Climate Report’s Dire Warnings: World Health Organization’s Dr. Maria Neira on Impact of Pollution and Climate Change on Health

Dr. Maria Neira

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Margaret Flin ter: Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter , a show where we speak to the top thought leaders
in health innovation, health policy, care delivery, and the great minds
who are shaping the health c are of the future. This week, Mark and
Margaret speak with Dr. Maria Ne i ra , Director of Pollution and Social
Determinants of Health at the World Health Organization . In light of
the recently released climate change report predicting a far more
rapid onset of harm from irreversible global warming , s he could speak
to how this affects health around the world . Pollution is now the
fourth le ading cause of death worldwide.

Lori Robertso n also checks in , the managing editor of FactCheck.org ,
looks at misstatement s spoken about health policy in the public
domain, separ ating the fake from the facts.

We end with a bright idea that's improving health and well - being in
everyday lives. If you have comments, please email us at
ch [email protected] or find us on Facebook , or Twitter , i T unes , or
wherever you listen to podcasts . You can also hear u s by asking Alexa
to play the program , Conversations on Health Care .

Now , stay tuned for our interview with Dr. Maria Neira on
Conversation s on Health Care .

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Mark Masselli: We're speaking today with Dr. Maria Neira , Director of the
Department of Public Health , Environmental and Social Determinants
of Health at the World Health Organization , which seeks to address
the root cause of envi ronmental and social threats to global public
health. Prior to that, Dr. Neira served as Vice Minister of Health and
President of the Spanish Food Safety Agency . She served as a Medical
Coordinator in Honduras and Salvador for Médecins Sans Frontières ,
Doc tors 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 University of Oviedo , Spain, and
her master ' s in public health at the Pi erre and Marie Curie University
in Paris . She received an international diploma in emergency
preparedness and crisis management from the University of Geneva .

Dr . Neira , welcome to Conversations on Health Care .

Dr. Maria Neira : Thank you very much.

Mark M asselli: The World Health Organization held a joint session with the United
Nations , addressing a report that's garnered quite a bit of attention

Dr. Maria Neira

recently . That report looked at global data around population health
and pollution, and concluded that polluti on kills more people around
the world in a given year than HIV / AIDS , malaria, and TB combined. I
wonder if you could just share with our listeners the scope of this
revelation and how pollution is specifically impacting population
health and mortality glob ally . What does the data show?

Dr. Maria Neira: The figure is dramatic. We have more than 12 .6 million deaths
occurring every year . Those deaths are caused by environmental risk
factors, whether it's air pollution , or unsafe water , or exposure t o
certain t ype of chemicals , like pesticides that are not authorized. This
is from a report that probably 10 years ago the situation was terrible
already. We did a new one , one year ago . Almost 25 % of all global
deaths , which are associated with these environmental p ollution ,
means risk factors coming from our daily environment and risk factors
that could be easily removed, which is the message I 'll like to give .

Margaret Flinter: Dr. Neira, all of us who work in the service of advancing the health of
people and popul ations are often struck by just the challenge and
weight of social determinants of health, whether it's poor air , or
water , or food quality, lack of access to decent housing . Really , there's
a unifying factor that comes into play whenever we look at popula tion
health issues . That's poverty, right? Poverty is such a common thread .
We'd like to ask you to talk about the connection between poverty,
exposure to environmental pollution , and a higher risk for 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 pollution.

Dr. Maria Neira: There is not a surprise to any of us that if you are vulnerable, if you
are poor, if you are living in a poor country, you wil l be more exposed
to issues like industrial pollution or the fact that you are missing lack
of safe 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 , in order to have the economic development that you need to
take these people out of poverty, you need to do it i n a way that you
will not destroy the environment where you are living on . 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
affecting the lungs of the ir citizens. Now they realize that you can go
for a good and rapid economic development without destroying and
polluting the water you drink or the air you breathe.

I think this is the key message. You can do it in a sustainable way . That
will be even quicker i n the way that you take people out of poverty.
They will not be exposed to those incredible risks coming from
pollution. We saw children now or in ma ny countries in Africa

Dr. Maria Neira

recycling lead from car batteries . That's really bad development. This
is really polluting the next generation . I think understanding the role
that th e socioeconomic and environmental determinants of our work
health plays is a critic al one for governments, for citizens , and of
course for people working on global health and global health care .

