Pollution Now a Leading Cause of Death Globally: WHO’s Dr. Maria Neira Discusses the Toll of Pollution on Human Health

Maria Neira

[Music]

Mark Masselli: This is Conversation s on Healthcare, I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well, Margaret, as expected the senators for Medicare and
Medicaid services has changed the rules regarding th ose who receive healthcare
through Medicaid . CMS administrator, CIMA Pharma announced last week that
states can now issue a work requirement for those receiving Medicaid coverage
as long as they are so called able body percipients.

Margaret Flinter: Ken tucky, now the first state to issue a work for Medicaid
requirement under the new CMS rules.

Mark Masselli: Some 74 million Americans are covered by Medicaid in this
country, Margaret, this ruling doesn’t a ffect children who make up more than 50%
of all Medicaid recipients but those who are deemed able bodied will be required
to work up to 20 hours a week for Medicaid coverage.

Margaret Flinter: You know Mark, the current data would suggest that four in ten
Medicaid recipients in fact are already workin g but they are likely to be in lower
wage jobs and work for companies that do not provide health insurance and
many low wage earners on Medicaid are also grappling with the other social
determinants of health that can lead to poor outcomes and that is some thing our
guest today is a global expert on.

Mark Masselli: Dr. Maria Neira is the D irector of the D epartment of Public Health
Environmental and Social Determinants of Health for the World Health
Organization . She is joining us today to discuss a recent report that points to
pollution as a leading cause of death around the globe.

Margaret Flinter: Really looking forward to that conversation Mark, and Lori
Robertson will check in with us , she is the Managing Editor of FactCheck.org.
N o matter what the topic though , you can hear all of our shows by going to
www.chcradio.com .

Mark Masselli: And as always if you have comments, please e - mail us at
[email protected] or find us on Facebook or Twitter, we would love to hear from
you.

Margaret Flinter: And w e’ll get to our interview with Dr. Maria Neira in just a
moment.

Mark Masselli: But first, here is our producer Marianne O’Hare with this week’s
Headline News.

Maria Neira

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Ma rianne O’Hare: I am Marianne O’Hare with these Healthcare Headlines. Flu
continues to spread at a rapid pace across the country taxing hospital emergency
rooms to capacity in a number of communities. The Centers for Disease Control
and Prevention saying that this year ’ s flu season could be described i s on the
severe side while this year ’ s flu vaccine is believed to be about 30% effective
against flu, officials say it ’s not too late to get the vaccine which can greatly
diminish the severity of a case if y ou do come down with flu and also health
prevented from spreading to others .

S peaking of the CDC they are reporting public health plans in place in the event
of a nuclear detonation here, CDC assembling numerous experts on radiation
exposure this week t o address ways that can mitigate the effects of exposure to
a nuclear blast and the ensuing radiation fallout. The FDA has approved a
cancer drug targeted to women with an inherited gene mutation that leads to
higher inciden ts of breast or ovarian cancer. AstraZeneca ’s drug Lynparza
targets the so called BRCA gene and has been approved for women who have
undergone chemotherapy already for metastatic breast cancer. The women in
the study saw a beneficial effect for months longer than others not being give n
the drug. There is still no breast cancer cure , but they see this as a potential
treatment to delay onset or advancing of the disease .

Kids and screen time, the [Inaudible 00:03:34 ] meet but at what cost, for some
time though the National Academy of Pediatrics has cautioned against any
screen time for kids younger than 2 but there is still not enough evidence to show
what happens to children’s brains and general health from exposure to screen
time at such an early age. Researche r s have long known the re is a link between
length of screen time especially in the evenings and a negative impact on sleep
quality for teens and adults. Now a study in Germany has looked at the impact of
screen time on 3 and 4 year old ’ s. They compared their average exposure to
screen time and found a direct correlation between poor sleep patterns and
higher exposure to electronic media, phones, tablets, TVs, even games. The
study found the kids exposed to more screen time are more likely to resist
bedtime, wake frequently an d show more fatigue during the following day.

I am Marianne O’Hare with these Healthcare Headlines.

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Mark Masselli: We are speaking today with Dr. Maria Neira , D irector of the
Department of Public Health Environmental and Social Determinants o f Health at
the World Health Organization which seeks to address the root cause of
environmental and social threats to global public health, prior to that Dr. Neira
served as the Vice Minister of Health and President of the Spanish Food Safety

Maria Neira

Agency , she served as a Medical Coordinator in Honduras in Salvador for
Doctors Without Borders . Dr. Neira was awarded the medal of National Order of
Merit from the French government for her work in global public health. She
earned her medical degree at the Universi ty of Vigo Spain and her master’s in
public health at the P ierre and Marie Curie University in Paris. Dr. Neira
welcome to Conversations on Healthcare .

