Original subtitles

WELCOME.

GOOD MORNING TO THE OVER 200

VIRTUAL ATTENDEES WE HOPE WILL

JOIN US TODAY.

WE'RE PLEASED WE'RE BEING JOINED

FROM ATTENDEES FROM THE U.S.,

FROM ABROAD, FROM TRAINEES TO

SENIOR FACULTY, MANY COLLEAGUES,

FEDERAL COLLEAGUES, FROM THOSE

WHO ALREADY KNOW A LOT ABOUT

PLANETARY HEALTH AND THOSE WHO

WANT TO LEARN MORE.

WE HAVE MANY OUTSTANDING

PRESENTERS.

OUR CO-CHAIRS, SONIA ANGELL AND

SANJAY RAJAGOPALAN.

I WANT TO THANK THEM FOR THEIR

HARD WORK.

I WANT TO HIGHLIGHT A SPECIAL

AND UNUSUAL SESSION WHICH WILL

OCCUR TODAY AT 3:30 THIS

AFTERNOON AFTER OUR AFTERNOON

BREAK.

IT WILL BE YOUR CHANCE BECAUSE

IT'S GOING TO BE INTERACTIVE TO

SEE HOW DIFFERENT POLICIES

INFLUENCE OUR PLANET, AND IT

WILL SUMMARIZE SOME OF THE

INSIGHTS FROM THE PRESENTATIONS

YOU'LL HEAR TODAY, AND MAY

PROVOKE ADDITIONAL RESEARCH

IDEAS.

THIS SIMULATION AS YOU CAN SEE

AT THE BOTTOM OF THE SLIDE HAS

BEEN WIDELY PRAISED.

SO, IF YOU HAVE THE TIME, PLEASE

STAY TUNED.

PLEASE STAY ON THE SEMINAR, ON

THE WORKSHOP, AT 3:30.

NEXT SLIDE PLEASE.

IT GIVES ME GREAT PLEASURE TO

INTRODUCE A SENIOR LEADER IN THE

NHLBI, DAVID GOFF, WHOSE

LEADERSHIP HAS BEEN

CHARACTERIZED BY ENCOURAGING

STAFF AND THE RESEARCH COMMUNITY

WHO WE SUPPORT TO TACKLE THE

MOST IMPORTANT UNANSWERED

QUESTIONS AND TO ENSURE THAT OUR

RESEARCH CAN BE WIDELY USED TO

IMPROVE HEALTH.

DAVID?

>> THANK YOU, LARRY.

I WANT TO ADD MY THANKS TO THE

ORGANIZERS AND CO-CHAIRS FOR

PUTTING TOGETHER THIS FANTASTIC

WORKSHOP.

NEXT SLIDE PLEASE.

SO, IT'S MY PLEASURE TO KICK

THIS OFF, AND ONE OF THE REASONS

I'M SO HAPPY ABOUT THIS IS THAT

WHILE ALL OUR WORKSHOPS ARE

REALLY IMPORTANT, THIS ONE IS

REALLY SPECIAL TO ME BECAUSE

I'VE HAD A LONG INTEREST IN THE

LINK BETWEEN CARDIOVASCULAR

HEALTH AND PLANETARY HEALTH.

NEXT SLIDE PLEASE.

MY LAST LECTURE AT THE COLORADO

SCHOOL OF HEALTH WHERE I WAS

BEFORE COMING TO NHLBI WAS ON

THE ISSUE OF PLANETARY HEALTH,

AND IT WAS BASED ON WHAT I

BELIEVE TO BE ONE OF THE MOST

IMPORTANT PAPERS RELEASED IN THE

LAST DECADE, "SAFEGUARDING HUMAN

HEALTH,."

A REPORT FROM THE ROCKEFELLER

FOUNDATION AND LANCET

COMMISSION.

THIS WAS WAS BASED ON THE

LANDMARK PUBLICATION FROM 2015

BUT IF ANY OF YOU HAVE NOT HAD

THE OPPORTUNITY READ THAT PAPER,

I STRONGLY RECOMMEND IT.

AS I SAID, IT'S REALLY, IN MY

PROFESSIONAL CAREER, ONE OF THE

MOST IMPORTANT PAPERS THAT I'VE

READ OVER THE PAST DECADE AND

HAS REALLY HELPED SHAPE MY

THINKING ABOUT THE IMPORTANCE OF

THE ISSUES WE'RE GOING TO BE

TALKING ABOUT TODAY AND HAS

ENCOURAGED ME TO THINK ABOUT HOW

I AND MY ORGANIZATION CAN

CONTRIBUTE IN THIS IMPORTANT

AREA.

NEXT SLIDE PLEASE.

IN 2021, I WAS HONORED TO BE

INVITED TO GIVE THE ANSEL KEYS

LECTURE AT AMERICAN HEART

ASSOCIATION.

I FOCUSED THAT OPPORTUNITY ON

OUR EFFORTS TO PURSUE ON HEART

HEALTHY PLANET.

IN RECOGNITION OF THE REALITY

THAT THOSE OF US WHO HAVE BEEN

WORKING ON PROMOTING HEART

HEALTH, WE CAN'T ACHIEVE A HEART

HEALTHY POPULATION ON AN

UNHEALTHY PLANET WE HAVE TO HAD

A HEALTHY PLANET TO HAVE A HEART

HEALTHY POPULATION.

NEXT SLIDE PLEASE.

SO IN THAT LECTURE I ASKED THE

AUDIENCE TO PICTURE THEMSELVES

DECADES IN THE FUTURE.

I PICKED 2060 AS THE YEAR.

WE HAD ACHIEVED THE GOAL OF

HAVING A HEALTHY PLANET WITH A

HEART HEALTHY POPULATION, AND

POSED THE QUESTION HOW DID WE

GET THERE FROM WHERE WE WERE IN

2021.

ADVANCE PLEASE.

REMEMBER, THIS WAS 2021.

AND THE SITUATION IS FAIRLY

SIMILAR TODAY.

WE HAD A WORLD WHERE THE

TEMPERATURES ARE HOT AND RISING,

WHERE THERE'S WILDFIRES THAT

WE'RE DEALING WITH, WHERE OUR

AGRICULTURE SYSTEM AND FOOD

SYSTEM PROMOTED UNHEALTHY

SITUATIONS FOR OUR POPULATION,

ESPECIALLY WITH RESPECT TO HEART

HEALTH, AND NOT JUST HEART

HEALTH.

SO HOW DID WE GET TO WHERE WE

WERE IN 2060 FROM WHERE WE HAD

BEEN IN 2021 AND WHERE WE STILL

ARE IN 2023?

NEXT SLIDE PLEASE.

I POSED THE POSSIBILITIES

LOOKING BACKWARDS WE COULD SEE

FIVE PATHWAYS OF RESEARCH THAT

WERE CRITICAL TO ACHIEVING A

HEART HEALTHY PLANET WITH A

HEALTHY POPULATION IN 2060.

AMONG THOSE FIVE PATHWAYS WAS

RESEARCH ON PROMOTING PLANETARY

HEART HEALTH, WHICH IS THE TOPIC

OF TODAY'S WORKSHOP.

SO I'M DELIGHTED THIS WORKSHOP

IS FOCUSED BOTH ON PROMOTING

PLANETARY HEALTH, AS WELL AS

INTERSECTION OF THAT WITH SOCIAL

DETERMINANTS AND WITH THE OTHER

ASPECTS LISTED ON THIS SLIDE,

ALL OF WHICH ARE INTERTWINED IN

OUR EFFORTS TO ACHIEVE A HEALTHY

POPULATION ON A HEALTHY PLANET.

NEXT SLIDE PLEASE.

SO, I KNOW THIS WORKSHOP IS

GOING TO ADD IMPORTANTLY, OH, I

THINK NEXT SLIDE PLEASE.

THANK YOU.

SO I KNOW THIS WORKSHOP IS GOING

TO CONTRIBUTE IMPORTANTLY TO OUR

UNDERSTANDING OF THE

OPPORTUNITIES THAT WE CAN PURSUE

TO ADVANCE PLANETARY HEALTH AND

CARDIOVASCULAR HEALTH.

AND SO I WANT TO THANK YOU FOR

YOUR WORK LEADING UP TO THIS,

YOUR CONTRIBUTIONS TO THE

WORKSHOP, THE TIME YOU'RE TAKING

TO CONTRIBUTE TO THIS THINKING

ABOUT THIS MAJOR CHALLENGE WE

FACE TOGETHER, AND YOUR

COMMITMENT TO THE WORK WE CAN DO

TOGETHER IN THE FUTURE.

I WANT TO THANK YOU AND PASS THE

BATON BACK TO LARRY FINE.

>> THANK YOU VERY MUCH, DAVID,

FOR GETTING US STARTED.

NEXT SLIDE PLEASE.

I'VE HAD THE PRIVILEGE OF

WORKING WITH TWO GIFTED

SCIENTISTS AND LEADERS WHO IN

THE PAST YEAR HAVE SHAPED THIS

WORKSHOP AND TAUGHT ME AND

OTHERS ON THE PLANNING COMMITTEE

SO MUCH.

THEY ARE OUR CO-CHAIRS.

SONIA ANGELL FROM JOHNS HOPKINS

BLOOMBERG SCHOOL OF HUSBAND

HEALTH IS AS YOU CAN SEE THE

BLOOMBERG DISTINGUISHED

PROFESSOR OF PRACTICE, AND

SANJAY RAJAGOPALAN, FROM

UNIVERSITY HOSPITAL AT CASE

WESTERN RESERVE UNIVERSITY, WHO

IS THE HERMAN HELLERSTEIN

PROFESSOR OF MEDICINE.

THEY ARE OUR CO-CHAIRS.

SO, SONIA, PLEASE SAY A FEW

WORDS.

>> THANK YOU SO MUCH.

IT IS SUCH A PLEASURE TO BE A

PART OF THIS PROCESS AND

EXPERIENCE.

AS WE ALL KNOW, CARDIOVASCULAR

DISEASE REMAINS A LEADING CAUSE

OF DEATH IN THE U.S. AND

GLOBALLY.

IT'S ALSO A LEADING RISK FACTOR

FOR HOSPITALIZATION AND DEATH

FROM COVID.

THIS PANDEMIC REMINDED US WHILE

WE MUST CONTINUE TO ADVANCE OUR

DEFENSES AGAINST INFECTIOUS

AGENTS THROUGH ENHANCED

SURVEILLANCE, VACCINE, AND

TREATMENTS, ADDRESSING CHRONIC

DISEASE, ESPECIALLY

CARDIOVASCULAR DISEASE, IS ALSO

PANDEMIC PREPAREDNESS.

IT'S ALSO REQUIRED FOR NATIONAL

HEALTH SECURITY, HEALTH EQUITY,

FOR CREATING RESILIENT

COMMUNITIES AND ECONOMIES.

BUT HEALTHY HEARTS REQUIRE A

HEALTHY PLANET AS DR. GOFF

LISTED UP, AND THIS PLANET IS

NOT HEALTHY.

THE SYSTEMS ARE NOT PROMOTING

CARDIOVASCULAR AND PLANETARY

HEALTH DUAL AIMS.

SYSTEMS THAT PRODUCE, ALSO

PRODUCE A THIRD OF THE WORLD'S

GREENHOUSE GASES.

FOOD SYSTEMS USE 70% OF FRESH

WATER, 80% OF DEFORESTATION, A

LEADING CAUSE OF BIODIVERSITY

LOSS.

STILL, DIETARY PATTERNS ARE NOT

IDEAL.

SYSTEMS WERE CREATED AT THE

HANDS OF HUMANS AND CAN BE

CHANGED BY US, THAT CHANGE NEEDS

TO BE STRATEGIC AND GUIDED BY

EVIDENCE.

WE NEED RESEARCH THAT WILL MOVE

US EXPEDITIOUSLY TO ACTIONABLE

SOLUTIONS AT THE LOCAL, STATE,

AND GLOBAL LEVEL.

WE'RE SO THANKFUL FOR DR. GOFF'S

LEADERSHIP IN IDENTIFYING THIS

GAP AND FOR DR. LARRY FINE AND

HIS REMARKABLE STAFF FOR LEADING

THE DESIGN OF THE SPACE FOR ALL

OF US TO COME TOGETHER AND

CONTEMPLATE HOW

TRANSDISCIPLINARY THINKING MIGHT

ADVANCE THE PLANETARY AND

CARDIOVASCULAR NEEDS OF OUR

COUNTRY AND OUR WORLD.

THE TIMELINESS OF THIS WORKSHOP

OFF COP28 IS NOT LOST.

I UNDERSTAND AS DR. GOFF SAID

THIS IS THE FIRST OF ITS KIND

FOR THE NHLBI, AS CO-CHAIR

WORKING WITH THIS TEAM TO HELP

SHAPE WHAT WE HOPE WILL BE A

REMARKABLE OPPORTUNITY FOR ALL

OF YOU, OUR TEAM ALSO RECOGNIZES

REMARKABLE OPPORTUNITY, TRAGEDY

OF THE LIMITED TIME AND TOPICAL

EXCLUSIONS THAT WERE NECESSARY.

STILL, THROUGH WORKING THROUGH

OUR WORKSHOP GOALS WE HOPE THIS

IS ONLY THE BEGINNING OF

REIMAGINING HOW WE CAN ADVANCE

THE SCIENTIFIC FIELDS THROUGH

IDENTIFYING CONCRETE SPECIFIC

RESEARCH NEEDS, METHODS,

COLLABORATIONS THAT WILL DRIVE

US TO A WORLD WITH HEALTHY

HEARTS ON A HEALTHY PLANET.

SO IF YOU'LL PLEASE ADVANCE TO

THE SLIDE ON OBJECTIVES, WOULD

LIKE TO REMIND US WHY WE'RE

GATHERED HERE TODAY.

THIS WILL WORK TO IDENTIFY KEY

SCIENTIFIC KNOWLEDGE GAPS,

RESEARCH METHODS, TOOLS AND

OPPORTUNITIES AT THE

INTERSECTION OF PLANETARY AND

CARDIOVASCULAR HEALTH.

WE'LL EXPLORE STRATEGIES TO

IMPROVE PLANETARY AND

CARDIOVASCULAR HEALTH AND

ADVANCE HEALTH EQUITY AND OUR

FINAL OBJECTIVES IS TO INCREASE

SCIENTIFIC UNDERSTANDING OF

BIODIRECTIONAL AND

INTERDEPENDENT RELATIONSHIP OF

PLANETARY AND CARDIOVASCULAR

HEALTH.

I'D LIKE TO THANK YOU ALL FOR

JOINING US THIS MORNING AND OVER

THE NEXT DAY, ESPECIALLY THANK

MY CO-CHAIR DR. SANJAY

RAJAGOPALAN FOR BEING PART OF

THIS AMAZING PROCESS WITH ME.

THANK YOU.

>> SANJAY?

>> THANKS, SONIA.

I'D LIKE TO ECHO YOUR COMMENTS

AND SINCERE THANKS TO LARRY AND

THE PROGRAM STAFF AND NHLBI AND

DAVID GOFF FOR THE SUPPORT.

DELIGHTED COP28 ENDED ON

POSITIVE NOTE, TAKING A

CONCERTED DECLARATION ON HEALTH

EFFECTS OF CLIMATE TO IDENTIFY

RESEARCH PRIORITIES AT THE NEXUS

OF PLANETARY AND CARDIOVASCULAR

HEALTH, AT THE OUTSET MIGHT BE

WORTHWHILE TO HIGHLIGHT

TRANSFORMATIVE TRENDS THAT

THOUGHTFULLY LEVERAGE COULD HAVE

MASSIVE IMPACT ON CARDIOVASCULAR

HEALTH AND REALLY REPRESENTS

MAJOR OPPORTUNITIES FOR

RESEARCH.

AND THESE ARE EMERGING

CO-CONVERGENT TRENDS IN CLIMATE

TECHNOLOGIES, CLEAN ENERGY,

SMART GRID ELECTRIC VEHICLES

THAT CAN OFFER SUBSTANTIAL CORE

BENEFITS REDUCING AIR POLLUTION,

AND CORRESPONDING RESEARCH

OPPORTUNITIES, LOW CARBON AND

NET ZERO AGENDAS, URBAN DESIGN,

PROVIDING OPPORTUNITIES TO

REDUCE CARDIOVASCULAR OUTCOMES

AND ASK WHY WITH REGARD TO

RESEARCH QUESTIONS, ADAPTATION,

INCREASING CONNECTIONS BETWEEN

BIODIVERSITY, CARDIOVASCULAR

HEALTH, AND THESE ARE JUST SOME

EXAMPLES WHERE THE FIELD IS

MOVING BUT PROVIDE SUPERB

OPPORTUNITIES FOR RESEARCH.

THE FINAL EXCITING ASPECT OF THE

FORUM HERE IS THAT THIS IS AN

UBER TEAM SPORT, ENGAGEMENT OF

TRANSDISCIPLINARY TEAMS OF A

VARIETY OF DIFFERENT SCIENTISTS

INCLUDING COMPUTATION, GEO

PHYSICAL AND HEALTH SCIENTISTS

TO EXPLORE, REALLY CRITICAL.

NEXT SLIDE PLEASE.

NEXT SLIDE.

THE FIRST SESSION IS REALLY

EXCITING, EXPLORE RELATIONSHIPS

AND DID I MECHANICSES OF

INTERACTIONS MODERATED BY DR.

CARREN SOLOMON, HARVARD MEDICAL

SCHOOL, PHYSICIAN AT THE BRIGHAM

AND WOMEN'S HOSPITAL.

RESPONSIBILITIES INCLUDE

OVERSEEING ONGOING FOSSIL FUEL

POLLUTION SERIES A TOUR DU FORCE

BRINGING AWARENESS.

I'LL SAY A FEW ADDITIONAL WORDS,

AND I'LL INTRODUCE THE FIRST

SPEAKER.

I WOULD LIKE TO POINT OUT THE

EXCELLENT BOOKLET ASSEMBLED BY

NHLBI STAFF THAT YOU CAN ACCESS

BY SCANNING THE QR CODE.

SO, WITHOUT MUCH ADO, I'D LIKE

TO INTRODUCE THE FIRST SPEAKER,

DR. SAM MYERS, WHO IS GOING TO

BE SPEAKING ON IS DESTROYING

NATURE BREAKING OUR HEARTS,

CONNECTIONS BETWEEN

CARDIOVASCULAR HEALTH AND GLOBAL

AND ENVIRONMENTAL CHANGE.

WELL KNOWN FOR WORK ON CLIMATE

CHANGE, DIRECTOR OF THE JOHNS

HOPKINS INSTITUTE FOR PLANETARY

HEALTH, FOUNDING DIRECTOR OF THE

PLANETARY HEALTH ALLIANCE.

DR. MYERS?

>> ALL RIGHT.

THANK YOU SO MUCH, SANJAY.

GREAT TO BE WITH EVERYBODY.

GREAT IF WE COULD GET MY SLIDES

UP.

SO, I'VE BEEN ASKED TO PROVIDE A

LITTLE BIT OF OPENING AND

CONTEXT FOR CONVERSATION WE'RE

GOING TO BE HAVING, SO ONCE WE

HAVE SOME SLIDES, I'M GOING TO

TRY TO OUTLINE CONNECTIONS

BETWEEN BIOPHYSICAL CHANGES AND

HUMAN HEALTH WITH FOCUS ON

CARDIOVASCULAR HEALTH.

I DON'T SEE MY SLIDES.

I'M GOING TO WAIT FOR A MINUTE.

IS THERE SOMETHING I NEED TO BE

DOING, BRITNEY?

>> I DON'T THINK SO.

>> OKAY.

CAN YOU ADVANCE THE SLIDES?

THERE WE GO.

LET'S GO AHEAD TO THE NEXT SLIDE

PLEASE.

AND WHAT I REALLY WANT TO DO IS

CONTEXTUALIZE THE NEXT TWO DAYS'

CONVERSATION A LITTLE BIT.

WHAT I THINK IS A REALLY

EXTRAORDINARY AND UNIQUE MOMENT

IN HUMAN HISTORY, WHAT WE'VE

BEEN WATCHING IS THIS

EXCEPTIONAL BALLOONING OF

HUMANITY'S TOTAL ECOLOGICAL

FOOTPRINT.

WE FIND OURSELVES IN THE MIDST

OF WHAT MANY PEOPLE CALL THE

GREAT ACCELERATION, WHERE FOR

MOST OF HUMAN HISTORY WE'VE SEEN

MODEST CONSUMPTION PATTERNS UP

THROUGH 1900, AND THEN THIS

GENTLE RISE IN GLOBAL

CONSUMPTION PATTERNS THROUGH

1950 AND THIS VERY STEEP

ACCELERATION WHERE WE'RE LOOKING

AT APPROPRIATION OF FRESH WATER,

PROLIFERATION OF CARS AND

TRUCKS, OR PRODUCTION AND USE OF

SYNTHETIC FERTILIZERS, PAPER

PRODUCTION, PLASTIC PRODUCTION,

ENERGY USE, THEY LOOK SIMILAR

WITH THIS STEEP INCREASE IN

TODAY'S CONSUMPTION RATES.

NEXT SLIDE.

NOT SURPRISINGLY, IF YOU LOOK AT

OUR IMPACT ACROSS OUR PLANET'S

NATURAL SYSTEMS YOU SEE AGAIN

VERY SIMILAR CURVES LOOKING AT

LOSS OF BIODIVERSITY OR

EXPLOITATION OF FISHERIES,

ADDITIONAL CARBON DIOXIDE TO THE

A ATMOSPHERE AND LOSS OF

FORESTS, THE NUMBER OF PEOPLE

THAT SHARE THE PLANET WITH US

HAS BEEN, AGAIN, VERY STABLE

THROUGH MOST OF HUMAN HISTORY,

GENTLE RISE THROUGH 1900, AND

THEN THIS EXTREMELY STEEP ALMOST

EXPONENTIAL GROWTH IN THE NUMBER

OF PEOPLE ON THE PLANET.

AND AT THAT SAME TIME, WE SAW AN

EVEN STEEPER INCREASE IN THE PER

CAPITA GDP, THE AMOUNT OF GOODS

AND SERVICES EACH OF US IS

ASKING OUR PLANET TO PROVIDE.

WHEN YOU MULTIPLY THE NUMBERS

AGAINST EACH OTHER YOU FIND THE

TOTAL SORT OF HUMAN IMPACT,

TOTAL GDP GROWTH GLOBALLY LOOKS

LIKE THIS ALMOST VERTICAL CURVE.

WE STAND TODAY ON THE TOP OF

THIS SORT OF VERTICAL CURVE IN

TOTAL CONSUMPTION.

NEXT SLIDE PLEASE.

THE SORT OF CORE ECOLOGICAL

FOOTPRINT OF HUMANITY, THE

COLLECTIVE IMPACT WE'RE HAVING

ON OUR PLANET'S NATURAL SYSTEMS,

IS REALLY HARD NOW TO OVERSTATE.

AS SONIA WAS SAYING WE USE 40%

OF TERRESTRIAL LAND SURFACE FOR

CROP LANDS AND PASTURE, 90 COMPS

OF WATER FOR DROPS.

WE'VE CUT DOWN AROUND HALF THE

TROPICAL AND TEMPERATE FORESTS

ON THE PLANET, DAMNED 60% OF

RIVERS, HAVING GROWING PROBLEM

OF GLOBAL SCALE POLLUTION OF

AIR, WATER, AND SOIL.

WE'RE DISRUPTING THE GLOBAL

CLIMATE SYSTEM.

ALL THESE MAJOR IMPACTS ON OUR

NATURAL SYSTEMS ARE NOW DRIVING

SPECIES EXTINCT AT A THOUSAND

TIMES THE BASELINE RATE.

THE POPULATION SIZE OF BIRDS,

MAMMALS, FISHES, REPTILES,

AMPHIBIANS, HAS FALLEN BY

TWO-THIRDS SINCE 1970, A MILLION

SPECIES ARE NOW FACING

EXTINCTION, MANY WITHIN THE NEXT

FEW DECADES.

NEXT SLIDE.

SO, THE CORE PROPOSITION OF THIS

FIELD OF PLANETARY HEALTH IS

THAT THE SIZE OF OUR TOTAL

FOOTPRINT, THAT EXCEEDS OUR

PLANET'S CAPACITIES TO EITHER

ABSORB WASTE OR PROVIDE

RESOURCES WE'RE USING

SUSTAINABLE.

AS A RESULT, OUR ACTIONS

COLLECTIVELY, ARE TRANSFORMING

NOT JUST CLIMATE SYSTEM BUT ALSO

DRIVING MASS EXTINCTION OF LIFE

ON EARTH, ALTERING BIOGEO

CHEMICAL CYCLES, CHANGING LAND

USE AND LAND COVER, DRIVING

SCARCITY OF RESOURCES LIKE FRESH

WATER AND ARABLE LAND, DRIVING

GLOBAL SCALE POLLUTION.

ALL THE COMPLEX BIOPHYSICAL

CHANGES THAT WE ARE MEDIATING IN

THE GLOBAL ENVIRONMENT ARE

INTERACTING WITH EACH OTHER IN

COMPLEX WAYS TO AFFECT

FOUNDATIONAL CONDITIONS FOR

HUMAN HEALTH AND WELL-BEING, THE

QUALITY AND QUANTITY OF FOOD

THAT WE PRODUCE, QUALITY OF AIR

WE BREATHE, OUR EXPOSURE TO

INFECTIOUS DISEASES, EXPOSURE TO

EXTREME WEATHER EVENTS, EVEN

HABITABILITY OF SOME PLACES WE

LIVE.

INCREASINGLY WE'RE SEEING LARGE

IMPACTS ACROSS EVERY DIMENSION

OF HUMAN HEALTH, AND OUR

TRANSFORMATION OF NATURE IS

LOOKING LIKE ONE OF THE PRIMARY

DRIVERS OF GLOBAL BURDEN OF

DISEASE OVER THE NEXT CENTURY.

NEXT SLIDE.

SO JUST AS WE HAVE SORT OF COME

TO UNDERSTAND OVER THE LAST

SEVERAL DECADES THAT THERE ARE

IMPORTANT SOCIAL AND CULTURAL

AND POLITICAL DETERMINANTS OF

HUMAN HEALTH, WE'RE COMING TO

UNDERSTAND THERE ARE VERY

IMPORTANT ECOLOGICAL

DETERMINANTS, THAT INDEED OUR

HEALTH IS NESTED IN A SET OF

BIOPHYSICAL CONNECTIONS AND THAT

THOSE ARE NOW CHANGING AT THE

FASTEST RATE IN THE HISTORY OF

OUR PLANET.

NEXT SLIDE PLEASE.

IN THE HISTORY OF OUR SPECIES,

NOT OUR SPECIES, I'M SORRY.

SO WHAT I THOUGHT I WOULD DO IS

TRY TO GIVE YOU A FEEL OF THE

DIVERSITY OF WAYS IN WHICH

BIOPHYSICAL CONDITIONS ARE

AFFECTING HEART DISEASE USING

SOME OF MY OWN GROUP'S RESEARCH

AND RESEARCH FROM OTHER GROUPS

AS WELL.

AND I WANT TO EMPHASIZE

SOMETHING THAT DAVID GOFF SAID

AT THE OUTSET, WHICH WAS THAT

NONE OF THE EFFECTS THAT I'M

GOING TO DESCRIBE TO YOU ARE

DIRECT EFFECTS OF CLIMATE CHANGE

PER SE.

DIRECT EFFECTS OF OTHER ASPECTS

OF BIOPHYSICAL CHANGE, SO WE

NEED A BROADER FRAME THAN JUST

CLIMATE CHANGE ALONE.

A FEW OTHER OVERARCHING POINTS

ARE, ONE, THAT MANY OF THESE

IMPACTS ARE REALLY SURPRISING,

THEY ARE NOT ONES WE NECESSARILY

WOULD HAVE ANTICIPATED.

TWO, THEY ARE OFTEN MEDIATED

THROUGH COMPLEX SYSTEMS AND,

THREE, THEY ARE UNEVENLY

DISTRIBUTED.

THEY TEND TO DISPROPORTIONATELY

IMPACT THE POOR AND FUTURE

GENERATIONS.

NEXT SLIDE.

SO HERE ARE A FEW EXAMPLES.

THIS IS WORK MY GROUP HAS DONE

IN WHICH WE'VE LOOKED AT THE

IMPACT OF RISING CONCENTRATIONS

OF CARBON DIOXIDE ON THE

NUTRIENT CONTENT OF STAPLE FOOD

CROPS.

USING THESE RINGS, ENRICHMENT

METHODOLOGY, ESSENTIALLY IS A

RING OF CARBON DIOXIDE-EMITTING

JETS, YOU CAN GROW CROPS INSIDE

THESE CIRCLES AT ELEVATED

CONCENTRATIONS OF CO2 THAT MIMIC

WHAT WE EXPECT THE WORLD TO LOOK

LIKE ABOUT THE MIDDLE OF THIS

CENTURY.

WHEN YOU DO THAT, YOU CAN

COMPARE CROPS AT HIGHER CO2 WITH

AMBIENT CO2 OUTSIDE THE RING BUT

OTHERWISE IDENTICAL FIELD

CONDITIONS AND SEE WHAT THE

ISOLATED EFFECT OF RISING CO2 IS

ON THOSE CROPS.

WHAT WE FOUND WHEN WE DID THAT,

NEXT SLIDE, WAS THAT INDEED

RISING CONCENTRATIONS OF CO2 ARE

ACTUALLY SIGNIFICANTLY REDUCING

THE AMOUNT OF REALLY IMPORTANT

NUTRIENTS IN STAPLE FOOD CROPS

LIKE WHEAT AND RICE.

NEXT SLIDE.

IN PARTICULAR, WHAT WE FOUND WAS

THAT IF WE ACTUALLY PROJECT

THOSE CHANGES ONTO DIETS OF

PEOPLE AROUND THE WORLD, ACROSS

150 COUNTRIES WE WOULD SEE

BETWEEN 150 AND 200 MILLION

PEOPLE PUSHED INTO NEW

DEFICIENCIES OF IRON, ZINC,

PROTEIN, AS A RESULT OF THIS CO2

MEDIATED EFFECT.

NEXT SLIDE PLEASE.

FROM A CARDIOVASCULAR

STANDPOINT, IT'S VERY

INTERESTING.

THIS IS SPECULATIVE BUT IT MAKES

US THINK ABOUT THE OMNI HEART

STUDY.

RIGHT NOW WHAT WE'RE DOING IS

THIS SORT OF GLOBAL EXPERIMENT

ON THE ENTIRE HUMAN DIET, WHERE

ESSENTIALLY WE'RE SUBSTITUTING

DIETARY STARCH OR CARBOHYDRATE

FOR DIETARY PROTEIN.

AND WE KNOW FROM THAT STUDY WHEN

WE DID THAT AT A LARGER SCALE,

STRONGER CONCENTRATION SHIFTS,

THAT THIS SHIFT FROM DIETARY

CARBOHYDRATE TO -- FROM PROTEIN

TO CARBOHYDRATE INCREASED RISK

OF CORE ANOTHER HEART DISEASE.

NOW WE'RE DOING SIMILAR

EXPERIMENT AT LOWER

CONCENTRATIONS, ON THE ENTIRE

GLOBAL POPULATION, AND IT IS

CONCERNING, WHAT MIGHT THE

IMPLICATIONS BE FOR

CARDIOVASCULAR HEALTH.

ANOTHER STUDY LOOKS AT CHANGES

IN INSECT POLLINATORS AFFECTING

GLOBAL HEALTH, ALSO PROTECTING

US FROM DISEASES LIKE HEART

DISEASE, STROKE, CANCER AND

DIABETES, AND WHEN WE LOOKED AT

THE GAP WE'RE ALREADY SEEING IN

FOOD PRODUCTION BECAUSE OF

INSUFFICIENT POLLINATORS

POPULATIONS, INSECT POPULATIONS

GLOBALLY HAVE BEEN DECLINING, WE

FOUND INEFFICIENT POPULATIONS

ARE REDUCING FRUIT, VEGETABLE,

NUT YIELDS BY 3 TO 5%.

WHEN WE LOOK AT THE NUTRITIONAL

EPIDEMIOLOGY RUNNING THAT

THROUGH THE IMPACT FOOD MODEL,

BIOECONOMIC MODEL, WHO WOULD

HAVE CONSUMED THOSE FOODS AND

WHAT THE IMPACTS WERE ON HEALTH,

WE FOUND ALMOST HALF A MILLION

DEATHS PER YEAR WE'RE SEEING

TODAY BECAUSE OF INCREASED HEART

DISEASE AS WELL AS OTHER

NON-COMMUNICABLE DISEASES AND WE

FOUND THESE SIGNIFICANT ECONOMIC

IMPACTS FOR LOWER INCOME

COUNTRIES.

NEXT SLIDE.

A THIRD AREA AROUND BIODIVERSITY

RELATES TO FISH CATCH.

THIS IS FROM SOMETHING WE

PUBLISHED A WHILE BACK THAT

SHOWED ABOUT A BILLION PEOPLE IN

THE WORLD ARE DEPENDING ON WILD

HARVESTED FISH TO GET ADEQUATE

INTAKES OF KEY NUTRIENTS,

INCLUDING OMEGA-3 FATTY ACIDS.

I DON'T KNOW IF YOU SAW THE

PAPER PUBLISHED IN NATURE

CLIMATE CHANGE LAST MONTH FROM

WILLIAM CHUNG'S GROUP, WE COULD

SEE 30% REDUCTION IN

SEAFOOD-BASED NUTRIENTS AS A

RESULT OF OCEAN WARMING AND BIG

CHANGES IN THE DISTRIBUTION OF

FISHERIES SO THAT IN COUNTRIES

PARTICULARLY AROUND THE TROPICS

WE COULD SEE REDUCED ACCESS TO

WILD HARVESTED FISH AND TO

NUTRIENTS INCLUDING OMEGA-3

FATTY ACIDS IMPORTANT FOR

CARDIOVASCULAR HEALTH AS A

RESULT OF SEA SURFACE WARMING.

NEXT SLIDE.

OF COURSE, INCREASED RISK AND

INTENSITY OF WILDFIRES AND

BIOMASS FIRES IS SOMETHING WE'RE

ALL AWARE.

WE'RE AWARE LAST SUMMER WHEN AIR

QUALITY IN WASHINGTON, D.C. AND

ALL ALONG THE EASTERN SEABOARD

DETERIORATED DRAMATICALLY AS A

RESULT OF THE CANADIAN

WILDFIRES.

WE'VE DONE RESEARCH IN INDONESIA

LOOKING AT THE CONNECTIONS

BETWEEN LAND USE DECISIONS

THERE, HOW THAT CHANGES THE RISK

OF THE FIRES THAT CREATE BIG

HAZE EPISODES, WHAT THE

EMISSIONS OF THOSE FIRES ARE

FROM A CHEMICAL STANDPOINT AND

HOW THEY CHANGE AS THEY MOVE

THROUGH SPACE AND TIME, AND

ULTIMATELY WHAT THE POPULATION

LEVEL PARTICULATE EXPOSURES ARE

FROM THE FIRES IN INDONESIA.

WHAT WE FOUND, NEXT SLIDE,

CUMULATIVELY WE ANTICIPATE

36,000 EXCESS DEATHS EVERY YEAR

INTO THE NEXT SEVERAL DECADES,

AS A RESULT OF THESE LAND USE

DECISIONS AND FIRES IN

INDONESIA, BUT IMPORTANTLY

ALMOST 2/3 COULD BE PREVENTED

WITH AGGRESSIVE PEATLANDS

RESTORATION IN INDONESIA.

THIS IS A PAPER WE WORKED ON

WITH THE INDONESIAN GOVERNMENT.

IN WORK I WAS NOT INVOLVED IN,

ANOTHER INTERESTING EXAMPLE WAS

SHOWING THAT CHANGES IN WATER

RESOURCE MANAGEMENT COMBINED

WITH SEA LEVEL RISE AND MORE

EXTREME STORMS ARE LEADING TO

SALT WATER INTRUSION UP THROUGH

THE BAY OF BENGAL AND INTO

COASTAL AQUIFERS IN BANGLADESH.

THE SALINITY IN GROUND WATER IN

THESE COASTAL REGIONS AS IT

RISES HAS BEEN DIRECTLY

CORRELATED BOTH WITH ECLAMPSIA

IN PREGNANT WOMEN AND

HYPERTENSION ACROSS THE ADULT

POPULATION, INTERESTING

CONNECTION BETWEEN SEA LEVEL

RISE, WATER RESOURCE MANAGEMENT,

HYPERTENSION IN THOSE

POPULATIONS.

NEXT SLIDE.

AND THEN FINALLY, POLLUTION

ITSELF.

IF YOU CAN GO BACK TO THE SLIDE

BEFORE.

THANK YOU.

POLLUTION ITSELF AS WE LEARNED

FROM THE GLOBAL POLLUTION AND

HEALTH STUDY IN " THE LANCET" A

FEW YEARS AGO IS DRIVING 9

MILLION DEATHS A YEAR.

WHEN YOU LOOK AT THE COMPOSITION

OF THOSE DEATHS, MOST OF THEM

ARE FROM AIR POLLUTION, A HUGE

CHUNK OF THE MORBIDITY AND

MORTALITY ASSOCIATED WITH GLOBAL

POLLUTION RELATES TO CARDIAC AND

LUNG DISEASE OVERALL.

NEXT SLIDE.

SO, I THINK WHAT'S REALLY

INTERESTING ABOUT THIS, RIGHT,

IS THAT, YOU KNOW, ALL OF THESE

DIFFERENT KINDS OF BIOPHYSICAL

CHANGE IN WAYS THAT AREN'T

NECESSARILY INTUITIVE OR THAT WE

WOULDN'T NECESSARILY HAVE

ANTICIPATED ARE ACTUALLY

AFFECTING CARDIOVASCULAR

DISEASE, FROM THE AMOUNT OF CO2

IN THE ATMOSPHERE TO LOSSES OF

BIODIVERSITY AND INSECT

POPULATION, TO CHANGES IN SEA

SURFACE TEMPERATURES, AND ACCESS

TO FISH IN THE DIET, TO LAND USE

DECISIONS THAT RELATE TO BIOMASS

FIRES, TO SEA LEVEL RISE, TO

POLLUTION, AND SO THERE ARE A

WHOLE HOST OF WAYS, AGAIN,

INDEPENDENT OF CLIMATE CHANGE

THAT OUR OWN SORT OF

TRANSFORMATION OF OUR PLANET'S

NATURAL SYSTEMS ARE ACTUALLY

IMPACTING RISKS OF

CARDIOVASCULAR DISEASE AND AS I

MENTIONED MANY OF THESE ARE

SURPRISING.

MANY OF THEM ARE MEDIATED

THROUGH COMPLEX SYSTEMS WHICH

MAKES THEM HARD TO EVALUATE AND

HARD TO ANTICIPATE.

THE IMPACTS WILL BE UNEVENLY

DISTRIBUTED AROUND THE WORLD,

WHICH IS REALLY IMPORTANT IN

COMMON THEME.

ONE OTHER THING INTERESTING,

THESE WILL BE UNACCOUNTED FOR.

NO ONE WILL HAVE SEA LEVEL RISE

OR BIODIVERSITY LOSS ON THEIR

DEATH CERTIFICATE.

AND YET, THESE BIOPHYSICAL

CHANGES ARE RESPONSIBLE FOR VERY

LARGE BURDENS OF DISEASE AROUND

THE WORLD.

NEXT SLIDE.

ANOTHER REALLY IMPORTANT POINT

AND SANJAY MENTIONED THIS

BRIEFLY BEFORE IS THAT THERE ARE

VERY IMPORTANT CO-BENEFITS

ASSOCIATED WITH ADDRESSING THE

EARTH CRISIS THAT WE FACE.

MANY THINGS WE NEED TO DO TO

ADDRESS THE EARTH CRISIS, BOTH

CLIMATE AND OTHER KINDS OF

ENVIRONMENTAL CHANGE, ALSO HAVE

CARDIOVASCULAR BENEFITS.

SO WE KNOW THAT SWITCHING AWAY

FROM AN ANIMAL-BASED DIET TO

MUCH MORE PLANT-BASED DIETS HAS

HUGE BENEFITS IN TERMS OF

CLIMATE CHANGE AND TOTAL

ECOLOGICAL IMPACT ON LAND, ON

WATER, BIODIVERSITY, ET CETERA.

BUT ALSO AT LEAST ON WEALTHIER

POPULATIONS SIGNIFICANT

CARDIOVASCULAR BENEFITS.

WE KNOW POLICIES TO ENCOURAGE

ACTIVE TRANSFER, WALKING AND

BIKING, GETTING AROUND 15-MINUTE

CITIES, WORKING AROUND

NEIGHBORHOODS, BUILDING OUR

CITIES SO THAT THEY ARE DESIGNED

FOR PEOPLE AND NOT FOR CARS, HAS

HUGE BENEFITS FROM A CLIMATE

STANDPOINT BUT ALSO HAS VERY

SIGNIFICANT CARDIOVASCULAR

BENEFITS.

AGAIN, THE TRANSITION TO

RENEWABLE ENERGY CLEARLY HAS

MAJOR CO-BENEFITS, HOPEFULLY

MANY OF YOU SAW THE "SCIENCE"

PAPER LAST MONTH THAT SHOWED

ALMOST HALF A MILLION DEATHS

OVER THE LAST 20 YEARS IN THE

UNITED STATES FROM COAL-FIRED

POWER PLANTS ALONE, PARTICLES

COMING OUT OF THOSE PLANTS, AND

SO THE TRANSITION AWAY FROM

FOSSIL FUEL COMBUSTION AND

TOWARD RENEWABLE ENERGY HAS

SIGNIFICANTLY -- HAS

SIGNIFICANTLY CO-BENEFITS.

AND THOSE ARE THE SORT OF DIRECT

EFFECT OF THESE POLICIES, BUT

THERE ARE OTHER KINDS OF

POLICIES THAT INVOLVE ADDRESSING

THE EARTH CRISIS, THINGS AS I

MENTIONED LIKE PEATLANDS

RESTORATION, BIODIVERSITY

CONSERVATION, PLANTING HEDGE

ROWS, MAINTAINING COVER,

REDUCING PESTICIDES THAT WILL

IMPROVE POLLINATORS WILL HAVE

IMPACTS ON CARDIOVASCULAR

HEALTH.

SO IN TERMS OF RESEARCH GAPS AND

PRIORITIES, I WOULD EMPHASIZE

WHAT WAS SAID AT THE BEGINNING

THAT WE NEED TO DO A BETTER JOB

OF MEASURING CARDIOVASCULAR

IMPACTS OF THESE DIFFERENT KINDS

OF BIOPHYSICAL CHANGES.

THESE ARE EXAMPLES OF INITIAL

STUDIES BUT THERE'S SO MUCH TO

UNDERSTAND ABOUT CHANGES IN

QUALITY AND QUANTITY OF FOODS IN

THE DIET, CHANGES IN FIRES, RISK

OF WILDFIRES, AIR QUALITY, HOW

RISING TEMPERATURES ARE GOING TO

AFFECT PEOPLE'S CAPACITY FOR

EXERCISE, WHAT THAT MEANS FOR

CARDIOVASCULAR RISK, THINGS LIKE

STRESS AND ANXIETY, AND THEIR

ROLES ON CARDIOVASCULAR DISEASE,

SO THERE'S A LOT WE NEED TO

UNDERSTAND BETTER TOWARDS THAT

QUESTION OF ATTRIBUTION.

I THINK IT'S IMPORTANT TO

MEASURE THE CARDIOVASCULAR

BENEFITS OF POLICY AND PRACTICE

INTERVENTIONS BECAUSE WE'RE

COMING TO A MOMENT WHERE WE'RE

AGGRESSIVELY TRYING TO ADDRESS

THE EARTH CRISIS AND NEED TO

UNDERSTAND HOW TO OPTIMIZE

HEALTH BENEFITS ASSOCIATED WITH

POLICIES WE'RE CONSIDERING AND

INTERVENTIONS.

SO HOW DO CHANGES IN ENERGY,

FOOD SYSTEMS, LAND USE, ET

CETERA, IMPROVE CARDIOVASCULAR

HEALTH, HOW DO WE REDUCE

VULNERABILITY TO CHANGING

BIOPHYSICAL CONDITIONS WITH

THINGS LIKE WATER RESOURCE

MANAGEMENT, PROTECTION FROM

HEAT, BETTER FIRE MANAGEMENT.

THERE'S A LOT TO UNDERSTAND HOW

POTENTIAL INTERVENTIONS THAT

WE'RE CONSIDERING WILL AFFECT

CARDIOVASCULAR HEALTH DOWN THE

ROAD.

NEXT SLIDE.

SO, FINALLY, I WELCOME ANY AND

ALL OF YOU TO JOIN THE PLANETARY

HEALTH ALLIANCE.

THIS IS A GLOBAL COMMUNITY OF

OVER 400 ORGANIZATIONS FROM 68

COUNTRIES NOW REALLY WORKING ON

ISSUES OF PLANETARY HEALTH.

THERE ARE A WHOLE VARIETY OF

WAYS TO BE ENGAGED.

WITH THAT I'LL CLOSE AND THANK

YOU SO MUCH.

>> THANK YOU, SAM, FOR THAT

REALLY BRILLIANT LECTURE AND

KICKING SESSION 1 OFF.

FOR THE AUDIENCE, PLEASE FIRE UP

YOUR QUESTIONS AND WE'LL HAVE A

VERY ROBUST SESSION WITH DR.

SOLOMON AT THE END OF SESSION 1,

A VIGOROUS DISCUSSION AND

HOPEFULLY YOU'RE PLANNING YOUR

QUESTIONS.

I'D LIKE TO INTRODUCE A SECOND

SPEAKER, DR. ANNA DIEZ ROUX,

SHE'S THE DISTINGUISHED

UNIVERSITY PROFESSOR OF

EPIDEMIOLOGY, DREXEL UNIVERSITY,

DIRECTS THE DREXEL URBAN HEALTH

COLLABORATIVE, AND SHE WAS A

FORMER DEAN OF THE SCHOOL OF

PUBLIC HEALTH FROM 2013 TO 2023.

THANK YOU, AGAIN, ANNA, LOOK

FORWARD TO YOUR TALK.

>> THANK YOU FOR HAVING ME.

GOOD MORNING.

IT'S GREAT TO BE PART OF THIS

SESSION, GREAT TO SEE NHLBI

TAKING ON LEADERSHIP LEADING

THIS KIND OF THINKING.

SO THANK YOU VERY MUCH.

I THINK WE CAN TRANSITION TO MY

FIRST SLIDE.

SO, NEXT SLIDE.

I WILL TRY TO ACCOMPLISH THREE

THINGS IN THIS PRESENTATION.

I'D LIKE TO JUST BRIEFLY REVIEW

SOME KEY CONCEPTS AND

UNDERSTANDING INEQUITIES AND

CARDIOVASCULAR DISEASE BECAUSE I

THINK THEY ARE RELEVANT TO ALSO

UNDERSTANDING THE NEXT POINT,

WHICH IS PLACING CARDIOVASCULAR

INEQUITIES IN A PLANETARY HEALTH

CONTEXT.

FINALLY, I'LL HAVE A FEW

REFLECTIONS, BRIEF REFLECTIONS,

ON SOME OPPORTUNITIES FOR

RESEARCH.

NEXT SLIDE.

KEY CONCEPTS IN UNDERSTANDING

INEQUITIES IN CARDIOVASCULAR

DISEASE.

NEXT.

SO, IT'S NO NEWS TO THIS GROUP

THAT CARDIOVASCULAR DISEASES ARE

STRONGLY AND PER VASIVELY

SOCIALLY PATTERNED, I INCLUDE

THREE EXAMPLES HERE.

ON THE LEFT SIGNIFICANT

DIFFERENCES IN CARDIOVASCULAR

DISEASE MORTALITY BY EDUCATION,

ON THE RIGHT PANEL OF THE LEFT

MOST FIGURE, CARDIOVASCULAR

DISEASE AND MORTALITY IS TWICE

AS HIGH IN THE LOWEST EDUCATION

COMPARED TO HIGHEST EDUCATION

GROUP.

LARGE DIFFERENCES BY RACE

BETWEEN BLACKS AND WHITES, IN

PARTICULAR IN THE UNITED STATES

AND MIDDLE PANEL DESPITE

DECLINING RATES OVER TIME IN

BOTH GROUPS, SOME STABILIZATION

IN RECENT YEARS.

ON THE RIGHT THE ASSOCIATION

BETWEEN COUNTY IN CARDIOVASCULAR

DISEASE MORTALITY, COUNTIES IN

HIGHEST QUARTILE OF

CARDIOVASCULAR DISEASE AND

MORTALITY RATES ARE

SIGNIFICANTLY MORE DEPRIVED IN

MANY WAYS THAN THOSE IN THE

LOWER -- THE CATEGORY OF THE

LOWER RATES.

NEXT SLIDE.

NEXT SLIDE.

SO, THE DRIVERS OF THESE

INEQUITIES ARE MULTI-LEVEL AND

LIFE COURSE.

AND OPERATE THROUGH MULTIPLE

PATHWAYS.

WE HAVE FOUR EXAMPLES OF

CONCEPTUAL MODELS THAT HELP US

UNDERSTAND DRIVERS OF INEQUITIES

IN HEALTH, BUT IN CARDIOVASCULAR

DISEASE TOO.

IMPACT OF MULTIPLE LEVELS OF

INFLUENCE ON THE LEFT, ROLE OF

DIFFERENT PATHWAYS, BEHAVIORS,

BIOLOGICAL FACTORS, DIRECT

EXPOSURES, AS WELL.

THE LIFE COURSE DIMENSION ON THE

BOTTOM LEFT, AND ALSO THE

DISTINCTION BETWEEN WHAT

SOMETIMES ARE CALLED BASIC OR

FUNDAMENTAL CAUSES LIKE

STRUCTURAL INEQUALITY AND

RACISM, AND MORE SPECIFIC,

QUOTE, SURFACE CAUSES THROUGH

WHICH THESE THINGS OPERATE.

NEXT SLIDE.

SO, THE OTHER KEY POINT THAT I

WANTED TO MAKE IS THAT THE

ENVIRONMENT BROADLY DEFINED IS

CRITICAL TO CARDIOVASCULAR

DISEASE INEQUITIES.

THIS SHOWS EXAMPLE OF

NEIGHBORHOOD DIFFERENCES IN

CARDIOVASCULAR DISEASE, HOW

ECONOMIC INEQUALITY AND RACISM

DRIVE RESIDENTIAL SEGREGATION

WHICH REINFORCES INEQUALITIES

AND POWER AND RESOURCE

DISTRIBUTION, THAT GENERATES

DIFFERENCES IN ENVIRONMENTS,

PHYSICAL AND SOCIAL

ENVIRONMENTS, WHICH IN TURN

REINFORCE EACH OTHER.

AND AFFECT BEHAVIOR AND

BIOLOGICAL MEDIATORS AND STRESS

PROCESSES WHICH ALSO REINFORCE

EACH OTHER AND LEAD TO

CARDIOVASCULAR DISEASE.

AND I WANT TO HIGHLIGHT THE

ENVIRONMENT ENCOMPASSES PHYSICAL

AND SOCIAL DOMAINS, THE

ENVIRONMENTAL FACTORS CLUSTER

AND INFLUENCE EACH OTHER, AND

THE ENVIRONMENT OPERATES THROUGH

MULTIPLE INTERRELATED PATHWAYS.

AND MORE BROADLY, WE CAN THINK

OF THIS, YOU KNOW, SCHEMATIC

NEIGHBORHOOD SYSTEM THAT I'VE

PUT INTO THE SLIDE AS ITSELF

NESTED WITHIN A BROADER

ENVIRONMENTAL SYSTEM, WHICH

INCLUDES ASPECTS THAT ARE

GLOBAL, AS SAM WAS REFERRING TO

IN HIS PRIOR PRESENTATION.

NEXT SLIDE.

AND THE FOURTH POINT I WANT TO

MAKE ABOUT HEALTH INEQUITIES

WHICH ALSO INTERSECTS WITH SOME

OF THE THINGS THAT SAM WAS

SAYING ABOUT THE COMPLEXITIES IN

SYSTEMS, IS THAT HEALTH

INEQUITIES EMERGE FROM DYNAMIC

SYSTEMS.

SO, THEY INVOLVE FACTORS AT

MULTIPLE LEVELS, UNITS THROUGH

NORMS, SOCIAL NEIGHBORHOODS

INFLUENCE EACH OTHER AS WELL.

THERE ARE MANY RECURSIVE

RELATIONSHIPS AND FEEDBACK

LOOPS.

WE'LL HEAR MORE FROM PETER.

THERE ARE CONDITIONAL EFFECTS,

THE IMPACT OF A PARTICULAR

FACTOR DEPENDS ON THE CONDITION

OF OTHER FACTORS IN THE SYSTEM.

THERE ARE NON-LINEAR EFFECTS,

THINGS THAT HAPPEN IN

UNANTICIPATED PLACES, DISTANT IN

SPACE AND TIME.

UNANTICIPATED EFFECTS, SOMETIMES

WE CAN HAVE MULTIPLE PATHS TO

THE SAME OUTCOME.

PEOPLE GET CARDIOVASCULAR

DISEASE FROM MANY PATHWAYS AND

MANY REASONS.

BUT AT THE SAME TIME, WE ALSO

HAVE SIMILAR DISCAL CAUSES OF

MULTIPLE OUTCOMES AS WELL.

ALL OF THIS LEADS TO EMERGENT

PATTERNS NOT EASILY REDUCIBLE TO

INTERDEPENDENTENT EFFECT.

WHEN WE THINK HOW THIS INTERSECT

WAS PLANETARY HEALTH WE NEED TO

THINK ABOUT THIS SYSTEMIC

DRIVERS OF INEQUITIES AND HOW

THE BROADENING OF OUR SYSTEM TO

ENCOMPASS PLANETARY FACTORS

HELP, YOU KNOW, HELPS US

UNDERSTAND, INTERFACES WITH

SOCIAL SYSTEMS.

NEXT SLIDE.

SO THIS IS A SUMMARY OF THE FOUR

POINTS THAT I MADE.

ENVIRONMENT IS A CRITICAL DRIVER

AND ROLE OF DYNAMIC SYSTEMS.

NEXT SLIDE.

NEXT IS SHARE IDEAS HOW

CARDIOVASCULAR INEQUITIES CAN BE

SEEN WITHIN A PLANETARY HEALTH

CONTEXT ARRIVED AROUND FIVE

FUNDAMENTAL LINKS.

NEXT SLIDE.

SO THE FIRST LINK IS THAT THERE

ARE SOCIAL INEQUITIES IN

EXPOSURES LINKED TO GLOBAL

ENVIRONMENTAL CHANGE.

THESE EXPOSURES RELATED TO

GLOBAL ENVIRONMENTAL CHANGE ARE

NOT EVENLY DISTRIBUTED.

NEXT SLIDE.

THESE ARE SOME EXAMPLES.

THIS IS AN EXAMPLE OF A PAPER

JUST A FEW YEARS AGO ON PM2.5

EXPOSURES, WHICH WAS QUITE

INTERESTING BECAUSE OF THE

APPROACH IT TOOK.

ON THE TOP LEFT YOU CAN SEE

SOMETHING DESCRIBED IN MANY

PAPERS, SOCIAL GROUPS IN THIS

CASE PEOPLE OF COLOR EXPERIENCE

GREATER THAN AVERAGE EXPOSURES

FROM SOURCE TYPES CAUSING 75% OF

OVERALL EXPOSURE TO PM2.5.

ALMOST EVERY SOURCE RESULTS IN

DIFFERENTIAL EXPOSURE BY WHICH

PEOPLE OF COLOR HAVE HIGHER

EXPOSURES THAN WHITE PEOPLE.

BUT THIS PAPER WENT FURTHER AND

ALSO EXAMINED THE DRIVERS,

CONTRIBUTORS TO PM2.5, AND FOUND

THAT, FOR EXAMPLE, NON-HISPANIC

WHITES EXPERIENCED SO-CALLED

POLLUTION ADVANTAGE BECAUSE THEY

EXPERIENCE 17% LESS EXPOSURE

THAN IS CAUSED BY THEIR OWN

CONSUMPTION.

BLACK AND HISPANIC POPULATIONS

WERE EXPOSED TO ABOUT 56 TO 63%

MORE PM2.5 POLLUTION THAN IS

CAUSED BY THEIR OWN CONSUMPTION.

SO LOOKING MORE DYNAMICALLY,

STARTING TO LOOK MORE

SYSTEMICALLY AT THE DRIVERS OF

THIS AND WHO SUFFERS THE

CONSEQUENCE OF THESE EXPOSURES.

NEXT SLIDE.

ANOTHER EXAMPLE OF DIFFERENTIAL

DISTRIBUTION, SOCIAL

DISTRIBUTION, OF GLOBAL

ENVIRONMENTAL CHANGE RELATED

EXPOSURES IS ON THIS SLIDE.

YOU MAY HAVE SEEN THERE'S BEEN

MANY PUBLICATIONS ON THIS,

LOOKING, FOR EXAMPLE, AT

ASSOCIATIONS BETWEEN LAND

SURFACE TEMPERATURE AND

HISTORICAL PRACTICES OF RED

LINING IN THE UNITED STATES, AND

THIS RELATIONSHIP SHOWING HOW

THERE ARE HIGHER LAND SURFACE

TEMPERATURES IN NEIGHBORHOODS

THAT WERE REDLINED.

AND THE CATEGORY, THE

DESIRABILITY, SO-CALLED, OF THE

AIR IS RELATED ALMOST IN A

DOSE-RESPONSE RELATIONSHIP, MANY

PATHWAYS THROUGH WHICH THESE

CONTINUE TO THIS DAY.

ON THE RIGHT AN EXAMPLE FROM

"NEW YORK TIMES" A COUPLE YEARS

AGO SHOWING ONE OF THE

MECHANISMS THAT COULD LEAD TO

THESE DIFFERENCES THAT HAS TO DO

WITH REMARKABLE DIFFERENCES IN

THIS CASE IN TREE COVER, ACROSS

NEIGHBORHOODS OF DIFFERENT

INCOMES IN FOUR CITIES.