Mark Masselli: Dr. Neira, climate change is also exacting a toll on human health . This
year we've seen widespread devastation here in North Amer ica from
back to back hurricanes. We've seen deadly wildfires as well. 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 order [inaudible 00:06:2 6]
organizations, we have plenty of evidence demonstrating that the
global warming, I mean the climate change , is really devastating
human health as well . N ot only because of heat waves and the floods ,
and droughts will have a very direct contribution to d eath, but as well
the climatic effects on agriculture, for instance, the [inaudible
00:06:54] responsible for changing the patterns of rainfall . Therefore ,
we are expecting decreases on crops yields in many developing
countries.

We are already seeing prob lems of malnutrition because of lack of
agricultural production caused by these direct or indirect effect s of
climate change and global warming. Of course, if you have a flood,
you will destroy life , but you will destroy shelter. You will force people
to g o on migration and displacement . We see as well that many of the
diseases that have been representing until now for us, a major
challenge like malaria or dengue , all of those diseases are transmitted
by bacter , by mosquitoes. They are finding our perfect c onditions to
spread because we can see even malaria in places in Nairobi where
we didn't see it before because it was mountain . The mosquitoes will
not have the conditions to grow and to transmit . Now they are finding
perfect condition for that.

There are many ways in which our health will be affected by climate
change and is already occurring . It's not just a question of developing
countries . I think we are all witness now of what major heat waves or
extreme weather events can bring to our health, the des truction of
the basis of our life like access to food, water, shelter . If those are
destroyed, obviously our health will be very much affected and is
already at risk .

Margaret Flinter: Well , Dr. Neira, while climate change poses a huge risk to global
healt h , you've also written about climate change as an opportunit y for
public health. Back in 20 14 , you outlined a number of ways in which
you could make the case that climate change is serving as a catalyst
for badly needed collaboration among most countries i n the world.
Can you talk about your recommendations for battling climate change

Dr. Maria Neira

and where you see the seam of opportunity?

Dr. Maria Neira: Yeah. In fact, when I attended all of those big meetings, the summits
on climate change , you see that the countries are negotiating and
putting together this Paris Treaty on climate change. When you look
at the recommendations to tackle the causes of climate change to
m iti gate climate change , there are all basic public health common
sense recommendations , means ensurin g that the way we commute
every day, I mean the way we use our transport , and the fuels we are
using that shouldn't be polluting our environment . All of that will land
in our lands . That pollution is really having a terrible impact on our
health.

Who will disagree with the fact that we need to create cities where
the air is not so polluted, where traffic and transit will be costing less
injuries and promoting a little bit more active life style instead of just
the sedentary lifestyle that is responsible for non - communicable
diseases ? Who will disagree on the need to have acc ess to clean
water and protect our resources on water management ? Who will
disagree with the need to have a better management of our wast e,
incredible amount of waste , that we all produce every day ? Who will
disagree with the need of non - contaminate our rivers and the land
where we produce agriculture ?

All of that is really basic public health and is basic common sense
recommendations for protecting our environment, but more
importantly f or protecting our health. That's why we said that this is a
public health opportunity. If the Paris Treaty 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 fantastic . This is something that we were not
saying clearly enough to our citizens. They thought that the climate
change was more a question of polar bears and glaciers melting. No .
This is a question of our lungs , the thought that our grandchild will
have asthma , the thought that we cannot drink water that is not
responsible for diarrheal diseases and other infections.

If we start to use the health argument, I think we can achieve much
more by telling people of the importance of protecting and reducing
environment al risk in order to protect our health .

Mark Masselli: We're speaking today with Dr. Maria Neira , Director of the
Department of Public Health, Environmental and Social Determinants
of Health at the World Health Organiz ation , which seeks to address
the root cause of environmental and social t hreats to global public
health. Dr. Neira , you've been connecting the dots on pollution and
non - communicable diseases caused by environmental factors, but we
still face a huge health burden of disease with illnesses , such as
HIV / AIDS , malaria , and emerging pandemics like Ebola and Zika . Many

Dr. Maria Neira

global health entities , including the World Health Organization , were
caught by surprise during the terrible Ebola epidemic , which led to
thousan ds of deaths .