Dr. Maria Neira: Thank you very much .

Mark Masselli: You know the World Health Organization just he ld a joint session
with the United Nations addressing a report , and that report looked at global data
around population health and pollution and concluded that pollution kills more
people around the world in a given year than HIV, AIDS, malaria and TB
comb ined . A nd I am wondering if you could just share with our listeners the
scope of this revelation and how pollution is specifically impacting population
health and mortality globally.

Dr. Maria Neira: We have more than 12.6 million deaths occurring every year
and those deaths are caused by environmental reflects whether it is air pollution
or unsafe water or exposure to certain type of chemicals like pesticides that are
not authorized. This is from a report that WHO did ten years ago the situation
was te rrible already, we did a new one, one year ago almost 25% of all global
deaths which are associated with this environmental pollution means risk factors
coming from our daily environment and the risk factors that could be easily
removed.

Margaret Flinter: Yeah , I would note Dr. Neira, that all of us who work in the
service of advancing the health of people and populations are often struck by just
the challenge and the way of the social determinants of health, whether it is poor
air or water or food qualit y, lack of access to decent housing but really there is a
unifying factor that comes into play whenever we look at population health issues
and that ’ s poverty right . A nd we’d like to ask you to talk about the connection
between poverty and a higher risk f or poor health outcomes and how we can
balance the need to promote economic growth while at the same time protecting
human health from the harmful effects of population.

Dr. Maria Neira: There is not a sort of price to any of us that if you are
vulnerabl e, if you are poor, if you are living on a poor country, you will be more
exposed to issues like industrial pollution or the fact that you are missing lack of
say water and sanitation and you will be more exposed to questions related to
climate change and global warming and the basics for your health. Now it ’ s clear
as well that in order to have the economic development that you need to take
these people out of poverty, you need to do it in a way that you will not destroy
the environment where you are livi ng on . A nd we see that now for instance in
China which was one of the countries that were polluting the most and
responsible for massive air pollution that was effecting the lungs of their citizens,

Maria Neira

now they have realized that you can go for a good and ra pid economic
development without destroying and polluting the water you drink or the air you
breathe . S o I think this is the key message , get people out of poverty, you can
do it i n a sustainable way, that will be even quicker on the way that you take
peo ple out of poverty, I think understanding the role that the socioeconomic and
environmental determinants of how our health plays is a critical one for
governments, for citizens and of course for people working in global health and
global healthcare.

Mark Masselli: Dr. Neira climate change is also exacting a toll on human health
and as you assess climate change around the world, how do you view the
growing threat to human health ?

Dr. Maria Neira: For us at the World Health Organization in other scientifi c
organization s , we have plenty of evidence demonstrating the global warming, I
mean , the climate change is really devastating human health as well, not only
because of heatwaves and floods and droughts will have a very direct
contribution to deaths becaus e they take human lives but that ’ s well because of
the situation that they will create, the climatic effect on agriculture for instance,
raise in temperature you see is responsible for changing the patterns of rainfall
and therefore we are expecting decrea se s in crops yields in many developing
countries . W e are already seeing problems of malnutrition because of lack of
agricultural production caused by this direct or in direct effect of climate change
and global warming .

Of course if you have a flood, yo u will force people to go on migration I mean
displacement and we see as well that many of the diseases that have been
representing until now for us are major challenge like malaria or dengue I mean
all of those disease s transmitted by bacteria by mosquito es, they are handling
now perfect conditions to spread because we can see even malaria in places in
Nairobi where we didn’t see it before , but now they are finding perfect conditions
for that. So there are many ways in which our health will be effected by climate
change and it is already occurring. It is not just a question of developing
countries, I think we are all witness now of what major heatwaves or extreme
weather events can bring to our health , the destruction of the basis of our lives
like access to food, water, shelter and if those are destroyed obviously our health
will be very much effected and is already at risk.

Margaret Flinter: Well Dr. Neira, while climate change poses as you have just
laid out in very clear detail a huge risk to global health, you have also written
about climate change as an opportunity for public health . Back in 2014, you
outlined a number of ways in which climate change is serving as a catalyst for
collaboration among most countries in the world, can you talk about yo ur
recommendations for bettering [PH] climate change as all th e s e global entities
come together?

Maria Neira

Dr. Maria Neira: Yeah , in fact , when you look at the recommendations to tackle
the causes of climate change to mitigate climate change that are all basic pub lic
health common sense recommendations, means ensuring that the way we
commute with every day, I mean the way we use our transport and the fuels we
are using that shouldn’t be polluting our environment and that pollution is really
having a terrible impact on our health . S o who we disagree with the fact that we
need to create cities where the air is not so polluted, where traffic and transit will
be causing less injuries and promoting a little bit more active lifestyle instead of
just a sedentary lifestyle that is responsible for non - communicable diseases who
will disagree on the need to have access to clea n water and protect our
resources on water management , who will disagree with the need to have a
better management of our waste that we all produce every day.