NEXT SLIDE.

SO IN ADDITION TO SOCIAL

INEQUITIES IN THE DISTRIBUTION

OF THESE CLIMATE CHANGE OR IN

GENERAL GLOBAL ENVIRONMENTAL

CHANGE-RELATED EXPOSURES, THERE

HAS BEEN A LOT OF DISCUSSION ON

HOW THE IMPACT OF THESE

EXPOSURES ON HEALTH CAN BE

MODIFIED BY THE CONTEXT,

INCLUDING SOCIAL CIRCUMSTANCES.

SOCIAL INEQUITIES IN THE EFFECTS

OF THESE EXPOSURES ON

CARDIOVASCULAR DISEASE RISK, FOR

EXAMPLE, AND THIS IS AN EXAMPLE

OF A CONCEPTUAL MODEL PUBLISHED

BY GRONLUND MANY YEARS AGO BUT

STILL USEFUL TODAY THINKING

THROUGH HOW RACIAL AND

SOCIOECONOMIC CHARACTERISTICS

MODIFY THE -- COULD MODIFY THE

IMPACT OF HEAT, FOR EXAMPLE, ON

ADVERSE -- ON HEALTH OUTCOMES.

NEXT SLIDE.

AND THERE HAS BEEN DOCUMENTATION

OF THESE SYNERGISMS AND

HETEROGENEOUS IMPACTS.

ON THE TOP YOU CAN SEE IMPACT OF

HEAT ON NEW YORK CITY

NEIGHBORHOODS.

YOU CAN SEE THIS PAPER IS ALMOST

TEN YEARS OLD.

AND SHOWING THAT THE MORTALITY

RATE RATIOS FOR HOT DAYS AMONG

OLDER ADULTS ASSOCIATED WITH

HEAT WERE SIGNIFICANTLY LARGER

THAN IN WEALTHIER NEIGHBORHOODS.

BELOW A MORE RECENT PAPER

SHOWING HOW PROJECTED ESTIMATED

EXCESS CARDIOVASCULAR DEATHS

ASSOCIATED WITH EXTREME HEAT IN

THE FUTURE COMPARED TO THE

CURRENT PERIOD, THE PROJECTION

SHOWED WE WERE GOING TO EXPECT A

GREATER IMPACT AMONG BLACK

PERSONS, AMONG AREAS -- PEOPLE

LIVING IN METROPOLITAN COMPARED

TO NON-METROPOLITAN COUNTIES.

HETEROGENEITY IN IMPACT OF THESE

EXPOSURES ON HEALTH.

NEXT SLIDE.

IN ADDITION TO DIFFERENTIAL

EFFECTS, GLOBAL ENVIRONMENTAL

CHANGE INTERSECTS WITH MULTIPLE

PATHWAYS THAT LEAD TO SOCIAL

DIFFERENCES IN CARDIOVASCULAR

DISEASE.

SO HERE I'VE PUT IN A CONCEPTUAL

MODEL DEVELOPED 20 YEARS AGO, MY

GOD, ON THE IMPACT OF

NEIGHBORHOODS ON CARDIOVASCULAR

DISEASE, ARTICULATING POTENTIAL

PATHWAYS.

HIGHLIGHTING IN RED ALL THE

AREAS WHERE PLANETARY

HEALTH-RELATED EXPOSURES FOR

GLOBAL ENVIRONMENTAL

CHANGE-RELATED EXPOSURES

INTERSECT WITH THESE PATHWAYS

AND CAN HAVE IMPACTS ON

CARDIOVASCULAR DISEASE

INEQUITIES THROUGH THEIR

RELATIONSHIP WITH THESE

PATHWAYS.

THERE ARE MANY MORE HERE BECAUSE

OF THIS MODEL COULD BE EXPANDED,

BUT MULTIPLICITY OF PATHWAYS

THROUGH WHICH THESE EFFECTS CAN

OPERATE TO CONTRIBUTE TO SOCIAL

INEQUALITIES IN CARDIOVASCULAR

DISEASE.

NEXT SLIDE.

IN ADDITION TO THIS, I THINK

IT'S ALSO IMPORTANT TO REMEMBER

THAT GLOBAL ENVIRONMENTAL CHANGE

IS ALSO A DRIVER OF UPSTREAM

PROCESSES THAT INTERACT WITH

SOCIAL INEQUALITY TO IMPACT

CARDIOVASCULAR DISEASE INEQUITY.

EVEN A MORE MACRO AND DISTAL

PERSPECTIVE.

NEXT SLIDE.

TWO EXAMPLES OF WHAT I MEAN BY

THIS.

SO DISRUPTION IN FOOD SYSTEM, SO

DISRUPTION TO FOOD SYSTEMS

RELATED GLOBAL ENVIRONMENTAL

CHANGE ARE RELATED TO THINGS

LINING REDUCTIONS IN ARABLE LAND

PER CAPITA, SOIL LOSS, HEAT

WAVES, INCREASE IN CO2,

REDUCTION IN BIODIVERSITY, NEW

PEST PATHOGENS, ALL THOSE THINGS

INFLUENCE TYPE AND AMOUNT OF

FOODS PRODUCED, INCLUDING SHIFTS

TOWARDS ULTRA PROCESSED AND

ANIMAL FOODS, LESS

MICRONUTRIENTS, INTERSECT WITH

COMMERCIAL DRIVERS, HAVE

DIFFERENTIAL IMPACTS BY COUNTRY

AND ALSO ACROSS SOCIAL GROUPS

WITHIN A COUNTRY.

HERE WE HAVE A MACRO CHANGE,

WHICH INTERACTS CAN SOCIAL

SYSTEMS AND ECONOMIC INEQUALITY

AND RACISM, AND TRANSLATES INTO

GREATER INEQUITIES.

NEXT SLIDE.

THIS IS ANOTHER EXAMPLE,

DISPLACEMENT AND MIGRATION.

WE KNOW THAT GLOBAL

ENVIRONMENTAL CHANGE CAN RESULT

IN FORCED DISPLACEMENTS AND

MIGRATION.

AND THESE THINGS ALSO ARE DRIVEN

BY POLITICAL INSTABILITY AND

PERSECUTION, RACISM, POVERTY,

IMPACT ACCESS TO RESOURCES AND

EXPOSURE TO ENVIRONMENTAL

EXPOSURE RELATED TO CHANGES IN

NORMS OF BEHAVIORS ASSOCIATED

WITH MIGRATION AND URBANIZATION,

HAVE MENTAL HEALTH AND

PSYCHOSOCIAL IMPACTS AND CAN

AFFECT HEALTH CARE ACCESS WITH

IMPLICATIONS FOR CARDIOVASCULAR

HEALTH.

NEXT SLIDE.

AND THE FIFTH LINK BETWEEN A

GLOBAL ENVIRONMENTAL CHANGE AND

CARDIOVASCULAR DISEASE HAS TO DO

WITH SOCIAL INEQUALITIES IN

ABILITY TO AVOID OR ADAPT TO

GLOBAL ENVIRONMENTAL CHANGE.

THIS IS ONE EXAMPLE.

THIS IS FROM A PAPER PUBLISHED A

COUPLE YEARS AGO DESCRIBING THE

PENETRATION OF AIR CONDITIONING

BY ANNUAL HOUSEHOLD INCOME AND

COOLING DEGREE DAYS, BASICALLY

HOW HOT THE DAY IS ACROSS 16

COUNTRIES, AND ON THE Y-AXIS IS

ANNUAL HOUSEHOLD INCOME, ON THE

X-AXIS IS HOW HIGH THE

TEMPERATURE IS.

WHAT YOU CAN SEE IS THAT THE --

IF YOU LOOK ACROSS INCOME

CATEGORIES, AT THE HIGHEST

INCOME PENETRATION OF AIR

CONDITIONING IS HIGH ACROSS

ALMOST THE FULL DISTRIBUTION OF

COOLING DEGREE DAYS, WHEREAS AT

THE LOWER INCOME LEVELS THE

PENETRATION OF AIR CONDITIONING

IS MUCH LOWER.

SO, OF COURSE, WE COULD DISCUSS,

YOU KNOW, HOW BENEFICIAL IS IT

GLOBALLY TO INCREASE AIR

CONDITIONING, BUT IT IS COMMON

ADAPTATION STRATEGY, FOR

EXAMPLE, TO HEAT AND WE CAN SEE

IN THIS FIGURE THAT IT IS VERY,

VERY INEQUITABLE DISTRIBUTED.

NEXT SLIDE.

SO, THESE ARE THE FIVE LINKS,

THERE MAY BE MANY OTHERS, BUT

OCCURRED DO ME IN TERMS OF

CONNECTING CARDIOVASCULAR

DISEASE INEQUITIES AND PLANETARY

INEQUITIES, EXPOSURES, IMPACT OF

GLOBAL ENVIRONMENTAL CHANGE ON

MULTIPLE PATHWAYS TO CVD

INEQUITIES, GLOBAL ENVIRONMENTAL

CHANGE AS DRIVER OF PROCESSES

THAT INTERACT, AND SOCIAL

INEQUITIES AND ABILITY TO AVOID

OR ADAPT TO GLOBAL ENVIRONMENTAL

CHANGE.

NEXT SLIDE.

SO I HAVE TWO QUICK SLIDES ON

SOME IDEAS FOR RESEARCH NEEDS IN

THIS AREA.

NEXT SLIDE.

SO, I THINK FIRST THERE IS STILL

A LOT OF USEFUL WORK THAT CAN BE

DONE IN TERMS OF DESCRIBING AND

QUANTIFYING IMPACT OF GLOBAL

ENVIRONMENTAL CHANGE ON

CARDIOVASCULAR DISEASE

INEQUITIES.

I THINK DESCRIPTION PARTICULARLY

IF IT'S DONE IN A WAY THAT

YIELDS NEW INSIGHTS JUST LIKE

THAT PM2.5 PAPER I THINK DID CAN

STILL BE A VERY POWERFUL

MOTIVATOR OF ACTION AND I THINK

WE STILL NEED IT.

SO, DISTRIBUTION OF ADVERSE

EXPOSURES, DIFFERENTIAL IMPACTS

OF EXPOSURES BY SOCIAL

CONDITIONS, HOW THESE

DIFFERENTIAL EXPOSURES CAN

CONTRIBUTE TO CVD INEQUITIES AND

CHANGES OVER TIME.

WITH SPECIAL ATTENTION TO

CLUSTERING CUMULATIVE AND

INTERACTIVE EFFECTS AND

DYNAMICS, SYSTEMIC NATURE OF

THESE PROCESSES.

AND MY FINAL SLIDE ALSO ABOUT

RESEARCH, MOVE ON, SORRY, IS

ALSO RESEARCH THAT CONNECTING

SOMETHING WAS SAM WAS SAYING AS

WELL.

RESEARCH ON THE EVALUATION OF

POLICIES AND INTERVENTIONS.

SO, HEALTH AND CARDIOVASCULAR

DISEASE CO-BENEFITS OF

MITIGATION AND ADAPTATION

POLICIES FROM THE POINT OF VIEW

OF EQUITY.

SO EVALUATING THE EQUITY

IMPACTS, USING NATURAL

EXPERIMENTS, USING SIMULATION,

THINGS LIKE HEALTH IMPACT

ASSESSMENT, A

STAKEHOLDER-ENGAGED AND

EQUITY-FOCUSED APPROACH TO

EVALUATION OF POTENTIAL

POLICIES, FOCUSING ON INEQUITIES

AND DIFFERENTIAL IMPACT BY

SOCIAL GROUPS INCLUDING

BENEFICIAL AND ADVERSE IMPACTS

BECAUSE SOME OF THESE ADAPTATION

AND MITIGATION STRATEGIES CAN

HAVE UNINTENDED ADVERSE

IMPACTION.

SOMETHING WE HAVE TO EXPLORE AND

DOCUMENT.

THAT'S MY LAST SLIDE.

THANK YOU AND LOOK FORWARD TO

THE DISCUSSION.

>> YOU NAILED A NUMBER OF ISSUES

SO IMPORTANT IN OUR DISCUSSION.

REMINDER, PLEASE DO JOT DOWN

YOUR QUESTIONS AND HOPEFULLY ALL

OF YOU WILL PARTICIPATE IN A

VERY ROBUST DISCUSSION SESSION

AT THE END.

IT'S MY PLEASURE TO INTRODUCE

NEXT SPEAKER DR. PETER HOVMAND,

COLLEAGUE OF MINE AT CASE

WESTERN RESERVE UNIVERSITY, AND

HE'S REALLY ONE OF THE LEADERS

IN SYSTEMS THINKING APPROACHES

AS PERTAINS TO THE COMMUNITIES,

ENGAGING COMMUNITIES.

HE'S GOING TO BE TALKING TO US

AND HOPEFULLY GIVING US AN

OVERVIEW OF SYSTEMS THINKING IN

HIS TALK IS INTRODUCTION TO

SYSTEMS THINKING APPROACHES TO

UNDERSTAND HEALTH AND PLANETARY

HEALTH.

AS I MENTIONED, DR. HOVMAND

COMES FROM CASE WESTERN RESERVE

UNIVERSITY, A PAM DAVIS

PROFESSOR OF MEDICINE, CENTER

FOR COMMUNITY HEALTH

INTEGRATION, SCHOOL OF MEDICINE.

ALSO PROFESSOR OF GENERAL

MEDICAL SCIENCES, BIOMEDICAL

ENGINEERING AT THE CASE SCHOOL

OF ENGINEERING.

THANK YOU, PETER.

>> THANK YOU FOR THE

OPPORTUNITY.

GOOD MORNING.

NEXT SLIDE PLEASE.

SO I WAS ASKED TO PROVIDE A

GENERAL OVERVIEW TO SYSTEMS

THINKING, HOW WE MIGHT THINK

ABOUT THAT.

AND SO I'LL PROVIDE SOME

BACKGROUND AND THEN END ON SOME

QUESTIONS FOR POTENTIAL

RESEARCH.

NEXT SLIDE.

SO SYSTEMS ARE EVERYWHERE.

WE THINK ABOUT COULD BE

WATERSHED SYSTEMS, CLIMATE IS A

SYSTEM, METABOLIC NETWORKS,

CARDIOVASCULAR SYSTEM ARE TWO

EXAMPLES OF BIOLOGICAL SYSTEMS.

INSTITUTIONS ARE SYSTEMS, SOCIAL

SYSTEMS, SO THAT WE'RE LIVING IN

SYSTEMS.

NEXT SLIDE.

THE CHALLENGE OF UNDERSTANDING

THE SYSTEMS ARE STABLE, WE CAN

RELY ON PAST EXPERIENCE TO

INFORM FUTURE BEHAVIOR BUT THE

CHALLENGE OF UNDERSTANDING

MAKING DYNAMIC -- MAKING

DECISIONS IS SOMETHING THAT JAY

FORESTER AS POINTED OUT MANY

TIMES OVER.

AND IN THIS GRAPH THIS IS

ACTUALLY A MUCH MORE FAVORABLE

SITUATION THAN WHAT SAM

PRESENTED IN TERMS OF GREAT

ACCELERATION, CHALLENGED WITH

INFORMATION DELAY IN TERMS OF

RELATIVE TO WHEN WE'RE MAKING A

DECISION, AND THERE'S ALSO

IMPLEMENTATION DELAY.

WE CAN ADDRESS SOME OF THE

INFORMATION DELAY BY USING

REALTIME DATA, FOR EXAMPLE, MORE

SOPHISTICATED TOOLS AND

ANALYSIS.

AND THERE'S SOME POSSIBILITY TO

ADDRESS THE IMPLEMENTATION DELAY

DRAWING ON SYSTEM SCIENCES, BUT

IN BOTH CASES WE HAVE THESE

DELAYS, AND THAT CREATES A

CHALLENGING SITUATION.

THIS IS AN EASIER SITUATION

BECAUSE IT'S BASICALLY

GOAL-SEEKING BEHAVIOR.

WHAT SAM PRESENTED WAS GREAT

ACCELERATION WHICH IN TERMS OF

EXPONENTIAL DYNAMICS, WE TEND TO

SIGNIFICANTLY UNDERESTIMATE THE

IMPACT OF ACTIONS.

I'LL TALK ABOUT WHAT THE

CHALLENGES THERE ARE, NEXT

SLIDE.

SO, ONE OF THE BIG CHALLENGES IS

BEING ABLE TO SEE AND UNDERSTAND

SYSTEMIC CAUSATION.

GEORGE LAKOFF TALKING ABOUT

GLOBAL WARMING HAS SPENT A LOT

OF TIME UNDERSTANDING HOW PEOPLE

THINK AND ACT IN SYSTEMS, AND

POINTS OUT THAT ONE OF THE

CHALLENGES HERE IS WE REALLY

HAVE A HARD TIME SEEING SYSTEMIC

CAUSATION.

JOHN POWELL TALKING ABOUT

STRUCTURAL RACISM, WHEN WE TAKE

A SYSTEMS APPROACH WHAT WE MIGHT

EXPECT IS BEING ABLE TO SHIFT

THE MEANING AND MEASUREMENT OF

CAUSATION, AND SOME OF THIS IF

YOU'RE LOOKING FOR MORE

PHILOSOPHY OF SCIENCE MARIO

BUNGE DOES SOMETHING SIMILAR

TALKING ABOUT HOW A SYSTEM WORKS

THAT IS BEING ABLE TO UNVEIL THE

MECHANISMS, SOME IS WHAT ANA WAS

TALKING ABOUT BEFORE.

THESE ARE CHALLENGES NOTICED.

AND NEXT SLIDE.

SO, WE COULD THINK ABOUT THE

TYPES OF INSIGHTES WE MIGHT

GAIN, WE'RE TALKING ABOUT DEEP

INSIGHTS HOW DOES SYSTEM

GENERATE DYNAMICS OF A SYSTEM,

BUT THERE ARE A RANGE OF

INSIGHTS WE MIGHT GAIN AND

LEVERAGE IN UNDERSTANDING

SYSTEMS FROM SURFACE INSIGHTS

LIKE BEING AWARE OF A SYSTEM, TO

WHAT THE COMPONENTS ARE, HOW

THEY ARE CONNECTED, HOW PEOPLE

THINK IN TERMS OF MENTAL AND

CULTURAL MODELS, WHETHER ACTORS

ARE, STARTING TO SEE MORE

GENERIC PATTERNS, UNDERLYING

STRUCTURES, IMPLICATIONS OF

ACCUMULATIONS, DELAYS,

NON-LINEAR RELATIONSHIPS, WHERE

WE COULD INTERVENE, LEVERAGE

POINTS WHERE SMALL CHANGES COULD

HAVE BIG EFFECT AND COROLLARY IS

THAT A LOT OF THESE NON-LINEAR

SYSTEMS COULD BE EFFECTIVE AT

THE APPROXIMATE LEVEL BUT HAVE I

HAVE LITTLE IMPACT AT SYSTEM

LEVEL, WHAT'S CAUSING THE

BEHAVIOR.

THE POINT IS IF YOUR GOAL IS TO

UNDERSTAND, RAISE AWARENESS,

PICTURES MAY BE SUFFICIENT.

IF YOU WANT TO UNDERSTAND

RELATIONSHIPS WE NEED SOMETHING

MORE EXPLICIT ABOUT THE

RELATIONSHIPS, SPATIAL MAPS,

WE'VE SEEN A COUPLE EXAMPLES,

NETWORK DIAGRAMS, CAUSAL MAPS.

FOR SOME DEEPER INSIGHTS WE NEED

MATHEMATICAL MODELS, STRUCTURAL

EQUATION, MULTI-LEVEL

STATISTICAL MODELS, DISCRETE

SIMULATION MODELING SYSTEM

DYNAMICS.

IF WE'RE LOOKING AT MODELS OFTEN

WE WONDER WHY THE SYSTEM IS AS

IT IS.

AND THERE WE CAN GAIN INSIGHTS

FROM STORY NARRATIVE POETRY FROM

THIS EXPERIENCE.

NEXT SLIDE.

SO ONE OF THE COMMON METAPHORS

IN SYSTEMS THINKING IS ICEBERG

METAPHOR.

WE SEE AT THE TOP ARE EVENTS,

THE FOREST FIRES THAT WE HAD

THIS SUMMER FOR EXAMPLE.

EXTINCTION EVENT.

WE SAW FROM SAM'S PRESENTATION

SOME NICE EXAMPLES OF TRENDS

OVER TIME.

SO THAT'S BENEATH THE SURFACE,

IT TAKES EFFORT TO ACCUMULATE

THE DATA, SEE WHAT TRENDS ARE,

PROJECT THEM OUT IF THEY

CONTINUE.

AND THOSE PATTERNS ARE BEING

CAUSED BY SOME STRUCTURES, AND

THEN THOSE ARE BEING --

STRUCTURES, SOME ARE BIOLOGICAL

NATURAL SYSTEMS, AND SOME A GOOD

DEAL ARE HUMAN IMPACT, DIRECTION

OF CAUSALITY HERE IS GOING FROM

THE VALUES, ATTITUDES, AND NORMS

IN TERMS OF SOCIAL SYSTEMS

INTERACTING WITH NATURAL

ENVIRONMENT THAT GENERATE

PATTERNS OVER TIME,

PROPENSITIES, THAT LEADS TO

EVENTSES WE SEE ON THE SURFACE.

THIS HAS RECIPROCAL

RELATIONSHIP, STARTING TO REACT

TO THESE EVENTS TO THINK ABOUT

CHANGING THE STRUCTURE AND

VALUE.

SO THIS IS ONE WAY WE CAN THINK

ABOUT SYSTEMS.

NEXT SLIDE.

I'M SPECIFICALLY WORKING IN THE

AREA OF SYSTEM DYNAMICS.

SO THERE ARE MULTIPLE METHODS OF

APPROACHING THIS BUT I'LL TALK

ABOUT SYSTEM DYNAMICS BECAUSE

THAT'S MY AREA AND ALSO BECAUSE

THIS TIES IN WITH THE WORK OF

EN-ROADS, BASED ON SYSTEM

DYNAMICS, LATER IN THE DAY.

SO WE'RE THINKING ABOUT

UNDERSTANDING SYSTEMS FROM

ENDOGENOUS PERSPECTIVE.

THIS IS A DEFINITION,

ACCUMULATIONS LEVELS, HOW THE

RATES OF ACTIVITY ARE

REPRESENTED BY FLOWS, AND USE OF

COMPUTER SIMULATION.

THIS PARTICULAR WAY OF THINKING

ABOUT SYSTEMS, THESE ARE

HIERARCHICAL, ENDOGENOUS

PERSPECTIVE IS MOST IMPORTANT.

USE OF COMPUTER SIMULATION

MODELS IS IMPORTANT BUT LESS

IMPORTANT THAN ENDOGENOUS

PERSPECTIVE.

NEXT SLIDE.

SO EXAMPLES OF DYNAMIC BEHAVIOR

WE'VE ALREADY SEEN SOME OF THESE

EXAMPLES EARLIER IN THE DAY.

BUT ANYTHING, TRAINED OVER TIME,

CONTRAST WITH WHAT YOU WOULD

LIKE TO SEE, AN EXAMPLE OF LEAD

EXPOSURE THAT I USE FOR CUYOGA

COUNTY.

NEXT SLIDE.

AND THEN IN TERMS OF CONTRASTING

ENDOGENOUS OR FEEDBACK

PERSPECTIVE AGAINST LINEAR CAUSE

EFFECT, THESE ARE TWO DIAGRAMS,

THEY BOTH HAVE VARIABLES RELATED

TO WORK AROUND STRUCTURAL

RACISM, AND RACISM AND PUBLIC

HEALTH CRISIS.

THE LEFT, SAME SET OF VARIABLES,

LEFT IS TRYING TO EXPLAIN

COMMUNITY RESPONSE TO STRUCTURAL

RACISM.

THE RIGHT IS THE SAME SET OF

VARIABLES BUT NOW ORGANIZED INTO

A SET OF CAUSAL LOOPS, CAUSAL

LOOP DIAGRAM IN TERMS OF

FEEDBACK MECHANISMS, THESE

MECHANISMS ARE CHARACTERIZED

BALANCING AND REINFORCING,

INTERACTING ACROSS TIME.

ON THE LEFT I'M LOOKING FOR

STRONGEST ASSOCIATION AND

DESIGNING INTERVENTION.

ON THE RIGHT FROM ENDOGENOUS

PERSPECTIVE I'M LOOKING FOR THE

STRENGTH OF THE FEEDBACK LOOPS

AND HOW THEY CHANGE AND EVOLVE

OVER TIME.

SO THESE ARE COMPLEMENTARY

PERSPECTIVES.

IT'S NOT AN EITHER/OR.

WE BENEFIT BY LOOKING AT BOTH.

THINKING ABOUT A SYSTEM AND

TRYING TO EXPLAIN FROM

ENDOGENOUS PERSPECTIVE I'M

TRYING TO EXPLAIN IN TERMS OF

THE FEEDBACK MECHANISMS.

NEXT SLIDE.

WE CAN GENERATE THESE USING --

GENERATE MAPS INFORMALLY USING

INFORMAL MAPS.

ON LEFT IS CAUSAL LOOP DIAGRAM,

THE SECOND IS STOCK AND FLOW

DIAGRAM, ON THE LEFT LOOKING AT

WHAT IT TAKES TO RAISE A CHILD

IN ST. LOUIS, ON THE RIGHT

HEALTH CARE LEADERS IN HONDURAS

LOOKING AT MATERNAL AND NEONATAL

MATERNITY.

THESE ARE IN GROUP MODEL

BUILDING WORKSHOPS, IN EITHER

CASE FORMAL TRAINING SYSTEM

DYNAMICS.

WE CAN MOVE TO MORE FORMAL

SIMULATION MODELS.

THIS IS ESSENTIALLY WHERE YOU

START TO LOOK AT DIFFERENT

INTERVENTIONS AND COMBINATIONS,

FROM SOME WORK IN HONDURAS,

MATERNAL AND NEONATAL MORTALITY,

WHERE THE MATERNAL MORTALITY

RATIO, NEONATAL RATE, THE GOAL

TO REDUCE BOTH.

YOU SEE SORT OF RANKED ORDER

FROM BASE CASE OF STATUS QUO TO

BEST CASE LOOKING FOR HIGH

LEVERAGE POINTS.

NEXT SLIDE.

THE PIECE THAT'S MORE

INTERESTING IN RECENT YEARS HAS

BEEN ABLE TO UNDERSTAND

STRUCTURE OF BEHAVIOR

RELATIONSHIP AND MAKE IT MUCH

MORE VISUALLY EXPLICIT.

SO THIS IS A VERY SIMPLE GENERIC

STRUCTURE LOOKING AT LIMITS TO

GROWTH WHERE HAVE YOU

POPULATION, CARRYING CAPACITY,

BIRTH RATE AND BASE MORTALITY

RATE.

AND THIS PARTICULAR EXAMPLE IF

YOU GO TO THE INTERFACE,

INTERFACES CAN NOW BE GENERATED

AND PUBLISHED ONEN LINE RELATIVE

EASY.

EN-ROADS LATER TODAY IS A

SUBSTANTIAL EFFORT.

TODAY IT'S NOT POSSIBLE TO DO

THIS, ALMOST AS A POWERPOINT

PRESENTATION, AND PUBLISH AT

ESSENTIALLY NO COST, INVOLVING

HIGH SCHOOL STUDENTS AND

GRADUATES.

STRUCTURED BEHAVIOR RELATIONSHIP

TALKING ABOUT FEEDBACK LOOPS IF

YOU GO TO THIS EXAMPLE THIS WILL

HAVE ESSENTIALLY TAKE YOU

THROUGH A SERIES OF EXERCISES

WHERE YOU CAN SEE THE DOMINANCE

OF THE FEEDBACK LOOPS, AND YOU

CAN SEE HOW WHEN YOU INTERVENE

IN A NON-DOMINANT LOOP THAT HAS

NO SIGNIFICANT EFFECT ON THE

DYNAMICS WHEN YOU TARGET A

FEEDBACK LOOP YOU CAN CHANGE

BASIC BEHAVIOR MODES.

SO IF WE WANT TO CHANGE

EXPONENTIAL PATTERNS THAT WERE

PRESENTED EARLIER INTO SOMETHING

MORE DESIRABLE WE'RE TALKING

ABOUT NOT JUST CHANGING THEM

NUMERICALLY, TRYING TO CHANGE IN

TERMS OF FUNDAMENTAL BEHAVIOR

MODES.

NEXT SLIDE PLEASE.

THE OTHER PART IS REALLY BEING

ABLE TO ENGAGE COMMUNITIES, SO

THIS IS FROM WORK FROM DEAN OF

BOSTON COLLEGE, AND FOUNDATION

FOR ECOLOGICAL SECURITY IN INDIA

USING METHODS LIKE COMMUNITY

BASED SYSTEM DYNAMICS, CAN

DIRECTLY ENGAGE STAKEHOLDERS,

PEOPLE WITH LIVED EXPERIENCE.

THIS IS A VILLAGE IN INDIA DOING

SOME WORK ON MANAGING WATER

RESOURCES, COMMON POOL OF

RESOURCE, AND THIS TYPE OF WORK

IS NOT ONLY FEASIBLE BUT WHAT IT

DOES IS BRING IN A MUCH MORE

LOCAL CONTEXT TO UNDERSTANDING

THE CAUSAL STRUCTURES UNDERLYING

THE SYSTEMS AROUND NATURAL

RESOURCES, HEALTH, SO FORTH.

NEXT SLIDE.

PROBABLY THE EXAMPLE I LIKE TO

HIGHLIGHT THE MOST HOW

COMMUNITY-BASED SYSTEM DYNAMICS

WORKS IS ENGAGING YOUNG PEOPLE.

THIS IS A PROGRAM FOR A NUMBER

OF YEARS AT WASHINGTON

UNIVERSITY IN ST. LOUIS ON

CHANGING SYSTEMS WHERE HIGH

SCHOOL STUDENTS WERE -- A GROUP

OF 12 TO 16 DEPENDING ON LEADING

A FOUR-DAY REGIONAL YOUTH SUMMIT

ON VARIOUS TOPICS BEGINNING ON

RACISM IN 2015, UP TO EMOTIONAL

SUPPORT IN 2019.

THE FELLOWS, THEY RETURN ONE

YEAR AFTER THE NEXT, FOR

EXAMPLE, AND OVER TIME WHAT YOU

SEE ON THE LEFT IS A SERIES OF

ACTIVITIES THEY DID EACH YEAR.

SO THEY BEGIN WITH INFORMAL

MAPPING, THINGS LIKE DRAWING

CONNECTION CIRCLES, CAUSAL LOOP

DIAGRAMS, MOVING INTO STOCKS AND

FLOWS, ACCUMULATION AND

SIMULATION, LAST YEAR EVALUATING

LEVERAGE POINTS FOR ADVOCACY

PLANS.

THAT'S HAPPENING BECAUSE BECAUSE

CAPACITY IS BEING BUILT ACROSS

PROJECTS AT A COMMUNITY LEVEL.

THIS IS ONE EXAMPLE LOOKING AT

GUN VIOLENCE.

THERE'S A VIDEO IF YOU WANT TO

SEE HOW THEY ARE TALKING ABOUT

IT.

NEXT SLIDE.

THE OTHER ASPECT THAT'S BECOMING

INTERESTING IS THINKING ABOUT

HOW TO ENGAGE COMMUNITIES TO

ADDRESS INJUSTICES, SPECIFICALLY

AROUND FAIR A.I.

THERE'S WORK BY DONNA MARTEN AT

GOOGLE, AND RUHA BENJAMIN,

THINKING ABOUT THIN DESCRIPTION,

BOTH ARE TALKING ABOUT WAYS YOU

CAN ENGAGE COMMUNITIES TO

ADDRESS SOME BIASES IN THESE

TOOLS.

THAT BECOMES RELEVANT THINKING

ABOUT HOW WE ADDRESS THE

CHALLENGE OF ACCELERATING CHANGE

IN THE CONTEXT OF HAVING

SIGNIFICANT DATA AND BEING ABLE

TO PROCESS AND LEVERAGE THIS IN

A WAY THAT WE'RE BOTH MITIGATING

INJUSTICE AND PREVENTING ISSUES

THAT SHOW UP WITH BIAS IN A.I.

AND FINDING OPPORTUNITIES TO

LEVERAGE A.I. EFFECTIVELY.

NEXT SLIDE.

SO THREE QUESTIONS I HAVE IN

MIND, HOW CAN WE ENGAGE

COMMUNITIES, ESPECIALLY YOUNG

PEOPLE, THINKING WE NEED TO DO

THIS AND DEVELOP FUTURE

SCIENTISTS, ACTIVISTS, LEADERS

TO ADDRESS GLOBAL WARM AND HELP

IN WAYS THAT LEAD TO ACTION.

BUT ALSO CREATE SENSE OF

BELONGING AND EPISTEMIC.

IT IS TALKED ABOUT IN THE BEYOND

STABLE STATE, WHAT HAPPENS WHEN

WE GIVE UP ON THE IDEA OF

UNDERSTANDING SYSTEMS, IN TERMS

OF EPISTEMIC KNOWLEDGE.

WE HAVE TO THINK CRITICALLY HOW

WE CREATE OPPORTUNITIES FOR

SENSE OF BELONGING EPISTEMIC

HOPE.

SECOND IS INCREASING RIGOR OF

SYSTEMIC EXPLANATION OF GLOBAL

WARMING, CARDIOVASCULAR HEALTH.

I SHOWED ONE EXAMPLE HOW WE

MIGHT DO THIS WITH SYSTEM

DYNAMICS.

LASTLY HOW WE CAN LEVERAGE TOOLS

TO ADDRESS EPISTEMIC UNCERTAINTY

IN A.I..

>> THANKS, PETER.

EXCEPTIONAL.

NEXT PRESENTATION, ON PLANETARY

HEALTH EXPOSURES, INCLUDES

CLIMATE CHANGE AND RELATIONSHIP

TO CARDIOVASCULAR HEALTH, GIVEN

BY DR. JONATHAN NEWMAN,

ASSISTANT PROFESSOR OF

CARDIOLOGY LANGONE NYU SCHOOL OF

MEDICINE, THE LINK BETWEEN

ENVIRONMENT AND CARDIOVASCULAR

DISEASE.

>> THANK YOU, SANJAY.

NEXT SLIDE PLEASE.

SO, THANK YOU TO THE NHLBI AND

ORGANIZERS, DR. RAJAGOPALAN AND

ANGELL.

I'M GOING TO FOCUS ON POTENTIAL

CLINICAL DIRECTIONS WITHIN THIS

BROAD TOPIC AND GET INTO SOME OF

THE IDEAS OF WAYS THAT WE MIGHT

CONSIDER SOME EXPOSURES WITHIN

CLINICAL FRAMEWORKS TO ADDRESS

BOTH ENVIRONMENTAL HEALTH AND

SOCIAL INEQUITIES.

NEXT SLIDE PLEASE.

SO, TO START, I WILL SORT OF

REFRAME A LITTLE BIT OF WHAT DR.

MYERS SHOWED A LITTLE BIT IN HIS

TALK.

I'M SHOWING HERE IN THE MIDDLE A

SLIDE FROM ABOUT SIX MONTHS AGO

OF THE RAPID WORSENING IN AIR

QUALITY IN NEW YORK CITY IN

MANHATTAN, THIS IS VIEWING

MANHATTAN FROM NEW JERSEY,

THROUGHOUT THE COURSE OF THE DAY

FROM MORE USUAL LEVELS OF FINE

PARTICULATE EMISSIONS TO A PEAK

ON WEDNESDAY, JUNE 7, OF 460,

OVER 460 MICROGRAMS PER METER

CUBED RELATED TO CANADIAN

WILDFIRES, JUXTAPOSED AGAINST

THE EMPEROR NERO IN ROME, AS

LEGEND HAS IT FIDDLING WHILE

ROME BURNS.

I'M NOT SUGGESTING HERE THAT

THIS AUDIENCE IN ANY WAY IS

UNAWARES OF THE RISKS OF CLIMATE

CHANGE AND PLANETARY HEALTH, BUT

THERE'S AN ELEMENT I THINK OF

SOCIAL UNAWARENESS THAT MAY BE

RELEVANT FOR SOME DIMENSIONS OF

THIS TALK.

NEXT PLEASE.

SO, THIS IS A REALLY ELEGANT

DIAGRAM THAT DR. RAJAGOPALAN

PUBLISHED A COUPLE YEARS AGO IN

THE NEW ENGLAND JOURNAL OF

MEDICINE ILLUSTRATING THE

MULTIPLE DIMENSIONS OF EXOGENOUS

POLLUTANTS FROM FOSSIL FUEL

COMBUSTION TO TOXIC MET A

LITTLE, TO CLIMATE CHANGE

PROCESSES RELATED TO GLOBAL

WARMING, INCLUDING EXTREME

TEMPERATURES AND WILDFIRES.

AND NOT ONLY GOING THROUGH SOME

OF THE WAYS IN WHICH THESE

EXPOSURES LEAD TO CARDIOVASCULAR

BUT IMPORTANTLY INDIVIDUAL

STRATEGIES WE CAN APPROACH TO

AMELIORATE ATTENUATE.

IN ANOTHER NICE REVIEW DRILLING

DOWN A LITTLE BIT MORE ON THE

SPECIFICS OF THE CARDIOVASCULAR

EFFECTS, DR. KHRAISHAH AND

COLLEAGUES WENT THROUGH A

WORKFLOW AND ILLUSTRATION OF THE

WAYS WHICH INDUSTRIAL EMISSIONS

LEADING TO DIRECT AND INDIRECT

EFFECTS OF CARDIOVASCULAR

DISEASE MORBIDITY AND MORTALITY

AND GOING THROUGH CHANGES IN

PATHWAYS, LET'S SAY RELATED TO

INFLAMMATION, SPECIFIC

ELECTROLYTE ABNORMALITIES,

HYPERCOAGULATION, EXTREME

DISRUPTION AND CHANGES CAN LEAD

TO INDIRECT EFFECTS, ALTERATIONS

IN CARE PATHWAYS THEMSELVES.

FURTHER WORSENING SOME ELEMENTS

OF CARDIOVASCULAR CARE.

NEXT SLIDE PLEASE.

SO, ONE THING THAT WE AND OTHERS

HAVE BEEN INTERESTED IN IS TO

UNDERSTAND THE WAYS IN WHICH IN

THE CASE OF FOSSIL FUEL

COMBUSTION PM2.5 PARTICLES LESS

THAN 2.5 MICROMETERS IN DIAMETER

HAVE A HOST OF PHYSIOLOGIC

EFFECTS, DIRECT AND INDIRECT, IN

HUMAN PHYSIOLOGY, LEADING

EVENTUALLY TO INCREASED BLOOD

PRESSURE, A VERY CLOSE SURROGATE

FOR CARDIOVASCULAR DISEASE, ONE

OF THE ONLY SURROGATES THAT THE

FDA WILL ALLOW FOR TESTING OF

NEW THERAPIES IN LIEU OF

CARDIOVASCULAR OUTCOMES, AND WE

AND OTHERS ARE STUDYING THE WAY

IN WHICH WIDELY AVAILABLE

TECHNOLOGY AS PORTABLE AIR

CLEANERS WITH HEPA FILTERS MIGHT

IMPROVE OR REDUCE LEVELS OF FINE

PARTICULATE EXPOSURE AND LOWER

BLOOD PRESSURE.

NEXT SLIDE PLEASE.

IS HE, ONE THING I WANT TO BRING

UP WHICH IS CONCEPT WELL KNOWN

TO THE AUDIENCE IS THE ISSUE OF

THE PREVENTION PARADOX, SICK

INDIVIDUALS AND SICK POPULATIONS

VIS-A-VIS CARDIOVASCULAR RISK

FACTORS, THIS IS WORK FROM

JEFFREY ROSE 20 YEARS AGO

DESCRIBING CHANGES IN BLOOD

PRESSURE DISTRIBUTIONS IN

POPULATIONS.

HOW ON THE INDIVIDUAL LEVEL, WE

CAN AFFECT WHAT MODEST REDUCTION

IN BLOOD PRESSURE, IN THIS CASE

FROM SYSTOLIC RE REDUCTION 2 TO

5, WITH STROKES AND

CARDIOVASCULAR MORTALITY, SHOWN

AS A MODEL LET'S SAY FOR

POLICIES OF SALT REDUCTION AND

REDUCING SALT INTAKE TO LOWER

INDIVIDUAL BLOOD PRESSURE,

HAVING VERY LARGE

POPULATION-WIDE BENEFITS.

I THINK SIMILAR APPROACH MAYBE

COULD BE USED IN THINKING ABOUT

THE USE OF PORTABLE AIR CLEANERS

OR INDIVIDUAL APPROACHES TO

MODIFY THE RISK OF CERTAIN

ENVIRONMENTAL EXPOSURES LIKE

FINE PARTICULATE AIR POLLUTION.

NEXT PLEASE.

SO, WE'RE CONDUCTING A TRIAL TO

TRY AND TEST THIS IN A

POPULATION WHICH AS OTHERS HAVE

TOUCHED UPON TODAY EXPOSE JUST

IN U RES -- EXPOSURES ARE NOT

HOMOGENOUS, WE'RE ATTESTING IN

PARALLEL ARM RANDOMIZE THE

CLINICAL TRIAL OF 440 PUBLIC

HOUSING RESIDENTS WITH HIGH

BLOOD PRESSURE, RANDOMIZED TO

IN-BEDROOM AIR FILTER OVERNIGHT

24 HOURS A DAY, ON AN ENDPOINT

OF SELF-MEASURED HOME BLOOD

PRESSURE TRANSMITTED REMOTELY,

I'LL GO INTO DETAILS, ENDPOINT

OF BLOOD PRESSURE OVER 30, 90,

100 DAYS, WITH ADDITIONAL

PHYSIOLOGIC AND DATA TO

UNDERSTAND BOTH EFFICACY OF

POTENTIALLY INDIVIDUAL STRATEGY

THAT MIGHT BE ABLE TO MODIFY

RISK IN INDIVIDUALS WITH STABLE

HIGH BLOOD PRESSURE.

NEXT SLIDE PLEASE.

SO, AS I THINK HAS BEEN TOUCHED

UPON A BIT, THERE'S A NICE

FRAMEWORK HERE TO THINK ABOUT

PLANETARY HEALTH THAT'S REALLY A

COMMON SOIL IN A SENSE, DRAWING

ON SOME OF DR. MYERS' SLIDES

EARLIER, AS A SOCIAL DETERMINANT

OF HEALTH IN WAYS WE CAN THINK

ABOUT PHYSICAL ENVIRONMENT AND I

THINK THIS MODEL FROM THE

NATIONAL ACADEMY OF SCIENCES AND

DR. COMMODORE-MENSAH DESCRIBES

CONTRIBUTIONS BUT IN REALITY THE

PHYSICAL ENVIRONMENT AND

PLANETARY HEALTH IS UNDERPINNING

THESE MULTIPLE DOMAINS OF HEALTH

CARE, HEALTH BEHAVIORS, AND

SOCIOECONOMIC FACTORS THAT LEAD

TO ROOT CAUSE AND POOR

HYPERTENSION OUTCOME.

NEXT SLIDE PLEASE.

SO ONE WAY THAT I THINK IS A

SIMPLISTIC MODEL TO THINK ABOUT

THIS IS A POSITIVE FEEDBACK

LOOP.

LOOKING IN CERTAIN COMMUNITIES

WITHIN NEW YORK CITY, WE SEE

UPWARDS OF 70% OF INDIVIDUALS

THAT HAVE HIGH BLOOD PRESSURE

HAVE POORLY CONTROLLED HIGH

BLOOD PRESSURE, MORE THAN 40,

50% HAVE DIABETES, THESE STATES

OF HEALTH INEQUITY INCREASED

RATES OF DIABETES, OF POORLY

CONTROLLED HYPERTENSION, RENAL

DISEASE, IN TURN INCREASE

SUSCEPTIBILITY AND REINFORCED BY

ENVIRONMENTAL INEQUITY WHICH

WERE HIGH LIGHTED SHOWING THIS

POLLUTION BURDEN AND POLLUTION

BENEFIT OR ADVANTAGE BASED ON

SOCIAL DETERMINANTS OF HEALTH,

IN WHICH THE COMMUNITIES MOST

VULNERABLE TO ENVIRONMENTAL

EXPOSURES AND FOSSIL FUEL

COMBUSTION FOR EXAMPLE ARE MOST

BURDENED BY AREAS OF HEALTH

INEQUITY.

NEXT SLIDE PLEASE.

I WANTED TO GIVE A FRAMEWORK

TOWARDS THE PLANETARY HEALTH AND

DOMAINS OF PLANETARY HEALTH,

VIS-A-VIS ECOLOGICAL CEILINGS

AND SOCIAL FOUNDATIONS AS RELATE

TO CARDIOVASCULAR DISEASE,

POTENTIALLY TO CLINICAL TRIALS.

AND BECOMING MORE FAMILIAR WITH

THIS MODEL RECENTLY, NO THE

SOCIAL FOUNDATION THIS IS

ILLUSTRATING WHICH IS IN WHICH

SHORTFALLS IN CERTAIN DOMAINS OF

INDIVIDUAL BEHAVIOR OR

INDIVIDUAL WELL-BEING SHORTFALLS

OR LACK OF ACCESS TO CLEAN

WATER, FOOD, ENERGY, HEALTH,

LEAD TO IMPAIRMENTS IN HEALTH

AND PLANETARY HEALTH ON THE

INDIVIDUAL LEVEL, AND ON THE

ECOLOGICAL CEILING BARRIER

OVERSHOOTS OF CERTAIN AREAS IN

CLIMATE CHANGE, BIODIVERSITY

LAWS, IN EXACERBATIONS OR AIR

POLLUTION ITSELF LEAD TO

WORSENING OF PLANETARY AND

INDIVIDUAL HEALTH AND WITHIN

THIS BOUNDARY REGION IS THE

REGION WHERE WE MIGHT SEE HEALTH

OF THE INDIVIDUAL AND HEALTH OF

THE PLANET MAXIMIZE TO THE

GREATER GOOD.

NEXT SLIDE PLEASE.

YOU KNOW, AS A CLINICAL TRIALS

AND CARDIOLOGIST, ONE OF THE

THINGS THAT I'M MOST INTERESTED

IN AND WE RELY UPON ARE CLINICAL

TRIALS.

UNFORTUNATELY AS DETAILED

PREVIOUSLY THERE'S ABOUT A

17-YEAR ODYSSEY BETWEEN

PRIORITIES FOR RESEARCH FUNDING,

FUNDING OF CERTAIN PRIORITIES,

AND THEN THOSE FINDINGS

EVENTUALLY BEING TRANSLATED INTO

CLINICAL PRACTICE, IF EFFICACY

PARAMETERS ARE MET.

CLINICAL TRIALS REMAIN THE GOLD

STANDARD, PREVIOUSLY WAS

MENTIONED LET'S SAY UNMEASURED

CONFOUNDERS OR CHARACTERISTICS

OF POPULATIONS BEING COMPARED,

THAT'S THE THING THAT CLINICAL

TRIALS CAN BALANCE OUT.

THESE CLINICAL TRIALS AS

POSITIVES GUIDE PROVIDER

BEHAVIOR AND CARE, ARE DRIVERS

OF CLINICAL PRACTICE GUIDELINE

WHICH IN TURN MADE PAYERS MAKE

DECISIONS ON WHAT PRACTICE

CLINICAL PATIENT ENCOUNTER WILL

NOT BE COVERED AND INFLUENCE

POLICY AND HEALTH STRATEGIES.

UNFORTUNATELY THERE ARE A WEALTH

OF RELATED ISSUES WITH CURRENT

CLINICAL TRIALS, IN GENERAL THEY

ARE COSTLY AND SLOW, THERE ARE

INEVITABLY QUESTIONS OF

GENERALIZABILITY FROM PATIENTS

THAT ENROLL IN CLINICAL TRIALS

TO LARGER POPULATIONS THAT WOULD

DERIVE BENEFIT OR APPLIED TO

CERTAIN THERAPIES, GUILTY OF

REINFORCING HEALTH AND SOCIAL

INEQUITIES, RAISING VALUE FOR

PUBLIC HEALTH QUESTIONS.

NEXT SLIDE PLEASE.

SO, I THINK ONE FRAMEWORK MAYBE

TO THINK ABOUT THAT WE'VE TRIED

TO APPLY IN SOME OF OUR WORK ARE

TO THINK ABOUT CONVENTIONAL

VERSUS DECENTRALIZED CLINICAL

TRIALS, AS POTENTIAL PATH FOR

ENVIRONMENTAL AND SOCIAL -- PATH

FOR ENVIRONMENTAL AND SOCIAL THE

QUESTION.

IN CONVENTIONAL RCTs,

RANDOMIZED CLINICAL TRIALS, UNIT

OF MEASURE IS IN-PERSON

PATIENT'S ENCOUNTER.

THERE'S THE PER PHYSICIAN

REFERRAL, IN-PERSON MONITORING

AND VISITS, CONVENTIONAL

CLINICAL TRIAL, GROUPS THAT HAVE

LOOKED AT CARBON FOOTPRINT OF

CURRENT CLINICAL PRACTICE AND

CLINICAL TRIALS, AND MORE

BROADLY OF THE HEALTH CARE

SYSTEM, IF HEALTH CARE IN

GENERAL WERE A NATION WE WOULD

BE THE FIFTH GREATEST POLLUTER

AND CARBON UTILIZER WORLDWIDE.

VERSUS DECENTRALIZED TRIALS MAY

BE RELYING MORE ON REMOTE OR

VIRTUAL OR ELECTRONIC HEALTH

RECORD EHR CONSENT MECHANISMS,

REGISTRIES AND VIRTUAL

RECRUITMENT PATHWAYS, RELIANCE

ON REMOTE PATIENT MONITORING

WHICH WE'RE TRYING TO DO, IN

PART TO BRIDGE THE DIGITAL

DIVIDE USING THESE TECHNOLOGIES

FOR UNDERRESOURCED POPULATIONS,

USING POTENTIALLY WEARABLE OR

IMPLANTABLE DEVICES, MOBILE

MONITORING, NEXT SLIDE.

MAYBE A FRAMEWORK, DECENTRALIZED

TRIALS AS POTENTIAL TO IMPROVE

PLANETARY HEALTH.

IF YOU'RE RUNNING A TRIAL OF

HIGH BLOOD PRESSURE ASKING

PARTICIPANTS TO DRIVE OR COMMUTE

TO PHYSICIAN OFFERS OR CLINICAL

TRIAL SPACE TO MEASURE THEIR

INPUTS, THAT'S GOING TO GENERATE

EMISSIONS BY PARTICIPATING IN

THE CLINICAL TRIAL, TO SAY

NOTHING OF THE DISTRACTIONS AND

TAKING PEOPLE AWAY FROM THE

LIVES THEY LEAD, CHILD CARE

RESPONSIBILITIES, MULTIPLE

EMPLOYMENTS FOR INDIVIDUALS

LIVING AT THE MARGINS OF

SOCIOECONOMIC WELLNESS.

IN CONTRAST MAYBE SHIFTING TO

DECENTRALIZED MODEL MIGHT

INCREASE EQUITY, RELIANCE ON

REMOTE TECHNOLOGY, DECREASE

EMISSION OF THE SORT OF CLIMATE

FOOTPRINT OF SOME CLINICAL

EVIDENCE BASE WE STRIVE TO

GENERATE.

NEXT SLIDE PLEASE.

SO, IN THE FEW MOMENTS THAT

REMAIN I'D LIKE TO HIGHLIGHT

SOME RESEARCH GAPS AND

UNANSWERED QUESTIONS.

NEXT SLIDE.

SO, ONE QUESTION I THINK IS

RELEVANT SHOULD ENVIRONMENTAL

RISKS BE CAPTURED IN CLINICAL

TRIALS AND COHORTS, EXISTING

TRIALS THAT ARE ONGOING AND

THOSE THAT HAVE BEEN COMPLETED.

AND I'M SHOWING TWO EXAMPLES.

YOU'LL HEAR MORE TOMORROW.

A NICE PAPER WAS PUBLISHED A

COUPLE YEARS AGO WHERE THEY

LOOKED AT DATA FROM THE LANDMARK

TRIAL, THE SPRINT TRIAL, THAT

TESTED IN ABOUT 9300 U.S.

RESIDENTS WITH HIGH BLOOD

PRESSURE AND CARDIOVASCULAR

DISEASE OR RISK FACTORS,

BENEFITS OF INTENSE BLOOD

PRESSURE LOWERING STRATEGY,

GETTING TO SYSTOLIC LESS THAN

120 COMPARED TO LESS THAN 140,

AND WHAT THEY SHOWED IS THAT

THERE WAS SIGNIFICANT

INTERACTION INDIVIDUALS LIVING

IN REGIONS WITH ZIP CODE 2.5

GREATER THAN EPA STANDARD OF 12

MICROMETERS PER METER CUBED HAD

GREATER BENEFIT OF MORE

INTENSIVE BLOOD PRESSURE

LOWERING STRATEGY COMPARED TO

THOSE LIVING IN LESS POLLUTED OR

IN AREAS BELOW THE CURRENT EPA

THRESHOLD AT THAT TIME.

MAYBE WE CAN UNDERSTAND MORE

ABOUT HIDDEN HETERO

HETEROGENEITY AND INTERVENTION

BASED ON ENVIRONMENTAL DATA

PERVASIVE FOR ALL PARTICIPANTS

WE WANT TO ENROLL IN STUDIES OF

CLINICAL INTERVENTIONS OVERALL.

ON THE OTHER SIDE I'M SHOWING

DATA FROM THE NIH ASSOCIATION OF

RETIRED PERSONS COHORT, OVER

500,000 RETIRED INDIVIDUALS,

SHOWING EFFECT MODIFICATION BY

QUINTILES OF MEDITERRANEAN DIET

CONSUMPTION, AND REALLY

ATTENUATION OF THE EFFECT FOR

CARDIOVASCULAR DISEASE, ISCHEMIC

HEART DISEASE, CEREBROVASCULAR

FROM PM 2.5 BASED ON QUINTILES

OF MEDITERRANEAN DIET IN

OBSERVATIONAL STUDY WITH DIETARY

DATA THAT HAS ITS LIMITS AND

THIS MAY REFLECT OTHER ASPECTS

OF HEALTH AND WELLNESS, THERE

MAY BE MEANINGFUL EFFECT

MODIFICATION THAT WE CAN CAPTURE

IN CLINICAL DATA ABOVE AND

BEYOND TRADITIONAL PARADIGMS OF

RISK.

NEXT SLIDE PLEASE.

SO, AGAIN, CAN WE APPLY THIS

BOUNDARY FRAMEWORK TO

ENVIRONMENTAL RISK?

I THINK THERE'S SOME INTERESTING

THINKING GOING ON IN THIS SPACE,

YOU KNOW, AS CLINICIANS AND

CLINICAL TRIALISTS WE THINK

ABOUT TRADITIONAL CARDIOVASCULAR

OR HEALTH RISK FACTORS, IN THIS

CASE MAYBE RESIDUAL THROMBOTIC

RISK, INFLAMMATORY RISK, MAYBE

WE NEED TO BROADEN THIS IN THE

SAME SORT OF BOUNDARY REGION FOR

THE PLANETARY HEALTH CONSTRUCT,

ENVIRONMENTAL RISK WORKING HAND

IN HAND WITH RESIDUAL SOCIAL

RISK, A NICE PAPER PUBLISHED

RECENTLY GETTING INTO SOME

CONCEPTUAL FRAMEWORK.

NEXT SLIDE PLEASE.

SO LASTLY, DR. DIEZ-ROUX SHOWED

DATA ON REDLINING DECISIONS FROM

THE 1930s INFLUENCING AND

CONTINUE TO PERPETUATE AREAS OF

ENVIRONMENTAL INEQUITY.

I'M SHOWING SOME PRELIMINARY

DATA FROM OUR GROUP IN NEW YORK

CITY, LOOKING AT THE EFFECT OF

ACTIVE AIR FILTERS, PACs,

VERSUS SHAM.

LOOKING, WE COMPARED JUST BASED

ON NUMBERS ALONE, THE GROUP C

AND D, REDLINE DISTRICTED

COMPARED TO A AND B.

YOU CAN SEE IN THE ACTIVE PAC

ARM, ACTIVE AIR FILTER ARM,

THERE'S REALLY NO DIFFERENCE

BETWEEN THE MEAN PM2.5 EXPOSURE,

MARRIED IN THE HOME WITH

COMMERCIALLY AVAILABLE DEVICE,

BUT WHEN YOU LOOK AT THE SHAM

DEVICES IN THIS TRIAL YOU SEE

THAT IN THE HOMEOWNERSHIP LOAN

CORPORATION REDLINE DISTRICTS,

CONTEMPORARY NEW YORK CITY,

THERE'S MUCH GREATER VARIABILITY

AND GREATER EXPOSURE COMPARED TO

THOSE IN AREAS A AND B IN NEW

YORK.

SO MAYBE THIS EXPOSOME,

QUOTE/UNQUOTE, IN THE CASE OF

PM2.5 AND AIR POLLUTION CAN BE

MODIFIED AT THE INDIVIDUAL LEVEL

AND MAYBE THINKING ABOUT RISK

FACTORS AS INDIVIDUALLY

MODIFIABLE I THINK IS A CONCEPT

THAT MAYBE WE CAN WRAP OUR HEADS

AROUND MORE FROM CLINICAL AND

TREATMENT FRAMEWORK.

NEXT SLIDE PLEASE.

BRIEF SUMMARY AND CONCLUSION, I

THINK AS HAS BEEN ALREADY SHOWN

THIS MORNING ELEGANTLY THESE

BOUNDARY DOMAINS AND SYSTEMS AND

EXCEEDING THESE SYSTEMS HAVE

MULTIPLE NEGATIVE CARDIOVASCULAR

EFFECTS.

