A recent profile in The Lancet describes Dr. Catherine Karr, Director of EDGE’s Clinical and Translational Sciences Unit, as “the best of a new breed of physician-scientists that are patient-centered, community-centered, and justice-centered.” The quote comes from Ruth Etzel, Director of the US Environmental Protection Agency’s Office of Children’s Health Protection.
Karr’s research focuses on the ways in which a child’s environment affects their long-term health and development and the disparities that characterize those impacts. Specifically, she has investigated the role of environmental contaminants in the health of children with asthma in Latino farmworker children living in Washington State’s Yakima Valley. Her work brought attention to the role of crop production, emissions from industrial-scale dairy production, and smoke from winter wood stove use in worsening asthma. Currently, she’s studying whether a combination of asthma education and the use of indoor portable air cleaners can improve children’s health.
Karr also leads NEXTGENNS, a project to address wood smoke with the Yakama Nation community and she is involved in the National Institute of Health’s Environmental Influences on Child Health Outcomes (ECHO) consortium. The goal of ECHO is to understand the effects of early life environmental influences, including chemicals and stress, on subsequent child health and development. One of these influences is exposure to lead, a topic of which Karr is an expert, and about which she was recently interviewed by KIRO 7 as part of a story about high levels of lead found in Washington schools.
Another theme that runs throughout Karr’s work is her emphasis on outreach. As she points out in The Lancet profile, “We are still not very good at communicating the pay-off of healthy environments on population health to key decision makers in government. Doctors also need to know more about the role of environment in their patient’s health. It is both part of prevention and sometimes cure.”
Karr holds a masters degree in toxicology, a medical degree, and a Ph.D. in epidemiology. She is currently a Professor of Pediatrics and Environmental and Occupational Health Sciences at the University of Washington as well as Director of the NW Pediatric Environmental Health Specialty Unit. Read the full profile of Karr in The Lancet here.
|Nereus Program Policy Director Yoshi Ota, and Swinomish tribal elder Larry Campbell converse during a Fish and Future breakout session. Photo Credit: Colby K. Neal.|
On April 3rd, 2018, tribal representatives, students, and academics gathered to discuss a pressing issue for coastal indigenous communities of the Pacific Northwest: the future of the fish they’ve relied on since time immemorial. Climate change, pollution, and toxic algae blooms are threatening the survival of salmon and shellfisheries relied upon by both the Native American tribes in Washington State and First Nations in British Columbia. These fisheries represent significant nutritional and economic value to both peoples, and they also have deep running cultural importance. All three aspects were considered during the gathering entitled Fish and Future held at the University of Washington’s wǝɫǝbʔaltxʷ (“Intellectual House” in the Luhshootseed language). The building was inspired by the traditional Long Houses of the Coastal Salish people, with lofty cedar walls and beams overlaid with indigenous artwork. Traditional song and drumming filled the space as Willard Bill Jr, Cultural Director of the Muckleshoot Tribe and his son, Justice Bill, delivered a welcome prayer to commence the meeting. The words, music, and setting created an unrivaled sense of place and purpose. “We are here,” Bill told us, referring to the Indigenous People of the Pacific Northwest. “We are alive and strong. We are from here – we’ve never been from anywhere else.”
|Justice Bill and his father, Cultural Director of the Muckleshoot Tribe Willard Bill Jr., lead welcome prayer to commence the meeting. Photo Credit: Colby K. Neal|
The environmental threats to the fisheries relied upon by 37 million coastal indigenous populations are born from the actions of developed nations, making food sovereignty for these groups a pressing issue of global equity. “Forty-one percent of First Nations people in BC experience food insecurity,” explained Dr. Laurie Chan. “Ninety-one percent of people surveyed want to eat more traditional food but simply don’t have access to it any longer. This is an issue for a number of reasons; one being because diets are healthier when more traditional food is eaten than market food.” And conditions are likely to get worse, Chan explained. “Under the influence of climate change, projections show a considerable decline of fish stocks along the coast of British Colombia. This could result in a decrease of healthy food and essential nutrient intake and also has a negative impact on the well being of the people’s culture.” In other words, this isn’t just a loss of nutrients; it’s a loss of heritage.
