Hello and welcome back everyone to the second day of our workshop towards a future of environmental health sciences. This workshop is being sponsored by the Standing Committee on the use of emerging science for environmental health decisions and the goal of this workshop is to gather numerous voices from around the scientific and practice community to better understand how we can envision the role of environmental health sciences and advancing the work and protecting human health far into the future. So it seems a little abstract and yet we're asking people to really think towards the future as a goal of redesigning and reevaluating our priorities and addressing environmental threats to human health here. We had a very dynamic day yesterday. And one of the goals of this particular workshop as the Standing Committee has been envisioning the future and addressing these challenges over the last year is to really bring a large number of voices from the broader community. So with that in mind, I think we could. There's a questionnaire that's at the bottom of those folks who are here. There's a questionnaire that we would love to hear voices from other folks, but some of the questions that we heard from the public to date that we would like to address include some of the challenges that we were talking about yesterday. So what is the health or societal challenge that you believe advances environmental health sciences and how can environmental health sciences address this over the next decade. Can you name two environmental health research topics that she should be prioritized in the next five years. What are those extrinsic factors such as environmental exposures lifestyle and social determinants of health that contribute heavily to the development of a disease. And what do you think is one barrier to fully integrate environmental health public health biomedical disease specific and prevention research, so that we can improve health for all. Answering these questions is challenging it's the crux of why we're here today. It's also why we're using this envisioning perspective to look towards the future to be better understand how we can address these challenging questions. So thank you to the public for raising those and to the audience. So anyone else in the audience we do have a button at the bottom of the screen both for providing questions for the panelists to respond to throughout the day, as well as for you to ask some of those big overarching questions to us as well and we'll try to address some of those at the end of the morning this morning in our final session and wrap up. So without any further ado, I really would like to thank our next panelists we have a wonderful panelists and sets of speakers from leaders from across the National Institute of Health, who will be talking broadly about how environmental health sciences can advance the work that they do within their agencies. So we've asked to talk about what does the future of environmental health sciences look like, how might we think about expanded mental models to address this, and then what scientific advances are needed to achieve these goals. So, with that, I'm going to pass things on to Dr. Gary Miller, and thanks to everyone for joining us this morning I look forward to a very exciting discussion. Thank you Kristen. I'm Gary Miller at Columbia University, and I was on the planning committee and I'm also on the standing committee for emerging science for environmental health decisions. So today we have the pleasure of having representatives from four different NIH institutes to talk about the future of environmental health sciences. For the purpose of today's discussion, I think we should think about the environment in two ways. One is the more holistic view of the environment being everything that is non genetic kind of the big definition. This would include chemical exposures, social determinants of health, dietary factors, pathogens, all of it. And then second, we also have to consider it in the way that NIH and NIH has have classally defined it as more than non volitional exposures thinking about chemical exposures, secondhand smoke, but not things like dietary factors or smoking or alcohol consumption. Again, I think that we want to look at it in both ways, but for the standpoint of the big definition I think that all of the NIH institutes work in that realm. But when you get into more of the specific more focused definition we see some differences there. So with that I'd like to start by introducing Dr. Rick Weicheck, he is the director of the National Institute of Environmental Health Sciences and the National Toxicology Program. He has been with the Institute for many years as deputy director. Before that he was at the Jackson Laboratory. His background is in genetics and it's very nice to see that he's taking this key leadership role on the environmental side. So with that, Dr. Weicheck. Great, can everyone hear me okay. Yes, always good to know the microphone is working so thanks Gary. So let me start off by thanking the committee for their work to coordinate this workshop. It's really important that we have this opportunity to look to the future. And as we look to the future it's a lot of work that needs to be done. And what's clear from the presentations that we've all heard thus far there are many things that we need to keep in mind. So therefore what I thought I would do is spend the 15 minutes that are assigned me to focus on a few topics that have been under discussion at NIHS over the past couple of years since I've been the director so let's go to the next slide please. So first and foremost, with the increasing recognition that environmental exposures play a critically important role in human health and disease. And as we plan for the future those of us in the environmental health sciences community must embrace the opportunities to collaborate with others studying the etiology of human disease. Other organizations including those, the, say the NCI, the National Institute of Aging, the National Institute of Nursing Research you're going to hear more about those in just a few minutes, as well as a broad base of other organizations that are studying again the etiology of human disease. I