PLANETARY HEALTH MAYBE IS A VIEW

FOR THIS APPROACH IS A COMMON

SOIL FOR HEALTH AND SOCIAL

INEQUITY.

RANDOMIZED TRIALS OF MAYBE

PERSONAL AND PATIENT

INTERVENTIONS WHILE WE WORK

TOWARDS THE LARGER POLICY

DIRECTIONS WHICH CLEARLY WE NEED

MAY GUIDE IMPLEMENTATION AND

ACTION.

AND NOVEL APPROACHES,

DECENTRALIZED TRIALS AND OTHERS,

MAY HELP IMPROVE HEALTH EQUITY

AND RESOURCE USE AS A WAY TO

UNCOVER HIDDEN HETEROGENEITY TO

MAYBE USE DETAILED CLINICAL

TRIAL PHENOTYPING, CORE LAB

ADJUDICATION AND REVIEW

COMMITTEES, TO UNDERSTAND THE

TRUE IMPACT IN MORE DETAIL SOME

PHYSIOLOGIC IMPACTS FROM THE

MYRIAD ENVIRONMENTAL EXPOSURES

WE HAVE.

THANKS VERY MUCH FOR YOUR TIME

AND ATTENTION.

NEXT SLIDE.

>> GREAT.

THANK YOU FOR THAT GREAT

OVERVIEW.

I THINK WE'RE JUST ON TIME, TWO

MINUTES I THINK AHEAD OF

SCHEDULE -- ACTUALLY BEHIND

SCHEDULE.

WE'RE GOING TO FORTUNATELY MAKE

THIS UP TODAY.

NEXT SPEAKER DR. SACOBY WILSON

ON THE AGENDA COULD NOT MAKE IT

TODAY.

AND WE'LL MOVE FORWARD WITH OUR

FINAL TALK AS A CONSEQUENCE,

WHICH IS GIVEN BY DR. STEVEN

DAVIS AND ATTEMPT THE NEXT NAME,

STEVEN DAVIS (INDISCERNIBLE) AND

BLACKFOOT CONFEDERACY.

FORGIVE ME IF I BUTCHERED THE

NAME, FROM MONTANA STATE

UNIVERSITY IN BOZEMAN, JOINED BY

DR. ALEXANDRA ADAMS, SAME

INSTITUTION, DIRECTORY AND

PROFESSOR OF CENTER FOR AMERICAN

INDIAN AND RULE HEALTH EQUITY IN

MONTANA STATE.

THANK YOU TO BOTH OF YOU FOR

GIVING THIS TALK AND INDIGENOUS

NATIONS THINKING IN TERMS OF

PLANETARY HEALTH.

THANK YOU SO MUCH.

I THINK YOU MIGHT BE MUTED,

STEVEN.

>> I'M WAITING FOR MY COLLEAGUE

TO KICK US OFF.

>> TERRIFIC.

>> I'M UNMUTED BUT I CAN'T SEE

ME.

I DON'T KNOW IF YOU CAN

HIGHLIGHT ME FIRST AND THEN

STEVEN.

THERE WE GO.

START MY VIDEO.

THANKS.

>> TERRIFIC.

WE CAN SEE YOU NOW.

>> GREAT.

THANK YOU SO MUCH.

>> WE HAVE PLENTY OF TIME, NOT

TO WORRY.

THANK YOU SO MUCH.

>> I'M SORRY JACOBY COULDN'T

MAKE IT.

THANK YOU TO THE PRESENTERS AND

PEOPLE LISTENING FOR HAVING US

SPEAK.

STEVEN AND I ARE SPEAKING FROM

BOZEMAN MONTANA, MONTANA STATE

UNIVERSITY.

I'M OF EUROPEAN DESCENT,

PHYSICIAN AND RESEARCHERS

WORKING IN PARTNERSHIP WITH MANY

NATIVE COMMUNITIES FOR THE PAST

25 YEARS.

IT IS WITH DEEP GRATITUDE TO

THOSE COMMUNITIES THAT I SHARE

WITH YOU TODAY.

NEXT SLIDE PLEASE.

VICTOR

VICTOR FRANKL SAID THIS.

A PAPER WAS WRITTEN INCLUDING

THREE CRITICAL ISSUES WE MUST

CONSIDER.

CONCEPTUAL FAILURES, KNOWLEDGE

FAILURES, IMPLEMENTATION

FAILURES.

WE'VE HEARD ABOUT PLANETARY

HEALTH TODAY AND A LOT OF

KNOWLEDGE FAILURES AND

IMPLEMENTATION FAILURES, AND

THESE ARE CRISES ABOUT WHAT WE

THINK, HOW WE RELATE, WHAT WE

KNOW AND DO.

WE'LL FOCUS ON HOW WE THINK AND

RELATE.

WE BELIEVE THIS IS ABSOLUTELY

CRITICAL TO WHAT WE KNOW.

THE QUESTIONS WE ASK IN RESEARCH

AND HOW WE ASK THEM.

AND WHAT WE DO WITH THAT

INFORMATION AND HOW WE IMPLEMENT

AND DISSEMINATE.

WE BELIEVE WE'RE IN A CRISIS OF

MINDSET TO NEEDS TO SHIFT TO

RELATIONAL WAY OF BEING.

NEXT SLIDE PLEASE.

AS I'VE BEEN TAUGHT BY MANY

NATIVE ELDERS PEOPLE LEARN BEST

FROM STORY.

I'LL START WITH A STORY OF MY

WORK WITH NATIVE COMMUNITIES AND

HOW THE RESEARCH QUESTIONS WE

ASK HAVE EVOLVED OVER THE PAST

20+ YEARS.

AND CONTRARY TO WHAT PEOPLE

EXPECT I'M NOT PRESENTING DATA

OR FOCUS ON HEALTH ISSUES

CRITICAL IN URBAN AND TRIBAL

NATIVE COMMUNITIES AROUND THIS

COUNTRY AND THE WORLD.

RATHER HOW THE QUESTIONS THAT

WE'RE ASKING TOGETHER HAVE

SHIFTED OVER TIME.

SO LIKE MANY RESEARCHERS I

STARTED OUT WORKING IN BASIC

SCIENCE, CLINICAL LABS, CLINICAL

TRIALS.

THANKFULLY I WAS INTRODUCED TO

STRONG MENTORS, CONCEPTS OF

COMMUNITY-BASED PARTICIPATORY

RESEARCH.

JUNIOR FACULTY AT THE UNIVERSITY

OF WISCONSIN SCHOOL OF MEDICINE

I PARTNERED WITH SEVERAL TRIBAL

COMMUNITIES AND WE STARTED TO

LOOK AT SERIES OF NHLBI-FUNDED

STUDIES HOW DO WE UNDERSTAND WHY

WE HAVE HIGH RATES OF

CARDIOVASCULAR DISEASE AND

DIABETES NEW THESE COMMUNITIES

AND RATES OF CHILDHOOD OBESITY

THAT MIGHT CONTRIBUTE TO THOSE

FACTORS.

WE DID FIND HIGH RATES OF

CHILDHOOD OBESITY AND OVERWEIGHT

COUPLED WITH HIGH RATES OF

HYPERLIPIDEMIA IN YOUNG

CHILDREN.

I BROUGHT THAT DATA BACK TO

COMMUNITIES, WE WORKED TO DESIGN

A FAMILY-BASED INTERVENTION TO

ADDRESS DETERMINANTS OF HEALTH,

TYPICAL PUBLIC HEALTH THINGS

SUCH AS PHYSICAL ACTIVITY,

NUTRITION, SCREEN TIME, SLEEP,

STRESS.

ALL PREDICTORS OF FUTURE CARDIAC

DISEASE.

THIS WAS IMPLEMENTED IN MULTIPLE

COMMUNITIES NATIONALLY, HERE IS

A PICTURE OF A PARTICIPATING

FAMILY.

THESE QUESTIONS, WHAT WOULD

BENEFIT, WHAT DOES THE COMMUNITY

THINK, WERE INCORPORATED.

IN ADDITION DURING THAT TIME I

WAS WORKING WITH A PARTICULAR

COMMUNITY IN WISCONSIN IN A

COMMUNITY ENGAGEMENT WORK GROUP.

OVER THE FIRST FIVE YEARS THIS

WORK GROUP BEGAN HAVING

INCREASING DISCUSSIONS OF THE

ROLE OF HISTORIC AND CURRENT

TRAUMA IN THE HEALTH OF THE

COMMUNITY.

WE DISCUSSED HOW ADVERSE

CHILDHOOD EXPERIENCES DUE TO

TRAUMA AND SOCIAL DETERMINANTS

OF HEALTH AS WE TALKED ABOUT

SUCH AS POVERTY, RACISM, FROM

PRIOR SPEAKERS WERE LEADING TO

POOR COPING STRATEGIES SUCH AS

USING TOBACCO, ALCOHOL, DRUGS,

UNHEALTHY FOODS THAT WERE

CONTRIBUTING TO THESE HIGH RATES

OF CHRONIC DISEASES.

SO THIS TRAUMA MODEL AND WORK OF

MANY COMMUNITY ORGANIZATIONS TO

ADDRESS TRAUMA INFORMED CARE HAD

A SIGNIFICANT IMPACT ON

COMMUNITY WELLNESS, COMMUNITY

GRADUATION RATES, ET CETERA.

IT WAS NOT ENOUGH.

NEXT SLIDE PLEASE.

SO IN 2017 I WAS INVITED TO GO

TO NEW ZEALAND FOR INDIGENOUS

KNOWLEDGE EXCHANGE AND MY FRIEND

JENNIFER AND I FROM THE MENONMI

NATION GRAN EXCHANGES WITH

NATIVE HAWAIIAN COLLEAGUES TO

SHIFT FROM PUBLIC HEALTH SUCH AS

WHAT I'VE TALKED ABOUT, PHYSICAL

ACTIVITY, EVEN TRAUMA INFORMED

CARE, TO THINKING ABOUT HOW

REVITALIZING CONNECTION TO LAND

AND CULTURE WAS MORE HOLISTIC

APPROACH TO WELLNESS.

WE SHIFTED TO THINKING ABOUT

CULTURE, MEDICINE, BEGAN WORKING

WITH THE COMMUNITY TO REVITALIZE

LANGUAGE AND CULTURE AND KINSHIP

CONNECTIONS, SOME BELONGING THAT

PETER TALKED ABOUT WAS REALLY

CRITICAL TO HEALTH.

WE CREATED A A WELLNESS MODEL TO

HELP THE COMMUNITY VISUALIZE.

THIS IS US IN NEW ZEALAND,

LEARNING KNOWLEDGE OF FERNS AND

HOW WE CANNOT SPEAK ABOUT HEALTH

AND CONNECTION TO FOREST OR

PLANETARY HEALTH WITHOUT

ACTUALLY BEING IN THE FOREST.

MUCH OF OUR LEARNING TOGETHER

OCCURS OUTSIDE IN THE

ENVIRONMENTS THAT WE'RE WORKING

TO, WORK WITH, UNDERSTAND AND

LEARN FROM.

NEXT SLIDE PLEASE.

THESE ARE SOME OF THE COMMUNITY

ENGAGEMENT LESSONS LEARNED THAT

I THINK ARE CRITICAL AS WE MOVE

FORWARD, MOVING TOGETHER WITH

HOW DO WE WORK WITH COMMUNITY

AND UP TOWARDS NATION AND

STATEWIDE CHANGES.

I THINK IT'S REALLY IMPORTANT TO

BEWARE OF DEFICIT MODEL, THEY

HAVE ALL THESE ISSUES AND

PROBLEMS AND HAVE HIGHER

EXPOSURES OF PM2.5 ET CETERA,

APPROACHING FROM DEFICIT MODEL

SHUTS PEOPLE DOWN INSTEAD OF

ACTIVATING PEOPLE.

BEING OPEN TO THE POSSIBILITY OF

PEOPLE COMING TOGETHER WITH

COMMON VISION FOR HEALTH OF

THEIR COMMUNITY, NOT JUST

COMMUNITY IN TERMS OF HEALTH OF

THE PEOPLE, BUT HEALTH OF ALL OF

THE PARTS OF THE COMMUNITY

AROUND THEM.

ENSURING THAT PEOPLE'S WHOLE

SELVES ARE ENGAGED, BODY, MIND,

SPIRIT.

STEVEN WILL ELABORATE MORE ON

THAT.

REALLY UNDERSTANDING WHAT IS THE

LOCAL KNOWLEDGE AND

UNDERSTANDING OF THE ROOT CAUSE

OF COMMUNITY ISSUES.

WE NEVER WOULD HAVE WENT DOWN

THE ROAD OF UNDERSTANDING DEEP

IMPACT OF HISTORIC AND CURRENT

TRAUMA ON THE COMMUNITY AND HOW

THAT NEEDED TO BE ADDRESSED IN A

DIFFERENT WAY, WITHOUT LISTENING

AND TALKING TO THE COMMUNITY

OVER A LONG PERIOD OF TIME.

USING EVIDENCE-BASED APPROACHES

AND COMMUNITY INPUT IN THE

INTERVENTION, LASTLY OF COURSE

MOVE AT THE SPEED OF TRUST.

SO REVITALIZING LANGUAGE,

CULTURE HEALING WITH INDIGENOUS

KNOWLEDGE IS OCCURRING IN

INDIGENOUS COMMUNITIES IN THIS

COUNTRY AND INTERNATIONALLY.

IT'S HELPING MOVE OUR VIEW OF

HEALTH FROM INDIVIDUAL TO

COMMUNITY, INTO THE HEALTH OF

THE SURROUNDING LAND AND HEALTH

OF THE PLANET.

REMEMBERING AS INDIGENOUS

COMMUNITIES HAVE ALWAYS KNOWN

THAT WE'RE ALL CONNECTED IS

CRITICAL FOR MUTUAL SURVIVAL.

MY COLLEAGUE STEVEN WILL FURTHER

ELABORATE ON THIS NEXT.

NEXT SLIGHT PLEASE.

AND STEVEN?

>>

[SPEAKING IN A FOREIGN LANGUAGE]

[ SPEAKING A NATIVE LANGUAGE ].

>> I GREET YOU IN MY FIRST

LANGUAGE, THE FIRST PEOPLE OF

THE LAND, AS RELATIVES BECAUSE I

BELIEVE WE'RE INTERCONNECTED IN

MORE WAYS THAN WE COULD KNOW OR

UNDERSTAND.

FLIP BACK TO THE PREVIOUS SLIDE

PLEASE.

I'M OF MIXED EUROPEAN AND

INDIGENOUS ANCESTRY, CAN TRACE

THAT DIRECTLY BACK TO FIRST

EUROPEAN CONTACT, COLLISION OF

TWO CULTURES.

WHICH IS TO SAY I'M DESCENDANT,

BIG SKY, A GLIMPSE OF MY

ANCESTORS AND YOUTH.

THIS IS THE LAKES INSIDE THE

MOUNTAINS, ST. MARIES'S IN

GLACIER NATIONAL PARK, BECOMING

UNRECOGNIZE THE AS CLIMATE

DESTABILIZATION WITH RAPIDLY

DISAPPEARING GLACIERS, EXTENDED

SUMMERS HAVE BECOME SUFFOCATED

WITH WILDFIRE SMOKE, DIRECTLY AS

A RESULT OF COLONIAL

MISMANAGEMENT OF FORESTS THE

LAST TWO CENTURIES.

I INTRODUCED MYSELF AS A MEMBER

OF OUR SACRED THUNDER MEDICINE

SOCIETY, I'M HONORING SACRIFICE

OF PREVIOUS SEVEN GENERATIONS BY

SHAPING AND ADVANCING THE NEXT

SEVEN.

I'M IN ENGINEERING BY TRAINING,

FUTURE RESEARCH AND SCHOLARSHIP

FOCUSED IN ATTEMPT TO HELP

BRIDGE THE DIVIDE BETWEEN

WESTERN WAYS OF KNOWING AND

INDIGENOUS WAYS OF KNOWING, ALSO

BROADENING ACCESS TO HIGHER

EDUCATION.

NEXT SLIDE PLEASE.

WHEN I GREET YOU AS RELATIVES I

HAVE EMPHASIZE THIS IS A

CONCEPTUALIZATION OF BROTHERS,

SISTERS, MOTHER, FATHER,

GRANDFATHER, GRANDMOTHERS, NOT

JUST MY AUNTS AND UNCLES OR

COUSINS, THE LAND, WATER, THE

SKIES, PLANT AND ANIMAL

RECOMMEND ACTIVES, MANY

INDIGENOUS CULTURES HOLD THIS

INTERCONNECTIVITY AS AXIOMATIC,

TRUE AND CENTRAL, TO WORLD

VIEWS, EXTENDS TO THE LIVING,

THE NON-LIVING, PLANET, COSMOS

THEMSELVES.

MANY SYMBOLS REPRESENTATIVE

BELIEFS AND CULTURES, THE CIRCLE

IS BASED ON LAKOTA CONCEPT WHERE

EVERYTHING IS RELATED,

EXEMPLIFIES BELIEFS ALL THINGS

ARE CONNECTED IN ONE CYCLE, THE

MEDICINE WHEEL IS PICTURED HERE,

FOUR COLORS MAP ENCOMPASS FOUR

SACRED DIRECTIONS, FOUR SEASONS,

ANCESTRAL TO MY ORIGINAL SYSTEMS

THINKERS UNDERSTANDING OF HEALTH

AND CONNECTION TO ALL THINGS.

NOT ONLY IS IT A MODEL FOR

PERSONAL SPIRITUAL PHYSICAL,

MENTAL AND EMOTIONAL WELL-BEING,

WE UNDERSTAND OUR ROLE, OUR

REALITY, INTERCONNECTED

INTERPLAY BETWEEN OUR MIND,

BODY, HEARTS AND SOULS.

AS MANY OTHER SOCIOECOLOGICAL

FRAMEWORKS PRESENTED TODAY

HIGHLIGHT STRONG HEALTHY

THRIVING COMMUNITIES AND NATIONS

COMPRISED OF STRONG HEALTHY

THRIVING INDIVIDUALS AND

FAMILIES SUCH AS SOCIAL

DETERMINANTS OF HEALTH, OTHER

CONCEPTUAL MODELS, EXTENDING TO

UNDERSTAND OUR PLACE IN ALL OF

REALITY, FROM PLANETARY HEALTH

PERSPECTIVE WHO DESCENDED FROM

THE CONTINENT, ENCOURAGED BY

PRESENTATIONS PRESENTED THIS

MORNING BECAUSE AS WE UNDERSTAND

THIS CONCEPT OF KIN-CENTRIC

ECOLOGY, OUR PLACE IN RELATION

TO LAND, WATER, SKIES, STARS,

NON-HUMAN BEINGS, NOT BE -- NOT

BE A TRACT.

FROM MY TRAINING, THE CLIMATE

AND FORCE WE'RE DISCUSSING ARE

ALSO A PRODUCT OF THE GEOLOGICAL

TIME SCALE INTERPLAY BETWEEN THE

LITHO SPHERE, HYDRO SPHERE AND

BIOSTEER.

BIOSPHERE.

WHEN WE UNDERSTAND THE BALANCE,

THE DIVERSITY OF THE ECOSYSTEM.

NEXT SLIDE PLEASE.

>> NEXT SLIDE.

>> THIS CONCEPT OF KINSHIP IN

RELATION IS NOT JUST HERE AND

NOW BUT ACROSS TIME.

I HIGHLIGHT THIS CONCEPT OF

SEVEN GENERATIONS BECAUSE IN

ACCORDANCE WITH MANY INDIGENOUS

PHILOSOPHIES EVERY DECISION WAS

DISCERNED TO HONOR SACRIFICE OF

PREVIOUS GENERATIONS, FULL

REGARD GIVEN TO THOSE WHO HAVE

COME BEFORE AND SEVEN

GENERATIONS TO COME, HONORING

INTERSACREDNESS OF ALL THINGS,

CORE BELIEFS GUIDE US, THE REAL

PEOPLE ARE ROOTED IN HERITAGE OF

VALUES AND BELIEF TRANSFERRED

AND PASSED ON ORALLY BY OUR

ANCESTORS GENERATION TO

GENERATION, AS OTHER INDIGENOUS

SCHOLARS BEFORE ME HAVE WRITTEN

ON THIS EMERGING CONCEPT,

HIGHLIGHTING FOUR Rs, I HOVER

THE QUESTION OF WHAT RESEARCH

AND ECHO WHAT ALEX OFFERED WHAT

ARE RESEARCH OPPORTUNITIES AND

GAPS REFRAMED FROM INDIGENOUS

PERSPECTIVE WHEN GOVERNING RULES

OF THESE RELATIONSHIPS

RESPONSIBILITY, RECIPROCITY,

REVERENCE, AND AS ALEX

HIGHLIGHTED MY ELDERS HAVE

SHARED THIS INTERGENERATIONAL

PERSPECTIVE IN WHICH WE

RECOGNIZE THAT OUR PEOPLE WERE

ONCE TREATED AS OBJECTS OF

RESEARCH, BECOMING SUBJECTS,

MAYBE UNWILLING PARTICIPANTS, TO

NOW PERHAPS WILLING PARTICIPANTS

AND SUBJECTS.

TODAY I'M ENCOURAGED TO KNOW MY

COLLEAGUES AND OTHERS LIKE ALEX

ARE COLLABORATIVELY SHAPING

COMMUNITY-BASED RESEARCH EFFORTS

AND PROJECTS, THEREFORE SHAPING

OUR NEXT GENERATION AT THIS

INSTITUTE FOR GENERATIONS.

I'LL LEAVE YOU WITH THE PHOTO OF

THE CHIEF MOUNTAIN.

WE HAVE SO MUCH ANCESTRAL WISDOM

AND KNOWLEDGE IN OUR NATIVE

LANGUAGE.

PICTURE IS THE RETURN AFTER MANY

GENERATIONS, RETURNED OUR FIRST

RELATIVES, RESTORATION OF

CULTURE WITH REINTRODUCTION OF

BISON TO THE LAND, WITH IT

COMING BACK STORIES, SONGS,

CEREMONIES.

OUR WORDS FOR THESE MOUNTAINS,

PEOPLE WERE SHAPED BY FOR

GENERATIONS, IS SIGNED LIKE

THIS.

OUR LANGUAGE IS DYNAMIC, NOT

STATIC, TO OFFER A STEM ANALOGY,

IT'S FLUX, IN CALCULUS LANGUAGE,

NOT SNAPSHOTS OR STATISTICS.

A DEEP INTIMATE CONNECTION TO

THIS PLACE, NOT ONLY WE KNEW

THESE MOUNTAINS, WE KNEW THE

FORCES THAT SHAPED OVER TENS OF

THOUSANDS OF YEARS, SINCE BEFORE

THE LAST EYE -- ICE AGE.

RELATIVES ON OTHER SIDE OF THE

DIVIDE HAVE WORDS FOR LAKE

MISSOULA, LAND OF THE GREAT ICE

WATER, THE GLACIAL LAKES THAT

SHAPED THE PACIFIC NORTHWEST.

WE UNDERSTOOD WE WERE NOT APART

FROM NATURE BUT AN INTEGRAL PART

AS BEING OF THE LAND SHAPED BY

THE LAND, WE DO TO LAND WATER

AND SKIES WE DO TO OURSELVES, A

JUXTAPOSITION OF WESTERN VIEW.

ONE OTHER THING I MIGHT OFFER IN

TERMS OF THAT PREVIOUS IMAGE,

AND STRESS AND HIGHLIGHT, OUR

CONCEPT OF MEDICINE HAS

COMPLETELY DIFFERENT CONNOTATION

IN CULTURES.

THE WORD I WOULD USE TO HUNT OR

GATHER ROOTS OR BERRIES IN A

PLACE PICTURED ON THE SCREEN,

UNDERSTANDING OF MEDICINE, IS A

CONCEPT OF WELL-BEING, MEANING

IT'S PRO-ACTIVE, PREVENTIVE, NOT

REACTIVE, PRESCRIPTIVE, OR

EPISODIC.

BECAUSE OUR ANCESTORS UNDERSTOOD

THAT FOOD WAS MEDICINE, CULTURE

WAS MEDICINE, WE'RE ULTIMATELY

STILL HERE, HAVE BECOME STORIES

WE TELL.

NEXT SLIDE PLEASE.

>> STEVEN, IT'S GOING TO TURN

BACK TO ME TO DISCUSS RESEARCH

GAPS.

THANK YOU.

WE WERE TALKING ABOUT WHAT WERE

SOME RESEARCH GAPS WE WOULD LIKE

TO PRESENT TODAY.

I THINK ONE OF THEM IS

COMMUNICATING CONNECTIONS

BETWEEN CLIMATE CHANGE AND HUMAN

HEALTH.

WE LIVE IN A VERY RURAL FRONTIER

STATE.

EVEN THOUGH A LOT OF PRODUCERS

HERE ARE PRODUCING FOOD AROUND

THE COUNTRY, THEY SEE CLIMATE

CHANGES HAPPENING, NOT ABLE TO

TALK ABOUT IT IN IMPORTANT WAYS,

THAT GETS INTO MESSING WITH

LOCAL AND STATE POLICY CHANGES,

THOSE ARE IMPORTANT TO THINK

ABOUT HOW WE COMMUNICATE THIS.

NEXT IS IMPLEMENTING BEST

PRACTICES IN SUPPORTING

COMMUNITIES, ACTION GROUPS TO

ENACT CHANGES THEY WANT IN

POLICY SYSTEMS AND ENVIRONMENT.

THEN ANOTHER ONE WE TALKED ABOUT

WAS A LOT OF BIG DATA NOW, IT'S

AVAILABLE, IT'S ALL THERE, BUT

REALLY NEEDS COMMUNITY INPUT TO

ASK THE RIGHT QUESTIONS OF THAT

BIG DATA.

I'VE SEEN SOME GREAT PROJECTS

BUT THEY ARE ASKING ALL THE

WRONG QUESTIONS.

WITHOUT COMMUNITIES HAVING INPUT

INTO THAT IT'S TRIPPED UP

PEOPLE'S INFORMATION THAT THEY

ARE OBTAINING.

NEXT I WOULD SAY WHAT WE SAW

DURING COVID WAS A REALLY

DIFFICULT SITUATION,

PARTICULARLY IN RURAL AND TRIBAL

AREAS, THAT ARE ALREADY FOOD

DESERTS AND LACK OF FOOD.

AND SO HOW DO WE HELP PROMOTE

GOOD FOOD SYSTEMS?

WE TALKED ABOUT SYSTEMS FOR

SUSTAINABILITY IN TIMES OF THE

COMING CLIMATE, FURTHER CLIMATE

CRISES.

AND THEN NEXT WE HAVE TO ENSURE

THE CRITICAL INDIGENOUS VOICE IS

AT THE TABLE, NOT ON THE MENU,

AS STEVEN TALKED ABOUT.

OFTEN INDIGENOUS VOICES ARE LEFT

OUT, PARTICULARLY OUT OF ANY

DATA, BUT PARTICULARLY AT

DISCUSSING THESE ISSUES.

NEXT SLIDE PLEASE.

SOME RESEARCH OPPORTUNITIES AS

WE SEE THEM, AGAIN THE ONES WE

TALKED ABOUT BUT MOVING AWAY

FROM EXPLOITATIVE PRACTICES AND

HOW DOES RESEARCH SERVE NEEDS OF

OUR COMMUNITIES, ALL OF OUR

COMMUNITIES, AND PLANETARY

HEALTH NOW AND FOR THE NEXT

SEVEN GENERATIONS?

WE BELIEVE THIS INTERCONNECTED

INTERGENERATIONAL RELATIONAL

APPROACH IS CRITICAL TO THE

PLANETARY AND HUMAN HEALTH.

BACK TO STEVEN.

>> I WANT TO LEAVE YOU WITH

THIS.

UNDERSTANDING THAT KINSHIP WITH

ALL CREATURES OF THE EARTH, SKY,

AND WATER WAS A REAL AND ACTIVE

PRINCIPLE.

THIS CONCEPT OF LIFE AND

RELATIONS FILLED US WITH JOY AND

MYSTERY OF LIVING, GAVE

REVERENCE FOR ALL, MADE A PLACE

FOR ALL THINGS IN THE SCHEME OF

EXISTENCE.

CHIEF STANDING BEAR.

THANK YOU.

[ SPEAKING NATIVE LANGUAGE ]

>> THANK YOU, ALEX AND STEVEN.

I WANT TO TAKE A MOMENT TO PAUSE

BECAUSE OF THE IMPACT OF WHAT

YOU JUST SHARED WITH US, AND HOW

IMPORTANT THIS MESSAGE AT THE

CONCLUSION OF THE SESSION IS TO

FRAME OUR DISCUSSIONS ABOUT THE

ULTIMATE EXISTENTIAL PROBLEM

FROM THE STANDPOINT OF

INDIGENOUS COMMUNITIES AND

ANCIENT WISDOMS THAT FRAMED HOW

INDIGENOUS COMMUNITIES HAVE

LIVED THEIR LIVES, SUSTAINABLY,

AND THAT THERE MIGHT BE POWERFUL

MESSAGING AND RESEARCH

OPPORTUNITIES.

THANK YOU VERY MUCH.

WE ARE FIVE MINUTES AHEAD OF

TIME.

WE'LL USE THIS EFFECTIVE.

WE WERE SCHEDULED TO MOVE TO THE

DISCUSSION SESSION, WHICH WILL

BE LED BY DR. CARREN SOLOMON.

THIS WAS ORIGINALLY SCHEDULED TO

BE FROM 12:00 TO 12:40 AND IF WE

FINISH EARLY MIGHT BREAK EARLY

ON AND COME BACK AFTER LUNCH AT

1:20 P.M.

IT'S MY PLEASURE TO INTRODUCE

DR. CAREN SOLOMON, DEPUTY

DIRECTOR NEW ENGLAND JOURNAL OF

MEDICINE, ASSOCIATE PROFESSOR AT

HARVARD, PHYSICIAN AT BRIGHAM

AND WOMEN'S HOSPITAL.

RESPONSIBILITY INCLUDING LEADING

EFFORTS RELATED TO COVERAGE OF

CLIMATE CHANGE, OVERSEEING

ONGOING FOSSIL FUEL SERIES, AN

EXTRAORDINARY SERIES OF PAPERS

THAT BROUGHT ATTENTION TO THIS

ISSUE BY THE WORLD'S LEADING

MEDICAL JOURNAL.

SO, I'D LIKE TO THANK HER FOR

TAKING TIME TO JOIN US TODAY AND

I TURN THIS OVER TO KICK OFF

THESE DISCUSSIONS.

CAREN, THANK YOU FOR JOINING US.

>> THANK YOU.

SO, THIS IS TERRIFIC.

I WANT TO THANK YOU FOR YOUR

EXCELLENT TALKS, I ALSO WANT TO

SAY THAT IT IS REALLY EXCITING

TO SEE NHLBI FOCUSING ON

PLANETARY HEALTH, INCLUDING

CLIMATE CHANGE, AND IMPLICATIONS

FOR CARDIOVASCULAR DISEASE,

REDUCTION AND HEALTH EQUITY.

EACH OF YOU SPEAKING TODAY

REVIEWED A LOT OF IMPORTANT DATA

AND HIGHLIGHTED SOME MANY

UNANSWERED QUESTIONS CRITICAL

INFORMING DEVELOPMENT OF

RESEARCH AGENDA.

I HAVE A LOT OF FOLLOW-UP

QUESTIONS AND EXPECT OUR

AUDIENCE WILL AS WELL.

SO, TO START, CRITICAL FOCUS OF

THE SYMPOSIUM TOUCHED ON BY ALL

SPEAKERS IS HEALTH EQUITY.

SO, BEGINNING THERE, I'M GOING

TO TURN TO ALEXANDRA AND/OR

STEVEN.

YOU UNDERSCORED TREMENDOUS VALUE

OF LOCAL KNOWLEDGE AND

UNDERSTANDING ROOT CAUSES OF

PROBLEMS, AND CLEARLY AS SANJAY

REITERATED WE HAVE A LOT TO

LEARN FROM INDIGENOUS

COMMUNITIES ABOUT LIVING IN

HARMONY WITH NATURE.

I'M HOPING THAT YOU CAN PROVIDE

SOME GUIDANCE REGARDING BEST

PRACTICES FOR WORKING ALONGSIDE

COMMUNITIES THAT ARE

DISPROPORTIONATELY AFFECTED BY

CLIMATE CHANGE AND OTHER

PLANETARY HEALTH DETERIORATION.

SO, ALEXANDRA?

>> MAYBE I'LL START AND TURN IT

OVER TO STEVEN.

I THINK REALLY THE MOST

IMPORTANT THING AS I HAD IN MY

SLIDE WAS MOVING AT THE SPEED OF

TRUST.

SO BUILDING RESPECT,

RELATIONSHIPS WITH COMMUNITIES

ARE REALLY IMPORTANT.

THINKING ABOUT THE RECIPROCITY

IN TERMS OF I'VE GOTTEN SO MANY

PEOPLE COMING TO ME SAYING WE

NEED TO PUT INDIANS IN OUR

RESEARCH.

JUST REALLY INSULTING.

IT'S REALLY TRICKY BECAUSE

THAT'S NOT THE WAY TO APPROACH

COMMUNITY, RIGHT?

YOU HAVE TO GO IN TRYING TO

UNDERSTAND HOW THE COMMUNITY AND

WHAT THE COMMUNITY NEEDS AND

WHAT THEY WANT.

GOING IN, AND HAVING TRUSTED

ALLIES FROM PERSPECTIVE OF LIGHT

RESEARCHER, I'VE FOUND PEOPLE IN

THE COMMUNITY WHO HELP ME LEARN

ABOUT THE COMMUNITY, UNDERSTAND

THE COMMUNITY, AND TEACH ME

ABOUT THE COMMUNITY AND THEN GO

IN WITH THAT VERY MUCH OF A HOW

CAN I LEARN THE MOST FROM THAT

COMMUNITY IN TERMS OF WORKING AS

A PARTNER BECAUSE I'M ALWAYS

AWED HOW MUCH MORE THEY KNOW

ABOUT ALL OF THE THINGS THAT

WE'RE TRYING TO DEAL WITH THAN I

DO.

SO, I WOULD SAY THAT

COMMUNITY-BASED PARTICIPATORY

RESEARCH IS A REALLY IMPORTANT

WAY TO DO IT BUT IT GOES BEYOND

THAT IN TERMS OF BUILDING TRUST

AND THAT RESPECT.

>> THANK YOU.

>> STEVEN, I'LL TURN IT OVER TO

YOU MAYBE NOW.

>> I WOULD ECHO THE

RELATIONSHIPS ARE THE

FUNDAMENTAL ASPECT OF ANY

INTERACTION.

WE'RE BATTLING GENERATIONS OF

ERASURE AND EXCLUSION, MANY

PROBLEMATIC PRACTICES.

BUT I'M ENCOURAGED, NOT THE

LEAST OF WHICH BY PRESENTATIONS

PRESENTED HERE, STARTING TO

REFLECT THAT RELATIONAL THAT OUR

PEOPLE KNEW SO WELL AND MOVING

AT THE SPEED OF TRUST IS KEY IN

ALL EFFORTS ANYWHERE.

>> THANK YOU.

OBVIOUSLY WE SHOULD BE APPLYING

THAT TO ALL OF OUR WORK WITH

FRONTLINE COMMUNITIES AND

OTHERS, BUT SUPER HELPFUL.

ANOTHER PIECE OF EQUITY HAS TO

DO WITH KIND OF BEST MEASURING

THE EFFECTS OF INEQUITY.

I'M GOING TO CALL ON AN AUDIENCE

QUESTION, MICHELLE ASKED HOW WE

MEASURE COST, NOT JUST FINANCIAL

BUT OTHER COSTS OF THESE

DISPARITIES THAT WE'RE SEEING,

EXPOSURES AND HEALTH OUTCOMES.

FOR EXAMPLE, IS THERE SOMETHING

BETTER THAN DISABILITY ADJUSTED

LIFE YEARS?

I'M GOING TO TURN THAT TO ANA

FIRST.

>> THANK YOU.

THAT'S A GOOD QUESTION.

I'M NOT SURE I FULLY UNDERSTAND

THE QUESTION.

CAN YOU RESTATE?

IT'S ABOUT -- THERE ARE MANY

DIMENSIONS TO MEASURING

INEQUITIES, OF COURSE.

AND IT DEPENDS ON WHAT YOUR

SPECIFIC GOAL IS.

>> VERY FAIR.

SO I THINK THAT QUESTION WAS

PRETTY FOCUSED I THINK ON REALLY

KIND OF BROADER QUESTION THAN

FINANCIAL COST BUT ARE THERE

WAYS THAT WE CAN QUANTITATIVELY

CAPTURE IMPACT?

IT'S A TOUGH ONE.

I DON'T KNOW THE RIGHT ANSWER.

THAT WE COULD QUANTITATIVELY

CAPTURE THESE IMPACTS AND REALLY

THEREFORE BE ABLE TO MAKE VERY

CLEAR HOW CERTAIN COMMUNITIES

ARE EXPERIENCING GREATER

SUFFERING AND THAT WOULD ALSO

TRANSLATE INTO INTERVENTIONS

THAT ARE TARGETED TO MITIGATE OR

FACILITATE ADAPTATION IN CERTAIN

COMMUNITIES ARE GOING TO END UP

ACTUALLY BEING, YOU KNOW, COST

SAVING AND HAVE MORE BENEFIT.

THE QUESTION IS AROUND THAT

BROAD QUESTION OF CAPTURING COST

AND COST EFFECTIVENESS.

>> YEAH, I MEAN IN GENERAL

TERMS, I MEAN, THERE ARE MANY

WAYS TO MEASURE INEQUITIES AND

SOMETIMES WE BUILD IN VALUE

JUDGMENTS IN THE WAY WE MEASURE

OR REPORT ON INEQUITIES.

IT'S IMPORTANT TO KEEP THAT IN

MIND AS WE THINK ABOUT MEASURING

INEQUITIES.

WHO IS THE COMPARISON GROUP, FOR

EXAMPLE, IS IT A RELATIVE OR

ABSOLUTE DIFFERENCE THAT WE'RE

LOOKING AT.

SO I GUESS WHAT I WOULD SAY IS

WE HAVE TO LOOK AT IT OFTEN IN

MULTIPLE WAYS.

BECAUSE EACH PIECE IS TELLING US

SOMETHING DIFFERENT, AND THAT

HAVING INPUT FROM COMMUNITIES ON

THE INTERPRETATION AND ON THE,

YOU KNOW, MEANING OF SOME OF

THESE DIFFERENCES IS VERY

IMPORTANT.

I'M NOT SURE IF I'M COMPLETELY

ANSWERING THE QUESTION BUT

THAT'S WHAT I CAN DO.

THE COST, YOU KNOW, COST-BENEFIT

ANALYSES AN IMPACT ON COST, IT'S

A WHOLE OTHER WORLD.

I THINK THERE ARE OFTEN A LOT OF

ASSUMPTIONS IN THERE ABOUT COST

TO WHOM, AND WHO PAYS FOR THE

COSTS, WHICH ARE COMPLEX AND

NEED TO BE TALKED ABOUT.

SO WE NEED TO BE CAREFUL ABOUT

THAT.

IN CHARACTERIZING INEQUITIES,

IT'S VERY IMPORTANT TO AVOID

STEREOTYPING, OR, YOU KNOW, I

THINK IT WAS ALLUDED TO BY SOME

PRESENTERS FOCUSING ONLY ON

DEFICIT MODEL BUT ALSO TALKING

ABOUT COMMUNITY ASSETS AND ALSO

THINKING DYNAMICALLY, GETTING

BACK TO, YOU KNOW, WHAT PETER

HAS BEEN TALKING ABOUT.

THAT'S WHY I LIKE THE PM2.5

PAPER SO MUCH BECAUSE IT LOOKED

NOT ONLY AT WHO WAS EXPOSED BUT

WHO WAS DRIVING THE EXPOSURES.

I THINK THAT'S AN ANGLE WE ALSO

NEED TO THINK ABOUT PARTICULARLY

AS WE'RE THINKING SYSTEMICALLY

ABOUT HEALTH INEQUITIES IN

GENERAL.

>> ABSOLUTELY.

THANK YOU.

SANJAY, BEFORE I ASK THE NEXT

QUESTION, IF I THROW OUT A

QUESTION WITHOUT POINTING IT TO

AN INDIVIDUAL SPEAKER, AM I

GOING TO DISRUPT THE

PROCEEDINGS?

>> NOT AT ALL.

I WOULD PREFER THIS TO BE A

FAIRLY UNSCRIPTED PRESENTATION

SO PEOPLE CAN SPEAK THEIR VIEWS.

GO RIGHT AHEAD.

>> I'M THROWING OUT MORE

GENERALLY THAN BEFORE WE MOVE TO

OTHER ASPECTS OF THE DISCUSSION,

WHETHER ANYBODY WANTS TO SORT OF

REITERATE OR EXPAND ON CRITICAL

WAYS THAT WE CAN ENSURE THAT ANY

RESEARCH ON PLANETARY HEALTH AND

CARDIOVASCULAR DISEASE IS EQUITY

CENTERED.

ANY TAKERS?

>> I'LL TAKE A STAB.

I'LL KICK THE DISCUSSION OFF

BECAUSE THIS IS A LOADED

QUESTION, FUNDAMENTALLY

IMPORTANT BUT I THINK IN MANY

WAYS CLIMATE CHANGE, UNLESS IT

REALLY ADDRESSES ISSUES

PERTAINING TO VULNERABLE

COMMUNITIES AND COMMUNITIES AT

RISK, CAN NEVER REALLY SOLVE THE

PROBLEM.

SO MANY WAYS THIS IS A PRIMARY

NEED FOR CLIMATE RESEARCH AND

CERTAINLY FROM CARDIOVASCULAR

ANGLE WE'VE LEARNED FROM ANA'S

WORK AND MANY OTHERS IN THE CORE

TODAY THAT SOCIAL INEQUITIES

DRIVE DISPROPORTIONATE NUMBER OF

CARDIOVASCULAR OUTCOMES AND

ENVIRONMENTAL AND CLIMATE

EXPOSURES DO SO IN A SIMILAR WAY

USING SIMILAR PATHWAYS.

AND DISPROPORTIONATELY IMPACT

THE COMMUNITIES.

IF YOU CAN'T ADDRESS THAT,

YOU'RE NEVER GOPHER TO SOLVE THE

PROBLEM.

I THINK THE YOUR COMMISSIONER

SAID THEY CANNOT BE A

TRANSITION, SOMETHING LIKE IT

CAN'T BE A TRANSITION UNLESS

THERE'S A JUST TRANSITION.

IN OTHER WORDS, IT HAS TO BE --

WON'T BE A TRANSITION UNLESS

IT'S A TRANSITION THAT WORKS

WELL FOR COMMUNITIES AT RISK.

I DON'T KNOW WHETHER OTHERS WANT

TO ADD.

>> I'LL ADD QUICKLY, I WOULD SAY

MAKING SURE THAT, AGAIN, THE

PEOPLE THAT ARE BEING MOST

AFFECTED ARE IN THE ROOM IN

THOSE DISCUSSIONS.

WHATEVER UNDERSERVED COMMUNITY

YOU'RE WORKING WITH THEY NEED TO

BE AT THE TABLE.

THAT'S CRITICAL.

OFTEN LEFT OUT.

>> I CAN'T SEE EVERYBODY BUT IF

SAM HAS A HAND UP WE'RE GOING TO

DO SAM AND THEN PETER.

>> THANKS.

JUST A COUPLE QUICK THOUGHTS.

ONE I THINK IT'S ACTUALLY

ABOUT -- EQUITY IS IMPORTANT

OBVIOUSLY BUT IT'S MORE THAN

JUST EQUITY.

IT'S ABOUT HOW WE TAILOR

INTERVENTIONS.

SO IT'S REALLY IMPORTANT TO

UNDERSTAND THE DISTRIBUTION OF

THESE FACTS ACROSS DIFFERENT

POPULATIONS SO WE KNOW WHAT TO

DO ABOUT THEM.

WHETHER IT'S RISING CO2 MAKING

FOOD LESS NUTRITION, WHAT ARE

POPULATIONS AROUND THE WORLD

THAT HAVE DIETS THAT SET THEM UP

TO BE PARTICULARLY VULNERABLE TO

THOSE CHANGES IN NUTRIENT

INTAKE, AND HOW DO WE TAILOR

INTERVENTIONS.

THAT'S JUST ONE THOUGHT.

I THINK IT'S IMPORTANT TO SHOW

DISPROPORTIONATE DISTRIBUTION

NOT ONLY BECAUSE FREQUENTLY IT'S

POOREST PEOPLE IN THE WORLD MOST

IMPACTED BUT SOMETIMES IT'S

POPULATIONS IN THE WEALTHY

PARTS, LIKE OUR WORK ON

POLLINATORS MOST IMPACTED, ALSO

AN IMPORTANT MESSAGE FOR PEOPLE

TO UNDERSTAND THAT THERE'S

NOBODY WHO IS FUNDAMENTALLY

IMMUNE FROM THESE IMPACTS.

THE SECOND THING I WANTED TO SAY

WAS THAT I AGREE ABOUT HAVING

VULNERABLE POPULATIONS

REPRESENTED IN THE ROOM BUT I

THINK WE ALSO HAVE TO RECOGNIZE

THAT THE HUGE INTERGENERATIONAL

EQUITY ISSUES, SO THE MOST

VULNERABLE PEOPLE CAN'T BE IN

THE ROOM BECAUSE THEY ARE IN

FUTURE GENERATIONS, AND ALSO

OFTEN NON-HUMAN SPECIES.

SO, WE HAVE TO ACKNOWLEDGE THAT

IN SOME WAYS WE HAVE TO THINK

ABOUT NON-REPRESENTED ENTITIES

AS WELL.

>> GOOD POINT.

PETER, DO YOU WANT TO WEIGH IN?

>> I'M THINKING BACK TO WORK OF

ALEX AND STEVEN REFERENCED, IN

COLLABORATING WITH FOLKS FROM

NEW ZEALAND, SOME WORK WE'VE

DONE, IT'S NOT JUST WHEN WE'RE

COMING TOGETHER AND FRAMING

QUESTIONS WE'RE DRAWING ON

LANGUAGE, MENTAL MODELS, IT

TAKES TIME TO JUST GET -- IT'S

NOT JUST BEING IN THE ROOM BUT

HAVING OPPORTUNITIES TO CONNECT

AND UNDERSTAND EACH OTHER'S

FRAMEWORKS.

AND HOW WE'RE PHRASING QUESTIONS

AND PRIORITIZING QUESTIONS AND

BUILDING OFF WHAT SAM WAS SAYING

IN TERMS OF ENVIRONMENT, ONE OF

THE THEMES THAT'S COME FROM SOME

OF THOSE INTERACTIONS THAT ALEX

AND STEPHEN TALKED ABOUT WHERE

WE'VE HAD SORT OF INVESTED TIME

AND EFFORT TO UNDERSTAND EACH

OTHER'S METAPHORS, WHERE WE'RE

COMING FROM.

IT'S BEEN -- AS AN EXAMPLE ONE

IS LIKE REALLY FLIPPING FROM

FOCUS ON HUMAN HEALTH TO

UNDERSTANDING ENVIRONMENT

ECOLOGY AS DERIVATIVES, AS

CHANGE TERMS INSTEAD OF

COMMUNITY HEALTH BEING

DERIVATIVE OF INDIVIDUAL HEALTH,

HEALTH IS DEFINED AT COMMUNITY

ECOLOGICAL LEVEL, HUMAN HEALTH

IS DERIVATIVE.

SO THAT'S AN EXAMPLE OF SOME

SHIFTS IN LANGUAGE, THOSE

INTERACTIONS AND I THINK IT'S

WITH THE SYSTEM DYNAMICS ONE OF

THE WAYS WE'VE BEEN ABLE TO

FLESH THAT OUT.

THE OTHER PIECE I WOULD SAY IS

IT'S NOT -- IT'S BEING CONSCIOUS

ALSO ABOUT -- AND LISTENING TO

WHAT IT IS WE MAY BRING

SOMETHING INTO CONTEXT THINKING

THAT'S WHAT'S GOING TO BE

VALUABLE BUT IT'S ACTUALLY FROM

MY EXPERIENCE LISTENING AND

FIGURING OUT IN THOSE

COLLABORATIONS WHAT IT IS THAT

COULD OFFER THAT WOULD BE

USEFUL.

AND SO I GUESS THAT'S WHAT I

WOULD SAY.

THAT ENDS UP SHAPING A LOT OF

HOW WE THEN GO ABOUT

CONCEPTUALIZING SOMETHING LIKE

EQUITY, WHAT IT MEANS, AND THEN

BEGINNING TO MOVE FORWARD TO

THINKING ABOUT WHAT DOES IT MEAN

TO CHANGE THE STRUCTURE OF A

SYSTEM AND WHAT STRUCTURAL

INEQUITIES VERSUS DISTRIBUTIONAL

INEQUITIES, HOW DO WE

DISENTANGLE.

>> ANA?

>> TWO THOUGHTS.

THINKING SPECIFICALLY ABOUT

CARDIOVASCULAR INEQUITIES, I

THINK THE FIRST THING IS THAT,

YOU KNOW, LARGE INEQUITIES IN

CARDIOVASCULAR DISEASE EXIST.

ENVIRONMENTAL FACTORS ARE MAJOR

CONTRIBUTORS ALREADY TO THOSE

DIFFERENCES, INCLUDING MANY OF

THE THINGS WE TALKED ABOUT TODAY

AND MORE.

AND I THINK THE METHODS THAT WE

USE AND EVEN SOMETIMES

CONCEPTUAL MODELS, THIS IS

EXPANDED OVER THE PAST COUPLE

DECADES DON'T FULLY CAPTURE

THIS.

IN SOME WAYS, BROADENING

THINKING TO PLANETARY HEALTH

FORCES UP TO GRAPPLE AND FIGURE

OUT WAYS TO BETTER UNDERSTAND

IMPACT OF ENVIRONMENTAL FACTORS

BROADLY DEFINED TO

CARDIOVASCULAR INEQUITIES.

QUESTIONS WE ASK, METHODS WE

USE, HOW WE THINK CONCEPTUALLY

AND SYSTEMICALLY ABOUT THESE

THINGS AS OPPOSED TO THE

TRADITIONAL BIOMEDICAL PARADIGM.

SO, THERE'S AN URGENCY ABOUT

UNDERSTANDING AND ADDRESSING THE

CARDIOVASCULAR INEQUITIES THAT

WE HAVE TODAY, AND THE SECOND

POINT THAT I WANT TO MAKE, IT'S

IMPORTANT TO REMEMBER THINGS WE

DO AS SOCIETY TO ADDRESS GLOBAL

ENVIRONMENTAL CHANGE INCLUDING

CLIMATE CHANGE MITIGATION AND

ADAPTATION STRATEGIES CAN HAVE

POSITIVE EQUITY BENEFITS OR CAN

INCREASE INEQUITIES.

SO IT'S VERY IMPORTANT FOR US TO

KEEP THAT IN MIND TOO, AS WE

THINK AND BE ABLE TO DOCUMENT

AND UNDERSTAND THOSE POTENTIAL

IMPACTS SO WE CAN MAKE SURE THAT

WE'RE NOT MAKING INEQUITIES

WORSE BY ADDRESSING -- BY THE

WAY WE DECIDE AS A SOCIETY TO

ADDRESS OR PERHAPS NOT ADDRESS,

YOU KNOW, THESE CHALLENGES.

>> SANJAY?

>> ONE THEME WAS HOW DO YOU

START TO ENGAGE IN SYSTEMS

THINKING, ANA ALLUDED TO THAT AS

WELL AS PETER, ALSO HOW DO YOU

START TO EXTRICATE SOME OF THESE

INFLUENCES THAT CO-SEGREGATE AND

TRAVEL TOGETHER, PARTICULARLY

SOCIAL AND ENVIRONMENTAL

EXPOSURES AND HOW MIGHT AS

RESEARCH QUESTIONS INVESTIGATORS

START TO PUT IN FRAMEWORKS OR

ASK QUESTIONS, WHERE THEY START

TO DISENTANGLE SOME EXPOSURES TO

TRY AND BETTER PUT A HANDLE ON

WHAT'S ACTUALLY CAUSING THINGS

SO THAT WE CAN DESIGN

INTERVENTIONS BETTER AND DO

FOLKS ON THIS PANEL HAVE

THOUGHTS ABOUT RESEARCH

METHODOLOGIES AS WELL AS

FRAMEWORKS THAT SHOULD PROBABLY

BE MUCH MORE PERVASIVE IN

RESEARCH APPLICATIONS, ET

CETERA, IN A SHIFT FROM AS ANA

MENTIONED FROM TRADITIONAL

BIOMEDICAL PARADIGM TO EXPOSOMIC

FRAMEWORKS, TOOLS IN

INFORMATICS, ANY COMMENTS FROM

MEMBERS OF THE PANEL ON WHAT

SOME OF THESE APPROACHES MIGHT

LOOK LIKE?

>> SAM?

>> I THINK ONE OF THE THINGS

THAT'S CHALLENGING ABOUT

PLANETARY HEALTH, ONE WAY THAT'S

QUITE DIFFERENT FROM CLASSIC

ENVIRONMENTAL HEALTH IS THAT

IT'S NOT NECESSARILY ALWAYS

ABOUT EXPOSURES.

AND OFTEN WHAT IT'S ABOUT IS THE

EROSION OF NATURAL LIFE SUPPORT

SYSTEMS, SO IT'S THE EROSION OF

THE LOSS OF POLLINATORS, OR, YOU

KNOW, THE LOSS OF COASTAL

BARRIERS THAT PROTECT US FROM

FLOODING, OR CHANGES IN CLIMATE.

BUT THESE ARE HARD TO THINK OF

AS EXPOSURES PER SE.

AND SO IT ACTUALLY I THINK NEEDS

CRACKING OPEN THE RESEARCH

METHODS BEYOND CLASSIC HEALTH,

EXPOSURE EPIDEMIOLOGY,

TRANSDISCIPLINARY WORK, SPEAKING

TO WHAT I LOVE IN COMMENTS FROM

ALEXANDRA AND STEVEN AND PETER

THAT EMPHASIZE NARRATIVE,

STORY-TELLING,

INTERCONNECTEDNESS.

I THINK AT THE HEART OF THE

MOMENT THAT WE'RE GRAPPLING

WITH, YOU KNOW, YOU CAN ARGUE

THERE ARE BROKEN STORIES ABOUT

OUR RELATIONSHIP TO NATURE AND

TO EACH OTHER AND ACROSS

GENERATIONS AND IT'S ONE OF THE

REASONS THIS CONVERSATION ABOUT

VULNERABLE POPULATIONS

PARTICULARLY IN INDIGENOUS

CONTEXTS MAKES ME UNCOMFORTABLE

BECAUSE I ACTUALLY SEE OURSELVES

AS ENORMOUSLY VULNERABLE IN

COMPARISON TO MANY INDIGENOUS

POPULATIONS BECAUSE WE'VE

MARGINALIZED THOSE CULTURES THAT

ACTUALLY HAD MUCH HEALTHIER

STORIES ABOUT INTERCONNECTION

WHICH ARE MUCH CLOSER TO THE

SCIENCE THAT'S COMING OUT OF THE

PLANETARY HEALTH COMMUNITY IN

THE FIRST PLACE SO WE'VE

MARGINALIZED THE CULTURES THAT

HAVE THE STORIES THAT ARE

EXACTLY THE STORIES WE NEED TO

GET OURSELVES OUT OF THE MESS WE

FIND OURSELVES IN.

NONE OF THAT HAS TO DO WITH

EXPOSURE AT THE FRAMEWORK.

IT'S MORE COMPLICATED.

>> I'M SORRY.

I COULDN'T HELP BUT RESPOND.

ONE OF THE ISSUES WITH THIS

PARADIGM WHICH IS ABSOLUTELY

IMPORTANT COULD NOT AGREE WITH

YOU MORE IS HOW DO YOU BRING

THAT INTO THE MAINSTREAM OF

RESEARCH METHODOLOGIES AND STUDY

SECTIONS AND RESEARCH GRANTS

BECAUSE I CAN TELL YOU THAT MANY

TIMES THIS SORT OF IS MINIMIZED

AS SOFT SCIENCE, MINIMIZED AS

NOT BEING RIGOROUS, AND THAT'S A

MAJOR PROBLEM BECAUSE I DO THINK

THERE'S A TREMENDOUS AMOUNT THAT

NEEDS TO BE INCORPORATED IN

TERMS OF THINKING BUT HOW DO YOU

GET THAT INTO THE MAINSTREAM

WHERE YOUR GRANTS DON'T GET

FUNDED AND NOBODY WANTS TO

LISTEN TO THESE TYPES OF THINGS,

RIGHT?

IT'S A MAJOR PROBLEM, SAM.

I WANT TO BRING THAT UP FOR

DISCUSSION BECAUSE THE CHARGE

HERE TODAY IS TO COME UP WITH

APPROACHES THAT NHLBI MIGHT

HOPEFULLY INCORPORATE THAT MIGHT

RESULT IN MORE REALISTIC

SOLUTIONS TO PROBLEMS, RIGHT?

SO, ANYBODY IN THE PANEL IF THEY

ARE SO INCLINED PLEASE JUMP IN.

>> THAT'S WHAT WE HAVE TO DO.

THAT'S THE RESPONSIBILITY AS

SCIENTISTS TO GET SPECIFIC, TO

SORT OF ARTICULATE THE WAYS

THESE GLOBAL PROCESSES END UP

AFFECTING INDIVIDUALS AND

CARDIOVASCULAR HEALTH.

THAT'S OUR JOB, I THINK.

WE CAN'T JUST WAVE OUR HANDS AND

SPEAK IN METAPHORS AND STORIES.

THAT IS IMPORTANT BUT WE DO HAVE

TO BE SPECIFIC BECAUSE THAT'S

HOW SCIENCE MOVES.

SO THERE ARE MANY OTHER USES OF,

YOU KNOW, METAPHORS AND STORIES

AND NARRATIVES.