|Dr. Sara Jo Breslow of the University of Washington’s Center for Creative Conservation led workshop participants in an interactive reading from her play The Last Best Place which was created using transcripts from interviews with local farmers, scientists, and tribal members. Photo Credit: Colby K. Neal|
The format of the gathering was innovated to inspire and generate creative thinking about what needs to be done. Academic talks and presentations were interspersed with a film screening of Colby K. Neal’s Broken Fish and an interactive reading from The Last Best Place, a play about salmon, people, and habitat by Dr. Sara Jo Breslow. Breslow’s play arranges the words of tribal members, farmers and scientists taken down during anthropological interviews to tell the story of the human-salmon ecosystem in the Pacific Northwest. She gathered eleven members of the audience around a table and handed them each a script. “But there are days when I wonder, if all what they really want, is control over what you do? Or do they really want to save fish?… And you know, you might not understand this, but my family’s been here for 110 years. That’s a long time. This land is my heritage and I intend to pass it on to my grandchildren,” read one participant, speaking the words of a farmer frustrated by restoration regulations. “It staggers me that someone could say that to, say, members of an Indian tribe,” replied another participant, speaking the words of a tribal staff person. “That, you know, to – to whom one hundred and ten years is not even a blink of an eye.” Participants were able to experience the perspective of the character they played, regardless of how different it was from their own, and speak the words of another human with feeling and empathy.
The morning’s proceedings inspired a generative planning session in the afternoon. Participants proposed creating a task force to align ongoing efforts, and to integrate Indigenous and western-based sciences to develop strategic adaptation and action plans. “When we take inquiry back to the tribal community, we get history, community, and culture along with the research objective,” said Swinomish tribal elder Larry Campbell. The meeting ended on a note of progress and excitement about new plans and initiatives inspired by the day’s dialogue. “All of the organizations here presumably started with a first meeting,” said Dr. Elaine Faustman. “I know this meeting will be the start of something new for many of you.”
|EDGE Center table display|
Danza Kalpulli Tlaloktekuhtli
The festival is a major effort of the DRCC and the many agencies and non-profit organizations who participated. It drew 1300 individuals and families who brought the diversity of languages and cultures found in the neighborhood. The event was family-friendly and focused on celebrating the many efforts to improve the health of the Duwamish River and surrounding communities of South Park and Georgetown.
Forty-seven interactive display tables filled the park, representing government, non-profit, commercial and local groups. They featured a variety of environmental and community health projects and resources in the Duwamish Valley. Music and dance performances, including the Amigos de Seattle Guatemala, Madcap Pusher Band of Georgetown, and the Bopha Lokei Cambodian Dance Group, represented the diverse cultures of Georgetown and South Park. Free boat and kayak tours were provided, and two food trucks offered free lunch.
The EDGE Center’s Community Engagement Core (CEC) manager Marilyn Hair staffed a table where she shared the Center’s environmental health research with festival goers. The EDGE table was located on the main thoroughfare this year and the central location drew a larger than usual audience to our display.
