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Harbor in Accra, Ghana
Harbor in Accra, Ghana

Interwoven

The UMass Amherst School of Public Health and Health Sciences shows us that global health is our health.

Picture people living by the banks of a river. Their community has developed into a modern city over many generations. A central road runs parallel to the watercourse. The wealthy people reside at higher altitudes—with a reliable power grid, paved roads, and sanitation service. Beneath the main road, on the waterfront, storm drains and sewage pipes open into the river. The streets in that part of town are unpaved and flood regularly, more regularly now that the ocean the river empties into is getting higher. 

In a municipality upstream, a power plant has been cited for contaminants leaching into the groundwater, yet, because of governmental intricacies, has not been penalized. Men still walk down to the river in the evenings to fish for their dinner, and on the outskirts of town, women collect reeds to weave into ceremonial baskets still important to their traditional culture. Outbreaks of disease cycle regularly through the poorer parts of town, but symptoms don’t seem to be passed from person to person.

If you were going to call on someone to study these outbreaks, would you send a doctor? A microbiologist? An ecologist? A fish biologist? A policy specialist? A social worker? 

Call in an environmental health scientist. Humans interact with their physical environment at countless points of contact. The field of environmental health covers all of them. Encompassing broad environmental issues and their influence on the health of people, environmental health science represents an intricate balance of clinical science, ecology, medicine, social justice, public policy, and—especially in the field—holistic, almost visionary, thinking. 

Environmental health sciences is one of six departments in the UMass Amherst School of Public Health and Health Sciences (SPHHS). Under the leadership of Marjorie Aelion, dean since 2009, the school has expanded rapidly in the last five years, adding faculty and attracting an increasingly large enrollment of students who want to work in applied science. The SPHHS currently boasts 2,127 undergraduate students, 589 graduate students, and 80 full-time faculty members. 

Each department within the SPHHS offers a different angle of approach to solving global health problems. Aelion prefers to conceive of the school as one entity with a single mission. "All departments in this school have the same vision," she says. "All have the aim to help large groups of people—to have a significant impact improving humans’ health and wellness through research, prevention, and intervention.”

One way the school is having a global impact is through the Department of Environmental Health Sciences and its faculty in the field. Their work in middle- to low-income countries and regions demonstrates the reach and potential of the deeply interwoven world of global health.

We want to be able to do bigger and better research, to have more impact locally and globally, and to offer more meaningful experiences to students.

Dean Marjorie Aelion

The Big Picture

Tim Ford, professor and chair of environmental health sciences and director of the UMass Amherst Institute for Global Health, studies water pollution around the globe. His career has taken him to the Ganges River, where religious bath­­­ing can expose bathers to contamination; to Cherepovets, a city north of Moscow, where he investigated an outbreak of waterborne pathogens, such as the parasite Cryptosporidium; and to reservations in Montana, where he examined industrial water contamination.

Ford is currently advising a National Institutes of Health-funded program at Salish Kootenai College on the Flathead Indian Reservation in Montana, which will train students in environmental science education. He is also at work studying the presence of cholera in Haiti, where he focuses on improving surveillance and response to the disease. His lab is refining a handheld genome sequencing device called the MinION, which allows its users to do environmental and clinical diagnostics of infectious diseases in the field. 

Ford explains how much ecosystems actually do influence human health—even though we might think we are safely encased in the trappings of humanity and civilization. “Climate change alters the vectors of disease and distribution of pathogens,” he explains. “Sea level rise causes coastal flooding, which means phytoplankton and zooplankton carrying cholera bacteria can travel farther up river estuaries.” Coastal inundation can cause extensive damage to water and waste-water infrastructures, placing populations at greater risk of a disease outbreak. 

“All global health issues need a cross-disciplinary approach to even begin to address them,” says Ford. “Everything we do in public health has to be linked to public policy, for example. They all connect.” 

Environmental Health Equity

Yet another overarching theme in environmental health science is environmental health disparity. The lack of access to resources like clean water or good health care, and physical or social factors, such as overcrowding, the organization of public works, and even the toxicity of fuel used in cooking, all affect health outcomes. Much depends on whether you are rich or poor—or whether your country is. 