TERRIFIC, WE NEED TO TALK ABOUT

THEM TO MOTIVATE THE PUBLIC AND

CREATE DIFFERENT LEVEL OF

UNDERSTANDING BUT IN TERMS OF

SCIENCE WE NEED TO SHOW HOW

APPROACHES HELP US UNDERSTAND

CARDIOVASCULAR DISEASE

ENDPOINTS, CONNECTING AND

FIGURING OUT THIS FITS IN AND

HOW THIS GIVES US BETTER ANSWERS

OR HOW THIS ANSWERS IMPORTANT

QUESTIONS WE'VE NOT ANSWERED

YET.

I THINK THAT'S OUR CHALLENGE AS

SCIENTISTS.

>> THANK YOU.

PETER?

>> YEAH, JUST RESPONDING TO

THAT, I THINK WHERE YOU HAVE

PARTICIPATORY SYSTEMS, SPEAKING

FROM SYSTEM DYNAMICS IN TERMS OF

MY EXPERIENCE, I'VE SEEN SIMILAR

THINGS WITH AGENT BASED MODEL,

SOCIAL NETWORK ANALYSIS, WHEN

WE'RE ENGAGING COMMUNITIES AND

FOLKS AND COULD BE A PRETTY

DIVERSE GROUP FROM LIVED

EXPERIENCE TO SCIENTISTS, AND

WE'RE GENERATING CAUSAL DIAGRAMS

FROM STORIES, WE'RE MOVING MORE

TOWARDS DEVELOPING EXPLICIT

STATEMENTS ABOUT THE CAUSAL

MECHANISMS, AND WHAT I EKE OUT

ABOUT WHAT'S NOW POSSIBLE IN

SYSTEM DYNAMICS WITH DOMINANCE

ANALYSIS, BUT YOU CAN GO FROM A

VISUAL DESCRIPTION TO FORMAL

SIMULATION MODEL TO NOW

PROPOSITIONS THAT ARE FORMALLY

TESTABLE IN SCIENTIFIC WAY ABOUT

HOW WE WOULD EXPECT PATTERNS OF

THE DOMINANCE TO EVOLVE OVER

SCENARIOS THAT WOULD RULE IN OR

RULE OUT VARIOUS TRAJECTORIES,

AND THAT FEELS INCREDIBLY

IMPORTANT TO ME WHEN WE'RE

THINKING ABOUT, YOU KNOW, SOME

OF THESE CHANGES, INTERVENTIONS,

WE WILL NOT SEE THE MEASURABLE

IMPACT FOR SOME TIME IF THEY ARE

WORKING.

AND THE TRAP WE COULD FALL INTO

IS FAVOR SHORT-TERM FIXES THAT

CONTRIBUTE TO REINFORCING

INEQUITIES, SO IS THERE A WAY WE

CAN DEVELOP, MOVE FROM STORIES,

NARRATIVES, LIVED EXPERIENCE,

THE SCIENCE WE KNOW, TO

DEVELOPING HYPOTHESES THAT HELP

US IDENTIFY EARLY OR LEADING

INDICATORS OF WHEN WE'RE ON THE

RIGHT TRACK AND WHAT IT IS WE

SHOULD BE LOOKING FOR,

EMPIRICALLY, WHEN THINGS ARE

GOING SIDEWAYS, AND COMING BACK

TO THIS POINT ABOUT SOME OF THE

INTERVENTIONS WILL HAVE -- ALL

INTERVENTIONS HAVE UNINTENDED

CONSEQUENCES, SOME COULD AMPLIFY

INEQUITIES.

WHEN WE THINK ABOUT INJUSTICE

FROM THAT IT FEELS DIFFERENT.

IF RANDOM AND HARMED VERSUS

CONSEQUENCES OF A PLANNED

POLICY, THAT HAS A DIFFERENT

IMPLICATION MORALLY.

TO ME THAT'S EXCITING ABOUT

SYSTEMS SCIENCE WHEN WE INVOLVE

PEOPLE IN THE PROCESS.

>> ANA?

>> YEAH, NO, I WANT TO SUPPORT

WHAT PETER IS SAYING, I THINK

THE WORK THAT PETER DOES IN

MODEL BUILDING, WAYS TO ENGAGE

COMMUNITIES AND STAKEHOLDERS IN

DEVELOPING CONCRETE, YOU KNOW,

CAUSAL LOOP DIAGRAMS FOR EXAMPLE

ABOUT HOW THINGS MIGHT WORK THAT

CAN THEN BE TESTED, THAT IS

INCREDIBLY POWERFUL, I THINK.

AND SUPER USEFUL.

>> YEAH, GREAT.

I WANT TO POINT TO A COMMENT

BECAUSE I WANT TO BUILD ON THAT

COMMENT FOR PART OF THE

DISCUSSION, SO MATTHEW BERG HAS

NOTED THAT WE MAY BE TRYING TO

FIT BEHAVIORAL ENVIRONMENTAL

FRAMEWORK IN A BIOLOGICAL

SCIENCE CONTEXT AND NEED TO

SHIFT NIH FOCUS TO BE MORE BROAD

AND POINT TO THE CONGRESSIONALLY

MANDATED NIH COMMITTEE LAST YEAR

CONCERNING INCLUSION OF

BEHAVIORAL SPECIALISTS ACROSS

THIS.

SO I WANT TO BRING UP A PIECE OF

THIS RESEARCH AGENDA THAT WE

DIDN'T TALK ABOUT, AND JUST NOTE

THAT WE ALL KNOW THAT THE ROOT

CAUSE OF THIS PROBLEM IS THE

EXTRACTION AND COMBUSTION OF

FOSSIL FUELS.

AND WHILE IT IS OBVIOUSLY WELL

UNDERSTOOD AND ACCEPTED, THAT

FOSSIL FUELS ARE CAUSING CLIMATE

CHANGE AND AIR POLLUTION,

CHEMICAL AND PLASTIC POLLUTION,

THESE ARE HARMING HEALTH, THAT

MESSAGING IS NOT EFFECTIVELY

SWAYING A NUMBER OF PEOPLE.

AND OBVIOUSLY THAT'S IN PART DUE

TO DISINFORMATION CAMPAIGNS

INVOLVING THE FOSSIL FUEL

INDUSTRY AND OTHERS.

I GUESS I HAVE A QUESTION

WHETHER A PIECE OF THIS RESEARCH

AGENDA SHOULD BE TRYING TO

UNDERSTAND WHICH PUBLIC HEALTH

MESSAGES ARE MOST EFFECTIVE TO

ENGAGE PEOPLE.

A LOT OF SPEAKERS TALKED ABOUT

ENGAGEMENT, IS THAT A PIECE OF

WHAT WE SHOULD BE DOING BECAUSE

WE CAN COLLECT ALL THESE DATA

BUT IF THEY DON'T CHANGE ACTION

AND POLICY THEN THAT IS A

PROBLEM.

SAM?

>> YEAH, NO, I WOULD DISPUTE THE

INITIAL CHARACTERIZATION THE

THING WE HAVE TO DO IS MOVE TO

RENEWABLE ENERGY.

IT'S NOT ONLY CLIMATE CHANGE

WE'RE TALKING ABOUT.

I GAVE SIX EXAMPLES OF DIFFERENT

KINDS OF BIOPHYSICAL CHANGE

WHICH ARE AFFECTING

CARDIOVASCULAR DISEASE, NONE OF

WHICH ARE CLIMATE RELATED.

SO IT'S THE BROAD SORT OF EARTH

CRISIS THAT I THINK WE'RE

ADDRESSING, BUT I COMPLETELY

AGREE WITH YOU THAT THIS IS A

CENTRAL RESEARCH GAP AROUND THE

COMBINATION OF COMMUNICATIONS

AND BEHAVIOR CHANGE AND WHAT ARE

THE WAYS TO TELL THESE MESSAGES

OR TELL THESE STORIES THAT ARE

MOTIVATING TO PEOPLE.

MY SENSE IS WE TEND TO EMPHASIZE

THE CATASTROPHIC APOCALYPTIC AND

DON'T DO A GOOD JOB TELLING

ASPIRATIONAL STORY WHERE WE'RE

TRYING TO GET TO AS A SOCIETY.

BUT THAT'S A HYPOTHESIS.

THAT NEEDS TO BE TESTED AND WE

NEED TO UNDERSTAND IF THERE ARE

DIFFERENT MESSAGES THAT ARE MUCH

MORE MOTIVATING OF BEHAVIOR

CHANGE AND IF THEY DIFFER

ACROSS DIFFERENT COMMUNITIES.

THERE'S SOME WORK PEOPLE HAVE

DONE, MAYBACH AND OTHERS, I

AGREE WE NEED MORE.

>> ALEX, DID YOU WANT TO --

>> I WANT TO ECHO.

GREAT COMMENT.

WE REALIZE ESPECIALLY IN A LOT

OF THESE WESTERN STATES, OTHER

STATES, THAT THIS IS ONE OF OUR

BIGGEST PROBLEMS, THIS

COMMUNICATION GAP FROM THE

NOSTALGIC POINT OF VIEW OF THE

GLOOM AND DOOM, ALSO BECAUSE

PEOPLE ARE IN DENIAL.

PEOPLE IN DENIAL AREN'T GOING TO

WANT TO ENGAGE IN ANY OF THESE

SORTS OF CHANGES, WHETHER POLICY

OR BEHAVIOR OR HEART HEALTHY, ET

CETERA.

AND SO I REALLY THINK THE

COMMUNICATION RESEARCH IS

CRITICAL.

I THINK THE OTHER PIECE THAT

WE'VE NOT TALKED ABOUT BUT I

THINK IS THE ELEPHANT IN THE

ROOM IN MANY COMMUNITIES, THE

OUTFALL FROM COVID AND

DEVASTATION THAT MANY OF THESE

COMMUNITIES HAVE GONE THROUGH IN

THE PAST THREE YEARS, BOTH

URBAN, INNER CITY, LATINO,

HISPANIC, AND AFRICAN AMERICAN,

BUT ALSO RURAL AND TRIBAL

COMMUNITIES LOSING A LOT OF

PEOPLE.

THEY ARE NOT THROUGH THAT YET.

I THINK THIS SORT OF TWIN COVID

ON TOP OF PLANETARY HEALTH

IMPACTS, COMMUNICATION LIKE WE

HAVEN'T REALLY GONE THROUGH THE

GRIEVING, AND IT'S REALLY TRICKY

TO COMMUNICATE.

I WANT TO PUT THAT OUT THERE, AS

A PIECE WE NEED TO THINK ABOUT

BECAUSE THIS IS WHAT I HEAR.

>> THANK YOU.

I DON'T KNOW IF ANYBODY WANTS TO

ADD.

I CAN MOVE US TO ANOTHER PIECE

OF SANJAY, WHAT YOU WERE

ALLUDING TO, THE TYPES OF

RESEARCH THAT NEED TO GO INTO A

BROAD AGENDA.

INTEREST WAS -- THERE WAS A

QUESTION FROM THE AUDIENCE,

WILLIAM ASKED ABOUT RESEARCH

TAKING ADVANTAGE OF NATURAL

EXPERIMENTS, HEAT WAVES,

WILDFIRES, ET CETERA, EXPLORING

HEALTH EFFECTS, SPECIFIC TO

CERTAIN COMMUNITIES, ACROSS

THAT.

SOME SPEAKERS HAVE ALLUDED TO

THIS BUT I DIDN'T KNOW IF

ANYBODY WANTED TO SORT OF

COMMENT ON THAT PIECE OF HOW WE

USE THE VERY UNFORTUNATE THINGS

THAT ARE ALREADY OCCURRING TO

KIND OF LEARN MORE, NOT JUST

ABOUT THEIR SERIOUS CONSEQUENCES

BUT ALSO ABOUT EFFECTIVE PILOT

STUDIES OF INTERVENTIONS TO

ADDRESS THEM.

SAM?

NOT SAM, I'M SORRY.

JONATHAN?

>> YES, SO, I WOULD -- MAYBE

THERE ARE ALSO POSITIVE EXAMPLES

OF THINGS WE CAN LEARN FROM AS

NATURAL EXPERIMENTS.

I WOULD SAY SOME OF OUR --

FIRST, AS A CLINICIAN, CLINICAL

TRIALIST, MY SORT OF UNIT OF

INTERACTION OR OVERALL TRAINING

AND FRAMEWORK IS ON THE PATIENT,

RIGHT, ON THE INDIVIDUAL AS A

PARTICIPANT IN CLINICAL RESEARCH

STUDIES, CLINICAL ENCOUNTER.

THROUGH OUR STUDIES THE ONLY

REASON WE'VE BEEN SUCCESSFUL SO

FAR IS BY LEVERAGING AS I THINK

ALEX AND STEVEN HAVE SAID,

MOVING AT SPEED OF TRUST.

WE'VE LEVERAGED COMMUNITY

PARTNERSHIPS TO WORK TOGETHER IN

PARTICULAR NEW YORK CITY ROLLED

OUT AN INTERESTING PROGRAM WHICH

DR. ANGELL WILL KNOW ABOUT,

SMOKE-FREE HOUSING LEGISLATION,

IT RAISES QUESTION OF INDIVIDUAL

RIGHTS AND RESPONSIBILITIES, ALL

PUBLIC HOUSING BUILDINGS WERE

MANDATED TO BECOME SMOKE FREE,

THERE WAS ALLOWANCE FOR

PROHIBITION OF TOBACCO USE IN

CERTAIN BUILDINGS.

AND THAT WAS A NATURAL HISTORY

EXPERIMENT TO MEASURE AIR

QUALITY IN DIFFERENT PUBLIC

HOUSING BUILDINGS IN NEW YORK

CITY THAT MY COLLEAGUE AND CHAIR

DR. THORPE LED THAT DOVETAILED

WITH A LOT OF OUR RESEARCH

PROJECTS.

I THINK WHETHER IT'S LET'S SAY

USING CONGESTION PRICING TO

STUDY DIFFERENTIAL EFFECTS ON

HEALTH OUTCOMES OR OTHER MORE

POSITIVE EXPERIENCES LET'S SAY

PLANNED OR UNPLANNED THERE'S A

LOT WE CAN DO FROM A RESEARCH

PERSPECTIVE THAT MAYBE CAN

INFORM OTHER SYSTEMS STEPS WE

WANT TO TAKE.

>> GREAT POINT.

I WANT TO FOLLOW UP.

I I DO THINK IT'S INTERESTING.

YOUR DISCUSSION OF HOW RCTs

FIT INTO THIS FRAMEWORK,

OBVIOUSLY THEY ARE NOT THE

TYPICAL WAY OF ADDRESSING THESE

QUESTIONS.

BUT THEY ARE VERY IMPORTANT.

I WANT TO FOLLOW UP ON

DECENTRALIZED TRIAL QUESTION

BECAUSE OBVIOUSLY THERE ARE

POTENTIALLY GREAT ADVANTAGES IN

TERMS OF DIVERSITY OF

POPULATION.

I'M GLAD YOU BROUGHT UP THE

CARBON FOOTPRINT OF PEOPLE

GETTING IN THERE AND DOING A

BUNCH OF TESTS IN THE HOSPITAL,

ET CETERA.

BUT I GUESS MY QUESTIONS, DO WE

KNOW MUCH ABOUT THE EXTENT AND

WE MAY TO WHICH DECENTRALIZED

TRIALS ARE ENGAGING A MUCH

BROADER DIVERSITY OF INDIVIDUALS

AND IS THERE A PROBLEM IN ACCESS

TO BROADBAND, FAST INTERNET, WHO

CAN PARTICIPATE?

>> YEAH, GREAT QUESTION.

SO, I WOULD SAY FOR THE FORMER,

WE KNOW TO ALEX'S POINT AND

OTHERS WITH THE SORT OF LEGACY

OF COVID AND SORT OF

UNDERSTANDING WITH NIH

INITIATIVES PERHAPS TO ADDRESS

OR UNDERSTAND LONG COVID THERE

HAVE BEEN STRIDES TO BROADEN

ACCESS NET.

I'M NOT SAY DECENTRALIZED

EFFECTS ARE A PANACEA BUT

PERHAPS A DIFFERENT APPROACH

THAN TRADITIONAL MEDICAL

CENTER-BASED MODEL.

THE LATTER QUESTION, THIS BRINGS

UP THE CLICHÉ, DIGITAL DIVIDE.

THERE ARE MODELS NOW FOR

INSTANCE IN OUR TRIALS WE'RE

USING REMOTE PATIENT MONITORING

DEVICES THAT DO NOT RELY ON

WI-FI.

THEY USE CELLULAR TECHNOLOGY OUT

OF THE BOX, THAT BOUNCE SIGNALS

OFF THE NEAREST CELL PHONE TOWER

WHICH IN NEW YORK CITY IS NOT AN

ISSUE, IN MONTANA MIGHT BE, TO

TRANSMIT DATA REMOTELY.

YOU DON'T NEED WI-FI.

THERE ARE MODELS TO DO THIS.

NOW, THE DECENTRALIZED TRIAL

FRAMEWORK HAS SOME LIMITATIONS,

RIGHT?

YOUR QUALITY OF DATA,

ADJUDICATION OF END POINTS.

THERE'S A FRAMEWORK.

I THINK THE CLINICAL TRIAL

QUESTION IS INTERESTING BUT

IT'S, AGAIN, A MORE, YOU KNOW,

FOCUSED APPROACH THAN SOME OF

THE BROAD STRATEGIES WE'VE

DISCUSSED SO FAR AND HOW WE

RECTIFY THOSE.

TO SOME EXTENT AS A CLINICIAN

WE'VE KNOWN FOR YEARS WHAT WORKS

BUT ADHERENCE AND SCIENCE OF

ADHERENCE AND PARTICIPATION

REMAINS LIMITED.

SO HOW WE APPLY THOSE LESSONS TO

SOME OF THE SYSTEMS-BASED

THINKING IN MAYBE STRATEGIES WE

CAN TARGET AS AN INDIVIDUAL OR

TO GET THE CLINICIAN TO BRING UP

AIR QUALITY DAYS OR STRATEGIES

TO AVOID EXPOSURE WHEN, YOU

KNOW, THERE ARE CERTAIN RELEVANT

METRICS WE CAN TRACK, I THINK IS

A REALLY IMPORTANT QUESTION.

>> THANK YOU.

DOES ANYBODY WANT TO ADD TO

THAT?

I HAVE A PROVOCATIVE QUESTION

FOR THE GROUP.

BUT SO, ALL THE SPEAKERS BROUGHT

UP REALLY IMPORTANT GAPS IN

UNDERSTANDING THESE COMPLEX

RELATIONSHIPS BETWEEN PLANETARY

HEALTH DETERIORATION AND

CARDIOVASCULAR OUTCOMES AND THEN

RACE AND ETHNICITY AND

SOCIOECONOMIC FACTORS.

THERE'S A LOT UNDERSTANDING HOW

WE'RE ENDING UP WHERE WE ARE.

THERE'S THE WHOLE PIECE OF US

UNDERSTANDING HOW WE CAN IMPROVE

THINGS.

AND I JUST WANT TO THROW OUT

THAT I'VE HEARD SOME PEOPLE

ARGUE THAT WE ALREADY HAVE A LOT

OF DATA TELLING US THAT WE ARE

IN BIG TROUBLE, OKAY?

CARDIOVASCULAR HEALTH IS

ADVERSELY AFFECTED BY THE

MULTITUDE OF FACTORS WE'VE

DISCUSSED, AND THAT THE FOCUS AT

THIS POINT SHOULD REALLY BE, YOU

KNOW, LARGELY IF NOT ENTIRELY ON

ASSESSING INTERVENTIONS THAT ARE

GOING TO HELP SOLVE THEM,

OPTIMAL IMPLEMENTATION, ET

CETERA.

I ACTUALLY WANT PEOPLE'S TAKE ON

THAT.

THERE'S A CERTAIN RESEARCH

BUDGET, HOW DO WE PARSE IT OUT.

SAM?

>> YEAH, I'VE HEARD THAT A LOT

AS WELL, IN THE PLANETARY HEALTH

COMMUNITY.

THERE'S AN ELEMENT WHICH I AGREE

TO BUT I DON'T THINK IT'S AS

BINARY AS THAT.

I DON'T THINK WE CAN DEVELOP THE

INTERVENTIONS THAT WE NEED

WITHOUT MORE INFORMATION ABOUT

HOW BIOPHYSICAL CHANGES AFFECT

WHICH DIMENSIONS OF HEALTH OR

WHICH POPULATIONS, AROUND THE

WORLD, WHO IS VULNERABLE.

SO, YOU KNOW, UNDERSTANDING THAT

RISING CO2 IS GOING TO REDUCE

ACCESS TO NUTRIENTS IN

PARTICULAR POPULATIONS, ZINC OR

IRON DEFICIENCY IN SOUTH ASIA,

SUB-SAHARAN AFRICA, KNOWING

THOSE POPULATIONS IS IMPORTANT

IF WE WANT TO DEVELOP

INTERVENTIONS, KNOWING HOW

POLLINATOR DECLINE AFFECTS

HEALTH, BEING ABLE TO SEE WHAT

THE HEALTH BENEFITS OF

POLLINATOR-FRIENDLY PRACTICES,

SORT OF POLICY INTERVENTIONS TO

PROMOTE POLLINATOR POPULATIONS

IS PART OF WHAT'S GOING TO

MOTIVATE PEOPLE TO PASS THAT

LEGISLATION.

SO WHAT I WOULD ARGUE INSTEAD OF

SAYING WE DON'T NEED MORE

SCIENCE, WE NEED TO ACT, IS WE

NEED SCIENCE AT THE INTERFACE.

WE NEED TRANSLATIONAL SCIENCE

THAT HELPS US TAILOR OUR

INTERVENTIONS MORE EFFECTIVELY

AND I THINK THAT'S WHY PEOPLE

ARE EMPHASIZING CO-BENEFITS.

BUT I THINK CURIOSITY-DRIVEN

RESEARCH JUST TO CATALOG

HORRIBLE PROBLEMS WE HAVE IS

MAYBE NOT SO USEFUL BUT THAT

RESEARCH THAT IS MAKING IT

CLEAR, YOU KNOW, THESE VERY,

VERY COMPLEX SYSTEMS, CONNECTING

DOTS BETWEEN BIOPHYSICAL CHANGE

AND HEALTH, AND THEN CAN HELP US

TAILOR INTERVENTIONS LIKE

PEATLAND INTERVENTION REDUCING

FIRES IN INDONESIA BECOMES

HELPFUL.

>> THAT MAKES SENSE.

SANJAY AND GREG.

>> I AGREE IN PART WITH SAM.

I DO COMPLETELY AGREE THAT THERE

NEEDS TO BE THE SCIENCE OF

ACTION, RIGHT?

WHAT ARE THE TYPES OF

INTERVENTIONS, CERTAINLY A LOT

OF DEBATE AND QUESTIONS ABOUT

RESILIENCE, ADAPTATION IN TERMS

THE NOT ONLY MONIES GOING IN BUT

SCIENCE OF ADAPTATION

RESILIENCE.

I WOULD ARGUE FOR SOME OF THE

ELEMENTS, PARTICULARLY THINGS

LIKE AIR POLLUTION, YOU DON'T

NEED MORE STUDIES CATALOGING

NATIONAL EXPERIMENTS OF AIR

POLLUTION.

I DO AGREE THERE ARE A LOT OF

COMPLEXITIES.

I WOULD SAY WHERE I DON'T

DISAGREE WITH SAM BUT THE

TEMPORAL SCALE AND COMPLEXITY OF

INTERACTIONS ARE SO

FUNDAMENTALLY COMPLEX AND

FEEDBACK LOOPS REQUIRED TO

DISCERN AN ANSWER ARE SO MUCH IN

THE FUTURE THAT IT MIGHT BE HARD

TO DISCERN WHAT TO DO EVEN IF

YOU DESIGN THE RIGHT

EXPERIMENTS.

I JUST DON'T KNOW.

FUNDAMENTALLY THERE ARE

COMPLEXITIES AND COMPLEXITIES OF

INTERACTIONS AND TEMPORAL SCALES

THAT MIGHT NOT LEND TO QUICK FOR

OUR SIX-YEAR TRIAL HORIZON

STUDY.

OTHERWISE I DON'T COMPLETELY

AGREE WITH SAM.

NATIONAL EXPERIMENTS

PARTICULARLY POWERFUL ARE THE

EXPERIMENTS THAT CAN EL IT US --

TELL US ABOUT ADAPTATION AND

RESILIENCE MORE THAN CAUSATION

OR ASSOCIATIONS THAT'S NEEDED,

PARTICULARLY ON THINGS LIKE AIR

POLLUTION, WHICH IS, YOU KNOW,

FOR LACK OF BETTER -- RIGHT NOW

IS DOMINANT FORCE IN TERMS OF

INFLUENCING GLOBAL MORTALITY

RATES, RIGHT?

I DON'T THINK YOU NEED MORE

EXPERIMENTS THERE BUT PERHAPS

THERE ARE BETTER EXPERIMENTS TO

UNDERSTAND RESILIENCE AND

ADAPTATION, WHAT TO DO.

SOME CLEAN ENERGY INTERVENTIONS

MIGHT PROVIDE AVENUES.

>> THANK YOU.

ABSOLUTELY.

GREG?

>> YEAH, SO GREAT DISCUSSION.

THANK YOU FOR LEADING THAT.

I GUESS AS I GET OLDER I FIND I

BECOME MORE CAUTIOUS ABOUT

JUDGING SORT OF WHAT RESEARCH WE

DON'T NEED OR WHAT WE HAVE

ENOUGH OF BECAUSE I THINK WE

ALWAYS NEED TO HAVE A HIGH BAR

TO MAKE SURE THAT WHERE OUR

MONEY IS GOING, YOU KNOW,

WHETHER NIH'S MONEY IS GOING TO

MOST IMPACTFUL SCIENCE BY SOME

MEASURE.

EVEN WITH AIR POLLUTION IF YOU

LOOK AT THE INTEGRATED SCIENCE

ASSESSMENT EPA DOES THERE'S

STILL LOTS OF GAPS, THINGS WE

DON'T KNOW, WHO IS MOST

VULNERABLE, INTERACTIONS WITH

CHANGING CLIMATE, WITH THE BUILT

ENVIRONMENT, EXPOSURES INDOORS.

I DON'T THINK WE'RE DONE.

TWO OTHER POINTS I'LL JUST RAISE

THERE IS THAT, ONE, EVERY TIME

WE HAVE A LARGE STUDY, LARGE

COMPELLING STUDY BE PUBLISHED,

IT GETS MEDIA ATTENTION, VERY

USEFUL, BACK TO THE

COMMUNICATION PIECE.

THAT WHY DO WE DO A LOT OF

RESEARCH?

IT HELPS DRIVE HOME THE MESSAGE

OVER AND OVER THAT THIS IS, YOU

KNOW, BAD FOR YOU.

AND THE PUBLIC HEALTH THREAT.

THE OTHER OTHER WE HAVE TO

TRAINING THE NEXT GENERATION,

RIGHT?

THEY CAN'T START BY JUST SOLVING

THE PROBLEM TODAY.

WHEN I THINK OF THE K AWARDS,

F31s, F32s, I THINK THAT

IT'S ENTIRELY APPROPRIATE TO

HAVE A SLIGHTLY LOWER BAR FOR

IMPACT IN THAT CONTEXT BECAUSE

WE'RE NOT GOING TO GET TO

CHANGING, YOU KNOW, HAVING THE

JUNIOR FOLKS JUST IMMEDIATELY

LEARN HOW TO CHANGE THE WORLD

WITHOUT SORT OF BUILDING UP

THEIR REPERTOIRE OF BACKGROUND

AND TOOLS IN THE TOOLBOX.

>> GREAT.

BOTH REALLY IMPORTANT POINTS.

I THINK I SHOULD ASK IF WE

SHOULD BE WRAPPING UP BECAUSE I

SAW IT'S 40 MINUTES.

I'D LIKE TO --

>> TWO MINUTES MORE WE CAN GO TO

12:40 IF YOU WANT TO TAKE

ADVANTAGE.

>> I'LL TAKE ADVANTAGE.

PETER, WEIGH IN.

>> YEAH, I THINK THE POINT I

WANT TO ADD THINKING ABOUT

SHORT, WHERE TO MAKE INVESTMENTS

IN TERMS OF RESEARCH, IT'S

IMPORTANT TO PAY ATTENTION TO

THE HALF-LIFE OF KNOWLEDGE.

LIKE OF FACTS.

HOW FAST IS THE ENVIRONMENT

CHANGING RELATIVE TO WHAT WE'RE

GOING TO GAIN BY SOMETHING AND

PRIORITIZING STUDIES WHERE THE

EMPIRICAL RESULTS WILL INFORM

SOMETHING THAT WILL STILL BE

RELEVANT WHEN THEY ARE AVAILABLE

TO IMPLEMENT.

THAT TO ME SEEMS CRITICAL.

AND IT'S REALLY ABOUT FRAMING

THE QUESTIONS.

>> THANK YOU.

ANYBODY HAVE FURTHER COMMENTS?

>> ONE QUESTION, RATHER MAYBE A

COMMENT, I DON'T KNOW.

WHICH IS PETER'S COMMENT ABOUT

ENGAGING YOUNG LEADERS AND

SYSTEMS THINKING, ALSO ANOTHER

COMMENT ABOUT, YOU KNOW, REALLY

UNDERSTANDING AT MUCH -- IN

COMMUNITIES LIKE SCHOOL AGE

KIDS, INSTILL THEM WITH THE

SKILLS NEEDED TO ADDRESS -- YOU

CAN LEARN SYSTEMS DYNAMIC AS A

HIGH SCHOOL STUDENT, RIGHT?

BUT ALSO INSTILL NOT ONLY TOOLS

TO START THINKING ABOUT PROBLEMS

BUT ALSO MAYBE FORUM FOR FUTURE

STUDIES, RIGHT?

WHAT TYPES OF STUDIES COULD BE

PERFORMED IN COMMUNITIES,

YOUNGER COMMUNITIES, WHERE YOU

NOT ONLY UNDERSTAND THE IMPACT,

LIFELONG IMPACT OF EXPOSURES AND

CONSEQUENCES OF CLIMATE CHANGE

BUT ALSO USE THEM AS COMMUNITIES

TO INCULCATE NEWER SKILLS AND

TOOLS BECAUSE ULTIMATELY THEY

ARE THE ONES WHO WILL BE

AFFECTED.

THE OTHER ONES WHO MIGHT NEED TO

BE EDUCATED ON THESE TYPES OF

TOOLS AND MAYBE THAT MIGHT

RESULT IN BETTER WAYS OF

ADVANCING THESE PROBLEMS.

>> THANK YOU.

I THINK WE DO NEED -- OH.

I DON'T KNOW IF -- SHOULD I WRAP

UP?

>> I'VE BEEN QUIET DURING THIS

BECAUSE OF THE BRILLIANCE THAT

HAS ALREADY BEEN SPEAKING.

I WANT TO ADD A COMMENT WHEN YOU

ASKED ABOUT ADDITIONAL RESEARCH

THAT WE MAY OR MAY NOT NEED, AND

I THINK VERY IMPORTANT

CONSTITUENCY ARE THE PEOPLE THAT

WOULD USE THE RESEARCH

INFORMATION, MEANING THE

POLICYMAKERS AND THOSE THAT HAVE

THE POWER TO CHANGE THE SYSTEMS.

AND I THINK THAT BOTH DR. ADAMS

AND DAVIS ALSO AS WELL AS MANY

HAVE LIFTED UP SO MUCH THE

VOICES OF THOSE BEING AFFECTED

BY RESEARCH SHOULD BE MAKING THE

DECISIONS TO SOME EXTENT ALSO

ABOUT WHAT ADDITIONAL RESEARCH

WE NEED.

WHILE WE IN THE ROOM ON THIS

CALL RIGHT NOW CAN MAKE

JUDGMENTS ABOUT WHERE WE THINK

SOME OF THE DIRECTIONS ARE, THIS

COMMENT AT SOME POINT IN THE

FUTURE HOPEFULLY NHLBI COULD

CONSIDER THIS, THINK ABOUT

HAVING THOSE USING DATA WHERE

OUR EVIDENCE GOES TO IMPACT,

TRANSLATION, AND USERS NEED TO

FIND IT USEFUL.

>> TERRIFIC.

GREG, DO YOU WANT TO SAY ONE

MORE THING?

>> A QUICK COMMENT, NIH AND

NHLBI ALSO NEED TO SEE HOW

RESEARCH ALIGNS WITH THEIR

STRATEGIC GOALS BECAUSE NOT

EVERY FUNDING AGENCY HAS THE

SAME GOAL.

IF I LOOK JUST AT AIR POLLUTION

RESEARCH DIFFERENCE IN RESEARCH

FUNDED BY NIH VERSUS HEALTH

EFFECTS INSTITUTE, WELLCOME

TRUST, HEART ASSOCIATION,

DIFFERENT GOALS AND TIMELINES

AND DEFINITIONS OF IMPACT AND

THAT'S OKAY AND APPROPRIATE.

SO NIH DOESN'T AND CAN'T TRY TO

DO EVERYTHING.

AND SO SORT OF WHERE IN THE

FUNDING LANDSCAPE DOES NIH FIT

IN, WHERE DOES IT WANT TO INVEST

ITS DOLLARS.

>> THANK YOU.

I WANT TO THANK ALL OF YOU FOR

BEING ON THE PANEL AND FOR OUR

AUDIENCE MEMBERS AND QUESTIONS.

I THINK IT'S CLEAR THAT THERE IS

A LOT WE KNOW BUT ENORMOUS

AMOUNT WE HAVE TO LEARN, AND I

LIKE FORWARD, WE ALL LOOK

FORWARD TO SEEING STUDIES WE'VE

BEEN TALKING ABOUT FUNDED BY

NIH, NHLBI, AND OTHERS, MOST

IMPORTANTLY REALLY SEEING THIS

WORK TRANSLATED INTO EFFECTIVE

POLICY AND ACTION.

THANK YOU SO MUCH.

>> THANK YOU.

DR. FINE?

>> I WANT TO THANK EVERYONE.

INCREDIBLE CONVERSATION.

IT WAS SO RICH, SO MUCH MORE US

TO THINK ABOUT.

AND DRAW ON.

WE HAVE WORKED A LOT IN COVID-19

ABOUT MISINFORMATION AND

BUILDING TRUST WITH COMMUNITIES,

SO THERE'S A LOT OF THINGS HERE

THAT WE CAN BUILD ON.

YOU LEFT US WITH A LOT OF GREAT

CHALLENGES ABOUT WHAT TO DO IN

THE FUTURE, WHICH IS EXACTLY

WHAT WE WANTED.

SO THANK YOU VERY MUCH.

AND DO REMIND YOU WE WANT YOU TO

COME BACK AT 1:10, AFTER OUR

LUNCH BREAK.

AND CONTINUE THIS GREAT SERIES

OF PRESENTATIONS AND DIALOGUE.

ALL I CAN DO IS CLAP FOR YOUR

GREAT, GREAT SESSION THAT YOU

HAD.

>> TERRIFIC.

THANKS, EVERYBODY.

SEE YOU AT 1:10.

>> WELCOME BACK FROM THE LUNCH

BREAK.

I'M GOING TO HELP KICK OFF

SESSION 2, AND WE WANT TO REMIND

EVERYONE TO STAY TUNED AFTER THE

BREAK, WHICH WILL BE AT 3:15 TO

3:30.

DON'T FORGET TO COME BACK AT

3:30 SO THAT YOU CAN ENJOY THIS

PLANETARY HEALTH SYSTEMS

SIMULATION HOSTED BY JASON, A

PRO, IT'S GOING TO BE AN

EXCITING SESSION TO WATCH HIM.

PLEASE STAY TUNED.

WE'RE GOING TO START THE NEXT

SESSION AND INTRODUCE INTEGRATED

FRAMEWORK TO DRIVE

CARDIOVASCULAR HEALTH THROUGH

INFRASTRUCTURE DESIGN.

THE LAST SESSIONS WERE A BROAD

OVERVIEW.

STARTING OFF WITH THIS SESSION

WE'LL DELVE DEEPER.

OUR DISCUSSION WILL BE MODERATED

BY JOEL KAUFFMAN FROM UNIVERSITY

OF WASHINGTON, I'LL DO A MORE

FORMAL INTRODUCTION AT THE END

OF THE SESSION BEFORE HE TAKES

OVER.

SO, WITH THAT I WAS GOING TO SEE

IF WE HAD SLIDES FOR OUR NEXT

PRESENTATION READY.

IT'S MY APPRECIATE TO PLUSH TO

-- IT'S MY PLEASURE TO WELCOME

DR. RAMASWAMI FROM PRINCETON

UNIVERSITY, WHO WILL BE SPEAKING

TO US AT THE KICKOFF OF OUR

SESSION WITH INTRODUCTORY TALK

ABOUT INFRASTRUCTURE, FOOD

SYSTEMS, TRANSFORMATION FOR

HUMAN AND PLANETARY HEALTH.

DR. RAMASWAMI, OVER TO YOU.

KICKS OFF.

>> THANK YOU FOR THE

INTRODUCTIONS.

I'M ASSUMING SOMEONE WILL PULL

UP THE SLIDES.

THIS WAS A VERY EXCITING

CONFERENCE.

THANK YOU FOR HAVING ME HERE.

I'M GOING TO TALK ABOUT

INFRASTRUCTURE AND FOOD SYSTEM

TRANSFORMATIONS, PLANETARY

HEALTH.

I'M AN INTERDISCIPLINARY

PROFESSOR OF CIVIL AND

ENVIRONMENTAL ENGINEERING,

PRINCETON UNIVERSITY WHERE I

ALSO DIRECT OUR CENTER FOR

GLOBAL INDIA AND I WANT TO

ACKNOWLEDGE SEVERAL GRANTS TO

NSF, THAT REALLY HELPED ADVANCE

THE FRAMEWORK AND MULTIPLE

FRAMEWORKS THAT I'M GOING TO

PRESENT OVER HERE, I WANT TO

ACKNOWLEDGE ALL THE COLLEAGUES

AND STUDENTS OVER THE YEARS THAT

HAVE COLLABORATED WITH, WE'VE

ALL BEEN PART OF BUILDING THIS

BIG FRAMEWORK.

I WANT TO SHOUT OUT TO OUR

CONFERENCE CHAIR, ALSO THE CHAIR

OF RECENT POLICY STATEMENT WHICH

WILL BE COMING OUT FROM THE

AMERICAN HEART ASSOCIATION, THE

TITLE TO HAVE HEART HEALTHY AND

SUSTAINABLE CITIES,

ACKNOWLEDGING SANJAY

RAJAGOPALAN, THE CHAIR OF THE

WONDERFUL GROUP OF COMMITTEE

MEMBERS, AND I SERVED AS VICE

CHAIR.

I ALSO WANT TO ACKNOWLEDGE

LAURIE WHITSEL AND CO-AUTHORS.

THIS SHOULD BE COMING OUT SOON

AND I HOPE WILL BE VERY

BENEFICIAL TO THE RESEARCH AND

PRACTITIONER COMMITTEES.

NEXT SLIDE IS EXPLAINING WHAT

I'M GOING TO TALK ABOUT TODAY.

SO I'M GOING TO FIRST ARTICULATE

A RATIONALE, WHY SHOULD WE FOCUS

ON INFRASTRUCTURE AND FOOD

PROVISIONING SYSTEMS, WHETHER

URBAN OR ELSEWHERE, WHY ARE THEY

IMPORTANT FOR SUSTAINABLE,

HEALTH, WELL-BEING AND EQUITY,

DISCUSSING FRAMEWORKS I'VE BEEN

DEVELOPING OVER MORE THAN 10

YEARS NOW, I'LL SHOW A FEW

APPLICATIONS IN MY LAB, THE

URBAN NEXUS LAB.

I'LL PREVIEW THE AHA STATEMENT

ON HEART-HEALTHY AND SUSTAINABLE

CITIES.

THE FIRST TOPIC, WHY DO WE CARE

ABOUT INFRASTRUCTURE AND FOOD

SYSTEMS.

NEXT SLIDE.

DRAWING ON THREE KEY

PUBLICATIONS, FIRST WAS AN

ARTICLE IN "SCIENCE" WHICH TALKS

ABOUT META PRINCIPLES FOR

DEVELOPING SMART, SUSTAINABLE,

HEALTHY CITIES, ARTICULATES THE

FRAMEWORK THAT I HAD PREVIOUSLY

PUBLISHED IN A JOURNAL OF

INDUSTRIAL ECOLOGY, IT'S CALLED

INFRASTRUCTURE OF SYSTEMS

FRAMEWORK THAT CAN

SYSTEMATICALLY ALLOW YOU TO

CONNECT RESOURCE VIEWS,

SUSTAINABILITY, THINGS WE HEARD

IN THE FIRST SESSION BUT

RECOGNIZING THAT INFRASTRUCTURE

IS THE MEDIATOR THROUGH WHICH

RESOURCES COME TO CITIES, TO

HUMAN SETTINGS.

THE SECOND ARTICLE IN ONE EARTH

TALKS ABOUT INFRASTRUCTURE,

NEXUS WITH ENVIRONMENT AND

HEALTH, BUT ALSO OPENS UP

FURTHER TO LIVEABILITY,

WELL-BEING, EQUITY.

AND THE THIRD REVIEW PAPERS JUST

CAME OUT LAST MONTH, SAYING DO

WE HAVE A FRAMEWORK TO EXPLORE

HOW TRANSITIONS WILL ADDRESS

HEALTH, ALSO CLIMATE RESILIENCE,

WELL-BEING AND EQUITY.

WITH THAT I'D LIKE US TO MOVE TO

THE NEXT SLIDE WHERE I'M GOING

TO PROVIDE THIS RATIONALE IN

URBAN AREAS.

THE IDEA HERE IN THE ARTICLE IN

"SCIENCE" WAS PART OF A SERIES

CALLED URBAN PLANET.

THE BIG POINT HERE WAS THAT WE

NOW LIVE IN AN URBAN PLANET,

MEANING EVEN THOUGH CITIES

OCCUPY ONLY 3% OF THE LAND AREA,

THEY ARE IMPACTING THE PLANET,

AT PLANETARY SCALES.

AND SO VERY OFTEN WE TEND TO,

YOU KNOW, URBAN PLANNERS, URBAN

POLICYMAKERS TEND TO LOOK WITHIN

THE CITY BOUNDARIES.

THIS FRAMEWORK IS SAYING WITHIN

THE CITY BOUNDARY IS IMPORTANT

BUT REALLY URBANIZATION AND

URBAN AREAS ARE JUST IMPACTING

RURAL AREAS, SUPPLY CHAINS,

THERE'S GLOBAL IMPACT.

SOME OF THESE ARE WITHIN THEIR

BOUNDARIES, MAY HAVE AN INTEREST

IN LOCAL HEALTH, LOCAL EQUITY,

BUT THEN THEY ARE IMPACTING

THINGS LIKE GLOBAL GREENHOUSE

GAS EMISSIONS, REGIONAL WATER

STRESSORS, SO CITIES ALSO HAVE

TO BE THINKING ABOUT THEIR

IMPACT OUTSIDE THEIR BOUNDARY,

AND RECOGNIZING THAT THESE

TRANSBOUNDARY IMPACTS AFFECT

URBAN RESIDENTS.

FOR EXAMPLE, AIR POLLUTION IS

TRANSBOUNDARY, IT DOESN'T STOP

AT THE CITY BOUNDARY,

MULTI-SCALE, THIS IS THE

GROUNDING OF WHAT KIND OF

FRAMEWORK WOULD REALLY HELP

CONNECT INFRASTRUCTURE AND FOOD

SYSTEMS TO BOTH HUMAN AND

PLANETARY HEALTH.

MY GROUP FOCUS ON SEVEN THINGS

THAT LIE AT THE CORE OF MULTIPLE

OUTCOMES.

HEALTH, WELL-BEING, EQUITY.

THERE'S URGENCY AND HISTORIC

OPPORTUNITY BECAUSE THE SYSTEMS

ARE UNDERGOING SIGNIFICANT

CHANGE.

SO IN THE U.S., YOU KNOW, OUR

INFRASTRUCTURE IS SO OLD MANY

CITIES ARE REDOING THEIR

INFRASTRUCTURE, ZERO CARBON

INITIATIVE IS FORCING A LOT OF

PEOPLE IN A GOOD WAY,

ENCOURAGING A LOT OF PEOPLE TO

THINK ABOUT MAJOR SYSTEMS

TRANSITIONS, AND ESSENTIALLY

THIS REQUIRES INTERDISCIPLINARY

AND MULTI-DISCIPLINARY WORK THAT

BRINGS STAKEHOLDERS TOGETHER

ACROSS ACADEMIC AND PRACTICE IN

THEIR COMMUNITIES.

THE NEXT SLIDE IS PROBABLY THE

KEY SLIDE I WANTED TO SHOW WHICH

ARTICULATES WHAT YOU'RE SEEING

SEVEN SECTORS, I DON'T KNOW IF

SOMEONE WITH MOVE THE POINTER

OVER THERE.

BUT YOU SEE THE RED IS ENERGY

SUPPLY.

BLUE IS MUNICIPAL WATER SUPPLY,

WASTE, SANITATION.

THE KEY IN THE MIDDLE,

TRANSPORTATION IS THAT PINK,

SALMON PINK.

VEHICLE OPERATIONS.

FOOD SUPPLY IS IN GREEN.

AND BUILDINGS AND PUBLIC SPACES

ARE IN GRAY.

WHAT YOU SEE ON THE LEFT SIDE OF

YOUR SCREEN ARE THE

ENVIRONMENTAL IMPACTS AT THE

GLOBAL SCALE.

THESE SYSTEMS ARE CONTRIBUTING

TO ALMOST ALL OF OUR GREENHOUSE

GAS EMISSIONS, 96%, CONTRIBUTING

TO ALMOST ALL OF OUR WATER

WITHDRAWALS, 94.7% OF GLOBAL

WATER WITHDRAWALS ARE ASSOCIATED

WITH THESE SECTORS.

ON THE RIGHT SIDE DATA FROM THE

GLOBAL BURDEN OF DISEASE AND

OTHER STUDIES WHICH IS SHOWING

PREMATURE MORE AT THAT TIMED,

ASSOCIATED WITH THESE SYSTEMS.

YOU HAVE INCLUDING POLLUTION BUT

ALSO INADEQUATE ACCESS.

POOR ACCESS TO SANITATION,

HAVING POLLUTING FUELS FOR

HOUSEHOLD COOKING, SO THAT IS

SHOWN AS AIR POLLUTION, INDOOR

AND OUTDOOR RELATING TO ENERGY

SYSTEM.

YOU HAVE THOSE SAME SECTORS THAT

ARE CAUSING ALL THIS

ENVIRONMENTAL IMPACT MAKING THE

CASE IF WE TRANSFORM

INFRASTRUCTURE PROVISIONS AND

FOOD PROVISION SYSTEMS WE CAN

SUBSTANTIALLY IMPROVE BOTH

ENVIRONMENT AND HEALTH OUTCOMES.

SO, THE FRAMEWORK DEVELOPED FROM

THIS IS ON THE NEXT SLIDE.

IT'S CALLED SOCIAL -- WELL,

BEFORE THAT I WANT TO HIGHLIGHT

WE USE ICONS IN MY LAB JUST TO

HIGHLIGHT WHAT THESE SYSTEMS

ARE, BUILDING MATERIALS AND

ENERGY, FOOD SYSTEMS, GREEN

INFRASTRUCTURE, MOBILITY, WATER

AND WASTE AND INTERACTIONS.

NEXT SLIDE IS OUTCOMES, LOOKING

AT WELL-BEING NOT JUST OBJECTIVE

MEASURES OF HEALTH BUT HOW

PEOPLE THINK AND FEEL ABOUT

THEIR LIVES OR SUBJECTIVE

ASSESSMENTS OF WELL-BEING,

MULTIPLE ENVIRONMENTAL IMPACTS.

WE JUST SAW WATER AND ENERGY,

COULD EXPAND TO LAND AND

BIODIVERSITY.

EQUITY AND LIVEABILITY, AND

CO-BENEFITS.

THAT WAS OF THE FRAMING OF

SECTORS AND OUTCOMES, ULTIMATELY

THE SYSTEMS ARE IMPACTING THE

EARTH TO PROVIDE SERVICES FOR

HUMANITY.

NEXT SLIDE IS SYSTEMS FRAMEWORK.

I'M GOING TO GIVE EXAMPLES OF

HOW IT'S IMPORTANT THAT PEOPLE

HAVE -- WE TALKED ABOUT

DIFFERENCE SYSTEMS FRAMEWORK.

THIS FRAMEWORK FOCUSES ON THAT

LINKAGE BETWEEN NATURAL

RESOURCES AND ENVIRONMENT,

INFRASTRUCTURE AND FOOD

PROVISION SYSTEMS, AND HEALTH

AND WELL-BEING OUTCOMES AT

DIFFERENT SCALES, SCALES ARE

IMPORTANT.

NEXT SLIDE, THIS IS WHAT I CALL

SOCIAL ECOLOGICAL INFRASTRUCTURE

SYSTEM FRAMEWORK.

WE SEE THAT RIGHT ON TOP.

SEIS.

AND I'LL WALK YOU THROUGH THE

FRAMEWORK.

WHAT YOU'RE SEEING, AND THIS WAS

IN OUR ARTICLE IN "SCIENCE,"

THAT HAS NOW BEEN ADAPTED INTO

THE OTHER PAPER, ON THE LEFT

SIDE IS THE BOUNDARY OF THE

CITY, YOU CAN SEE THERE'S A MAN

AND WOMAN IN THE CITY, THERE ARE

LOTS OF PEOPLE AND WE'RE LOOKING

AT THESE PROVISIONING SYSTEMS,

BUILDINGS, GREEN AND PUBLIC

SPACES, WASTE AND SANITATION,

FOOD SUPPLY, WATER SUPPLY,

TRANSPORTATION, AND ENERGY

SUPPLY.

THE REALITY IS VERY FEW CITIES

CAN PROVIDE ALL THESE THINGS

USING RESOURCES WITHIN THEIR

BOUNDARIES, ALMOST NO CITY DOES

THAT.

CITIES RELY ON LARGER NETWORKS,

EVENTUALLY GLOBAL TRADE.

FOOD IS GLOBALLY TRADED.

SO WE HAVE IMPACTS WELL OUTSIDE

OUR BOUNDARY.

ULTIMATELY LOOKING FROM THE

REGIONAL TO THE NATIONAL TO EVEN

THE GLOBAL SCALE.

AND SO WE HAVE MULTI-SCALE AIR

POLLUTION AND GREENHOUSE GAS

EMISSION FOOTPRINTS MY GROUP

PIONEERED METHODS TO MEASURE.

AND BRING THEM BACK TO

RESPONSIBILITY FOR URBAN

PROVISIONING SYSTEMS.

SO THIS ALLOWS URBAN

PROVISIONING SYSTEMS TO TAKE

GLOBAL RESPONSIBILITY, IN

ADDITION TO LOCAL AIR POLLUTION

AND THOSE EFFECTS, AND BELOW

YOU'RE SEEING SOCIAL INEQUALITY.

SUBSTANTIAL INEQUALITY, NOT ONLY

IN ACCESS TO THESE

INFRASTRUCTURE AND FOOD

PROVISION SYSTEMS WITHIN THE

CITY BUT ALSO THE KINDS OF

EXPOSURES WE CAUSE.

IF I CHOOSE TO MOVE POWER PLANT

OUTSIDE COMMUNITY THEY GET MOVED

SOMEWHERE ELSE AND IMPACT

SOMEONE ELSE.

THIS KIND OF SYSTEMS APPROACH

MAKES VISIBLE NOT ONLY

INEQUALITY WITHIN YOUR CITY BUT

ALSO TRANSBOUNDARY ASPECT OF

INEQUALITY CAUSED BY THE

DECISIONS WE'RE MAKING AROUND

INFRASTRUCTURE.

I HOPE THIS IS SOMETHING WE CAN

HAVE THE PUBLIC HEALTH COMMUNITY

ADOPT, I'VE HEARD US TALK ABOUT

SOCIAL AND ECOLOGICAL

DETERMINANTS OF HEALTH.

I THINK INFRASTRUCTURE GETS

IGNORED.

SOCIAL IS MEANT TO INCLUDE THE

BUILT ENVIRONMENT.

WE SAY BUILT ENVIRONMENT.

OUR PURPOSE WITH THIS MAKING

INFRASTRUCTURE EXPLICIT IS TO

SAY IT IS THE ENVIRONMENT BUT

ALSO THE HUMAN-MADE SYSTEMS THAT

TRANSFORM THEM AND BRING THEM TO

US, AND THAT NOT ONLY CAN WE --

YOU KNOW, WE CAN LOOK AT

BIODIVERSITY, ENVIRONMENTAL

IMPACT, BUT WE SHOULD LOOK AT

INFRASTRUCTURE BECAUSE IT

MEDIATES THAT LINK.

HENCE THE NAME.

WE THINK EMPHASIZING THAT ALLOWS

YOU TO LOOK AT THE SOLUTIONS.

BUT INFRASTRUCTURE, NOT ONLY

CAUSED THE PROBLEM, BUT

TRANSFORMATION OF INFRASTRUCTURE

CAN PROVIDE SOLUTIONS AND THAT'S

WHAT WE'RE DOING.

WE'RE TRANSFORMING

INFRASTRUCTURE AND FOOD SYSTEMS.

NEXT SLIDE EXPLORES THE EFFECT.

IF YOU LOOK AT INFRASTRUCTURE

AND FOOD SYSTEMS FROM THIS

PERSPECTIVE IT'S NOT JUST ONE

CITY, IT'S MULTIPLE CITIES THAT

ARE NETWORKS BETWEEN CITIES

GOING FROM LOCAL TO GLOBAL

SCALE.

AND IF YOU LOOK AT ENVIRONMENTAL

IMPACT, WE HAVE MULTI-SCALE

HOUSEHOLD AIR POLLUTION,

UNHEALTHY DIETS FROM THE LEFT

SIDE, POOR NEIGHBORHOOD ACCESS,

TO GREEN INFRASTRUCTURE,

NUTRITIOUS FOOD, WALKABLE

STREETS, YOU HAVE URBAN/REGIONAL

HEAT, NOISE, FLOODING, YOU HAVE

NATIONAL AND REGIONAL PATTERNS

OF AIR POLLUTION, FLOODING,

DROUGHT.

ULTIMATELY GLOBAL CLIMATE

CHANGE.

IT ALLOWS US TO SAY THE RISKS

THAT IMPACT US HERE ARE NOT JUST

ORIENTED OR LIMITED TO

COMMUNITY.

SHOWN BELOW, WE COULD NUDGE

PEOPLE TO TRANSFORM LIFESTYLES

AND BEHAVIORS, CHANGE

NEIGHBORHOOD DESIGN, LOOK AT

URBAN METROPOLITAN

TRANSPORTATION AND LAND USE

PLANNING.

WE COULD LOOK AT NATIONAL

POLICIES LIKE CARBON GRIDS,

CREATING CLEAN INDUSTRY,

POTENTIALLY LOOK TO

ORGANIZATIONS LIKE THE U.N. TO

USE THE FRAMEWORK TO GUIDE THESE

CHANGES.

I'M GOING TO MOVE QUICKLY, EACH

ADDED A FEW THINGS.

NEXT SLIDE.

THIS IS FROM OUR ONE EARTH

ARTICLE.

YOU SEE ESSENTIALLY THE SAME

THING, AGAIN SOMEONE CAN USE THE

POINTER, WE HAVE SEVEN PHYSICAL

PROVISIONING SYSTEMS, PHYSICAL

PROVISIONING SYSTEMS CONNECT TO

SOCIAL PROVISIONING SYSTEMS LIKE

EDUCATION, HEALTH CARE, AND

THESE PROVISIONING SYSTEMS ARE

EMBEDDED IN MULTI-SCALE SOCIAL

AND NATURAL SYSTEMS.

AND THEY HAVE ALL THESE

OUTCOMES.

MY GROUP, WE FOCUS ON

ENVIRONMENTAL SUSTAINABILITY,

HUMAN HEALTH AND WELL-BEING.

ECONOMY AND SECURITY.

AND AS WELL AS EQUITY.

WE'RE LOOKING AT DISTRIBUTIONAL

EQUITY, DEFINED THEM AS

INEQUALITY AND FAIRNESS IN

DISTRIBUTION, OF BURDENS AND

BENEFITS, ACROSS BOTH

DETERMINANTS AND OUTCOMES WITH

THE GOAL OF REDUCING DISPARITIES

FOR THE MOST DISADVANTAGED AND

THE MOST HISTORICALLY

MARGINALIZED.

THE PURPOSE OF THE PAPER WAS TO

THINK ABOUT HOW TO THINK ABOUT

EQUITY IN SYSTEMS ORIENTATION.

IF YOU MOVE TO THE NEXT SLIDE.

I WANT TO HIGHLIGHT THE THIRD

ASPECT OF THIS, WHICH I THINK WE

TALKED A LITTLE BIT ABOUT, THAT

IT'S JUST NOT ENOUGH FOR

RESEARCHERS TO TALK ABOUT THESE

THINGS PARTICULARLY EQUITY, AND

THE NEXUS, BECAUSE THERE ARE

INHERENTLY GOING TO BE TRADEOFFS

AND CO-BENEFITS.

IT'S SO ESSENTIAL BECAUSE VALUE

SYSTEMS ARE DIFFERENT, THE

EFFECTS ARE DIFFERENT, HEALTH

EFFECTS AND ENVIRONMENTAL

EFFECTS THAT WE ENGAGE WITH

SCIENCE OF CO-PRODUCTION, AND

THIS IS JUST SAYING THAT

RESEARCHERS AND PRACTITIONERS

SHOULD ENGAGE TOGETHER AND I

SHOW A PICTURE OF MYSELF AND MY

POSTDOC, I BELIEVE, IN THE NEXT

SLIDE WORKING WITH FOOD POLICY

COUNCIL AS WE LAUNCHED FOOD

ACTION PLANNING.

