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(AV17316) Climate Change, Sustainable Agriculture and Human Nutrition 1/2

the memory of the man who really is
behind it as Aldo Leopold observed in his writings we abuse land because we
regard it as a commodity belonging to us when we see land as a community in which
we belong we may begin to use it with love and respect dr. kieny exemplifies
the essence of that belief in his role as the Leopold Center director he took
the new concept of the center and really ran with it he helped form issue based
communities of researchers from several disciplines who then tackle these very
difficult and challenging problems associated with production agriculture
and really crafted it into the study of sustainable agriculture and that was
really that was 20 years ago so that was not a common thing for that day and yet
somehow Denis had the foresight the vision and the ability to bring together
a community of scientists and for those scientists to work with farmers so that
the research was addressing problems that were on their farm in their fields
dr. Keeney’s leadership alleles Leopold Center reflects where he came from
he grew up on a dairy farm near Runnels and then he decided to go to college and
he came here at Iowa State got his bachelor’s degree in agronomy at Iowa
State moved on to Wisconsin to get a master’s degree there in soil science
from University of wisconsin-madison they decided to come back to Iowa State
University and got his doctorate degree in soil biochemistry with his education
and training he has pioneered research and outreach
outreach and agricultural issues related to sustainability land use rural
community development and water quality dr. kieny has also served as president
of the American Society of agronomy and the soil science Society of America
again reflecting his passion both for science and for the profession but
sustainable agriculture is just one of his passions and I happen to know about
this she may not have known that he’s a dead it was a dedicated runner
he runs now we sort of talked about different things but he during the time
that he was here as the director Leopold Center often while I was on runs with my
colleagues over the noon hour I would run into Dennis and his friends and we’d
chat about this and often we’d end up throughout the year running in the same
Road races I’d see him and he was passionate about his running and its
really his commitment to healthy running that is much like his commitment to the
health of farming and the environment through sustainable agriculture it is a
testament to dr. Keeney’s ability skills and knowledge that the Leopold Center
has thrived after his capable launch and given the medical the many political and
economic challenges that Iowa has faced even the critical Des Moines Register’s
editorial page paid a compliment to dr. kieny
upon his retirement when it stated kini kept the center on the cutting edge of
progressive agriculture championed the concepts of low-impact farming and
survival of this small farm Aldo would have been proud of one of his
most devoted pupils ladies and gentlemen Dennis Cady thanks Joe for that wonderful
introduction it brings back a lot of memories and this auditorium is so
wonderful I have been in it until tonight thanks a lot for getting it done
Wendy and all those that helped you and all I can say is 20 years I can’t
believe it was 20 years ago anyway really I’m happy to have our guest
speaker tonight the gentleman I’m going to introduce is a good friend we’ve been
involved in committee work at johns hopkins and board work been involved in
some other issues that you’ve overlapped him so it’s great to have Bob here as he
as our lecturer he has an incredible list of achievements they go on and on
and but they all Center on went over a budding theme I was dedicated the
world’s people to their health and welfare Bob and his lovely wife Cynthia
and Cynthia perhaps you could stand up right now and be recognized we’re both natives of Connecticut Bob
received degrees from Harvard College and Harvard Medical School he’s trained
in internal medicine at the Massachusetts General Hospital in Boston
which said and we have family in Boston Swiss brings us together again he has
served in the Center for Disease Control the University of North Carolina at
Chapel Hill the Cambridge hospital and was director
of Health Services at the Rockefeller Foundation this is one of his real
dedications he founded the Johns Hopkins center for liberal future in 1996 this
great organization focuses attention on equity health and the earth resources
and I’m part of that board on one of those in that organization he also
founded the physicians for Human Rights organization and this is a fantastic
organization he’s participated in human rights investigators on behalf of PHR in
many third world countries I think there could be many stories right there and
what bob is seen he is also providing support for the current Pew Commission
on being on the FM on industrial animal farm production and the director of the
center mass director of the center fredchristman is also on that commission
in a 2002 bob received one of the most prestigious awards the Albert Schweitzer
prize for mana terrorism and mana terrorism we’ve had the privilege of
having Bob and Cynthia with us at our home for the past few days and it’s been
a real delight bob is an avid biker and I heard he also was a good cross country
and track runner so we have another thing in common I found another thing