mean they can all bring complimentary and powerful capabilities to better understand the biological mechanisms that underlie health and disease. And as we discussed earlier on the meeting of these collaborations need to extend beyond just the usual suspects, and they need to include those investigators working on the social determinants of health. And furthermore, we also need to be very purposeful and how we engage with communities in the research that we conduct so lots of different things to keep in mind next slide. Again in a limited time that I have I want to focus on some specific research programs that have been kind of in the, in the focus over the past couple of years, and the first program I want to describe is what we heard a bit about yesterday. But I first learned about this when Cheryl Walker and Andrea Baccarelli and Dana Dolanai described the concept of precision environmental health and they did this at a recent NIHS console. And all this program is all about recognizing that individuals respond to environmental exposure in different ways. So some of these differential responses will be due to the underlying genetic differences between individuals. But it also includes it's not just genetics. It also includes the epigenetic and other biological variabilities that can arise that make us all uniquely ourselves are unique human beings. And I recognize that some of these biological variations or epigenetic changes can occur as a consequence of exposures during development. So the program, the precision environmental health, I think nicely dovetails with the precision medicine program, which is connected with the all of us 1 million person cohort at the NIH. And as well with the programs across the globe that are collaborating as part of the what's come to be referred to as the International Common Disease Alliance or the ICDA. So I think in the end, this is all about trying to identify the genetic the genomic and the biological signals that regulate how genes are being expressed, and how those changes in gene expression can confer different phenotypes that either promote health or cause disease. The shell Walker puts it precision environmental health is about working at the intersection of genetics and environmental health as well as data science, all focus on the purpose of studying gene by environment interactions. So next slide please and I also want to focus it's about preventing disease. So the, the next program I want to talk about is, I'm sorry go back to the previous slide, not quite done. And also coupled with the precision environmental health is this concept of the expose on framework that we need to be employing to collect exposure data. And I think as we have all come to recognize and the environmental health sciences community the expose on is about the totality of exposures over lifetime. So the expose on concept recognizes that if we truly want to understand the impact of the environment on human health. We have to develop a research strategy that moves beyond studying single exposures. And it needs to include the windows of exposure over a life course, especially during development. So the environmental health sciences community has been discussing the expose on concepts since 2005 when wild originally proposed the concept. But what's been lacking is a clear experimental design of how to conduct an experiment in exposomics. So we need to define what data needs to be collected to conduct an expose on experiment. We're working together with Gary Miller and many of his colleagues and IHS will be sponsoring a set of five virtual workshops over the coming months that will culminate in an in person workshop in September at and IHS. And the purpose of these workshops will be to really work out with the global environmental health sciences community to define how do we operationalize exposomics. So let's go to the next slide please. So the program that's been kind of in focus that we've been spending a lot of time talking about is the climate change and health program. So soon after the inauguration and January of 2021 is I think we all realize it's the Biden administration is putting climate change as a major focus of its effort. So the executive order 14 008, which amongst many other things creates the office of climate change and health equity and HHS. So the executive officer, the executive order also specifies that the NIH needs to take on the challenge of addressing the health related issues associated with climate change. IHS has been one of the leading ICs funding climate change and health research over the past 10 years. It just was abundantly clear that studying the health consequences climate change is much bigger than what one IC can accomplish on its own. So therefore I've taken the initiative to reach out to six other IC directors which includes Dr. Zane who will be speaking to just a few minutes. And we've got a self form co less than to form what we're calling the executive committee for climate change and health. So together we've re energized a working group with membership from across the NIH. And we are now at a point where we have developed a strategic framework for climate change and health with the NIH. Again, this is an NIH wide program. This framework is based on four different core elements that you can see on the right hand side of the slide, which includes health effects research health equity, training and capacity building and intervention science. Now the center is a focus on multidisciplinary transformative research, and the work will be conducted with global cross sector interagency and community partnerships. And once around is the periphery of this diagram represent elements. Well the broad assortment of different types of research that will be necessary to support the framework and these range from basic mechanistic research to behavioral and social science research epidemiology and predictive modeling, all the way to adaptation research. If you're interested, visit the website that we developed is www.nih.gov forward slash climate and health you can see that in the lower right hand corner of the diagram. And I should add that Dr. Flotis and Dr. Sharpless expressed an interest in continuing to work with