Public Health 30 Final

Where is lead found

"moonshine" whisky made in lead glazed vats, lead sodered stills or even radiator coils was a rich source of lead poisoning. -Glazed pottery from some developing countries. Ceramic vases are an important source of population lead poisoning internationally - in Mexico, for example. -Lead crystal is expensive and beautiful, yet materials such as fruits and wines, sherries and other alcoholic beverages can leach some of the lead from the crystal. -Folk remedies, and cosmetics of certain ethnic groups sometimes contain lead. -Lead has been found in the wicks of certain kinds of candles. -All of these unusual sources, together, are far less important in the U.S. than lead from paint and soils. -found in spices, low cost jewelry, candles, pottery, imported candy -high risk professions include workers who scrape, chip, heat or sandblast old paint

Infectious diarrhea

-2-4 billion episodes of infectious diarrhea occur each year -especially prevalent in infants -three classes of infectious agents, i.e., bacteria, viruses and parasites. -diarrhea is simply an altered movement of ions and water that follows an osmotic gradient. -Under normal conditions,the gastro-intestinal tract has tremendous capacity to absorb fluid and electrolytes, where 8-9 liters of fluid are presented to the intestine daily and only 100-200 ml are excreted in the stool. -Enteric pathogens, however, can alter this balance towards net secretion, leading to diarrheal disease. -occurs either through transporters or the lateral spaces between cells, which are regulated by tight junctions

disparities in injuries

-About 16 000 people die every day as a result of injuries - about 10% of all deaths. The principal causes of death from injury are road traffic accidents (22%), suicide (15%) and homicide (10%), with war accounting for another 3%. -Road traffic injuries alone are responsible for 1.3 million deaths per year globally. In many developing countries, urbanization and the increased number of motorized vehicles have not been accompanied by adequate transport infrastructure, enforcement of traffic regulations or implementation of measures to ensure improved road safety. -Low- and middle-income countries have higher road traffic fatality rates (20.1 and 22.1 per 100 000 population, respectively) than high-income countries (11.9 per 100 000). -More than 90% of the world's road fatalities occur in low- and middle-income countries, which have only 48% of the world's registered vehicles.

Cholera in Haiti 2010

-Cholera importation in Haiti triggered an epidemic in October 2010. -Outbreak worsened by earthquake: thousands homeless and destroyed sanitation and water infrastructure -250,000 cases with 4,000 deaths in first 6 months, 493,069 cases one year later -This cholera epidemic appear to be the largest ever recorded in a single country during the past 50 years. -What was the cause of Cholera in Haiti? -Human causal hypothesis -Climate causal hypothesis

communicable diseases

-Cities deserve special attention for the control of communicable diseases because they also have features that make them uniquely vulnerable. -High population density can cluster people around risk. -For example, in cases where there is unsafe water or poor sanitation, even one individual can make entire communities sick in densely populated spaces. -Children are particularly at risk of vaccine-preventable and diarrheal diseases under these conditions -High human density can expose residents to airborne diseases such as influenza or TB. -Urban areas are home to millions of people who are excluded from social, political and economic progress, and thus are more likely to be at higher risk of diseases such as HIV. -Urban characteristics, especially in slums, of poor sanitation and overcrowding are also linked to a higher risk for TB, a leading cause of death among people living with HIV. -Malnourished children tend to have more frequent episodes of severe diarrhoea and are more susceptible to infectious diseases, such as respiratory infections and meningitis. -Malnourished children have a poorer prognosis for almost all infectious diseases (except HIV), and malnutrition is thought to play a role in more than half of all child deaths worldwide, which makes malnutrition one of the most important risk factors for children globally

cardiovascular effects of lead

Chronic lead exposure can result in adverse cardiovascular effects. -Most studied endpoint: lead-induced increases in blood pressure, particularly systolic blood pressure, or risk of hypertension. -Other several cardiovascular endpoints: cardiovascular mortality, stroke mortality, myocardial infarction mortality, inotropic and chronotropic cardiotoxicity, and peripheral arterial disease -Evidence effects at blood lead concentrations <10 μg/dL.

HIV AIDS

Cities and urban areas bear a major part of the global HIV burden—in sub-Saharan Africa, nearly half (45%) of people living with HIV reside in urban areas. In many countries outside of sub-Saharan Africa, such as Brazil, Jamaica, and the Russian Federation, cities are home to more than half of all people living with HIV nationally. -More than 60% of urban residents in Africa live in slums; in Asia, at least a third of urban residents do so. Cities will struggle to control their AIDS epidemics as long as these populations are marginalized from the benefits of city life.

Asbestosis

It can cause pleural plaques, asbestosis, lung cancer, mesothelioma, and tumor. -Symptoms do not usually show up until years after exposure. -Effects depend on length, diameter and composition of fiber -A chronic and progressive lung disease caused by inhaling asbestos fibers over a long period of time. -5- 20 years to develop -Inflammation from fibers causes scarring (fibrosis) and stiffening of the lung. This causes less oxygen exchange -Symptoms - short of breath, cough, chest tightness -Usually worsens overtime and may lead to respiratory failure and death.

what does lead lead to

Lead inhibits certain types of enzymes, Particularly enzymes dependent uponsulfhydryl groups. Organ systems affected include: Neurologic Endocrine (including BP) Reproductive Musculoskeletal Blood Renal GI Deficits in children: Psychomotor performance Auditory and language processing Sustained attention & concentration There does not appear to be any threshold effect. Performance correlates with lower lead levels. Measured outcomes: Less likely to graduate High School More likely to be convicted of felonies* Deficits consistent across cultures and controlled for SES lead can damage the brain and destroy brain cells

what are lead exposure pathways

Lead is usually encountered by inhalation or oral ingestion. Respiratory exposure is more commonly the primary route in adults, while ingestion is often most important in children. 1. RespiratoryBreathing in dust that contain lead. Lead is absorbed and distributed to other parts of the body via the bloodstream 2. IngestionAdults absorb about 6% of ingested lead. Fasting adults absorb more.Children absorb much more lead(30-50% if well fed, and more, if fasting or malnourished). 3. SkinSkin is relatively impervious to lead, lead oxides , or lead salts. Some may get through scrapes or wounds, but organic leads (such as in leaded gasoline - tetraethyl lead), will go through skin into the bloodstream.

