Making science work for health
We are delighted to present "Making science work for health", the PHG Foundation podcast that explains the most promising developments in science and their implications for healthcare. In each episode, host Ofori Canacoo discusses with a PHG Foundation policy analyst, the underpinning science, the ambitions for improving population health and the impact it could have on patients, on society and on the people delivering your healthcare.
Making science work for health
Precision health in a changing climate
Dr Chantal Babb de Villiers and Dr Hayley Wilson discuss integrating genomics into the health response to climate change. Listen and discover how research is uncovering links between climate change, environmental exposures, and genomics to inform future healthcare and public health strategies.
Welcome back to Making science work for health, the PHG Foundation podcast that explains the most promising developments in science and their implications for healthcare. We discuss the underpinning science, the ambitions for improving population health and the impact it could have on patients, on society and on the people delivering your healthcare.
If you would like to find out more about what was discussed in this episode, you can find additional information on our website, https://www.phgfoundation.org/insight-and-analysis/climate-change-and-human-genomics/.
If you have any questions about the topic then you can email us at intelligence@phgfoundation.org.
Welcome to Making Science Work for Health. I'm Afori Kaniku, and for this episode I am joined by Dr. Chantal Babdevillius.
SPEAKER_00:Hi Afori.
SPEAKER_02:And Dr. Haley Wilson.
SPEAKER_00:Hi there.
SPEAKER_02:Chantal and Haley have just co-authored a compelling new position statement that frames climate change as a direct, personal, and urgent health emergency. So, Chantal Haley, if you could set the stage for us, when you talk about climate change health impacts, what are you most concerned about?
SPEAKER_01:Thanks, Afori. It's great to be able to have a chat about this. So these threats that we're thinking about, they're unfortunately already here. And we're actually talking about acute life-threatening events like heat stroke and cardiovascular strain during severe heat waves. But then there's also this problem of these chronic slow burn crises. So we're looking at dramatic worsening of respiratory diseases, diseases like asthma and chronic obstructive pulmonary disease. And that can be caused from things like wildfire smoke and higher ozone levels. But then just to complicate matters further, there's also the spread of infectious diseases as a result of climate change. So we've got carriers like ticks and mosquitoes. Those insects that carry Lyme disease or dengue fever, they're starting to expand into new warmer regions that we're seeing as a result of climate change.
SPEAKER_02:So it's a rather broad threat, but your recent position statement introduces a variable that perhaps has not been connected to this crisis, genetics. So could you explain that link for us? How does DNA factor into conversations about heat waves and wildfires?
SPEAKER_00:No, certainly. So that is the central point of our statement in the fact that genomics is a bit of a missing piece in the health response to climate change. Let's continue looking at the example of heat. So during record-breaking heat domes and heat waves, two people living in very similar conditions are going to be exposed to the same extreme temperatures. One person may feel terrible and they're able to cope with these extreme heats, but then another person will suffer severe life-threatening heat stroke. And that critical difference often comes down to how their body is able to manage these extreme thermal heat stresses. So, what is their biological ability to thermoregulate their body temperature? This could be explained by some of their genetics. And this process is reliant on many different factors, including the clothing and how hydrated a person may be. But there is emerging evidence that's suggesting that these responses could be due to a person's individual genetics as well. We're applying the same logic to how our lungs process pollution or how our immune system responds to new pathogens. This is the central point we're trying to break down a bit more, is in the conversation about the health impact of climate change, what can genomics add to this story?
SPEAKER_01:So, what we're saying here is that genomics isn't the only solution, but it's actually a key piece in this much wider puzzle, and it can really help us untangle these complex responses to an environmental exposure, and that in the long term is going to help us understand mechanisms of disease, and then also with this information, we can develop new treatments and new interventions that would help people cope and manage the health impact of a changing climate.
SPEAKER_00:Exactly. We're just trying to understand a lot better how we're having these health responses to these new environmental exposures.
SPEAKER_02:Can you give us any other real-world examples?
SPEAKER_01:So, yes, I can give a really fascinating but also quite worrying example of genetic evolution in the face of climate change, and that's going to come from a fungal pathogen rather than a person. But this pathogen is called Candida auris, and it was previously found in aquatic reservoirs and wetlands. And similar to most fungal agents that aren't pathogenic to humans, they live in these cooler, wetter areas, and that's because they've got skills related to the thermal restriction zone. So this is the difference that you see between a basal human temperature and the environment. And those fungal agents that are frequently found in cooler environments, they just don't grow well in warmer locations like the human body. What we're seeing now is genetic changes in Candida Auris that mean instead of being able to inhabit cooler, wetter areas, it can now infect warmer areas such as the human body, and it's causing severe human infections, and it also displays an alarming level of drug resistance.
SPEAKER_00:It's a really fascinating example, and here genetics has helped us understand how this pathogen has changed due to the environmental pressures. So surveillance of this kind has enabled us to look at how the disease is spreading. And this specific example shows us that the pathogen has not been spread by humans travelling to new areas or new regions, but rather that the pathogen has been changing in these different locations because of the environmental pressures it's being put under.
