Air & Water Hazards In China:Air & Water Hazards In China:How Bad Is It, &How Bad Is It, &

How To Stay HealthyHow To Stay Healthy

About Me…About Me…

I am I am Dr Richard Saint CyrDr Richard Saint Cyr, a family medicine , a family medicine doctor, from Americadoctor, from America

I work at Beijing United Family HospitalI work at Beijing United Family Hospital Director of Marketing, UFHDirector of Marketing, UFH My health website: My health website: MyHealthBeijing.comMyHealthBeijing.com Weibo: Weibo: weibo.com/daniudaifuweibo.com/daniudaifu

Let’s Review Pollution…Let’s Review Pollution…

The Common Air PollutantsThe Common Air Pollutants

Particulates (PM10, PM2.5)Particulates (PM10, PM2.5) Nitric oxide/dioxide Nitric oxide/dioxide Sulfur dioxideSulfur dioxide OzoneOzone Carbon monoxideCarbon monoxide

The worst one is:The worst one is:small particlessmall particles

(PM = particular (PM = particular matter)matter)

These Are Very, Very Small…These Are Very, Very Small…

Health EffectsHealth Effects

Short-term (days):Short-term (days):– Heart attacksHeart attacks– AsthmaAsthma– BronchitisBronchitis

Long-term (>8 years):Long-term (>8 years):– COPD/emphysemaCOPD/emphysema– Heart DiseaseHeart Disease– CancerCancer

London in 1952!

The Great London Smog of 1952The Great London Smog of 1952

It was a bad combo of cold weather + more It was a bad combo of cold weather + more coal burning + inversion layer of air…coal burning + inversion layer of air…

= disaster for 5 days…= disaster for 5 days…– pollution at 3,000-14,000! (Beijing is usually pollution at 3,000-14,000! (Beijing is usually

~140)~140)– 12,000 premature deaths12,000 premature deaths– 100,000 illnesses100,000 illnesses

Many People Died In DaysMany People Died In Days

USC Children’s Health StudyUSC Children’s Health Study

((http://www.arb.ca.gov/research/chs/chs.htm), ), following thousands of kids in smoggy Los following thousands of kids in smoggy Los Angeles over 9 years, from 4th to 12th grade. Angeles over 9 years, from 4th to 12th grade.

In Los Angeles, the average annual Air Quality In Los Angeles, the average annual Air Quality Index is around 50, which is almost 3 times lower Index is around 50, which is almost 3 times lower than here in Beijing. than here in Beijing.

““Air Pollution Harms Children's Air Pollution Harms Children's Lungs for Life”Lungs for Life”

- Children exposed to higher levels of particulate - Children exposed to higher levels of particulate matter, nitrogen dioxide, acid vapor and elemental carbon, matter, nitrogen dioxide, acid vapor and elemental carbon, had significantly lower lung function at age 18…had significantly lower lung function at age 18…– N Engl J Med 2004; 351:1057 – 1067N Engl J Med 2004; 351:1057 – 1067

Children that were exposed to current levels of air pollution had Children that were exposed to current levels of air pollution had significantly reduced lung growth and development when exposed to significantly reduced lung growth and development when exposed to higher levels of acid vapor, ozone, nitrogen dioxide and particulate higher levels of acid vapor, ozone, nitrogen dioxide and particulate matter …matter …– Am J Respir Crit Care Med 2002; 166:76 - 84 Am J Respir Crit Care Med 2002; 166:76 - 84 

Children living in high ozone communities who actively participated in Children living in high ozone communities who actively participated in several sports were more likely to develop asthma than children in several sports were more likely to develop asthma than children in these communities not participating in sports. these communities not participating in sports. – Lancet 2002; 359:386 - 391Lancet 2002; 359:386 - 391

Closer Look:Closer Look:

 ” ”The estimated proportion of 18-year-old The estimated proportion of 18-year-old subjects with a low FEVsubjects with a low FEV11 (defined as a ratio  (defined as a ratio

of observed to expected FEVof observed to expected FEV11 of less than  of less than

80 percent) was 4.9 times as great at the 80 percent) was 4.9 times as great at the highest level of exposure to PMhighest level of exposure to PM2.52.5 as at the  as at the

lowest level of exposure (7.9 percent vs. 1.6 lowest level of exposure (7.9 percent vs. 1.6 percent, P=0.002).”percent, P=0.002).”

N Engl J Med 2004; 351:1057 – 1067

Long-Term Effects: Heart DiseaseLong-Term Effects: Heart Disease A curved line (maxes/tapers off)A curved line (maxes/tapers off) Relative risk in Beijing air: 1.32 (ie, 32% increase)Relative risk in Beijing air: 1.32 (ie, 32% increase)

– 1ppd smoker: ~2.3 relative risk (230% increase)1ppd smoker: ~2.3 relative risk (230% increase)

http://t.cn/StQNu6

Long-Term Effects: Lung CancerLong-Term Effects: Lung Cancer

Linear; NO MAXLinear; NO MAX– 1ppd smoker: ~21 risk (2100% increase)1ppd smoker: ~21 risk (2100% increase)– Beijing air: 1.49 risk (49% increase)Beijing air: 1.49 risk (49% increase)

http://t.cn/StQNu6

Do You Like Those Odds?

Conclusions?Conclusions?