Cancer from Asbestos exposure

Lung Cancer -Usually takes 10-20 years to develop after exposure. -Symptoms: persistent cough, weight loss, cough up blood -"Synergistic" effect from smoking: -Asbestos in non-smokers: 5x background rateAsbestos in smokers: 50x background rate -Malignant Mesothelioma -A cancer of the lining of the lung and chest cavity or the lining of abdominal cavity -Can take 30 to 50 years to develop after exposure -Symptoms: short of breath, chest pain, weight loss -Rapidly fatal : 75% dead 1 year after diagnosis

how can cities lead efforts to curb some of the most decastating infectious diseases

-Cities have demonstrable advantages for controlling communicable diseases -play a central role in reducing global burden. -They are comparatively well resourced with health workers, financial resources and facilities. -They are more likely to have stable electricity and refrigeration facilities as well as stronger supply chain management for vaccines and other medicines and commodities. -The relative human density of cities enables mobility and access at scale for reaching healthcare providers, facilities, medicines, and more. -Cities may also lead at the front lines of outbreaks. -In 2014, the Ebola outbreak entered Nigeria via Lagos, a city with the largest population and greatest population density on the African continent. Aggressive contact tracing efforts identified all 900 people who had been in contact with the disease; 19 were eventually diagnosed with the disease, 12 survived, and the virus was effectively halted

Cities have been significant contributors to climate change how

-Collectively, cities account for 75% of global energy consumption and a similar proportion of all waste. -According to latest estimates, urban areas contribute directly to more than 60% of greenhouse gas emissions. -It is no coincidence, therefore, that climate change has emerged at the forefront of international debate at precisely the same time that the planet has become predominantly urban.

dengue

-Dengue is fast emerging pandemic-prone viral disease causing a severe flu-like illness (related to the viruses that cause West Nile infection and yellow fever) -Severe dengue (previously known as dengue haemorrhagic fever) has become a leading cause of hospitalization and death among children and adults in Asia and Latin America characterized by high fever, damage to lymph and blood vessels, bleeding from the nose and gums, enlargement of the liver, and failure of the circulatory system. The symptoms may progress to massive bleeding, shock, and death. -Dengue and dengue hemorrhagic fever could be almost entirely prevented by good management of water bodies in and around houses. -The main mosquito vector, Aedes aegypti commonly breeds in temporary water-storage containers in the domestic environment -tanks and drums, -plant pots, -standing water in solid waste (e.g. tires and discarded food containers.) -The global mean environmental attributable fraction for dengue was estimated to be 95% (90—99%).

urban areas make it easy for infectious diseases to spread how

-Especially in areas of high population densities with low resources such as slums. -Increased international travel and migration have resulted in cities becoming important hubs for the transmission of infectious diseases, as shown by recent pandemics such as H1N1 and Ebola virus. -Rapid urbanization can introduce diseases mostly prevalent in remote rural areas into cities affecting much greater populations. -Schistosomiasis has established itself in urban areas, most probably through infected migrants in many sub-Saharan African cities. -Global incidence of dengue has grown dramatically in recent decades with about half of the world's population now at risk. It is found mostly in urban and semi-urban areas in tropical and subtropical climates worldwide.

disparities in violence

-Worldwide, over 1.6 million people lose their lives to violence each year. Suicide accounts for 844 000 deaths, homicide for 600 000 deaths and collective violence for 184 000 deaths. For every person who dies from violence, many more are injured and suffer a range of physical, mental and other consequences. -Child maltreatment, youth violence, intimate partner violence, sexual violence and elder abuse, although unlikely to result in death, are other highly prevalent forms of violence with significant behavioral and health consequences. -Major contributors to urban violence include social exclusion, poverty, unemployment and poor housing conditions. -The fear of such violence further contributes to the fragmentation of cities, socially, economically and politically. -Young people are particularly affected by urban violence. In urban areas, people aged 15 to 24 commit the largest number of violent acts, and are also the principal victims of violence.

Natural intervention studies for air pollution

-coal heating was banned in Dublin 1990 -ambient air BS index reduced by 70 percent -respiratory deaths decreases by 15.5 percent -cardiovascular deaths decreased by 10.3 percent

Severe acute respiratory syndrome SARS

-in 2003 sars highlighted the fact that no city is automatically protected from disease by its wealth -sars was a disease in properous urban centers and spread mostly in sophisticated city hospitals - spread was halted less than four months

cities have what health risks

-infectious diseases exacerbated by poor living conditions; -noncommunicable diseases and conditions (such as heart disease, cancer and diabetes) -Behavioral exposures from tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol; -Occupational exposures -Injuries (including road traffic accidents) -violence

Cardiovascular modifiable risk factors

-physical inactivity -stress -diabetes -tobacco -genetics -diet -cholesterol -hypertension -obesity

Hyde Park/Oxford street

-urban diesel particle exposures -randomized crossover design -winter to reduce effects of pollen -60 participants -each walked for 2 hours long -Oxford street diesel and on a separate occasion in Hyde park -asthma increased when there was exposure to diesel -airway inflammation increased

Where do people live in slums

1. sub saharan africa 2. southern asia 3. south eastern asia 4. eastern asia 5. western asia 6. oceania 7. Latin American and caribbean

cholesterol

Cholesterol is a soft, waxy substance found among the lipids in the bloodstream and in all the body's cells. It is important to the healthy functioning of our bodies. It is needed to form cell membranes and hormones. -The human body makes cholesterol and we also consume it when we eat animals and animal derived food like milk and cheese. We can also make cholesterol from foods that do not contain cholesterol such as coconut fat, palm oil and trans fats, often used in foods such as french fries, cakes and cookies. -Cholesterol is carried through our blood by particles called lipoproteins: low-density lipoprotein (LDL) and high-density lipoprotein (HDL). High levels of LDL cholesterol lead to atherosclerosis increasing the risk of heart attack and ischemic stroke. HDL cholesterol reduces the risk of cardiovascular disease as it carries cholesterol away from the blood stream. -Estrogen, a female hormone, raises HDL cholesterol levels, partially explaining the lower risk of cardiovascular disease seen in premenopausal women.

Chen impact of sustained exposure to air pollution on life expectancy from China's Huai River policy

1950-1980 Chinese government established free winter heating of homes and offices via the provision of free coal for fuel boilers North of the line formed by the Huai River and Qinling Mountain range long-lived heating systems continue to make indoorheating much more common in the north. -North of the Huai River, particulate concentrations are 184 μg/m3 or 55% higher, and life expectancies are 5.5 y lower, almost entirely due to an increased incidence of cardiorespiratory mortality -The estimates suggest that the 500 million residents of Northern China during the 1990s experienced a loss of more than 2.5 billion life years owing to the Huai River policy.Implications -The resulting estimates suggest that long-term exposure to an additional 100 μg/m3 of TSPs is associated with a reduction in life expectancy at birth of about 3.0 y (95%CI: 0.4, 5.6). -more than 5X larger than the estimated impact of TSPs on life expectancy from fitting a conventional ordinary least squares equation on the same data.April 2014University of California Irvine What are the implications -The use of a regression discontinuity design based on the Huai River provides a quasi-experimental approach that can help to move the existing literature from documenting a robust association between particulates and health toward documenting a causal relationship -The resulting estimates suggest that long-term exposure to an additional 100 μg/m3 of TSPs is associated with a reduction in life expectancy at birth of about 3.0 y (95%CI: 0.4, 5.6). -This estimate is more than five times larger than the estimated impact of TSPs on life expectancy from fitting a conventional ordinary leastsquares equation on the same data.

