. 2010.
10,000–20,000 acute poisonings per year in the U.S.
EPA 1992, Blondell 1997, Calvert 2008
Magnitude of Exposure
Prenatal OP exposure in a farm worker cohort associated with lower mental development index scores at 24 months
Median Maternal Urinary MDA level 0.82 mcg/L
(Eskenazi at al EHP 2007)
Child exposure through conventional produce diet
Median Child Urinary MDA level 1.5 mcg/L
(Lu et al EFP 2006)
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A bit of apples and oranges?In the same ball park but different exposure
windows
Pesticide Exposure Reduction
OP residues dramatically reduced (malathion, chlorpyrifos)
� in elementary school children with organic diets substituted for conventional diets for 5 days in a longitudinal designLu et al, EHP 2006
Recombinant Bovine Growth Hormone (rBGH)
Used to increase milk production in dairy cows
↑ udder infections, necessitating the use of antibiotics
↑ levels of insulin-like growth factor (IGF-1) found in milk
Banned inCanada, Australia, New Zealand,
Japan, all 25 countries of the European Union
Arsenic Use in Poultry Production
Arsenic is fed to ~70% of US broilers Chicken meat can carry arsenic residues
Chicken waste contains ¾ of arsenic dose 90% applied to cropland as fertilizer Fed as a protein source to beef cattle
Water Contamination 13 million Americans drink water contaminated
with arsenic beyond the safety standard of 10 ppb
Never approved for use inall 25 countries of the European
Union
Health Concerns Related to Arsenic Exposure
Cancer (even at low levels of exposure)
Neural tube defects
Neurodevelopmental effects
Diabetes
Heart disease
The Antibiotic Resistance Crisis
Without effective action, treatments for
common infections “will become
increasingly limited and expensive – and,
in some cases, nonexistent.”
Source: www.cdc.gov/ drugresistance/actionplan/
Source: Union of Concerned Scientists, "Hoggin' It" 2001
United States Antibiotic Use
0
5
10
15
20
25
30 NonRxAnimal
RxAnimal
HumanRx
Other(soaps,pets)
Millions of pounds
~80% is nontherapeutic use in livestock production
Antibiotics widely used in livestock production:ErythromycinTetracyclineBacitracinPenicillinSulfathiazoleSulfamethazineTylosin (macrolide)Virginiamycin (streptogramin)Fluroquinolones (withdrawn in 2000)
Agricultural Use of Antibiotics
There is consensus among
independent experts that
antibiotic use in agriculture
contributes to resistant
bacteria affecting humans.
Banned in Denmark and restricted in the European Union
HUMANS(General Populace)
Routes of human exposure to resistant bacteria
Antibiotics
Via WORKERSHandling of Feed, Manure; transfer to family, community
Via FOODSlaughter, Handling, Consumption (undercooked meat, cross-contamination)
Via ENVIRONMENTContamination of ground & surface water, spray fields by resistant bacteria AND undigested antibiotics from manure
Bacteria
Animals
David Wallinga, Institute for Agriculture and Trade Policy
Food Borne Illness in the U.S.
>47.8 million cases annually ~128,000 require hospital
care
~ 3,000 deaths annually 1/3 are from tainted meat
Multiple routes of exposure
20% of supermarket samples in Washington D.C. were contaminated with salmonella
84% of these isolates were resistant to at least one antibiotic
“The Isolation of Antibiotic-Resistant Salmonella from Retail Ground Meats”
Volume 345:1147-1154 October 18, 2001
Bisphenol-A (BPA)
Widespread Human Exposure Over 90% of Americans have
residues in their urine (CDC) > 6 billions lbs produced / year
Health Concerns Endocrine disruption Neurodevelopmental impairment Developmental toxicity Cancers Cardiovascular disease &
diabetes Obesogen/Insulin Resistance
BPA and Phthalate Exposure: Findings from a Dietary Intervention
3 day “fresh foods” intervention
Urine levels of BPA and DEHP metabolites ↓ significantly
↓ of mean concentrations of BPA by 66% and DEHP by 53-56%
Rudel RA, et al. 2011. Environ Health Perspect. 119(7):914-920
Endocrine Disrupting Chemicals
Bisphenol A, PCBs, PBDEs, phthalates, organochlorine pesticides, atrazine
Chemical compounds with the capacity to interfere with development, behavior, fertility and maintenance of homeostasis
Health concerns include: reproductive problems, early puberty, brain and behavior problems, impaired immune functions, various cancers
Obesogens
Bisphenol A, phthalates, non-stick PFOAs,
and certain organophosphate pesticides Chemical compounds hypothesized
to disrupt normal development or homeostasis of metabolism of lipids, ultimately resulting in obesity
Interplay between genes and fetal and early postnatal exposures
National Academy of Sciences on Animal Data
Studies of comparison between developmental effects in
animals and humans find that “there is concordance of
developmental effects between animals and humans and that humans are as sensitive or
more sensitive than the most sensitive animal
species”.