us and planning this planning the future of this NIH wide climate change and health program. So thank you Richard for your your efforts. Next slide please. So another big area of focus at NEHS is has been around mechanistic and translational toxicology. Sorry division of the National toxicology program has undergone a major transformation over the past couple of years under the leadership of Dr. So the DNTP is increasingly interested in developing a research platform that produces results that can be seamlessly translated to predict adverse health effects in human populations. The NTP is focused on the kind of the innovative research that will move toxicology to become a more predictive science. So we don't have time to discuss all the areas of progress but suffice it to say there are many, many different noteworthy areas of innovation some of them are illustrated on the right hand side of this diagram. I mean one of them includes the development of sophisticated computational approaches using artificial intelligence and machine learning to leverage existing data sets that the NTP has been collecting over the last several decades and these range from gene expression profiles to digitize pathology images. Another example relates to innovative new strategies involving the use of in vitro pipelines with human IPSCs that are differentiated form complex 3D modeling systems. And Brian and his colleagues assume that these will enhance our ability to identify and characterize potential say for example cardiovascular hazards related to environmental exposures. The third area of innovation is the use of genetic diversity to study the toxicity of different environmental agents. They've used the diversity outbreak population based model from the Jackson laboratory to study the influence of high fat diet and they're also creating embryonic stem cell populations from the diversity output mice to study toxic dynamic variability factors. This is an example of the neural progenitor stem cell system so working on mechanisms associated with toxicity during neural development. So next slide. And I also want to just comment very briefly here. Another recent area of focus has been better understanding how do we address the issues of social justice and health disparities. And as many of you know in IHS has a long history of studying environmental justice DJ, and we've recently developed a cross divisional planning team to begin to explore how we might develop research strategies to address health disparities that build on our past accomplishments. So we've done a lot in the past but we need to do more. The planning group hosted a workshop on environmental justice and health disparities several weeks ago. They brought together members of the environmental justice communities, including those close to Superfund sites in our own backyard in central North Carolina. And some of those located next to those large log farming operations we talked about yesterday in Eastern North Carolina. So it's very interesting bringing these community members in we receive an earful from these community members. I mean they understand that we do research and it's important to do the research but I think they're also tired of coming to us and describing their problems they want their neighborhoods to be cleaned up they want something to be done. And as Dr. right indicated yesterday in his comments, the issues with these communities are complicated because many members of these communities are employed by the business operations that are contributing to the environmental problems. So the working group is now working on strategies so how do we figure out how we can bring the capabilities in the environmental health sciences research community together and to address the needs of these environmental justice community so stay tuned and more workshops will be on the way and we encourage you to participate. So I think, hopefully this just gives you a little idea of some of the things that we've been talking about. So, Gary, I'm going to turn the virtual point in back over to you. Thank you, Dr by chick. So, I would like to remind the audience members to post questions in the q amp a box that will come to at the end after all the discussion. So next we have Dr Richard Hodes who is the director of the National Institute of aging. I can't recall a time when he wasn't the director of the National Institute of aging. And if you look back since he's been leader since 1993. The Institute just had extraordinary growth and impact and it's very exciting to see the work they've been doing so I will turn it over to you Dr. Gary and thank you for the opportunity to participate reflecting as Rick has noted, our Institute's commitment and appreciation of our partnership with all of you. I'd like to focus a bit on the areas and domains this important field that are particularly related to national student aging and the fate of older adults as a result of environmental exposures. The next slide please. One illustration of the particular disproportionate effect of exposures and climate change is that reflected here in this Lancet countdown report, which identified older adults as a particular vulnerable population, experiencing morbidity mortality consequences and natural and alarming changes in weather, as well as we get to some of the non natural and man made disasters that that have occurred over past years and decades and and threaten to continue. The next slide please. So the exposure and effective age is really at two levels first it's, it's got to do with the cumulative effect of exposures across the lifespan lifespan something that Rick emphasized to include the important to us so that we can monitor exposures and understand how over time they lead to epigenetic in other changes that are detectable and individuals is critically important. And this history of prior exposure, then determines some differentials potentially in the response to acute insults and exposure so for both these dimensions studying of acute events and their outcomes, as well as the critical importance of longitudinal studies, and I is very much enthusiastic as a participant in the overall emphasis on expose own and the intersection as Gary put it at the