What are DNA adducts

A segment of DNA bound to a cancer causing chemical -the Benz[a]pyrene adduct is one of the more carcinogenic compounds commonly found in wood smoke emissions -

lead metabolism

Adults: -95% long bones.Binds into matrix, and released during osteolysis. -4% brain, liver, kidneys. -1% blood -Low dietary intake of vitamin D, vitamin C, and iron enhance absorption and retention of lead in the body. Vitamin D modifies lead-bone metabolism, while vitamin C and iron may also modify excretion.Cheny L, et al AJ Epi 1998:147:1162-1174 - it gets out of the body through the kidneys, bowels, sweat glands, breast milk, hair nails and teeth

What has improved with smoking recently

Age standardized global prevalence of daily smoking fell to 15·3% (95% UI 14·8-15·9), a 29·4% (27·1-31·8) reduction from 1990, -smoking rates decreasing from 34·9% (34·1-35·7) to 25·0% (24·2-25·7) in men and from 8·2% (7·9-8·6) to 5·4% (5·1-5·7) in women. -These reductions were especially pronounced in high SDI countries and Latin America, probably reflecting concerted efforts to implement strong tobacco control policies and programs in Brazil and Panama, among others. -Brazil saw the 3rd largest overall decline in daily smoking prevalence since 1990 - a drop of 57% for men and 56% for women. The country has implemented a combination of tobacco control policies, including advertising restrictions, smoking bans, and taxes on tobacco products. -Globally smoking significantly decreased for each sex, falling from 16·1% (95% UI 14·4-18·0) to 10·6% (9·3-12·1) for men and from 4·8% (4·3-5·6) to 3·0% (2·6-3·7) for women (table 2). -No country had a significant increase for men or women in this age group since 2005 -In 2015, there were 22 countries with female smoking prevalence in this age group higher than 15·0%, 18 of which were located in western or central Europe. -3 countries saw smoking prevalence in 15 to 19 year-olds significantly drop for both men and women since 2005 (New Zealand, Iceland, and the USA). Iceland had the largest significant decrease among men, decreasing from 14·8% (95% UI 11·7-18·5) in 2005 to 9·0% (5·6-13·3) in 2015. -New Zealand had the largest significant decline among women, decreasing from 20·8% (18·1-23·8) in 2005 to 12·5% (10·1-15·5) in 2015

the London smog from December 5-9 1952 and what acts did it lead to

Air in London had been gradually getting worse since the Industrial Revolution -Previous crises associated with high mortality -December 1952 saw an inversion event -Cold air trapped under a warmer layer -Smoke could not escape -Most smoke from coal -Policy impact: -Clean Air Acts of 1956 and 1968 -the effects were that there were 900 death per day -people suffered long term consequences including cancer, impaired child development and asthma -childhood asthma risk increased in infancy 9X, in utero 3X -adult asthma risk was infancy 6X, in utero 1.3X -increases chances of diabetes and neurological disorders

NCDs

Approximately 38 million people die annually from NCDs, representing 63% of the total global deaths from all causes. -CVDs account for most NCD deaths (17.5 million people annually), followed by cancers (8.2 million), respiratory diseases (4 million) and diabetes (1.5 million) -In LMICs, NCDs now coexist with communicable diseases, representing a significant challenge to disease prevention and control efforts. The burden of NCDs in LMICs is disproportionately high -In India, for example, urbanization and its associated lifestyle changes have triggered a health transition in favour of NCDs. CVD and cancer are now the top two leading causes of death in urban areas -In Kenya, CVD and injuries significantly increased and mortality related due to HIV/AIDS declined among the urban poor of Nairobi between 2003 and 2012. Cardiovascular deaths steadily increased from 2% in 2003 to 8% in 2012, and peaked at 14% in 2005, with women more frequently affected

treatments for lead poisoning

Chelation is an adjunct to the real treatment in lead poisoning. For children and adults, the real treatment is to decrease exposure. What chelation can do is speed up the process of reducing the lead in circulating blood. Chelation is much less effective at attacking bone stores; a single chelation treatment (for example 5 days of I.V. EDTA) mobilizes much less than 10% of whole body lead burden. - The reason to chelate are to reduce symptoms or physical findings, or because there is legitimate fear of untoward outcomes (such as seizure). The advantages of a quick drop in circulatory blood lead must be weighed against possible complications of chelation such as kidney damage or arrhythmia or even increased blood lead if exposure persists. In addition, the quick decrease in circulating stores is not permanent. The equilibration between "compartments" explains the "bounce back" (increase in blood lead levels) that commonly follows treatment. chelation therapy Until recently, it was common to chelate symptomatic children whose blood lead was 20-45 μg/dl, in an effort to preserve and protect CNS function. A recent controlled therapeutic trial found no detectable benefit of this practice in children 1-3 years old with blood lead levels of 20-44 μg/dl. When followed to grade school, children treated with chelation did not perform better than untreated, lead-poisoned peers. (Rogan WJ et al. The effect of chelation therapy with succimer on neuropsychologic development in children exposed to lead. N Engl J Med 2001; 344: 1421-6).Must be considered in light of possible complications- kidney damage and arrhythmia.Will cause increased lead absorption if exposure persists.

oxidative stress and epigenetic in disease

Colorectal cancer (CRC) - third most common cancer in the United States. -Results from a combination of genetic, epigenetic, and environmental factors. -Diet is widely believed to play an important role in the development of CRC, and several biological mechanisms provide a theoretical link between micronutrients and reduced risk of CRC. -Oxidative stress plays a major role in CRC development and progression and results from an excess production of free radicals or insufficient antioxidant defenses. -The balance between free radicals and antioxidants is critical. Numerous dietary nutrients, such as vitamin C, vitamin E, carotenoids, and selenium, have antioxidant properties and protect against the damaging effects of free radicals. -In addition to their antioxidant properties, these nutrients may also inhibit tumor development by stimulating the immune system and regulating cell growth. -Aberrant DNA methylation is a well-known process involved in colorectal carcinogenesis, which includes global hypomethylation and hypermethylation of CpG islands. -DNA hypomethylation is an early and consistently observed feature in colorectal carcinogenesis due to low levels of S-adenosyl methionine (SAM) -Production of SAM depends on dietary factors such as folate, vitamin B6, and vitamin B12. -Folate role is to provide one-carbon units in several reactions necessary for DNA methylation and synthesis -Vitamins B12 and B6 serve as cofactors in some of these reactions. Therefore, sustained low levels of these nutrients may lead to disturbances in DNA methylation, synthesis, and repair, possibly influencing colorectal carcinogenesis.

burden of disease from water and sanitation 2012

Diarrhea is among the main contributors to global child mortality, causing one in ten child deaths (WHO 2009;Liu et al. 2012) -inadequate drinking water 502 000 diarrhea deaths -inadequate sanitation 280 000 deaths inadequate hand hygiene amounts to 297 000 deaths. -In total this cluster of risk factors 842 000 diarrhea deaths -5% of the total disease burden and 58% of diarrheal diseases. -In children under 5 years old, 361 000 deaths could be prevented, representing 5.5% of deaths in that age group. -confirms the importance of improving water and sanitation in low- and middle-income settings for the prevention of diarrheal disease burden. -underscores the need for better data on exposure and risk reductions that can be achieved with provision of reliable piped water, community sewage with treatment and hand hygiene.

