New findings explain how politics, economics, and ecology can help or hurt our bodies.
posted Aug 21, 2012
Talking with Dr. Ted Schettler is probably unlike any conversation
you have had with your physician. Raise the topic of breast cancer or
diabetes or dementia, and Schettler starts talking about income
disparities, industrial farming, and campaign finance reform.
The Harvard-educated physician, frustrated by the limitations of
science in combating disease, believes that finding answers to the most
persistent medical challenges of our time—conditions that now threaten
to overwhelm our health care system—depends on understanding the human
body as a system nested within a series of other, larger systems: one’s
family and community, environment, culture, and socioeconomic class, all
of which affect each other.
It is a complex, even daunting view—where does one begin when trying to solve problems this way?
-
Schettler is an exceedingly logical thinker, and his vision for a
more evolved kind of health care came from the down-to-earth experience
of helping to clean clam flats along the St. George River in Maine
during the 1980s. “I was living and practicing on the coast there, and
working with a local organization to clean up the river because we had
these rich clam flats that had been closed for years because of periodic
spikes of E. coli. If anyone ate the clams they would get very sick.”
Meanwhile, paper mills were dumping dioxins into other rivers nearby,
and Schettler learned that fish from those rivers sometimes had even
higher chemical levels than fish caught in urban harbors. But factory
bosses claimed that regulating waste from the pulp mills would cost
community jobs, which prompted dozens of young factory workers to
protest. Schettler, despite being steeped in traditional medicine, was
unable to ignore these interrelationships: a degraded natural
environment, a precarious local economy, and perennially sick people.
“These things—the effect of the environment on peoples’ health—were
never discussed at the medical conferences,” he said. “So it caused in
me a major re-examination.”
Schettler went back to school, earned a master’s degree in public
health, and began applying a scientist’s rigor to his wide-ranging pool
of interests. Since then, he has researched connections between poverty,
iron deficiency, and lead poisoning; insecticide use, Parkinson’s, and
Alzheimer’s disease; income disparities and asthma.
He calls this new approach to medicine “the ecological paradigm of health.”
“It sounds like tree-huggers or something,” Schettler said in an
interview. “But I mean ‘ecological’ in the sense that there are these
multiple systems, one within the other—a family within a community,
within a society, within a culture—and that’s the way ecologists tend to
talk about ecosystems. It’s accepting up front that humans do not stand
apart from the environment. We’re a major species, along with the
mosquitoes and fish and trees and bacteria. And there are all of these
wonderful interrelationships.”
Our Health and Ecosystem Health
Currently getting over a case of Lyme disease, Schettler notes that
the condition wasn’t even on the radar three decades ago. Likewise, West
Nile Virus. And dengue fever, first identified in the late 18th
century, has soared since the 1960s, now infecting up to 100 million
people worldwide each year.
“Can there be any doubt that human health is enormously dependent on
ecological systems that we are having a major influence on?” Schettler
says. “It’s all one world. Our tendency to describe the natural world as
something without humans is part of the problem.”
When economic inequality gets this wide it has an adverse effect on people’s health.
Such a holistic approach to human health is often received as heresy
within traditional medicine, but Schettler is hardly a Don Quixote
tilting at windmills. He has testified before the U.S. Senate about
links between Parkinson’s and pesticide use. He has been interviewed on
public radio and co-authored two oft-quoted books,
Generations at Risk: Reproductive Health and the Environment and In Harm’s Way: Toxic Threats to Child Development.
Both explore Schettler’s belief about the environmental underpinnings
of a host of disorders, from learning disabilities to cancer. And both
lay out the limitations of Western medicine in coming up with clear
causes and effective treatment.
Breast cancer is a prime example. Dissatisfied with research into the
origins of the disease, Schettler began to wonder whether chemicals
found in cancerous breast tissue actually encouraged tumor growth. He
found that a girl’s exposure to DDT before the age of 14 corresponded to
a greatly increased risk for breast cancer later in life. “If we’re
looking only at adults, we’re missing this important window of
susceptibility,” Schettler says. “But in medicine we weren’t going
there. We were responding only to the illness. I was interested in its
origins.”
Food is another favorite “wedge issue,” a way of examining diseases
like diabetes in relation to agricultural policies. Schettler, noting
America’s current epidemic of childhood obesity and diabetes, began
examining not only blood sugar levels in children but also the
neighborhoods in which they lived. He found that many did not have a
single market selling fruits and vegetables.
That led his musings a step further, to inquiry into the agricultural
policies guiding food into stores. Which flowed naturally into an
examination of conditions for agricultural workers who, it turned out,
had high rates of cancer.
In Schettler’s analysis, each of these factors—the mass production of
processed food, the lack of easily accessible fruits and vegetables,
the health condition of farm workers—is fused with the others: “It’s
fine to give people dietary advice, and advise them to exercise—in this
country we have a long history of telling people how to change their own
lives,” he says. “But it’s not just a matter of an individual making a
poor choice. It’s what our system has provided to them, so it needs to
be changed at the systems level. Diabetes and obesity are big-ticket
items with huge implications for the federal budget.”
Thinking that way, it’s no stretch for the physician to segue into a
discussion of federal farm subsidies for chemically produced foods. Or,
on a more personal level, to question colleagues in health care about
their failure to advocate for changes to the food served in schools.
Schettler’s approach touches everyone: He asks school districts that
cut physical education programs as soon as budgets get tight, “What’s
the message we’re giving to kids? This is really troubling. We’re facing
an obesity and diabetes epidemic that’s going to overwhelm our health
care system. And if there’s one thing that we should be doing it’s
stressing the importance of diet and exercise for young people.”