about Bobby would never know he was team’s physician for a high school
football team real North Carolina and I thought that was the greatest thing I
can imagine the Cyclones could have used his service some on Saturday and even
the week before anyway please help me welcome dr. Lawrence speaking about the
agriculture Public Health connection thank you very much Dennis Dennis and
Betty have been great hosts and hostesses we’ve met
Friday afternoon down in Des Moines at a conference that Dennis was participating
in and I got my early introduction to the excitement of the kinds of things
that go on here in Iowa with regard to sustainable agriculture and then we went
to that exciting football game that was almost a really great upset got to the
concert yesterday afternoon met many of Dennis and Betty’s friends
and colleagues and then today had wonderful interactions with students and
staff of the Leopold Center so it’s a wonderful thing to be here and I thank
all of you for coming out this evening really to honor Dennis not necessarily
to hear me although you have to put up with me in order to honor Dennis when I
was thinking about what is a city boy from Baltimore who grew up Hartley and
Yonkers in Hell’s Kitchen I have to say about sustainable agriculture to a group
of distinguished scientists at the oldest land-grant University in the
United States well Dennis got me off the hook by saying I should focus on the
impact of agriculture on health and the connection but it still doesn’t quite
get me off the hook so I want to tell you a brief story before I get started
there was a survivor of the Johnstown Flood in Pennsylvania I was born in
Philadelphia so I heard a lot of Pennsylvania stories before my family
moved to Yonkers and this man basically supported himself for the rest of his
life by going around and telling the story of the Johnstown Flood and how he
miraculously escaped it he finally got old and he died
and when he got to the pearly gates he was a little surprised when st. Peter
said welcome but you need to know one of the expectations while you’re with us
through eternity is that you will be in charge of the evening entertainment and
give a talk sometime during your first year of residence he thought well I’ll
just use my Johnstown Flood talk it’s no problem so a couple of months later he
got the call from st. Peter that was his turn and he showed up and people were
sitting around like this and he was just getting ready to speak when sent Peter
leaned over to him and said remember Noah’s in the audience well I look out
here and I see a couple of Noah’s in the front row and some Noah’s back there so
please bear with me hmm Dennis mentioned the center what we
attempted to do was trace the relationship between human health and
diet which has been a subject of public health for many many years the
environmental impacts on public health have similarly been a subject of public
health scrutiny for many years but talking about food production and food
systems and how they connect to both the food we eat and the state of the
environment in which we live had not been addressed in public health
before I was also concerned about the fact that we were dealing with the
carrying capacity of the planet finite resources and continued growth in our
population and then the central driver of equity that if we are to do the right
thing by developing sustainable food production systems to share them
equitably around the world then they were going to have to be some fairly
profound changes the center is based in part on Sir Albert Howard famous quote
from 1939 the whole problem of hell in soil plant animal and man is one
great subject of a faculty of 450 people at the School of Public Health when I
propose starting the center we had one bona fide ecologist and he was working
on hantavirus and rats that’s an important problem but it
doesn’t give the kind of breadth of ecologic perspective that Sir Albert
Howard was talking about but we are fortunate in being able to reach out to
other faculty and to reach out to people like Dennis who have generously shared
of their time and expertise to help us along but maybe this connection is going
to be a hard thing to fit together Wendell Berry said there is no
connection between food and health people are fed by a food industry which
pays no attention to health and are healed by a health industry that pays no
attention to food and I can tell you when I was a medical student what I
learned about human nutrition I could summarize in about three sentences that
would be a list of the essential amino acids and the micronutrients that
everybody should have why figure it out yourself we were told now you’ve already
heard from Joe Caleta that this wonderful quote but I’m going to give it
again I’m glad that we both came upon the same one we abused land because we
regard it as a commodity belonging to us when we see land as community to which
we belong we may begin to use it with love and respect and that I think is the
essence of what Leopold’s ecological perspective meant and what has been
sorely lacking in public health and we need to do our job better to become much
more ecologically oriented and I think for agriculture to do its job better it
has to return to its ecologic roots I was asked several times today about
the farm bill what a public health people have to do with the farm bill and
a few people were surprised to learn that I had actually been
down on Capitol Hill a couple of times this summer advocating with Congress