air pollution

Different concerns in different parts of the world -EXPOSURE matters - what dominates the exposure? -Important implications for disease estimates -Large errors in some analyses -Behaviors and activities -Fuel use -Housing -Income -Acute health threatening episodes characterized by combination of -High emissions -Meteorology -Topography

there are ways to transition to clean energy and avoid air pollution how

Dublin ban on coal burning 1990 -Indonesia 2007 to 2009 the number of liquefied petroleum gas stoves jumped from 3 million to 43.3 million in 3 years, serving almost two-thirds of Indonesia's 65 million households (or about 216 million people). -In Ulaanbaatar, Mongolia approximately more than 103,255 stoves were replaced in the capital city in 2 years -In Brazil 90% of all new vehicles sold in 1981 could run on ethanol 6 years after initiation of the program, -In South Korea, the household transition from coal to liquid fuels took place over a 9-year period from 1986 to 1995 -China's National Improved Stove Program (NISP) was responsible for the installation of 185 million improved cookstoves with more than 80% coverage by 1998 , with the vast majority in the period 1991-1998 -Almost complete transitions to oil and electricity in Kuwait, natural gas in the Netherlands, and nuclear electricity in France took about 10 years to occur

What are epigenetic and how does it relation to environment and lifestyle

Epigenetic mechanisms are flexible genomic parameters that can change genome function under exogenous influence but also provide a mechanism that allows for the stable propagation of gene activity states from one generation of cells to the next -Increasing evidence shows that environmental and lifestyle factors may influence epigenetic mechanisms, such as DNA methylation, histone modifications and miRNA expression. -Alterations in epigenetic marks have been associated with a variety of human diseases, including cancer, cardiovascular, respiratory and neurodegenerative diseases

cardiovascular risk factors no modifiable

Family history -If a first-degree male relative (e.g. father, brother) has suffered a heart attack before the age of 55, or if a first-degree female relative has suffered one before the age of 65, you are at greater risk of developing heart disease. -If both parents have suffered from heart disease before the age of 55, your risk of developing heart disease can rise by 50% compared to the general population. -Similar for strokes -Genetic component for both hypertension and abnormal blood lipids (high cholesterol level, known as familial hypercholesterolemia) -Type 2 diabetes also has a genetic component, Age Gender Ethnicity Socioeconomic status

how cities are focusing to end HIV AIDS epidemic

Global epidemic may have peaked in the early 2000s, HIV has been concentrating more in cities. -UNAIDS 200 high prevalence cities -25% of all people living with HIV but represent only 10% of the world's total population. -HIV is highly concentrated in cities in sub-Saharan Africa. -Nearly half of all people living with HIV live in urban areas, but the subcontinent is only 40% urbanized. -A similar pattern of urban concentration manifests in other high prevalence countries as well. -In Brazil and the Russian Federation, more than half of all people living with HIV live in urban areas. -In the USA, just 21 cities can account for 40% of all HIV cases. -In Viet Nam, 31% of all people living with HIV live in just two cities.

Cities with injecting drug use and paid sex are prevalent with HIV infection

HIV prevalence among intravenous drug users in Indonesian cities estimated at up to 56% -infection rates among men who have sex with men (MSM) can be considerably higher in cities. -MSM are 19 times more likely than other men to be living with HIV -Only 14% of MSM living with HIV have access to treatment in low-income countries. -In Bangkok HIV in MSM more than three times the national average. 7% in Thailand vs 25% in Bangkok. -Similarly, in Nigeria, the HIV infection level among MSM is 17%; in the Federal Capital Territory it is more than twice as high (38%) -A study in 24 Mexican cities among MSM found that about 17% of them were HIV-positive

Short term effects of air pollution

Irritation and inflammation -Eyes -Respiratory tract - asthma -Susceptibility to respiratory tract infection -pneumonia -Acute bronchiolitis/RSV disease (respiratory syncytial virus ) -acute infectious disease of the lower respiratory tract due to a viral infection of the bronchioles, usually RSV -Tuberculosis -Toxic chemical effects -Intrauterine effects on fetus -Growth -Development -Fetal abnormalities -Intellectual development

hypertension

Hypertension is one of the leading risk factors for heart disease and the single most important risk factor for stroke -The World Health Organization rates hypertension as one of the most important causes of premature death worldwide and the problem is growing. In 2025 it is estimated there will be 1.56 billion adults living with high blood pressure. -Hypertension is high or raised blood pressure defined as systolic blood pressure level of 140 and above. -Hypertension stresses your body's blood vessels, causing them to clog or weaken. Hypertension can lead to atherosclerosis and narrowing of the blood vessels making them more likely to block from blood clots or bits of fatty material breaking off from the lining of the blood vessel wall. Damage to the arteries can also create weak places that rupture easily or thin spots that balloon out the artery wall resulting in an aneurism. -Raised blood pressure in someone less than 50 years old is associated with an increased cardiovascular risk. As you get older, your systolic blood pressure becomes a more important predictor of the risk of cardiovascular disease. -Dietary salt is a significant factor in raising blood pressure in people with hypertension and in some people with normal blood pressure. If you are already overweight then a high intake of salt increases your risk of cardiovascular disease.

obesity

If you are overweight you may develop hypertension, diabetes and atherosclerosis. These conditions will put you at high risk of cardiovascular disease. -Obesity is one of the many major risk factors for CVD and other NCDs like diabestes. The overall human population is getting heavier as shown by the increasing rates of obesity. Currently, there are 400 million adults worldwide who are obese and one billion who are overweight. There are also increasing rates of obesity in children. Worldwide, 17.6 million children under five are estimated to be overweight. -The latter half of the twentieth century saw major changes to all our diets and how we live. We moved from plant-based diets to high-fat, energy-dense animal-based diets while at the same time becoming physically inactive. Many developing countries face the strange situation of having the problems of under nutrition and obesity, at the same time. -Intra-abdominal fat affects your blood pressure; your blood lipid levels and interferes with your ability to use insulin effectively. You use insulin to process glucose derived from food, our body's primary fuel. If you cannot use insulin properly you may develop diabetes, a risk factor of cardiovascular disease. -As you become overweight, your risk of developing Type 2 diabetes and hypertension rises steeply. Statistics show that 58% of diabetes and 21% of ischemic heart disease are attributable to a BMI above 21.

diabetes

If you develop diabetes you are at greater risk of developing cardiovascular disease. Physical activity is known to reduce the risk of developing Type 2 diabetes. This is particularly true if you are at high risk of diabetes. If you do have diabetes, keeping physically active will better protect your heart. -One study showed that walking at least two hours a week reduced the incidence of premature death from cardiovascular disease by about 50%. In people with diabetes exercise is thought to improve blood glucose control, which reduces the negative impact of diabetes on vascular health.