So all of that is really basic public health and is basic common sense
recommendations for protecting our environment but more importantly for
protecting our health . That’ s why we said that this is a public health opportunity i f
the Paris Treaty Agreement is implemented, this is a fantastic public health
opportunity because all of those recommendations will be protecting the health of
our citizens of our population and this is something that we were not saying
clearly enough to our citizens , they saw that the climate change was more a
question of polar bears and glaciers melting, no , this is a question of our land, the
fact that our grandchild will have asthma . S o if we start to use the health
agreement I think we can achieve much more by telling people of the importance
of protecting and reducing environmental risk in order to protect our heath.

Mark Masselli: We are speaking today with Dr. Maria Neira , D irector of the
D epartment of Public Health Environmental and Social Determinants of Health a t
the World Health Organization which seeks to address the root cause of
environmental and social threats to global public health. You know Dr. Neira we
still face a huge health burden of disease with illnesses such as HIV AIDS,
malaria, in emerging pande mics like a Ebola and Zika and many global health
entities including the World Health Organization were caught by surprise during
the terrible Ebola epidemic which led to thousands of death and I am wondering
if you could share with us lessons learned from the Ebola and Zika crisis and the
new emergency risk communication guidelines, is the global health community
better prepared for the next pandemic?

Dr. Maria Neira: Yes, yes, we are better prepared, the governments after the
Ebola outbreak which was so terrifying for all of us in demonstrating that we are
not alone there are not borders we are all in the same boat and it is extremely
important . So WHO has now a very strong and separate health emergency
program to lead and coordinate in conventional hea lth response to effect the
people. This year we received an incredible amount for investigation on what are
the disease alert, every month , this month WHO has already received 36,000
disease alert s of which only 360 deserve d an investigation but regarding
communication, I think it ’ s extremely important for the people, they need to know

Maria Neira

what health risk s they will face and I think we cannot paralyze our audience just
by telling them what are the risks they face, they need to know what actions they
can take to protect their lives, their health, their community , so that ’ s why they
are accurate in very accurate information needs to be provided and we work with
partners to support that training and this month we will be launching this first ever
evidence based g uidance in emergency risk communication.

Margaret Flinter: And Dr. Neira I would like to talk a little bit about HIV AIDS,
millions have died, 37 million people are living with HIV AIDS around the world
and still so many unaware that they are affected, i t ’ s been wonderful to witness
the tremendous progress in treating HIV particularly earl y on with retroviral drugs
and obviously we made enormous strides in reducing mother to child
transmission, but I would like to ask you what is hopeful on the horizon?

Dr. Maria Neira: The good thing is that today we have 21 million people with HIV
with access to HIV treatment, that ’ s really amazing compared with the fact that
when we started, and we wanted to reach 3 million, everybody was saying this is
totally crazy . Today 7 out of 10 pregnant women are living with HIV , but they
receive antiretroviral treatment to prevent transmission to their babies . A nd since
2000, I think HIV related deaths have went down by one third and new infections
have reduced by 40%, even more progress needed definitely and once again
related to poverty Africa is still by far they are reaching with the highest number
of people living with HIV worldwide. We know that the re are an estimate d of 7%
of people which are living with HIV and they don’t know their status , so means
more transmissions . S o we need to improve access to testing services
increased education and clearly still promote a lot on education . A nd the big
worry here is about drug resistant, that could undermine the fantastic pr ogress
that has been done.

Mark Masselli: Dr. Neira , we ’ ve had the opportunity to interview a number of
leaders of organizations doing great work like yourself Doctors Without Borders
America and S ave the Children all addressing everything from warzones to
refugee crisis to the loss of childhood for millions of children . A nd as you look to
the future, your work outside of WHO and the ongoing collaboration with the
United Nations, what do you see is the best pathways to overcome many of
these global healt h challenges?

Dr. Maria Neira: We have so many global health challenges , but definitely apart
of the infectious diseases that we have been talking on HIV, malaria, and TB;
making sure that our cities , our urban development is such that will not put our
h ealth at risk . T he cities are the places where now in 20 years 70% of the
population will be leaving in urban areas, so we need to make sure that those
urban areas that are not places where people will have the best conditions to die
or to be sick but on the contrary it has to be a healthy environment and therefore
we need to look at the sustainable transport system, we need to look at the better
way of handling and managing our waste production, better energy for the

Maria Neira

buildings, energy efficient, non - pollu ting fuels, industrial production that will not
a ffect the pollution in the places where we live, that is a big challenge together
with a non - communicable diseases . I think environmental health and non -
communicable diseases are the big challenges we are f acing , and we need to
connect all of those agendas sustainable development , environment climate
change and health.