mostly on the house side because at that point the Peterson committee was still
debating the House version of the farm bill and this is a list that one of my
staff Ronny Neff who headed a kind of public health coalition with David will
linga at the International agriculture trade policy group in Minneapolis where
Dennis is now consulting and a number of other people around the country first of
all the farm bill needs to emphasize the helpfulness of foods a lot of promotion
of the farm bill has been in commodity crops like corn and soybeans which are
so important to Iowa agriculture but 60 years ago there were 30 other crops
important to Iowa agriculture that are healthier for people we need to
rediscover that access to healthy food we need to expand the food stamp system
to achieve that equity that I talked about is one of the central drivers we
have to improve access to sustainably produced food including local food
systems and food networks and there is an opportunity that has been denied
through inadequate funding in the previous farm bills to forward give some
forward motion to that resource depletion in greenhouse gases i if I
have time I’m going to get back to that at the end but clearly everybody is now
aware of the challenges of greenhouse gas emissions global climate change the
conservation title within the farm bill leads directly to issues that have a
profound public health impact the quality of the air we breathe the water
we drink the food we eat and the soil that’s going to sustain future
generations all depend on having greater conservation based policies in the farm
bill food sovereignty we need to respect the ability of poor farmers in low and
middle income countries to survive on the cash that they receive for their
crop without having to contend with the
global commodity market that is artificially depressed because of our
farm policy the overly cheap feed grains are an indirect subsidy for industrial
animal producers and they make the grass fed beef operator operate on an uneven
playing field that has to change we need greater information for consumers about
healthy diet and healthy nutrition the same federal agency the US Department of
Agriculture has a food pyramid over here that encourages more fruits and
vegetables fewer fats and sweets and then over here it has an agricultural
support policy that is totally the reverse we need to change that
alternative energy sources that can be an important way of dealing creatively
with biomass and with other things now Dennis had a wonderful comment this
weekend about ethanol it was a good idea until we thought about it and we need to
think better about other alternatives and then finally something that’s so
important to people in Iowa rural communities than the impact that Betty
and Dennis took us on a drive yesterday through this beautiful rolling farmland
but we also passed through a ghost town of a small town and I know that’s
replicated many times throughout the Midwest we need to figure out how to
make small and medium-sized farms productive and profitable again so that
we can rebuild and revitalize our rural communities
now you notice at the bottom the need for public health oversight that
probably strikes some of you as the utmost arrogance typical of the medical
profession what I mean by this is that there are a lot of issues in addition to
the integration of these 10 points I’ve made where there is a public health
responsibility to broaden our vision to become better informed about the
impact of agricultural policies and the food system on the health of the public
which is our professional responsibility to look out for so who now consumes the
world’s food I’m sure a lot of you have seen this slide each of us per capita
consumption of about 800 kilograms of grain per year this is data from the
Worldwatch Institute Italy they’re very nice northern Italian cuisine 400 Taiwan
300 China 250 India 200 well the reason we consume so much is that we first feed
it to our animals 65 percent of our dietary protein is from animal sources
and it’s a not very efficient conversion about a seven to one conversion for beef
four to one for pork and two to one for poultry the implications of this system
in terms of first raising crops to feed to animals rather than directly to
people for a world which still has a billion hungry people are not very
promising China just look at the projections here they started out in
1983 consuming 16 million metric tonnes tripled almost tripled that two and a
half times in 93 but by 2020 it’s estimated that they’ll be up to 85
million metric tons and the global consumption will be 303 million metric
tons China is currently increasing its rate of pork consumption on an annual
percentage basis basis that is greater than the total net pork exports of
American hog industry so if it doubles in 30 years and we were already back in
1961 when Dennis was working on his master’s degree
we have been increased our consumption since then by about 70% now about a
hundred kilograms per capita and the average for all of the other in
just realized countries is 77 kilograms and for the non-industrialized it’s 27
there seems to be a direct connection between rising economic development and
increasing appetite for meat and we clearly cannot continue in that
direction more and more inputs are required for this high volume of meat
production pesticide residues are now entering us our body through food water
and air we use about a billion pounds a year in the US and 35% of our food is