lead movement

In childhood, blood lead levels reflect the environmental lead level (i.e. exogenous lead). Protection requires placing barriers between the child and the lead.In adults, lead levels reflect the release of endogenous lead from bone, as well as the intake of exogenous lead. Protection requires 1) prevention of exposure and 2) preservation of bone density. -Mobilization of maternal bone lead stores constitutes a major source of fetal lead exposure. -Skeletal contribution to blood lead levels increases from 9% to 65% during pregnancy -Crosses placenta: Fetal/maternal ratio: 0.9 -Fetal blood-brain barrier is open -Peak transfer is at 12-14 weeks gestation

undernutrition and low birth weight

In developing countries, poor perinatal conditions are responsible for approximately 23% of all deaths among children younger than five years old -These deaths are concentrated in the neonatal period (i.e. the first 28 days after birth), and most are attributable to LBW. -LBW can be a consequence of Intrauterine growth retardation (IUGR), preterm birth, or both, but in developing countries most LBW births are due to IUGR -Although the etiology of IUGR is complex, a major determinant of IUGR in developing countries is maternal undernutrition. -Evidence has shown that there is a greater incidence of IUGR births among women who are underweight or stunted prior to conception, or who fail to gain sufficient weight during pregnancy compared to women with normal weight and weight gain.

lead and hemoglobin

Inhibition of the enzymes involved in the formation of the hemoglobin molecule - at BLLs as low as 10 μg/dL. -Intermediate products of inhibited hemoglobin formation (i.e. protoporphyrins) break down and are scavenged along with the red blood cells containing them. -Accelerated scavenging of cells leads to anemia with iron deficiency. -As lower iron levels also promote increased uptake of lead from the gut, this sets up a "positive feedback loop" for lead poisoning and iron deficiency - each promoting the other. -Children have better compensatory erythropoietin responses than adults, and may delay onset of anemia.

Harvard six cities study

Initiated in early 1970s in the following cities Watertown, Massachusetts; Portage, Wisconsin; Topeka, Kansas; Kingston/Harriman, Tennessee; St. Louis, Missouri; Steubenville, Ohio -Release of the study's results in 1993 - different from expected. - Indoor air quality more important to overall health than outdoor air; most people simply spend much more of their time indoors, and pollutants often become concentrated inside homes and workplaces. - Strong, positive correlation between levels of air pollution in cities and mortality: deaths from lung cancer, pulmonary disease, and heart disease were 26 percent higher in Steubenville-a city so polluted that air-born sulfates turned lead-based house paint black within a year-than in Portage, the cleanest city in the study. -Rather than indicating sulfur dioxide, directed attention to the hazards of PM10. This lethal relationship between particulates and cardiovascular mortality has been replicated in studies performed in cities around the world, and focus has subsequently shifted to PM2.5 particles and smaller. -Many subsequent studies, and data re-analyzed for input to federal regulations

long term effects of air pollution

Irritation and inflammation -Chronic lung disease -Toxic chemical effects -Lung cancer -Any other cancers -Long term epigenetic effects on the next generation -Cognitive development/intelligence -Chronic respiratory disease/asthma -Growth and nutrition -Cardiovascular disease -Susceptibility to cancer -Liver disease -Kidney disease -Cardiovascular disease -Stroke

Air pollution and gene expression

Methylation of inducible nitric oxide synthase gene promoter region was decreased in blood samples of individuals exposed to PM10 after 3 days of work in steel plant when compared with baseline. Methylation of Alu and LINE-1 was negatively related to long-term exposure to PM10. -PM exposure associated with histone modifications in steelworkers with high exposure level to PM. -exposure to metal-rich PM induced rapid changes in the expression of two inflammation related miRNAs, i.e. miR-21 and miR-222, measured in peripheral blood leucocytes -extensive alterations of miRNA expression profiles in human bronchial epithelial cells treated with diesel exhaust particles. Out of 313 detected miRNAs, 197 were either up- or down-regulated by at least 1.5-fold. -Black carbon linked to decreased DNA methylation in LINE-1 repetitive elements in 1097 blood DNA samples of elderly men in the Boston area. mice exposed to air particles collected from a steel plant showed global DNA hypermethylation in sperm genomic DNA, a change that persisted after removal of environmental exposure.

NCD and aging populations

NCDs are not confined to cities, but the city environment is conducive to lifestyles and behaviors that contribute to their development, including greater consumption of unhealthy foods, use of tobacco and alcohol, and physical inactivity. -Demographic shifts associated with population ageing also have implications for NCD prevention and control - not only are people living longer, they are also developing NCDs at an earlier age -With up to 80% of older people expected to be living in LMICs by 2050, urgent action is required to ensure that health and social systems are ready to address the growing burden of NCDs

what is the personal cost of NCD

NCDs can also have an adverse effect on the economic position of individuals and their families. -NCDs can be an additional burden to those already facing financial hardship. -In China, 73% of stroke survivors reported experiencing catastrophic health expenditure, whereby their out-of-pocket health-care costs exceeded 30% of their annual household income

arsenic

Naturally occurring element in the earth's crust. -No smell, no taste -Most arsenic compounds dissolve in water -Arsenic compounds are classified as: -Inorganic arsenic (usually combined with oxygen, chlorine, or sulfur) -Organic arsenic (combined with carbon & hydrogen) -Organic arsenic is usually less harmful than inorganic arsenic. -Major route of human exposure to inorganic arsenic -Drinking water -Other minor exposure pathways -Wood preservative -Electronics industry -Manufacturing of copper and other metals -Medicine health effects of arsenic kin: Bowen's disease Cancer: skin, liver, lung, kidney, bladder, prostate Non-cancer Circulatory problems (trouble with blood vessels and circulation) Stocking & glove neuropathy Kidney damage Keratosis, abnormal pigmentation, hair loss

neurodegenerative effects of lead

Neurodegenerative effects (e.g., cognitive decline) have not been as well studied as developmental neurotoxicity. -Associations between bone lead concentrations and neurodegenerative effects are more consistently reported than those between blood lead and neurodegenerative effects. -Scoring less than 24 on the Mini-Mental State Exam (MMSE) was inversely associated with blood lead concentrations among the older men of the Normative Aging Study (NAS) with mean blood lead concentrations of 5 μg/dL (Wright et al. 2003). -Tibia lead, but not blood lead, has been associated with cognitive decline in a cohort of older women with blood lead concentrations of 2.9 μg/dL (Weuve et al. 2009).

