ACP says policies needed to improve environmental health 

1. ACP says policies needed to improve environmental health  

Abstract: https://www.acpjournals.org/doi/10.7326/M22-1864  

Editorial: https://www.acpjournals.org/doi/10.7326/M22-2808  

Note: Expert soundbites available for download at https://www.dssimon.com/MM/ACP-environment-health 

URL goes live when the embargo lifts 

Environmental pollutants can seriously harm human health, says the American College of Physicians (ACP) in a new position paper published today in the Annals of Internal Medicine, Environmental Health: A Position Paper From the American College of Physicians. The paper details policy actions that are needed to address the climate crisis and reduce exposure to hazardous substances and air and water pollution. ACP affirms the need to achieve environmental justice so that everyone can live, work, learn, and play in a safe, healthy environment. 

The paper reflects many of the concerns previously outlined in ACP’s 2016 paper, Climate and Health, but broadens recommended policy actions to include a wider array of environmental exposures that impact human health. In order to improve environmental health for all: 

• ACP recognizes that human and planetary health are interconnected, and that climate change is a global human and environmental health crisis. ACP calls for immediate action to limit global temperature rise to 1.5 degrees Celsius above preindustrial levels.  

• ACP calls for comprehensive action to achieve environmental justice. 

• ACP supports efforts to reduce indoor and outdoor air pollution and affirms support for the Clean Air Act. The Environmental Protection Agency (EPA) should set robust air quality standards to protect public health and welfare. 

• ACP supports improvements to the Safe Drinking Water Act, Clean Water Act, Lead and Copper Rule, and other laws and regulations dedicated to ensuring access to clean, potable, safe water. 

• ACP supports action to protect the public from harmful exposures to toxic substances, including new and existing chemicals, with particular attention to children, pregnant people, and other susceptible populations. 

• ACP recommends sustainable and sufficient funding for federal agencies with an environmental health mission 

An accompanying editorial by authors from Icahn School of Medicine and Harvard Medical School call on ACP’s policy recommendations to be implemented immediately to both save lives and relieve stressed healthcare delivery systems already struggling from increased demand. The authors also call on ACP to translate their policy recommendations into actionable plans to ensure that healthcare systems can act on recommendations. They also advocate for policies link greenhouse gas reductions to Centers for Medicare & Medicaid Services participation and payment models, rather than healthcare systems only making pledges to implement policies.  

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with someone from ACP, please contact Jacquelyn Blaser at jblaser@acponline.org.  

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2. Vitamin D deficiency associated with increased mortality risk 

Abstract: https://www.acpjournals.org/doi/10.7326/M21-3324  

URL goes live when the embargo lifts    

A study of more than 300,000 adults in the United Kingdom has found support for a causal relationship between vitamin D deficiency and mortality. These findings suggest a need for public health strategies to maintain healthy levels of vitamin D in the population. The study is published in Annals of Internal Medicine.  

Low vitamin D status has been linked to increased mortality, but mortality in the context of vitamin D deficiency remains unclear. Randomized controlled trials either fail to recruit people with severe deficiency or, because of ethical reasons, are prevented from doing so. 

Researchers from the University of South Australia, Adelaide, South Australia, conducted a nonlinear mendelian randomization study of 307,601 participants in UK Biobank, a large-scale biomedical database and research resource, to assess genetic evidence for the causal role of low vitamin D status in mortality. The authors evaluated measurements of participants’ 25-hydroxyvitamin D (25-(OH) D) and other genetic data. They also recorded and analyzed both all-cause and cause-specific mortality data. Over a 14-year follow up period, the authors found that the risk for death decreased significantly with increased vitamin D concentrations, and the strongest effects were seen for persons in the severe deficiency range. They note that recent estimates for the prevalence of severe deficiency range from 5 to 50 percent of the population, with rates varying by geographic location and population characteristics. According to the authors, their study affirms the potential for a notable effect on premature death and the continued need for efforts to abolish vitamin D deficiency. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Elina Hyppönen, PhD, please email elina.hypponen@unisa.edu.au. 

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3. Physicians call on health care organizations to reduce greenhouse gas emissions 

Abstract: https://www.acpjournals.org/doi/10.7326/M22-1241    

URLs go live when the embargo lifts    

In a new commentary published in Annals of Internal Medicine, authors from Lahey Hospital and Medical Center, Beth Israel Lahey Health, Tufts University of School of Medicine and Case Western Reserve University offer strategies for healthcare organizations to reduce greenhouse gas emissions and outline potential strategy tradeoffs to consider toward this goal.  They say health care has a moral imperative to reduce its emissions and environmental footprint and force transformation across all other sectors it touches. 

The health care industry is both directly impacted by and a contributor to climate change. Extreme temperatures, forest fires, and natural calamities, and the expansion of the range of infectious 

Diseases all have health impacts on persons worldwide. The global health care industry also leaves a significant environmental footprint, with healthcare accounting for the fifth-largest source of all greenhouse gas (GHG) emissions. Currently, there is no mandate to force these organizations to prioritize the reduction of GHG emissions.  

In their call to action, the authors outline three broad scopes to understand the sources and magnitude of GHG emissions in the health care industry: direct emissions from healthcare organizations; indirect emissions by energy and utility suppliers; and supply chain and other emissions. The authors then argue that the short-term investments in more expensive but sustainable health care infrastructure are often both reasonable and profitable in the long term. They also call on health care stakeholders, policymakers, and clinicians to implement high-level changes to make healthcare more sustainable. They advise that providing health care for all will not succeed without addressing the twin risk for environmental pollution and ecological catastrophes secondary to climate change. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author, Sarju Ganatra, MD, please contact Sarju.ganatra@Lahey.org.  

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