contaminated with trace amounts of pesticide
there are about 62,000 chemicals different chemicals produced in the
United States and my toxicology colleagues in the Department of
Environmental Health Sciences tell me that a very very small percentage of
those have ever been adequately tested for their toxicity to humans much less
their toxicity to the larger ecosystem so we have to be cautious about relying
on this kind of heavy input to produce the amount of food that is currently
being consumed here in the United States I want to say a little word about food
security when the term was first introduced by the FAO in 1984 the
definition was a little simpler it was refined in 1996 to say that it exists
when all people at all times have physical and economic access to
sufficient safe and nutritious food to meet their dietary needs and food
preferences for an active and healthy life the original definition did not
include the active and healthy life that was sort of assumed by this definition
the children attending the public schools of New York City 25% of them
lacked food security I study the data of which being currently analyzed in East
Baltimore supported by the Center for a livable future is beginning to look as
though it’ll be more like 35% of our school-aged children in East
Baltimore lack food security there’s a definition coming up in a few slides and
by that definition not a single one of us in this room have food security the problem of hunger and famine a more
direct statement of food insecurity have been with us for millennia and at the
present time despite a highly productive agricultural system in the
industrialized world about 20 million infants per year are born with low birth
weight and low birth weight at birth is a high risk factor for infant mortality
and in many of these countries infant mortalities are still infant mortality
rates are still up around a hundred deaths in the first year of life per
thousand live births so we recognize that food is necessary for life the
Universal Declaration of Human Rights which was released December 10th 1948
included article 25 everyone has the right to a standard of living adequate
for the health and well-being of himself and of his family including food
clothing housing and medical care and necessary social services it’s not
surprising at all that food would be first on that list the Institute of
Medicine in 1988 in a report on the future of public health stated
unequivocally that the duty and obligation of government is to create
the conditions in which people can be healthy including food clothing housing
and medical care necessary social services these are core values and these
are core values that I believe have to be integrated into our analysis of what
our current food system needs to change in order to become sustainable the world
food production particularly in grains continues to grow in 2004 it was
over 2 trillion tons it provided about 322 kilos of grain per person per year
remember we’re at 800 and Italy’s at 400 and Taiwan’s at 300 but 322 pretty good
it means almost everybody could eat an Italian diet if it were adequately and
equitably distributed but of course it hasn’t been so now I’m going to give the
revised 2001 food security definition and you see whether you think that my
earlier statement is correct a world where every person has access to
sufficient food to sustain a healthy and productive life well malnutrition is
absent and where food originates from efficient effective and low-cost food
systems that are compatible with sustainable use of Natural Resources
anybody think we’re there that’s setting the bar pretty high but I believe it is
an appropriate challenge and it’s one that I think we can meet and certainly
the work that’s been done at the Aldo Leopold Center here in the College of
agronomy and other land-grant universities is helping to point the way
but it really is sobering when you stop and say well are these just sort of
pie-in-the-sky words or do they really have meaning this is the general mood of
the rest of the world taking very seriously the FOB the problems of
sustainable agriculture now this is a bit of a cognitive test we were asked at
in preparation for a major dedication of a new building at the School of Public
Health a few years ago and the renaming of the school in honor of Michael
Bloomberg the mayor of New York who happens to be a Hopkins alumnus and as
you’ve probably read in the newspapers a wealthy man and
he was going to be giving a major gift and the schools going to be renamed and
we put this booklet together and each unit in the school was asked to sort of
summarize your work in one or two slides so this is our effort the the broad red
plane is the actual global pop population and in 1990 we had a
population of 5.2 billion people a grain based diet of the food that had been
produced in 1990 had it been equitably distributed around
the world was sufficient to feed 6.2 billion so we had a billion population
margin of error however had the rest of the world tried to eat the way we were
eating in 1990 there was only enough food for 2.5 billion people that’s the
triple Mac that’s shown in the bottom if we stay the same course we’re on right
now and China continues to adopt our dietary patterns and abandon their
traditional grain based diet and India which didn’t look quite as alarming on
that graph as China but many other middle-income countries are beginning to
increase the amount of animal protein in their diet we would buy estimates of