Margaret Flinter: We have been speaking today with Dr. Marie Neira Director of
the D epartment of Public Health , E nvironmental and Social De terminants of
Health at the World Health Organization, you can learn more about their work by
going to who.org or follow them on Twitter @ who or @ Dr. Maria Neira and that ’ s
N - E - I - R - A. Dr. Neira, we thank you for the work that you do and for joining us on
Conversations on Healthcare today.

Dr. Maria Neira: I t hank you very much and all the best to all of you.

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Mark Masselli: At Conversations on Healthcare, we want our audience to be
truly in the know when it comes to the facts about healthcare r eform and policy,
Lori Robertson is an award - winning journalist and Managing Editor of
FactCheck.org, a non - partisan, nonprofit consumer advocate for voters that aim
to reduce the level of deception in U.S. politics. Lori, what have you got for us
this we ek?

Lori Robertson: Several readers have asked us about a rumor that under the
republican tax legislation, Medicare will stop covering cancer treatment, that ’ s not
true, increased deficits could have led to Medicare spending cuts however, that ’ s
where th is rumor got started . Under congressional rules a tax cut that isn’t paid
for would trigger offsetting spending cuts under PAYGO or Pay As You Go rules.
If legislation increases the deficit, the White House’s Office of Management and
Budget would have to order spending reduction, that ’s unless other legislation is
enacted to offset the deficit increase or there is a wa i ver of these PAYGO rules.
Senate majority leader Mitch McConnell and house speaker Paul Ryan said that
Congress would waive the PAYGO req uirement so that the across the board cuts
to some mandatory spending programs including Medicare wouldn’t happen,
even if Medicare did face looming spending cuts, what does that have to do with
cancer treatment, well when Medicare faced an automatic 2% cu t under the
sequestering 2013, some cancer clinics told the Washington post that they
couldn’t afford to continue administering pricy chemotherapy drugs and stay in
business. The post wrote that cancer patients may seek care at hospital if they
are turned away from oncology clinics . A n advocacy group for these practices
said that a further cut “ will reduce access and increase cost for patients ” of
course that is not the same as Medicare no longer covering cancer treatments,
the rumor our readers asked us about . A nd that ’ s my FactCheck for this week. I
am Lori Robertson , Managing Editor of FactCheck.org.

Maria Neira

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country’s major political players and is a project of the Annenberg Public Po licy
Center at the University of Pennsylvania. If you have a fact that you would like
checked, email us at www.chcradio.com , we will have FactCheck.org’s, Lori
Robertson, check it out for you, here on Conversations on Healthcare.

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Mark Masselli : Each week Conversations highlights a bright idea about how to
make wellness a part of our communities into everyday lives. Fitness trackers
have become all the rage especially among upwardly mobile fitness consciou s
people seeking to monitor their own health , but another trend has emerged in the
age of wearable devices. After a few months about a third of users simply stop
using them, the reality captured the imagination of Tufts University School of
medicine, Prof essor Dr. Lisa Gualtieri.

Dr. Lisa Gualtieri : And I thought what if you could take all of these abandoned
trackers and give them to the people who could benefit most from them.

Mark Masselli : She thought what if we could get disinterested owners to don ate
their used fitness trackers to be repurposed and donated to underserve
populations.

Dr. Lisa Gualtieri : A lot of the work that we have been doing has been with older
adults, racial and ethnic minorities and for a lot of people the cost of [inaudible
00:23:47 ] so I think that that ’ s a barrier.

Mark Masselli : So , in 2015, she launched recycle health and online social media
campaign to raise awareness for her program which seeks to donated wearable
devices to provide these expensive devices for free to those in need. She
partnered with organization s working with low income adults, seniors in f a ll
prevention programs and veterans as well.

Dr. Lisa Gualtieri: What we need to do is talk to people about how access how
sedentary they are and coming up wit h a reasonable goal, they might start off
with 3 , 000 steps as their goal , but they know how to make that higher when they
are ready to.

Mark Masselli: Recycle Health , a simple repurposing of personalized wearables ,
providing these tools for free to vulne rable populations empowering them to
improve their own health, now that’s a bright idea.

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Margaret Flinter: This is Conversations on Healthcare, I am Margaret Flinter.

Maria Neira

Mark Masselli: And I am Mark Masselli, peace and health.
Conversations on H ealthcare broadcast from WESU at Wesleyan University,
streaming live at www.wesufm.org and brought to you by the Community Health
Center.