Air pollution risk is real – but small?Air pollution risk is real – but small? Risk: Risk:

– Individual = small effectIndividual = small effect– Population = large effectPopulation = large effect

Smoking is really, really badSmoking is really, really bad

Compare To Other RisksCompare To Other Risks

Weight change (Kg)

Cardiovascular Risk: Meet JoeCardiovascular Risk: Meet Joe

Myhealthcheckup.com

How Bad Is Beijing?How Bad Is Beijing?

World Cities & PM10 Levels (2004-World Cities & PM10 Levels (2004-5)5)

WHOWHO

ChinaChina

USUS

Beijing

A Day In Beijing Is Like Smoking A Day In Beijing Is Like Smoking How Many Cigarettes?How Many Cigarettes?

1/6?1/6? 1?1? 5?5? 10?10? 20?20?

= 1/6 Of A Cigarette!= 1/6 Of A Cigarette!

How To Protect YourselfHow To Protect Yourself

Indoor protectionIndoor protection– Air purifiersAir purifiers– PlantsPlants

Outdoor protectionOutdoor protection– Avoidance AQI >200Avoidance AQI >200– N95 masksN95 masks– School action plansSchool action plans

Don’t Forget: 90% Don’t Forget: 90% of Your Life Is of Your Life Is Spent Indoors!Spent Indoors!

Schools Should Have Action Plans!Schools Should Have Action Plans!

In Other Words:In Other Words:

Any AQI over 200 = Any AQI over 200 = NO NO OUTDOOR SCHOOL OUTDOOR SCHOOL ACTIVITIESACTIVITIES

Air Purifiers Really Work!Air Purifiers Really Work!

My own tests: reduce PM0.3 95-99%My own tests: reduce PM0.3 95-99%

Imported brands: IQAir, Blueair, Alen…Imported brands: IQAir, Blueair, Alen…– Must be true HEPA!Must be true HEPA!– Cheap? Too good to be true…Cheap? Too good to be true…

Local?Local?

Maybe Helps The Heart?Maybe Helps The Heart? An Air Filter Intervention Study of Endothelial Function among Healthy An Air Filter Intervention Study of Endothelial Function among Healthy

Adults in a Woodsmoke-impacted CommunityAdults in a Woodsmoke-impacted Community

ConclusionsConclusions: : – improved endothelial functionimproved endothelial function– decreased concentrations of inflammatory biomarkers (CRP)decreased concentrations of inflammatory biomarkers (CRP)

So…less disease? Maybe…probably…So…less disease? Maybe…probably…

http://ajrccm.atsjournals.org/content/183/9/1222.abstract?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=HEPA+pollution&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

Indoor Plants Help!Indoor Plants Help!

Indoor PlantsIndoor Plants

Areca PalmAreca Palm  (( 风尾竹风尾竹 , , fengfeng(4)(4)weiwei(3)(3)zhuzhu(2), about RMB (2), about RMB 180 each) - 180 each) - – Efficiently converts CO2 to oxygen. Efficiently converts CO2 to oxygen.

Mother-in-Law TongueMother-in-Law Tongue  (( 虎皮兰虎皮兰 , , huhu(3)(3)pipi(2)(2)lanlan(2), about (2), about RMB 50 each) RMB 50 each) – Efficiently converts CO2 to oxygen at night Efficiently converts CO2 to oxygen at night – Good for bedrooms. Good for bedrooms.

Money Plant Money Plant  （绿萝（绿萝 , , lvlv(4)(4)luoluo(2), about RMB 150 each(2), about RMB 150 each ） ） – Removes formaldehydes and other volatile chemicals. Removes formaldehydes and other volatile chemicals.

Food Safety: The Main Food Safety: The Main ProblemsProblems

BacteriaBacteria– InfectionsInfections– Food poisoningFood poisoning

Chemicals & PesticidesChemicals & Pesticides– Cause cancer?Cause cancer?– Endocrine problemsEndocrine problems– Allergic reactionsAllergic reactions

Your GoalsYour Goals Minimize your exposure to toxinsMinimize your exposure to toxins Control what & where you eatControl what & where you eat Control what & where you buyControl what & where you buy Live SUPER-healthyLive SUPER-healthy

– Antioxidant lifestyleAntioxidant lifestyle– Don’t smokeDon’t smoke– ExerciseExercise– Stay slimStay slim

Water SafetyWater Safety

Big Water jugs? Maybe notBig Water jugs? Maybe not– 50% counterfeit water50% counterfeit water– Bacteria in waterBacteria in water– Cheap plastic leaches into itCheap plastic leaches into it– Good brand? Good brand? Beijing Kangtai Gaoke Co. Beijing Kangtai Gaoke Co. 

Install A Water FilterInstall A Water Filter

Tap water – add a filterTap water – add a filter– Aquasana highly rated (many others)Aquasana highly rated (many others)

Food Handling Is A Major Issue!Food Handling Is A Major Issue!

http://www.who.int/foodsafety/consumer/5keys/en/index.html

cc

Wash Your Produce!Wash Your Produce!

Store brandsStore brands CitrusCitrus SaltSalt VinegarVinegar ChlorineChlorine

Basic TipsBasic Tips

If it can be peeled, peel it!If it can be peeled, peel it!– Less nutrientsLess nutrients

Leafy greens -- SOAKLeafy greens -- SOAK

United Family Healthcare

Address: #2 Jiangtai Lu, Chaoyang District, Beijing 100015 P.R.C.Tel: +86 (10) 5927 7000 Fax: +86 (10) 5927 720024 Hour Emergency Hotline: (010) 5927 7120www.ufh.com.cn

Thank You

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www.myhealthbeijing.comWeibo.com/daniudaifuRichard.saintcyr@ufh.com.cn