food production only be able to feed 3.5 to 4 billion people in the year 2025 the
population of the world at that time is estimated to be 7.9 we’re already at six
point six adding about 90 million people a year but if we shift food systems
toward a sustainable production of grains fruits and vegetables with some
meat and dairy we ought to be able to feed between nine point five and ten
billion people but how to mobilize the collective will of farmers around the
world and consumers around the world to do that is the
Challenge now let me just talk a few minutes about the obesity epidemic much
on the minds of many people and especially in public health we have seen
the rates of type 2 diabetes double in the last 15 years we’ve seen children
preteens developing type 2 diabetes unprecedented when I was in medical
school and in training in residency 17% now of our children and adolescents are
overweight and 32 percent of the adult population in America is obese
disparities are emerging a paradox that the most food insecure among us are at
the greatest risk for obesity we now estimate from a population health
perspective that over 300,000 premature deaths per year can be attributed to
this epidemic mainly mediated by heart disease diabetes cancer stroke and the
stigma associated with it that’s leading to mental illness depression and suicide
a conservative estimate is that it’s costing us a hundred and seventeen
billion dollars in treatment and direct and indirect cost some of you have seen
this set of maps that I’m going to just click through year by year the CDC has
put these data together it doesn’t look too bad right here mainly because only a
29 of the states weren’t providing any data including Iowa I don’t know why
Iowa didn’t provide data but they didn’t 1985 you come in in a few slides I’m
just going to go through it and here the darkest color means that up to 14
percent of the population in that state is obese and you’ll notice that the
colors new colors have to be added to keep up with the epidemic I was now in now classic epidemic curve and
development if this worked tuberculosis if this were a V and influenza h5n1
disease if this were hiv/aids people would be screaming from the rooftops
wouldn’t they and yet we haven’t made the connection between our food system
our tolerance for 11 billion dollars a year of commercial marketing to get us
to eat fast food and to drink high fructose corn syrup sweetened
beverages and eat candies 65 million dollars a year is spent just to market
M&Ms that’s more than the NIH National Heart Lung and Blood Institute had
allocated to it to push the five portions a day of fruits and vegetables
than their big campaign in the 90s to try to reduce the prevalence of
hypertension so this is a serious issue now the answer isn’t so straightforward
if you take the obesity epidemic global climate change healthy nutritious diet
support for rural communities just think about these this question what’s better
to eat organic grapes that are transported thousands of miles from
Chile using fossil fuels conventional grapes from California that have been
grown using pesticides or in season apples grown in the next town our food
system is complex there is no simple single answer to all these problems but
we must begin and we must go step by step and I think a good starting place
is the principle of harm reduction which we use in public health there are very
few perfect solutions in public health there are no silver bullets my clinical
colleagues and the clinical life that I lead fort when
five years we very often had an intervention for a single patient that
would dramatically turn things around a new drug and operation something like
that but in public health we have to weigh many competing demands and try to
overall reduce harm to people several times today I’ve shared the example with
colleagues in conversation about needle exchange injection drug users are at
high risk for transmitting HIV AIDS and hepatitis C by sharing dirty works a
number of studies have now demonstrated that if you provide clean needles you
interrupt the transmission of HIV AIDS and hepatitis C and you don’t increase
drug use in fact you develop bonds of trust between the drug injection user
and the public health system and they begin to ask about method on treatment
and so on so what would be the harm reduction approach we need to have more
information to make informed choices about the pesticide treated grape from
California versus the organically grown grape flown in from Chile we need to
think about the consequences and the consequences of what we do and measure
the trade-offs and make some informed policy decisions because we can’t turn
the system around overnight I was impressed by how far apart people live
in Iowa gonna be hard to find an alternative method of transportation
that doesn’t require some use of fossil fuel for the foreseeable future but can
we do something about food miles can we do something about distribution systems
can we do something about the inputs to industrialize agriculture that saves
some of those fossil fuels for use in the transport secretary
good nutrition and a variety of fruits and vegetables are important but does
that mean we need to eat asparagus all year long or raspberries all year wrong
we have become so accustomed be able to go into the grocery store and get
exactly what we want I’m old enough to remember that peaches were a seasonal
delight strawberries were a seasonal delight root crops in the fall and
winter and I’m sure many of you remember that as well so what can we as public