The display focused on the health risks of UV exposure from the sun. A large environmental health game wheel drew attention, especially from the children. The visitor spun the wheel and answered a question: “Are you wearing sunscreen?” “Do you know what SPF stands for?” “Can you get a sunburn on a cloudy day?” Prizes were sample size tubes of sunscreen (“You’re not wearing sunscreen? Here, I have some for you.”) and ever-popular UV bead bracelets. The conversation was also an opportunity to offer our handout, Fast Facts about Protecting Your Skin from UV Exposure.
|UV beads on the bracelet prize turn
color when exposed to UV light
|Environmental Health Game Wheel|
Most people, including the children, knew they should wear sunscreen and the reasons to protect their skin. In the morning, most of the visitors said they were wearing sunscreen, but by afternoon, many admitted they were not. A perfect opportunity to give out sample tubes of SPF 30 UV protection.
|Dr. Michael Chin|
EDGE Center member Michael T. Chin is the principal investigator. His team used 4 groups of mice. The first group was exposed during gestation to filtered air, then underwent sham surgery as adults. The second group was exposed during gestation to diesel exhaust particulates, then underwent sham surgery as adults. The third group was exposed during gestation to filtered air, then underwent transverse aortic constriction (TAC) surgery as adults, and the final group was exposed during gestation to diesel exhaust particulates, then underwent TAC surgery as adults. TAC surgery is an experimental model used in mice to cause enlargement of the left ventricle of the heart; it leads to heart failure.
Following the exposures, the expression of heart genes in the four groups was compared. The scientists identified three candidates genes (Mir133a-2, Ptprf, and Pamr1) that were expressed differently in the group of mice exposed to both diesel exhaust and TAC surgery. The target genes identified in this study are the first genes identified as likely playing an role in adult heart failure.
Further examination found that in those mice exposed to both diesel exhaust and TAC surgery, DNA methylation was altered in the promoter region of the Mir133a-2 candidate gene. DNA methylation, also known as epigenetics, consists of chemical groups that attach to the DNA molecule and work as on/off switches to regulate gene expression.
Mir133a-2 has been identified as a biomarker for patient outcomes after heart valve replacement in humans and is presently being studied as a potential treatment to improve patient outcome after a heart attack. Finding out whether Mir133a-2 can protect against heart failure from exposure to diesel exhaust will help further drug development for patients with heart failure associated with air pollution.
Chin suggests that these findings can inform public policy: “Our study adds to the large body of evidence that air pollution exposure has significant harmful effect on the cardiovascular system, and extends these findings to show the effects of this exposure on the developing heart — effects that can last for decades. By demonstrating this potential public and global health problem, we hope that our study prompts leaders to develop thoughtful environmental regulatory policies that promote the health and wellbeing of future generations.”
Dr. Chin, M.D., Ph.D., is associate professor of medicine at the UW Center for Cardiovascular Biology in the School of Medicine and a member of the UW EDGE Center.
|Dr. Aubrey Miller from NIEHS presents the
DEOHS Environmental Health Seminar
(photo: Liz Guzy)
The EDGE Center was privileged to host Dr. Aubrey Miller of the National Institute of Environmental Health Sciences (NIEHS) to present the DEOHS Environmental Health Seminar on May 25th. Dr. Miller is Senior Medical Advisor to NIEHS Director Dr. Linda Birnbaum. He leads the NIH Disaster Research Response (DR2) Program and has been extensively involved in the NIH Gulf Oil Spill response, among other national disasters.
When a disaster occurs, the immediate focus is to save lives and protect health. But after these immediate needs are met, questions arise about health effects on communities and rescue workers. There is an opportunity to learn from the disaster and be able to respond better the next time. A great deal of public health work is built on what has been learned from disasters.
But responding to a disaster is all-consuming. The response is not set up to do research. So a goal of DR2 is to fill this gap by figuring out how to do well-designed and effectively executed research in and after an emergency. The program aims to assemble tools in a ready-to-go toolkit. Epidemiological tools, bio-specimen kits, and environmental sampling tools are being developed to quickly initiate studies after a disaster.
|EDGE Director Terry Kavanagh
and NIEHS’s Aubrey Miller
(photo: Marilyn Hair)
Dr. Miller said that one of the challenges in a disaster is coordination. No single agency or community has all the tools and information needed to respond to a disaster. A multitude of public and private agencies must coordinate efforts.