Non communicable disease disparities

Noncommunicable diseases and conditions, such as asthma, heart disease and diabetes, are a significant problem in urban centers. -Most of this heightened risk can be traced back to changes in diet and physical activity as a consequence of urbanization, as well as exposure to air pollutants, including tobacco smoke. -urbanization is associated with a shift towards calorie-dense diets, characterized by high levels of fat, sugar and salt - As a result, obesity is on the rise in cities around the world. -people in cities tend to have physically inactive types of employment, and urban sprawl further discourages physical activity. Other factors that inhibit regular physical activity include overcrowding, high-volume traffic, overreliance on motorized transportation, crime and poor air quality. -Poor housing conditions, overcrowding, noise pollution, unemployment, poverty and cultural dislocation can cause or exacerbate a range of mental health problems, including anxiety, depression, insomnia and substance abuse

What areas have the most people living in urban areas

North America 82 Latin America and caribbean 80 europe 73

Observational and quasi experimental studies

Observational studies of the health effects of particulates boils down to a comparison of health outcomes across space and/or time among places with differing levels of air pollution. -Statistical methods, based mostly on regression approaches, aim to "adjust" for observed confounders, by including the available measures of behavioral, socioeconomic, and locational differences as covariates in the regression model. -Since many determinants of health are unobserved, these methods that rely on adjustment for observed confounders can lead to biased estimates of the relation between health and particulates. -e.g people who live in the more polluted places frequently have differing initial levels of health -Another challenge is that there may be locational determinants of health (e.g., hospital quality or water pollution) that differ across the places and are correlated with air pollution levels. -People may choose to live in locations on the basis of their susceptibility to pollution and other related health problems, -may spend greater resources on self-protection in polluted locations

Diseases for air pollution in infants

Pneumonia -Acute bronchiolitis/RSV disease -acute infectious disease of the lower respiratory tract due to a viral infection of the bronchioles, usually RSV -Tuberculosis -Late effects -Cognitive development/intelligence -Chronic respiratory disease/asthma -Growth and nutrition -Cardiovascular disease -Susceptibility to cancer

asthma and air pollution

Regulatory T (Treg) cells are suppressors of immune responses involved in asthma pathogenesis. -Increased DNA methylation of Forkhead box transcription factor 3 (Foxp3) associated with Treg-cell impairment -Ambient air pollution suppresses Treg-cell function allowing amplification of an inflammatory response.

what happens when nations develop

infectious disease rate drop -life expectancy increases -infant mortality declines -cancer and cardiovascular diseases increases sometimes this isn't true because the developing world have modern and tradition risk, where the profile is additives

diarrheal disease

makes up 80 percent of infectious diseases, 5 million people die each year, 2 mill die from water related

tobacco

Smoking is a major cause of heart disease. Smoking increases the risk of stroke, coronary heart disease and impotence by 100%. Smoking increases the risk of death from undiagnosed coronary heart disease by 300% -Many people do not recognize smoking as a cause of heart disease. For example, only 4% of Chinese know that smoking causes heart disease. In the USA, the majority of smokers do not believe they have a greater risk of heart disease than non smokers. -If you smoke and started smoking while still a child, your risk of cardiovascular disease is much higher than someone who started as an adult. -Smoking promotes cardiovascular disease through a number of mechanisms. It damages the endothelium (the lining of the blood vessels), increases fatty deposits in the arteries, increases clotting, raises low-density lipoprotein cholesterol, reduces high-density lipoprotein and promotes coronary artery spasm. -Globally, one in five men smoke -However, there is substantial regional variation: in the Asia-Pacific region, 1 in 2 urban men smoke compared to 1 in 6 in the African and LAC regions -The poorest 1/5 of urban men are nearly twice as likely to smoke as the richest 1/5 -Smoking is particularly high among the urban poor in Bangladesh and Indonesia, where 7 in 10 and 8 in 10 urban men in the poorest 1/5 of households smoke.

what are the effects of smoking

Smoking is the second-leading cause of death globally. More than 11% of all global deaths in 2015 were attributed to smoking, totaling 6.4 million. Over half of these smoking-related deaths took place in just four countries: China (1.8 million) India (743,000) the United States(472,000) Russia (283,000) -Despite strong declines in the rate of tobacco smoking over the past 25 years, in 2015 1 in 4 men still smoke daily, as do one out of every 20 women -Prevalence of daily smoking declined on a global scale - decreasing by 28% for men and 34% for women between 1990 and 2015. -The number of daily smokers globally continues to rise year-over-year due to population growth. As of 2015, there were 933 million daily smokers. -Growth in the sheer number of daily smokers still outpaces the global decline in daily smoking rates, indicating the need to prevent more people from starting -3 countries with the most male daily smokers in 2015 accounted for over half of all men who smoked daily worldwide. Countries with the most male daily smokers in 2015 were China with 254 million, India with 91 million, and Indonesia with 50 million. -3 countries with the highest number of female daily smokers in 2015 accounted for just over 25% of all female daily smokers worldwide. Countries with the most female daily smokers in 2015 were the Unites States with 17 million, followed by China with 14 million, and India with 13.5 million.

genetics

Some smokers possess a gene that increases their risk of developing coronary heart disease by up to four times. About a quarter of us have this gene. -If you are a woman and smoke three to five cigarettes a day, you double your risk of heart attack. A man would have to smoke six to nine cigarettes a day to double his risk. -Quitting smoking effectively reduces cardiovascular risk to close to that of a person who has never smoked over a period of time.

stress

Stress has been shown to be a possible risk factor for cardiovascular disease. This is because living a stressful life can cause people to adopt poor habits like smoking and eating badly, which are risk factors for cardiovascular disease. -But being stressed itself can alter the way the body behaves and this can bring about changes to the blood and nervous system, which can have negative effects on your heart health. -One way to alleviate stress is through regular physical activities like running or riding a bike - another reason why it is important to maintain an active lifestyle

Tuberculosis in relation to HIV

TB continues as a major public health threat, particularly in large urban centers. -It ranks alongside HIV/AIDS as a leading cause of death worldwide -WHO estimates that 9.5 million people were sick with TB in 2014. -For 1.5 million people, the illness was fatal. -Complicating the challenge is that the disease continues to evolve due to incomplete or inappropriate treatment. Drug resistant strains have emerged, with 500 000 cases of MDR-TB estimated worldwide. -More troubling still, the emergence of extensively drug resistant tuberculosis (XDR-TB) means that most second-line therapies are no longer efficacious for affected patients, treatment can cost up to half a million dollars and cure rates are very low

TB in cities

TB has managed to proliferate in large urban areas, particularly among densely populated, deprived communities. -TB continues to be more widespread in large cities in the developing world, where rapid urbanization, poverty and inadequate living conditions exist on a far greater scale without commensurate capacity in the health system to cope -A study in three slum districts of Abia and Anambra States in Nigeria found the prevalence of TB to be 6.4%. -Similar studies have shown lower, but still unacceptably high TB prevalence in slums in Bangladesh (0.3%), Cambodia (0.2%) and Uganda (3.5%)In some larger cities of low-burden, higher-income countries, TB incidence can be several multiples or more of the national average. -TB incidence in Toronto, Canada, and Osaka, Japan, is three times their respective national averages. -At least 15 large cities in Europe have been found to have more than doubled the national incidence rate, even as national rates are falling in Europe

physical inactivity

The increasing urbanization and mechanization of the world has reduced our levels of physical activity. The World Health Organization believes that more than 60% of the global population is not sufficiently active. -Physical activity increases your life span, regardless of any adverse inherited factors. Physical activity, at any age, protects against a multitude of chronic health problems including many forms of cardiovascular disease. -Physical activity protects you by regulating your weight and improving your body's use of insulin. Being active is beneficial for your blood pressure, blood lipid levels, blood glucose levels, blood clotting factors, the health of your blood vessels and inflammation, which is powerful promoter of cardiovascular disease. -Studies show that doing more than 150 minutes (2 hours and 30 minutes) of moderate physical activity every week will reduce your risk of coronary heart disease by about 30%. -Even if you have existing risk factors for cardiovascular disease, if you keep active the evidence suggests that this may lower your risk of premature death compared to inactive people with no risk factors for cardiovascular disease. -The good news is that even small increases in physical fitness are associated with a significant reduction in cardiovascular risk, even if you have existing disease.