health professionals bring to the table to work with you in the agricultural
sciences community well individually we can all make conscious food choice
decisions we can think about the carbon footprint of what we’re about to put in
our mouth and be guided by that we can support sustainable agriculture we can
pay that slight premium for locally grown and produced fruits and vegetables
locally grown and produced grass-fed beef free-range eggs whatever it is we
we have the capacity each time we purchase food to vote the right way we
can link food production and food security to public health through
greater emphasis on research and scholarship ten years ago when we
started the Center for livable future there were a lot of my colleagues who
were indulgent of my doing this for two reasons one I was an associate dean and
two I seemed to have a wealthy patron and I made a very conscious decision
that we were going to be a pass-through organization we were going to use our
funds to provide $20,000 innovation grants to students and faculty who were
willing to do research on food systems and with advice from people like Dennis
we developed our innovation Grants Program we have now made 60 of these
grants over the last seven or eight years I’m
going to show a few pieces of data from some of those grants on antibiotic
resistance in the poultry industry and the hog industry we’ve also begun to
look at food security issues locally in Baltimore regionally in the mid-atlantic
and with some colleagues looking at the nutrition transition in China and then a
few years later I was able to raise some additional money to start funding
pre-doctoral fellows in our ph.d program in the School of Public Health the only
requirement was they had to work on food systems and specifically in the first
few years they had to work on public health issues related to industrial food
animal production well that Tom Sawyer approach has now
led to we’ve been able to fund a total of 11 fellows four have their PhDs one
has gone on to be one of the first three members of the department of
environmental health at University of Maryland College Park another land-grant
institution another is taking a position at Arizona State and we’re gradually
trying to have the public health agriculture connection strengthened by
saying there are a lot of unanswered questions here how can we stimulate
scholarship in this area well it’s not all doom and gloom I’m going to quote
Dennis here our society and the natural environment bear the cost of these
unintended consequences in the form of environmental and public health impacts
and the message the public health message and the Agricultural Sciences
methods are beginning to come together in a nice parallel way which i think is
going to be synergistic in the lessons that we learn together we have to do
something from an economic perspective about identifying and capturing the
externalities these aren’t included in the retail
price of our foods and we can no longer tolerate the disincentive to do things
the right way because the industrialization of Agriculture has
allowed much of the food system to externalize the costs of pollution the
costs of the risk of infection with antibiotic resistant bacteria the
pollution caused by transporting an increasingly decentralized system that
requires many many food miles for each item there are other health impacts of
food production methods that we also have some data about but we could really
benefit from much better knowledge the impacts on the environment and through
that impact how it influences human health water we’ve got a couple of
projects underway looking at trace elements of things like triclosan and
tried to many personal care products and are showing up in water systems
throughout the country following toxins through the food through the water
system from agricultural runoff and from industrial runoff it’s very hard to
tease them out the important thing is that they together are creating a lot of
risk for human health water use somewhere between 65 and 70% of water
throughout the world is used for growing our food much of it through irrigation
but aquifers are being depleted faster than they’re being recharged here at
home the Ogallala Aquifer but the northern plain of China the Punjab the
breadbasket of India and other parts of the world there is a direct relationship
between the availability of water and our ability to meet
attrition requirements it takes about a thousand tons of water to produce a ton
of grain so are you going to use seven tons of grain to produce a ton of beef
and require seven tons I’m 7,000 tons of water to produce that ton of beef or are
you gonna produce 7,000 tons of water to produce seven tons of food for people to
eat directly chemical use has been an explosive industry in the last hundred
years I mentioned already that there are 62,000 different chemicals manufactured
in the United States we don’t know the toxic profile of a small percentage of
those the total amount of chemical fertilizers used worldwide the nitrogen
load that I’ve been learning a lot about the last few days here in Iowa with the
extensive tiling of your wet fields and the conduit of those waters into the Des
Moines River and ultimately into the Mississippi or in western Iowa into the
headwaters of the Missouri these are things that are just not sustainable and
we have to come to terms with them most of the chemicals used in the manufacture
of pesticide have not been tested and the direct impact on human health is