volitional and non volitional aspects of exposures. And social economic status at the time of an event, as well as during the lifespan are important, determining the resilience economically and, and financially at the individual level disease burden that's a function of age and aging, the medical and social resources that are accessible during times of acute events and recovering from them. Next slide please. NIH's research priorities at the level of behavior and social research are to support and understand the way in which the outcomes of older adults health and their preparedness may be able to mitigate and provide some resilience in the face of climate change and extreme weather conditions. And as a long history of studying the consequences of these unfortunate natural experiments and exposures with I think what we've all seen a disproportionate consequences for older populations in the face of some of the most extreme natural disasters. Next slide please. These photographs just illustrate the the spectrum of events natural disasters that can lead to harmful exposures, be it flooding fires, wind and earthquakes, all of which we've seen nationally and globally over past years. And again, where the fate of so many has been reflected in adverse consequences which are emphasized in the older adult populations. Next slide please. Some of these examples, the, the exposures are included usual and natural levels if you will of air pollution, wildfires, hurricanes, etc. The exposures are the particles of all sizes, reactive gases secondary pollutants and the 180 plus hazardous pollutants on the EPA list. Next slide please. In terms of some of the documented outcomes these are not randomized control studies of course these are observational studies which give us clues as to the nature of consequences of post tragedies include some of those noted here so after the Japanese tsunami. Cardiometabolic risk factors increased respiratory disease, cardiometabolic disease, post traumatic stress syndrome and cognition in the extensively study now World Trade Center exposures, century visual and vestibular dysfunction after Gulf Deepwater horizon spill and respiratory conditions are very predominant after exposure of wildfires. Next slide please. Recent NIA funded studies have found for example that in those areas where older women in the US have lived in regions of improved air quality there appears to be a slower rate of cognitive decline than those who are in areas of sustained poor air quality. In those areas of China where the government has said air quality improvement targets and spend a small decline in cognitive function. It's been shown that the long term ozone exposures associated with increased cognitive impairment among older Chinese adults. And in one study is a combination of observation and hypothetical modeling that reduction in air pollution was associated with a reduced risk of dementia and older adults living in France. Examples they need to be improved upon by better longitudinal studies that are controlled by quasi experimental methods at least to help us to isolate the nature of exposures and as Rick was emphasizing the role of individual differences, defined by genetic epigenetic and other phenotypic measures so we can understand who is the greatest risk and how to address the mediation of those risks and exposures. Next slide please. So among the research interests, looking to the future that NIA has its high priorities. Looking at the way in which exposure to air pollution heat wildfires and others affect well being in mid life and later life so the acute and again long term result of those exposures. There are active age related changes and social and cognitive factors the social determinants of health, which intersect with some of the other aspects of the expose on how individuals maintain and make behavior change that will reduce risk of exposure to mitigate recovery from exposure, and the contribution of extreme weather events and some very interesting opportunities to study in wild natural habitat of non human primates in particular, the exposures of these populations to natural disasters. We look in those areas that can control and allow longitudinal studies in a way that can supplement and complement what we do in human studies. Next slide please. The impact of extreme weather events in particular on individuals with dementia, Alzheimer's and other forms, people living in those dimensions those who care for them are particularly heartrending and we look at some of the impacts of recent natural migration on populations, some of whom are institutionalized some living at home with very much compromised ability to respond to these events and threats. The impacts of internal migration change environments displacement on social structures and how this affects individuals as they move into older ages of adult life. Next please. I have a final offer and request to all of you to please stay in touch and help us stay in touch at NIA with the missions of all of you. Happy to be addressing questions you might have in a constant ongoing way. And with this, let me close and thank you for the opportunity to be a part of this very important study and workshop. Thank you Dr. Otis. So next up we have Dr Shannon zinc that the director of the National Institute of Nursing Research. She comes from the University of Illinois, Chicago, just starting in 2020 so relatively young director of one of the United Institutes, and I've worked with several people in in schools of nursing and I've noticed over the years that in our has been very much an early adopter of things like microbiome and expose them sort of things. And I think it comes mainly from the, the profession of nursing, understanding the holistic nature of health. So I'm looking forward to hearing what Dr zinc has to say Dr saying. Thank you. Good morning, everyone. Hopefully you see my slides and appreciate this opportunity to join the panel. I'm honored to represent NIH with my colleagues Rick Richard and Gary and to share my perspective on the connections between nursing science and the environmental health sciences. So first let me tell you a little bit about my perspective on environmental health. I see