What Goes Around Comes Around

By Devon Murray 

Photos by Ahmad El-Nimr

Healthy Environment, Healthy Body

Numerous studies have linked the fallout of climate change to an increase in both infectious and chronic diseases, many of which are irreversible.  

AUC’s Institute of Global Health and Human Ecology (IGHHE) is working to identify and understand more of these links, which may help us anticipate, mitigate or adapt to these challenges. 

“Climate change is a complex issue that goes beyond weather patterns, melting of polar ice caps and rising sea levels,” said Hassan El-Fawal, professor of biomedical sciences and IGHHE founding director.

“What we’re talking about are the harmful human activities that have led to climate change and the fact that they impact our health. It’s a vicious cycle because humans do not exist in a vacuum. They affect and are affected by their environment, from before the cradle to the grave.” 

At the institute, which includes physicians, toxicologists, environmental scientists and psychologists, El-Fawal and his team are investigating the dire health consequences of general pollutants such as synthetic fertilizers and pesticides; toxicants and bacteria in water, fish and plants; industrial emissions; and microplastics. “The World Health Organization reports that non-communicable diseases pose the greatest challenge to low- and middle-income countries,” said El-Fawal. 

The team is also looking at the effects of climate change and associated chemicals on the increase in non-communicable diseases, such as diabetes, strokes, heart conditions, chronic respiratory illnesses, cancer, Parkinson’s and Alzheimer’s — which makes it crucial to study the global aging population. “The most vulnerable populations to climate change are at the two ends of the age spectrum: children and the elderly,” said Mohamed Salama, associate professor at IGHHE. “The fact that a disease like Parkinson’s tends to occur later in a person’s life could mean that there is a direct correlation between age and lifetime exposure to environmental hazards.”

The Exposome

A study led by Salama and El-Fawal is particularly pertinent in the realm of climate change. Funded by the Bartlett Fund for Critical Challenges, the study investigates biological and environmental factors related to Parkinson’s disease. In the process, the two scientists are conducting what is called an “exposome-wide” association analysis in an attempt to create a vulnerability profile that maps and explains the various environmental exposures that the Egyptian population faces from the moment of conception until death, identifying adaptation strategies that will lead to better health outcomes. 

“Egypt is transitioning from an agricultural to an industrial society, meaning that the population — more than 100 million people — is exposed to a range of different environmental hazards,” Salama said, highlighting air pollution, pesticides and drinking water contaminants as key concerns.

The exposome takes a holistic approach to public health. “It looks at the totality of your exposure — not simply chemical, but also social factors, genetics, diet and so on,” El-Fawal said. 

It is widely accepted that chronic diseases are multifactorial, meaning they have more than one cause. For example, someone who has the genetic variant associated with Alzheimer’s disease will not necessarily develop the condition, but if other environmental factors are present, such as high cholesterol or a head injury, the likelihood increases. 

The exposome study takes one step further, analyzing the roles and relationships between multiple environmental exposures, lifestyle factors and genetics — starting from a person’s genome and proteome (proteins) and extending to their working and living conditions. Participants in the study are asked to wear silicone bracelets that absorb the different pollutants and toxins they come into contact with over a period of 48 hours, after which the wristbands are analyzed at IGHHE labs. Blood samples from participants are also examined, along with information about their lifestyle habits and day-to-day routine. In addition, environmental sampling conducted by Anwar Abdelnaser, assistant professor at IGHHE, and remote sensing are used to measure water and air quality in different areas across Egypt. 

“Real life is not individual chemicals,” El-Fawal said. “We’re talking about the totality of the internal and external surroundings. Environmental factors are equally as important as biological ones.” 

How to Adapt

A better understanding of the role of the environment in the prediction and diagnosis of diseases — whether in the heart, lungs, kidneys or brain — is needed to design interventions capable of reducing exposure to modifiable risk factors. Just as our blood type tells us which other types our body can and cannot accept, having an exposome profile could inform someone to avoid living in a certain location or working in a specific occupation. “The goal is to come up with certain steps and precautions that people can take to protect themselves,” El-Fawal explained, adding that in the long term, findings can be used to outline informed policy and behavioral interventions that address the disease. 

In terms of climate, El-Fawal says that building these profiles could help humans adapt to the changing environment. “Environmental health is indeed human health, and Earth is our only address,” said El-Fawal. “We talk about Mars exploration and colonization, but right now, Earth is where we live, so this is very important.”