diet

The role of diet is crucial in the development and prevention of cardiovascular disease. -Diet is one of the key things you can change that will impact all other cardiovascular risk factors. -A diet high in saturated fat increases the risk of heart disease and stroke. It is estimated to cause about 31% of coronary heart disease and 11% of stroke worldwide. -Comparisons between a diet low in saturated fats, with plenty of fresh fruit and vegetables, and the typical diet of someone living in high-income countries show that in the former there is a 73% reduction in the risk of new major cardiac events. -A diet high in saturated fats (e.g. cheese) and trans fats (often used in cakes, cookies and fast food) leads to high levels of cholesterol. -Saturated fats are found in animal products. Trans fats are oils that have been hydrogenated to turn them into semi-hard fats. Hydrogenated fat is found in processed food like shop-bought cakes, biscuits, stock cubes and a range of other products you buy every day. Saturated and trans fats raise cholesterol levels in the blood, which in turn can lead to atherosclerosis. -Unsaturated fats, polyunsaturated and monounsaturated are beneficial for heart health. They are present in fish, nuts, seeds and vegetables.

how are tobacco industries trying to grow and who are they targeting

The tobacco industry is now turning its focus toward emerging markets in sub-Saharan Africa, seeking to exploit the continent's patchwork tobacco control regulations and limited resources to combat industry marketing advances -Helped by increasing urbanization -Unless daily smoking is significantly reduced from current levels, the total number of smokers will continue to rise and place tremendous burden on health systems -Mostly in countries who don't have the resources to cope -Given the large effects of population growth and ageing on smoking-attributable disease burden—and Africa's rapidly changing demographic profile - the increase in health impacts will be dramatic -World Health Assembly in 2003 adopted the WHO Framework Convention for Tobacco Control (WHO FCTC)-implementation of robust tobacco control programs -In 2008 WHO established the MPOWER measures with a focus on cost-effectiveness, practicality, and impact

UNAIDS 90-90-90

UNAIDS asked mayors in the 35 highest prevalence nations, which account for over 90% of all new infections and more than 90% of people who die from AIDS-related causes to sign the Paris Declaration -pledged to reach three concrete goals by 2020 -90% of their constituents living with HIV will know their HIV status, -90% of those who know their status will be receiving HIV treatment, -90% of people on HIV treatment will have a suppressed viral load (the) -These "fast-track countries" are home to more than three quarters of the highest prevalence cities in the world.

undernutrition

Undernutrition, defined as underweight, is a serious public-health problem that has been linked to a substantial increase in the risk of mortality and morbidity. -Women and young children bear the brunt of the disease burden associated with malnutrition. -In Africa and south Asia, 27−51% of women of reproductive age are underweight -Many of the 30 million low-birth-weight babies born annually (23.8% of all births) face severe short-term and long-term health consequences. -Undernutrition is defined by an insufficient provision of energy and nutrients, such as good quality protein with an adequate balance of essential amino acids, vitamins and minerals, and an inability to meet the requirements of the body to ensure growth, maintenance, and specific functions. -affects more than 900 million individuals around the World. -per year more than 160 million DALYs are lost due to hunger, which is more than 6 percent of the total burden of disease -Although it is rarely the direct cause of death (except in extreme situations, such as famine), child malnutrition was associated with 54% of child deaths (10.8 million children) in developing countries in 2001 -Child and maternal undernutrition is responsible for approximately 3.5 million deaths in children below the age of 5 years and for 35% of the disease burden in this age group -Stunting, low weight and low birth weight (LBW) are together responsible for 2.2 million deaths among children (<5 y) worldwide and for 21% of disability-adjusted life years (DALYs) -highest mortality rate in children

inadequate drinking water, sanitation and hygiene (wash)

WASH to include the following transmission pathways: (i) ingestion of water - for example diarrhoea, arsenicosis, fluorosis; (ii) lack of water linked to inadequate personal hygiene - for example diarrhoea, trachoma, scabies; (iii) poor personal, domestic or agricultural hygiene - for example diarrhoea, Japanese encephalitis; (iv) contact with water - for example schistosomiasis; (v) vectors proliferating in water - for example malaria; and (vi) contaminated water systems - for example legionellosis (Prüss et al. 2002).

what is histone modification

a combination of different molecules can attach to the tails of proteins called histones, these alter the activity of the DNA wrapped around them -the histone core is an octamer of 4 histone proteins -each protein has a structured domain, histone fold and unstructured n terminal tail -protection and packaging of the genetic material are largely performed by histone proteins -Also offer regulate DNA transcription, replication and repair -Histones can be covalently modified by acetylation (Ac), methylation, phosphorylation, glycosylation, sumoylation, ubiquitination and adenosine diphosphate (ADP) ribosylation thus influencing chromatin structure and gene expression. -The most common histone modifications that have been shown to be modified by environmental chemicals are acetylation and methylation -A single acetyl group added to each amino acid residue usually increases gene transcriptional activity; -Histone methylation (Me), found as mono (Me), di-methyl (Me2), and tri-methyl (Me3) group states inhibit or increase gene expression depending on the amino acid position that is modified

What is malnutrition

malnutrition generally refers both to undernutrition and overnutrition Increasingly undernutrition is used in its broadest sense, meaning inadequate nutrition, which includes an insufficient quantity of food as well as an inadequate consumption of food in qualitative terms. This is important because the consumption of energy-dense foods with poor nutrient quality is a problem today that also affects developing countries and the poorest populations. This new nutritional situation further increases the impact of the long-lasting effects of undernutrition. overlapping burdens of undernutrition and overnutrition—often referred to as the double burden of malnutrition (DBM)—are the new normal

what non communicable diseases are men and women dominated by

men are by cardiovascular disease and women are by cancer

Histone modifications for acetylation and methylation

acetylation -It is the introduction of an Acetyl functional group to the Lysine amino acid of the histone tail. -These reactions are catalyzed by enzymes with "histone acetyltransferase" (HAT) or "histone deacetylase" (HDAC) activity. -Acetylation removes +ve charge of the histone tail, reducing affinity for the -ve charged phosphate groups of DNA -It also reduces affinity of tail for adjacent nucleosomes, thus affecting ability of nucleosome arrays to form more repressive higher-ordered chromatin structures. -Also, acetylation is involved in nucleosome assembly and interaction of histone with other regulatory proteins, creating a transcription permissive environment. -Modification of histone tails by acetylation is known to increase the access of transcription factors to DNA through structural changes in nucleosomes or nucleosomal arrays. Acetylated histones are also specifically recognized by other proteins. The bromodomain, found in transcription factors and HATs allows for the preferential recognition of histone tails when they are acetylated at specific lysine residues Methylation -It is the introduction of an Methyl functional group to Lysine or Arginine of the histone tail. -These reactions are catalyzed by enzymes with "histone methyltransferase" -'Arg' can be methylated once or twice, and 'Lys' once, twice of trice. -Methylation does not neutralize charge but recruit silencing or regulatory proteins that bind methylated histones. -Chromodomain containing proteins interact with methylated histone tails. -Methylation generally associated with transcription repression, but specific methylations result in activation. -They can loosen the tail allowing transcription factors to access DNA or encompass the tails around DNA restricting access

what are the determinants of health

age sex and hereditary individual lifestyle social and community influence living and working conditions socioeconomic, cultural, and environmental conditions

where does lead exposure vary

by race, and socioeconomic status -black people have the highest -low income is the highest

