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Scientific and Economic Perspectives of Inquiry Paper
Food environment related to the Decline in Bee Populations as a Public Health Issue
Would Approaching the Food Environment Related to the Decline in Bee Populations as a Public Health Issue Decrease Rates of Chronic Disease for Americans?
A Registered Dietitian’s Perspective
August 25, 2020
Kathryn Ayres MA RD LDN
West Coast University
Evidence of the connection: Decline in bee population and chronic illness
The decline in the honeybee population has raised concerns for many environmental, health, and economic experts. Pollinators are responsible for the production of approximately 35% of the world’s supply of crops (Klein et al., 2007). This contributes 15 billion dollars to the United States economy ( The Economic Challenge Posed by Declining Pollinator Populations, 2014). The honeybee alone pollinates 80% of over 100 cultivated crops ( Bees as Pollinators: Arkansas Pollinators, n.d.), providing 40% of the supply of essential micronutrients (Eilers, Kremen, Smith-Greenleaf, Garber, & Klein, 2011). The intake of these foods has shown to decrease chronic diseases because of their high concentration of vitamins, minerals, fiber and phytonutrients (Boeing, et al, 2012). The loss of the honeybee would result in the loss of food security, nutrient intake, biodiversity and profitability.
A study published in the Lancet investigated the consequences of the loss of pollinator populations at 50 percent, 75 percent and 100 percent. A database of 224 types of foods from 156 countries was used to quantify nutrient composition and pollinator dependence around the world. This compilation was used to estimate the reductions of micronutrient intake and the health burden that would result at each percentage of decline. The study estimated that a 100% decline in pollinator populations could result in a decrease the supply of fruit by 22.9%, vegetables by 16.3% and nuts and seeds by 22.1%. It was estimated that this reduction of food supply could cause 1.42 million deaths related to chronic disease and malnutrition. The findings also suggested that individuals living in poor countries would experience the decline of produce differently than those living in developed countries. Areas such as the Sub-Saharan region of Africa and South Asia would be more likely to experience an increase in diseases related to deficiencies of vitamin A and folic acid leading to more night blindness and neural tube defects respectively. While wealthier countries, such as North America and Europe, would see an increase in chronic diseases and a significant rise in healthcare costs (Smith et al, 2015).
The increase in chronic illness would be a consequence of a decreased intake of micronutrients found in plant foods such as fruits, vegetables, nuts and seeds. Nutrition and pollination experts have found that the majority of vitamin C, lycopene, β-cryptoxanthin and β-tocopherol, carotenoids, calcium, fluoride, and folic acid come from pollinated crops (Eilers et al, 2011). Micronutrients are essential in the diet because are actively involved in many biological pathways that maintain physiological function. Many trace minerals such as zinc and selenium act as essential cofactors in 100s of enzymatic reactions. Organic compounds, such as vitamins, aid in biological reactions by acting as coenzymes. Some vitamins, such as vitamin A and D, can enter the nuclear envelope and act as transcription control factors and regulate gene expression. Lastly, micronutrients that include vitamin C, lycopene, β-cryptoxanthin and β-tocopherol function as antioxidants to prevent the destructive activities of reactive oxygen species (Shenkin. 2006). These micronutrients found in foods that are dependent on pollination, have been linked with the prevention of chronic diseases such as cardiovascular disease, stroke and diabetes (Eilers et al, 2011; Smith et al, 2015).
Medical Diagnosis One: Cardiovascular Diseases
Cardiovascular disease (CDV) is an umbrella diagnosis for medical conditions related to the heart and vasculature, some of which include coronary artery disease, deep vein thrombosis, pulmonary embolism, cardiomyopathy and myocardial infarction. One in four deaths are caused
by cardiovascular disease making it the leading cause of death the United States (Center for Disease Control [CDC], 2020). Two of the most common risk factors for cardiovascular diseases are elevated LDL levels and high blood pressure (CDC, 2020) because of their ability to destroy endothelial tissue in the vasculature tissue causing atherosclerosis (Talayero &, Sacks, 2011).
