American Heart Month- The Environmental Health Connection

The American Heart Association designates February as American Heart Month.  During the month, much effort is spent on helping the public become aware of the importance of addressing lifestyle factors, like diet and exercise, keeping blood pressure within the optimal range, knowing the signs of heart attack, and being able to perform cardio-pulmonary resuscitation (CPR).  All of these factors and more are important to avoid heart disease and support those who are affected.  Heart disease is the number one cause of death overall for men and women in the United States.

One rarely hears any mention of the role that environmental exposures play in causing or exacerbating heart disease.  Scientists have established that environmental factors increase the risk of cardiovascular disease.  For example, carbon monoxide and ultra-fine particles that result from combustion and the complex mixture of toxic chemicals present in tobacco smoke all have been associated with cardiovascular disease. Sodium, which is a very common ingredient in processed and prepared food, has been connected with elevated blood pressure.  Excessive refined sugar has been shown to be associated with heart disease risk.  Maternal exposure to certain substances in the environment can increase the risk of birth defects in children.

Other connections between heart health and the environment are present.  For example, we know that people prefer to be physically active in settings (i.e., environments) that are clean, well-lighted, safe, and have well-maintained amenities.   Regulation of the environment, coupled with good planning, help to provide places in communities that have healthy places like parks, trails, schools, and other community facilities.  Community blight, neglect, litter, deteriorated housing, and noise levels foster persistent stress among residents and contribute to greater cardiovascular risk.

Environmental Health Professionals can and do contribute to heart health is many ways.  They investigate and evaluate environmental contamination, air pollution, indoor environments, building hygiene, and food establishments and stores.  Environmental Health Professionals work with community members to identify problems, to improve conditions in neighborhoods by eliminating places with improperly disposed trash, to help to get stray animals controlled (who wants to go out and exercise with packs of stray dogs in the streets?), and to eliminate blight.  Environmental Health Professionals help community members improve overall environmental awareness.  They work with city planners to plan, design, and oversee the building of new amenities like parks and trails.  They work with employers to cut down on unnecessary vehicle use by encouraging walking, bicycling, and transit use, and help to ensure that the risks from injury are minimized.

The U.S. Environmental Protection Agency has a healthy heart program that emphasizes the connection between good environment and heart health.  EPA also provides the AirNow web page that forecasts local air pollution levels and lets community members know the when it is safer and healthier to be active outdoors.  The Centers for Disease Control and Prevention also promotes the connection between healthy environment and improved heart health and overall well-being.

Public health approaches that address multiple sets of factors and target multiple levels or domains are the most likely to be successful. Public health professionals and community members should support comprehensive approaches that promote healthy lifestyle through awareness, education, public policy, and improvement of the environment.  Support the efforts to improve heart health and reduce the toll of heart and circulatory diseases throughout the Nation.  Good environment and heart health complement each other nicely!

Smoking and the Surgeon General

In January 1964, the Surgeon General of the United States, Luther Terry, did something extraordinary.  Dr. Terry released a report, on behalf of the U.S. government, that stated to the American people that something in their lifestyle was harming them.  Smoking up to that point was not commonly viewed as a health hazard. The most popular people in America promoted smoking (including a future President). Doctors frequently were smokers (including Dr. Terry) and advice from doctors was prominent in tobacco advertising. At the time, over 40 percent of Americans were smokers. In those days, government health programs were mostly focused on communicable disease prevention efforts.

Dr. Terry's report awoke Americans to an awful truth: smoking is a serious, deadly health problem.  It causes cancer, heart disease, respiratory conditions, pediatric problems, injury from house fires, and more.  Even though the Surgeon General's report began a series of actions to reduce the harmful effects and to counter widespread marketing, sales, and use of tobacco products, we continue to suffer from the burden today, as millions still smoke, many former smokers eventually have compromised health or die early, and many non-smokers (including children) suffer health problems from second-hand smoke.

Since 1964, 29 Surgeon General's reports have been issued.  Topics have ranged from the health risks of specific diseases like cancer, lung, and heart disease to ways to quit.  Another report addressed the health effects from second-hand smoke effects. Many others have become involved, including the CDC, NIH, FDA, World Health Organization (WHO), non-government groups like the American Cancer Society and the American Lung Association, medical doctors, and nearly every state or local health department.

The latest report, The Health Consequences of Smoking: Fifty Years of Progress, documents how we have made progress in addressing this scourge.  The rate of smoking in the U.S. has fall by over one-half. Millions of premature deaths have been prevented because of the efforts of public health workers, politicians, educators, and citizens who have taken a stand against tobacco. The Surgeon General documents many of the personal battles to break free from tobacco addiction.  The report also discusses what needs to be done in the future to eliminate disease, disability, and death from tobacco.

Unfortunately, tobacco continues to be the cause of a huge burden of death and illness. Over 40 million American adults continue to smoke, according to the CDC. The rate of smoking (and health burden) worldwide continues to increase. New challenges have been introduced like e-cigarettes, little cigars, hookah, and flavored tobaccos. Public health personnel, including environmental health, are on the front lines of the effort to address smoking, still rightfully called the leading preventable cause of death in the U.S.  It continues to be a major priority for public health and will continue to be for the foreseeable future.