Share with us lessons learned from the Ebola and Zika crisis , and the
new emergency risk communication guidelines developed by the
World Health Organization . Is the global health community better
prepared for the next pandemic?

Dr. Maria Nei ra: I want to think that yes, we are better prepared , t he government after
the Ebola o utbreak , which was so terrifying for all of us and probably
as well as kind of shaking us , demonstrating that we are not alone.
We are all in the same boat [inaudible 00: 13:00] .

WHO has now a very strong and separate health emergency program
to coordinate international health response to affected people. For
instance, this year , we receive d an incredible amount of, for
investigation , what are the disease alert . WHO has al ready received
36,000 disease alerts . Regarding communication , I think it's extremely
important for the people , they need to know what health risks they'll
face . Not only that . I think we can not paralyze our audience just by
telling them what are the risk s they face. They need to know what
actions they can take to protect their lives , their families, their
communit ies .

That's why a very accurate information needs to be provided and in a
way that will enable people to make their own choices and to protect
themselves. We work with partners to support that training . We will
be launch ing this first ever e vidence - based guidance on emergency
risk communication.

Margaret Flinter: Dr. Neira, I'd like to talk a little bit about HIV/AIDS, a disease that still
has no vaccine and no cure. Millions have died. 37 million people are
living with HIV/ AIDS around the world and still so many unaware that
they are affected. It's been wonderful to witness the tremendous
progress in treating HIV , particularly early on with retro viral drugs ,
and obviously we've made enor mous strides in reducing mother - to -
child transmission. What is hopeful on the horizon?

Dr. Maria Neira: The good thing is that, and believe me, this is something that we will
never dream about many years ago when w e started we found the
retroviral treatment. Today , we have 21 million people with HIV with
access to HIV treatment. That's really amazing compared with the
thought that when we started and we wanted to reach 3 million,
everybody w as 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 . Since 2000 , I think HIV - related deaths have went down by

Dr. Maria Neira

one - third and new infections has reduced by 40 % . Is more progress
needed , and once again related to poverty, Africa is still by far the
region with the highest number of people living with HIV worldwide,
which is unacceptable because we know that there are an estimated
7% of people which are living with HIV , a nd they don't know their
status , means more transmissions.

We need to improve access to testing services, increase education ,
and clearly still promote on education. The big worry here is about
drug resistance that will undermine the fantastic progress 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 , Americares , and Save the Children , all addressing everything
from war zones to refugee crisis to the loss of childhood for millions
of children . As you look to the future and the ongoing collaboration
with United Nations , what do you see as the best pathways to
overcome many of these global health challenges?

Dr. Maria Neira: We h ave so many global health challenges . Definitely , apart from 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 health at risk. The cities are the pla ces where now in 20
years, 70 % of the population will be living in urban areas. We need to
make sure that those urban areas 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 environm ent .

Therefore , we need to look at the sustainable transport system , we
need to look at a better way of handling and managing our waste
production , better energy for the building s , energy efficient ,
nonpolluting fuels, industrial production that will not affect the
pollution in the places where we live. That is a big challenge , together
with non - communicable diseases. I think environmental health and
non - communicable diseases are the big challenges we're facing . We
need to connect all of those agendas, sus tainable development ,
environment , climate change , and health.

Margaret Flinter: We've been speaking today with Dr. Maria Neira, Director of the
Department of Public Health, Environmental and Social Determinants
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 Hea lth Care today.

Dr. Maria Neira: Thank you very much .

Dr. Maria Neira

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Mark Masselli : At Conversations on Health Care, we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy. Lori Robertson is an award - winning jo urnalist and managing
editor of FactCheck.org, a nonpartisan, 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 week?

Lori Robertson: The midterm elections are less than a month a way and we are seeing
ads on health care in several races. For instance, in the Tennessee
Senate r ace , a democratic ad from the group , Majority Forward , spins
the facts in claiming that Representative Marsha Blackburn voted " to
give members of Con gress health care for life " . In fact, lawmakers
already had received a health insurance retirement benefit before the
2012 vote in question. There was a possibility at the time that
lawmakers could have lost the benefit, but that never happened. The
vote w as actually to repeal the Affordable Care Act.