Fortunately, many micronutrients, found in crops that are dependent on pollination, are able to actively prevent and reverse pathways involved in the initiation of CDV at the molecular level. For example, the antioxidants β-carotene and lycopene are fat soluble which allows them to be transported by lipoproteins such as LDL (Goulinet & Chapman, 1997). This gives them access to lipids that have been oxidized and prevent free radical damage in the vasculature. Lycopene has also shown to have gene regulation ability. In an in vitro study lycopene was able to decrease the production of LDL molecules and upregulate LDL receptors, which remove LDL from the blood. When this was tested in vivo, subjects had a 14% reduction in plasma LDL. The researchers estimated that if individuals ate foods high in lycopene there could be a 30 – 40% reduction in myocardial infarction (Fuhrman, Elis & Aviram, 1997). The prevention of oxidative stress and plaque formation is important because it can also play a role in other chronic illnesses such as diabetes and stroke.
Medical Diagnosis Two: Diabetes II
An estimated 34.2 million people in the United Stated are diagnosed with diabetes. Individuals with this medical condition are at a higher risk for heart disease, stroke, kidney failure, blindness, neuropathy and amputations. Approximately 90- 95 percent of cases of diabetes are type two. This type of diabetes is linked with poor diet and lifestyle (CDC, 2020). Type II diabetes is a complex metabolic disease that affects the body’s ability to regulate blood glucose resulting in hyperglycemia. Prolonged exposure to modified glucose molecules in the microvasculature increases oxidative stress, further contributing to insulin insensitivity (Vlassara, & Uribarri, 2014).
Many micronutrients form pollinated crops are antioxidants and can play a role in decreasing oxidative stress. A study published in the Diabetes Care Journal investigated the effects of vitamin E supplements on patients with diabetes found a 27% decrease of plasma peroxidases, a reactive oxygen species responsible for endothelial damage, after 3 months and by 29% at 6 months. Vitamin E was able to bind to the unpaired electrons in the plasma without becoming destabilized, preventing endothelial damage. However, the improved blood glucose control was only observed temporally indicating that insulin sensitivity is highly complex and needs multiple interventions (Manning, et al, 2004).
Medical Diagnosis Three: Cerebrovascular Accident
Strokes are the fifth leading cause of death in the United States and is the leading cause of disability. 87% of strokes are ischemic and are caused by the blocking of an artery that supplies brain cells with oxygen. This blockage can occur in two ways. Atherosclerotic plaques can block off the artery entirely or a plaque in the vasculature can break off and travel in the blood to the brain and become lodged. A hemorrhagic stroke occurs when an artery in the brain bursts and creates pressure that damages brain cells. A major risk factor for this type of cerebrovascular accident (CVA) is hypertension (CDC, 2020).
Micronutrients found in pollinated crops can also help to decrease the risk for stroke through multiple mechanisms. For example, calcium is involved in blood pressure regulation through several interrelated pathways. Serum calcium levels are controlled by parathyroid hormone (PTH). When levels are low PTH released calcium form the bone into the blood. In this attempt to correct calcium levels, intracellular levels of calcium in the smooth muscle of the vasculature increase. This causes vasoconstriction by allowing contractile fibers to interact. Low levels of calcium also activate the rennin-angiotensin pathway which stimulates the reuptake of sodium and water into the blood (Martinez, 2004). The combination of vasoconstriction and increased blood volume increase blood pressure and which could result in hypertension. Diets with sufficient calcium have shown to lower the risk for stroke (Larsson, Orsini, & Wolk 2013).
