Environmental health podcast

This podcast provides a forum for health and research experts to discuss pollution and its impacts on our health, and what you can do to reduce your risks.

Episodes

Episode 1: Air pollution

Transcript: Episode 1

Moderator: Breathing is the most natural thing, right? And yet every day with every breath, air pollution affects our health. We provide a forum for health and research experts to discuss air pollution and its impact on their health and on possible solution to address this issue. Now, take a deep breath and enjoy.

Dr. Scott Weichenthal: My name is Scott Weichenthal. I'm an Assistant Professor in the Department of Epidemiology, Biostatistics and Occupational Health at McGill University and my research is in the area of air pollution health effects.

Fiona Hanley: My name is Fiona Hanley, I am a nurse. I teach in the Faculty of Nursing at two different places in Montreal. One is a college, a cégep called Dawson College, and I also teach at McGill University in the Ingram School of Nursing.

Dr. Claudel Pétrin-Desrosiers: My name is Claudel Pétrin-Desrosiers, I'm trained as a family doctor and currently doing a master in environment and sustainable development at the University of Montreal. I am the current president of the Quebec Association of Physicians for the Environment.

Dr. Scott Weichenthal: So air pollution is caused by a number of sources, primarily combustion sources. So any time you're burning fossil fuels or any kinds of materials, there's a range of pollutants that are emitted into the atmosphere, these can be very small particles, so they can be different kinds of different types of gases.

Air pollution also includes sort of vapors that are released from indoor materials, so painting, glues, adhesives, things that are used on things we have in our homes. So air pollution is really just a mixture of chemicals that are in our environment.

Dr. Claudel Pétrin-Desrosiers: I think overall, we don't know enough about air pollution being medical student or being the general population. Air pollution is a big burden on our health. We recently estimated that it was responsible of the death of one in five people around the world, and it's not something we often discuss, be it in the medical curriculum or overall in the news.

Fiona Hanley: It should be from the very beginning of education for all health professionals, whether they're medical students, nursing students, respiratory therapy students, physiotherapy students, occupational therapy, etcetera, everybody needs to know the connection between our health and the environment. After all, I mean it's fundamental, we all need to have clean air to breathe, we all need to drink fresh water and have water to bathe in, we all need to eat food that is going to be good for our health.

Dr. Scott Weichenthal: So in Canada there are a range of important sources, so obviously traffic is an important one. In terms of traffic in addition to combustion sources, there's also things like brake and tire wear that contribute to air pollution. So these brake wear for instance is, contributes to metals in our environment. Also, we call biomass burning, so residential wood burning, forest fires, these are also really important sources of air pollution in Canada.

Dr. Claudel Pétrin-Desrosiers: Well, I worry about air pollution because it's an invisible killer and it, I mean as a doctor, as a health professional I think we should be worried about the fact that there's something out there that kills one in five people around the world.

Dr. Scott Weichenthal: We know that around the world air pollution kills millions of people on an annual basis. And when people think about air pollution, they often think of very polluted locations in the world.

And one of the interesting things about air pollution is that we haven't really identified a level that is known to not cause effects. So even in a place like Canada where we have relatively, well not relatively, we have excellent air quality in general, even at the levels we experience, there are around 15,000 people that are killed every year by long term exposures to air pollution. This includes things like cardiovascular mortality, respiratory mortality, lung cancer.

Dr. Claudel Pétrin-Desrosiers: And that costs like $120 billion a year to the system, that's massive.

Dr. Scott Weichenthal: So air pollution is not a concern because the risks are very large at an individual level. They are a concern because everyone is exposed, and any time you have an exposure that has even a small risk, but that loss of people experience, this can give rise to a large number of cases.

And so early on, of course, researchers focussed on the respiratory health effects of air pollution, so we know that it contributes to things like lung cancer and exacerbation of respiratory illnesses like asthma. And then the research sort of moved on to cardiovascular effects and now we know that the cardiovascular effects of air pollution are probably more important than the respiratory effects.

So we know that there's contributing to things like myocardial infarction, cardiovascular mortality. We know that people with existing cardiovascular diseases, so things like diabetes make you more susceptible to air pollution.

And now research is really moving into looking at the neurological effects of air pollution, so impacts on the brain, things like dementia, recent studies of brain tumors, and this has really been motivated by the fact that we know that that certain kinds of particles can actually reach the human brain. So we know they're getting there.

Fiona Hanley: Well, if we want to consider people who are more vulnerable to air pollution, children are the first ones that come to mind.

Dr. Scott Weichenthal: Obviously, younger, younger children who, whose lungs are still developing.

Fiona Hanley: For a variety of different reasons, and one is physiologically they tend to breathe more, they breathe faster, more air per kilogram if you like, as well too they have a faster rate of breathing.

Dr. Scott Weichenthal: Also pregnant women of course, because you want to limit their exposures to any harmful pollutants to protect both them and the developing fetus. Older people who may have underlying diseases that make them more susceptible to air pollution health effects.