How do genes interact with the environment?

coding sites-mutation interacts with gene-adducts transcription site-expression --DNA methylation --Histone modification --miRNA

Urban health can be broadly divided into

communicable diseases, maternal and infant health, undernutrition, noncommunicable diseases including mental health, accidents, and violence and crime

what are some urban hazards

crowded living conditions and no housing -problems with food and water supply -inadequate sanitation and solid waste disposal services -air pollution -congested traffic -leave poor more injured -leads to obesity -triple threat of infectious diseases, non communicable diseases, and unhealthy lifestyles

where will urban population grow in the next 30 years

developing countries mostly in Asia and africa

what are some diseases relating to the environment

diarrhea, lower respiratory infections, unintentional injuries, malaria, road traffic injuries

Death in urban poor Kenya

epidemiological transition with deaths linked to communicable diseases declining from 66 % in 2003 to 53 % in 2012, -Deaths due to non-communicable causes experienced a four-fold increase from 5 % in 2003 to 21.3 % in 2012 -Another two-fold increase in deaths due to external causes (injuries) from 11 % in 2003 to 22 % in 2012.

Comparative risk assessment method

exposure levels, exposure response relationships and the disease burden all add up to attributable burden by age sex and region

PAPAS

five studies of the acute mortality impact of current ambient particulate air pollution in several large metropolitan areas in East and Southeast Asia. -10-μg/m3 increase in PM10 level was associated with a 0.6% (95% confidence interval, 0.3-0.9) increase in daily rates of all natural-cause mortality -comparable to those reported in U.S. and European multi-city studies at levels of exposure several times higher than those in most large Western cities -significant effect modification of influenza -significant effect of temperatures

What is a downfall of urbanization

government cannot provide essential infrastructure -poorly designed water and sanitation -unsuitable housing -in undesirable parts of the city

health quite part 2

health equity remains a hurdle to accomplishing the fast-track goals by 2020. -Urban slums and informal settlements are crucial issues that must be addressed not only on the grounds of social justice, but also as clear obstacles to making progress with HIV poor -less educated urban women, in particular, are less likely to have comprehensive knowledge of how the HIV virus is transmitted than their wealthier, more educated peers -In Pakistan, for example, the wealthiest urban women are nearly six times more likely to have knowledge of transmission than the poorest urban women. -In the Ukraine, highly educated women are more than 2.5 times more likely to have comprehensive knowledge than poorly educated women. -Urban women in nearly all fast-track countries are less likely to have this knowledge than urban men

Lead

housing problem -lead paint as well as other paints chips pose a problem with older homes, buildings, and schools -lead contaminated soil is a significant source of lead exposure in children -other sources are drinking water, imported candles and food, workplace or hobbies -lead used in gasoline declines by 99.8 percent from 1976 to 1990 -percentage of food and soft dink cans manufactures in the United States that contained lead solder declined from 47 percent in 1980 to 0.9 percent in 1990

Lead nowadays

in California 5427 children less than 6 years old had dangerous levels of lead in their blood in 2005 there are two types of lead paint -white lead -red lead -it makes air pollution worse as well -lead exposure increases violent crime

what can we learn from outbreaks to make cities more resilient

in an acute emergency, people need to make decisions in a short time, the decisions may be irreversible, and yet information can be incomplete or uncertain. -Equally importantly, people and their communities need to trust the messenger and the information that they receive. -need to communicate to the public what they know about the disease and how to prevent its further spread. -uncertainty is a given, that community members need help to accept it and that communicating honestly about it can build trust and confidence

Is the proportion of people living in urban areas increasing or decreasing

increasing in 1950 around 3 in 10 people lived in urban areas in 2008 more than half did in 2050 it will grow from 7 to 10 people

what is DNA methylation

methyl marks added to certain DNA bases repress gene activity -most commonly studied and best understood epigenetic mechanism regulates gene expression and maintains genome stability -reactivation transcription of otherwise silenced adjacent genes. -Global hypomethylation (reduction in DNA methylation content) is associated with genomic instability and an increased number of mutational events -because of their high representation throughout the genome, LINE-1 and Alu have been used as global surrogate markers for estimating the genomic DNA methylation level in cancer tissues. -Aberrant gene transcription often occurs by hyper- or hypo-methylation in promoter regions of the genes. -Methyl groups may be attached to cytosine (C5 position). -Methyl groups provide a tag. -Concentrated in CG-rich domains: often in promoter regions. -Methylation of promoter DNA highly correlated with gene repression.

miRNA

miRNAs are short single-stranded RNAs of approximately 20-24 nucleotides in length that are transcribed from DNA but not translated into proteins. -miRNAs negatively regulate expression of target genes at the post-transcriptional level by binding to 3'-untranslated regions of target mRNAs - the section of messenger RNA (mRNA) that immediately follows the translation termination codon -miRNAs are involved in the regulation of gene expression during cell proliferation, apoptosis, control of stem cell self renewal, differentiation, metabolism, development and tumor metastasis. -Fine-tuning of gene expression or quantitative regulation. miRNAs also play key roles in modifying chromatin structure and participating in the maintenance of genome stability -The aberrant expression of miRNAs has been linked to various human diseases, including Alzheimer's disease, cardiac hypertrophy, altered heart repolarization, lymphomas, leukaemias, and cancer at several sites

racial differences for undernutrition

no difference for children under 6 years old

is it straight forward to compare health effects across disease types and population groups

no, death is easy to determine but hard to measure -everyone dies -health never achieved -age is important

health inequalities

refer to the subset of health inequalities that are systematic, socially produces and unfair. they are not distributed randomly but rather show a consistent pattern across the population often by socioeconomic statues or geographical location ex: in glasgow scotland male life expectancy varies from 54 to 82 depending on which part of the city in which the person lives

health inequality

simple differences in health between groups of people. These differences might be due to non modifiable facts such as age or sex, or modifiable factors such as socioeconomic status ex: the death rates among people in their eighties are higher than those among people in their twenties

Megacities are dualcities

the poor are living in slums while the middle and upper class are getting recourses and opportunities -gap is widening

attributable burden is

the population attributable fraction (PAF or the fraction of the disease due to the risk factor) plus the disease burden

lead and adult reproduction

women have miscarriages and still births and inability to conceive wen have decreased libido, decreased fecundity, sperm abnormalities