You might think that a physician like Schettler—unafraid of skewering
sacred cows wherever he finds them—would be a lightning rod for
criticism. And indeed, the American Council on Science and Health issued
a sharp rebuke in 1999 after Schettler attacked a report issued by the
organization (and co-authored by former Surgeon General C. Everett Koop)
for its stand on phthalates: “The American Council on Science and
Health is disappointed, but not surprised, by activists’ continued
attempts to discredit a panel of well-respected, nationally and
internationally recognized scientific and medical professionals,” the
statement said. “Once again, there has been an attempt to shift
attention from sound science to misrepresentations and half-truths.”
Other than this, there is virtually no public criticism of
Schettler’s work. And even that fracas left him singularly unperturbed.
“Some of these chemical groups might label me an ‘enviro’ but that’s
about it,” he said. “Still, this is an area of great debate—whether our
job is merely to identify and treat disease or whether it is also to be
advocates in public policy.”
Clearly, Schettler has made his decision. “You really do get into
down-and-dirty politics here. That’s where this all plays out.”
Inequality Makes Us Sick
Wherever Schettler turns his focus, drilling down to the root causes
of illness inevitably means confronting social problems, foremost among
them economic inequality.
Richard Wilkinson discusses inequality and the effects it can have on a country’s citizens.
Take lead poisoning: Poor diet leaves children from lower-income
families more likely to suffer iron deficiencies. And an iron-deficient
diet allows more lead to be absorbed in the intestinal tract,
transporting more of the damaging metal to the brain and leading to
increased neurological impairment among kids whose families are least
able to counter those effects.
“If you just address the lead itself, without looking at diet and
social circumstances, you don’t get very far,” Schettler says. “So yes,
it’s important to make sure that kids aren’t being exposed to excessive
amounts of lead and neurotoxins, and we need to keep doing that work.
But we also need to be looking at housing, income disparities, the food
system, energy production—things that are likely to have a bigger impact
on a larger set of conditions and diseases.”
In short, poverty leads to increased exposure, which is exacerbated
by heightened vulnerability (in this case, the iron-deficient diet) and
an impaired ability to respond—“a toxic triad,” Schettler calls it.
The link between socioeconomic status and poor health is widely
acknowledged. But perhaps less obvious is the finding that income
disparities within a community also appear to have a deleterious effect,
making one family susceptible to illnesses that another living in the
same area—but at a higher income level—might escape.
As proof, Schettler cites research on asthma that found poorer
kids—even when symptom-free—had higher levels of inflammatory markers in
their blood than youths from wealthier families in the same
neighborhood. Meaning that it took fewer irritants to push the poorer
children over the threshold into a full-blown attack. Once sick, they
were also less resilient—that is, less able to quickly recuperate—than
wealthier children, either because they lacked treatment at home or were
unable to get to a doctor.
“Higher income is protective—even in the same community,” Schettler
says. “That’s why it’s so concerning to see this income gap in America
now. We know it’s setting the stage for adverse health outcomes for
people. Is that class warfare? Well, yes. When economic inequality gets
this wide it has an adverse effect on people’s health. That’s what the
literature tells us. We shouldn’t shy from saying it.”
Show Me the Progress
After spending 30 years as an emergency medicine physician, Schettler
now serves as science director for two organizations, the Science and
Environmental Health Network and the Collaborative on Health and the
Environment. The latter is a partnership of some 4,000 health
practitioners and scientists committed to promoting discussion of the
connections between the environment and learning disorders, birth
defects, infertility, childhood leukemia, endometriosis, and various
cancers.
Admittedly, it’s a pretty bleak vision, this tangled web of social,
medical, and political problems. And looking at it, you might expect
Schettler to be wracked with hopelessness. Yet he is not.
“I actually think it’s a very important time in the world now,” he says. “There’s something here for everyone to do.”
He points to examples of significant change already underway within
the health care industry itself, where the incineration of hospital
waste has long been a leading source of dioxin emission. Hospital food,
too—traditionally a fatty rotation of grilled cheese, burgers, French
fries, and milkshakes—has been little more than “a joke,” Schettler
says.
But since its founding in 1996, the international collective Health
Care Without Harm has steadily been chipping away at these problems, and
has now seen the closure of thousands of medical waste incinerators. It
has initiated a Green Building program geared toward creating
energy-efficient medical centers; and it has begun to change the way
hospitals, with their enormous purchasing power, buy food to promote
more locally grown and sustainable agriculture practices.
“The medical industry itself has been a great place to look at
cleaning up,” says Schettler, who advises Health Care Without Harm.
“Particularly as health care is almost 20 percent of the GDP.”
Even as a high school student in 1950s Ohio, the seemingly mild young
man showed a talent for leadership. (“Ted’s ability to organize his
pals has made him a leader in the senior class,” notes his yearbook.
“His sincere, fun-loving personality will draw friends to him.”) These
days, Schettler puts those skills to work before crowds of students,
researchers, and policy makers. Yet nearly every conversation circles
back to same question: How is anyone to make a difference when
confronted with Schettler’s vision?
“I encourage people to recognize that they’re working in common cause
with others,” he says. “Many people are carrying a common message, just
coming at it from different angles.”
By way of example, he cites Detroit, long a metaphor for urban
blight, ingrained misery and societal failure. Though there is not a
single major-chain supermarket within the city limits, Schettler focuses
instead on a crop of urban gardens now dotting the broken blacktop.
“People are starting to grow their own food, healthy food!” he exclaims.
“There are wonderful things going on.”
Claudia Rowe wrote this article for
It's Your Body,
the Fall 2012 issue of YES! Magazine. Claudia has been an award-winning
social issues journalist for more than 20 years. Her work has appeared
in
Mother Jones, The New York Times, The Seattle Times, and
The Seattle Post-Intelligencer.
Interested?