When the health care legislation was being debated , an amendment
by Republican Senator Chuck Grassley was added to require that
members of Congress and their staff get insurance coverage through
the ACA 's exc hanges as opposed to lawmakers continuing to get
insurance through the Federal Employees Health Benefit s Program .

The idea behind Grassley's amendment was that if the exchanges
were good enough for other Americans , they should be good enough
for Congress . Federal employees can keep their health care coverage
once they retire , provided they are eligible to retire and had at least
five years of FEHB coverage immediately before retirement or
coverage for the entire period of their service.

Once the ACA was e nacted in 2010, it required members of Congress
to eventually move to the ACA exchanges , which held the first open
enrollment period i n late 2013 . It looked like lawmakers would lose
their health insurance retirement benefit .

When House Republicans voted to repeal the law in 2012, Democrats
made the argument that the vote would rei nstate the benefit for
Congress . A few months before the ACA exchange coverage would
take effect , the Office of Personnel Management issued a final rule ,
saying that lawmakers an d their staff would still be eligible to join the
Federal Health Benefits Program and retirement , provided they had
five years of continuous coverage through either the FEHB or the ACA
exchanges. The ad doesn't mention that eligible lawmakers had this
so c alled health care for life benefits before the ACA and they still
have it today .

That's my fact check for this week. I'm Lori Robertson, managing

Dr. Maria Neira

editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you'd
like checked, email us at chcradio.com . We'll have FactCheck.org's
Lori Robertson check it out for you here on Conversations on Health
Care.

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Margaret Flinter: Each week , Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Of the roughly
4 million women who gi ve birth annually in the United States, a
quarter of them retain at least 10 pounds gained during their
pregnancy. Those numbers go up significantly for African - American ,
Hispanic , and low income women.

Dr. Suzanne Phelan: Something about weight retention during this period, after having a
baby , that increases lifetime risk of health problems, cardiovascular
disease. I was interested in finding a way to help women during this
time because weight gain during this period is kind of independent
risk factor we call it.

Margaret Flinter: California Polytechnic Institute researcher , Dr. Suzanne Phelan ,
wondered if a customized intervention designed around the
supplemental nutrition program for women might help such women
shed postpartum weight.

Dr. Suzanne Phelan: Women during the postpartum period, they're busy with their baby,
they've got this erratic, unpredictable schedule. Our team got
together and we thought, well, let's try something online.

Margaret Flinter: Her team designed a website with features such as weekly lessons, a
web diary, instructional videos, computerized feedback, text
messages , and monthly face - to - face groups at the WIC c linic s .

Dr. Suzanne Phelan: The intervention targeted healthy eating and physical activity , and
then behavioral strategies . We provided some menu plans online that
women could access and use . We gave them calorie goals dependent
on if they were breastfeeding or not . We also gave them physical
activity goals . We gave behavioral tools to o, including self - monitoring .

Margaret Fl inter: The results were significant . More women with the Internet
intervention , 57% los t weight than the WIC participants alone , 36% .

Dr. Suzanne Phelan: We got a greater proportion of women who lost the 5% and 10% of
their body weight, which we k now are c linically significant . Then t hey
reduced their waist circumference. It was exciting that we prevented
that and even reduced waist circumference in this intervention .

Dr. Maria Neira

Margaret Flinter: Dr. Phelan says that even though the weight loss amount seems
relatively small, the lost translates into a statistically lower risk of later
weight gain.

Dr. Suzanne Phelan: The other key finding is we've got a greater percentage of women
return to their pre - pregnancy weight and the fact that we got them
back to their prepregn ancy weight is really exciting because that does
appear to be where the risk is . If you retain weight above pre -
pregnancy, that 's the risk factor for long - term health problem s .

Margaret Flinter: A low - cost guided online nutrition and weight loss support pr ogram ,
designed for women receiving SNAP and WIC benefits for postpartum
nutrition, yielding a greater weight loss success , and healthier
outcomes , n ow that's a bright idea .

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Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.

Margaret Flinter: I'm Margaret Flinter.

Mark Masselli: Peace and health.

Margaret Flinter: Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at chcradio.com , iTun es, or wherever you
listen to podcasts. If you have comments, please email us at
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