Variations in exposure to pollutants are often based in social inequality, which means that public health scientists often deal with environmental justice issues—for instance, how a city is laid out. In the words of Raphael Arku, assistant professor of environmental health sciences, “Where you live matters a lot.” The class structure of cities can dictate whether you can afford to live at a high elevation or near a sewage disposal outlet. 

The wealth of a country is also a factor, as are its environmental regulations, in the health of its citizens. For example, when a country such as Nepal imports cars that have not met the air-quality standards of higher-income nations, the pollution from the exhaust of those cars chokes both its environment and its people. 

trafficcontrollers.jpg

Traffic controllers in Kathmandu, Nepal

Street level in Kathmandu, Nepal: high-polluting gasoline and diesel engines make breathing the air a health hazard to traffic police. Researchers found the simple intervention of a paper face mask can save lives.

Photo by
Sergey Ashmarin/Wikimedia Commons

Over a Hot Stove

A specialist in measuring the effects of air pollution, Raphael Arku has brought his focus indoors to interior spaces—at the moment, household kitchens in his native Ghana.

Although a home’s cookstove seems a simple element, it illustrates the complexity that environmental scientists must untangle in order to do their work. A home’s indoor space is subject to pollution more diffuse than the smoke from a cigarette, yet more collected than outdoor air quality. And a multitude of surprising economic and social elements come into play that the scientist must understand in order to get a whole picture. First, there is an individual household’s ability to afford clean fuel. And do they have a reliable supply chain to get it? Such external factors bear down on the choices a family can afford to make. Do they keep a dirty fuel as backup in case the preferred fuel runs out (a practice called fuel stacking)? In Ghana, homes range in style from “modern” Western in structure to a traditional circular home with the cookstove in the center. Another factor to take into account is gender roles in the home, which can determine who stands closest to the fire, and for the longest—thus receiving the highest exposure to pollutants. 

This is where the work of an environmental health scientist also becomes the work of a social scientist, because there are factors in play that would not take place in any lab. The level of pollution in the air of a house can even be subject to idiosyncratic preferences: many times the woman of the house would be willing to change to a cleaner fuel, but the man prefers the flavor of food cooked with the dirty fuel, Arku explains. 

Arku is in the midst of a 10-year study, done with an international consortium of cardiologists and encompassing a range of countries from Tanzania to China, that will relate exposure to particulates in the air near cookstoves to cardiovascular outcomes. The group will then supply the data to governmental organizations, so it can serve as a resource and reference for developing air-pollution management plans. “This is an issue of prevention prior to health care,” says Arku. 

Because he is being allowed into people’s homes, Arku’s research requires intense interpersonal skills: a style of interviewing that is respectful, nonexploitive, encourages the subject to participate, and is sensitive to nuance. In addition to taking surveys, blood samples, lung function measurements, and reviewing hospital reports, “You have to observe,” he stresses.

If you as a country only care about today and don’t care about tomorrow, it will probably cost you more in the long term. 

Associate Professor Richard E. Peltier

Diplomats in the Field 

Arku’s colleague, atmospheric chemist Richard E. Peltier ’97, associate professor of environmental health sciences, relates to the challenge of conducting research work in a place where it’s really hard to do research. 

His lab assessed the air pollution exposure of traffic police in Kathmandu, Nepal, who stand in the midst of exhaust fumes at street level for hours a day. His group found that wearing a simple, industrial-filter face mask—as opposed to a bandanna, which had been the common, and cheaper, practice—has a huge effect on the level of pollution absorbed by an individual. He found a willing population of participants eager to contribute their time and energy to the study. “We do applied research,” Peltier explains. “It’s more than measurements of x, y, z. It provides a meaningful impact for the community that supports the research project.” 

Peltier also works in Canada with the First Nation Omushkego Cree, 600 miles north of the Amherst campus, in a community that cannot be reached by road. “This is a highly disenfranchised community with terrible health status that is underserved by their government,” he explains. Peltier’s recent project there was to look at the literal fallout from a huge diamond mine upwind of the community, operated by one of the world’s largest diamond producers. Tribes often lease or sell to non-native mining and farming operations that don’t have the same sense of care for the land. Such exploitation is not uncommon on native land, where money is scarce. “They gave up some of their indigenous land to get a few jobs,” says Peltier sadly. After sampling for a month “in this rural place where you would expect little pollution,” he found “urban-level air pollution with toxic chemicals. Heavy metals. Cadmium. Mercury.” 