WE'VE ALSO WORKED WITH CITIES ON

ZERO CARBON TRANSITION.

BUT REALLY KEEPING THIS WORK IN

THE LAB, JUST DOING IT AS A

MODEL DOESN'T ADDRESS TRADEOFFS

AND CO-BENEFITS PARTICULARLY

WITH EQUITY WITH GROUPS

EXPERIENCING BENEFITS

DIFFERENTLY.

I'M GOING TO GO RAPIDLY THROUGH

EXAMPLES AND INTRODUCE THE AHA

STATEMENT.

WE CAN GO FASTER BECAUSE I THINK

IT'S 1:30 NOW.

I WANT TO SHARE ONE EXAMPLE OF A

PAPER THAT CAME OUT IN NATURE

CLIMATE CHANGE, LOOKING AT WHAT

WE CAN DO WITHIN CITIES.

MULTI-OR SECTOR, CROSS-SECTOR

ACTION FOR CARBON MITIGATION

WITH LOCAL BENEFITS.

I ACKNOWLEDGE CO-AUTHORS.

WE'RE SAYING WHAT HAPPENS IN THE

NEXT SLIDE IF INDIVIDUAL CITIES

STARTED SHARING RESOURCES,

AWARENESSES ENERGY, PARTICULARLY

IN CHINA CREATE ENORMOUS

RESOURCE EFFICIENCIES AND REDUCE

YOUR GRID DEMAND.

IT'S HELPFUL TO LOOK AT IF ALL

THE CITIES ADOPTED THESE

STRATEGIES, YOU CAN ACHIEVE IF

YOU LOOK AT THE NEXT SLIDE,

ACHIEVE SIGNIFICANT AMOUNT OF

DECARBONIZATION, WHAT WE'RE

SHOWING HERE IS THAT THOSE

CROSS-SECTOR ACTIONS CAN

CONTRIBUTE ABOUT 40% OF WHAT

NATIONAL STRATEGIES CONTRIBUTED,

A POWERFUL WAY TO LOOK AT WHAT

URBAN AREAS CAN DO FOR NATIONAL

DECARBONIZATION, AND IN THE NEXT

SLIDE, WE ALSO MODELED WHAT WAS

THE IMPACT OF THOSE ACTIONS FOR

ALL THE CITIES IN CHINA, USING

STRAIGHT FORWARD AIR POLLUTION

MODEL.

EVERY YEAR WE COULD AVOID 45,000

PREMATURE DEATHS FROM THIS.

WHAT WAS INTERESTING IS THAT

SOME CITIES, THE 1:1 BENEFIT, IF

YOU DO THESE THINGS, RENEWABLE

ENERGY, YOU WILL ACHIEVE

BENEFITS, BUT SOME ARE NOT

LOCAL, BECAUSE OF THE

TRANSBOUNDARY NATURE, THAT'S

WHAT WE SHOW HERE.

SOME CITIES HAD HIGH CARBON AND

HIGH HEALTH BENEFITS, SOME

CITIES HAD LOW CARBON AND LOW

HEALTH BENEFITS, ALSO ALIGNED

WITH OUR UNDERSTANDING OF

CORRELATION.

THERE WERE OTHER CITIES WITH

OTHER BENEFITS BECAUSE OF THE

TRANSBOUNDARY DYNAMICS.

THE IDEA IT'S NOT SIMPLE.

WE NEED GOOD MODELS TO MODEL

THESE RELATIONSHIPS.

AND THEN THE REMAINING I'M GOING

TO BREEZE THROUGH, ANOTHER WORK

STREAM WITH MY POSTDOC DANA

BOYER CONNECTING FOOD SYSTEMS,

ENVIRONMENTAL IMPACT, DIETARY

CHANGES AND OTHER INTERVENTIONS.

NEXT SLIDE TALKS ABOUT

INEQUALITY AND EXPOSURE TO WASTE

BURNING IN INDIAN CITIES.

WE MAY HAVE A LOT OF MODELS BUT

FUNDAMENTALLY IF YOU'RE DATA DO

NOT CAPTURE WHAT'S HAPPENING ON

THE GROUND WE'RE MISSING HALF OF

THE ENVIRONMENTAL DETERMINANTS

AND IN THIS CASE THERE WAS VERY

LITTLE DATA BEFORE OUR STUDY ON

HOW MUCH WASTE BURNING HAPPENS

IN INDIAN CITIES UNTIL WE SHOW

HIGH AND LOW U.S. NEIGHBORHOODS,

AND SIGNIFICANT WASTE BURNING

THAT HAS CAUSED A LOT OF HEALTH

IMPACT AND WE WERE THE FIRST

STUDY TO BRING THIS UP AS AN

UNCOUNTED SOURCE.

CASE STUDIES, FINE SCALE

MEASURES ARE ALSO IMPORTANT IN

ADDITION TO MULTI-SCALE LOOK.

THE LAST SET OF PAPERS TACKLED

WELL-BEING.

SO WE TALK ABOUT INFRASTRUCTURE

AND FOOD SYSTEM CORRELATES,

SUBJECTIVE WELL-BEING, THIS IS

MOTIVATED BY THE W.H.O.

DEFINITION ON THE NEXT SLIDE

THAT HEALTH IS NOT THE ABSENCE

OF DISEASE MERELY, IT SEEKS TO

IMPROVE HOW PEOPLE THINK AND

FEEL ABOUT THEIR LIVES, WHICH

RELATES TO AGENCY, BUT ALSO

PHYSICAL AND STRUCTURAL DESIGN.

AND SO THIS WAS A COLLABORATION

WITH UNIVERSITIES OF MINNESOTA,

A POSTDOC IN MY LAB.

I'M GOING TO GIVE A FEW EXAMPLE

PAPERS WHERE SINCE WE WERE

INTERESTED IN THE FOOD SYSTEM IF

YOU GO TO THE NEXT SLIDE --

>> I'M SORRY, IS THIS THE LAST

COUPLE SLIDES?

>> YES.

>> OKAY.

>> WE'RE LOOK AT HOW YOU CAN

MEASURE WELL-BEING, BECAUSE OF

GARDENING, PEOPLE WHO GARDEN,

AND SO VERY INTERESTING

CONNECTIONS WITH WELL-BEING.

AND THE LAST THING I WANT TO DO,

NEXT SLIDE, IS TO INTRODUCE THE

AHA POLICY STATEMENT WHICH YOU

SEE FOLLOWS, BUILT UPON SYSTEMS

IDEAS.

WE CAN LOOK AT SPECIFIC PATHWAYS

TO ZERO CARBON TRANSITION

THROUGH SPATIAL PLANNING,

EFFICIENCY, DECARBONIZING

ELECTRICITY.

IF YOU INVEST IN GREENERY, YOU

CAN SPECIFICALLY CONNECT

INFRASTRUCTURE WITH HEALTH AND

THE LAST TWO SLIDES WE CAN JUST

FLIP THROUGH, THE FRAMEWORK HOW

SPATIAL PLANNING AND

INFRASTRUCTURE, NEXT SLIDE,

CHANGES THE IMPACT RISK EXPOSURE

AND THAT IN TURN ADDRESSES THE

CARDIOMETABOLIC OUTCOMES.

I'LL STOP THERE AND SHARE MY

CONTACT INFORMATION.

THANK YOU FOR LISTENING.

>> THANK YOU.

VALUABLE PERSPECTIVE TO LINK

HEALTH AND INFRASTRUCTURE WITH

LENS ON EQUITY.

IN THE INTEREST OF TIME CAN WE

GET THE NEXT SPEAKER'S SLIDES

CUED UP.

I'D LIKE TO WELCOME DR. WEI

PENG, ASSISTANT PROFESSOR, ALSO

FROM PRINCETON UNIVERSITY, SHE'S

GOING TO GIVE A TALK ON

INTEGRATING AIR QUALITY AND

HEALTH CONSIDERATIONS INTO LOW

CARBON ENERGY DECISIONS.

>> THANKS FOR THE INVITE.

IT'S GREAT TO FOLLOW MY

COLLEAGUE'S TALK BECAUSE SHE

GAVE A VERY GOOD OVERVIEW OF THE

SYSTEMS THINKING AND NOW I WANT

TO DIVE INTO ONE OF THE CRUCIAL

FACTORS AND SYSTEMS, WHICH IS

ENERGY.

NEXT SLIDE PLEASE.

I'LL START WITH THE BIG PICTURE,

ENERGY SYSTEM IS GOING TO

EXPERIENCE UNPRECEDENTED CHANGE

IN THE NEXT FEW DECADES.

IN THIS COUNTRY, FOR EXAMPLE,

SET A GOAL TO REACH NET ZERO BY

2050.

WHERE WE ARE AND WHERE WE WANT

TO BE THREE DECADES FROM NOW,

THIS IS REALLY THE TYPE OF

TRANSFORMATION THAT NEEDS TO

HAPPEN.

IT'S GOING TO FUNDAMENTALLY

CHANGE THE WAY WE DRIVE, THE WAY

WE LIVE, THE WAY WE USE ENERGY,

AND TO SOME PEOPLE EVEN THEIR

JOBS AND LIVELIHOODS.

AROUND THE WORLD MORE THAN 100

COUNTRIES ARE IN THE PROCESS OF

THINKING ABOUT NET ZERO TARGETS,

THAT INCLUDES ALL THE MAJOR

EMITTERS LIKE CHINA, EUROPEAN

UNION, ET CETERA.

I GET THIS QUESTION A LOT.

CAN WE GET THERE?

I WISH I HAD THE SUPERPOWER OF

PREDICTING THE FUTURE BUT

UNFORTUNATELY I DON'T.

SO THIS IS REALLY THE QUESTION

THAT I DON'T KNOW, REALLY NOBODY

KNOWS.

IF THE PAST CAN TELL ABOUT THE

FUTURE, NEXT SLIDE PLEASE, SINCE

I GREW UP IN CHINA THAT WAS

SHANGHAI IN 1980s, AND

SHANGHAI THREE DECADES AFTER

THAT.

SO, I KNOW IT IS MUCH EASIER TO

BUILD NEW INFRASTRUCTURE THAN

TEARING DOWN EXISTING

INFRASTRUCTURE, ESPECIALLY

CONSIDERING HOW POWERFUL AND HOW

DEPENDENT WE HAVE BEEN ON THE

FOSSIL INDUSTRY, BUT THE POINT I

WANT TO MAKE IF WE HAVE THE

RIGHT PEOPLE, THE RIGHT

INCENTIVE DOING THE RIGHT THING,

THEN SO MUCH CAN BE ACHIEVED IN

THREE DECADES, AND THERE'S

REASON TO REMAIN OPTIMISTIC.

NEXT SLIDE PLEASE.

EVEN THOUGH I CANNOT ANSWER THE

QUESTION, CAN WE GET THERE, AS A

RESEARCHER PERHAPS THE QUESTION

THAT WE CAN BE MORE HELPFUL

ABOUT IS HOW CAN WE GET THERE?

NEXT SLIDE.

AND THIS IS WHERE THE ENERGY

SYSTEM MODELING HAS BEEN SUPER

HELPFUL BECAUSE USING THE MODEL

WE FOUND THERE ARE MANY

TECHNOLOGY PATHWAYS THAT CAN GET

US THERE AND WE ALSO KNOW

GENERAL FEATURES AN DIRECTIONS

TO MAKE EFFORTS ON.

THIS FIGURE IS TAKEN FROM THE

WHITE HOUSE REPORT ABOUT THE

U.S. LONG-TERM STRATEGY TO REACH

NET ZERO.

YOU CAN SEE FROM THE LEFT

LOOKING AT THE REPRESENTATIVE

PATHWAY TO 2050, WE NEED TO

TRANSFORM, DECARBONIZE

ELECTRICITY, TECHNOLOGY CHOICES,

END USE.

ON TOP OF THAT, EVEN IF WE HAVE

A DIFFERENT VIEW IN TERMS OF

WHAT KIND OF ENERGY TECHNOLOGY

WOULD BE MORE AVAILABLE, LESS

AVAILABLE, FOR EXAMPLE IF YOU

DON'T REALLY THINK NUCLEAR

SHOULD BE PART OF THE PICTURE OR

IF YOU THINK THAT RENEWABLE

ELECTRICITY WOULD NOT SCALE UP

AS QUICKLY AS WE THINK, NO

WORRIES.

BECAUSE USING ENERGY SYSTEM

MODEL WE CAN SHOW YOU TENS OR

THANS OF WAYS TO GET TO NET

DEZEE ROW EVEN WITH DIFFERENT

ASSUMPTION ABOUT THE FUTURE, AND

I SHOW SOME EXAMPLES ON THE

RIGHT PART OF THE SLIDE.

THIS THE REASON ENERGY MODELS

HAVE BEEN USEFUL AND WIDELY USED

BY THE DECISION MAKERS, GLOBALLY

LIKE THE IPCC PROCESS AND ALSO

DOMESTICALLY BY A LOT OF

AGENCIES AND ALSO MORE RECENTLY

BY NATIONAL CLIMATE ASSESSMENT.

ON ONE HAND AS PART OF THE

COMMUNITY I FEEL EXCITED ABOUT

HOW OUR EFFORTS TURNED INTO

ACTION.

ON THE OTHER HAND, I ALSO THINK

THERE'S FUNDAMENTAL ISSUE IN THE

WAY WE'RE USING INTERPRETING

ENERGY RESULTS, IF YOU REALLY

LOOK AT OUR MODELING RESULT,

HEAVILY FOCUSED ON TECHNOLOGY.

WE THINK THE MODEL IS A BUNCH OF

TECHNOLOGIES COMPETING WITH EACH

OTHER BUT THERE'S NO HUMAN

PHASE, OR COMPANY PHASE, LIKE

REAL WORLD PHASES TO HELP US

MAKE THE CONNECTION BETWEEN WHAT

DOES IT MEAN TO EACH INDIVIDUAL

IN THE TRANSITION.

THIS IS ONE SCENARIO FOR THE

U.S. TO REACH NET ZERO.

YOU CAN SEE IF YOU LOOK AT

TOMORROW PRIME ENERGY USE, HEY,

WE NEED TO BRING DOWN THE TOTAL

PRIMARIAN ENERGY USE BY 30% AND

FOSSIL FUEL SHARE FROM 84% WHERE

WE ARE TODAY TO 25% BY

MID-CENTURY.

SO ONCE WE MOVE OUR FOCUS FROM

TECHNOLOGY, THERE ARE TWO SETS

OF QUESTIONS.

ONE HAND, THE QUESTION BECOMES

IS IT REALISTIC TO MAKE THIS

TRANSITION?

FOR EXAMPLE, GIVEN HOW DEPENDENT

WE ARE ON FOSSIL FUEL NOW CAN WE

SCALE DOWN AND PHASE OUT FOSSIL

FUEL THAT QUICKLY?

CAN WE REALLY SCALE UP RENEWABLE

INVESTMENT THAT QUICKLY GIVEN

ALL THE TRANSMISSION GRID

BARRIERS AND ALSO PUBLIC OPINION

OPPOSITION, ET CETERA.

THE OTHER SET OF PERHAPS PERHAPS

FOR RELEVANT TO TODAY WHAT ARE

IMPLICATIONS ON EACH LIVING

HUMAN BEING, IN PARTICULAR WHAT

DOES IT MEAN FOR AIR QUALITY AND

HEALTH AND ALSO DISTRIBUTION OF

THOSE EFFECTS BECAUSE WE KNOW

THAT ON ONE HAND FOSSIL FUEL IS

REALLY THE DOMINANT REASON WE

HAVE A LOT OF POLLUTION ISSUES,

BUT ON THE OTHER HAND SOME OF

THE LOW CARBON STRATEGIES LIKE

MITIGATION ACTIONS MAY ALSO LEAD

TO NEW SOURCES OF AIR POLLUTION

AND HEALTH DAMAGES.

THIS IS WHERE THE CO-BENEFITS

COME INTO A VERY IMPORTANT ROW.

IT CAN MAKE ENERGY POLICY MORE

ATTRACTIVE.

FIRST OF ALL, BENEFITS ARE

IMMEDIATE.

NOT FUTURE GENERATIONS.

WE'RE REALLY TALKING ABOUT LIKE

TODAY WE'RE GOING TO BENEFIT

FROM THE TRANSITION.

IN ADDITION IT'S ALSO TANGIBLE,

NO LONGER TALKING ABOUT POLAR

BARS LOSING HABITAT, WE'RE

TALKING ABOUT OUR HEALTH AND

HEALTH OF OUR FAMILY.

FINALLY, IT MAKES ENERGY

TRANSITION MORE PERSONALLY

RELEVANT.

I HAVE A 3-YEAR-OLD, HE HAS ALL

KINDS OF ALLERGIES.

WHEN WE HAVE A HIGHLY POLLUTING

DAY IT'S PERSONALLY RELEVANT TO

ME BECAUSE I DON'T WANT LIMB TO

BE MISERABLE ON THAT DAY.

NEXT SLIDE PLEASE.

THAT BECOMES THE CORE QUESTION

OVER THE PAST DECADE,

INTEGRATING AIR QUALITY AND

HEALTH CONSIDERATION INTO OUR

ENERGY DECISIONS.

NEXT SLIDE.

THANKS TO DECADES OF EFFORTS

FROM THE COMMUNITY, NOW WE HAVE

A GOOD UNDERSTANDING OF HIGH

LEVEL, WHAT IS GUIDING PRINCETON

-- GUIDING PRINCIPLE TO

STRATEGY.

ONE EXAMPLE, WE DID A SYNTHESIS

ANALYSIS AROUND IF WE WANT TO

INTEGRATE AIR QUALITY ON HEALTH

CONSIDERATION INTO THE EFFORTS

TO DECARBONIZE THE POWER SECTOR,

WHERE ARE THE MOST IMPORTANT

THINGS TO FOCUS ON?

SO, WE THINK THERE ARE FOUR

AREAS.

FIRST, WHEN WE REPLACE OLD

INFRASTRUCTURE, RETIRING

EXISTING COAL PLANTS, TARGET

HIGHLY POLLUTING SOURCES IN

DENSELY POPULATION REGIONS THAT

WILL BRING A LOT OF HEALTH

BENEFITS TO EXPOSED POPULATION.

THE SECOND PART OF THE PUZZLE IS

WE BUILD NEW INFRASTRUCTURE, WE

REALLY NEED TO FOCUS ON SCALING

UP .

WITH MORE ELECTRIC CARS WE'LL

NEED TO INCREASE ELECTRICITY

DEMANDS, IN THIS COUNTRY WE'RE

GOING TO INCREASE HOW MUCH

GENERATION WILL COME FROM POWER

PLANTS AND HOPEFULLY THOSE NEW

DEMANDS WILL BE MET BY

DECARBONIZED ELECTRICITY RATHER

THAN FOSSIL FUELS.

THIRD IS CONNECTING STATES, TWO

IMPORTANT ELEMENTS.

ONE IS BECAUSE THE POWER GRID IS

CONNECTED.

SO WHEN WE RETIRE OR ADD IN ONE

REGION, IN THE ONLY AFFECT

LOCALLY, ALSO AFFECTS THE WHOLE

GRID REGION BECAUSE OUR SUPPLY

AND DEMAND DECISIONS ARE AT A G

LEVEL.

ON TOP OF THAT WE'LL TRANSPORT

FROM ONE TO THE OTHER.

WE THINK ABOUT CONNECTING SPACE,

WAYS TO MINIMIZE CROSS-STATE

DAMAGES FROM ELECTRICITY TRADE

AND ALSO POLLUTION TRANSPORT.

THE MOST DIFFICULT PART IS HOW

WE CAN PUT EQUITY AT CENTER OF

LOW CARBON ENERGY INFRASTRUCTURE

DESIGN.

SO, TO A LARGE EXTENT THE

DECISIONS WE MADE IN THE PAST

REGARDING FACILITIES AND WHERE

ARE WE GOING TO BUILD IT, THOSE

ARE REALLY THE FUNDAMENTAL ISSUE

WHY WE HAVE INJUSTICE TODAY.

AS A RESULT WHEN WE THINK ABOUT

ENERGY TRANSITION TO NET ZERO

IT'S CRUCIAL TO THINK AHEAD OF

TIME HOW ARE WE THINKING ABOUT

TECHNOLOGY CHOICES AND DECISIONS

AND PUTTING EQUITY AS THE CENTER

OF THE NEW INFRASTRUCTURE DESIGN

SO WE WON'T HAVE THE SAME

PROBLEM AND ISSUE THREE DECADES

FROM NOW.

ALTHOUGH WE HAVE A GOOD

UNDERSTANDING OF BROAD STRATEGY

THE KEY CHALLENGE IS AROUND

SPECIFIC POLICY DESIGNS.

I WANT TO GIVE A QUICK EXAMPLE

ABOUT THE ELECTRIC VEHICLES.

IF YOU LOOK AT -- SOME

REGIONALIZATION IS MESSED UP.

I HOPE I CAN EXPLAIN WELL

ENOUGH.

IF YOU LOOK AT THE POLICIES

TODAY WE HAVE A BUNCH OF POLICY

TARGETS WHICH INCLUDE EV CELLS,

ALSO ECONOMY-WIDE EMISSIONS.

WE HAVE A WIDE RANGE OF POLICY

INSTRUMENT CHOICES, IT CAN BE

PURCHASE INCENTIVE, FUNDING FOR

CHARGER INFRASTRUCTURE, ALSO

FUNDING FOR EP MANUFACTURE --

EV MANUFACTURING, ET CETERA.

HOW CAN WE PUT HEALTH AS ONE

CONSIDERATION FOR POLICY

ASSESSMENT, AND ON TOP OF THAT,

HOW CAN WE THINK ABOUT NOT ONLY

EMBRACING POLICY INSTRUMENT

CHOICES THAT WOULD BE USEFUL IN

ACCELERATING ADOPTION BUT ALSO

AT THE SAME TIME ENSURING GOOD

AIR QUALITY AND HEALTH OUTCOMES.

WE MAKE ENERGY CITIESES FOR

TODAY -- ENERGY DECISIONS FOR

TODAY AND OPENING THE DOOR TO

ACCELERATE ENERGY POLICY IN THE

FUTURE.

SO HERE IS ANOTHER IMPORTANT SET

OF QUESTIONS, HOW CAN HEALTH

CONSIDERATIONS PLAY A ROLE SO

THAT WE CAN REALLY REDUCE THE

BARRIERS TO HAVE MORE EFFECTIVE

CLEAN ENERGY POLICY IN THE

FUTURE.

AND THAT IS WHERE THE SOCIAL

POLITICAL AND TECHNOLOGY

CONCERNS ARE IMPORTANT.

FOR EXAMPLE, HOW CAN WE USE

HEALTH AS A WAY TO INCREASE

PUBLIC SUPPORT, ACCELERATE

ADOPTION, STRENGTHEN GREEN

COALITION, EVEN LIKE INCREASE

MARKET SHARE FOR THE LOW CARBON

TECHNOLOGIES.

NEXT SLIDE PLEASE.

THE FRONTIER, TURNING WHAT WE

KNOW INTO ACTIONABLE KNOWLEDGE

AROUND POLICY DESIGN, FOR

INTEGRATIVE ENERGY AND HEALTH

DECISIONS.

I THINK THERE ARE THOSE

INSTITUTIONAL CHALLENGES AND

SCIENCE CHALLENGES.

NEXT SLIDE.

SO, REGARDING INSTITUTIONAL

CHALLENGES I THINK THE KEY THING

IS HOW CAN WE NAVIGATE COMPLEX

DECISION MAKING LANDSCAPE.

I HAVE TWO SUBPOINTS ON THIS.

FIRST OF ALL, WE DO NEED TO

START TO THINK ABOUT BRIDGING

AGENCIES, TRADITIONALLY HAVE

VERY DIFFERENT FUNCTIONS AND

GOALS.

SO IF YOU THINK ABOUT ENERGY,

FEDERAL LEVEL WE HAVE DEPARTMENT

OF ENERGY, IF YOU THINK ABOUT

AIR QUALITY WE HAVE EPA, CDC FOR

HEALTH, DEPARTMENT OF HEALTH AND

HUMAN SERVICES.

BUT THIS KIND OF LIKE DIFFERENT

GOALS OF DIFFERENT AGENCIES IS

NOT REALLY PROVIDING THE RIGHT

CONTACT TO THINK ABOUT

INTEGRATIVE DECISIONS, THINKING

ABOUT THE VENN DIAGRAM TO MAKE

GOOD DECISIONS THAT TACKLE ALL

THREE ISSUES.

ANOTHER SIDE IS THINKING ABOUT

COORDINATING EFFORTS ACROSS

MULTIPLE LEVELS OF GOVERNMENTS.

SO, FOR ENERGY FOR AIR QUALITY

AND HEALTH WE NOT ONLY HAVE

EFFORTS AT FEDERAL LEVEL, WE

ALSO HAVE ACTIONS AT STATE

LEVEL, AND HOUSEHOLD AND

COMPANIES LEVEL, CHANGING FROM

THE FRAMEWORK ON LEFT TO RIGHT A

LOT OF HEALTH AND AIR QUALITY

ISSUES ARE AT STATE AND LOCAL

LEVELS, NOT ONLY IMPORTANT

ACTORS TO RESPOND TO ENERGY

PROGRAM, THEY ARE ALSO LEADING

ACTORS FOR AIR QUALITY

MEASUREMENT SUCH AS STATE

IMPLEMENTATION PLAN FOR AIR

QUALITY CONTROL.

ALONG THOSE LINES HOW CAN WE

REALLY EMPHASIZE THE ROLE OF

STATE AND LOCAL ACTORS AND AT

THE SAME TIME THINK ABOUT THE

LINKAGE BETWEEN THE FEDERAL

GOVERNMENT AND ALSO CREATE

EFFECTIVE RESPONSE, THAT CREATES

NEW CHALLENGES WHEN THINKING

ABOUT POLICY COORDINATION ACROSS

MULTI-LEVEL STRUCTURE.

THERE ARE ALSO IMPORTANT SCIENCE

CHALLENGES.

THE KEY CHALLENGE IS HOW CAN WE

GENERATE ROBUST INSIGHT FOR

COMPLEX SYSTEMS.

I HAVE A FEW ELEMENTS TO

DISCUSS.

FIRST OF ALL HOW CAN WE

UNDERSTAND THE HEALTH DRIVERS

AND HEALTH OUTCOMES.

I WANT TO GIVE ONE QUICK EXAMPLE

ABOUT EXPOSURE DISPARITIES, WHAT

MATTERS, WHAT DETERMINES

EXPOSURE DISPARITY, IT'S THE

CORRELATION BETWEEN WHERE

POLLUTION IS HIGH AND WHERE

DISADVANTAGED POPULATIONS LIVE.

SO WHEN WE THINK ABOUT WHAT

WOULD CHANGE IN THE FUTURE,

THERE ARE TWO ASPECTS GOING TO

CHANGE WHERE THE POLLUTION IS

HIGH.

THE GLOBAL ENERGY TRANSITION IS

GOING TO INFLUENCE OUR FUTURE

CLIMATE AS A RESULT OF CHANGE IN

CONDITIONS AND THAT WILL BE

CRUCIAL WHEN THINKING ABOUT

POLLUTION FORMATION AND

POLLUTION REMOVAL.

DETERMINING WHERE POLLUTION IS

HIGH.

MORE IMPORTANT IS NATIONAL,

STATE, LOCAL ENERGY DECISIONS

ARE GOING TO INFLUENCE OUR

EMISSIONS DIRECTLY INFLUENCING

WHERE FUTURE POLLUTION SOURCES

WOULD OCCUR.

ON TOP OF THAT, THINKING ABOUT

PROJECTING WHERE DISADVANTAGED

POPULATIONS MAY LIVE IN THE

FUTURE WE NEED TO THINK ABOUT

ECONOMIC TRENDS INCLUDING

POPULATION GROWTH, URBANIZATION,

AGING, ET CETERA.

THOSE DEMOGRAPHIC TRENDS NOT

ONLY INFLUENCE WHERE THE

DISADVANTAGED COMMUNITIES LIVE,

IT ALSO PROVIDES THE FOUNDATION

FOR A LOT OF ENERGY TRANSITIONS

I WAS TALKING ABOUT EARLIER AT

NATIONAL, STATE, LOCAL LEVEL.

HERE WE HAVE A VERY COMPLEX

SYSTEM AND INTERACTIONS LINKING

HEALTH DRIVERS TO HEALTH

OUTCOMES, AND THAT'S WHERE I

THINK A LOT OF SCIENTIFIC

UNDERSTANDING IS NOT THERE YET.

THE OTHER PART IS WE ALSO HAVE

IMPORTANT MULTI-SECTOR

LINKAGINGS.

I WANT TO USE ELECTRIC --

>> WE'RE RUNNING OUT OF TIME.

>> YEAH, SURE.

I CAN QUICKLY GO THROUGH AND

JUMP THROUGH A FEW AS WELL.

BRIEFLY, IF YOU THINK ABOUT THE

EV ADOPTION, IT WOULD INFLUENCE

TRANSPORTATION SECTOR, IT'S

INDUSTRY AND POWER AS A RESULT

CHANGING HEALTH EXPOSURE AND

HEALTH IMPACTS.

JUMP TO THE NEXT ONE.

I CAN END ON THIS.

CRAFTING USABLE KNOWLEDGE FOR

REAL WORLD DECISIONS REQUIRES

LEARNING AND KNOWLEDGE FOR

CO-PRODUCTION.

INTERDISCIPLINARY LEARNING NOT

JUST ABOUT ENERGY SYSTEMS, ALSO

ABOUT HEALTH, EQUITY AND ETHICS,

KNOWLEDGE CO-PRODUCTION, WORKING

CLOSELY WITH THE RELEVANT

STAKEHOLDERS AS WE TALKED IN THE

PREVIOUS SESSION.

I'LL END WITH THIS.

I LEAD A PROJECT, THE CORE FOCUS

THINKING ABOUT HOW WE CAN BRING

AIR QUALITY AND HEALTH TO ENERGY

POLICY.

I LOOK FORWARD TO DISCUSSIONS

TODAY AND LEARNING FROM THE

OTHER PANELISTS AND AUDIENCE

TODAY.

THANK YOU.

>> THANK YOU.

JUST SO ALL OF OUR PANELISTS

KNOW, THERE ALREADY AMPLE TIME

FOR DISCUSSION.

WE'LL HAVE A CHANCE TO EXPAND ON

CONCEPTS IN THE DISCUSSION

SECTION.

INCOME DR. JESS FRANZO, INTERIM

DIRECTOR OF INTERNATIONAL

RESEARCH INSTITUTE FOR CLIMATE

AND SOCIETY, COLUMBIA CLIMATE

SCHOOL, COLUMBIA UNIVERSITY.

WELCOME.

WE LOOK FORWARD TO YOUR TALK ON

HARNESSING FOOD SYSTEMS AS A

SOLUTION FOR CHANGING CLIMATE.

>> THANK YOU FOR THE OPPORTUNITY

TO BE HERE.

I'LL TRY TO KEEP THIS UNDER 15

MINUTES.

I'M GOING TO TALK ABOUT FOOD

SYSTEMS AND RELATIONSHIP WITH

CLIMATE, WHAT WITH KEY DO NOW,

IT'S AN IMPORTANT MOMENT OUT OF

COP28.

FOOD WAS A LITTLE BIT IN THE

NEGOTIATIONS AND IN THE FINAL

TEXT BUT NOT SO MUCH.

IT'S REALLY IMPORTANT THAT WE

BRING THIS TO LIGHT.

CLIMATE HAS SIGNIFICANT IMPACT

ON FOOD AND HEALTH SYSTEMS CAN

SIGNIFICANT REPERCUSSION ON

DIET AND DISEASE.

FAR LEFT, DIRECT EFFECT, EXTREME

WEATHER EFFECT, FLOODS, DOUBTS,

HEAT WAVE, WARMING TEMPERATURES,

SEA LEVEL RISE, OCEAN

ACIDIFICATION, AND I'LL BE

FOLLOWED BY DR. DAHER TALKING

ABOUT WATER, WITH IMPACT ON

WATER, FOOD INSECURITY, TWO

PATHWAYS IN YELLOW, FOOD SYSTEM

AND HEALTH SYSTEM PATHWAY IN

WHICH THROUGH FOOD WE HAVE

INEFFICIENT QUANTITY AND QUALITY

BEING CONSUMED OR ACCESSED,

INCREASED DISEASE AND STRESS

WITH IMPLICATION ON NUTRITION,

STUNTING AND WASTING,

MICRONUTRIENT DEFICIENCIES,

OBESITY, DIET-RELATED

NON-COMMUNICABLE DISEASES.

NEXT SLIDE.

FOOD SYSTEMS ARE PART OF THE

PROBLEM.

FOOD SYSTEMS ACCOUNT FOR 30% OF

GREENHOUSE GAS EMISSIONS.

THAT COMES FROM LIVESTOCK

FERMENTATION, AS WITH RISE, WITH

THE ENERGY INVOLVED IN GROWING,

MOVING, PACKAGING OF FOOD AND

THE RUNOFF, WHETHER MANURE OR

WASTE.

LIVE STOCK IS A BIG CONTRIBUTOR

PARTICULARLY BECAUSE IT -- OF

THE ENTERIC FERMENTATION WHICH

RELEASES METHANE, FOOD SYSTEMS

ARE A VICTIM OF CLIMATE CHANGE

BUT CONTRIBUTORS, PART OF THE

PROBLEM.

WE KNOW THE FOODS WE'RE GROWING

HAVE CERTAIN ENVIRONMENTAL

STRESSES, SHOWING YOU FIVE

DIFFERENT ENVIRONMENTAL

STRESSES, GREENHOUSE GAS

EMISSIONS, LAND USE CHANGE,

WATER USE, NITROGEN AND

PHOSPHORUS APPLICATION, CAUSING

POLLUTED WATERS THROUGH NUTRIENT

RUNOFF.

LIGHT BLUE IN TOP TWO BARS ARE

LIVE STOCK, BEEF AND LAMB, LIVE

STOCK PRODUCE A LOT OF

GREENHOUSE GASES, LAND USE

CHANGE, TYPICALLY IN TROPICAL

FOREST, DEFORESTATION.

DIFFERENT FOODS HAVE DIFFERENT

ENVIRONMENTAL STRESSES DEPENDING

WHERE THEY ARE GROWN AND HOW

THEY ARE GROWN.

THAT'S REALLY IMPORTANT.

AVOCADOS AND NUTS ARE BIG WATER

CONSUMERS, STAPLE GRAINS USE A

LOT OF WATER AND CHEMICALS.

NEXT SLIDE.

NOT ONLY THE FOODS WE'RE

CONSUMING HAVE ENVIRONMENTAL

FOOTPRINTS BUT HAVE IMPACTS ON

HUMAN HEALTH; ON LEFT DIETARY

RISKS FOR MORBIDITY AND

MORTALITY IN THE WORLD, DIETS

MEANT TO NOURISH US ARE KILLING

US.

THIS IS DATA FROM THE GLOBAL

BURDEN OF DISEASE, MOST OF THAT

DEATH IS DUE TO NON-COMMUNICABLE

DISEASES, CARDIOVASCULAR DISEASE

BEING THE TOP.

DIETS CONTRIBUTE TO OTHER

NON-COMMUNICABLE DISEASE, ON THE

RIGHT IS WORK SHOWING TYPE 2

DIABETES, SUBOPTIMAL DIETS ARE

THE MAIN RISK FACTOR, AND OTHER

FACTORS CONTRIBUTING TO

DIABETES, LACK OF INTAKE OF

WHOLE GRAINS, EXCESS INTAKE OF

REFINED GRAINS AND PROCESSED RED

MEATS.

NEXT SLIDE.

DIGGING FURTHER INTO DIET AND

FOODS THAT ARE POTENTIALLY

PUTTING PEOPLE AT RISK FOR

CARDIOVASCULAR DISEASE AND TYPE

2 DIABETES, I'VE HIGHLIGHTED IN

RED WHERE YOU CAN SEE HIGHER

RISK OF CARDIOVASCULAR DISEASE

AND TYPE 2 DIABETES, A LITTLE

BIT OF STROKE IN THERE, RED MEAT

AND PROCESSED MEATS, SHOWN IN

MANY STUDIES THAT BUILT UPON

THAT, WHEN WE LOOK AT HEALTH AND

ENVIRONMENT BENEFITS, RED MEAT,

RED PROCESSED MEATS ARE THE

OUTLIERS OF HAVING A DOUBLE

IMPACT ON HEALTH AND THE

ENVIRONMENT, WHEN EATEN OR

PRODUCED IN EXCESS.

NEXT SLIDE.

BUR IT'S NOT SUCH AN EASY

PICTURE, IN THAT WHAT IS HEALTHY

IS SUSTAINABLE.

THAT'S NOT NECESSARILY TRUE.

THIS IS WORK BY MIKE CLARK AND

COLLEAGUES.

IT'S SHOWING THESE SPIDER WEBS

ON THE LEFT PART OF THE SPIDER

WEB IS HEALTH.

ON THE RIGHT IS ENVIRONMENT.

YOU CAN SEE THERE'S MORTALITY,

CORONARY HEART DISEASE,

COLORECTAL CANCER, DIABETES,

STROKE.

ON THE LEFT ARE THOSE FIVE MAJOR

ENVIRONMENTAL STRESSORS LOOKED

AT IN ENVIRONMENTAL PAPERS.

WATER USE, ACIDIFICATION.

NUTS, HEALTHY, PROTECTIVE, BUT

HIGH WATER USE.

OR LOOK AT THE THIRD ROW, ON THE

VERY FAR RIGHT, UNPROCESSED RED

MEATS.

RISKS ON THE NON-COMMUNICABLE

DISEASE SIDE, HIGH RISK ON

ENVIRONMENT SIDE.

AT THE BOTTOM, SSB, THAT'S

SUGAR-SWEETENED BEVERAGES.

NOT GREAT FOR HEALTH.

BUT PRETTY LOW ENVIRONMENTAL

FOOTPRINT.

SO, HEALTHY FOODS ARE NOT ALWAYS

NECESSARILY THE MOST SUSTAINABLE

FOODS.

IT'S NOT ALWAYS AN EQUAL

PAIRING.

NEXT SLIDE.

LAST THING WE KNOW HEALTHY DIETS

ARE INEQUITABLE, ACCESS TO

HEALTHY DIETS ARE UNAFFORDABLE

FOR MANY PEOPLE IN THE WORLD.

THIS MAP IS SHOWING YOU THE

PERCENTAGE OF THE POPULATION WHO

CANNOT AFFORD A HEALTHY DIET.

THE DARK BROWN IS WHERE 75% OR

MORE OF THE POPULATION CANNOT

AFFORD A HEALTHY DIET.

3.2BILLION PEOPLE CANNOT AFFORD

THAT HEALTHY DIET WHICH IS

INCREDIBLE WHEN YOU THINK ABOUT

THAT STATISTIC.

I WANT TO HIGHLIGHT, IT WAS GOOD

TO HEAR FROM DR. PENG TALKING

ABOUT THE ENERGY SECTOR, THAT IS

THE BIGGEST CONTRIBUTOR TO

GREENHOUSE GASES.

IF WE DO NOTHING ON FOOD, WE

WILL NOT REACH THE PARIS CLIMATE

CHANGE TARGETS TO STAY BELOW 1.5

DEGREES.

IF WE FIX THE ENERGY SECTOR, WE

FIX TRANSPORTATION,

INFRASTRUCTURE, FROM DR.

RAMASWAMI'S PRESENTATION WE

STILL WON'T MEET PARIS AGREEMENT

IF WE DO NOTHING.

67% CHANCE STAYING BELOW 1.5 WE

NEED TO DO MANY THINGS,

IMPROVING EFFICIENCY OF WHAT'S

GROWN, INCREASING YIELDS IN SOME

PARTS OF THE WORLD LIKE

SUB-SAHARAN AFRICA, INCREASING

PLANT-BASED DIET CONSUMPTION,

CONSUMING RIGHT AMOUNT OF

CALORIES, NOT OVERCONSUMING.

AND CUTTING FOOD LOSS WASTE IN

HALF.

WHAT THAT LAST BAR SHOWS IS THAT

WE NEED TO DO ALL OF THAT IF WE

WANT TO HAVE A STANDING CHANCE

TO STAY BELOW 1.5 DEGREES.

NEXT SLIDE.

UNFORTUNATELY THIS CUT OFF.

THAT'S OKAY.

SOME INDIVIDUALS, COMMUNITIES,

AND COUNTRIES NEED TO MAKE

BIGGER CHANGES THAN OTHERS.

ENERGY INTENSIVE LIFESTYLES FOR

MANY ARE SIGNIFICANT

ANTHROPOGENIC CONTRIBUTORS TO

CLIMATE CHANGE WITH

DISPROPORTIONATE IMPACT IN

PLACES THAT ARE RESOURCE

CONSTRAINED.

SIX ECONOMIES EMIT HALF THE

GREENHOUSE GASES, U.S., CHINA,

BRAZIL, INDIA, INDONESIA AND

E.U.

WE CONSUME A LOT OF MEAT,

SOMETIMES 30 TIMES MORE MEAT

THAN BANGLADESH PER DAY OR PER

WEEK.

WE REALLY NEED TO SEE AND

UNDERSTAND THE INEQUITIES THAT

WE'RE FACING WHEN IT COMES TO

DIETS AND WHO NEEDS TO TAKE

BIGGER ACTION ON FOOD SYSTEMS.

I'LL GO THROUGH THIS AND TALK

ABOUT RESEARCH.

TO HIGHLIGHT AGAIN IT'S NOT ONLY

THAT WE HAVE TO FIX AGRICULTURE

PRODUCTION, ENSURE PEOPLE GET

ACCESS TO HEALTHY DIETS, MOVE TO

PLANT-BASED DIET, CUT FOOD WASTE

IN HALF, WE NEED DIFFERENT

POLICY LEVERS TO BE ABLE TO HELP

FARMERS, HELP CONSUMERS MAKE

HEALTHIER SUSTAINABLE CHOICES.

FROM AGRICULTURE PRODUCTION TO

TRANSPORT, TO FOOD ENVIRONMENTS,

WHERE YOU ENGAGE WITH THE FOOD

SYSTEM EVERY DAY, YOU GO INTO A

MARKET, GO INTO A RESTAURANT,

MAKE CHOICES.

AS WELL AS AROUND LABELING AND

PROMOTION AND DIETARY

GUIDELINES.

WE NEED GOVERNMENTS TO TAKE

DIFFERENT ACTIONS ACROSS

DIFFERENT ASPECTS OF THE SUPPLY

CHAIN.

IT'S A SYSTEM.

IT'S COMPLICATED.

IT'S MESSY.

A SILVER BULLET WON'T SOLVE

CLIMATE CHANGE AND FOR

OURSELVES.

THERE'S A RANGE OF INCENTIVES

AND DISINCENTIVES AND

REGULATION, AND KNOWLEDGE

GARNERING THAT NEED TO HAPPEN

ACROSS THE ENTIRETY OF FOOD

SUPPLY CHAINS AND FOOD SYSTEMS.

GOVERNMENTS AND PRIVATE SECTOR

ARE RESPONSIBLE AND NEED TO TAKE

MORE ACTION, TO LEAVE IT IN THE

HANDS OF CONSUMERS IS UNFAIR.

NEXT SLIDE.

I'LL PRESENT THREE AREAS, AND

I'LL BE QUICK.

THE PROBLEM WHEN WE'RE TALKING

ABOUT FOOD SYSTEMS IS THAT YOU

HEAR THIS ARGUMENT THAT FOOD

SYSTEMS ARE FAILING US.

WHEN YOU LOOK AT WHAT'S THE

FAILURE ABOUT, AGRICULTURISTS

WILL SAY WE NEED TO PRODUCE MORE

FOOD.

NUTRITION COMMUNITY SAYS, NO, WE

NEED TO PRODUCE DIFFERENT KINDS

OF FOODS.

WE NEED TO FILL THE NUTRIENT

GAP.

THOSE WHO WORK ON SOCIAL JUSTICE

SAY, NO, WE NEED LOCALIZED

SYSTEMS, AUTONOMY, DEMOCRACY,

SOCIAL AND FOOD JUSTICE.

THOSE WHO WORK IN ENVIRONMENT

SAY WE NEED TO REDUCE THE

ENVIRONMENTAL FOOTPRINT OF FOOD

SYSTEMS.

THE PROBLEM IS NONE OF THESE

GROUPS CAN AGREE ON HOW WE MOVE

FORWARD WITH FOOD SYSTEM

TRANSFORMATION, AND WHAT SHOULD

BE PRIORITIZED.

IT'S VERY COMPLICATED BECAUSE WE

HAVE MANY DIFFERENT SECTORS AND

DISCIPLINES THAT NEED TO COME

TOGETHER TO TRANSFORM FOOD

SYSTEMS.

NEXT SLIDE.

>> TWO MINUTES LEFT.

>> OKAY.

I'M MEETING MY TIME.

I'M TIMING MYSELF.

I GET AN EXTRA 30 SECONDS FOR

SLIDES NOT MOVING FORWARD.

WHEN WE'RE THINKING ABOUT IN THE

NUTRITION WORLD, HOW DO WE

ENSURE THAT WE HAVE STRONGER

INTERSECTION BETWEEN FOOD

SYSTEMS, ENVIRONMENT, CLIMATE,

NUTRITION, WE NEED A LOT OF

DIFFERENT METHODS, A LOT OF

DIFFERENT INTERVENTIONS, AND A

LOT OF GOALS TO COME TOGETHER.

IT IS INCREDIBLY CHALLENGING TO

WORK ACROSS METHODS EVEN IN OUR

OWN DISCIPLINES, BUT ACROSS

DISCIPLINES WITH DIFFERENT GOALS

AND INTERVENTIONS IN MIND.

IT'S NOT EASY TO TRANSFORM THE

ENERGY SECTOR, FOOD SYSTEMS,

LET'S DO IMPORTANT RESEARCH THAT

GETS TO SOLUTIONS; THERE'S A LOT

OF METHODS AND INTERVENTIONS

THAT NEED TO COME TOGETHER THAT

REQUIRE TIME AND ENERGY FOR

DISCIPLINES TO BE ABLE TO BE

MARRIED.

NEXT SLIDE.

AND MY SECOND TO LAST SLIDE, ONE

OF THE THINGS I WANT TO

EMPHASIZE IS WE'RE IN A TIME

WHERE FACTS AND EVIDENCE ARE

UNDER SCRUTINY.

SOMETIMES OPENLY DISREGARDED OR

SUSPECT.

TO ME RESEARCH CAN CHART A

POSITIVE PATH FOR THE WORLD AND

BRING WHOLESALE CHANGES IN

ATTITUDES, POLITICAL THOUGHT AND

ACTIONS.

MANY PEOPLE ON THE CALL ARE

RESEARCHERS, AND WE HAVE A VERY

IMPORTANT ROLE IN PUSHING

FORWARD SCIENCE, DATA, EVIDENCE.

AND ENSURING THAT WE HOLD OUR

POLICYMAKERS TO USE THAT

EFFECTIVELY.

SECOND, NEXT SLIDE, AND JUST

LAST I'M NOT GOING TO PRESENT

THIS MUCH BUT THIS IS WORK DONE

BY SEVERAL COLLEAGUES TO MAP OUT

FOOD SYSTEMS.

THE BOTTOM BAR STARTS WITH

GOVERNANCE OF FOOD SYSTEMS.

NATIONAL GOVERNANCE.

WE NEED GOVERNANCE TO START

TAKING ACTION ON FOOD SYSTEMS.

AND ENSURING THAT THEY ARE --

THEIR HANDS ARE ON THE WHEEL.

PRIVATE SECTOR CONTROLS, WHAT WE

EAT, THEY ARE IN CONTROL.

THEY ARE THE DRIVERS OF THE FOOD

SYSTEM GOVERNANCE.

WE NEED OUR GOVERNMENTS TO TAKE

ACTION AND CARING ABOUT THE

KINDS OF DIETS THAT PEOPLE GET

ACCESS TO AND KIND OF FOODS

WE'RE GROWING IN THE WORLD, FOR

BOTH HUMAN AND PLANETARY HEALTH.

I'LL END THERE.

THANK YOU SO MUCH.

>> THANK YOU FOR LAYING GROUND

WORK TO START THINKING ABOUT

FOOD SYSTEMS.

I CAN'T WAIT FOR THE PERSPECTIVE

IN THE DISCUSSION.

I'D LIKE TO WELCOME DR. BASSEL

DAHER, RESEARCH SCIENTIST, TEXAS

A & M, CONVERGENCE RESEARCH

INCUBATOR, ADJUNCT ASSISTANT

PROFESSOR IN AGRICULTURE

ENGINEERING AND RESEARCH FELLOW

AT INSTITUTE FOR SCIENCE,

TECHNOLOGY, PUBLIC POLICY AT

TEXAS A & M.

>> IT'S A PLEASURE TO BE PART OF

THIS DISTINGUISHED PANEL.

ALSO A PLEASURE TO FOLLOW DR.

FANZO, WHOSE BOOK, THE ONE SHE

SHARED ON THE LAST SLIDE, I

THINK THIS BOOK SHOULD BE OF

INTEREST TO THIS CROWD SO HIGHLY

RECOMMEND IT.

MY TALK ABOUT FOCUS ON WATER

SYSTEMS AT THE NEXUS AND HUMAN

AND PLANETARY HEALTH.

BUT I'M HOPING THROUGH MY

PRESENTATION AND AS I BUILD

INTERCONNECTIONS WE ARRIVE TO A

BROADER SYSTEM LEVEL PICTURE AND

SYSTEM LEVEL INTERCONNECTIONS OF

WATER SYSTEMS AND OTHER SYSTEMS

THAT ARE CONNECTED.

I'D LIKE US TO REFLECT FOR A FEW

SECONDS HERE ON THIS GLOBAL

RISKS REPORT FROM 2020, AN

ANNUAL PUBLICATION BY THE WORLD

ECONOMIC FORUM ISSUED AT THE

BEGINNING OF EVERY YEAR, WHICH

INCLUDES THIS GRAPH OF RISKS

EXPECTED FOR THAT SPECIFIC YEAR

WHICH IS RESULT OF SURVEY THAT

IS USUALLY CONDUCTED WITH MORE

THAN A THOUSAND BUSINESS

EXECUTIVES, ACADEMICS,

GOVERNMENT ENTITIES, NGOs,

INTERNATIONAL ORGANIZATIONS,

AMONG OTHERS.

HAVE A LOOK AT RISKS THAT WERE

IDENTIFIED IN 2020.

SEE ON THE UPPER LEFT CORNER

INFECTIOUS DISEASES, THAT MADE

IT TO THE LIST, AND HAD

RELATIVELY HIGH IMPACT COMPARED

TO OTHER RISKS BUT WAS LOWER ON

THE LIKELIHOOD SCALE.

REFLECT ON THE OTHER RISKS AND

CHALLENGES WE ENDED UP FACING.

WHAT STARTED AS PUBLIC HEALTH

CRISIS SHOWED US FOOD SUPPLY

CHAIN FAILURES, UNEMPLOYMENT,

FINANCIAL CRISIS, ENERGY PRICE

SHOCKS.

ALL OF THE CRISES, ALL THESE

THINGS ARE CHALLENGES THAT WE

SAW DURING THAT YEAR, THAT WERE

REALLY CATALYZED BY THE PUBLIC

HEALTH CRISIS.

A FEW REFLECTIONS FROM THE

SURVEY, NEXT PLEASE, THAT WE

LIVE IN A WORLD WITH WIDE RANGE

OF CHALLENGES.

WE SEE HERE DIVERSITY OF THESE

DIFFERENT CHALLENGES FROM

ECONOMIC, ENVIRONMENTAL,

GEOPOLITICAL, TECHNOLOGICAL,

SOCIETAL, AMONG OTHERS.

HIGHLY INTERCONNECTED, DO NOT

EXIST IN SILOS, DO IMPACT ONE

ANOTHER.

ANOTHER REFLECTION IS THAT THESE

CHALLENGES AND RISKS ARE OFTEN

HARD TO PREDICT, AND WE OFTEN DO

NOT HAVE THE LUXURY OF TIME TO

RESPOND TO THESE CHALLENGES.

THEREFORE WE NEED TO HAVE THE

NECESSARY INFRASTRUCTURE READY

FOR US TO RESPOND TO THE NEXT

SHOCK WHEN IT HAPPENS, NOT AS IT

HAPPENS.

THAT REQUIRED ACADEMICS TO WORK

TOGETHER WITH DIFFERENT SECTORS

FROM PUBLIC TO PRIVATE, AS WELL

AS ACTIVE ENGAGEMENT OF CIVIL

SOCIETY IN ORDER TO ADDRESS

CHALLENGES.

TO BETTER UNDERSTAND AND BE

PREPARED TO IMPROVE OUR

UNPREPAREDNESS, TO ADDRESSING

THESE CHALLENGES AS WE MOVE

FORWARD, IT'S CRITICAL THAT WE

LOOK AT THESE SYSTEMS AND

INTERCONNECTED MANNER AND BE

INSPIRED BY SYSTEMS THINKING AS

AN APPROACH FOR US TO MOVE

FORWARD AND I WOULD ARGUE THAT

IMPROVING OUR FUTURE RESILIENCE

WILL REQUIRE INVESTING IN A NEW

TYPE OF INFRASTRUCTURE, AND

ENABLING ENVIRONMENTS THAT ALLOW

US TO FIRST OF ALL DEVELOP

RESEARCH AT THE INTERFACE OF

CURRENT DISCIPLINES, NO ONE

DISCIPLINE WILL BE ABLE TO

ADDRESS ALL THESE COMPLEXITY, NO

ENGINEER, NO SOCIAL SCIENTIST,

NO PUBLIC POLICY PERSON WILL BE

ABLE TO ADDRESS THAT.

ALSO NO ONE SECTOR WILL BE ABLE

TO ADDRESS ALL OF THESE

COMPLEXITIES SO WE NEED TO

INVEST IN ENABLING ENVIRONMENTS

THAT WOULD MAKE IT EASIER FOR

THESE SECTORS AND THESE ACTORS

TO COOPERATE.

THE WATER SITUATION TODAY,

REFLECTING ON HOW -- WHAT BECAME

MORE PROMINENT OVER THE YEARS

LOOKING AT HOW IT WAS ONE OF THE

TARGETS AS PART OF AN

ENVIRONMENTAL GOAL, PART OF THE

MILLENIUM DEVELOPMENT GOALS

WHICH CAME BEFORE, AND HOW IT

TOOK A MORE PROMINENT ROLE NOW

WITH SUSTAINABLE DEVELOPMENT

GOAL DEDICATED TO WATER FOCUSING

ON ENSURING AVAILABILITY AND

SUSTAINABLE MANAGEMENT OF WATER

AND SANITATION FOR ALL BY 2030.

AS WE CROSS OF HALFWAY LINE TO

2030, IN 2020 STILL HAD MORE

THAN 2.2 BILLION PEOPLE WHO

LACKED ACCESS TO SAFELY MANAGE

THE DRINKING WATER, 3.3 BILLION

PEOPLE STILL LACK SAFETY MANAGED

SANITATION, 2.2 BILLION LACK

BASIC HAND WASHING FACILITIES.

WITH REALLY A LOT OF THE

COUNTRIES, MORE THAN 25

COUNTRIES, THAT ARE FACING

EXTREME HIGH WATER STRESS

ANNUALLY, I'D LIKE TO REFLECT ON

HOW A LOT OF THESE COUNTRIES ARE

LOOKING AT MIDDLE EAST AND SOUTH

ASIA, WHERE A LOT OF POPULATION

CENTERS GLOBALLY EXIST, INDIA,

CHINA, ALSO MIDDLE EAST WHICH IS

EXPECTED TO DOUBLE IN POPULATION

BEFORE 2050.

I'D LIKE TO REFLECT ON RELATIONS

WHEN SCARCITY AND CONTAMINATION

AND LOOK AT EVIDENCE IN

LITERATURE THAT SUPPORTS THAT.

NEXT PLEASE.

WATER IMPACT ON HUMAN HEALTH,

THERE'S AMPLE EVIDENCE IN

LITERATURE, FIRST OF ALL

1.7 MILLION DEATHS PER YEAR ARE

ATTRIBUTED TO UNSAFE WATER,

IMPROPER SANITATION, POOR

HYGIENE WHICH LEADS TO DISEASES

IN DIFFERENT PLACES GLOBALLY.

AND AS WE LOOK AT WATER

AVAILABILITY, AND THE LACK OF

DRINKING WATER, THERE'S EVIDENCE

LINKING DEHYDRATION WITH

DISEASE, INCREASED RISK OF

CARDIOVASCULAR DISEASES, AS WELL

AS RELATION BETWEEN HYPERTENSION

AND HYDRATION PARAMETERS AND

ACUTE HYPOHYDRATION, VASCULAR

FUNCTION IMPAIRMENT, BLOOD

PRESSURE REGULATION.

REALLY, THE LINK BETWEEN

AVAILABILITY AND ENSURING WE'RE

GETTING THE RIGHT HYDRATION AND

RIGHT ACCESS TO WATER AND HUMAN

HEALTH IS VERY CLEAR HERE, ALSO

QUALITY OF WATER.

RISK OF CONTAMINATED WATER, 88%

ACCORDING TO CDC, 88% OF

DIARRHEA-ASSOCIATED DEATHS ARE

CAUSED BECAUSE OF LACK OF ACCESS

TO SAFE WATER AND SANITATION AND

HYGIENE.

THERE'S EVIDENCE BETWEEN LINKS

ON CONTAMINATED WATER SOURCE,

CHOLERA, DYSENTERY, SANITATION,

DIARRHEA, STH INFECTION AND

SCHISTO.

REFLECTING WITH IMPACT ON

PLANETARY HEALTH, WATER

SCARCITY, SO WATER IS UNDERGOING

PRESSURES OF DIFFERENT SYSTEMS,

WE'RE LOOKING AT URBAN GROWTH,

LOOKING AT GROWTH IN AGRICULTURE

SECTOR, IN ENERGY SECTOR, AND

THE NEED FOR MAINTAINING

ECOSYSTEMS, COMPROMISING ACROSS

DIFFERENT SECTORS WHICH WITH ALL

PROJECTED TO GROW AS WE MOVE

FORWARD.