Preventing damage to the vasculature and plaque formation is also important in stroke prevention. For example, folic acid found in dark leafy greens acts as a cofactor in the recycling of homocysteine to methionine. Homocysteine is a sulfur containing intermediate in amino acid metabolism involved in methionine and cystine synthesis. These amino acids are eventually used for gene regulation and protein synthesis. However, if homocysteine levels are elevated, the molecule has the ability to induce endothelial dysfunction, eventually resulting in plaque formation (Wang, Mao, Wang, & Zhang, 2004). Although many studies have failed to find lower homocysteine levels after folate supplement interventions (Marcus, Sarnak, & Menon, 2007), strong evidence does exist that diets high in folate rich foods decreases the risk for stroke. In fact, there is a more substantial decrease in risk when a combination of fruits and vegetables are consumed, allowing multiple micronutrients to regulate biological pathways simultaneously (Hariri et al, 2013). This indicates that a reductionist approach to treating and preventing chronic illness is not sufficient. If disease prevention is the goal, the availability of a diverse crop supply must be protected.
Economic Burden: Agricultural and Healthcare
Agricultural
The loss of crop diversity is only one consequence related to the decline of pollinator populations. The economic burden of this issue is two tired. Initially the impact will fall on the agricultural sector. Honeybees are responsible for contributing $15 billion dollars to the economy ( The Economic Challenge Posed by Declining Pollinator Populations, 2014). The honey crop alone has been valued at $300 million for the product itself as well as its usage in other foods and cosmetics a year. Honeybees are responsible for not only crops used for human consumption, but also livestock. It is estimated that they contribute $20 billion a year to the agricultural sector (Honey Bees Are Pollinators, n.d). Wild species of the bees, such as the bumble bee and alfalfa cutters, also play a significant role in the pollination of citrus fruit, berries and alfalfa. Their contribution has been valued at $4 billion a year (Ramanujan, 2012).
Healthcare
The second economic burden will fall on the healthcare field and to some degree already has. The cost of diabetes in the United States in 2017 was estimated at $327 billion. $237 billion was spent on direct medical costs and $90 billion in reduced productivity. The estimated cost of cardiovascular diseases was $219 billion between 2014 and 2015. The CDC also estimated that the cost of strokes, including the cost of cost of care services, medicines to treat stroke, and missed days of work was $34 billion (CDC, 2020). That is a total of $580 billion dollars spent on the treatment of diseases that can be prevented through diet.
A study published in PLOS ONE analyzed the impact of 10 dietary factors, including fruits and vegetables, to estimate the summative total of a diets that do not include adequate intake of nutrients. Their study found that the cost of a poor diet was approximately $50 billion per year for cardiometabolic diseases (CMD) including as heart disease, stroke and type 2 diabetes. The researchers estimate that $9.552 billion and $10.055 billion dollars are spent on healthcare costs related to CMD due to suboptimal intake of fruits and vegetables respectively (Jardim et al, 2019)
The healthcare costs in the United States compared to other countries showcases a system that does not promote prevention. In 2016 Americans spent $9,892 per capita on healthcare costs, about 25 percent higher than the next country. The reason for this difference is medical care is more expensive in the United States. But despite the high cost, Americans have less access to healthcare providers compared to other developed countries. (Anderson, Reinhardt, Hussey, & Petrosyan, 2003). With extravagant costs and less access to healthcare, a decrease in the availability of disease preventative foods would only exacerbate an already existing healthcare crisis in America. A public health approach to addressing the decline in bee populations could help to ensure continued production of diverse crops and that a healthy food environment is even possible.