A Precautionary Approach
An ounce of prevention is worth a pound of cure.
When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically.
-Wingspread Conference on the Precautionary Principle
HEALTH AND ENVIRONMENTAL COSTS
ARE NOT REFLECTED IN THE PRICE OF FOOD OR
ACCOUNTED FOR IN THE FOOD SYSTEM
Promoting health
Households
Institutions
Communities
Regionally
Nationally, Globally
David Wallinga, Institute for Agriculture and Trade Policy
Increase procurement of healthy food for healthy bodies, farms, communities and environment
Make food a part of the healing process
Lead by example and educate patients, visitors, and the community about healthy, sustainable food
Pool purchasing power to move the marketplace
Making change
In Hospitals
www.HealthyFoodinHealthcare.org
ProcurementCafeteria &Patient trays
Buying local, organic, fair trade, rBGH-free, antibiotic and hormone-free, grass-fed, cage-free
Reducing meat & sugar sweetened
beverages
↑ Contracting with local and regional
vendors, farmers, distributors and processors
On-site Farmers’ markets & hospital gardens Waste reduction - composting & reusable dishes
PolicyHealthy Food in Health Care Pledge Advocating for federal legislation, e.g. Preservation of Antibiotics for Medical Treatment Act
What Health Care Facilities Are Doing
4 Pilot Hospitals: Reduced meat by 28% in 12
months
Achieved $402,000 savings Used savings to purchase more
sustainably-produced meat
Saved the equivalent of over 1,000 tons/year reductions in greenhouse gas emissions
55
Making change
In Hospitals
Balanced Menus Challenge
Making change
In Communities
Farm to School Farmtoschool.org
Sustainable Table Sustainabletable.org
Community Food Security Coalition Foodsecurity.org
Making change
Nationally
Sign the Charter atwww.HealthyFoodAction.org
Facebook - A Citizen’s Guide to a Better Food System
Literature: Wallinga D. Contribution of Agricultural Policy to Childhood Obesity. Health Affairs. March 2010
Imhoff. Food Fight: The Citizen’s Guide to a Food and Farm Bill
Webinars: www.HealthyFoodAction.org
The Farm Bill
Making change
Nationally
Healthy Food ActionMaking Health the Future of Food and Farmingwww.healthyfoodaction.org Safer Chemicals, Healthy FamiliesReform Toxic Substances Control Act (TSCA) to keep toxins out of
foodwww.saferchemicals.org
Preservation of Antibiotics for Medical Treatment Act Sign the Health Care Without Harm Petition www.protectantibiotics.org
Principles of a Healthy, Sustainable Food System
Uniting health professions in a common visionhttp://www.planning.org/nationalcenters/health/food.htm
Food Matters Clinical Advisory TeamJudy Focareta, RNJoel Forman, MD
Sarah Janssen, MDPreston Maring, MDJoanne Perron, MD
Naomi Stotland, MDDavid Wallinga, MD
Food Matters is made possible with generous support from:
Rose Foundation Stonyfield Organics Profits for the Planet Program The Cedar
Tree FoundationThe Orchard Foundation W.K. Kellogg Foundation