ALSO, WATER STRESS ECOSYSTEMS

RESULT IN LOSS OF BIODIVERSITY,

AS WELL AS IMPACT, SO IT HAS AS

WE'RE LOOKING AT WATER

CONTAMINATION AS WELL, AND ITS

IMPACT ON BIODIVERSITY AND

ECOSYSTEMS.

GLOBAL WATER QUALITY DECLINED AS

WE FOCUS ON QUALITY, HAS LED TO

AGRICULTURAL LOSSES FROM SALINE

WATER EQUIVALENT TO ANNUAL FOOD

REQUIREMENTS OF 170 MILLION

PEOPLE WHICH AGAIN REFLECTING ON

THE IMPACT OF WATER QUALITY ON

AGRICULTURE SYSTEMS AND HOW IT

IMPACTS ON FOOD AVAILABILITY,

OFTP AFFECTING THOSE WHO ARE

LEAST ABLE TO FACE THE

CHALLENGES.

WATER SYSTEM AS WELL IS UNDER

GROWING PRESSURES FROM TRENDS

THAT WE'RE SEEING IN TERMS OF

POPULATION GROWTH, EXPECTING TO

HIT 10 BILLION BY 2050, GROWING

CLIMATE CHANGE TRENDS AFFECTING

THE AVAILABILITY OF WATER AND

DIFFERENT PLACES, AGAIN OFTEN

AFFECTING THOSE WHO ARE MOST

VULNERABLE AND LEAST ABLE TO

RESPOND TO THESE CHALLENGES,

GROWING URBANIZATION WHERE MOST

PEOPLE ARE LIVING IN CITIES AND

THAT TREND KEEPS CONTINUING.

WE FACE DIFFERENT SHOCKS,

INCLUDING EXAMPLES WE SEE WITH

COVID-19 AND THE RAPID OR SUDDEN

DEMAND FOR MORE ACCESS TO WATER

FOR MORE HYGIENE AND HAND

WASHING PURPOSES.

THE IMPACT OF NATURAL DISASTERS

AND IMPACT OF THAT ON

INFRASTRUCTURE AND ON WATER

CONTAMINATION, AS A RESULT, AS

WELL AS TRENDS THAT RESULT FROM

CONFLICTS AND LEADING TO

MIGRATION WHICH ALSO COULD PUT

PRESSURES ON HOST COUNTRIES, WHO

ARE ALSO MIGHT BE VULNERABLE AND

FACING -- ALREADY FACING

PRESSURES ON WATER SYSTEMS.

THERE ARE ALSO SOME SYSTEMIC

CHALLENGES AND CROSS-CUTTING

CHALLENGES, WITH THE LACK OF

INTEGRATED APPROACHES TO WATER

MANAGEMENT AND LACK OF FINANCING

AS WELL.

THE WORLD BANK IN 2023 REPORT

ESTIMATED $6.7 TRILLION NEEDED

FOR WATER-RELATED INFRASTRUCTURE

BY 2030, AND THERE'S A MAJOR

INVESTMENT GAP THERE IN MEETING

THOSE FINANCING NEEDS.

THAT PRESSURE ON WATER SYSTEM IS

ONLY PART OF THE PICTURE.

NEXT SLIDE PLEASE.

AS WE PROJECT INTO 2050 AND

THESE NUMBERS ARE RELATIVE TO

YEARS 2015, WE ARE EXPECTING TO

NEED 55% MORE WATER, 60% MORE

FOOD, AND 80% MORE ENERGY.

THESE ARE GRAND CHALLENGES,

COMPLEX CHALLENGES, BUT THESE

ARE VERY MUCH CONNECTED,

INTERCONNECTED CHALLENGES.

THAT IS AT A TIME MORE THAN 2

BILLION PEOPLE LACK ACCESS TO

SAFE DRINKING WATER, 700 MILLION

SUFFER FROM CHRONIC HUNGER, MORE

THAN 700 MILLION PEOPLE STILL

LACK ACCESS TO ENERGY.

UNLESS WE TAKE A SYSTEMS

APPROACH TO ADDRESS THESE

CHALLENGES, QUANTIFY THEM AND

DEVELOP NECESSARY TOOLS, WE WILL

NOT BE ABLE TO ADDRESS THESE

CHALLENGES AS WE MOVE FORWARD.

THE CHALLENGE WE'RE LOOKING AT

AND THIS WAS KIND OF A

CONCEPTUALIZATION, TYING THIS

BACK TO HUMAN HEALTH AND

PLANETARY HEALTH, NEXT SLIDE

PLEASE, IS --

>> ONE MINUTE LEFT.

>> OKAY.

>> NEXT SLIDE PLEASE.

IS BEING ABLE TO MEET ALL OF

THESE DEMANDS AND BRIDGE THOSE

GAPS, WHILE MEETING HUMAN HEALTH

AND WELL-BEING NEEDS, BUT WHILE

ALSO WITHIN THE BOUNDARIES OF

OUR PLANETARY HEALTH, UNDER

THESE GROWING PRESSURES AND

STRESSES ON OUR INTERCONNECTED

RESOURCE SYSTEMS AT A TIME WE

STILL LACK THE PROPER DECISION

SUPPORT TOOLS TO GUIDE

EVIDENCE-BASED DECISION MAKING,

LACK CROSS-SECTOR MECHANISMS FOR

COORDINATION, WE HEARD A LOT

FROM SPEAKERS TODAY ABOUT HOW WE

HAVE DIFFERENT SECTORS WITH

DIFFERENT PLAYERS, DIFFERENT

OBJECTIVES, WITH NO PROPER

MECHANISMS FOR THEM TO DO THIS

KIND OF INTEGRATIVE PLANNING

WITH NO RIGHT TOOLS TO DO THIS

KIND OF TRADEOFF ANALYSIS THAT

MEETS DIFFERENT OBJECTIVES WHICH

MIGHT BE POTENTIALLY

CONFLICTING.

NEXT SLIDE PLEASE.

SO MOVING FORWARD, SOLUTIONS,

THE MESSAGE I'D LIKE TO LEAVE

YOU WITH IS AS WE'RE THINKING OF

WATER-RELATED CHALLENGES,

SOLUTIONS TO WATER CHALLENGES

WON'T EXCLUSIVELY COME FROM THE

WATER SECTOR.

SIMILARLY SOLUTIONS TO PUBLIC

HEALTH CHALLENGES WON'T

EXCLUSIVELY COME FROM THE HEALTH

SECTOR.

WE NEED TO UNDERSTAND HOW

SECTORS ARE INTERCONNECTS,

QUANTIFY, DEVELOP TOOLS AND HELP

US EVALUATE THE TRADEOFFS

BETWEEN DIFFERENT PATHWAYS

FORWARD AND DIFFERENT

INTERVENTIONS WHETHER TECHNICAL,

POLICY, SOCIAL, BEHAVIORAL, AND

IMPACTS ON CO-CREATED METRICS

THAT NEED TO BE CO-CREATED WITH

DIFFERENT SECTORS AND

STAKEHOLDERS.

THERE'S A NEED TO WORK ON

DEVELOPING INTERDISCIPLINARY

RESEARCH THAT IDENTIFIES

OPPORTUNITIES, ENABLES US TO

DEVELOP NEW KNOWLEDGE THAT

INDEPENDENTLY WE WON'T DEVELOP

UNLESS WE COLLABORATE AND

COOPERATE AND DEVELOP NEW

ENVIRONMENTS FOR PARTNERSHIPS

BETWEEN PRIVATE, PUBLIC,

SOCIETY, AND ACADEMIA, AND LAST

BUT NOT LEAST ALSO ENSURING THAT

AS WE'RE BUILDING THOSE

INTERDISCIPLINARY RESEARCH TEAMS

AND LOOKING AT INTERACTING WITH

AND BUILDING THESE ENVIRONMENTS

FOR BETTER COOPERATION ACROSS

SECTORS THAT WE KEEP THOSE TWO

ENVIRONMENTS CLOSELY ALIGNED AND

INTEGRATED IN A WAY WITH EACH

OTHER WITH CONTINUOUS FEEDBACK

AS WE DEVELOP THIS RESEARCH

WHILE ENGAGING STAKEHOLDERS VERY

EARLY ON IN THE PROCESS AND

DRIVING OUR RESEARCH AGENDA AS

A RESULT OF FEEDBACK AND INPUT

FROM THAT ENGAGEMENT.

LAST SLIDE, TEN SECONDS, THESE

ARE RESEARCH OPPORTUNITIES THAT

ARE, AGAIN, ALIGNED WITH WHAT I

JUST MENTIONED.

SO HOW DEVELOP NEW DECISION

TOOLS AND METHODOLOGIES, TO

IDENTIFY IDENTIFICATION OF

SYNERGIES AS WE THINK OF FOOD

SYSTEM TRANSFORMATION, ENERGY

TRANSITION, AND WATER SECURITY

WITHIN THE BOUNDS OF MEETING

HUMAN HEALTH AND PLANETARY

HEALTH NEEDS, WHAT ARE THE

METRICS THAT WE NEED TO USE,

WHAT DOES SUSTAINABILITY AND

RESILL RESILIENCY MEAN, WHAT

DOES SUSTAINABLE AND RESILIENCY

MEAN FOR ONE COMMUNITY OVER

ANOTHER, THE IMPORTANT NEED OF

CONTEXTUALIZING THESE CHALLENGES

AND WORKING CLOSELY WITH

COMMUNITIES, ALSO IN TERMS OF

GOVERNANCE STRUCTURES, WHAT ARE

THESE GOVERNANCE STRUCTURES AND

POLICY FRAMEWORKS THAT WOULD

ALLOW FOR THIS TYPE OF

INTEGRATED APPROACHES, AND THE

LAST TWO, MORE LIKE MAYBE TEAM

SCIENCE RESEARCH QUESTIONS, WHAT

CONSTITUTES ENABLING ENVIRONMENT

THAT ALLOWS FOR THIS TYPE OF

CROSS-DISCIPLINARY RESEARCH

COLLABORATION KNOWING THAT

DIFFERENT DISCIPLINES HAVE

DIFFERENT APPROACHES,

METHODOLOGIES, LANGUAGES, SO

THAT'S ALSO SOMETHING THAT'S

WORTH EXPLORING AS WE MOVE

FORWARD.

I'LL STOP HERE AND I HAVE MY

CONTACT INFORMATION IF ANYONE

WOULD LIKE TO CONTINUE THE

CONVERSATION.

THANK YOU VERY MUCH.

>> THANK YOU VERY MUCH.

WE CAN SEE CROSS-CUTTING THEMES

ACROSS MANY OF THE TALKS TODAY.

WE'RE DELIGHTED TO WELCOME DR.

ANA NAVAS-ACIEN, DEPARTMENT OF

ENVIRONMENTAL HEALTH SCIENCES,

COLUMBIA MAILMAN SCHOOL OF

PUBLIC HEALTH, PHYSICIAN

EPIDEMIOLOGIST, P.I. OF

ENVIRONMENTAL STUDIES IN

MULTIPLE NHLBI INCLUDING STRONG

HEART STUDY, MULTI-ETHNIC STUDY

OF ATHEROSCLEROSIS.

>> IF YOU CAN START WITH THE

NEXT SLIDE.

VERY GOOD.

I WANT TO THANK THE PREVIOUS

PANELISTS, FOCUS WAS AT THE

MACRO LEVEL.

I'M GOING TO MAYBE BRING THE

MICRO LEVEL, HOW COMMUNITIES ARE

AFFECTED BY THESE ISSUES IN

THEIR LIVES, IN THEIR HEALTH,

WHAT CAN WE DO TO HELP PREVENT

OUTCOMES.

I WANT TO START WITH THE GLOBAL

BURDEN OF DISEASE RELATED TO

ENVIRONMENTAL CONTAMINANTS.

FOR CARDIOVASCULAR DISEASE, IT

HAS BEEN ESTIMATED BY THE WORLD

HEALTH ORGANIZATION THAT WE

COULD ELIMINATE 31% OF THE

CARDIOVASCULAR BURDEN IF WE

COULD ELIMINATE SOME SPECIFIC

CONTAMINANTS.

THE ONES INCLUDED SO FAR BASED

ON EVIDENCE AVAILABLE ARE AIR

POLLUTION, TOBACCO SMOKE,

SECONDHAND SMOKE, AND AMONG

CHEMICALS, THE ONLY ONE THAT HAS

INCLUDED SO FATHER HAS BEEN

LEAD.

AND LEAD EXPOSURE IN

CARDIOVASCULAR DISEASE HAS

BECOME MORE ESTABLISHED, AND

ACTUALLY ONE OF THE ARGUMENTS

FOR THE RECENT INITIATIVE TO

PROTECT COMMUNITIES FROM LEAD

PIPES AND PAINT ACROSS THE

UNITED STATES WHICH IS A

BIPARTISAN INFRASTRUCTURE LAW

PASSED RECENTLY, HAS BEEN BASED

ON THE BENEFIT FOR THE

CARDIOVASCULAR SYSTEM FROM

REMOVING LEAD.

AND IF YOU GO TO THE NEXT SLIDE,

YOU CAN SEE ALSO THE AMERICAN

HEART ASSOCIATION RECENTLY

ESTABLISHED CONTAMINANT METALS

INCLUDING SPECIFICALLY LEAD,

AND CADMIUM.

THIS IS RELEVANT BECAUSE THIS

EXPOSURE IS HAPPENING, I'M

FOCUSING ON METAL BUT MANY OTHER

ENVIRONMENTAL CONTAMINANTS,

HAPPENING THROUGH HIGH RISK

EXPOSURE AND CHRONIC LOW LEVELS

TO OUR DAILY LIFE.

ALL THE THINGS WE'VE BEEN

DISCUSSING AT THE VERY MACRO

LEVEL, POLLUTION IN THE AIR,

ENERGY, THE WAY WE IMPLEMENT

ENERGY, FOOD SYSTEMS, WATER

SYSTEMS WILL IMPACT LOW-LEVEL

CHRONIC EXPOSURES.

NEXT.

IF WE TAKE FOR INSTANCE ARSENIC

IN THE WATER AS AN EXAMPLE OF

CONTAMINANT THAT AFFECTS

COMMUNITIES ACROSS THE U.S., YOU

CAN SEE IT IS SUBSTANTIAL

EXPOSURE IN PRIVATE WELLS

THROUGH GROUND WATER, PEOPLE WHO

RELY ON GROUND WATER, VERY

IMPORTANT IN RURAL COMMUNITIES,

AND COMMUNITY WATER SYSTEMS THAT

OFTEN RELY ON GROUND WATER, AND

THIS IS A DIRECT CONNECTION WITH

CLIMATE CHANGE, DROUGHT, AND

WATER SCARCITY, THE NEED TO RELY

ON GROUND WATER.

AS WE KNOW WITH CLIMATE CHANGE

THESE LEVELS OF CONTAMINANTS IN

GROUND WATER ARE LIKELY TO

INCREASE.

NEXT.

AND WHILE THIS CONTAMINATION IS

OFTEN NATURALLY OCCURRING IT'S

RELATED TO ANTHROPOGENIC

ACTIVITIES OFTEN RELATED TO

ENERGY POLICY DECISIONS, WARS IN

THE WORLD, AS YOU CAN SEE IN THE

UNITED STATES WE'VE DONE VERY

IMPORTANT MINING IN COMMUNITIES,

ESPECIALLY IN THE WESTERN PART

OF THE COUNTRY, AND URANIUM

MINING DETRIMENTAL PARTICULARLY

AFFECTING INDIGENOUS COMMUNITIES

WHICH TEND TO BE CLOSE TO THESE

MINING AREAS.

THIS IS A REAL ISSUE.

URANIUM CONTAMINATION IN

DRINKING WATER IS A REALITY IN

THE COUNTRY, THIS IS SOMETHING

UNDERSTUDIED.

URANIUM IS A KIDNEY TOXICANT,

NEPHROTOXIC ELEMENT WITH

POTENTIAL EVIDENCE FOR

CARDIOVASCULAR TOXICITY BUT

RESEARCH IS TINY SO HOW THIS

VARIABILITY IN URANIUM

CONTAMINATION IS CONTRIBUTING TO

DISEASE RISK IS UNKNOWN.

NEXT.

I WAS TELLING YOU I WANTED TO

BRING YOU TO A MORE COMMUNITY

PERSPECTIVE.

IF YOU TAKE THIS COMMUNITY IN

SOUTH DAKOTA, EACH OF THESE DOTS

IS THE WATER THAT THEY ARE

DRINKING.

THIS IS THE WATER THEY HAVE IN

THE HOUSE.

THEY DON'T HAVE ANY OTHER WATER.

AND THE DOTS ARE RED IF THEY

HAVE HIGH ARSENIC AND URANIUM,

BLUE ARSENIC, BLACK YOUR

URANIUM.

EVERYBODY IN THE FAMILY,

CHILDREN, ADULTS, PREGNANT

WOMEN, ARE GOING TO BE AFFECTED

BY THIS CONTAMINATION ON CHRONIC

BASIS.

NEXT.

SO EPIDEMIOLOGICAL FRAMEWORK AND

APPROACHES ARE ABLE TO INTEGRATE

MULTIPLE SOURCES OF EXPOSURE

INCLUDING IN THIS CASE WATER

CONTAMINANTS, WHICH COULD BE

QUITE DIFFICULT TO DO, IF WE TRY

TO REALLY GO TO THESE ASSESSMENT

AT THE ENVIRONMENTAL LEVEL, BUT

THROUGH THE USE OF METAL

BIOMARKERS WE'RE ABLE TO

ACTUALLY QUANTIFY INDIVIDUAL

EXPOSURES.

NEXT.

AND WHEN WE'VE DONE THAT TYPE OF

WORK, WE'VE COMPARED TWO

DIFFERENT POPULATIONS, BOTH FROM

THE NHLBI, WITH HELP FROM THE

NIEHS, TO FUND ENVIRONMENTAL

BIOMONITORING AND METALS

ASSESSMENT, RURAL COMMUNITIES IN

THE U.S., MESA STUDY, URBAN

COMMUNITIES, YOU CAN SEE

AMERICAN INDIAN COMMUNITIES IN

THE STRONG HEART STUDY ARE

AFFECTED BY HIGHER ARSENIC,

HIGHER URANIUM, HIGHER TUNGSTEN,

METALS THAT CLUSTER IN DRINKING

WATER, SUPPORTING THIS

CLUSTERING IN THE URINE IS

REFLECTING SOURCE OF WATER

CONTAMINATION AND ACTUALLY IN

ADDITIONAL WORK WE'VE DONE WE

HAVE QUANTIFIED HOW MUCH OF THE

URINARY EXPOSURE IS RELATED TO

THE WATER CONTAMINATION.

THIS IS IMPORTANT BOTH IN THE

STRONG HEART STUDY AND ALSO EVEN

IN URBAN COMMUNITIES LEVELS OF

CONTAMINANTS IN THE WATER AFFECT

HUMAN EXPOSURE.

NEXT.

SO TO UNDERSTAND THE HEALTH

EFFECTS AND IMPLICATIONS OF

EXPOSURES, EPIDEMIOLOGICAL

STUDIES ARE REALLY IMPORTANT.

THE RESOURCE FROM NHLBI COHORTS

ARE CRITICAL.

NEXT.

THE STRONG HEART STUDY IN

PARTICULAR HAS BEEN A ROLE MODEL

OF PARTICIPATORY SCIENCE, SINCE

THE EARLY '80s WHEN THE COHORT

STARTED 9.

THE WORK HAS BEEN POSSIBLE

BECAUSED DAY-TO-DAY ELABORATION

OF COMMUNITY MEMBERS,

INVESTIGATORS, THIS IS A PICTURE

OF THE STEERING COMMITTEE WHICH

HAS INCLUDED FROM THE BEGINNING

COMMUNITY MEMBERS, AT THE BOTTOM

YOU SEE A PICTURE OF THE FIELD

TEAM, LOCAL RESEARCH TEAM,

FORMED BY LOCAL COMMUNITY

MEMBERS WHO ARE IN CHARGE OF

DOING THE -- IMPLEMENTING THE

STUDY, REALLY HAS BEEN A ROLE

MODEL FOR PARTICIPATORY-BASED

RESEARCH FOR DECADES GOING ON.

NEXT.

AND THROUGH THAT WORK, BRINGING

IN ENVIRONMENTAL EXPOSURES TO

UNDERSTANDING THE ROLE IN

CARDIOVASCULAR DISEASE, WE WERE

ABLE TO DOCUMENT THAT ARSENIC

EXPOSURE WAS RELATED TO HIGHER

RISK OF CARDIOVASCULAR DISEASE,

MORTALITY AND INCIDENCE IN

ADULTHOOD, OLDER ADULTHOOD.

YOU CAN ALREADY IDENTIFY

CLINICAL EFFECT WITH THE LEFT

VENTRICULAR MASS INDEX,

INDICATES THE HEART IS ALREADY

AFFECTED AT EARLY AGES,

REPLICATED IN OTHER RURAL

COHORTS IN THE UNITED STATES, IN

COLORADO AREA, AND ALSO IN

ANIMAL MODELS THAT TRY TO

REPLICATE THE HUMAN FINDINGS.

NEXT.

IN ADDITION TO UNDERSTANDING HOW

MUCH RISK OF DISEASE THERE IS

BASED ON THIS ENVIRONMENTAL

EXPOSURE, BY HAVING TRACKING

OVER TIME WE CAN ACTUALLY

DOCUMENT WHAT HAPPENS WHEN YOU

REMOVE ENVIRONMENTAL TOXICANTS

FROM THE ENVIRONMENT.

WHAT HAPPENS TO THE COMMUNITIES,

CAN YOU SEE ANY BENEFIT?

AND LEAD AND BLOOD PRESSURE

CONNECTION HAS BEEN SHOWN FOR

DECADES, ACTUALLY FOR MORE THAN

A CENTURY, IT'S BEEN SHOWN LEAD

POISONING INCREASES BLOOD

PRESSURE LEVELS.

AND WE HAVE THE OPPORTUNITY IN

THE STRONG HEART STUDY TO

DOCUMENT BECAUSE OF LEAD HAS

BEEN DECLINING IN THE U.S. THAT

HAPPENED ALSO IN STRONG HEART

STUDY COMMUNITIES, WE WERE ABLE

TO SHOW HISTOGRAM SHOWS DECLINE,

SO POSITIVE NUMBERS ARE PEOPLE

WHO DECLINED OVER TIME, AND

NEGATIVE NUMBERS WHICH ARE FEWER

PEOPLE WHO DIDN'T DECLINE.

THEY ACTUALLY INCREASED.

YOU CAN SEE DECLINE THAT ALSO

HAPPENED IN SYSTOLIC BLOOD

PRESSURE LEVELS, AS SHOWN IN

REMOVING EXPOSURE HAS ACTUALLY A

REAL BENEFIT FOR HUMAN HEALTH.

THIS PAPER IS COMING IN A COUPLE

WEEKS.

NEXT.

GIVEN THESE FINDINGS, WORK PRIOR

TO SYSTOLIC STUDY BUT RELATED,

WE WERE INTERESTED IN WORK LED

BY MARIA, SAYING IF THERE

DECLINE AND CARDIOVASCULAR

DISEASE HAS DECLINED IN THE U.S.

CAN WE LEVERAGE THE NHANES

COHORT SAND IMPLEMENTING

FRAMEWORK WHERE PERIOD IS THE

EXPOSURE AND MEDIATOR IS THE

CHANGES IN LEAD LEVELS AND

CADMIUM, CAN WE DOCUMENT IF THIS

EXPLAINS CHANGES IN

CARDIOVASCULAR DISEASE, IF YOU

GO NEXT WHAT WE FOUND IS THAT

ACTUALLY THE CHANGES IN BLOOD

LEAD WERE EXPLAINED QUITE A

SUBSTANTIAL AMOUNT OF THE

REDUCTION IN PREVENTION IN

CARDIOVASCULAR DISEASE DEATHS,

SAND THIS IS ON STOP OF

CONTROLLING FOR RISK FACTOR FOR

CARDIOVASCULAR DISEASE,

TREATMENT, AND ACCESS TO HEALTH

CARE, OTHER DEMOGRAPHIC CHANGES

IN THE POPULATION.

OF 231 DEATHS PER 100 SOMEHOW

BETWEEN THE PERIODS, 22% COULD

BE EXPLAINED BY CHANGES IN LEAD

REDUCTION.

ACTUALLY, THIS WAS ONE OF THE

BIGGEST RISK FACTORS THAT

EXPLAINED ANY CHANGES IN

CARDIOVASCULAR DISEASE.

SO THIS DOCUMENTS THESE

ENVIRONMENTAL EXPOSURES ARE VERY

IMPORTANT FOR CARDIOVASCULAR

DISEASE, WE ACTUALLY CAN DO

SOMETHING ABOUT THIS FOR

PREVENTION BY TARGETING THESE.

NEXT.

I'M IN EPIDEMIOLOGY.

YOU CANNOT CONTINUE WITHOUT

TRYING TO THINK OF WHAT CAN WE

MOVE INTO PREVENTION

INTERVENTION.

AND NEXT.

SO ARSENIC WAS IMPORTANT, FIRST,

SORRY, I WANT TO ACKNOWLEDGE

THAT BIG INFRASTRUCTURE

HAPPENED, KIND OF IN PARALLEL TO

OUR REPORTING OF THE ARSENIC AND

CARDIOVASCULAR DISEASE FINDINGS.

BUT BECAUSE TO TRY TO BRING IN

SAFE DRINKING WATER TO THE

COMMUNITIES IN THE STRONG HEART

STUDY AREA, NEXT, BUT ONE OF THE

ISSUES, AND IN CONNECTION WITH

THAT WORK, WE PUT TOGETHER -- WE

DEVELOPED BRINGING IN DIFFERENT

DISCIPLINES TO TRY TO ADDRESS

THE PROBLEM OF ENVIRONMENTAL

HAZARDOUS CONTAMINATION RELATED

TO MINING AND NATURALLY

OCCURRING IN THE NORTHERN

PLAINS, PART OF THE SUPERFUND

RESEARCH PROGRAM.

I WANT TO HIGHLIGHT THIS PROGRAM

WHICH IS FUNDED THROUGH A

DIFFERENT MECHANISM BECAUSE

FUNDING COMES FROM DEPARTMENT OF

THE INTERIOR, BUT IT'S HANDLED

LEAD BY NIEHS, AND THIS PROGRAM

IS UNIQUE IN THE NIH BECAUSE IT

BRINGS IN MULTI-DISCIPLINARY

SCIENTISTS, A WONDERFUL MODEL TO

DEALT WITH CLIMATE HEALTH

ISSUES, BRINGS IN SCIENTISTS,

ENGINEERS, EARTH SCIENTISTS,

BIOMEDICAL SCIENTISTS INCLUDING

BASIC SCIENTIST AND

EPIDEMIOLOGIST, COMMUNICATION,

PARTICIPATORY SCIENCE, APPLYING

THAT MODEL TO SPECIFIC

COMMUNITIES IN THE NORTHERN

PLAINS.

IF WE GO NEXT, BRING IN

TRADITIONAL KNOWLEDGE,

INDIGENOUS PRINCIPLES TO THE

WORK IS REALLY CRITICAL.

INCLUDING COLLECTIVE LEADERSHIP,

VALUE OF TRADITIONAL KNOWLEDGE,

VALUE FOR WATER, SEVEN

GENERATION PRINCIPLE WHICH IS SO

IMPORTANT FOR THE ISSUES OF

CLIMATE AND HEALTH, HOW

DECISIONS THAT WE MAKE TODAY ARE

GOING TO AFFECT DECISIONS SEVEN

GENERATIONS DOWN THE ROAD, AND

ASPECT OF RELATIONALITY

CONNECTED WITH SYSTEMS SCIENCE,

CONNECTIONS BEING CIRCULAR

RATHER THAN LINEAR AND ACCEPTING

RESEARCH GOAL TRIBES DEVELOPED

WHICH HAS BEEN DISCUSSED ALSO

EARLIER AND I DON'T WANT TO --

WE DON'T HAVE TIME BUT

ESPECIALLY CONCEPT OF

SOVEREIGNTY.

NEXT.

SO, ON AS PART OF THE SUPERFUND

RESEARCH PROGRAM,

MULTI-DISPLINARY CENTER, WE HAVE

FIVE PROJECTS.

EACH PROJECT HAS A LITTLE BIT OF

SLIGHTLY ANGLE, MORE BIOMEDICAL

IN BLUE, ENGINEERING AND EARTH

SCIENCE IN BROWN,

INTERCONNECTION AMONG THE

PROJECTS.

AND ALSO BRINGING IN INCREDIBLE

AMOUNT OF PARTNERSHIPS, BOTH

TRIBAL LEVEL, TRIBAL

ORGANIZATIONS, AS WELL AS

DIFFERENT GOVERNMENTAL

ORGANIZATIONS.

TOGETHER WITH US AT THE

UNIVERSITY LEVEL, AND PARTNERS,

RESEARCH PARTNERS LOCALLY,

ALLOWS US TO DO THIS AMBITIOUS

WORK.

NEXT.

ONE OF THE RELATED PROJECTS WAS

TO BRING IN SAFE DRINKING WATER

TO THE COMMUNITY MEMBERS THAT

STILL RELY ON PRIVATE WELLS.

WE CALL THIS PROJECT THE STRONG

HEART WATER STUDY, PARTICIPATORY

RANDOMIZED TRIAL IN SOUTH DAKOTA

THAT BROUGHT IN FILTERS TO

ELIMINATE ARSENIC FROM THE

DRINKING WATER, RANDOMIZATION

WAS SIMPLE EDUCATIONAL

INTERVENTION STANDARD AND VERSUS

MORE COMPREHENSIVE INTERVENTION,

EVERYBODY RECEIVED SAFETY WATER.

NEXT.

I WANT TO BRING SOME PICTURES,

SORRY, FIRST I WANT TO BRING IN

THE NEED TO DO THIS VERY

MULTI-LEVEL CONCEPTUAL FRAMEWORK

WHEN DOING INTERVENTIONS OF THIS

SCALE, THINKING WHEN YOU'RE

BRINGING INTERVENTIONS, IT'S

COMPLICATED, THINK ABOUT

BENEFITS AND RISK, BRING IN THE

INDIVIDUAL LEVEL, HOUSEHOLD

LEVEL, COMMUNITY, TRIBAL LEVEL,

AND THEN THE FEDERAL LEVEL ALSO.

NEXT.

WHAT I WANTED AND THE PAPER FOR

THIS WORK IS GOING TO BE PUBLISH

THE VERY SOON.

WE FOUND A SUCCESS IN THE

INTERVENTION COMING AS SOON

AS -- STILL UNDER REVIEW BUT

POSITIVE INITIAL REVIEWS.

I WANT TO SHOW THE PICTURE FROM

CHRISTINE GEORGE, P.I. OF THE

STUDY, WITH MYSELF.

WHEN WE FIRST PRESENTED THE

PROJECT I TOOK THIS PICTURE WHEN

SHE WAS TALKING.

YOU CAN SEE THE COMMUNITY

MEMBERS DIFFERENT LEVELS OF

LEADERSHIP, WONDERFUL EXPERTISE

HERE IN THIS PICTURE FROM TRIBAL

WATER, HEALTH DEPARTMENT, AND

REPRESENTING THIS PROJECT, YOU

CAN SEE THERE'S A LOT OF

CONCERN, THERE'S A LOT OF

ATTENTION.

THIS IS AN IMPORTANT ISSUE.

BUT IT'S NOT NECESSARILY THE WAY

WE PRESENTED, THE IDEAS WE

THINK, AND NOT RESONATING

COMPLETELY.

THERE IS A LOT OF DEBATE AND

DISCUSSION, AND TALKING WHICH IS

REALLY IMPORTANT.

AND I WANT NEXT, IF YOU GO TO

THE NEXT PICTURE, I REALLY LIKE

THE FINAL PICTURE BECAUSE AFTER

SEVERAL HOURS OF REALLY STRONG

DEBATE AND DISCUSSION ABOUT HOW

TO DO THIS WORK, WE CAME TO SOME

REAL CONNECTION, HELP US A LOT

TO ACTUALLY PUT THIS WORK

TOGETHER.

AND THIS REQUIRES A LOT OF TIME,

EFFORT, WORKING WITH

COMMUNITIES, BEING CONNECTED.

AND INCORPORATING A LOT OF

FEEDBACK AND DOING THIS REALLY

COLLECTIVELY.

NEXT.

AND THE OTHER ASPECT I WANT TO

TALK ABOUT IS TECHNOLOGY.

REALLY IN THE FIELD OF

ENVIRONMENTAL TOXICANTS, NOT

ONLY METALS, ABILITY, ANALYTICAL

ABILITY, IT'S REALLY -- IT'S

BEEN POWERFUL, ALLOWING US TO DO

THIS WORK.

NEXT.

THIS IS PARTICULARLY IMPORTANT

WHEN YOU GO TO COMMUNITIES LIKE

MESA, I WAS TELLING YOU EARLIER,

PLEASE NEXT.

>> WE HAVE ABOUT A MINUTE LEFT.

>> OKAY.

VERY GOOD.

WHEN WE GO TO MESA TECHNOLOGY,

YEAH, I'M ALMOST DONE.

WE FOUND IN IN MESA, RELATED

TO TOTAL MORTALITY, NEXT, SO --

NEXT.

I WANT TO JUST FINALLY SAY THERE

ARE OPPORTUNITIES FOR

INTERVENTION THAT ARE BEYOND

PREVENTION OR POLICY LEVEL OR

INFRASTRUCTURE LEVEL, SO NEXT.

I WANT TO BRIEFLY MENTION THE

OPPORTUNITY OF METAL CHELATION

AND RECOGNIZE, NEXT, A CLINICAL

TRIAL, NEXT, SORRY, I SHOULD NOT

HAVE ANIMATIONS.

AND THIS IS A TRIAL THAT WAS

CONDUCTED A NUMBER OF YEARS AGO,

THERE IS NOW A SECOND TRIAL,

COLLECTIVELY BETWEEN THE TWO

TRIALS HOPEFULLY WE CAN LEARN

SOMETHING ABOUT THE POTENTIAL.

NEXT.

ABOUT THE POTENTIAL -- THIS IS

THE SECOND TRIAL, WHICH WILL BE

REPORTED VERY SOON AND

COLLECTIVELY WE HOPE TO LEARN

ABOUT THIS POTENTIAL OPPORTUNITY

FOR CARDIOVASCULAR DISEASE

TREATMENT.

NEXT.

AND THIS IS -- IF YOU DO NEXT,

THIS WILL BE MY FINAL SLIDE.

IN CARDIOVASCULAR DISEASE

PREVENTION, MOST OF THE

GUIDELINES FROM THE AMERICAN

HEART ASSOCIATION AND COLLEGE OF

CARDIOLOGY AND IN GENERAL FOCUS

ON LIFESTYLE AND CLINICAL CARE,

THAT RECOGNITION AND JUST THE

FACT NHLBI IS ORGANIZING THIS

PANEL, THIS WORKSHOP, IS REALLY

RECOGNIZED HOW IMPORTANT ADDING

THE ENVIRONMENTAL PIECE TO

CARDIOVASCULAR DISEASE

PREVENTION IS.

THANK YOU SO MUCH FOR YOUR

ATTENTION AND HAPPY TO START THE

DISCUSSION.

>> THANK YOU.

EXCELLENT TALK.

I WANT TO THANK THE SPEAKERS FOR

EXTREMELY THOUGHT-PROVOKING

TALKS.

WE'LL BRING THEM ALL BACK TO THE

GALLERY AT THIS POINT.

ALSO BRING IN OUR CO-CHAIRS TO

KICK OFF THE DISCUSSION LED BY

DR. JOEL KAUFMAN, UNIVERSITY OF

WASHINGTON SEATTLE.

PROFESSOR, PHYSICIAN,

EPIDEMIOLOGIST, DIRECTOR OF

WASHINGTON CENTER FOR DISEASES,

EDITOR IN CHIEF OF ENVIRONMENTAL

HEALTH PERSPECTIVES PUBLISHED BY

NATIONAL INSTITUTE OF

ENVIRONMENTAL HEALTH SCIENCES.

WE'RE FORTUNATE HE ACCEPTED OUR

REQUEST TO MODERATE WITH HIS

EXPERT PERSPECTIVE.

THANKS AND WELCOME.

>> HELLO, THANKS FOR THAT

INTRODUCTION.

I WANT TO ASK THAT PEOPLE FEEL

FREE TO PUT THEIR QUESTIONS INTO

THE Q&A SO WE HAVE INPUT FROM

LARGE NUMBER OF ATTENDEES HERE.

THIS WAS QUITE A VARIED SET OF

DISCUSSIONS THAT WE HAD HERE.

I WANT TO CIRCLE BACK AROUND TO

A FEW OF THE TALKS AND THINK A

LITTLE BIT MORE ABOUT REALLY THE

COMPLICATED NATURE OF TRYING TO

THINK ABOUT SOLUTIONS WITH

SYSTEMS APPROACHES WHICH WAS A

THEME OF SEVERAL OF THE TALKS

THAT WE HAD IN THIS AND START ON

THAT CONVERSATION.

I THINK WE ALL RECOGNIZE THAT

THERE'S A VERY COMPLEX

INTERCONNECTED NATURE OF TRYING

TO MEET THE CHALLENGES TO BOTH

IMPROVE HEALTH AND UNDERSTAND

THE RELATIONSHIP BETWEEN

PLANETARY HEALTH AND HUMAN

HEALTH.

AND I MIGHT CIRCLE BACK AT FIRST

TO THINKING ABOUT THE QUESTION,

THE COMMENT DR. FANZA HAD ABOUT

SORTING OUT OUR MESSAGES, A GOOD

LINKAGE TO DISCUSSIONS WE HAD IN

THE FIRST SESSION.

IF I CAN GET A FINER POINT ON

THAT, HOW DO YOU SEE THE

MESSAGING THAT WOULD MOVE THIS

CONVERSATION FORWARD THE MOST

AND MAYBE DRIVE ACTION AND

INTEREST IN THESE QUESTIONS.

>> YEAH, THANKS SO MUCH FOR THE

QUESTION.

MAYBE DR. PE NEXTG COULD COME IN

TOO.

I WROTE DOWN THREE THINGS SHE

SAID ABOUT THE ENERGY TRANSITION

THAT REALLY RESONATED.

IT HAS TO BE IMMEDIATE, THERE'S

IMMEDIATE BENEFIT FOR ACTING.

IT HAS TO BE TANGIBLE.

YOU UNDERSTAND IF YOU DO ACT IT

WILL RESULT IN SOMETHING.

AND IT'S PERSONAL.

I DON'T THINK -- THE PROBLEM I

SEE IN THE FOOD SYSTEMS WORLD IS

THAT THERE'S A LOT OF DIFFERENT

PLAYERS.

AND IT'S NOT JUST THE FARMERS

AND PRODUCERS AND FISHER FOLK.

THERE'S A WHOLE SECTOR OF

TRADERS AND RETAILERS.

AND WITHIN THAT, THESE DIFFERENT

SCIENCE DISCOURSE, THERE'S A LOT

OF DIFFERENT DISCIPLINES FROM

ECONOMISTS TO MEDICAL

PROFESSIONALS THAT ARE TRYING TO

UNDERSTAND THE IMPACTS OF FOOD

ON WHAT WE WANT FOOD SYSTEMS TO

RESULT IN, BETTER HEALTH AND

NUTRITION, BETTER

SUSTAINABILITY, FAIR LIVELIHOOD,

SOCIAL EQUITY.

I THINK THERE HAS BEEN A

COALESCENS AROUND MESSAGES, BUT

THERE'S STILL A LOT OF

DISAGREEMENT IN THE SCIENCE,

THERE'S A LOT OF DISAGREEMENT ON

HOW WE TRANSMIT THE EVIDENCE TO

POLICYMAKERS.

AND I THINK WHERE WE STAND NOW,

WE DO A LOT OF WORK TRYING TO

PRESENT DATA TO POLICYMAKERS.

SOMETHING CALLED THE GLOBAL

SYSTEMS DASHBOARD, A PAPER IS

COMING OUT ON GLOBAL MONITORING

OF FOOD SYSTEMS PERFORMANCE.

TO US POLICYMAKERS ARE OFTEN

NAVIGATING IN THE DARK.

THEY DON'T KNOW HOW THEIR FOOD

SYSTEMS ARE PERFORMING, WHAT

ACTORS ARE DOING WHAT ACROSS

FOOD SYSTEMS.

IT BECOMES DIFFICULT TO RELAY

MESSAGES THAT ARE COMMON AND THE

DATA NEEDS TO FEED INTO THAT.

I THINK I DON'T THINK WE'RE AS

FAR ALONG AS THE ENERGY SECTOR.

MAYBE DR. PENG CAN TALK ABOUT

THAT.

THE ENERGY TRANSITION HAS GONE

FURTHER THAN FOOD SYSTEM

TRANSITION AND I THINK SOME IS

AROUND THE SCIENTIFIC COMMUNITY

COMING TOGETHER AROUND CORE

MESSAGES.

BUT WE ALL COME FROM DIFFERENT

DISCIPLINES AND HAVE DIFFERENT

ENTRY POINTS, FOOD SYSTEM ACTORS

THAT WE ENGAGE WITH, MAKES IT

MORE COMPLICATED.

>> PROFESSOR RAMASWAMI?

>> I THINK -- CAN YOU HEAR ME?

>> YES.

>> I THINK BY GETTING INTO

SECTORS I WANT TO GET ONE LEVEL

HIGHER THAN THAT.

THAT IS THAT ALL THESE KEY

PROVISIONING SYSTEMS ARE

IMPORTANT.

SO FOOD, ENERGY, WATER,

MOBILITY, CONSTRUCTION

MATERIALS, BECAUSE THEY AFFECT

HEAT, STRESS, ALL OF THAT.

TO ME THAT'S THE ULTIMATE FIRST

MESSAGE, KEY PHYSICAL

PROVISIONAL SYSTEMS ARE

EXTRAORDINARILY IMPORTANT.

SECOND, THAT URBAN AREAS ARE

IMPORTANT BECAUSE 85% OF US LIVE

IN URBAN AREAS.

THAT'S THE HIGHEST LEVEL, THEIR

ARE PROVISIONAL SYSTEMS, MOST OF

US LIVE IN CITIES IN THE U.S.

AND IT'S GOING TO BE SO IN THE

FUTURE.

AND SO IF WE CAN THINK ABOUT

URBAN HEALTH FROM A PLANETARY

PERSPECTIVE, SYSTEMS

PERSPECTIVE, YOU CAN GET BOTH --

YOU CAN HAVE A FRAME FOR

EVALUATING.

I JUST WANTED TO SAY BEFORE WE

SAY, WELL, THIS SECTOR AND THIS

SECTOR, OF COURSE THEY ARE ALL

IMPORTANT.

I'M NOT SAYING ONE MORE THAN THE

OTHER BUT HOLISTICALL YOU NEED

ALL, FOOD, ENERGY, WATER,

HOUSING, TO LIVE.

IT'S NOT JUST HEALTH RISKS.

IT'S ALSO YOUR ABILITY TO LIVE

AND THRIVE.

I JUST WANT TO SAY TO ME THAT'S

THE MOST FUNDAMENTAL MESSAGE.

URBAN SYSTEMS MATTER, PHYSICAL

PROVISION SYSTEMS MATTER BECAUSE

THEY ALSO SHARE EDUCATION,

HEALTH CARE.

I'LL STOP THERE.

THAT WAS THE GIST, WHATEVER I

WAS TRYING TO SAY.

THERE ARE SECTORAL QUESTIONS YOU

JUST CAN'T LIVE ANYWHERE WITHOUT

THOSE PROVISIONS.

>> DR. PENG?

>> YEAH, SO IN MY VIEW THINKING

ABOUT EFFECTIVE MESSAGING WE

FIRST THINK ABOUT WHO WE WANT TO

TALK TO, WHAT KIND OF DECISIONS

WE WANT TO CHANGE.

IF I CAN SPEAK ABOUT THE ENERGY

SIDE, WHAT WE HAVE FOUND OVER

THE PAST FEW YEARS I'VE HAD THE

PRIVILEGE TO WORK WITH

RESEARCHERS WE FOUND, YES, AT

VIRTUAL LEVEL WHEN WE MESSAGE

AROUND HEALTH, MAKING MORE

RELEVANT, MAKE THEM -- INCREASE

SUPPORT LEVEL FOR ENERGY POLICY

BUT A HUGE GAP BETWEEN

INCREASING SUPPORT TO CHANGING

THE DECISIONS.

BECAUSE AT THE INDIVIDUAL LEVEL

THERE'S LIMIT TO SOME EXTENT.

THAT'S THE REASON OVER THE PAST

LIKE TWO YEARS ACTUALLY WE HAVE

BEEN THINKING ABOUT MAYBE WE'RE

NOT TARGETING THE RIGHT AUDIENCE

IN THE FIRST PLACE BECAUSE IF

YOU ARE THINKING WHO CAN CHANGE

THE SYSTEM, WHAT ACTIONS THAT

CAN REALLY INTEGRATE ENERGY AND

AIR QUALITY AND HEALTH DECISIONS

IN THIS COUNTRY IN PARTICULAR I

THINK THE STATES ARE MORE

EFFECTIVE ENTRY POINTS BECAUSE

STATE AGENCIES RIGHT NOW WE HAVE

WINDOW OF OPPORTUNITY THANKS TO

INFLATION REJECTION ACT WHICH IS

CONGRESS INVEST INTO LOW CARBON

ENERGY, STATES ARE THE IMPORTANT

ACTOR THAT CAN DIRECTLY APPLY TO

FUNDING RESOURCES THAT CAN ALSO

HELP BUSINESSES AND LOCAL ACTORS

TO RESPOND AND TAKE ADVANTAGE OF

A LOT OF PROGRAMS.

AT THE SAME TIME STATES ARE AT

THE FOREFRONT FOR AIR QUALITY

STATE IMPLEMENTATION PLAN, A LOT

OF PUBLIC HEALTH INITIATIVES.

THAT'S WHY WE HAVE BEEN CHANGING

OUR FOCUS RECENTLY, THINKING

ABOUT MAYBE STATE AGENCIES ARE

THE RIGHT ACTORS WHERE WHEN WE

THINK ABOUT RIGHT MESSAGING AND

RIGHT IMPORTANT, USEFUL RESEARCH

INSIGHT, THOSE PLACES WHERE MORE

EFFECTIVE ACTION COULD

POTENTIALLY TAKE PLACE.

>> DR. NAVAS?

>> YES, I AGREE.

ACTUALLY THE IDEA OF THE STATE I

LIKE IT A LOT.

I THINK IT'S VERY TRUE, STATE,

TRIBAL ORGANIZATIONS, THIS

LEVEL, IT'S VERY RELEVANT.

I WAS THINKING IN TERMS OF

MESSAGING HEALTH CARE SYSTEM IS

VERY IMPORTANT.

I THINK IT'S REALLY BEHIND, HAS

BEEN QUITE BEHIND, ESPECIALLY IN

THE TRAINING IN MEDICAL SCHOOLS,

THINGS ARE CHANGING, BUT I THINK

IT'S BEEN A CHRONIC DEFICIT IN

EDUCATION.

SO I THINK THAT HAS MADE THE

MESSAGES IN THE CLINICAL WORLD,

THE HEALTH WORLD, IN GENERAL, TO

ACCEPT YOU KNOW SPECIFIC PUBLIC

HEALTH OR AREA.

TO THINK THIS IS NOT RELEVANT OR

SECOND LEVEL PRIORITY.

AND I THINK INCORPORATING BETTER

TRAINING, BETTER -- SO THOSE

MESSAGES ARE INCORPORATED INTO

THE MEDICAL CLINICAL THINKING I

THINK IS IMPORTANT.

OTHERWISE IT DOESN'T GET

TRANSMITTED TO THE REST OF THE

POPULATION.

EACH YEAR IN THE CLASS THAT I

TEACH ENVIRONMENTAL INJUSTICE AT

COLUMBIA UNIVERSITY I ASK

UNDERGRADUATE STUDENTS WHAT DO

YOU THINK OF THE RISK FACTORS

FOR CARDIOVASCULAR DISEASE,

MONEY SAYS ANYTHING ABOUT

ENVIRONMENT.

NOTHING.

NOTHING-- NOBODY SAYS ANYTHING

ABOUT ENVIRONMENT, FOOD SYSTEMS,

NOTHING.

THEY MIGHT SAY SOMETHING ABOUT

THE FOOD OR DIET OR DIET OR

SOMETHING LIKE THAT, BUT THAT'S

IT.

I THINK THIS SHOWS WE HAVE A LOT

TO DO IN THAT AREA.

>> DR. DAHER?

>> AS I REFLECT ON THE COMMENT

ON THE IMPORTANCE OF ALL OF

THESE SECTORS, THEY ARE

INTERCONNECTED.

ONE OF THE KEY MESSAGES THAT WE

NEED TO PUT OUT IS THE CURRENTLY

UNTAPPED POTENTIAL BY THE LACK

OF NATIONS, CURRENTLY EXISTS,

HOW WE CAN TAP INTO THIS SPACE

AND IMPROVE SYNERGY BY LOOKING

AT WAYS THAT THESE SECTORS COULD

BETTER COORDINATE AND BETTER DO

INTEGRATIVE PLANNING AND

GOVERNANCE OF THESE

INTERCONNECTED RESOURCE SYSTEMS.

>> YES, DR. RAMYASWAMI.

>> ON THIS QUESTION OF WHAT'S

THE BEST POLICY SCALE, I WANT TO

PUSH BACK.

BY STATE, I DON'T KNOW IF YOU

MEAN STATE OF MINNESOTA, THAT

KIND OF STATE, I THINK THAT'S

TRUE IF YOU'RE LOOKING AT THE

SUPPLY SIDE.

HOWEVER, ENERGY SUPPLIED, HOW DO

YOU CHANGE POLL CIRCUMSTANCES SO

MUCH OF DECARBONIZATION CAN BE

ACHIEVED BY URBAN PLANNING,

WHICH CAN HAVE CARDIOVASCULAR

BENEFITS THROUGH ACTIVE

LIFESTYLES, NON-MOTORIZED

TRAVEL.

IT'S MULTI-SCALE, NOT ONE SCALE

AND IN SOME WORK WE'VE SHOWN

THAT THOSE LEVELS ARE JUST NOT

BEING COUNTED WHEN YOU DO -- NET

ZERO DOESN'T CONSIDER THOSE

KINDS OF THINGS, THAT CITIES CAN

DO.

THAT'S WHERE LOCAL PLANNING

MATTERS, METROPOLITAN AND

REGIONAL PLANNING, MULTI-SCALE,

NOT A STATE OR NATION, YOU WANT

TO LOOK AT INSTITUTIONS ACROSS

SCALE.

I WANT TO SAY IN ANY SECTOR YOU

SEE THAT, THERE'S LOCAL LEVEL,

CITY LEVEL, NEIGHBORHOOD LEVEL

PLANNING, METROPOLITAN REGIONAL,

THEN THE STATE, EVEN REGIONAL

PUBLIC UTILITY COMMISSIONS,

BROADER REGION, FEDERAL POLICY.

AND SO ONE OF THE NICE THINGS IN

THE AMERICAN HEART ASSOCIATION

IS WE'RE ACTUALLY IDENTIFIED AT

WHICH SCALE THE POLICY ACTORS

ARE RELEVANT.

SO YOU CAN GET CROSS-SCALE

CONNECTION GOING ON BECAUSE IT

IS A MULTI-SCALE MULTI-SECTOR,

TOTALLY AGREE, MULTI-SECTOR,

MULTI-SCALE.

AND THEN THOSE PLACES WHERE YOU

CAN CONVENE PEOPLE ACROSS SCALE,

THAT'S WHERE YOU CAN GET

COORDINATION HAPPEN.

I WANT TO SAY WHICH SCALE IS

IMPORTANT DEPENDS WHICH LEVEL.

IF YOU LOOK AT DEMAND SIDE

LEVELS, URBAN, HOW URBAN AREAS

ARE DESIGNED, ARE A HUGE PART OF

THE DEMAND SIDE.

>> SANJAY, DO YOU HAVE A

QUESTION?

>> I THINK YOU'RE STILL MUTED.

>> SORRY.

SORRY ABOUT THAT.

I JUST WANT TO FIRST OF ALL

CONGRATULATE ALL THE SPEAKERS

BUT I HAD TWO QUESTIONS, MAYBE

COMMENTS.

ONE, TO JESS.

SUPERB TALK ON FOOD SYSTEMS.

THE QUESTION IS ONE OF THE OTHER

ASPECTS TO BE CONSIDERED WHEN

YOU PUT THIS WORKSHOP TOGETHER

WAS ALL OF THE THINGS THAT ARE

HAPPENING IN THE PRIVATE SECTOR

ON NEW TECHNOLOGIES LIKE

CELL-BASED MEATS, FERMENTATION

TECHNOLOGY, ALL THINGS THAT HAVE

DUBIOUS HEALTH EFFECTS RIGHT

NOW.

WE DON'T UNDERSTAND ENOUGH ABOUT

IT.

I WANT TO ASK HER FOR SOME

COMMENTS ON WHAT THE INTERESTING

QUESTIONS MIGHT BE.

THE SECOND QUESTION TO ANU, AND

WEI, BRILLIANT TALKS.

THE QUESTION WITH REGARDS TO HOW

DO YOU -- THERE'S GOOD

COMMENTARIES AND TALKS FROM

DIFFERENT ORGANIZATIONS ABOUT --

AND WE'VE TALKED ABOUT

COLLECTING HEALTH INFORMATION,

RIGHT, ON ALL DECISIONS.

THERE ARE URBAN PLANNING

DECISIONS, ET CETERA.

IT'S VERY GOOD.

HOW DO YOU ACTUALLY MAKE THAT

HAPPEN?

HOW SHOULD IT -- SINCE YOU HAVE

THE CONFLUENCE OF DIFFERENT

ACTORS, HOW SHOULD THIS

ACTUALLY -- ANY WORDS OF ADVICE

OR WISDOM HOW THIS SHOULD HAPPEN

ESPECIALLY WHEN PLANNING MANY

SECTORIAL INTERVENTIONS, ANY

FINAL POINTS TO FURTHER

ELIMINATE HEALTH IMPACT PLANNING

OF URBAN DECISIONS?

>> I WITH START WITH THE ALT

PROTEIN SPACE, A HUGE FIELD.

THERE'S PLANT-BASED PRODUCTS,

ALL THE WAY TO LAB GROWN MEAT,

MIMICKING, LOOKS, SMELLS, TASTE

LIKE MEAT BUT NOT MEAT.

IT'S AN INTERESTING TIME.

IF YOU GO TO KENYA YOU'LL SEE

SOME OF THESE PLANT-BASED MEATS

MIMICKING MEAT IN SUPER MARKETS,

IT'S NOT JUST HIGH-INCOME

COUNTRIES.

YOU'RE SEEING IT IN LOW TO

MIDDLE INCOME COUNTRIES.

THE INDUSTRY IS $12.7 BILLION

INTO ALT PROTEINS, A HUGE

INDUSTRY BUT ALL TIED UP IN

PRIVATE SECONDER AND VENTURE

CAPITALISM.

AND WE CAN ASSESS THESE

PARTICULARLY THOSE HIGHLY OR

ULTRA PROCESSED FOODS.

WE CAN ONLY DO SO MUCH RESEARCH

ON THAT BUT WE NEED TO OPEN UP

THE RESEARCH AGENDA AND ALLOW

FOR PUBLIC RESEARCH TO BE DONE

ON MANY OF THESE PRODUCTS.

IT'S QUITE TIED UP IN THE

PRIVATE SECTOR.

D BEZOS EARTH FUND IS BUILDING

CENTERS OF RESEARCH EXCELLENCE

TO TRY TO UNDERSTAND ALT

PROTEINS AND THEIR FUTURE,

DEMAND FOR THEM AND HEALTH AND

ENVIRONMENT IMPACTS.

WE LOOK AT THE LIVE STOCK

INDUSTRY IN THE UNITED STATES,

WHAT IF IT CONTRACTED WITH

SUBSTITUTION ALTERNATE PROTEINS

FILL IN, AND THERE'S

CONSEQUENCES.

THERE'S BENEFITS TO THE

ENVIRONMENT, BUT WE ESTIMATED

LOSS OF 1.2 MILLION JOBS IF LIVE

STOCK SECTOR IF AMERICANS

SHIFTED 10 TO 15% OF BEEF

CONSUMPTION TO ALT PROTEINS.

SO IT'S AN INTERESTING SPACE.

AND I THINK WITH ALT PROTEINS

IT'S REALLY GOING TO COME DOWN

TO PRICE, TASTE, AND WHAT

CONSUMERS VALUE.

DO THEY CARE ABOUT ANIMAL

WELFARE, ABOUT THE ENVIRONMENT,

ABOUT HEALTH, FARMERS AND

RANCHERS?

AND THEY ARE GOING TO MAKE

CHOICES BASED ON THAT.

WE HAVE UNDERSTAND HOW POWERFUL

AND COMPLEX THAT CHOICE IS WHEN

SOMEONE WALKS INTO THE MARKET

AND DOES THAT.

BUT THE BIGGEST ISSUE HAVE, WE

NEED TO OPEN UP THAT SPACE AND

ALLOW FOR PUBLIC UNIVERSITIES TO

BE ABLE TO START UNDERSTANDING A

LOT OF THESE PRODUCTS BECAUSE

RIGHT NOW IT'S LOCKED INTO

VENTURE CAPITALISM.

SO, YEAH.

>> LET ME CIRCLE BACK AROUND

KNOWING THAT A BIG PART OF THIS

SYMPOSIUM IS TO TRY TO

UNDERSTAND RESEARCH GAPS AND

THINK ABOUT HOW THE KINDS OF

SYSTEMS THAT WE'VE TALKED ABOUT

IN THIS SESSION PARTICULARLY

LEND THEMSELVES TO NEW -- TO

RESEARCH GAPS THAT HAVE TO BE

FILLED.

