Home to multiple high-power universities, agencies, corporations, and non-profit organizations, the Triangle Area presents an ideal environment for stimulating productive, synergistic, activity exploring environmental aspects of health. Members of the Duke School of Medicine (DSOM) together with investigators at the Duke Nicholas School of the Environment (NSOE), the Duke Law of School, the Duke Margolis Center for Health Policy, and other Duke institutes and centers have a history of involvement in both basic and population research arenas.
Environmental health research explores the impacts of our natural and man-made environment on human health. Yet, the environment is not limited to our air, water, soil and food. It also encompasses our sociocultural environment, economic environment, work environment and family environment. The phrase “applied environmental health” means translating the results of environmental health research into positive actions and public health interventions that are appropriate in the context of our total sociocultural and economic environment at local, national, and global levels.
Dr. H. Kim Lyerly, Director of the Duke Center for Applied Therapeutics, Chief of the Section of Applied Therapeutics, Department of Surgery, has therefore established an Environmental Health Scholars program to maintain the momentum created by their work in applied environmental health, and to support new investigators focused on these activities.
Research, Bioinformatics, and Population-Based Studies That Can Influence Policy
New research in applied environmental health will be greatly facilitated by the coordination of diverse databases and registries, including clinical, behavioral, environmental, geospatial, and biomarker datasets. The advent of data interoperability opens up new possibilities for research into as yet poorly understood associations between environmental factors and disease risk. An example initiative exploiting coordinated data repositories at Duke is the use of geospatial information system (GIS) applications, in combination with advanced spatial statistical approaches, to investigate clinical and environmental factors associated with the physical location of patients.
Core objectives of dataset coordination include the following:
- Identification of temporal and spatial clusters of diseases, overall and by tissue classification
- Description of longitudinal temporal and spatial patterns of disease occurrence and progression
- Determination of the relationship between diseases and possible environmental threats, analyzed by patients’ socioeconomic status, racial/ethnic status, disease characteristics, and access to care
The approach of leveraging coordinated datasets to better understand patterns of disease impact creates a research infrastructure that can powerfully support analyses of associations between environmental exposures and disease incidence.
There is a growing recognition that, in order to ensure the affordability of the healthcare system, healthcare policy must prioritize prevention. Critical information that can help to shape health policy focused on disease prevention will pertain to associations between environmental factors and health risk. To generate this information and to provide it to operative individuals in federal and state government, we have begun an active agenda of communication, education, and collaboration.
Since January 2010, Duke has engaged William G. Ross, Jr., former Secretary of the North Carolina Department of Environment and Natural Resources – to lead the policy-oriented efforts of the research. He has begun to forge dynamic connections between multi-disciplinary Duke investigators involved in environmental research and policy-makers.
Activity was launched with a presentation made on April 6, 2010 by Ken Cook, founder and president of the Environmental Working Group (EWG), a nonprofit organization headquartered in Washington, DC; the EWG focuses on the areas of toxic chemicals, agricultural subsidies, public lands, and corporate accountability. Mr. Cook’s talk, attended by approximately 200 people, was followed by numerous events designed to initiate ongoing discussion and working relationships between the EWG, state policy-makers, and Duke investigators studying health/environment associations. Example outcomes of the event were (1) networking between the EWG policy director and state legislators interested in issues related to toxic chemicals, and (2) the inclusion of epigenetics (a topic raised by Dr. H. Kim Lyerly, in conversations preceding Mr. Cook’s presentation) in recently introduced legislation to reform the Toxic Substances Control Act of 1976.
By investing in investigators whose major goal is to study the effects of the environment on health and disease risk, society will accrue enormous benefits. By fostering collaboration, it would allow investigators to do better research and make more rapid progress than they could working on their own. An illustrative example of the dynamic and collaborative activities of the Environmental Health Scholars is illustrated by recent work in respiratory health and air quality.
The Research Triangle Environmental Health Collaborative, a coalition of university programs and agencies, holds summits on issues related to the environment and health including a 2010 summit titled “America’s healthcare policy through the lens of environmental health.” A white paper report of this summit was published as an academic report "Bridging the information gap between health and the environment in North Carolina" by Kearney GD, Shehee M, Lyerly HK, in the Journal of Public Health Management Practice in 2013. A major conclusion of this paper was to bridge knowledge gaps between environmental and health data to draw attention to the environmental effects of health.
Based on that recommendation, Dr. Lyerly and his group published an academic report “Long-term dynamics of death rates of emphysema, asthma, and pneumonia and improving air quality” by Julia Krauchanka, Igor Akusheveich, Amy P. Abernethy, Sheila Holman, William G. Ross Jr., and H. Kim Lyerly, in the International Journal of Chronic Obstructive Pulmonary Disease in 2014. Using mortality trends from state public health data, along with monthly measurements from air-monitoring stations across North Carolina from 1993-2010, they were able to draw a close association between improved air quality and declining death rates from respiratory illnesses. They concluded that national and state air pollution controls that went into effect in the early 1990s coincide with decreasing death rates from emphysema, asthma and pneumonia among people in North Carolina. This study was specifically cited by editorials regarding the US Supreme Court’s decision in June 2014 to keep intact the Environmental Protection Agency’s power to regulate carbon emissions.
Key opportunities include a new understanding of the role of environmental signals that trigger cell behavior along disease pathways. This knowledge can results in:
- Informing environmental scientist and policy makers about the potential risk of environmental pollutants, better inform studies designed to document these risks
- Creating opportunities to intervene and develop treatment or prophylaxis to these environmental exposure
- Knowledge gained by the process will lead to opportunities to develop key information about molecules that have therapeutic effects on pre-disease conditions
Most importantly, this effort would ensure progress on the path toward both saving lives and our environment that are now being lost or destroyed by diseases and environmental exposures.
- NC Medical Journal: Health and the Environment in NC
- Duke Nicholas School of the Environment (NSOE)
- Duke Law of School
- Duke Margolis Center for Health Policy
- Clean Air Carolina
Advanced Education and Training
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Please contact H. Kim Lyerly at firstname.lastname@example.org.