1. health and fitness

What is « environmental health »?
International ENSSER Meeting
Dr Joël Spiroux de Vendômois
Président de l’ASEGO
CRIIGEN/ENSSER
CRIIGEN
University of CAEN
March 24-26, 2011
What is the environnement?
•  The environment is everything that is not me! A. Einstein 2 The constituents of the environment:
•  The biological environment: bacteriological, viral, fauna and flora, all the biomass, ourselves included! •  The physical environment: ionazing radia@on, electromagne@c radia@on, temperature, humidity… •  The chemical environment: xenobio@c present in the air, the water, the soil, food… •  The sensory environment: noise, colour, smell… •  The socio anthropological environment •  The cogni@ve environment: knowing by what we make sense of our environment: our culture, the media, adver@sing, educa@on… •  Whithout forgeFng the behavioural aspects which follow on from this. 3 What is « health »?
•  Health is a state of complete physical, psychological and social well-­‐being and not simply the absence of illness or infirmity (defini:on from the WHO) •  Defini:on of environmental health (WHO, Helsinki Conference,1994): •  In France, environmental health comes within the framework of Environmental Charter made public on the 28th of February 2005 in the form of cons@tu@onal law under which: « Each person has the right to live in a stable environment conducive to their health » 4 Environmental health:
a complex problem!
–  « Complex » is from the La@n complexus: which is made up of different elements, combined in a fashion which cannot directly perceive: « Woven together » –  The different environmental categories cons@tute, therefore, the determining factors for health. 5 Environmental pathologies confirm
complexity of the world
•  Neither life nor pathologies can be thought of a binary or linear way. •  Limits of current medical thinking are based in large part on a pasteurian vision of illness… One cause, one specific pathology! •  What is true for infec@ous pathologies is not so for other environmental pathologies. •  Environmental factors or xenobio@cs can provoke one or many different pathologies. •  The current epidemiology is not adapted to the environmental pathologies! •  We are neither used to, nor trained in, thinking about the ‘complex’. 6 Consequently:
•  Our socie@es produce care, but not health! •  The rise in cancers, allergies, neonatal malforma@ons, sterility and orphan diseases tes@fy to this. •  Moreover, this is translated into a tendency towards diminishing longevity… •  Our socie@es are ‘schizophrenic’ as they generate pathologies which they have difficulty in trea@ng whilst, at the same @me, regreFng the high cost of the treatment! 7 Let us take an exemple:
medicinal residues in the environment.
8 Study:
« MEDICINAL RESIDUES IN THE EFFLUENT FROM ROUEN
HOSPITAL AND ITS SURROUNDING »
Dr Dominique Cellier 1, Pr Jean-Pierre Goullé 2,3, Pr Michel Guerbet 3,
Pr Christian Lacroix 2, Dr Elodie Sassereau2, Dr Joël Spiroux 4.
1Université
de Rouen, UFR des sciences et techniques, 2Groupe hospitalier du Havre, 3Université de Rouen, UFR Médecine
et Pharmacie, ADEN EA 4311, 4Union Régionale des Médecins Libéraux de Haute Normandie, URML HN.
Study published in « annales de toxicologie analytique » mars 2011
- Kinetic study of detection and quantification of medicinal residues
released from a hospital; for 30 consecutive days with servo-controlled
sampling of the flow.
- Follow-through of detected molecules up as far as the exit of the
Water Works Treatment Plant (WWTP). 5 sampling points.
- Search for specific markers of hospital activity.
9 Why this study?
10 Material and methods
•  Liquid Chromatography /Mass Spectrométry. (HPLC/MS)
11 Medicines measured:
only 25 different molecules:
lidocaine ;dm.venlaflaxine; tramadol; metoprolol; acebutolol;
Meprobamate; propranolol; venlaflaxine; buflomedil; bisoprolol;
Labetolol; disopyramide; celiprolol; carbamazepine; oxazepam;
Norpropoxyphene; propoxyphene; hydroxyzine; cetirizine; flecaine;
Verapamil, citalopram, codeine, oxydocone, ticlopidine
12 Hospital Waste Sampling Places Water WWTP entrance Middle WWTP WWTP exit Waste Water Flow (m3/day) 289 81798 77631 77631 Drug: kg/year
TRAMADOL MEPROBAMATE VENLAFLAXINE OXAZEPAM CETIRIZINE FLECAINE 0,25 0,17 0,087 0,119 0,068 0,048 32,784 35,397 23,401 34,544 20,759 28,954 36,157 31,993 24,35 33,46 18,948 29,75 38,081 12,079 24,33 31,93 19,145 28,283 CODEINE 0,075 15,805 16,805 1,2 kg 392 kg TOTAL for 25 Drugs USE Antalgic anxioly0c an0depressant anxioly0c an0histaminic an0arrythmic antalgic, 8,445 an0tussive 300kg Results for a population of 400.000 persons during one year
WWTP: Waste Water Treatment Plant 13 68 metals measured
Inductively Coupled Plasma (ICP)
14 Sampling places Hospital Waste Water Waste Water Flow (m3/
day) 289 81798 77631 77631 Metal: kg/year 107 Ag 0,24 18,063 11,01 8,217 127 I 33,029 706,868 791,142 562,159 157 Gd 0,27 5,259 4,853 4,497 195 Pt 0,05 0,563 0,444 0,25 TOTAL for 68 metals 15 t 3.087,7 t WWTP entrance Middle WWTP WWTP Exit 2.987,5 t Results for a popula9on of 400.000 persons during one year Pla@num and Gadolinium are two specific markers 15 of hospital ac@vity. A number of comments are necessary:
•  The contribution of the hospital is small with regard to that of the
city.
•  Nearly all the molecules are found at the exit of the Waste Water
Treatment Plant (WWTP).
•  The WWTP is not efficient at stopping this type of molecules.
•  Let us be clear that what does not come out of the wwtp is present in
the sludge.
•  Some of these molecules are incompatible and their mixture is
dangerous for the health…
•  What impact can all these molecules have, on their own, in a cocktail
and mixed with other xenobiotics such as pesticides, for example?
16 The great question: What is the impact
on the flora, fauna and the food chain?
Means by wich pharmaceu@cal substances arrive in water Trophic chain Man Ocean Land Carnivorous fish Herbivores Herbivorous fish Zooplankton Plants Phytoplankton Autotrophes and mineral elements Rise in concentra@on of pharmaceu@cal pollutants, pes@cides, nano-­‐products or residues from GMOs in the food chain All this requires:
•  A re-­‐evalua9on of chemical products, in vitro and in vivo, in short, medium and long term as well as across genera@ons. •  The development of chronic and low-­‐dose toxicologies… •  The development of the toxicology of mixtures (cocktails) •  The development of a chemical hygiene comparable to Pasteur’s bacterial hygiene. •  The adapta@on of the epidemiology to the complex condi@ons of the environmental pathologies. •  The crea@on of a new scien@fic discipline at the crossroads of all sciences: « The environmental health » 18 It is for these reasons that we are here for two days, to bring
together our different scientific disciplines to work for:
An environment more favourable to selffulfillment and good health.
Thank you very much!