Are We Healthy If Our Environment Isn’t?

It’s no surprise: the health of people and populations is closely related to what’s in their environment. Pollution in the air, contaminants in water, chemicals in food and products—all of these interact to influence health in complex and significant ways, with climate change growing in influence over environmental health. At the University at Buffalo, ongoing, interdisciplinary research is addressing varied aspects of environmental health and is a growing area of expertise. With support for SPHHP researchers’ work and their integral role in the reinvigorated UB RENEW Institute, now is a critical point for the school’s work in the field. Health Impact’s editor, Grace Lazzara, spoke recently with four UB experts about environmental health, its importance and the work they’re doing to, ultimately, improve health outcomes.

Diana Aga, PhD
Henry M. Woodburn Professor, Department of Chemistry; director, UB RENEW Institute

Expertise: chemicals of emerging concern; industrial pollution; wastewater treatment; environmental impact of PFAS (“forever chemicals”), PCBs, PBDEs (flame retardants), pesticides, nanomaterials, antimicrobials, pharmaceuticals and personal care products; antibiotic resistance in the environment; target and non-target analysis; Great Lakes pollution

Pauline Mendola, PhD
Professor and chair, Department of Epidemiology and Environmental Health

Expertise: environmental factors impacting reproductive and pediatric health; health effects of air pollution and extreme temperatures; chronic diseases in pregnancy

Riana Pryor, PhD, ATC
Assistant professor, Department of Exercise and Nutrition Sciences

Expertise: heat and exercise; heat illness, including heat stroke; hydration; high school sports and athlete safety; occupational safety; exercise physiology

Meng Wang
Assistant professor, Department of Epidemiology and Environmental Health; director, MPH Concentration in Environmental Health

Expertise: Environmental exposure monitoring, air pollution modeling, health impacts of environmental exposures

Riana Pryor: I’ve always liked the idea of helping the people who help you. I started off researching ways to improve the health and safety of firefighters, EMS and law enforcement officers. For example, firefighters run into a burning building, into a fire up to 1000 degrees, wearing fully encapsulating clothing that doesn’t allow them to thermoregulate well and carrying 50 or 60 pounds of equipment. They have lots of heat illnesses on the job, but there’s very little research out there specifically on them. I wanted to study the demand they’re going through, and then find interventions to help them in extreme heat, which we know is only going to get worse with climate change.

Diana Aga: When I moved here to UB, so many people were doing really interesting work looking at pollutants in all kinds of matrices. I get ideas from other people’s needs for analytical chemistry. For instance, at conferences people discuss environmental problems and say, “I wish I could analyze mineral samples for residues of antimicrobials.” I start thinking, “We can do that.”

Meng Wang: I’m involved in this field because I have a lot of traction in it and can really hope to improve it, especially with air pollution. People think about the level of air pollution, whether the air is safe or not, about the source of air pollution, and whether it can really affect human health. Then we think about whether other factors could have a co-effect. We have studied air pollution for a long time, but the questions go on and on, and it’s exciting.

Pauline Mendola: We often think about risk factors for health and communicate those to people, but people often can’t do a lot about them. If we can make changes on an environmental level, particularly a regulatory environment, or if we can minimize exposures that can be generally promoting positive health in the population, that’s a good place to target efforts that could have a significant effect.

PM: There’s always some tension when we think about environmental factors that influence health. Most of the time, what people might consider strong science on environmental factors are rodent studies, or they use other animal models or even in silico models. In fact, humans are exposed to complex environments, and not just chemicals, but also social factors or stressors. So, the idea of looking at mixtures in real-world exposures and populations has become more important, as has what we study in free-living populations.

DA: Exactly. For example, we’re very interested in neurotoxins’ effect on mental development, seeing a lot of increase in ADHD or things that are not easily measured, like behavioral effects. We’re looking at that, but our model is so simple. Right now, we’re using zebrafish, but how can we translate it to humans? We have a long way to go.

RP: In my field, heat physiology, participants in nearly every study are college-age men because they’re available. I’m happy to say in recent years, there has been a lot more focus on a greater age range, on children and older adults. For instance, many kids are going back to school in a hot classroom, but can they learn when they’re in a stressful physical environment? So, there’s more research in those sorts of areas. We’re also seeing a greater focus on females. Originally, all the U.S. Army models for predicting how well somebody will do in an extreme environment were based on data from men. They’re finally starting to study females. I have two studies focusing on female warfighters, and, unsurprisingly, we’re seeing differences.

MW: I agree with Pauline and Diana. People are thinking more about total exposure, trying to identify as many exposure factors as possible. I also observe in air pollution studies that the technology has been improving quite rapidly. Ten years ago, when I started to do exposure assessments, we would rely on local studies focusing on one or two cities’ exposure. Many new technologies, like satellite remote sensing and high-resolution modeling, allow us to focus on a national or global level.

The population size of our studies has also increased. Previously, environmental health studies focused on a traditional cohort that usually included thousands or ten-thousands of people. But now, many data, like health digital data, are available, and it’s possible to include millions of people in a study. Analyzing these data is challenging, but the results will be really reliable compared to previous years.

RP: One of the big challenges is related to the growing number of heat waves occurring. They sometimes last longer than they used to and are more extreme than they used to be. We know that if you’re going to be in the heat for, let’s say, two weeks, your body is going to adapt. But if you’re exposed to heat for just three or four or five days, or if it’s too extreme too quickly, we’re going to see maladaptations and difficulties, whether it’s heat illnesses or, if there are too many extreme events, things like chronic kidney issues. We don’t have much information on situations like that right now.