So people who live in say a low income area that's very close to a highway might experience say, a higher exposure to air pollution then a higher income area that's very green and away from busy roadways.

Fiona Hanley: Some of the air pollution particles are even found in the placenta, and so children are exposed even in the womb.

Dr. Scott Weichenthal: So those are the populations that we sort of generally target when it comes to public health messaging around air pollution health effects.

Dr. Claudel Pétrin-Desrosiers: Well we can have an impact on our patients life just by raising our voice and making sure that when I see my patient at the clinic, I can provide them with solutions or ideas to make sure that you know, they have better health. I could say, you know you could go take a walk in a green space in the park in nature.

Dr. Scott Weichenthal: For physicians, I think the challenge is to, they're so much focused on individual level patient care, right, that it's easy to maybe overlook sort of these exposures that have a smaller risk at the individual level but are more important on a population level. They can play an important role by raising awareness of these environmental exposures and how they're relevant to cardiovascular health or to cancer and maybe telling their patients about them as well.

Dr. Claudel Pétrin-Desrosiers: There's a growing interest in the social determinants of health and I think now the movement is to consider the environmental determinants of health.

Fiona Hanley: In many ways we have to be opportunistic, because I think that there are many occasions that present themselves to us where we can have a conversation about environmental health, whatever the subject happens to be. If we're talking about a condition like a cardiovascular condition, for example, or we're talking about heart disease or we're talking about pregnancy and how to promote health in pregnancy, for example, there are many, many different occasions to be able to have that conversation about what are the influences of the environment on health.

Dr. Claudel Pétrin-Desrosiers: I don't want to put the burden on them. So there's something there in terms of this problem needs to be addressed by society as a whole. So I think we need to make sure that we sort of do a catch up work for every physicians that were trained in the last years or in the last decades because this is something that were not known as well as we know today.

Fiona Hanley: It shouldn't depend on one's individual interest. It should be part of the formalized curriculum for all students in the field of health.

Dr. Claudel Pétrin-Desrosiers: There's obviously a lot of training and raising awareness that need to be done to make sure that it's integrated perfectly or better in our practices. But I think we're heading in that direction.

Fiona Hanley: That very rarely do we ask, well, what are you using to clean yourself or to clean your house, or what is the state of carpets in your home, or do you live by a high traffic area, or do you know about the air quality health index? Do you know how to check whether today is a good day to go and do exercise outside or is it maybe something that we should do as an exercise inside today because that the air quality is not very good.

Dr. Claudel Pétrin-Desrosiers: Medical professionals and medical students are given an enormous trust by the population. We're trusted people. When we, usually when we say something to a patient it has an impact on their life, on their habits, on their choices. And I think we have to honour this trust when it comes to problems that are beyond the walls of our clinics, then I think we have to make sure that we, that our voices are heard but that we make sure that we are able to also amplify the voices of people who may not have this chance.

Dr. Scott Weichenthal: The solutions are sometimes source specific or pollutant specific. Generally decreasing large combustion sources in heavily populated areas is a good idea, right. So one of the, one of the actions that Montreal has done I think that was a good idea was to limit residential wood burning. Because wood, residential wood burning can produce a lot of air pollution which might not be a concern if you live in the country with not a lot of neighbors around.

But when you're in a major, a major city and everyone's burning wood that means millions of people are now exposed to these harmful pollutants. Reducing fossil fuel combustion is a good one. And I think, you know cities have made an effort to try and promote sort of active transportation. So things like cycling and walking.

I think governments around the world are really recognizing the health and economic impacts of air quality. And I think you know places like China have made really incredible strides to improve their air pollution, improve their air pollution levels.

Most Canadians, not just physicians, but most Canadians don't know is what a leader Canada is in air pollution research. We have some of the best researchers in the world here in Canada. But yeah, generally I think I am optimistic.

Dr. Claudel Pétrin-Desrosiers: If I had to summarize the situation of air pollution in Canada, I would say opportunity, because we have now the opportunity to improve the life of people and to save 14, over 15,000 deaths a year. And I don't think we've been giving any other opportunities as big as this.

Fiona Hanley: I think I'm very inspired by the passion that I see in the students around me. People go into nursing because they care about other people, and there's a huge passion that I see that is carrying them forward and that has a huge potential for influencing. It's like a stone in a pond. Despite everything, I do feel optimistic and now I think there's a whole community of people out there that is, that have caught fire with this idea as well too. So yes, it's inspirational.

Moderator: You listened to a podcast produced collaboratively by Health Canada, University La Rue(ph) and IFMSA Quebec which is the international and community affair division of the Quebec Medical Student Federation.

Concerned about air quality and its impact on health? Do you have a solution in mind? We invite you to take the floor to share your experiences or your opinion on this subject.

Write to us on the University La Rue Facebook page with the hashtag environment and health. If you want to learn more, search the Health Canada website for the keyword air and health.

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