It’s Peltier’s goal to collaborate with the communities he is surveying, providing them with the data they need to represent their interests and also the training and resources to survey the environment on their own. Working with Ford through a National Institutes of Health grant, Peltier is putting together a tool kit of approaches that tribal members and laboratories can use to monitor environmental contamination. 

“We are very sensitive of our position and what we do. We are not part of that culture, and we can’t be colonialist and tell them how to do their culture,” says Peltier. This is one of the unique aspects of public health science: that it happens where science butts up against culture. Peltier is an advocate of community-based participatory research that is empowering to the people surveyed, and, also, by involving them, provides more accurate data than could be gathered by a complete outsider. 

Environmental Justice Warriors 

Air pollution kills between six and seven million people per year. “It’s a profound public health hazard,” says Peltier. He hopes that his findings will help influence decision makers to create policies that save lives—and the Earth’s environment. It is stunning to realize how closely the well-being of both are intertwined.

“One of our key goals as researchers,” says Arku, “is to estimate the global disease burden due to environmental factors and provide this information to each country.” Looking deeper into environmental health science reveals how inextricably a country’s health-care costs are interlinked with its energy policy, for example, and how much they also connect to environmental policies and income inequality. 

“If you change just one factor, it affects other sectors,” says Arku. “In the past, we would focus on one thing and deal with it, but it’s becoming very clear that we have to look at it transdisciplinarily.” 

Environmental health problems are not specific to high- or low-income nations. And, as the United States is currently witnessing, environmental regulations and responses to natural disasters—which, Aelion points out, are also global health issues—are subject to change with administrations and the makeup of Congress. 

Low-income countries tend to prioritize infrastructure and economic growth because they want to generate revenue in the moment. Peltier calls it a developmental mind-set. He says, “If you as a country only care about today and don’t care about tomorrow, it will probably cost you more in the long term. The social costs of regulating air quality are not obvious; they occur only later when people start getting sick, which could be 10 to 20 years later.” 

But one advantage low-income countries often do have, Peltier observes, is that their policies tend to be more adaptable, and nimble, as they implement a fresh vision for what they want to become—versus, he says, “turning the Titanic of regulations in the United States. One of the drivers for me,” he continues, “is that many of these places have immature or nonexistent policies in place, so if you want to make a difference in that, you can get in on the ground floor; they are more open to it. They want happy economies and nice roads. They don’t want a degraded environment. So, they can weave the science into their policies as they are developing.” 

One Vision 

As one may imagine, the complex field of environmental health presents new vistas every day, creating entirely new areas where science can be of service. “Boston and Barcelona aren’t representative of all the regions of the world,” states Peltier matter-of-factly. “We are asking, ‘How does this kind of pollution affect health?’ ”

Facing so much potential for discovery inspires Dean Aelion to continue to evolve, refine, and add to the array of approaches the SPHHS offers. “We want to be able to do bigger and better research, to have more impact locally and globally, and to offer more meaningful experiences to students,” Aelion says. She recently returned from a trip to Cuba, where the SPHHS will send a cohort of undergraduate students in the spring of 2019 to learn about and from that country’s public health-care system. “Cuba’s a great example of another approach to public health, and it’s so close geographically!” she points out. “This is cultural exchange at its best.”

Peltier understands the spirit of service that is drawing students in increasing numbers to the school. Looking back to the start of his career, he considers: “I was interested in helping people, but not in the clinical path of being a physician. I wanted the training to understand and describe the problems I was seeing,” he says. “Every talk I give, I start with my motivation, why am I doing this work? It’s for human health; it’s for the environment. It’s important to me to remember why this is relevant, doing what I do.”

Arku returns to the theme of interconnectedness that drives so much of the study of environmental health. “Think of the global context of everything that happens,” he says emphatically. “The pollutants that come from dirty cooking fuel also contribute to global warming. It’s not localized. It’s not just the direct impact in the communities where we work. There are consequences to your environment no matter where you live.” 

Put simply, in the words of Tim Ford: “Global health is our health.”

 


 

Lead photo: Jamestown Fish Harbor in Accra, Ghana: life-giving and culturally important, estuaries can also be vectors of disease. Photo by Muntaka/Wikimedia Commons.