more severe in middle-income and low-income countries I spent a couple of
years in El Salvador doing malaria epidemiology for the CDC and I used to
go down to collect blood samples on the Pacific coastal plain and have to
scramble out of the way the crop dusters just as this man in this picture is
there have been tremendous impacts on negative impacts on human health because
of our reliance on pesticides we have about 76 million cases of foodborne
illness a year in the u.s. and much of the increase with produce
that we’ve seen in recent years is directly related to contamination with
farm animal waste from confinement facilities so why don’t we know more
about these problems why am i standing here sounding like the public health
community has been asleep at the switch for the last 30 years well partly we
have been but partly it’s because the structure in which we have tried to link
at the federal level the agencies responsible for Public Health and the
agencies responsible for our food system haven’t done much cross talk the norms
for example the National antibiotic antimicrobial resistance monitoring
system is essentially managed by the CDC and the FDA and there’s no crosstalk
with USDA therefore most of the assumptions about the continued steady
rise of antibiotic resistance in bacteria in the United States has been
assumed to come from hospital no Zucco meal infections
whereas increasing evidence suggests that other pathways are more important
these are the fda-approved antimicrobials for use in poultry the
underlined ones are antibiotics that are used in treating human infection so you
can see how much overlap there is and this is something that should never been
permitted in my view but we now need to call for a moratorium and stop licensing
antibiotics that are critical for human health for use in sub therapeutic doses
as growth promoters in confinement operations there are two very different estimates here the IHI is the animal
husbandry Institute an industry related group and the ucs stands for Union of
Concerned Scientists so if there’s ever a classic
example of two people looking at the same thing and having a Russian kind of
experience here it is eh I says that we’re spending using 3.1 million pounds
a year for growth promotion the best estimates of the Union of Concerned
Scientists and I say best because it’s very hard to get the data from the
industry are that we’re using twenty seven point six million pounds per year
prophylaxis and disease treatment four point fourteen point seven estimated by
a hi2 million by UCS and this compares with the amount used for human disease
and I don’t know where H I gets these numbers because they’re totally off the
wall but they say thirty two million thirty two point three million pounds a
year spent treating human infections and Union of Concerned Scientists say only
four point five the bottom line is that the best data suggests that about
seventy to seventy five percent of all the antibiotics produced in the United
States are being used as feed additives in the poultry and swine industry for
sub-therapeutic growth enhancement and creating a problem of enormous
proportions in the area of antibiotic resistance so this summarized you see
that North Carolina leads the way with over three million pounds in Iowa’s
close behind than Georgia Arkansas Texas and then the sum of all human use is in
the green bar on the right what are the conditions that promote resistance
first of all crowding if you took twenty five hundred humans and had them spend
24 hours a day in the same space that’s allotted to a ferret of finished
operation there would be all kinds of disease colds pneumonias urinary tract
infections maybe even some sexually transmitted infections so it’s often
sub-optimal hygiene the exposure antibiotics is widespread prolonged and
in sub-lethal doses so the growth-promoting dose kills off all the
susceptible bugs and the hardy bugs with their genetic resistance that have
evolved can begin to dominate the bacterial flora and then there is very
very poor dose control one of my colleagues went into a store on the
Eastern Shore of Maryland and and said she needed some tetracycline no
questions asked actually one question was asked you want the 25 pound bag or
the 50 pound bag she wasn’t a veterinarian she happens to be an
environmental health scientist studying bacteria resistant organisms I mean
antimicrobial resistant organisms and then she went on to buy the 25 pound bag
not that she was going to use it for anything but there’s absolutely no dose
control that we can glean the data are usually regarded as proprietary Fleur
acquittal and resistance I apologize for the messy slide but the point that I’m
illustrating here is that if you in Spain if you looked at Quinlan resistant
in human isolates of Clostridium jejune I or cluster D and coli in Spain it was
down below 10 percent until 1990 at that point fluoroquinolones were licensed for
poultry and livestock and look what has happened since then now you might argue
well looked as though the curve was starting to go up who knows this is
really related to allowing the cross use of this antibiotic but if you then
looked a little deeper many places around the world Canada New York Georgia
Oxfordshire England and you find that the pathogens that are
common in human infection ecoli Campylobacter Cryptosporidium and so
forth have been traced back either to runoff from farm sites to manure runoff
or runoff from a fairground where there were animals being shown and all of