Also, community involvement is essential. Listening to and addressing community concerns and questions builds cooperation and trust, increases the chance that the right questions are being asked, and offers an opportunity to collect on-the-ground information. DR2 emphasizes community engagement, helping to apply scientific research to help communities. It's a chance to protect communities.
While on campus Dr. Miller also met with researchers from the University of Washington Post-Disaster Rapid Response Research Facility (RAPID), a disaster investigation center that provides instrumentation and tools to collect and assess critical post-disaster data with the goal of reducing physical damage and socio-economic losses from future disasters. More about the new RAPID facility at UW can be found here and here. The goal of the meeting between the EDGE and RAPID Centers was to brainstorm ways for future collaboration, leveraging the unique resources of each Center.
|Dr. Miller and Outreach Manager
Marilyn Hair discuss DR2
(photo: Christine Tran)
The EDGE Center hosted an afternoon reception in Dr. Miller's honor, giving about 30 Department of Environmental and Occupational Health Sciences (DEOHS) researchers, staff and students, and RAPID, Seattle & King County Public Health, Northwest Healthcare Response Network, and the City of Seattle Office of Emergency Management partners the opportunity to meet him and discuss disaster research response.
The 5th Annual Living Breath of Wǝɫǝbʔaltxʷ Symposium was held May 5-6, 2017 at Wǝɫǝbʔaltxʷ or Intellectual House,* on the University of Washington campus. The symposium was bigger and better than ever.
The meeting began with the leaders acknowledging the Duwamish tribe on whose traditional land the UW is located. Next was an extended Elder Blessing with chanting and speaking by Hyamiciate, Della (Rice) Sylvester (Cowichan), a traditional medicine woman.
Attendees graced Wǝɫǝbʔaltxʷ with ceremonial dresses and shawls, cedar hats, jackets embroidered with symbols from Standing Rock, and caribou-skin boots with sealskin soles worn by Inupiaq youth. I was struck by the many ways participants honored the elders who were present, from bringing them beverages and food samples, to inviting them to the front of the buffet line.
Lunches and snacks were traditional local foods, as you might expect at a conference focused on indigenous foods. I greatly enjoyed seed-filled muffins, strawberries, blueberries, sockeye salmon, nettle pesto, wild rice, elk burgers, seal oil, dried huckleberries, moose jerky, nettle bread and evergreen tree-tip tea. Participants were reminded not to decide you don’t like something the first time you taste it. You have to try a new food 6 times to decide whether you like it.
Speakers came from near and far away: Coast Salish, Alaska and Inupiaq tribes, as well as tribes from eastern Washington, the US southwest, Canada, and Mexico. Presentation topics included soil, corn, seeds, climate resilience, youth leadership, indigenous lands, traditional languages, native curriculum, traditional foods and beverages, and food sovereignty projects.
The event honored and highlighted Native Youth. The keynote speaker was 16-year old Kalilah Rampanen from Vancouver Island (Nuu-chah-nulth, Woodland Cree and Finnish), a young activist who told her story through words and song. Her presentation on Saturday morning was followed by 13-year old Tim Masso (Tla-o-quiaht/Nu-chah-nulth) who told his story of learning and teaching the Nu-chah-nulth language. He wanted to learn his native language and pressed his school to teach Nu-chah-nulth. At first he was told to take French. When eventually a native language teacher was hired, students were taught just colors and numbers. Tim used books to learn Nu-chah-nulth on his own, and volunteered to teach the class himself. He has become the spokesperson for teaching native languages in schools in British Columbia. Tim concluded his presentation by teaching the audience some Nu-chah-nulth vocabulary: Choo (spelled phonetically) means I’m done. Che KO means Thank you.