References
Anderson, G. F., Reinhardt, U. E., Hussey, P. S., & Petrosyan, V. (2003). It's the prices, stupid: why the United States is so different from other countries. Health affairs (Project Hope), 22(3), 89–105. https://doi.org/10.1377/hlthaff.22.3.89
Bees as Pollinators: Arkansas Pollinators. (n.d.). Retrieved August 19, 2020, from https://www.uaex.edu/farm-ranch/special-programs/beekeeping/pollinators.aspx
Boeing, H., Bechthold, A., Bub, A., Ellinger, S., Haller, D., Kroke, A., Leschik-Bonnet, E., Müller, M. J., Oberritter, H., Schulze, M., Stehle, P., & Watzl, B. (2012). Critical review: vegetables and fruit in the prevention of chronic diseases. European journal of nutrition, 51(6), 637–663. https://doi.org/10.1007/s00394-012-0380-y
Eilers, E. J., Kremen, C., Smith Greenleaf, S., Garber, A. K., & Klein, A. M. (2011). Contribution of pollinator-mediated crops to nutrients in the human food supply. PloS one, 6(6), e21363. https://doi.org/10.1371/journal.pone.0021363
Fact Sheet: The Economic Challenge Posed by Declining Pollinator Populations. (n.d.). Retrieved August 24, 2020, from https://obamawhitehouse.archives.gov/the-press-office/2014/06/20/fact-sheet-economic-challenge-posed-declining-pollinator-populations
Fact Sheets. (2020, July 08). Retrieved August 25, 2020, from https://www.cdc.gov/diabetes/library/factsheets.html
Fuhrman B, Elis A, Aviram M. Hypocholesterolemic effect of lycopene and beta-carotene is related to suppression of cholesterol synthesis and augmentation of LDL receptor activity in macrophages. Biochem Biophys Res Commun 1997;233:658–62
Goulinet S, Chapman MJ. Plasma LDL and HDL subspecies are heterogenous in particle content of tocopherols and oxygenated and hydrocarbon carotenoids. Relevance to oxidative resistance and atherogenesis. Arterioscler Thromb Vasc Biol 1997;17:786–96.
Hariri, M., Darvishi, L., Maghsoudi, Z., Khorvash, F., Aghaei, M., Iraj, B., Ghiasvand, R., & Askari, G. (2013). Intakes of Vegetables and Fruits are Negatively Correlated with Risk of Stroke in Iran. International journal of preventive medicine, 4(Suppl 2), S300–S305.
Heart Disease Facts. (2020, June 22). Retrieved August 25, 2020, from https://www.cdc.gov/heartdisease/facts.htm
Honey Bees Are Pollinators. (n.d.). Retrieved August 26, 2020, from https://www.abfnet.org/page/PollinatorFacts
Jardim, T. V., Mozaffarian, D., Abrahams-Gessel, S., Sy, S., Lee, Y., Liu, J., Huang, Y., Rehm, C., Wilde, P., Micha, R., & Gaziano, T. A. (2019). Cardiometabolic disease costs associated with suboptimal diet in the United States: A cost analysis based on a microsimulation model. PLoS medicine, 16(12), e1002981. https://doi.org/10.1371/journal.pmed.1002981
Larsson, S. C., Orsini, N., & Wolk, A. (2013). Dietary calcium intake and risk of stroke: a dose-response meta-analysis. The American journal of clinical nutrition, 97(5), 951–957. https://doi.org/10.3945/ajcn.112.052449
Klein, A. M., Vaissière, B. E., Cane, J. H., Steffan-Dewenter, I., Cunningham, S. A., Kremen, C., & Tscharntke, T. (2007). Importance of pollinators in changing landscapes for world crops. Proceedings. Biological sciences, 274(1608), 303–313. https://doi.org/10.1098/rspb.2006.3721
Ramanujan, K. (2012, May 22). Insect pollinators contribute $29 billion to U.S. farm income. Retrieved August 26, 2020, from https://news.cornell.edu/stories/2012/05/insect-pollinators-contribute-29b-us-farm-income
Manning, P., Sutherland, W., Walker, R., Williams, S., Jong, S., Ryalls, A., & Berry, E. (2004, September 01). Effect of High-Dose Vitamin E on Insulin Resistance and Associated Parameters in Overweight Subjects. Retrieved August 25, 2020, from https://care.diabetesjournals.org/content/27/9/2166
Marcus, J., Sarnak, M. J., & Menon, V. (2007). Homocysteine lowering and cardiovascular disease risk: lost in translation. The Canadian journal of cardiology, 23(9), 707–710. https://doi.org/10.1016/s0828-282x(07)70814-0
Martinez, C. (2004, June 22). Calcium and Hypertension. Retrieved August 25, 2020, from https://escholarship.org/uc/item/68b658ss