these animals had been exposed to Subterra peuta kosis so to summarize
this problem we see that animals when given antibiotics and their feed then
the antibiotic resistant bacteria emerge the antibiotic resistant bacteria and
the waste may end up contaminating the meat and in the environment one of the
innovation grants those 60 grants that I mentioned allowed one of our graduate
students to go out and purchase packaged chicken from 30 different supermarkets
around Baltimore Maryland he then brought them back to the lab very
carefully opened them under sanitary conditions and cultured the product that
looked so nice under the plastic wrapper two of the major vertical integrators in
the poultry industry 100% of their chicken product had Campylobacter
species isolated from their product and belen Evans which was not using
antibiotics as a growth promoter had about 50% of their product positive for
Campylobacter the 50% was probably in part because they in the absence of
growth promotion and prophylactic use of antibiotics were paying closer attention
to how frequently they cleaned the poultry houses the broiler houses and
other changes in the bacterial background for those birds a couple of
examples from swine Capo’s right here in Iowa the team at the School of Public
Health in Iowa City Jim merchant the Dean there and
and three or four of his colleagues have published a number of studies in the
last few years comparing the rates of asthma among
children who live on industrialized hog production facility versus control group
of children living on smaller hog farms where hogs are being raised in a more
sustainable way or children living on farms that are restricted to corn and
soybeans and the children living on those industrial animal facilities have
higher rates of respiratory problems higher rates of asthma and nausea
diarrhea headaches plugged ears which is a the bane of every pediatricians life
is trying to figure out how to help a family get their kids middle ear
infections under control there are also higher rates of vine nose
and throat irritation and significantly more episodes of depression anxiety
anger fatigue and confusion among neighbors of swine Capo’s it’s
interesting we know that hydrogen sulfide is a neurotoxin and people have
been killed by high exposure to hydrogen sulfide low-level exposures such as can
be experienced downwind of a facility that is blowing exhaust fans out from
5,000 or 10,000 animals in confinement maybe may be responsible for some of
this confusion another one of our graduate students sampled air inside a
Maryland swine CAFO and found that the mean concentration of airborne bacteria
on small fomites was 10 colony forming units per a meter of air that doesn’t
sound like a lot except if you’re working in that facility without a
respirator she had a respirator on but most of the
agricultural workers who attend these animals
don’t the number of meters of air that we breathe particularly when we’re doing
physical work is well over a hundred per hour and so here we have ten colony
units per meter a hundred and thirty seven presumptive entered practice
species and then other bacterial species also provided regardless of which
species enterococci Staphylococcus I and streptococcus I 98% of all of the eye
slits were drug-resistant multi drug-resistant some as – as many as four
different classes of antibiotics and 98% of them – at least two antibiotics and
interestingly not a single one of the isolates was resistant to vancomycin
which has never been approved by the FDA for use in poultry production or in hog
production these are some of the results I it’s a busy slide but just to show
that the antibiotic resistant pattern typically included erythromycin
clindamycin tetracycline Virginia Meissen and bacterial genetics teaches
us now the little plasmids that contain bacteria contain genetic units of
information that are not bound to the chromosome are swapped freely between
different bacterial families so an enter a caucus with the plasmid containing
resistant genes to tetracycline cozies up to a Staphylococcus and shares a few
plasmids and these bugs are really promiscuous – by the way and so then you
end up with a Staphylococcus that is resistant to tetracycline as well as
erythromycin and maybe in return they’ve shared resistant genes to Virginia
Meissen the same team did water sampling found 200 presumptive enterococci
species mean concentration were about ten squared per hundred milliliters in
surface water and about ten colony forming units in groundwater and both
the ground and surface water eye slits were downstream of the cave of displayed
patterns of antibiotic-resistant that were very similar to what was recovered
in the airborne sample so pretty convincing data from a bacteria logic
perspective that workers neighbors and potentially consumers of the product
coming out of that confinement facility were being exposed to bacteria with
multi-drug resistance so we need to be aware of the fact that this is a growing
problem it’s a problem related to overuse of antibiotics in human medicine
but clearly the contribution from these sub-therapeutic applications are an
important and growing public health threat I’m gonna stop here got a whole
bunch of climate change but I thought I would probably run out of time because
there’s plenty that I’ve said that should provoke a few questions so I’ll
be happy to take those questions at this time Oh oh right here how do I explain the

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