1. Air & Water Hazards In China: How Bad Is It, & How To Stay Healthy

2. About Me…  I am Dr Richard Saint Cyr, a family medicine doctor, from America  I work at Beijing United Family Hospital  Director of Marketing, UFH  My health website: MyHealthBeijing.com  Weibo: weibo.com/daniudaifu

3. Let’s Review Pollution…

4. The Common Air Pollutants  Particulates (PM10, PM2.5)  Nitric oxide/dioxide  Sulfur dioxide  Ozone  Carbon monoxide

5. The worst one is: small particles (PM = particular matter)

6. These Are Very, Very Small…

8. Health Effects  Short-term (days): –Heart attacks –Asthma –Bronchitis  Long-term (>8 years): –COPD/emphysema –Heart Disease –Cancer

9. London in 1952!

10. The Great London Smog of 1952  It was a bad combo of cold weather + more coal burning + inversion layer of air…  = disaster for 5 days… –pollution at 3,000-14,000! (Beijing is usually ~140) –12,000 premature deaths –100,000 illnesses

11. Many People Died In Days

12. USC Children’s Health Study  (http://www.arb.ca.gov/research/chs/chs.htm), following thousands of kids in smoggy Los Angeles over 9 years, from 4th to 12th grade. http://www.arb.ca.gov/research/chs/chs.htm  In Los Angeles, the average annual Air Quality Index is around 50, which is almost 3 times lower than here in Beijing.

13. “Air Pollution Harms Children's Lungs for Life”  - Children exposed to higher levels of particulate matter, nitrogen dioxide, acid vapor and elemental carbon, had significantly lower lung function at age 18… –N Engl J Med 2004; 351:1057 – 1067  Children that were exposed to current levels of air pollution had significantly reduced lung growth and development when exposed to higher levels of acid vapor, ozone, nitrogen dioxide and particulate matter … –Am J Respir Crit Care Med 2002; 166:76 - 84 –Am J Respir Crit Care Med 2002; 166:76 - 84  Children living in high ozone communities who actively participated in several sports were more likely to develop asthma than children in these communities not participating in sports.  Children living in high ozone communities who actively participated in several sports were more likely to develop asthma than children in these communities not participating in sports. –Lancet 2002; 359:386 - 391

14. Closer Look:  ”The estimated proportion of 18-year-old subjects with a low FEV 1 (defined as a ratio of observed to expected FEV 1 of less than 80 percent) was 4.9 times as great at the highest level of exposure to PM 2.5 as at the lowest level of exposure (7.9 percent vs. 1.6 percent, P=0.002).” N Engl J Med 2004; 351:1057 – 1067

15. Long-Term Effects: Heart Disease  A curved line (maxes/tapers off)  Relative risk in Beijing air: 1.32 (ie, 32% increase) –1ppd smoker: ~2.3 relative risk (230% increase) http://t.cn/StQNu6

16. Long-Term Effects: Lung Cancer  Linear; NO MAX –1ppd smoker: ~21 risk (2100% increase) –Beijing air: 1.49 risk (49% increase) http://t.cn/StQNu6

17. Do You Like Those Odds?

18. Conclusions?  Air pollution risk is real – but small?  Risk: –Individual = small effect –Population = large effect Smoking is really, really bad

19. Compare To Other Risks Weight change (Kg)

20. Cardiovascular Risk: Meet Joe Myhealthcheckup.com

22. How Bad Is Beijing?

23. World Cities & PM10 Levels (2004-5) WHO China US Beijing

24. A Day In Beijing Is Like Smoking How Many Cigarettes?  1/6?  1?  5?  10?  20?

25. = 1/6 Of A Cigarette!

26. How To Protect Yourself  Indoor protection –Air purifiers –Plants  Outdoor protection –Avoidance AQI >200 –N95 masks –School action plans

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

28. Schools Should Have Action Plans!

29. In Other Words:  Any AQI over 200 = NO OUTDOOR SCHOOL ACTIVITIES

30. Air Purifiers Really Work!  My own tests: reduce PM0.3 95-99%  Imported brands: IQAir, Blueair, Alen… –Must be true HEPA! –Cheap? Too good to be true…  Local?

31. Maybe Helps The Heart?  An Air Filter Intervention Study of Endothelial Function among Healthy Adults in a Woodsmoke-impacted Community  Conclusions: –improved endothelial function –decreased concentrations of inflammatory biomarkers (CRP)  So…less disease? Maybe…probably… http://ajrccm.atsjournals.org/content/183/9/1222.abstract?maxtoshow=&hits=10&RESULTFORMAT=&full text=HEPA+pollution&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT

32. Indoor Plants Help!

33. Indoor Plants  Areca Palm ( 风尾竹, feng(4)wei(3)zhu(2), about RMB 180 each) -  Areca Palm ( 风尾竹, feng(4)wei(3)zhu(2), about RMB 180 each) - –Efficiently converts CO2 to oxygen.  Mother-in-Law Tongue ( 虎皮兰, hu(3)pi(2)lan(2), about RMB 50 each) –Efficiently converts CO2 to oxygen at night –Good for bedrooms.  Money Plant （绿萝, lv(4)luo(2), about RMB 150 each ） –Removes formaldehydes and other volatile chemicals.

34. Food Safety: The Main Problems  Bacteria –Infections –Food poisoning  Chemicals & Pesticides –Cause cancer? –Endocrine problems –Allergic reactions

35. Your Goals  Minimize your exposure to toxins  Control what & where you eat  Control what & where you buy  Live SUPER-healthy –Antioxidant lifestyle –Don’t smoke –Exercise –Stay slim

36. Water Safety Big Water jugs? Maybe not –50% counterfeit water –Bacteria in water –Cheap plastic leaches into it

37. Install A Water Filter  Tap water – add a filter –Aquasana highly rated

38. Food Handling Is A Major Issue! http://www.who.int/foodsafety/consumer/5keys/en/index.html

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40. Wash Your Produce!  Store brands  Citrus  Salt  Vinegar  Chlorine

41. Basic Tips  If it can be peeled, peel it! –Less nutrients  Leafy greens -- SOAK

42. United Family Healthcare Address: #2 Jiangtai Lu, Chaoyang District, Beijing 100015 P.R.C. Tel: +86 (10) 5927 7000 Fax: +86 (10) 5927 7200 24 Hour Emergency Hotline: (010) 5927 7120 www.ufh.com.cn Thank You 42 www.myhealthbeijing.com Weibo.com/daniudaifu Richard.saintcyr@ufh.com.cn