National Honey Board Press Kit: Honey Industry Facts. (n.d.). Retrieved August 25, 2020, from https://www.honey.com/files/general/NHB-Press-Kit-Honey-Industry-Facts_April_2014-1.pdf
Shenkin A. (2006). Micronutrients in health and disease. Postgraduate medical journal, 82(971), 559–567. https://doi.org/10.1136/pgmj.2006.047670
Smith, M. R., Singh, G. M., Mozaffarian, D., & Myers, S. S. (2015). Effects of decreases of animal pollinators on human nutrition and global health: A modelling analysis. The Lancet, 386(10007), 1964-1972. doi:10.1016/s0140-6736(15)61085-6
Stroke Facts. (2020, January 31). Retrieved August 25, 2020, from https://www.cdc.gov/stroke/facts.htm
Talayero BG, Sacks FM. The role of triglycerides in atherosclerosis. Current cardiology reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234107/. Published December 2011. Accessed April 15, 2020.
Vlassara, H., & Uribarri, J. (2014). Advanced glycation end products (AGE) and diabetes: cause, effect, or both?. Current diabetes reports, 14(1), 453. https://doi.org/10.1007/s11892-013-0453-1
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Topic you chose from Google forms
Would Approaching Wildfires as a Public Health Issue Decrease Rates of cardiopulmonary diseases for Americans?
From a Future Nurse’s Perspective
September 10, 2022
Kaytlin De Los Santos
West Coast University
Evidence of the connection: Wildfires and cardiopulmonary disease
In this section you will use evidence to illustrate that the injustice increases the risk for your medical condition. One of the best ways to do this is first find statistics related to your injustice to show that it is a problem. The writing style is formal and must have fluidity. You need a strong introductory sentence that describes what the section will be about but without vague/weak language and is not painted with too broad a brush. You also need transition sentences and summary sentences. Use credible sources in this part because you cannot make up information. The citations will go after the last sentence with information from that source. Each paragraph must have at least ONE in text citation otherwise this is plagiarism. You also need to write formally, meaning NO PERSONAL PRONOUNS (we, our, my or you). This is no place for personal opinions either so the word should cannot be used. Look at my full list of words and phases in my Writing Style handout that make your writing juvenile (get/ing, a lot, huge, big, “when it comes to” to name a few). If you use them I will know you did not look at the videos and are not participating in class. NO QUOATATIONS either. Information needs to be paraphrased and cited correctly in your own words.This is also a form of plagiarism. Look at my example about the decline in bee populations and the peer review rubric for guidance. They are both posted in the announcements. You will need to type outside of the templated box if you need more paragraphs. You can’t indent here in the box. Each paragraph will need to have at least one in text citation to avoid plagiarism.
In the next paragraph include a study that links the injustice to the medical condition and population. You want the study to be original research which means that researchers conducted an experiment and reported their findings. This is different than a review which is a summary of the current information on the topic. Reviews can be helpful though in backing up claims and conclusions that you make on your topic. In the very last sentence, or close to it, you must list out the three medical conditions you are going to discuss below in a fluid way. Look at my example paper to see how I did this. You will need to type outside of the templated box if you need more paragraphs. You can’t indent here in the box. Make sure all the information is covered by an intext citation around the end of the paragraph. One in text citations is required to avoid plagiarism issues. The last sentence in this section should include the three diagnosis that will be discussed as a transition to the next part of the paper.