SPEAKER_02:So the position statement is a call to action. So if we break down those recommendations, who needs to be at the table?
SPEAKER_00:Our position statement is adding to a lot of the conversations you're hearing that we need all hands on deck to be able to combat climate change and the impact it's having on our health. So there are a few target groups that we are looking at and would like to be able to respond to the calls to action that we've put in place. But we're also fully aware that we don't want to add to the problem, we don't want to add to climate change problems, and we need to be sure we're not contributing or exacerbating the problem without unnecessary travel, for example, unnecessary experimentation, or the environmental impact of using new technologies, be they wearables, computer usage such as AI, we need to also be fully conscious and aware that we're not contributing to this problem. When we look at the different groups that we would like to have at the table, the first group that I can think of is maybe the most fundamental is our own research community in genomics, it's the researchers and the academics.
SPEAKER_02:So, what are you asking your community, your colleagues to do?
SPEAKER_00:We have two main calls for them. The first is a moral imperative to diversify our genetic data. Right now, the vast majority of genomic information and data that is used to understand the health impacts comes from very restricted population set, which is European ancestry. This frankly needs to change. We are literally not going to understand the specific gene environment risks that we are facing and the impact that this is having on our health for the vast majority of the world's population if we don't start diversifying genomic data. On top of that, it's mainly populations outside of Europe that are being severely affected by these climate changes. So this must be a top funding priority.
SPEAKER_01:And the second call we have really, I think, is to break down our silos, and what we mean by that is that genetic researchers are often in one place, we've got epidemiologists in another, and then climatologists in another. So we're calling for funding for new and integrated centres to try and bring these teams together so they can work on these complex gene by environment problems. As part of this, we also need to consider how data sharing between these different disciplines can complement each other's work. What we really need is interoperable systems, so computer systems and data systems that can talk well to each other. That's going to help us maximise the utility of the information we have, and what's really important as well is it can help those different disciplines talk to each other better and understand what information each other needs and also what information they can each provide, and that's really going to help galvanize these different sectors into a more collective action.
SPEAKER_02:So that's the research, but what about people on the ground? What's the recommendation for public health officials?
SPEAKER_00:Certainly, so clinicians are the critical frontline group. For clinicians, the recommendation is about raising awareness and enhanced risk estimation for individuals. So it's not about us ordering a new expensive genetic test for everyone. It's about a clinician knowing that their patient would say a pre-existing asthma, so a known condition, or they might have epilepsy who lives in near a major highway, so social risk, might have a genetic predisposition to a more extreme response to these environmental exposures.
SPEAKER_01:So, yeah, to think about this on the ground and from a practical nature. For example, your clinic might get a public health alert about high pollution levels, or you know, we often see those extreme heat, amber, and red warnings. What it means is that the clinics can now be a bit more proactive because they've got more information to work from. So they could potentially identify their most at-risk patients. They could call them directly and then warn them that there is a high danger this week for you personally, and we need you to use your maybe your preventative inhaler, make sure your air conditioning is working, and have a plan to stay indoors. So it's using this kind of knowledge, and that's going to make care more proactive and more personal, make people feel more in control of their health care.
SPEAKER_00:There's also the side where clinicians can start becoming more aware of if they're starting to see more asthma patients coming in, could it be because of some sort of climate effect? So, with the asthma, in for example, the change in allergen exposures. So plants are being able to produce pollen a lot more frequently and maybe even get a second season. So clinicians can be a lot more aware of understanding what these climate change effects are having within their local community and population.
SPEAKER_02:And then what about the top-level policymakers and government officials?
SPEAKER_01:So at this level, uh people actually hold two of the most important levers in this area, and that we see as funding and regulation. So from the funding side, you can fund these massive, diverse, long-term studies that we need, and that's really going to help us to properly understand the population health and how we are responding to climate change. But then on the regulatory side, the genetic data is a tool that can be used to protect everyone's health. So, for example, when agencies are setting safe limits for ozone or particulate matter, what we can have is research that shows that current safe limits is not safe for everyone. It's not a one size fits all situation. And the data is going to provide us a stronger legal and scientific argument for much stricter air quality standards that protect not just the average person, but we're we're recognising that not everyone is the same and not everyone's going to respond the same, but we can work to try and protect all people, not just the average person.
SPEAKER_02:If we start incorporating this genetic lens into climate and health research, what does that change?