I MEAN, WE KNOW THAT THERE'S,

YOU KNOW, GENERALLY ALL THE

SYSTEMS ARE INTERRELATED,

BIDIRECTIONAL, THERE'S

CO-BENEFITS TO, YOU KNOW, LOTS

OF THINGS, SMART CITIES HAVE

LOTS OF CO-BENEFITS TO THEM.

WHAT IS SORT OF HEART HEALTH

RESEARCH QUESTIONS THAT WE CAN

SORT OF SINK OUR TEETH INTO I

THINK AS PLACES WHERE THE GAPS

NEED TO BE FILLED.

I'M SURE A FEW PEOPLE HAVE AN

IDEA, I'M SURE SANJAY DOES.

>> MAYBE I'D REFRAME, NOT

REFRAME BUT RATHER DEFLECT THAT

QUESTION WITH YOUR PERMISSION

AND INDULGENCE, JOEL, TO ANU.

FROM URBAN HEALTH PLANNING

PERSPECTIVE GIVEN THE FACT

THERE'S A HUGE OPPORTUNITY NOW,

WHAT ARE SOME OF THE RESEARCH I

GUESS QUESTIONS AND PRIORITIES

WE CAN PROBABLY HANG TOGETHER

WITH SOME OF THE INTERVENTIONS

HAPPENING, MULTI-SCALE AND

MULTI-DIMENSIONAL INTERVENTIONS

AS PART OF THE IRA, ARE THERE

THINGS YOU GUYS THINK MIGHT BE

PARTICULARLY IMPORTANT THAT'S

NOT HAPPENING RIGHT NOW?

I GUESS WOULD BE MY QUESTION.

IS IT MERELY ENGAGEMENT TO BE

PART OF URBAN PLANNING DECISIONS

BY THE CARDIOLOGIST?

WHAT DOES THAT LOOK LIKE TO YOU

GUYS?

>> MUTED AGAIN.

ANU, YOU'RE MUTED.

>> CAN YOU HEAR ME NOW?

>> YES.

>> YES.

SO I THINK THERE'S MULTIPLE

KNOWLEDGE GAPS.

LET ME GO BACK TO THE EARLIER

QUESTION SANJAY ASKED BECAUSE IT

RELATES TO THE KNOWLEDGE GAPS.

AND THAT IS HOW DO YOU GET

GOVERNANCE, NOT POLICY BUT

GOVERNANCE ACROSS SCALE WHICH

INCLUDES INDIVIDUAL BEHAVIORS,

NEIGHBORHOOD DESIGN,

METROPOLITAN DESIGN, ALL THOSE

THINGS.

I WOULDN'T SAY THAT

THEORETICALLY A STATE CAN

IMPOSE, METROPOLITAN REGION CAN

ENGAGE WITH UTILITY.

SO WHAT I FOUND IS ANYWHERE

WHERE THE INSTITUTION IS STRONG

ENOUGH TO GET MULTI-SCALE

MEANING, FOR EXAMPLE WHEN I

FIRST WORKED WITH DENVER ON

GREENHOUSE GAS, THEY HAD

INCREDIBLE CAPACITY TO CONVENE

ACROSS SCALE.

SO THE UTILITY WAS THERE.

THE METRO REGIONAL

TRANSPORTATION PLANNERS WERE

THERE, LOCAL COMMUNITIES, YOU

KNOW.

AND THAT'S WHY I THINK WHOEVER

HAS THAT SKILL CONVENING, IT

DOESN'T HAVE TO BE THIS SCALE OR

THAT SCALE.

IF YOU DO BY FIAT, PEOPLE WON'T

DO IT UNLESS YOU ACTUALLY ENGAGE

THEM.

THAT'S MY FIRST TAKEAWAY.

I THINK IT'S THE SCIENCE THAT

HASN'T CAUGHT UP.

FOR EXAMPLE THE MODELS USED IN

GLOBAL MODELS, THEY PAY NO

ATTENTION TO WHAT'S HAPPENING IN

THE CITY.

EVEN THE NATIONAL MODEL DOESN'T

HAVE -- IN FACT WE'RE HOPING TO

PUBLISH THIS PAPER IN NATURE

SUSTAINABILITY, IT'S NOT BECAUSE

THEY DON'T WANT TO, IT'S BECAUSE

IT'S COMPUTATIONALLY DIFFICULT

AND EXPENSIVE.

YOU TALKED ABOUT CROSS-SECTOR

INTERACTION, YOU NEED VERY FINE

DATA.

SO I THINK IT'S ON THE SCIENCE

SIDE REALLY UNDERSTANDING THESE

ARE MODELS ACROSS SCALE.

THERE AREN'T METHODS BECAUSE

THESE THREE SCALES ARE USING

VERY DIFFERENT METHODS, FOR GOOD

REASON, BECAUSE IT'S ACTUALLY

TOO COMPLEX TO PULL THEM

TOGETHER.

AND I THINK THE THIRD THING I

WORRY ABOUT TOO MUCH ON MILES

PER HOUR.

IF YOU DO THIS ALL THESE HAPPY

THINGS HAPPEN.

I SHOWED TRADEOFFS.

I DON'T THINK WE'VE DONE A GOOD

JOB DEMONSTRATING CAUSALITY AT

ALL.

WE SHOW BETTER DIET, BUT WHAT

INTERVENTIONS WILL ACTUALLY

IMPROVE DIETS, HOW DO YOU ADJUST

FOR, YOU KNOW, DIFFERENCES IN

INCOME.

TO ME FROM -- IN TERMS OF HEALTH

RESEARCH I THINK HOW DO YOU GET

AT CAUSALITY TO DEMONSTRATE THAT

THESE INTERVENTIONS ARE ACTUALLY

UNPACKING ALL THE COMPLICATION

THAT COMES FROM INCOME EFFECTS,

RACE, SO ON.

SO THAT'S WHERE I SEE THESE

THREE THINGS.

ON THE PHYSICAL SIDE WE DON'T

HAVE VERY GOOD MODELS THAT

REALLY CONNECT ACROSS SCALE.

SO IF MANY INTERESTING THINGS

ARE HAPPENING IN CITIES WITH

WALKING, BICYCLING, REDUCING

TRAVEL DEMAND, SO I THINK THE

BIGGER QUESTION IS WE SHOULDN'T

BE SO OPTIMISTIC.

YOU KNOW, WHEN I READ THE IPCC

CHAPTER, ALSO VERY POSITIVE.

YOU COULD EASILY SAY, WELL, AN

ENVIRONMENTALIST WROTE IT

BECAUSE IT'S JUST VERY POSITIVE.

I'LL STOP THERE.

SKEPTIC COULD SAY, WELL, DO YOU

REALLY KNOW THIS?

>> THANK YOU.

DR. PENG, YOUR HAND IS UP AGAIN.

>> YES, I AGREE WITH ANU ABOUT

IMPORTANCE OF IMPROVING MODELING

CAPABILITY FOR MULTI-SECTOR

SYSTEMS BUT I THINK SANJAY ASKED

A RIGHT QUESTION, HOW TO MAKE

THIS HAPPEN.

IF YOU THINK ABOUT THE POLICY

PROCESS, IT'S NEVER A CONTINUOUS

STEADY PROCESS.

THERE'S ALWAYS CRITICAL WINDOW

OF OPPORTUNITY WHERE THE

OPPORTUNITY FOR US TO EMBRACE.

IF YOU THINK ABOUT COORDINATING

ENERGY AND AIR QUALITY AGENDA,

IN CHINA THAT WAS 2013.

WHEN WE HAD VERY SEVERE -- I'M

CHINESE.

VERY SEVERE AIR, HIGHLY

POLLUTING EVENTS, AS A RESULT

CENTRAL GOVERNMENT DECLARED WAR

AGAINST AIR POLLUTION.

THAT WAS THE WINDOW OF

OPPORTUNITY FOR CHINA TO START

TO TAKE THE ACTION IN

COOPERATING THOSE.

ACTIONS TOGETHER.

I SEE SIMILAR WINDOW OF

OPPORTUNITY OPENING UP IN THE

UNITED STATES RIGHT NOW, THANKS

TO INFLATION REDUCTION ACT, A

HUGE AMOUNT OF EFFORT FROM ALL

LEVELS TO ACCELERATE ENERGY

TRANSITION.

AT THE SAME JUSTICE40 INITIATIVE

OPENED THE DOOR TO THINKING

ABOUT THE COORDINATION BETWEEN

ENERGY AND ALSO JUSTICE.

SO THAT WAS THE REASON WHEN I

WAS SAYING WHY I FEEL THAT

STATES COULD BE THE STARTING

POINT NOT TO SAY OTHER ACTORS

ARE NOT IMPORTANT.

MY POINT WAS I DO SEE STATES AS

VERY NATURAL ENTRY POINT NOW

THAT WE HAVE A WINDOW OF

OPPORTUNITY OPEN UP IN

PARTICULAR, EXCEPT CALIFORNIA,

MOST OF THE OTHER STATES WE'VE

INTERACTED WITH ARE SCRAMBLING

FOR HELP, ASKING FOR WHAT DATA

IS AVAILABLE NOW BECAUSE THEY

ONLY HAVE TWO MONTHS TO RESPOND

TO FUNDING OPPORTUNITY FROM

GOVERNMENT, EPA, ELSEWHERE.

IN MY VIEW THERE ARE TWO THINGS

PRIORITIES RIGHT NOW, ONE

EMBRACING THE CURRENT WINDOW OF

OPPORTUNITY TO SYNTHESIZE

EVERYTHING WE KNOW AND PROVIDE A

TOOL THAT'S AVAILABLE NOW SO THE

STATES CAN MAKE GOOD DECISIONS

TODAY.

AT THE SAME TIME THIS IS A

STARTING POINT.

WE SHOULD BE THINKING ABOUT

THROUGH THIS PROCESS LET'S BUILD

PARTNERSHIPS AND TRUST,

ANTICIPATING THE FUTURE WINDOW

OF OPPORTUNITY SO WE VIEW THE

CAPACITY FOR MODELING

PERSPECTIVE SO THAT WE HAVE THE

FUTURE WINDOW OF OPPORTUNITY

OPEN WE HAVE BETTER TOOLS AND

BETTER PARTNERSHIPS TO REACT

FAST AND ALSO BETTER NEXT TIME.

>> OKAY.

DR. NAVAS?

>> THANK YOU FOR ALL OF THESE

VERY INSPIRING IDEAS AND

COMMENTS.

WHAT I WAS THINKING MYSELF WHICH

GOES ALONG VERY WELL WITH WHAT

ANU AND WEI HAVE SAID IS WITH

ALL THE CHANGES THAT ARE GOING

ON RIGHT NOW, THE OPPORTUNITIES,

THE WATER INFRASTRUCTURE

CHANGES, THE URBAN PLANNING

CHANGES, FROM THE RESEARCH SIDE

I THINK IT'S A REALLY GREAT

OPPORTUNITY TO TRY TO GO IN

PARALLEL TO BE ABLE TO DOCUMENT

WHAT THE HEALTH IMPACTS WOULD

BE.

EITHER DOING REALLY WELL DONE

HEALTHY BALANCED IMPACT

ASSESSMENT, HAVING REAL DATA

THAT COULD BE ABLE TO DOCUMENT

WHAT IS THE IMPACT, POTENTIAL

BENEFITS OR LESS SOE SO THAT WE

CAN TRY TO MAYBE IDENTIFY WHICH

ARE THE MOST EFFECTIVE

INTERVENTIONS.

THIS IS NOT EASY AT ALL TO DO.

BUT I THINK THERE IS REALLY A

LOT OF OPPORTUNITY.

THE OTHER THING I WAS GOING TO

MENTION THAT EVEN THOUGH I AGREE

THAT URBAN SETTINGS ARE CRITICAL

AND IMPORTANT, I REALLY WANT TO

KEEP BRINGING AND REMINDING US

OF THE MORE MAYBE ONE OF OUR

COMMUNITIES LIVING IN MORE

REMOTE AREAS, BECAUSE THERE ARE

LOTS OF ISSUES, ENVIRONMENTALLY,

THAT AFFECT THOSE COMMUNITIES,

AND I DON'T THINK IT'S ENOUGH,

BECAUSE YOU'RE MANY MORE

MILLIONS OF PEOPLE IN ONE PLACE,

THAT THAT'S ENOUGH FOR US TO

PRIORITIZE DECISION MAKING.

I THINK THIS CAN LEAVE MANY

PEOPLE BEHIND AND IT'S NOT -- I

DON'T THINK IT'S GOOD AS A

SOCIETY TO TOTALLY DISREGARD

COMMUNITIES IN RURAL AREAS.

THE SAME FOR URBAN COMMUNITIES.

CLEARLY IN OUR COMMUNITIES ARE

EQUAL, AND I THINK INEQUALITIES

ASPECTS I THINK ARE VERY, VERY

IMPORTANT BECAUSE ALL OF THESE

URBAN DESIGNS AND PLANNING ARE

NOT ALSO BENEFITING EVERYBODY

EQUALLY.

THAT'S A REAL CHALLENGE NOWADAYS

BUT SOMETHING THAT IS VERY

IMPORTANT FOR US TO KEEP FROM

THE RESEARCH PERSPECTIVE AND

ALSO PRACTICE PERSPECTIVE.

>> I NEED TO TURN TO QUESTIONS

IN THE Q&A AFTER DR. DAHER.

>> QUICKLY, I THINK THE GOAL OF

THE CHALLENGE THAT WE FACE HERE

WHILE WE'RE LOOKING AT DIFFERENT

SECTORS WITH DIFFERENT

OBJECTIVES IS HOW SECTORS

MEASURE SUCCESS AND EVALUATE

THEIR SUSTAINABILITY AND

RESILIENCE.

I THINK THERE'S AN IMPORTANT

NEED FOR US TO IDENTIFY WHAT ARE

THESE COMMON COLLECTIVE OUTCOMES

AND METRICS THAT YOU CAN

IDENTIFY ACROSS SECTORS SO WE

CAN ACHIEVE BETTER ALIGNMENTS

ACROSS STRATEGIES THAT ARE PUT

FORWARD ACROSS DIFFERENT

SECTORS.

ONE QUICK EXAMPLE TO SHARE THAT

WE'RE WORKING ON CURRENTLY WITH

CITY OF SAN ANTONIO, DEVELOPING

ETHNICITY LEVEL, WORKING AT THE

DISTRICT LEVEL WITH ONE OF THE

CITY COUNCIL MEMBERS, DEVELOPING

DASHBOARD WITH LOCALIZED

INDICATORS, SO BASICALLY GOING

BACK TO ANU'S COMMENT ON

IMPORTANCE OF COLLABORATING WITH

SOMEONE WITH CONVENING POWER,

WHEN WE DO THIS KIND OF

STAKEHOLDER ENGAGEMENT MEETINGS

I'M NOT INVITING FOR THESE

MEETINGS, THE CITY COUNCIL

MEMBER IS THE ONE WHO IS

INVITING ALL OF HER CONSTITUENTS

AND STAKEHOLDERS ACROSS FOOD,

ENERGY, HEALTH, EDUCATION, WHO

COME AND CONTRIBUTE TO THESE

MEETINGS AND AS A RESULT WE'RE

DEVELOPING THIS DASHBOARD TO ACT

AS FUTURE TOOL TO EVALUATE

PROGRAMS FOR THE CITY AND THAT

WOULD GUIDE FUTURE INVESTMENT IN

DIFFERENT PROGRAMS WHILE

UNDERSTANDING THE IMPACT,

POSITIVE AND NEGATIVE, OF

DIFFERENT PATHWAYS AND DIFFERENT

PROGRAMS INCLUDING HEALTH AND

WATER AND OTHERS.

>> QUICKLY SOME OF THESE

COMMENTS, THE FIRST WOULD BE A

COMMENT FROM CARL MAYER ON

ORIGINAL CONVERSATION THAT WE

STARTED WITH ON MESSAGING,

SAYING HE WOULD SUGGEST MULTIPLE

MESSAGES ARE IMPORTANT TO THE

EXTENT THEY DON'T CONFLICT.

THAT IS THIS IS THE MOST

IMPORTANT THING TO DO TO REACH

DIFFERENT PUBLICS, INDIVIDUALS

WITH VARIED VALUES, WE NEED TO

KNOW OUR AUDIENCE, SIMILAR FOR

POLICY.

DOES ANYBODY WANT TO ADD

ANYTHING TO THAT COMMENT BASED

ON WHERE WE LANDED THERE?

AND THEN A QUESTION FOR DR.

NAVAS.

SHE ANSWERED OFFLINE, ON MEDICAL

HEALTH CARE EDUCATION, INCLUDING

PLANETARY HEALTH IN THAT.

I THINK THERE'S LOTS OF DEMANDS

ON MEDICAL EDUCATION.

IT REMAINS THE CASE, ALTHOUGH

CHALLENGED IN THE LAST FEW YEARS

I THINK BY PUBLIC OPINION THAT A

DOCTOR'S WORD STILL MEANS A LOT

TO PEOPLE AND GOOD IF WE COULD

MESSAGE BETTER TO THE HEALTH

CARE COMMUNITY ON PLANETARY

HEALTH FOR SURE.

THERE WAS A QUESTION, HOW MUCH

REFIRES, ESPECIALLY ASHES

CONTAINING CHROMATE COPPER AND

ARSENIC, AN INTERESTING

QUESTION, JUST A PAPER IN

"NATURE COMMUNICATIONS" THIS

WEEK SHOWING WE HAVE TO WORRY

ABOUT THE BURNING OF

COPPER-CONTAINING TREES,

COPPER-TREATED WOOD IN THIS

CASE, CCA TREATED WOOD, BUT

CHROMIUM IN THE SOIL IS

TRANSFORMED BY WILDFIRES INTO

HEXAVALENT CHROMIUM, THE MORE

TOXIC CHROMIUM SPECIES.

DID YOU WANT TO ADD ANYTHING,

ANA?

>> YEAH, THANK YOU FOR THE

QUESTION.

THERE IS NOT REAL RESEARCH DONE

IN THAT REGARD.

THE WILDFIRES RESEARCH,

CONNECTING THAT TO DISEASE, THAT

WOULD BE SUPER INTERESTING TO

DO.

IN ONE OF THE SLIDES, REALLY

QUICKLY, COPPER IS RELATED TO

CARDIOVASCULAR DISEASE, IN THE

MESA STUDY.

COPPER IS A VERY INTERESTING

METAL, VERY REACTIVE.

SO ANYWAY, YEAH, WORK TO DO IN

THIS AREA.

A LOT OF WORK TO DO.

>> ANU YOUR HAND HAS BEEN UP.

>> THANK YOU.

I JUST WANTED TO APPRECIATE

ANA'S COMMENT, TREMENDOUS.

WHEN WE WROTE OUR REVIEW PAPER

THE NUMBER OF -- TWO THINGS.

THERE'S A LOT OF URBAN

INEQUALITY.

AND THE SUBSTANTIAL NUMBER OF

PEOPLE, EVEN JUST LOOKING AT

HOMELESSNESS IN THE U.S., SO

THROUGH HOMELESSNESS THERE ARE

PEOPLE WHO ACTUALLY DON'T HAVE

ACCESS TO TOILET, SANITATION,

AND SO I WANT TO SAY IT'S NOT

LIKE URBAN PLACES ARE DOING VERY

WELL.

THE SECOND IS IN THIS URBAN

SYSTEMS APPROACH IT'S NOT MEANT

TO EXCLUDE RURAL, I WANT TO

EMPHASIZE, WHERE YOUR PRODUCTION

COMES FROM IS ENGAGING THE RURAL

AND SO I HAVE SEEN SOME GREAT

EXAMPLES WITH FARMERS MARKETS,

WITH FOOD SYSTEMS, WHERE THE

URBAN FOOD SYSTEM IS ENGAGING

WITH THE RURAL FOOD SYSTEM,

THROUGH THESE LOCAL SUPPLY

CHAINS, FOR HEALTHY FOOD, SO

JUST TO CLARIFY DOESN'T MEAN

IT'S IGNORING EVERYONE ELSE BUT

IF YOU LOOK AT WHERE RESOURCES

ARE COMING, IF YOU LOOK AT

MIGRATION, INDIA AND OTHER

PLACES, THEY ARE CONNECTED.

ONE OF THE MESSAGES WAS IT JUST

GIVES A DIFFERENT FRAME TO

THINK.

P IT WAS -- IT WAS SHOCKING THE

AMOUNT OF DEPRIVATION IN U.S.

URBAN AREAS WHEN YOU LOOK AT IT.

>> WE NEED TO BE WRAPPING UP FOR

A BREAK.

I DO WANT TO PLANT ONE MORE SEED

FOR FUTURE DISCUSSION WHICH WAS

SORT OF INTO THAT IN EARLIER

CONVERSATIONS TODAY, AND IN THE

PRESENTATIONS IN THIS SESSION.

AS WE THINK ABOUT THE SORT OF

COMPLEX MULTI-SYSTEM

MULTI-DIRECTIONAL INPUTS ON

PLANETARY HEALTH, I THINK THAT

WE AS HEALTH SCIENTISTS HAVE NOT

ALWAYS INTEGRATED ON A GLOBAL

SCALE THE ROLE OF ECONOMIC

DEVELOPMENT AND WEALTH

DISTRIBUTION INTO THE CALCULUS

AS MUCH AS WE PROBABLY SHOULD

BE.

AND THEN IMPLIES NOT JUST TO

URBAN SETTINGS, SAY, IN THE

UNITED STATES WHERE WE HAVE

CRISES OF HOMELESSNESS AND

SANITATION ACCESS AND SO FORTH

BUT GLOBALLY AS ECONOMIC

DEVELOPMENT IMPROVES QUALITY OF

LIFE GENERALLY IMPROVING HEALTH,

INTERSECTIONS BETWEEN ECONOMIC

DEVELOPMENT AND INCREASING

GREENHOUSE GASES VERSUS

RENEWABLES IS A BIG TOPIC I

THINK IN THIS FIELD AND THAT

HEALTH OFTEN DOESN'T GET PUT

INTO CONTEXT AS MUCH AS IT NEEDS

TO BE.

ALL RIGHT.

I SEE WE'RE AT TIME.

I'LL TURN IT BACK TO WHOEVER IS

RUNNING THE SHOW AND LET THEM

TAKE IT FROM HERE.

>> I THINK THAT'S ME.

LARRY FINE.

AGAIN, ANOTHER INCREDIBLE SET OF

DISCUSSIONS WITH REALLY RICH IN

TERMS OF RESEARCH OPPORTUNITIES,

CHALLENGES, HOW TO FORM OUR

INFORMATION, RESEARCH

INFORMATION, SO IT AFFECTS

POLICIES, YOU'VE ALSO JUST

POINTED OUT THE COMPLEXITY OF

THE SYSTEMS AND OUR NEED TO

BUILD DATA SYSTEMS THAT ALLOW US

TO IMPROVE OUR MODELS AND TO

ADDRESS THESE WEALTH OF ISSUES

THAT YOU'VE RAISED.

THANK YOU VERY MUCH.

AGAIN, YOU EXCEEDED MY

EXPECTATIONS, I'M SORRY WE

DIDN'T HAVE MORE TIME TO ALLOW

YOU TO ELABORATE FURTHER.

IN THE WORKSHOP PAPERS THERE

WILL BE ANOTHER OPPORTUNITY TO

CRYSTALLIZE AND MAKE SURE THAT

WE'RE CLEAR ABOUT WHAT WE THINK

THE RESEARCH FUTURE SHOULD HOLD

AND WHY THAT'S SO IMPORTANT.

AGAIN, I WANT TO THANK YOU VERY,

VERY MUCH.

WE'RE GOING TO TAKE A TEN-MINUTE

BREAK, COME BAG AT 3:40 FOR THE

SIMULATION EXERCISE, GIVE US

ANOTHER CHANCE TO EXPLORE THE

COMPLEXITY OF THE SITUATION.

ALSO SHOW WHAT THE MODELS

SUGGEST ABOUT SOME OF THE

INTERVENTIONS THAT WOULD HAVE

THE GREATEST IMPACT.

ALSO THE DIVERSITY, TO ALLOW US

TO -- EACH OF US TO MAKE CHOICES

WHERE WE THINK WE SHOULD PUT

ACTION AND SEE WHAT HAPPENS.

SO PLEASE COME BACK IN TEN

MINUTES, AT 3:40.

AND THANK YOU VERY MUCH FOR A

GREAT AFTERNOON SO FAR.

>> THANK YOU FOR JOINING THIS

SESSION, AGAIN.

I'M REALLY EXCITED TO INTRODUCE

DR. JASON JAY TO TAKE US THROUGH

THIS SIMULATION EXERCISE WHICH

IS I THINK TRANSFORMATIVE IN ITS

OWN WAY BECAUSE IT EXPOSES US TO

THE TYPES OF THINKING WE'VE BEEN

TALKING ABOUT THIS MORNING AND

AFTERNOON.

DR. JAY IS SENIOR LECTURER AND

DIRECTOR M.I.T. SLOAN

SUSTAINABILITY INITIATIVE, ONE

OF JASON'S STUDENTS MYSELF I CAN

TELL YOU HE'S NOT ONLY A

BRILLIANT ORATOR BUT SUPERB

THINKER, TEACHES MASTER'S LEVEL

COURSES, HELPED SECURE M.I.T.'S

SLOAN POSITION, PUBLICATION ALSO

APPEARED IN CALIFORNIA

MANAGEMENT REVIEW, M.I.T. SLOAN

MANAGEMENT REVIEW, STANFORD,

WORLD ECONOMIC FORUM, I'VE READ

HIS BOOK, I HIGHLY RECOMMEND IT,

THE AUTHOR OF THE INTERNATIONAL

BESTSELLER, "BREAKING THROUGH

GRIDLOCK," A FACILITATOR FOR

BUSINESSES SUPPORTING

HIGH-QUALITY CONVERSATION AND

SHARED COMPLIMENT TO AMBITIOUS

SUSTAINABILITY GOALS.

I'M GOING TO TURN THIS OVER, YOU

MIGHT NOTICE A LINK POSTED IN

THE CHAT WHICH I WOULD HAVE YOU

CLICK TO PARTICIPATE IN THE

POLLING.

THANKS AGAIN, JASON.

>> THANK YOU FOR HAVING ME,

SANJAY.

THE FIRST IMPORTANT CAVEAT IS

THAT THE DOCTOR BEFORE MY NAME

IS A Ph.D. IN ORGANIZATIONAL

STUDIES.

AND I'M NOT A MEDICAL DOCTOR.

MY WIFE IS A PHYSICIAN AT MASS

GENERAL IN GENERAL MEDICINE, DR.

RAY, I'M ALSO NOT A CLIMATE

SCIENTIST, OR ENVIRONMENTAL

SCIENTIST AS MANY OF YOU ARE.

SO I WANT AT ANY POINT IN THIS

TO CHALLENGE, RAISE QUESTIONS,

YOU CAN DO THAT THROUGH THE

CHAT, THROUGH THE Q&A FUNCTION,

YOU CAN DO THAT BY WAVING AT ME

ON THE VIDEO FOR THOSE WHO ARE

ON THE PANEL HERE.

I HAVE A SCREEN WHERE I CAN SEE

ALL OF THAT.

I'VE GOT MY CONTENT OVER HERE.

WHAT WE'RE GOING TO DO IS

EXPLORE PART OF THIS TOPIC OF

PLANETARY HEALTH.

THE SECOND CAVEAT BESIDES MY

DOCTORHOOD IS THE CAVEAT ABOUT

CLIMATE VERSUS PLANETARY HEALTH.

SO, THE SCOPE FOR WHAT WE'RE

GOING TO DO NOW FOR THIS NEXT

HOUR AND CHANGE IS REALLY

FOCUSED ON CLIMATE CHANGE.

I THINK THIS IS A REALLY

IMPORTANT POINT MADE THROUGHOUT

THE DAY, A SET OF PLANETARY

BOUNDARIES HUMANS ARE CROSSING

WHICH A VARIETY OF HEALTH

IMPACTS RELATED TO THAT.

WE'VE GOING TO ZOOM IN ON REALLY

NARROWLY LOOKING AT CLIMATE

IMPACTS BUT AS ANY OF YOU KNOW

WHO WORK IN THIS FIELD CLIMATE

IS COMPLEX.

THIS IS FROM THE W.H.O.

CLIMATE CHANGE CREATES HEALTH

RISKS, WHICH THEN CREATES HEALTH

OUTCOMES, BUT THOSE HEALTH

OUTCOMES ARE MEDIATED VERY MUCH

BY VULNERABILITY FACTORS, EQUITY

CONSIDERATIONS THAT HAVE TO DO

WITH GENDER, SOCIOECONOMIC

DIFFERENCES, MARGINALIZED AND

UNDERREPRESENTED GROUPS.

THERE'S NOT AN EASY TRANSLATION

FROM CLIMATE IMPACTS TO DIRECT

HEALTH OUTCOMES BUT I WANT US TO

BE CONNECTING THE DOTS AS WE GO

TOGETHER TODAY.

WHAT WE'RE GOING TO DO IS

UNDERSTAND THE CLIMATE CHANGE

IMPACTS AND THE POSITIVE IMPACTS

WE CAN HAVE TRYING TO MITIGATE

SOME OF THESE EFFECTS.

SO, THE WAY I THINK ABOUT THE

PROBLEM WE'RE TRYING TO SOLVE IS

REALLY DEPICTED BY THIS PICTURE

WHICH IS MAYBE FAMILIAR TO SOME

OF YOU WHO HAVE BEEN WORKING

THIS SPACE.

THIS COMES FROM IPCC SPECIAL

REPORT, 2019, AND THE Y-AXIS

HERE IS MEASURED IN DEGREES

ABOVE PRE-INDUSTRIAL LEVELS, SO

WE'VE WARMED THE PLANET ABOUT

1.1 TO 1.2 DEGREES ALREADY.

AND AS A RESULT WE'RE ALREADY

SEEING THE EFFECTS OF CLIMATE

CHANGE, DETECTABLE IMPACTS AND

RISKS ON THESE -- THIS WAS A

GRAPH OF TERRESTRIAL INDICATORS

OF CLIMATE IMPACT SO DRY LAND

WATER SCARCITY, SOIL EROSION,

WILDFIRE DAMAGE, TROPICAL CROP

YIELD DECLINE, FLOOD SUPPLY

INSTABILITY THAT RESULT FROM

THAT, WE'RE SEEING THESE EFFECTS

BUT IF WE KEEP GOING IN THE

DIRECTION WE'RE GOING THE

BUSINESS AS USUAL FORECASTS ARE

THAT WE END UP IN A WORLD 3 TO 5

DEGREES WARMER ABOVE

PRE-INDUSTRIAL LEVELS.

IN THAT SITUATION WE ENTER INTO

THIS ZONE THAT EVEN WITH ALL OF

THE MASSAGING AND CONSENSUS

BUILDING PROCESS IN THE IPCC YOU

END UP WITH A LANGUAGE OF VERY

HIGH RISK OF SEVERE IRREVERSIBLE

IMPACT WITH LIMITED ABILITY TO

ADAPT.

AND SO THE KEY PROBLEM WE'RE

TRYING TO SOLVE IN TERMS OF A

GAP BETWEEN CURRENT STATE AND

GOAL STATE THE CURRENT STATE

WE'RE LIVING INTO A FUTURE

THREE-SOMETHING EVEN MORE

DEGREES ABOVE PRE-INDUSTRIAL

LEVELS AND WANT TO GET THAT DOWN

TO A SAFER LEVEL.

YOU CAN SEE WHY SO MANY

CONVERSATIONS CENTER AROUND THIS

FIGURE OF 1.5 DEGREES CELSIUS,

SOME RISKS ARE SIGNIFICANT, WE

CAN STILL HANDLE AND ADAPT,

MANAGE THEM.

SO THE QUESTION IS HOW ARE WE

GOING TO GET THERE?

THE SECOND CHALLENGE THAT WE

HAVE, THE SECOND PROBLEM WE HAVE

IN CLIMATE COMMUNICATION IS

SOMETHING THAT MY COLLEAGUE IS

FOND OF POINTING OUT, JOHN

STIRMAN, SHOWING PEOPLE RESEARCH

DOESN'T WORK.

THAT'S A HARD THING TO SAY AFTER

A DAY OF PEOPLE PRESENTING

RESEARCH TO EACH OTHER BUT WE'RE

A WONKY CROWD.

WHAT THIS IS ABOUT IS THAT IF I

SHOW ANY GROUP OF POLICYMAKERS

AND DECISION MAKERS OTHER

CITIZENS A SORT OF PARADE OF

CONSEQUENCES IN THE FORM OF

POWERPOINT DECK, IT'S UNLIKELY

TO BUILD AN UNDERSTANDING OF THE

ISSUE, IN A RICH COMPLEX

EMBODIED WAY, OR A WILLINGNESS

TO TAKE ACTION.

AND SO WE HAVE TO DO SOMETHING

DIFFERENT.

WE HAVE TO MAKE THIS AN

INTERACTIVE EXPLORATION WHERE WE

CAN BUILD AN UNDERSTANDING FOR

YOURSELVES, OURSELVES, ABOUT THE

CLIMATE CHALLENGE.

AND THAT'S WHAT WE'RE GOING TO

DO.

THE FIRST POINT OF

INTERACTIVITY, THE MECHANISM FOR

ME TO ENGAGE NOT JUST THE 21

PEOPLE ON THE PANEL BUT

ADDITIONAL 36 ATTENDEES AND EVEN

ADDITIONAL FOLKS WHO MIGHT BE

WATCHING OVER LIVE STREAMING,

EVEN YOU CAN PARTICIPATE IN

THIS.

I'M GOING TO USE A POLL

EVERYWHERE TOOL, AND WHAT THIS

DOES IS ALLOWS ME TO POSE A

QUESTION TO YOU, AND FOR YOU TO

ANSWER THAT QUESTION AND FOR

YOUR ANSWER TO SHOW UP REAL TIME

ON THE SCREEN.

SO, WE POSTED THE LINK IN THE

CHAT EARLIER, I'LL POST IT ONE

MORE TIME HERE FOR THOSE WHO

HAVE ACCESS TO THE CHAT.

IF YOU HAVE A PHONE, YOU CAN

HOLD YOUR CAMERA TO THE SCREEN

AND GRAB THE QR CODE OR TYPE

THIS INTO A BROWSER.

KEEP THAT OPEN ON YOUR PHONE OR

ANOTHER WINDOW ON THE COMPUTER

SO AS I ASK DIFFERENT QUESTIONS,

YOUR ANSWERS WILL POP UP ON THE

SCREEN.

FIRST QUESTION I'VE ASKED HERE

IS JUST A WARMUP.

WHAT CITY ARE YOU FROM?

SO WE'VE GOT A NICE RANGE OF

FOLKS FROM BOZEMAN TO MIAMI,

BOSTON, PALO ALTO, ALL THE

CORNERS OF THE UNITED STATES.

EXCELLENT.

IN A COUPLE POLLS, I WILL SAY

ANSWER WITH ONE WORD OR A

HYPHENATED NAME.

THE REASON IS SO THAT THE WORDS

STAY TOGETHER IN THIS WORD

CLOUD.

PALO ALTO STAYED TOGETHER

BECAUSE OF THE HYPHEN, NEW

ORLEANS GOT SPLIT UP.

THAT'S JUST GETTING THE

TECHNOLOGY RUNNING.

HERE IS THE REAL QUESTION.

MY REAL QUESTION IS HOW ARE WE

GOING TO SOLVE THE CLIMATE

CHALLENGE?

WHAT ACTIONS WILL HELP US LIMIT

WARMING TO NO MORE THAN 1. 1.5

DEGREES, MOVING THAT, WHAT IS IT

THAT'S GOING TO ALLOW US TO DO

IT?

TECHNOLOGY, COLLECTIVE ACTION,

THIS COULD BE ANYTHING THAT

YOU'VE HEARD ABOUT, A PARTICULAR

TECHNOLOGY, PARTICULAR POLICY,

PARTICULAR IDEA FOR HOW TO

TACKLE THE CLIMATE CHALLENGE.

AND YOU CAN ANSWER MORE THAN

ONCE.

AND WE CAN HAVE A FEW DIFFERENT

IDEAS POPPING UP HERE.

I'VE SEEN NO MEAT IN DIETS,

REDUCED EMISSIONS, EDUCATION,

COLLECTIVE ACTION.

AGAIN, IF YOUR ANSWER IS

SOMETHING THAT'S MULTIPLE WORDS

PLEASE PUT A HYPHEN CONNECTING

THEM SO THE TOOL CAN KEEP THEM

TOGETHER.

WE'VE GOT A A FEW KINDS OF

IDEAS.

CLEAN TECHNICALLY, ELECTRICITY,

INTENTIONAL BEHAVIORS, FEELING

THE CONSEQUENCES, THAT'S WHAT'S

GOING TO WAKE PEOPLE UP AND

WE'LL TAKE ACTION.

SYSTEMS THINKING, SUE THE FOSSIL

FUEL COMPANIES, REDUCE MEAT.

THIS IS GREAT.

I WANT TO GET THESE IDEAS OUT

HERE INTO THE PICTURE.

NOW, WHAT I WANT TO ALSO POINT

OUT IS THAT PUT YOURSELF IN THE

SHOES OF A TOP DECISION MAKER,

SOMEBODY WHO MIGHT BE A STATE

GOVERNOR, OR HEAD OF A MAJOR

HOSPITAL, OR CEO OF A MAJOR

CORPORATION OR INVESTOR WHO IS

PLACING CAPITAL WITH NEW

TECHNOLOGIES.

AND OR CIVIL SOCIETY LEADER,

HEAD OF NGO.

YOU ASK THE QUESTION, YOU KNOW,

HOW ARE WE GOING TO SOLVE

CLIMATE CHANGE?

THIS IS THE ANSWER THAT YOU GET,

WHICH IS A WHOLE ARRAY OF

DIFFERENT POSSIBILITIES.

AND THE REALITY OF TOP DECISION

MAKERS IS THAT YOU ONLY HAVE SO

MUCH BANDWIDTH FOR ATTENTION,

RIGHT?

YOU'RE WORRIED ABOUT THE WAR IN

ISRAEL AND PALESTINE, UKRAINE,

INFLATION, YOU KNOW, EQUITABLE

ACCESS TO HEALTH CARE, AND

THERE'S A VARIETY OF ISSUES

BEFORE YOU HAVE ATTENTION TO

THINK TO THINK ABOUT THE

ENVIRONMENT WITHIN WHICH YOU'RE

WORRIED ABOUT THINGS WE HEARD

ABOUT, HEAVY METALS, WATER

POLLUTION, AIR POLLUTION, THIS

MUCH INTENTIONAL BANDWIDTH TO

THINK ABOUT CLIMATE.

WITHIN THAT THIS IS THE ANSWER

YOU GET OF ALL THE DIFFERENT

POSSIBLE WAYS WE COULD GO ABOUT

TRYING TO SOLVE CLIMATE CHANGE.

IT IS THAT -- IT IS THE ABILITY

AND HOPE WE MIGHT BE ABLE TO

UNTANGLE SOME OF THIS VARIETY

AND COMPLEXITY AND UNDERSTAND

WHAT ACTIONS, HIGH LEVERAGE, LOW

LEVERAGE, THAT SPURRED THE KIND

OF INQUIRY THAT WE'RE IN AT MIT

SLOAN AND YOU'RE NOW PART OF.

EARLIER TODAY WE HAD A GREAT

PRESENTATION THAT TOUCHED ON

SYSTEM DYNAMICS CONCEPTS, WHICH

IS ABOUT STOCKS AND FLOWS,

FEEDBACK LOOPS.

AND THAT IS VERY MUCH KIND OF

THE UNDERLYING DISCIPLINE WE USE

HERE TO BUILD AND INTERACTIVE

SIMULATION TOOL CALLED EN-ROADS

WHICH WE'RE GOING TO USE AS A

PLACE TO RUN EXPERIMENTS AND TRY

TO UNDERSTAND HOW THESE

DIFFERENT LEVERS MIGHT INTERACT

WITH ONE ANOTHER.

THIS IS THE TOOL.

WE HINTED WITH SOME TEASER

SLIDE.

THIS IS A TOOL THAT WILL IS

GETTING TO BE WIDELY USED WITH

POLICYMAKERS AND MORE BROADLY.

SO ABOUT 6500 LEADERS ACROSS

GOVERNMENT, BUSINESS, NGOs,

ACADEMIA USED THIS EN-ROADS

TOOL.

WE'RE KEEPING THE TALLIES.

WE HAVE TESTIMONIALS FROM

DEMOCRATS, REPUBLICANS, AND

PEOPLE AROUND THE WORLD.

WE'VE BUILT A NETWORK OF

FACILITATORS, EN-ROADS

AMBASSADORS, WHO ARE ENGAGING IN

EVENTS ALL AROUND THE WORLD.

WE'VE PASSED THE 200,000 MARK IN

TERMS OF PEOPLE WHO PARTICIPATED

IN THIS, IN 7,000 EVENTS, 139

COUNTRIES.

WHAT WE'RE TRYING TO DO IS SPUR

A GLOBAL CONVERSATION ABOUT WHAT

MIGHT REALLY WORK.

SO, WE'RE GOING TO TEST YOUR

IDEAS ON THE EN-ROADS TOOL.

SO FIRST I'M GOING TO GIVE YOU A

LITTLE TOUR AND BACKDROP.

THIS RUNS ON A SYSTEM DYNAMICS

MODEL.

SO THERE'S THOUSANDS OF

EQUATIONS BEHIND THE SCENES

HERE.

BUT IT BEHAVES THE SAME AS THE

BIG SUPERCOMPUTER MODELS, SO IF

WE LOOK AT ANY GRAPHS OF

HISTORICAL -- IT'S BEEN

CALIBRATED FROM HISTORICAL DATA.

WE CAN LOOK AT THE HISTORY OF

THE TEMPERATURE MODEL VERSUS

ACTUAL, WE COULD LOOK AT HISTORY

OF COST OF SOLAR ELECTRICITY,

ACTUAL VERSUS MODELED SO YOU CAN

GET A SENSE OF THE THINGS WE

CALIBRATE TO, HISTORY OF

GREENHOUSE GAS EMISSIONS, SO ON.

THIS IS DESIGNED TO PRODUCE

REALITY UP THROUGH 2022, AND

THERE'S REAL DATA IN THE SYSTEM

THROUGH 2022.

BUT IT BEHAVES THE SAME, IT'S

CALIBRATED TO BEHAVE AS THE BIG

SUPERCOMPUTER MODELS BUT RUNS

INSTANTLY ON ANY BROWSER FOR

ANYBODY, IT'S FREELY AVAILABLE.

AND SO I APPRECIATE WHAT WAS

SHARED IN THE CHAT, A LINK TO

THE TOOL TO PLAY WITH IT ON YOUR

OWN TIME.

A HUGE CAVEAT ABOUT EN-ROADS FOR

THIS CROWD, IT IS GLOBALLY

AGGREGATED.

WHAT THAT MEANS IS ALMOST ALL

THE GRAPHS THAT WE'RE GOING TO

BE LOOKING AT ARE GRAPHS FOR THE

WHOLE WORLD, AND WHEN WE TAKE

ACTION, WHEN WE PULL THE LEVERS,

RUN AN EXPERIMENT, WE'RE GETTING

TO PLAY AN ALL-POWERFUL BEING

THAT IS ABLE TO MAKE THAT CHANGE

HAPPEN AT A GLOBAL SCALE.

AND THAT ALLOWS US TO UNDERSTAND

IN A BIG PICTURE LEVEL WHERE ARE

THE BIG LEVERS FOR CHANGE ON

CLIMATE.

BUT THE HUGE LIMITATION OF THAT

IS THAT ALL OF THE DIVERSITY AND

VARIETY AND NUANCE OF WHAT

HAPPENS AT THE NATIONAL SCALE,

STATE SCALE, URBAN SCALE, WHICH

HAS BEEN A HUGE EMPHASIS OF

TODAY'S DISCUSSIONS, IS BLURRED

OUT.

AND SO WE'RE GOING TO HAVE TO

GRAPPLE WITH THAT AS WE GET INTO

ANY CONVERSATION ABOUT IT.

BUT WE'VE FOUND THAT THIS KIND

OF GLOBAL LEVEL SETTING IS A

REALLY IMPORTANT PART OF

UPGRADING THE QUALITY OF

CONVERSATION ABOUT CLIMATE.

SO, ON THE GRAPH HERE IS

MEASURED IN -- ON THE LEFT HERE

IS OUR SOURCES OF ENERGY,

MEASURED IN EXIT JULES PER YEAR,

ALL THE ENERGY THAT HUMANS USE,

COAL, OIL, GAS, RENEWABLE ENERGY

WHICH IS MODELED SEPARATELY

UNDER THE HOOD, SOLAR, WIND,

GEOTHERMAL, HYDRO.

AND THEN -- HYDROPOWER.

BIOENERGY HERE.

THERE'S THE BAND OF NUCLEAR

ENERGY, THIS TEAL BAND AT THE

TOP.

NEW RADICAL ZERO EMISSIONS

TECHNOLOGY, LIKE NUCLEAR FUSION,

NOT YET ON THE PICTURE BUT WE

COULD GET THERE IF WE RUN THAT

EXPERIMENT.

ON THE RIGHT IS THE STACK OF

GREENHOUSE GASES THAT ARE

RELATED BUT NOT COMPLETELY TO

THAT ENERGY SYSTEM.

SO YOU HAVE THIS GREEN BAND OF

LAND USE EMISSION, THIS IS FROM

DEFORESTATION, LOSS OF PEAT LAND

AND CARBON SINKS.

THE GRAY BAND IS CO2 FROM

BURNING FOSSIL FUELS, WHICH IS

IN 2022, LET'S SEE, 35 GIGATONS,

35 BILLION TONS FROM THAT.

THE ORANGE BAND IS FLUORINATED

BANDS USED IN INDUSTRIAL

PROCESSES.

THIS LIGHT BLUE IS METHANE, AND

THIS DARK BLUE IS NITROUS OXIDE.

THESE GASES AND THEIR FATE AND

TRANSPORT AND LIFETIME IN THE

ATMOSPHERE ARE MODELED

SEPARATELY, DIFFERENT RESIDENCE

TIMES, DIFFERENT IMPACTS ON

CLIMATE BUT WE PUT THEM ON ONE

YEAR, 100-YEAR CO2 EQUIVALENCE

UNITS TO VISUALLY UNDERSTAND HOW

THAT STACKS UP.

AND THEN THIS STACK OF

GREENHOUSE GAS EMISSIONS,

ANOTHER WAY TO THINK ABOUT THIS

IS -- I'LL CHANGE THE CAUSALITY,

THE SEQUENCE OF CAUSALITY HERE,

IS THAT THIS GREENHOUSE GAS

EMISSIONS IS KIND OF LIKE THE

FAUCET IN THE BATHTUB OF THE

PLANET'S ATMOSPHERE.

EVERY YEAR WE'RE PUTTING MORE

GREENHOUSE GASES INTO THE

ATMOSPHERE.

AS A RESULT, THE CONCENTRATION,

THE WATER IN THE TUB, IS RISING

AND 2022, 450 PARTS PER MILL,

HEADED TO 800 BY THE END OF THE

SEVEN SENT -- CENTURY, THAT

HOLDS IN THE HEAT THAT WOULD

OTHERWISE RADIATE OUT, MAKING

THE PLANET WARMER SO BY 2100

WE'VE WARMED THE PLANET 3.4

DEGREES CELSIUS IN THE BASELINE

SCENARIO.

THIS IS AN AMERICAN CROWD,

YOU'RE ORIENTED TO FAHRENHEIT, 6

DEGREES FAHRENHEIT ABOVE

PRE-INDUSTRIAL LEVELS.

AND WITH THAT LEVEL OF WARMING

COMES A WHOLE SUITE OF IMPACTS

THAT YOU, YOU KNOW, MAY HAVE

HEARD ABOUT, AND MAY BE

CONCERNED ABOUT.

SO, WE SEE SEA LEVEL RISE, ABOUT

374 MILLION PEOPLE AT RISK TO

ANNUAL FLOODING, 217 LIVING

BELOW THE HIGH TIDE LINE,

FLOODING IS ON A DAY-TO-DAY

BASIS.

WE'LL SEE DECREASES IN CROP

YIELDS, FOOD SECURITY AND EQUITY

AND ACCESS TO FOODS WE'VE TALKED

ABOUT.

MAZE, WHEAT, RICE, SOYBEANS,

CORNERSTONES OF THE GLOBAL

SYSTEM AND AGRICULTURE,

SIGNIFICANT DROPS IN YIELD WHICH

HAS IMPACT ON FOOD SECURITY.

IT MEANS THAT WE'LL SEE

ADDITIONAL DEATHS FROM EXTREME

HEAT IN A VARIETY OF REGIONS.

SUB-SAHARAN AFRICA AND MIDDLE

EAST ARE NOT HERE BECAUSE DATA

IS INSUFFICIENT.

AND MODELS HASN'T BEEN

SUFFICIENT TO GET THOSE NUMBERS.

YOU CAN SEE THERE ARE CERTAIN

GLOBAL HOT SPOTS WHERE WE

ANTICIPATE ADDITIONAL DEATHS

FROM EXTREME HEAT.

AND THE FREQUENCY OF THOSE

EXTREME HEAT EVENTS RIGHT NOW

VERY EXTREME HEAT EVENTS LIKE

HEAT DOME IN THE PACIFIC

NORTHWEST, LIKELY OCCUR ABOUT

SEVEN YEARS OUT OF 50, WE'RE

HEADING TOWARD A SCENARIO 3.3

WHERE IT'S 29 YEARS OUT OF 50 WE

SEE VERY EXTREME HEAT EVENTS

WHICH AS WE KNOW HAVE SOME VERY

IMPORTANT HEALTH EFFECTS.

THEN THIS AMOUNT OF ENERGY,

FOSSIL FUEL COMBUSTION, IS

RELATED TO AIR POLLUTION AS WE

HEARD IN SOME EARLIER

PRESENTATIONS TODAY.

THE PM2.5 AIR POLLUTION WHICH

HAS IMPORTANT CARDIOVASCULAR AND

NEUROLOGICAL IMPACTS IS ON THE

RISE, AS YOU'RE BURNING THIS

AMOUNT OF FOSSIL FUEL.

SO THAT'S A TOUR.

AND THEN LEVERS WE CAN PULL TO

AFFECT THESE OUTCOMES ARE DOWN

HERE.

WE CAN PLAY WITH ENERGY SUPPLY

LEVERS THAT CHANGE THE MIX OF

ENERGY ON THE GRID, AND THAT WE

USE TO PRODUCE PRIMARY ENERGY.

THIS BASKET IS ABOUT ENERGY USE.

SO IN TRANSPORTATION AND

BUILDINGS, WE HAVE OPPORTUNITIES

TO BE MORE EFFICIENT OR TO

ELECTRIFY OUR FORMS OF ENERGY

UTILIZATION.

AND THOSE ARE IN TURN UNDERNEATH

DRIVEN BY POPULATION ECONOMIC

GROWTH WHICH IN OUR SCENARIO IS

JUST USED AS A U.N. MEDIAN

FORECAST OF POPULATION, AND

WORLD BANK ASSUMPTION ABOUT THE

FUTURE ECONOMIC GROWTH THAT

DRIVE THOSE.

AND THEN THE THIRD BASKET HERE

ARE THE NON-ENERGY-RELATED

ASPECTS OF ANTHROPOGENIC IMPACT

ON THE CLIMATE WHICH IS ABILITY

TO CHANGE PATTERN OF

DEFORESTATION, TO PLANT NEW

TREES, TO AFFECT METHANE AND

OTHER NON-CO2 GREENHOUSE GASES

AND TO USE TECHNOLOGIES TO DO

CARBON REMOVAL, TO REMOVE CARBON

FROM THE ATMOSPHERE, AND THERE'S

A BUNCH OF DETAILED SETTINGS

WHERE WE CAN PLAY WITH SPECIFIC

TECHNOLOGIES THAT MIGHT COME UP

OR MIGHT BE OF INTEREST TO YOU

ALL.

SO, THAT'S KIND OF THE TOUR.

NOW WHAT I'M GOING TO DO IS GO

TO YOUR SUGGESTIONS HERE ABOUT

WHAT CAN WE DO TO TRY TO TACKLE

THIS ISSUE.

AND SO, I'M GOING TO JUST KIND

OF GRAB A FEW.

EDUCATION, THERE'S A COUPLE

THINGS HERE WHICH I CALL META

SOLUTIONS, MEANING THAT

EDUCATION, MASS MOBILIZATION OF

POLITICAL ADVOCACY,

UNDERSTANDING, SYSTEMS THINKING,

I WANT TO CALL ALL OF THOSE

INTENTIONAL BEHAVIORS, I'LL CALL

THOSE META SOLUTIONS, WHICH IS

THE WAY WE CAN USE

SOCIAL/POLITICAL ORGANIZING AND

POWER TO ACTUALLY PULL THESE

LEVERS.

WE'LL COME BACK TO THAT LATER.

FOR NOW WHAT I WANT TO DO IS

LOOK AT SOME KIND OF TECHNO

ECONOMIC LEVERS THAT ARE

AVAILABLE TO US, AND WHICH HAVE

BEEN MENTIONED HERE.

SO, I'M GOING TO SORT OF GRAB A

COUPLE THAT STAND OUT FOR ME.

NUCLEAR IS HERE.

FUSION IS HERE.

I DON'T KNOW IF THAT WAS THE

SAME PERSON WHO SAID NUCLEAR

FUSION OR IF TWO PEOPLE SAID

NUCLEAR AND FUSION.

LET'S GO AHEAD AND PLAY WITH

THOSE.

I PARTICULARLY LIKE THAT LEVER

BECAUSE THAT WAS ONE OF THE

ORIGINAL MOTIVATIONS FOR WHY

CLIMATE INTERACTIVE BUILT

EN-ROADS WAS THAT BILL GATES

WHEN HE WAS GETTING INVOLVED IN

CLIMATE INVESTING SAID WE JUST

NEED TO INVENT NUCLEAR FUSION

AND WE'LL SOLVE THE CLIMATE

CRISIS, HIS FIRM IS BREAKTHROUGH

ENERGY VENTURES.

WE HAD A SYSTEMS INTUITION THAT

WASN'T THE CASE, BUT WE WANTED

TO TEST IT OUT.

SO THE MODEL, THAT WAS ONE OF

THE ORIGIN STORIES FOR THE

MODEL.

LET'S SEE WHAT HAPPENS IF WE

INCREASE AMOUNT OF NUCLEAR

ENERGY AND SEPARATELY DO WHAT

HAPPENS IF WE INVENT NUCLEAR

FUSION, A NEW ZERO CARBON SOURCE

OF ENERGY.

SO, FIRST LET'S DO THE

EXPERIMENT OF NUCLEAR ENERGY.

AND THE WAY I'M GOING TO DO AN

EXPERIMENT IS THAT I'M GOING TO

SAY, ALL RIGHT, I'M GOING TO

CLICK AGGRESSIVE GLOBAL SUBSIDY

ON NUCLEAR ENERGY.

I WANT YOU AS AN ACTIVE LEARNER

TO MAKE A HYPOTHESIS IN YOUR

MIND ABOUT HOW BIG A CHANGE

THAT'S GOING TO BE.

THE MORE MENTALLY ACTIVE YOU ARE

IN THE EXPERIMENTATION PROCESS,

THE MORE YOU'LL LEARN FROM THE

EXERCISE.

IN FACT, I'M GOING TO MAKE YOU

TAKE A STAND ON THIS.

AND I'M GOING TO POSE ANOTHER

POLL QUESTION HERE.

IF I DO A GLOBAL SUBSIDY ON

NUCLEAR ENERGY, WHAT IS GOING TO

BE THE IMPACT ON TEMPERATURE?

AND SO THIS QUESTION WILL NOW BE

AVAILABLE ON YOUR POLL

EVERYWHERE ON YOUR BROWSER TAB

OPEN TO ANSWER THE PREVIOUS

QUESTION.

WHAT WILL BE THE TEMPERATURE

CHANGE?

I'M GOING TO HIDE THE RESULTS

FOR A SECOND SO YOU DON'T BIAS

EACH OTHER IN THE BEGINNING AND

WATCH THE RESPONDENT COUNT RACK

UP, NO CHANGE, HELP AND COOL THE

PLANET .1 TO .5 DEGREES OR MORE,

OR SOME COUNTERINTUITIVE EFFECTS

THAT MAYBE INCREASE TEMPERATURE

AS A RESULT?

LET'S TAKE A LOOK AT YOUR

RESPONSES HERE.

OKAY.

SO THE MAJORITY OF YOU SAY .1 TO

.5 DEGREES OF IMPROVEMENT, WITH

A FEW OF YOU BEING MORE

OPTIMISTIC.

AND I WILL SAY WHEN WE ENGAGE

WITH REPUBLICAN POLITICAL

LEADERS AND AUDIENCES, NUCLEAR

IS OFTEN THE FIRST EXPERIMENT

THEY WANT TO TRY.

AND SO IT'S ONE WE ALWAYS LIKE

TO RUN.

SO LET'S SEE WHAT THE RESULTS

ARE.

OKAY.

SO THAT'S A 7-CENT PER KILOWATT

HOUR GLOBAL SUBSIDY ON NUCLEAR

ENERGY.

FIRST QUESTION TO ASK WITH AN

EXPERIMENT LIKE THIS, DID IT

WORK IN THE SENSE DID IT PRODUCE

THE OUTCOME WE THOUGHT IT WAS

GOING TO PRODUCE IN THE

NARROWEST SENSE?

AND WHAT WE'RE DOING IS GOING

FROM 14 OR 15 EXIT JULES OF

ENERGY FROM NUCLEAR TO 95, WE'RE

MULTIPLYING BY FACTOR OF MORE

THAN SIX.