environmental health as crucial from a social justice perspective to achieving health equity. And it's, I see it as really closely connected to the social determinants of health, which as we know are the conditions in which people are born, live, learn, work, play and age that affect health and quality of life. From this perspective, I am drawn to APHA's description of environmental health as focusing on the relationships between people and their environment to promote human health and well being and foster healthy and safe communities. Here it's understanding the health impacts of climate change, promoting healthy community design through the built environment, or improving the quality of the air we breathe the water we drink and the food we eat. Nursing research builds on a long tradition of considering environmental and social factors that affect a wide range of health functioning and quality of life outcomes and risks. Let me give you some context on nursing's history and recognizing of recognizing and addressing the connections between social and environmental factors and living conditions. I'm sorry, the connections between social environmental factors and health. So nursing's earliest pioneers recognize that health must be considered within the realities of people's lives and living conditions. In other words, they were among the earliest to incorporate social and environmental factors into their solutions to health problems. Florence Nightingale was one of the first to recognize and address the connection between health and environmental elements, such as ventilation and warming, clean air and water, noise pollution and provision of light. Lillian Wald saw nurses as working at the intersection of medicine and society to care for individuals, families and communities in the context of social, economic and industrial conditions. And we continue to build on this rich history through nurse led efforts to address intensifying health inequities. In fact, the recent future of nursing report from the National Academy of Medicine and the Robert Wood Johnson Foundation makes a compelling case for nurses to assume leading roles in eliminating persistent health inequities in our society. We couldn't agree more at NINR. Specifically, the report focuses on the role of nurses and addressing the social determinants of health. Acknowledges that environmental hazards and natural disasters disproportionately impact low income communities and those populated by people of color and explicitly addresses climate change as a looming public health threat. So, in fact, NINR's research is critical in generating the evidence needed for nursing interventions that address these pressing health challenges. So in defining NINR's mission, we recognize the importance of solving our nation's most pressing health challenges by supporting research to inform practices and policies that will advance health equity. One of the most important factors that influences health equity is the environment into which people are born and live. Still, the impacts of historic and contemporary racist policies like neighborhood redlining that discouraged investment in non-white neighborhoods influence too often the conditions in which we live. We ignore the fact that there are communities that through no fault of their own, lack the resources needed to live their healthiest lives. Nor can we ignore the fact that the most vulnerable among us will disproportionately experience the effects of climate change. In the U.S., people of color and those living in poverty are far more likely than their white and socioeconomically advantaged counterparts to live in areas affected by so-called urban heat islands. This is something we're examining in my own lab as we're in the process of developing a new line of research to investigate multi-level determinants of and disparities in personal heat exposure and the implications for individual cardiometabolic health. I'm sure that all of our funded research supports our mission, NINR developed these guiding principles for the qualities that all NINR supported work should have going forward. In considering awards for funding, extent to which studies reflect these principles will be a factor in our decision. The support research that's innovative applies rigorous research methods, has the potential for significant impact on health and wellness beyond the initial study sample. Advances equity, diversity, and inclusion addresses today's challenges and helps us be better prepared for the future and provides solutions to optimize health across clinical, community, and policy settings. Furthermore, the framework for our next strategic plan, which will be released soon, includes five research lenses that describe broad perspectives by which to examine health challenges. So let me explain what we mean by a research lens. The field of nursing science is comprised of many perspectives on what topics nursing science should address and how we should do so. Simply put, when we say a lens, we're describing a perspective through which to examine an identified health challenge. We think these lenses best leverage the strengths of nursing science to innovate, think bigger, and greatly increase our impact. So as you can see, social determinants of health is among these lenses, and I believe that environmental factors could be considered under that lens, and even under all the lenses. Because social and environmental factors impact so many facets of our health and well being, we believe it's vital to support research that will examine them and identify effective approaches to address them. So we're committed to collaborating with partners within NIH and across the federal government on social and environmental determinants of health and health equity efforts. These partnerships are crucial to achieving the missions of NINR and NIH and advancing research that aligns with our strategic plan. For example, I'm excited to share with you about two common fund programs to advance health equity at NIH that are squarely focused on social and environmental determinants of health. So as background common fund programs address emerging scientific opportunities and pressing challenges and biomedical research that