DA: Prioritization is so important. When we have so many clinical studies, which do we prioritize? Because we can only study so much. Also, our current methodologies are limited. When I mentioned that we want to know the effects of PFAS on neurodevelopmental effects, and our model is zebrafish—is that really the right model? In fact, the Food and Drug Administration is pushing toward not using animals. I’ve been to talks where they’re using “organs on chips” [systems containing engineered or natural miniature tissues grown inside microfluidic chips] now, but will that really give us the right answer? If we’re studying the liver, for example, on chips instead of live animals?

MW: We have studied air pollution and health effects quite a lot, in terms of their scope and detailed biological mechanisms. The current limitation is that, even if we know these things, how we can prevent people from exposure? What’s the next step we can take? I’m especially interested in, for example, doing a climate change-related wildfire and dust storm study. We’re thinking about how we can protect people’s health, because climate change is rapidly heightening these disasters. What we need to do is provide strategies, not only in personal prevention—like using air purifiers for air pollution—but also, to leverage modeling techniques to encourage policymakers to understand the future challenges globally, and then develop ways to protect human health. One thing we do is use modeling technology to predict wildfire smoke and dust storms 100 years in the future. Then we can understand the places where these will frequently happen and propose landscape change and other techniques to reduce the threat. Thinking more about prevention will be really important in the future.

PM: We know that there are a lot of disparities in health in our populations driven by factors in social environments like structural racism. We also know marginalized communities tend to have higher levels of environmental exposures and fewer resources to mitigate the effects of extreme weather events. That’s another feature of population health that we need to pay attention to, because often people who have the smallest carbon footprint will suffer the greatest impacts. We also have to think about expanding the range of what we look at in terms of population health. For a long time, we studied heat waves and mortality. After a heat wave, you can see pretty easily how many people died or went to the hospital. But we don’t look at, say, stillbirth or NICU admission, where you can see incredibly high risk for things that are huge population health effects. We’re not paying attention to them, because it’s not what we’re used to looking at. We’re getting a glimmer of a lot of those very impactful health outcomes now, and I think that’s just the beginning.

PM: I worked for 10 years at the EPA, which is probably where I get my regulatory bent. I also was at the National Institutes of Health for more than 10 years and the National Center for Health Statistics. I think about things in a large system level and have spent a lot of my career trying to influence policymakers. The things that drive policymakers are often economic, on a broad scale, but also personal stories. Data itself is not particularly compelling for policy unless it’s also tied to those personal things. So, there’s a balance of macroeconomics with a personal connection I can make, but those are complex messages. It’s a bit of a challenge to know your audience. When we write papers, we need to try to write for a policy audience as well as other researchers.

DA: Going back to some of the PFAS products that are in our food packaging, in our pans—we could find which ones should be replaced and find good replacements. Sometimes a chemical is considered bad, and we ban it or remove it from the market, but we replace it with another chemical that is just as bad. Then we have to study all the health effects of this new chemical. We obviously need chemicals to control pests and for other good reasons. But a good outcome would be that chemists, health professionals and material scientists work together to predict if a new chemical is good or bad and find better substitutes.

RP: I want to echo what you said about health disparities. We’re in Buffalo; it gets cold here, and having heating in the winter is considered a necessity. But air conditioning is sometimes considered a luxury. Think about all the schools that don’t have air conditioning, or about the more rural or inner-city areas that are less likely to have air conditioning. You could have just as poor health outcomes if you’re too hot all the time as if you’re cold all the time. We need to rethink what is necessary and healthy, versus what is a luxury. Air conditioning and air filtration systems are considered luxuries that are not always available to us unless we’re willing to go above and beyond to purchase them, but heating is automatically built into [structures]. That’s something else we need to think about: how do we make these “luxuries” equitable among individuals who may not have the means to do so themselves?

MW: Many air pollution scientists are thinking about how low air pollution should be to protect human health. Trying to answer this question is also why many studies are attempting to combine population data and improve their technology. So far as I know, there is no clear answer. Studies do show an association between air pollution and health outcomes even below the Clean Air Act guidelines, so I think the challenge is how low it should be. We cannot just think about health science, but also about economics and other issues. The ideal outcome would be that we use an integrated method to reduce air pollution or increase air quality, not just simply reduce air pollution by closing factories or reducing the number of vehicles on the road but by thinking about a strategy related to climate change, like carbon neutralization, to get co-benefits.

DA: I’m the director of the UB RENEW Institute at UB [see below], and I’m seeing that we have a lot of talent in UB. It’s really exciting for me to be able to bring them together and work on this exact problem that you are asking us about today: How to remove chemicals from the environment, how to study the effects in humans, and how to better create new materials.

PM: I’ll add that we recently were awarded a disciplinary excellence initiative by UB’s provost to look at climate change, and it’s a significant investment. Diana was involved in a lot of the preliminary planning for the initiative. We’ve been thinking about adding faculty in this area, including people and with expertise in environmental justice, trying to take advantage of what we have here at UB and build on it to make this a strong program for the university.

MW: I agree with Diana. I’m also a member of RENEW, which is a great strategy for allowing us to identify people who want to collaborate with us. Environmental health is really an interdisciplinary research field, and we can’t do it all by ourselves. I always get benefits when I approach people from UB for help.

RP: Graduate students are seeking universities that have a lot of research opportunities and that can make a difference in the world. From the faculty perspective, I appreciate the support UB gives us when we mentor students, because we need to keep bringing people up who are passionate in this.