SUBSIDY WORKS IN THAT SENSE, AND

WHAT YOU CAN SEE AS THAT BAND OF

NUCLEAR EXPANDS, IT IS REDUCING

THE GAS AND COAL THAT WE'RE

BURNING TO PRODUCE ELECTRICITY.

IT'S POSSIBLE THAT A FEW OF YOU

WERE THINKING ABOUT THIS MORE AT

THE UPPER END, .5, A DEGREE OR

MORE.

SO, WE NEED ASK THE QUESTION

WELL, WHY DON'T WE SEE A BIGGER

CHANGE IN THE TEMPERATURE

PICTURE FROM THE MASSIVE

INVESTMENT IN NUCLEAR ENERGY?

WHAT DO WE THINK IS GOING ON?

IF YOU WANT TO SHARE ANY LIKE --

WHEN HE POSE A QUESTION LIKE

THAT I WOULD LOVE TO HEAR YOUR

THOUGHTS ABOUT WHY THAT'S THE

CASE.

SHARE THOSE VIA THE CHAT OR

THROUGH THE Q&A IF YOU HAVE

ACCESS TO THE Q&A.

OR IF SOMEONE WANTS TO UNMUTE,

WHAT'S GOING ON HERE, WHY DON'T

WE SEE A BIGGER CHANGE FROM THIS

INTERVENTION?

BRIAN SAYS REPLACING NUCLEAR

WITH RENEWABLES, RENEWABLES

DECREASE.

THANK YOU ON THE Q&A.

THAT'S EXACTLY RIGHT.

WHEN WE LOOK AT WHAT IS

DECREASING WHEN WE INCREASE

NUCLEAR, YES, IT IS SUBSTITUTING

A WAY FOR SOME FOSSIL FUELS, BUT

ALSO SHRINKING THE AMOUNT OF

RENEWABLE ENERGY BECAUSE WE'RE

CHANGING THE COST STRUCTURE,

CHANGING ON THE MARGIN THE

DECISION THAT A POWER PLANT

BUILDER, ELECTRIC UTILITY, IS

GOING TO MAKE.

SO WE'RE TRADING ONE FORM OF

GREEN ENERGY FOR ANOTHER, AND

NUCLEAR GREEN OR NOT, IT'S LOW

CARBON, WE'RE TRANSFERRING ONE

FORM OF LOW CARBON ENERGY FOR

ANOTHER.

THAT IS DAMPENING EFFECT.

THE OTHER THING THAT PEOPLE WILL

NOTICE IS IT WAS VERY SMALL.

YES, WE'RE ENDING UP WITH SIX

TIMES BIGGER BUT STILL ONLY

PROVIDING RELATIVELY SMALL

PERCENTAGE OF THE GLOBAL ENERGY

NEEDS OF THAT SCALE.

ALSO, THE FINAL THING IS THAT

NUCLEAR ENERGY TAKES A LONG TIME

TO BUILD.

YOU HAVE TO GET THE LAND,

OVERCOME ALL KINDS OF NIMBY

OPPOSITION, PLANS ARE COMPLEX.

THERE'S A RAMP-UP PERIOD TO GET

TO THAT LEVEL, AND YOU'RE

CONTINUING TO BURN COAL, OIL,

AND GAS.

LET'S TRY THE OTHER EXPERIMENT

WHICH IS KIND OF IN A WAY

SIMILAR, A NUCLEAR FUSION.

THIS REQUIRES A BIG

TECHNOLOGICAL BREAK THROUGH

BECAUSE WE DON'T HAVE IT YET.

THERE IS COMMONWEALTH FUSION IN

THE BACK YARD IN MASSACHUSETTS

WORKING ON THIS.

NOBODY HAS PRODUCED A TRULY NET

POSITIVE FUSION REACTION.

LET'S SAY WE HAVE A BIG

BREAKTHROUGH.

I LOVE TECHNOLOGY.

I THINK THIS HAS GREAT POTENTIAL

BUT LET'S SAY WE GET A

BREAKTHROUGH IN NEW ZERO CARBON

TECHNOLOGY, CHEAPER THAN COAL,

NEW EMISSION, LESS RADIATION

CONCERNS THAN REGULAR NUCLEAR,

LET'S SEE WHAT HAPPENS IF WE GET

THAT BREAKTHROUGH.

I'M NOT GOING TO DO THE POLL BUT

I WANT YOU TO DO THE MENTAL

PREDICTION ABOUT HOW BIG A

CHANGE WE'RE GOING TO SEE FROM

THAT.

OKAY.

SO, THERE IS OUR NUCLEAR FUSION.

WE'VE ADDED THAT TO THE ENERGY

MIX.

IT'S PRODUCING 145 EXAJOULES A

YEAR OF ENERGY, GOOD CHUNK OF

THE GLOBAL ENERGY MIX.

AND IF WE REFRESH CAREFULLY WE

SEE THAT WE'RE GETTING A TENTH

OF A DEGREE OF FAHRENHEIT

IMPROVEMENT THAT'S NOT QUITE

ADDING UP TO A TENTH OF A DEGREE

IN CELSIUS TERMS.

AGAIN, MUCH SMALLER IMPACT THAN

SOMETIMES PEOPLE HOPE AND,

AGAIN, THE REASON IS SIMILAR TO

WHAT WE SAW WITH NUCLEAR, THAT

WE'RE SUBSTITUTING A WAY FROM

RENEWABLES ALONG WITH THAT

SUBSTITUTION AWAY FROM COAL, OIL

AND GAS.

THAT'S GOING TO PARTLY MITIGATE

EFFECTS, AND THERE'S A VERY

SIGNIFICANT TIME DELAY WITH

THESE NEW TECHNOLOGIES BECAUSE

IT'S NOT JUST SOMEONE INVENTS

FUSION IN A LAB, THAT'S GREAT

NEWS.

BUT THEN YOU'VE GOT TO BUILD A

FIELD INSTALLATION, THEN TRAIN

PEOPLE, BUILD A WHOLE INDUSTRY

AND SUPPLY CHAIN AND REGULATORY

APPARATUS TO DEPLOY NEW

TECHNOLOGY AND WE CONTINUE TO

BURN COAL, OIL, GAS.

THESE ARE IMPORTANT.

THEY ARE VALUABLE.

EVERY TENTH OF A DEGREE MATTERS.

BUT OFTEN THE EXPERIENCE OF

FOLKS IS THAT WE GET LESS IMPACT

THAN WE THOUGHT WE WOULD.

LET ME GO BACK AND LOOK AT MAYBE

ONE MORE EXAMPLE HERE FROM FREE

RESPONSES BEFORE I ASK YOU TO

START VOTING ON SOME OF THE

SOLUTIONS.

SO, THERE'S A FEW HERE THAT TALK

ABOUT NO MEAT IN DIETS, REDUCED

MEAT.

THIS IS A GREAT QUESTION.

AS YOU MAY KNOW, THE REASON WHY

PEOPLE ARE CONCERNED ABOUT --

THE REASON PEOPLE ARE CONCERNED

ABOUT MEAT IS BASICALLY TWO

ASPECTS.

ONE, IN ORDER TO GROW A COW TO

MAKE DAIRY OR STEAK OR

HAMBURGERS THAT COW NEEDS TO EAT

A LOT OF PLANTS.

NEEDS TO EAT A LOT OF GRAIN.

USUALLY GRASS FED UNTIL A

CERTAIN POINT, FINISHED WITH

CORN IN THE UNITED STATES.

AND THE LAND THAT IT TAKES TO

GROW ALL OF THAT FEED IS VERY

EXTENSIVE COMPARED TO IF I WAS

JUST FEEDING PEOPLE THAT

VEGETARIAN DIET.

THERE'S BEEN A NUMBER OF

ATTEMPTS TO CALCULATE THE RATIO.

AN ORDER OF MAGNITUDE MORE LAND,

WATER, OTHER RESOURCES.

THAT'S GOING TO PUT LESS

PRESSURE ON FORESTS IF WE CAN

DECREASE MEAT CONSUMPTION.

AND FOR THAT REASON, THE FOOD

FROM ANIMALS IS HERE UNDER THE

DEFORESTATION PART OF THE MODEL.

THERE'S A SECONDARY EFFECT,

WHICH IS THAT LARGE MAMMALS

PARTICULARLY COWS AND SHEEP AND

LAMB, HAVE ENTERIC FERMENTATION,

RELEASE METHANE THROUGH BURPS,

AND ALL ANIMAL MANURE IS A

METHANE, NITROUS OXIDE SOURCE,

SO THERE'S OTHER GREENHOUSE

GASES WHICH CAN BE RELEASED

THROUGH THE ANIMAL DIGESTION.

SO IF WE REDUCE FOOD FROM

ANIMALS, THEN MAYBE THAT WILL

HELP.

SO WE'VE GOT 30% OF DIET BY

2100.

THAT'S KIND OF OUR BASELINE

ASSUMPTION THAT COMES FROM FAO

SORT OF UNDERSTANDINGS AND

FORECASTS.

SO WHAT HAPPENS IF WE COULD

DRAMATICALLY REDUCE THAT NUMBER,

AND CUT THAT FROM 30% OF DIETS

DOWN TO 10% OF DIETS.

THAT NUMBER MAY SEEM LOW TO YOU

BECAUSE THIS IS AN AMERICAN

AUDIENCE, IN AMERICA WE'RE USED

TO GETTING A LOT MORE OF DIE

FRET AN -- DIET FROM ANIMAL

PRODUCTS, WE'RE THINKING ABOUT

MEAT CONSUMPTION, PLANT BASED

SUBSTITUTES AVAILABLE IN KENYA

OR IN SOUTH ASIA YEA AND OTHER

PLACES WITH GROWING ECONOMIES.

LET'S DO AN EXPERIMENT, CUTTING

TO GET DIETS TO SHIFT.

LET'S HIT ENTER AND SEE WHAT

HAPPENS.

#R* THAT GOT US ANOTHER TENTH OF

A DEGREE OF AVOIDED FUTURE

WARMING.

THERE'S A COUPLE REASONS.

ONE IS THAT IT'S REALLY

SIGNIFICANTLY SLOW

DEFORESTATION.

ANIMAL AGRICULTURE IS THE BIG

DRIVER OF DEFORESTATION.

AND THERE'S GREAT SIDE BENEFITS,

RIGHT?

SO THIS IS ONE OF THE PLACES

WHERE ALSO THE PLANETARY HEALTH

VERSUS CLIMATE MODEL DISTINCTION

IS REALLY IMPORTANT.

BECAUSE WE'RE JUST LOOKING AT

GREENHOUSE GAS EMISSIONS HERE

BUT NOTICE THAT THIS CESSATION

OF DEFORESTATION HAS TREMENDOUS

EFFECT ON SOIL EROSION, A NUMBER

OF OTHER CONSIDERATIONS RELATED

TO DEFORESTATION.

THE OTHER THING THAT'S HAPPENING

HERE IS THAT WE ARE REDUCING

METHANE AND OTHER GASES, SO IF I

REDO THAT CHANGE, CHANGING

DIETS, WE'VE BENT THE CURVE ON

NON-CO2 MEANING METHANE, NITROUS

OXIDE IN PARTICULAR, BENT THE

CURVE ON EMISSIONS WHICH IS VERY

IMPORTANT, PART OF WHAT'S

GUESSING US THIS EXTRA TENTH OF

A DEGREE.

YOU CAN SEE THAT WITH THIS

REDUCTION OF METHANE AND LAND

USE EMISSIONS HERE.

SO, NOW, FOR ME PERSONALLY, THAT

WAS A SURPRISE.

THAT WAS A SMALLER CHANGE THAN I

THOUGHT, A DRAMATIC SHIFT.

SO WHY DON'T WE GET MORE CLIMATE

IMPACT, POSITIVE IMPACT, FROM

SUCH A HUGE CHANGE CUTTING

ANIMAL FOOD CONSUMPTION BY 2/3?

AGAIN, THROUGH CHAT OR THROUGH

THE Q&A, WHAT DO YOU THINK?

WHAT MIGHT BE GOING ON HERE,

WHAT ARE YOU NOTICING IN SOME

GRAPHS THAT WE'RE LOOKING AT

THAT MAKE THIS LESS IMPACTFUL

THAN PEOPLE OFTEN IMAGINE?

TO HELP I'LL MAKE SURE TO GO

BACK TO SOME OF THESE GRAPHS.

POPULATION IS STILL GROWING.

EXCELLENT ANSWER, JEN.

THE MEAT CONSUMPTION HERE IS

PERCENTAGE OF DIET BY 2100.

BUT THAT'S A PERCENTAGE OF DIET.

ABSOLUTE AMOUNT OF FOOD

CONSUMPTION IS GOING UP WITH THE

POPULATION.

SO GLOBALLY WE'RE AT 8 BILLION

PEOPLE.

WE'RE HEADING TOWARDS A FUTURE

OF $10.4 BILLION PEOPLE.

AND THAT MEANS THAT WE ARE GOING

TO NEED THAT MUCH MORE FOOD

PRODUCTION.

AND THE WARMING THAT WE'RE DOING

IS ALSO AFFECTING CROP YIELDS.

SO, THIS IS KIND OF WHAT'S

CALLED A REINFORCING FEEDBACK IN

THE CLIMATE SYSTEM WHICH IS THAT

THE MORE GREENHOUSE GAS

EMISSIONS WE DO, THE MORE WE

HEAT THE PLANET, WE DRIVE

DEFORESTATION, THAT HEATS THE

PLANET, BUT THE HEATING OF THE

PLANET DECREASES CROP YIELDS.

THAT DECREASING MEANS TO MAKE

THE SAME AMOUNT OF FOOD WE NEED

MORE LAND.

WE HAVE TO GROW ON LARGER

AMOUNTS OF LAND TO HANDLE CROP

LOSSES FROM CLIMATE CHANGE WHICH

MEANS WE'RE PUTTING MORE

PRESSURE ON FORESTS.

ALL OF THAT TOGETHER THAT IS

PART OF THE THINGS THAT ARE

DAMPENING EFFECTS, THAT'S A VERY

IMPORTANT PIECE.

THE OTHER PIECE IS AS YOU'LL GET

TIRED OF ME TALKING ABOUT THE

TIME DELAYS.

ALL THE WHILE THAT YOU'RE

WORKING TO DECREASE THOSE, TO

CHANGE THOSE DIETS, WE'RE STILL

DEFORESTING SO THERE'S -- THE

EARLIER AND THE SOONER THOSE

EFFECTS CAN HAPPEN, THE BETTER.

ANYTHING THAT TAKES A WHILE WILL

BE LESS EFFECTIVE.

THERE'S ANOTHER INTERESTING

PHENOMENON WHICH IS THAT A LOT

OF LOSS OF FOREST BIOMASS AND A

LOT OF EMISSIONS FROM FORESTS

ISN'T JUST ABOUT CLEAR CUTTING

THE LAND FOR AGRICULTURE BUT

IT'S ABOUT DEGRADING FORESTS FOR

OTHER PURPOSES INCLUDING

BIOENERGY AND WOOD PRODUCTS,

UNRELATED TO FOOD CONSUMPTION.

AND THEN ON THE METHANE FRONT,

YES, WE TAKE A GOOD DENT OUT OF

ANTHROPOGENIC METHANE BUT

THERE'S STILL A BIT OF EMISSION

LEFT BECAUSE METHANE IS NOT JUST

ABOUT AGRICULTURE, ALSO ABOUT

INDUSTRY.

WE'VE GIVEN YOU A FEEL FOR

WHAT'S GOING ON HERE WE'VE

GOTTEN TO REDUCE TEMPERATURE BY

2/10 OF A DEGREE.

I WANT US TO SOLVE GLOBAL

CHANGE, 30 MINUTES TO DO IT.

NEXT I'M GOING TO A KIND OF

TOOL, ANOTHER POLL, WHICH WILL

ALLOW YOU TO VOTE ON WHAT DO YOU

WANT ME TO DO.

SO, IN THIS POLL YOU'LL HAVE --

IF YOU TAP ON THE IMAGE WHEREVER

YOU TAP A PIN WILL APPEAR.

THAT WILL TELL ME THAT YOU VOTED

FOR ANOTHER EXPERIMENT.

REMEMBERING WE'VE GOT AN ARRAY

OF LEVERS HERE, ENERGIES APPLY,

ENERGY USE, AND

NON-ENERGY-RELATED AMISSIONS,

POLL EVERYWHERE LINK, I'LL GROW

THIS QR CODE AGAIN IN CASE IT'S

EASIER TO DO ON YOUR PHONE, GO

AHEAD AND TAP ON WHAT SHOULD WE

TRY, WHAT EXPERIMENTS SHOULD WE

RUN?

>> MORE THAN ONE OR ONLY ONE?

>> NO, YOU CAN TAP MULTIPLE.

I BELIEVE I'VE GOT IT SO YOU CAN

TAP MULTIPLE TIMES.

IF IT'S NOT LETTING YOU TAP

MULTIPLE TIMES, IT MIGHT MAKE

YOU UNDO AND MOVE IT.

BUT I THINK YOU CAN MAKE A

COUPLE VOTES.

I'LL KEEP THE POLL OPEN SO YOU

CAN DECIDE WHAT WE WANT TO DO.

THREE OF YOU ARE VOTING FOR

PLANTING TREES.

AFORESTATION.

WHICH IS GREAT.

THIS IS ABOUT -- WE'VE

DEFORESTED A LOT OF LAND.

LET'S AFOREST, PLANT NEW TREES

AND RECOVER.

THIS IS ALSO A COMMON IDEA

BECAUSE IT IS THE MOST COMMON

FORM OF CARBON OFFSET.

IF YOU GO TO SAY I'M TAKING THIS

AIRPLANE TRIP TO TAKE MY FAMILY

TO DISNEYLAND, I'LL BUY CARBON

OFFSETS A LOT OF OF TIMES THEY

ARE AFFORESTATION PROJECTS.

A TRILLION TREES INITIATIVE

ADVANCED BY A VARIETY OF PEOPLE,

MARK BENIOFF, SALES FORCE, FORCE

IN THE TRUMP FAMILY.

WE THINK ABOUT AFFORESTATION AS

A LEVER, WHAT PERCENTAGE OF LAND

THAT'S AVAILABLE FOR

AFFORESTATION SHOULD WE USE TO

PLANT TREES?

THIS IS A SERIOUS ENDEAVOR,

RIGHT?

WE'RE SAYING LIKE IF I TURN THIS

NUMBER TO 50%, THAT'S GOING TO

MEAN OF ALL THE AVAILABLE LAND

WHERE WE COULD PLANT TREES HALF

IS FOREST, WE'RE GOING TO PLANT

TREES.

LET'S SEE WHAT HAPPENS WHEN I

CLICK ENTER ON THAT ONE.

OKAY.

SO DID IT WORK, FIRST OF ALL?

YES, WE PLANTED THE TREES.

THE TREES GREW.

WE ENDED PUTTING 3 GIGATONS INTO

THE TREE PLANT TAIGS.

PLANTATION.

WE GOT ANOTHER POINT .06,

ROUNDING UP TO 1/10 OF IS A

DEGREE OF AVOIDED FUTURE

WARMING.

EXCELLENT, IF WE WERE ALL IN A

ROOM TOGETHER WE COULD GO

"WHOOP" EVERY TIME WE GET A

TENTH OF A DEGREE.

YOU'LL HAVE TO IMAGINE THAT IN

THE VIRTUAL ENVIRONMENT.

I WISH I GOT MORE THAN THAT 1/10

OF A DEGREE.

THE BIG STORY, FIRST OF ALL

THERE'S A QUESTION OF MAGNITUDE.

YOU CAN SEE THAT MAGNITUDE

CLEARLY ON THIS GRAPH WHICH IS

THAT YES WE'RE PUTTING AWAY 3

BILLION TONS INTO THE TREES, BUT

THAT'S HAPPENING AT THE SAME

MOMENT THAT WE'RE BURNING 34

BILLION TONS FROM OUR FOSSIL

ENERGY SYSTEM.

THE IDEA THAT WE'RE GOING TO

OFFSET OUR FOSSIL FUEL EMISSION

BY PLANNING TREES IS JUST A

MISMATCH OF SCALE OF AN ORDER OF

MAGNITUDE.

SECONDLY THIS DELAY PROBLEM,

THAT YOU HAVE TO GET THE LAND,

PLANT THE TREES, TREES HAVE TO

GROW.

WHEN YOU FIRST PLANT A SAPLING

IT'S ABSORBING MILLIGRAMS, THEN

GRAMS BEFORE IT'S ABSORBING

KILOGRAMS OR TONS OF CO2 AND

WE'RE TRYING TO GET TO BILLIONS

OF TONS.

THIS IS PART OF THE ISSUE.

SATURATION, ONCE THE TREES REACH

MATURITY THEY ARE IN QUILL

L ICK -- EQUILIBRIUM.

LESS AS THE TREE REACHES

MATURITY.

DAMPENED IMPACT.

WHAT ELSE HAVE WE GOT HERE?

I'M CHECKING THE VOTES.

TWO VOTED FOR A CARBON PRICE.

WHAT IS A CARBON PRICE?

WE HEARD -- YOU MAY HAVE SEEN

EARLIER IN THE DAY, SOME STUDIES

LOOKING AT DIFFERENT WAYS OF

THINKING ABOUT CLIMATE ACTION AS

BEING REPRESENTED BY A CARBON

PRICE, A CONVENIENT WAY TO DO

THAT.

LET'S CALIBRATE WHAT THAT MEANS.

CARBON PRICE IS BASED ON THE

IDEA THAT RIGHT NOW, IT IS FREE

FOR ALL OF US TO POLLUTE.

WE CAN JUST, YOU KNOW, BURN GAS

IN OTHER CARS, BURN COAL IN OUR

POWER PLANTS, KEEP THE PLANET,

CAUSE THE DIFFERENT EFFECTS

WE'VE BEEN TALKING ABOUT,

THERE'S NOT REALLY ANY -- IT'S A

COMMON RESOURCE ALL OF US HAVE

THE RIGHT TO BURN AND PUT THINGS

IN THE ATMOSPHERE.

CARBON PRICE SAYS NO.

IT COSTS SOCIETY MONEY, COSTS

LIVES, COSTS HEALTH AND

MORBIDITY AND MORTALITY.

SO WE NEED TO CHARGE PEOPLE FOR

THE PRIVILEGES OF USING THE

ATMOSPHERE AS DUMPING GROUND.

SO LET'S PUT A PRICE ON CO2

EMISSIONS.

THAT CAN BE A CARBON TAX, LIKE

YOU EMITTED 10 TONS OF CO2 SO

I'M GOING TO CHARGE YOU $500 AS

A TAX, 50 BUCKS A TON.

OR IT CAN BE YOU HAVE A PERMIT

TO POLLUTE ONLY SO MUCH BECAUSE

WE'RE TRYING TO CAP EMISSIONS.

AND WE'RE GOING TO REDUCE THAT

CAP OVER TIME.

YOU HAVE TO REDUCE YOUR

MISSIONS.

IF YOU CAN'T REDUCE YOUR

EMISSIONS, YOU'VE GOT TO BUY

YOURSELF A PERMIT FROM SOMEBODY

WHO WAS ABLE TO REDUCE

EMISSIONS.

AND IN THE BUYING AND SELLING OF

PERMITS WHAT'S CALLED A CAP AND

TRADE SYSTEM, A PRICE IS

REVEALED OR DISCOVERED, WHICH IS

THE PRICE OF CO2 EMISSIONS.

AROUND THE WORLD NOW AS A LITTLE

SNAPSHOT OF WHERE WE ARE, THE

WORLD BANK KEEPS TRACK OF CARBON

PRICING INITIATIVES.

SO, EMISSIONS TRADING SYSTEMS

ARE LIKE THE CAP AND TRADE,

CARBON TAX IS MORE THE DIRECT

CHARGE.

AND YOU'LL SEE THERE'S A VARIETY

OF JURISDICTIONS PRICING CO2 IN

DIFFERENT WAYS.

IN NEW ENGLAND WE HAVE REGI,

CALIFORNIA HAS A SIMILAR SYSTEM.

EUROPEAN UNION HAS THE MOST

ROBUST CAP AND TRADE SYSTEM.

AND THE PRICES VARY GREATLY.

SWITZERLAND, SWEDEN, URUGUAY

ABOVE $130 A TON.

EUROPEAN UNION TRADES AT $80 TO

$100 A TON.

WE DON'T HAVE A NATIONAL CARBON

PRICE, HERE IN NEW ENGLAND THE

REGI SYSTEM $15 TO $20 A TON.

A WEIGHTED AVERAGE, THE

EFFECTIVE CARBON PRICE ON

AVERAGE IS $5 A TON OF CO2 ON A

GLOBAL AVERAGE.

SO, EXPERIMENT WE'LL TRY HERE

IS --

[ NO AUDIO ]

SO WHAT HAPPENS IF THE REST OF

THE WORLD DOES WHAT EUROPE IS

DOING, AND PRICES CO2 AT $100 A

TON?

I'LL HIT ENTER.

WE'LL SEE WHAT HAPPENS.

OKAY.

6/10 OF A DEGREE OF AVOIDED

FUTURE WARMING.

DOING THIS REPLAY, SO NOTICE

THIS IS ON TOP OF THE OTHER

THINGS THAT WE'RE DOING.

SO WE'RE ALREADY MITIGATING SOME

OF OUR FOSSIL EMISSIONS BY

HAVING A MAJOR NUCLEAR AND

FUSION RENAISSANCE, AND OVER AND

ABOVE THAT WE'RE GETTING 6/10 OF

A DEGREE OF AVOIDED FUTURE

WARMING.

IF I GO TO A FRESH MODEL WHERE

WE'RE NOT TRYING ANY OTHER

EXPERIMENTS, I'LL KEEP THIS OPEN

TO DO MORE ISOLATED TYPE OF

EXPERIMENTS, AND SAY WHAT HAPPEN

IF THE ONLY THING WE DO IS $100

PRICE ON CARBON, AGAIN, 6/10 OF

A DEGREE OF AVOIDED FUTURE

WARMING.

SO THAT'S INTERESTING.

SOME OF YOU MAYBE TUNED IN TO

THE IDEA CARBON PRICING MATTERS,

THAT'S WHY YOU VOTED FOR IT.

THAT'S WHAT YOU EXPECTED.

SOME MAY NOT HAVE REALIZED

THAT'S SO IMPACTFUL.

LET'S UNPACK FOR A SECOND WHAT'S

GOING ON.

THERE'S TWO THINGS THAT I WANT

US TO NOTICE ON THE LEFT SIDE

GRAPH HERE.

ONE IS THAT THE OVERALL HEIGHT

OF THE MOUNTAIN IS DECREASING.

SO WHAT DOES THAT MEAN?

THAT MEANS WE'RE USING LESS

ENERGY.

AND THE REASON WE'RE USING LESS

ENERGY IS THAT WE'VE MADE ENERGY

MORE EXPENSIVE.

SO WE'RE CHARGING PEOPLE MONEY

TO POLLUTE WITH THE SOURCES OF

ENERGY WE'RE USING.

SO PEOPLE ARE GOING TO BUY

SMALLER CARS, MORE ENERGY

EFFICIENT CARS AS THEY DO IN

EUROPE, THEY ARE GOING TO

INSULATES HOMES, USE LED LIGHT

BULBS, MIGHT TAKE THE SUBWAY OR

BUS, MIGHT CARPOOL IN THE CAR

THEY HAVE.

SO THERE'S AN ENERGY EFFICIENCY

AND CONSERVATION IMPROVEMENT

THAT COMES FROM THAT.

AND THEN THERE'S A SECOND THING

GOING ON, THAT THE REDUCTIONS

HAPPENING ARE NOT -- REMEMBER

BEFORE WHEN OUR EXPERIMENT

WAS -- I'M GOING A FRESH MODEL

HERE.

WHEN THE EXPERIMENT WAS LET'S

SUBSIDIZE NUCLEAR, INCLUDING

RENEWABLES, ALL ELSE BEING

EQUAL, COSTS BEING EQUAL,

RENEWABLES ARE VARIABLE AND

REQUIRE BATTERY STORAGE AND SO

PEOPLE WILL SUBSTITUTE AWAY FROM

THEM.

WHERE AS I'M MOST SPECIFICALLY

GOING AFTER THE MOST CARBON

INTENSIVE FUELS WITH CARBON

INTERVENTION.

COAL IS DECREASING, NALTREXONE

GAS DECREASING BUT RENEWABLES,

NUCLEAR AND FUSION, ARE ALL

INCREASING.

BECAUSE WE'RE ADVANTAGING THE

LOW CARBON ENERGY SOURCES HERE.

I CAN VISUALIZE THAT IN ANOTHER

WAY ON THESE GRAPHS.

THIS IS A KAYA IDENTITY,

POPULATION TIMES GDP, AND WHAT

HAPPENS WE HAVE TWO SIMULTANEOUS

EFFECTS.

WE'RE REDUCING ENERGY INTENSITY

OF GDP, BECOMING ENERGY

EFFICIENT, AND DECARBONIZING

ENERGY SUPPLY, THIS GRAPH HERE.

THIS DELTA MULTIPLIED BY THIS

DELTA IS RESULTING IN A

PARTICULAR REDUCTION IN CO2

EMISSIONS.

IF YOU'RE PAYING CLOSE ATTENTION

THERE'S ANOTHER EFFECT GOING ON

HERE WHICH IS QUITE INTERESTING.

WHICH IS THAT AS WE INCREASE

CARBON PRICE, OUR ECONOMIC

PRODUCTIVITY IS ALSO INCREASING,

WHICH IS COUNTERINTUITIVE,

PARTLY HAS TO DO WITH STAGE OF

MODEL, REFLECTS IMPORTANT

PHENOMENON THAT GDP PER CAPITA

IS HARMED BY CLIMATE CHANGE.

SO, THE FACT THAT WE ARE WARMING

THE PLANET BY -- SORRY, I'M

GOING TO ANOTHER FRESH MODEL

HERE, THE FACT THAT WE'RE

WARMING THE PLANET BY 3.3

DEGREES MEANS THERE'S HUGE LOSS

OF ECONOMIC PRODUCTIVITY.

ALL THAT LOSS OF COASTAL

INFRASTRUCTURE, HEAT STRESS AND

HEALTH EFFECTS, ALL THE LOSS OF

CROP PRODUCTIVITY, ALL OF THOSE

THINGS TOGETHER CREATE ECONOMIC

DAMAGE.

THERE'S A LOT OF UNCERTAINTY

ABOUT THE ECONOMIC DAMAGE

FUNCTION, WE USE A MIDDLE OF THE

ROAD ESTIMATE, CONSERVATIVE BY

OUR POINT OF VIEW, BUT NOTICE

THAT THIS ALSO ECONOMIC DOWNTURN

IS FROM COVID.

AND THIS ECONOMIC DOWNTURN IS

FROM CLIMATE.

MASSIVE EFFECTS ON GLOBAL

ECONOMY.

WHEN WE MAKE THE CLIMATE BETTER

WE ACTUALLY RESTORE SOME

PROSPERITY, BECAUSE WE'RE

BREAKING THE CLIMATE LESS.

SO THAT'S ANOTHER SORT OF FACTOR

OF PART OF WHAT'S GOING ON HERE.

AND NOW, MANY PEOPLE WILL ARGUE

THAT THE CARBON PRICE ITSELF

WILL HAVE ECONOMIC -- NEGATIVE

ECONOMIC EFFECT, A VERY

IMPORTANT CONSIDERATION,

PARTICULARLY IN CONVERSATIONS

WE'VE HAD TODAY THERE'S SERIOUS

EQUITY CONSIDERATIONS BECAUSE --

THIS GOES TO THE POINT ABOUT

TRADEOFFS AND UNINTENDED

CONSEQUENCES THAT WERE BROUGHT

UP IN PREVIOUS SESSION.

WHICH IS THAT OUR ENERGY COST IS

INCREASING PRETTY DRAMATICALLY,

NOT BY ORDER OF MAGNITUDE OR

DOUBLING BUT WE'RE GOING FROM

$22 A GIG AJOULE TO $30, THAT'S

50% INCREASE, SUBSTANTIAL

INCREASE IN ENERGY COST, HITTING

LOW INCOME PEOPLE HARDEST WHO

SPEND HIGHER PROPORTION OF

INCOME ON ENERGY.

WE HAVE TO BE CAREFUL ABOUT

DISTRIBUTIONAL IMPACT OF THIS

CHANGE TO GIVE THE ECONOMY MORE

TIME TO ADJUST, INSTEAD OF

RAMPING UP CARBON PRICE OVER TEN

YEARS, I RAMP UP OVER 20 YEARS,

TO GET TO THAT $100 A TON, IT

DOESN'T, YOU KNOW -- WE DON'T

LOSE TOO MUCH EFFECT ON THE

CLIMATE BUT WE GAIN A BIT OF

SMOOTHER TRANSITION ON THE

ENERGY PRICE SIDE.

BUT AN EVEN BETTER SOLUTION TO

EQUITY CONSIDERATIONS IS TO TAKE

THE MONEY IN TO THE GOVERNMENT

IN THE FORM OF PERMIT AUCTIONS

OR CARBON TAXES, AND WRITE

CHECKS FOR PEOPLE.

IF YOU DO WHAT'S CALLED A FEE

AND DIFFERENT, I WRITE A CHECK

TO EVERY PERSON IN THE ECONOMY,

FOR IT'S MONEY I GET FOR MINE

CARBON PRICE WHAT HAPPENS IS IF

I'M A PRIVILEGED PERSON WHO

LIVES IN A SINGLE FAMILY HOME,

WITH TWO CARS, ANNUAL TRIP TO

DISNEYLAND, I'LL PAY A BIG

CARBON BILL EVERY YEAR BUT I'M

GOING TO GET A CHECK BACK THAT

DOESN'T -- THAT'S SMALL.

I'LL HAVE A FLEET PAYMENT -- NET

PAYMENT.

IF I'M LOWER INCOME, LIVE IN

APARTMENT, TAKES THE BUS,

DOESN'T FLY, THAT CHECK I GET IN

THE MAIL IS GOING TO BE BIGGER

THAN MY CARBON BILL, A

PROGRESSIVE CASH TRANSFER IN A

SENSE.

YOU CAN MEANS TEST TO MAKE IT

EVEN BETTER.

A NUMBER OF POLICY PROPOSALS ARE

OUT THERE HOW TO DO A

PROGRESSIVE REVENUE NEUTRAL

CARBON PRICE.

AND THAT'S A VERY IMPORTANT

TOPIC.

I'VE SPENT A LOT OF TIME TALKING

ABOUT THE CARBON PRICE HERE, BUT

NOTICE THAT WE'RE NOT QUITE

THERE YET.

WE'RE STILL 2.4 DEGREES, WE WANT

TO REACH THE PARIS ACCORD

OBJECTIVE OF 2 DEGREES, IDEALLY

1.5, SO WHAT ELSE CAN WE TRY?

I'M GOING TO COME BACK TO OUR

VOTING THING HERE AND PAUSE FOR

A SECOND HERE AND LET FOLKS VOTE

FOR ANY OTHER THINGS WE HAVEN'T

TRIED YET WHILE I ALSO LOOK AT

THE CHAT.

I SAW COMMENTS.

A REALLY IMPORTANT COMMENT ABOUT

THE NEED FOR MULTI-SCALE MODELS,

THIS IS I THINK MADE VERY

VISIBLE BY OUR EXERCISE HERE,

SUPER INTERESTING TO UNDERSTAND

THAT WE'RE GOING TO HAVE HEAT

STRESS AT GLOBAL LEVEL BENEED TO

UNDERSTAND IN A MORE

GEOGRAPHICALLY DISAGGREGATED

WAY.

THERE ARE TOOLS, WHAT I'M DOING

WORKSHOPS LIKE THIS, I'LL OFTEN

FLIP OVER TO A TOOL CALLED

PROBABLE FUTURES.

WHICH IS A SET OF INTERACTIVE

MAPS THAT IS ORGANIZED AROUND

TEMPERATURE SCENARIOS.

SO, AGAIN, REMEMBER OUR BASELINE

WAS A 3-DEGREE SCENARIO WHERE

THIS IS A MAP OF THE NUMBER OF

DAYS PER YEAR ABOVE 28 DEGREES

CELSIUS, WHERE YOU START TO SEE

IMPORTANT HEAT STRESS,

PARTICULARLY IN VULNERABLE

POPULATIONS.

AND CAN YOU SEE HOW CURRENTLY

THIS IS 1 TO 7 DAYS OF THAT KIND

OF HEAT STRESS, 3-DEGREE WORLD

HAS THAT BECOMING MORE LIKE 28

DAYS IN THE SOUTHEAST, AND THAT

KIND OF HEAT MAKING ITS WAY UP

NORTH, SO YOU CAN USE SOME OF

THESE TOOLS TO EXPLORE WHAT THIS

COULD LOOK LIKE IN A

GEOGRAPHICALLY DISAGGREGATED

WAY, BUT JUST RECOGNIZING THE

SCIENCE ON THIS IS STILL PRETTY

YOUNG AND THERE'S PLENTY MORE

WORK TO DO TO CLARIFY ALL OF

THAT.

OKAY.

WE HAVE TWO VOTES HERE FOR

REDUCING COAL.

WHICH IS GREAT.

AND THAT'S IMPORTANT.

LET'S TAKE A LOOK.

NOTICE THAT COAL IS VERY

IMPORTANT.

IN OUR -- SO IN OUR PICTURE

WE'VE ACTUALLY SIGNIFICANTLY

REDUCED COAL AS A RESULT OF OUR

CARBON PRICE.

AND FOR A MEDICALLY AND

HEALTH-ORIENTED AUDIENCE LET'S

REMEMBER THAT ONE OF THE

CRITICAL REASONS WHY WE WANT TO

DO THAT IS BECAUSE IT'S GOING TO

REDUCE AIR POLLUTION.

IF I DO A REDO OF OUR CARBON

PRICE HERE, IN ADDITION TO

CLIMATE EFFECTS, AND WHATEVER

ECONOMIC CONSEQUENCES, THE

CARBON PRICE A LOT OF ANALYSES

SUGGEST IT WILL PAY FOR ITSELF

JUST IN REDUCE THE POLLUTION AND

HEALTH BENEFITS.

SO COAL IS A VERY IMPORTANT

TOPIC.

IT IS I THINK BECAUSE AGAIN THIS

IS A U.S. FOCUSED CONVERSATION

TODAY, IT'S IMPORTANT TO

RECOGNIZE THAT THIS IS A VERY

MUCH GLOBAL PICTURE.

THE HEAT -- SORRY, AIR

POLLUTION, GEOGRAPHY OF AIR

POLLUTION THAT'S GLOBALLY REALLY

A STORY ABOUT INDIA AND CHINA,

AS WELL AS INDONESIA AND OTHER

RAPIDLY DEVELOPING COUNTRIES IN

SOUTHEAST ASIA AS WELL AS THERE

ARE OTHER GEOGRAPHIES WHERE AIR

POLLUTION IS A SERIOUS

CONSIDERATION, BUT THE MOST

INTENSE POPULATIONS INTERSECTION

BETWEEN POPULATION CENTERS AND

VULNERABILITY DUE TO LACK OF AIR

CONDITIONING AND FILTRATION AND

AIR POLLUTION IS IN SOME OF

THESE REGIONS, AND IT'S THESE

MIDDLE INCOME COUNTRIES ARE THE

ONES WHO HAVE THE MOST

SUBSTANTIAL COAL -- THIS

DIRECTIONAL SLASH IS COAL, SO

POWER PLANTS FROM COAL ARE

SOMETHING WE BUILD A LOT OF AS

WE'RE HEADING TO BECOMING A

MEDIUM-INCOME COUNTRY AND IN THE

VERY HIGH-INCOME COUNTRIES OVER

TIME WE'RE STARTING TO

DECARBONIZE THAT PART OF OUR

ENERGY SYSTEM BUT THAT'S NOT

TRUE IN INDIA AND CHINA.

SO, THE REDUCTION OF COAL AND

LIFE-SAVING POTENTIAL OF THAT

JUST THE CAVEAT THOSE ARE --

SOME ARE AFFECTS THAT ARE

REGIONAL SPECIFIC.

WHAT ELSE COULD WE DO TO REDUCE

COAL?

IF I JUST DRAG THIS SLIDER OVER

AND DO A TAX ON COAL, YOU'LL SEE

IT'S NOT REALLY HAVING MUCH OF

AN EFFECT.

THAT'S BECAUSE WE'VE ALREADY

TAXED COAL THROUGH THE CARBON

PRICE.

IF I -- A FRESH MODEL WITH

NOTHING ELSE IF I TAX COAL I'LL

SEE 2/10 TO 3/10 OF A DEGREE OF

IMPROVEMENT BECAUSE NOTHING ELSE

HAS SORT OF REDUCED COAL

UTILIZATION.

OVER AND ABOVE TAXATION THE

OTHER IDEA WHICH I THINK IS A

VERY IMPORTANT IDEA IS JUST STOP

BUILDING NEW COAL PLANTS.

THERE'S A LOT OF PEOPLE IN THE

WORLD WHO DEPEND ON COAL AS

THEIR PRIMARY SOURCE OF ENERGY.

MY WIFE IS FROM CALCUTTA, THAT'S

HOW WE HAVE THE LIGHTS ON THERE.

TURNING OFF THE COAL PLANTS IS

THREATENING.

IF YOU STOP BUILDING NEW ONES

AND HAVE ALL THE NEW ENERGY

NEEDS MET WITH RENEWABLES AND

SORRY LOW CARBON ENERGY SOURCES,

THEN THAT CAN BE QUITE

IMPORTANT.

SO, REDUCING THAT NEW COAL

INFRASTRUCTURE, LETTING THE OLD

COAL PLANTS DIE OUT, THAT TURNS

OUT TO BE ANOTHER KIND OF

MECHANISM WE CAN USE TO REDUCE

COAL.

MY PUP HAS COME TO VISIT.

HI.

AND YOU CAN SEE IT'S NOT HAVING

MUCH OF AN IMPACT ON THIS

PICTURE BECAUSE WE'VE ALREADY IN

A SENSE REDUCED COAL

SIGNIFICANTLY ALTHOUGH YOU CAN

SEE FROM THE -- LET ME

SIMULTANEOUSLY SHOW THE AIR

POLLUTION AND GREENHOUSE GASES.

YOU KNOW, STOP BUILDING NEW COAL

PLANTS, THIS IS HAS AN AIR

POLLUTION BENEFIT MORE THAN

DEGREE HOUSE GAS BENEFIT ONCE

WE'VE ALREADY DONE A CARBON

PRICE.

IF THE ONLY THING WE DO, RESET

EVERYTHING ELSE, THE ONLY ACTION

WE TAKE IS TO JUST STOP BUILDING

NEW COAL PLANTS, THAT IS A

PRETTY IMPORTANT -- AGAIN,

THAT'S AT LEAST A 2/10 OF IS A

DEGREE IMPROVEMENT, BUT WITH

DOING NOTHING ELSE, WITHOUT THE

CARBON PRICE WHAT HAPPENS IS YOU

STOP BUILDING NEW COAL BUT

EXPAND NATURAL GAS.

WHEN YOU DO THAT YOU'RE

SIMULTANEOUSLY BURNING CO2 FOR

GAS, AND YOU'RE INCREASING

THE -- PRESERVING OR INCREASING

AMOUNT OF METHANE THAT'S LEAKING

FROM THE NATURAL GUESS SYSTEM.

NOT SEEING BIG ENOUGH IMPACTS

FROM OVERAND ABOVE WHAT WE'VE

DONE FOR COAL BUT INTEREST.

IN THE INTEREST OF TIME, I'M

GOING TO CHEAT A LITTLE BIT HERE

AND GO WITH THE SOLUTIONS THAT

YOU DID VOTE ON, BUT WHICH I

KNOW ARE GOING TO BE

PARTICULARLY IMPACTFUL.

ONE OF THOSE IS ENERGY

EFFICIENCY MEASURES IN BUILDINGS

AND INDUSTRY.

SO, A CARBON PRICE DOES HELP US

BECOME MORE ENERGY EFFICIENT.

BUT ECONOMIC INCENTIVES ARE NOT

THE ONLY FACTOR THAT GETS IN THE

WAY OF ENERGY EFFICIENCY.

THERE'S A LOT OF

LANDLORD-TENANTS PROBLEMS, FOR

EXAMPLE, WHERE THE TENANTS WILL

PAY FOR ENERGY BILLS BUT

LANDLORD IS BUILDING THE

EQUIPMENT.

YOU HAVE TO OVERCOME SOME OF

THOSE WITH DIRECT ENERGY

EFFICIENCY SUBSIDIES AND

MEASURES IF YOU WANT TO GET THAT

TO HAPPEN.

BUILDING CODE CHANGES AND OTHER

THINGS LIKE THAT.

WE CAN INCREASE BUILDING

EFFICIENCY OVER AND ABOVE WHAT

WE'VE DONE SO FAR, AND THAT

REDUCES AMOUNT OF ENERGY THAT WE

HAVE TO PRODUCE IF WE DO ENERGY

EFFICIENCY IN BUILDINGS, 3/10 OF

A DEGREE.

THEY SAVE MONEY BUT YOU HAVE TO

HELP PEOPLE OVERCOME THE

BARRIERS OF ENERGY EFFICIENCY.

THERE'S PRESCRIPTIONS FOR

BOILERS IN THE U.K.,

WEATHERIZATION TO HELP PEOPLE

REDUCE HOME ENERGY USE.

WHY SHOULDN'T THE -- THERE ARE

TWO CEOS IN NEW YORK CITY WHO IN

THE LAST YEAR FOR WHICH DATA --

FURTHER MEASURES TO REDUCE

METHANE GASES, TEND TO BE POTENT

IN THEIR IMPACTS.

SO, JUST LOOKING AT THE CHART

HERE, IF OVER AND ABOVE WE CAN

REDUCE THESE GASES THAT HAS A

SUBSTANTIAL IMPACT AND WITH A

REALLY AGGRESSIVE GLOBAL EFFORT,

BY THE WAY OUT OF THE COP

NEGOTIATIONS, AN AGREEMENT TO

WORK ON METHANE WITH THE U.S.

STARTING TO PUT IN PLACE METHANE

POLICY WAS A KEY PART OF THE

GLOBAL AGREEMENT SO THERE'S GOOD

NEWS ON THIS FRONT.

THIS IS A POWERFUL LEVEL FOR TWO

REASONS THAT HAVE TO DO WITH

SOME BASIC CLIMATE SCIENCE

PHENOMENA.

THE METAPHOR I USED EARLIER

WAS -- I USED TWO.

ONE ABOUT THE BATHTUB OF THE

ATMOSPHERE.

SO THE BATHTUB METAPHOR TEACHES

US THAT THERE'S A FAUCET AND

DRAIN, WE EMIT, SOME OF THE

GREENHOUSE GASES ARE BROKEN DOWN

OR ABSORBED.

METHANE BREAKS DOWN FASTER IN

THE ATMOSPHERE THAN CO2 DOES.

WHEN YOU TURN OFF THE FAUCET,

THE METHANE FAUCET, IT DRAINS

OUT FASTER AND SO YOU HAVE A

NEARER-TERM FASTER IMPACT ON

TEMPERATURE.

AND THEN SECONDLY, OUR OTHER

METAPHOR WAS THE IDEA CO2 IS A

BLANKET THAT HOLDS TEMPERATURE,

HOLDS HEAT INTO THE ATMOSPHERE

AND BY THAT METAPHOR WE CAN

THINK ABOUT METHS -- METHANE AS

A THICK BLANKET THAT HOLDS IN

HEAT MORE DRAMATICALLY.

SO THAT GREENHOUSE EFFECT IS

MUCH STRONGER WITH THE MORE --

THE HIGHER GLOBAL WARMING

POTENTIAL OF GASES.

SO THERE'S THIS DOUBLE EFFECT

THAT YOU GET, MANY PEOPLE ARE

TALKING NOW ABOUT HOW AS A NEAR

TERM ACTION WE NEED TO REDUCE

METHANE TO BUY TIME FOR THE

SORTS OF THINGS THAT WILL TAKE

LONGER LIKE CHANGING OVER THE

ENERGY SYSTEM.

SO, NOW, I WANT TO JUST PAUSE

FOR A SECOND AND TAKE STOCK OF

WHAT WE'VE GOT HERE.

WHICH IS THAT WE HAVE A SET OF

ACTIONS, AT A GLOBAL SCALE, THAT

HAVE GOTTEN US FROM A 3.3-DEGREE

WORLD TO 1.9-DEGREE WORLD.

MY ONLY DISSATISFACTION WITH

THIS IS THAT WE DID WAVE A MAGIC

WAND AND GET A MAGICAL

BREAKTHROUGH WITH THAT FUSION

THAT SOMEONE PROPOSED EARLIER.

SO I WANT TO RUN THE EXPERIMENT

OF NOT HAVING TO INVENT FUSION,

AND WHAT DOES THAT DO FOR US?

WELL, OKAY, YOU KNOW, WE DID

LOSE A TENTH OF A DEGREE SO

THERE'S SOME -- THAT'S A KIND OF

UNCERTAINTY, DO WE GET THIS

IMPROVEMENT OR NOT?

BUT NOTICE THE WHOLE FATE OF THE

PLANET ISN'T HANGING ON THAT

NECESSARILY.

YOU KNOW, HOW MUCH IS IT HANGING

ON THE SUBSIDY FOR NUCLEAR?

WE COULD -- SIMILAR MAGNITUDE

HERE, IF YOU THOUGHT THAT THERE

WERE OTHER HEALTH CONSEQUENCES

EARLIER PEOPLE TALKING ABOUT

URANIUM CONTAMINATION IN WATER

SUPPLIES, IF YOU'RE CONCERNED

ABOUT THAT AND WANT TO PEEL THAT

OFF, NOT HAVE THE TECHNOLOGICAL

MIRACLE OF NUCLEAR, WE STILL AT

THIS 2-DEGREE WORLD WITH

RENEWABLES AND STORAGE POWERED

GRID, SO THERE'S REASONS THAT

PEOPLE MIGHT WANT TO DO THAT

FOR THE SAKE OF STAYING WITH

WHAT YOU ALL SUGGESTED, LET'S

LOOK AT THIS SCENARIO FOR A

SECOND.

WHAT I WANT US TO DO IS THINK

ABOUT THIS IN A PARTICULAR WAY.

WHICH IS IT'S ONE THING TO SEE

THIS AS A SET OF GRAPHS.

IT'S ANOTHER THING TO

CONTEMPLATE WHAT DOES THIS

FUTURE MEAN?

SO THE LAST POLL QUESTION THAT

I'M GOING TO ASK YOU THROUGH OUR

POLL EVERYWHERE HERE IS A

QUALITATIVE POLL, AND IT'S THE

FOLLOWING QUESTION.

WHAT WOULD YOU LOVE ABOUT BEING

PART OF THIS FUTURE?

AGAIN, THIS POLL IS OPEN, IT'S

THE SAME URL.

THE QR CODE IS HERE, THE LINK IN

IN THE CHAT.

RESPOND WITH A PHRASE, IT CAN BE

A QUICK THOUGHT, A THOUGHT

BUBBLE.

WHAT WOULD YOU LOVE ABOUT

GETTING TO BE PART OF THIS

FUTURE?

I'M GOING TO TAKE YOU THROUGH A

TOUR OF WHAT THE CHANGES ARE.

WHAT WOULD YOU LOVE ABOUT

GETTING TO BE PART OF THIS

FUTURE?

THIS MAY BE A TECHNOLOGICAL

BARRIER TO ANSWER, SOME MIGHT BE

DRIVING HOME FROM WORK AND

JOINING THE WEBINAR FROM THE

CAR.

AND THAT'S VALID.

FOR ME, I LOOK AT THIS AND I

SAY, LOOK, THERE'S STILL

PROBLEMS TO SOLVE.

WE HAVEN'T CREATED A TRULY SAFE

FUTURE BUT WE'VE CREATED A

FUTURE THAT I'M MUCH MORE PROUD

AND HAPPY AND COMFORTABLE

LEAVING TO MY KIDS AND

GRANDKIDS.

WHERE WE'VE SAVED A LOT OF

LIVES, DUE TO AIR POLLUTION,

WE'VE LEVELED OUT THE

TEMPERATURE, WE'VE GOTTEN THE

CLIMATE PROBLEM UNDER CONTROL.

IT'S NOT JUST CONTINUING TO

INCREASE INTO THE FUTURE

GENERATIONS, RIGHT? WE GO BACK

TO INDIGENOUS WISDOM WE HEARD

EARLIER ABOUT THINKING ON A

SEVEN-GENERATION TIME HORIZON,

THE OLD WORLD WE WERE GOING TO

KEEP COOKING THE PLANET WITH

EACH PASSING GENERATION.

THIS IS A WORLD WHERE WE'VE

REINED EXCESSES AND SAVED LIVES.

THERE'S REGIONAL SPECIFICITY,

BUT WE'VE TAKEN A HUGE AMOUNT OF

THAT BURDEN OUT OF THE SYSTEM.

AND MY HOPE IS THAT SEEING THIS,

AND EXPERIMENTING WITH IT ON

YOUR OWN TIME AND OWN TERMS, YOU

GET A CHANCE TO FALL IN LOVE

WITH THIS FUTURE AND COMMIT

YOURSELVES AS YOU ALREADY HAVE

DONE AS WE'VE SEEN TODAY, TO

HELPING TO CREATE THIS FUTURE

BECAUSE GETTING TO THE LEVEL OF

ACTION ON A GLOBAL SCALE THAT'S

REFLECTED IN THESE LEVERS WILL

IN FACT TAKE EXACTLY WHAT YOU

ALL DESCRIBED AS EDUCATION,

UNDERSTANDING INTENTIONAL

BEHAVIORS, COLLECTIVE ACTION.

IT WILL TAKE WORKING TOGETHER.

MY HOPE IS THAT ALL OF US

TOGETHER AND ALL OF THE

INSTITUTIONS AND ORGANIZATIONS

THAT WE'RE REFLECTING AND PART

OF CAN JOIN IN THIS GLOBAL

CONVERSATION AND HELP PROPEL

FURTHER.

PLEASE SEE US AS A RESOURCE.

HOPEFULLY THIS WAS SOMETHING

INFORMATIVE AND MAYBE INSPIRING.

>> JASON, THAT WAS PHENOMENAL.

THE EXERCISE WAS AN IDEAL

CONCLUSION TO OUR SESSIONS, IN

THE MORNING AND AFTERNOON.

REALLY UNDERSCORES IMPORTANCE OF

SYSTEMS THINKING.

ALTHOUGH OBVIOUSLY THERE ARE

SOME LIMITATIONS TO THE MODEL,

REALLY PROVIDES A VERY UNIQUE

PERSPECTIVE TO NOT ONLY STARTING

TO THINK ABOUT RESEARCH

QUESTIONS BUT HOW TO FRAME THEM

FROM FROM INTERCONNECT THENESS.

WE HAVE TO WRAP UP.

I'LL TURN OVER TO LARRY TO CAP

PROCEEDINGS AND PROVIDE

CONCLUDING REMARKS.

>> THANK YOU.

ECHOING WHAT SANJAY SAID, THAT

WAS PHENOMENAL.

I THINK IT FITS IN VERY WELL

WITH TODAY, IN THAT MANY

HOPEFULLY A DECADE FROM NOW

WE'LL HAVE A MODEL THAT NOT ONLY

WILL DO CLIMATE CHANGE BUT IT

WILL DO PLANETARY HEALTH ON A

BROADER SCALE.

AND IT MAY NOT BE THAT MUCH

DIFFERENT THAN THIS MODEL BUT I

THINK THAT'S THE CHALLENGE.

THERE ARE RESEARCHERS TO CREATE

DATA TO ALLOW MORE COMPLEX

MODEL, PERHAPS ADD SOME POSSIBLE

SOLUTIONS THAT MIGHT DEVELOP, ET

CETERA, THAT WE HAVE MORE DATA

ON, ET CETERA.

I THINK IT WAS A GREAT

CONCLUSION FOR THE DAY.

ALL I WANT TO SAY, I HOPE THAT

YOU'VE ALL HEARD, WHAT YOU'VE

HEARD SO FAR TODAY HAS ENTICED

YOU TO COME BACK TOMORROW AT 10

A.M.

AND CONTINUE OUR MUTUAL

EXPLORATION OF PLANETARY HEALTH

AND CARDIOVASCULAR HEALTH.

AND TOMORROW WE'LL CONTINUE OUR

FOCUS, NOT EXCLUSIVELY BUT WE

WILL HAVE MORE ON THE URBAN

ENVIRONMENT, AND HOW TO IMPROVE

HEALTH PARTICULARLY

CARDIOVASCULAR HEALTH THROUGH

REDUCING EXPOSURES, HOW TO

RECONFIGURE OUR ENVIRONMENT AND

ECONOMY, ET CETERA.

LATER ON IN THE DAY TOMORROW WE

WILL FOCUS ON THE RESEARCH TOOLS

AND METHODS THAT CAN ASSIST US

TO ENSURE THAT WE UNDERSTAND THE

HEALTH BENEFITS AND UNINTENDED

CONSEQUENCES OF SOLUTIONS AND

THEIR BENEFITS AND THE HEALTH

COASTS OF NOT ADDRESSING THESE

PLANETARY ISSUES.

SO I HOPE TO SEE YOU TOMORROW AT

10 A.M.

I THANK EVERYONE WHO

PARTICIPATED TODAY.

IT WAS A FANTASTIC DAY.

AND I KNOW TOMORROW WILL BE

EQUALLY AS GOOD.

THANK YOU ALL.

HOPE YOU HAVE A GREAT EVENING.

>> LARRY, I'LL TURN THIS OVER TO

SONIA FOR FINAL REMARKS FOR WE

MOVE ON.

>> GOOD IDEA.

>> ECHOING HOW WONDERFUL IT WAS

TO HAVE EVERYBODY ENGAGED, GREAT

QUESTIONS, GREAT DISCUSSION, I'M

EXCITED FOR TOMORROW AS WELL.

LOOKING FORWARD TO SEEING YOU.

>> THANKS SO MUCH.

BYE-BYE.

>> GOOD EVENING.

9925 06:20:55,666 >> BYE.