Another inspiring presentation was titled, Building Food Sovereignty, Climate Resilience, and Youth Leadership in the Northwest Alaskan Arctic. Four youth from the Inupiaq community of Kivalina, Alaska who worked as interns in the Kivalina Food Sovereign Project presented a vivid story of life and changes in this subsistence fishing-and-hunting community. Kivalina, with 90 households, is located on a barrier island north of the Arctic Circle. Their traditional foods include beluga whale, bearded seal, caribou, moose, and deer. The island is overcrowded and lacks running water. With climate change the ice is melting, affecting animal habitat, bringing more severe storms, and raising the sea level. The oil industry has also destroyed habitat, and a neighboring village dumps waste into the river which flows through Kivalina. A project called Re-locate is working to move the village to the mainland to address overcrowding and provide fresh running water.
Our partners in Tend, Gather & Grow, Elise Krohn and Valerie Segrest (Muckleshoot), presented their curriculum, Training Track: Empowering Health Champions with a Traditional Beverage Campaign. Their toolkit, coming out May 12th, includes a recipe book called Native Infusion, Rethink Your Drink, and 6 theme posters (Build Strength – nettles; Be Resilient – evergreen fir tips; Food is Our Medicine – huckleberries, and others). Find a description of their May 12th training at the Muckleshoot Elder’s Complex on our Native Teach Facebook Page.
Here’s the symposium program. It’s clear that food sovereignty programs are increasing in number and growing in scope. Congratulations to the eight (mostly native) women academics who volunteered to plan the symposium.
P.S. One of the resource tables displayed traditional Nuu-chah-nulth foods and the community’s fish cookbook, Camas. Camas can be ordered from the Nuu-chah-nulth tribe for $12.95. Baked sockeye marinated in maple syrup and soy sauce caught my eye.
*Wǝɫǝbʔaltxʷ is a longhouse-style building that pays homage to the Coast Salish culture and architecture. Wǝɫǝbʔaltxʷ opened in February 2015, the realization of a 40-year dream. The Intellectual House exemplifies the spirit of sharing, cooperation and commitment to indigenous knowledges and local and national indigenous communities.
|The Tend, Gather and Grow team|
|Early spring violets|
The teaching toolkit is directed at young people ages 5-18. Lessons focus on common wild plants and offer supporting material about traditional land management practices, plant identification, harvest protocols, nutrition and cooking, medicine-making, and traditional technologies. Teaching videos will show youth demonstrating their plant knowledge; educator field trip guides will help teachers lead visits to camas prairies, wetlands, forests, saltwater beaches and mountain huckleberry meadows.
Dr. Karr is a pediatric environmental medicine specialist and environmental epidemiologist. Her primary appointment is in the Department of Pediatrics. In addition to her role as Director of the Clinical & Translational Services in the EDGE Center, she has an appointment in the Department of Pediatrics, is an adjunct professor of epidemiology, and directs the Northwest Pediatric Environmental Health Specialty Unit (PEHSU), where she sets the direction for outreach and education as well as responding to queries from health care providers, government officials, and families regarding health risks associated with environmental exposures. Dr. Karr cares for patients and teaches residents at the Pediatric Care Center, UW Medical Center-Roosevelt and provides specialty pediatric environmental medicine consultation at Roosevelt and Harborview Medical Center. She is affiliated with the Center for Children’s Environmental Health Research and the Pacific Northwest Center for Agricultural Safety and Health (PNASH), both based at UW, and is involved in policy and education through the American Academy of Pediatrics National Council on Environmental Health.
Karr uses a community engaged approach to her research focusing on environmental contaminants and pediatric respiratory health — including asthma, the health of farmworker children and global children’s environmental health. Her recent projects include working with Native American and Latino communities in the Yakima Valley to develop low-cost air pollution sensors aimed at reducing wood smoke exposure, conducting an intervention trial among Yakima youth with asthma to evaluate the effectiveness of home air cleaners, and investigating how exposure to environmental factors from conception through early childhood influences the health of children and adolescents. Karr said this about receiving the award: “My success reflects the shared dedication and hard work of community partners and community members who enable community engaged research to be done and be relevant.”