SPEAKER_00:It's a very valid point, and it immediately brings up a huge concern of equity and responsibilities. So we already know climate change disproportionately harms low income and marginalized communities. So, how does this genetic information intersect with these social and economic factors? Does it risk creating new or reinforcing old disparities? These are questions that still need to be fully unpacked and fully understood. It adds to the question of who's going to take responsibility and accountability for actions and interventions that need to be put in place for these at-risk communities. Is it going to land up being the individual who's going to be held responsible? Is it a community level? Is it a government level? How are we going to be able to equitably use this information and ensure we aren't stigmatizing individuals because of this information? But what we are trying to say is that this information can help us understand people's responses to climate change a lot better and help us understand what we could do and put into place to improve people's lives while we've got this problem in front of us. It's going to take years before climate change can be halted or reversed, ideally, and in the meantime, we've still got people who are suffering from the consequences of being exposed to climate change. So being able to understand that a bit better and understanding where we can develop new treatments and interventions is where we could have a lot of benefit from this information. But we do still need to understand this the social and ethical questions that come alongside using genomic information.
SPEAKER_01:Yeah, I think that's a really good point, right? Because ethics and the moral s moral questions around this are a huge, a huge issue, and they're quite they can be controversial. I think that's the sort of thing that we really need to unpack really sensitively and spend time working out how all these different intricacies work together.
SPEAKER_00:And definitely they can be done while we're looking at understanding the biological responses we're having to these climate, to these climate exposures. So it's not that we're saying we can't do one without the other, but we do need to be very considerate about why we're doing this and the importance of doing this. And that adds into, you know, we don't want to necessarily have climate change seen as something that a technology is going to fix. We do still need to work very hard in trying to combat and halt and reverse the impacts that climate change is having and what is causing climate change.
SPEAKER_02:Before you said scientists need to break down uh their silos. Now, as I understand it, I think that's a a hard thing to do in academia. So, what in your view is the biggest barrier preventing that collaboration right now?
SPEAKER_01:So, yeah, this is a really interesting problem actually. It's one of those ones that is often comes around quite regularly. And what we seem to have is a bit of a collective action problem here. So that happens when everybody recognises that there is a problem, but nobody's quite sure how to coordinate or where individual effort will actually make a difference. And we see this in other large health-related problems such as the antimicrobial resistance pandemic. There's this disconnect fuelled by a lack of enabling environments, lack of responsibility and accountability at national and international levels, often suffers with inadequate financing and insufficient cohesion of data collection. Like we said before, we need to have those interoperable data systems, and that really affects the data storage and the sharing and how we can utilize that. So that is the problem that we need to overcome at the moment.
SPEAKER_00:I think that has been one of the most interesting things looking at this topic is that we've seen these problems before, we've encountered these problems before. When you're dealing with such a big, complicated, complex health issue, it's who holds responsibility for trying to steer direction. And it's been very heartening looking at climate and health, in that so many people do want to contribute, and so many people do want to help understand what is happening, but no one actually knows where to start. And you have lots of people doing little bits of effort to unpack this problem and provide solutions to this problem to try and have people not have so extreme health reactions, but getting people coordinated that it is targeted and moving in the right direction, and that we are generating the type of information and evidence we need to do this has been very difficult.
SPEAKER_01:Yeah, I think that's what we hope to get out of this position statement as well. Is it's we're trying to bring people together and show that there is sort of a collective understanding, and we all need to sort of work together to move forward, and hopefully, we've highlighted that in the position statement that we're releasing.
SPEAKER_00:Yeah, exactly.
SPEAKER_02:Thank you both. This has been incredibly in insightful. As we wrap up, what's the one final message that you would want our listeners to take away from our conversation?
SPEAKER_01:I think one of the key things that we need to understand is that climate change is actually a deeply personal health crisis, but that doesn't mean that it's a personal failure. So it's actually a collective and it's a systemic problem. So by understanding all of this new genetic information and the genetic dimension that we've got, we're really going to have the tools that can build solutions that they're not just smarter and they're more effective, but actually they're going to work out to be more just and they're going to be more equitable. So it's not, we're not just one size fits all, we're not just covering the average person, but we're actually taking into account people's individual health differences, and I think that's really, really, really important.
SPEAKER_00:Definitely, I'd agree. And then I'd also add, you know, we need to advocate for climate action as a health intervention, and that talking about it this way could actually draw attention to climate change as a more practical, tangible issue. So by you asking your local officials, your city councillors, and your public health department what they are doing to protect your health and the health of the most vulnerable in your community from heat and pollution, for example, your voice is absolutely essential to ensuring we all treat this like the health emergency it is. If anyone's interested in understanding more about this, the position statement is live on our website, and within it we've also got a couple of case studies where we have shown where we think genomics can help in this conversation.
SPEAKER_01:So, yes, if you're interested in finding out more or speaking to us about this, you can go to the website and you can sign up to our e-Alert, which is called Climate Change and Human Genomics, and we would love to hear from you.
SPEAKER_02:Wonderful. Chantel Haley, thank you very much for joining me.
SPEAKER_00:Thank you.
SPEAKER_02:That brings us to the end of the episode. If you would like to find out more about what was discussed, please email us at intelligence at phgfoundation.org. Thank you for listening, and we look forward to bringing you a new topic in the next episode.