Medical Diagnosis One: Chronic obstructive pulmonary disease
In this section you will discuss the medical diagnosis that falls under your medical condition in the research question. For example, in my paper my medical condition in my research question is chronic disease and in this part of the paper I have one section each for cardiovascular disease, diabetes and stroke. All of which are chronic diseases. You will need to create the same uniformity and cohesion for your paper. Begin this section my defining the medical condition and including rates using statistics (probably from the CDC). All of the writing style and citation formatting is the same as mentioned in the above section. Please review to ensure strong academic composition. You will need to type outside of the templated box if you need more paragraphs. You can’t indent here in the box. Make sure all the information is covered by an in text citation around the end of the paragraph. One in text citations is required to avoid plagiarism issues.
In this next paragraph include a research study that links this specific body system/diagnosis to your injustice and population. This may have been one of your articles in assignment 2 and can be copy pasted into this section. For my paper is was how plants that require pollination to produce fruits and veggies help to decrease risk for CVD, DM and stroke. Each diagnosis/body system has its own section and its own study to support the connection. You want to make sure your study used subjects that are members of the population you chose to include as well. All of the writing style and citation formatting is the same as the above section and throughout the paper. You will need to type outside of the templated box if you need more paragraphs. You can’t indent here in the box. Make sure all the information is covered by an in text citation around the end of the paragraph. One in text citations is required to avoid plagiarism issues.
Medical Diagnosis Two: Heart disease
In this section you will discuss another medical diagnosis that falls under your medical condition in the research question. For example, in my paper my medical condition in my research question is chronic disease and in this part of the paper I have one section each for cardiovascular disease, diabetes and stroke. All of which are chronic diseases. You will need to create the same uniformity and cohesion for your paper. Begin this section my defining the medical condition and including rates using statistics (probably from the CDC). You will need to type outside of the templated box if you need more paragraphs. You can’t indent here in the box. Make sure all the information is covered by an in text citation around the end of the paragraph. One in text citations is required to avoid plagiarism issues.
In this next paragraph include a research study that links this specific body system/diagnosis to your injustice and population. This may have been one of your articles in assignment 2 and can be copy pasted into this section. For my paper is was how plants that require pollination to produce fruits and veggies help to decrease risk for CVD, DM and stroke. Each diagnosis/body system has its own section and its own study to support the connection. You want to make sure your study used subjects that are members of the population you chose to include as well. All of the writing style and citation formatting is the same as the above section and throughout the paper. You will need to type outside of the templated box if you need more paragraphs. You can’t indent here in the box. Make sure all the information is covered by an in text citation around the end of the paragraph. One in text citations is required to avoid plagiarism issues..
Medical Diagnosis Three: Asthma
In this section you will discuss the final medical diagnosis that falls under your medical condition in the research question. Begin this section my defining the medical condition and including rates using statistics (probably from the CDC). All of the writing style and citation formatting is the same as mentioned in the above section. You will need to type outside of the templated box if you need more paragraphs. You can’t indent here in the box. Make sure all the information is covered by an in text citation around the end of the paragraph. One in text citations is required to avoid plagiarism issues.
In this next paragraph include a research study that links this specific body system/diagnosis to your injustice and population. This may have been one of your articles in assignment 2 and can be copy pasted into this section. For my paper is was how plants that require pollination to produce fruits and veggies help to decrease risk for CVD, DM and stroke. Each diagnosis/body system has its own section and its own study to support the connection. You want to make sure your study used subjects that are members of the population you chose to include as well. All of the writing style and citation formatting is the same as the above section and throughout the paper. Please review to ensure strong academic composition. Last sentence(s) or even paragraphs need to be a good transition into the next section. You are not writing several separate papers. This is one paper and must show cohesion. You will need to type outside of the templated box if you need more paragraphs. You can’t indent here in the box.
Economic Burden: Healthcare cost, Loss of productivity, Restoration of buildings
Health care cost
In this section you will discuss the first economic burden of the topic listed above. You need to use monetary values to illustrate the impact it will have on the economy and how it impacts your specific population. Finding studies for this section is useful in making your point as well but not required. All assignments must discuss at a minimum the healthcare cost and another component of the economy. For example, the death of the bees will result in lost revenue in the agricultural sector as well.
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