no single NIH institute or center can address on its own, but are of high priority for the NIH as a whole. The common fund is thus a unique resource at NIH where high risk innovative endeavors with the potential for extraordinary impact are supported. So launched in 2021, the first common fund program was the transformative research to address health disparities and advance health equity common fund program. This program is supporting innovative translational research projects addressing social determinants of health to prevent, reduce and eliminate health disparities and advance health equity. In recognizing though the urgency of health equity research, we also launched a second new 10-year $397 million common fund program called Compass. Compass will be transformative, we believe, and help us make real progress in eliminating health inequities and achieving health equity by looking upstream at the systems and structures that are causing socially and economically disadvantaged populations to become sick in the first place. The program has two overarching goals. First, the program will facilitate and implement an NIH wide framework for health equity intervention research. Second, it will deploy and evaluate community driven structural health equity interventions that leverage intersectoral partnerships. I'm also pleased to let you know about a new NIH wide social determinants of health research coordinating committee that was launched with NIA, NIHS, and others. The goal of this new research coordinating committee is to accelerate research across NIH on social determinants of health across diseases and conditions, populations and stages of the life course. In addition to NINR's contributions to these NIH initiatives and committees, among others, focused on social and environmental determinants of health. We're also represented on HHS and government wide initiatives. To the social determinants of health interagency policy committee, and we're contributing, for example, to the climate change food systems and nutrition security working group of the US global change research program. So I'm very excited to be representing for NINR to be representing NIH and many of these committees. Those might just like to share a few additional thoughts on the importance of nursing research to the health and well being. As you know, nurses are everywhere in our hospitals and clinics in our schools and workplaces in homes and justice settings, and throughout our communities. We approach prevention treatment and care holistically and in context, and the scope of our practice and our discipline extends from improving the health of individuals to that of entire populations. So what sets NINR apart is that our research is focused on health solutions for people in the context of their lives and living conditions. And it's that perspective that makes our scientific discipline so well positioned to lead research focused on the whole picture of the biology of a person's cells and genes to their whole self, their family and resources, and the environment community and society in which they live. So thanks again for inviting me to share nursing sciences perspective on how the environment in all its forms influences health and health disparities. I look forward to the discussion. Thank you, Dr. Zink. So our next speaker is Dr. Gary Ellison from the National Cancer Institute. He is the chief of the Environmental Epidemiology branch. His own research is in cancer epidemiology of prostate cancer. And he's just an excellent person to be speaking here because he has a great relationship with NIH S. He's not an associate on Council, but he actually served as acting director of the division of extramural research and training at NIH S during the recent transition. So with that, I will turn it over to you, Dr. Ellison. Okay, great. So first, I'd like to thank you for the opportunity to participate as a panelist during this workshop. It's great to be here with my colleagues and envision how we can collaborate and leverage resources to improve health. UCI has enjoyed a longstanding and rich collaboration with the National Institute of Environmental Health Sciences on matters of the environment and cancer. And I'm reminded of the first project that I had the opportunity to work on. The NIH S National Cancer Institute breast cancer and environment research program, which was transdisciplinary and included basic scientists epidemiologists, clinical scientists behavioral and communication scientists and community advocates, and it focused on environmental factors and breast cancer. Now this review demonstrates the emerging science from epidemiologic and mechanistic studies that point to the influence of environmental chemicals on breast cancer risk, and how this risk might be greater during several windows of susceptibility prenatal development, puberty, pregnancy, and menopausal transition. So from this effective prevention efforts could occur at each point during these specific windows and these discoveries, I don't think would have been would have been difficult to achieve with the single discipline doing the work. So today what I'd like to cover is talk a little bit about the cancer control continuum as a framework for for guiding our efforts at NCI, the challenges and opportunities for studying the environment and cancer, and also new opportunities to integrate environmental health sciences into our cancer epidemiology work. So what is cancer control. So cancer control is essentially reducing the burden from cancer, and the cancer control continuum shown here has been used to describe the stages from etiology to survivorship and end of life with several cross cutting areas like health disparities. So this is a framework for to identify research gaps plan review progress and priorities, and most of my focus today will be on the, the, the lower end of this the etiology and prevention, but I strongly believe that there is opportunity environment effects cancer control throughout this continuum. For example, we've heard about climate change and how it poses an imminent threat to human health. And it's imperative that we understand where and how its impact can be realized so that efforts to adapt and mitigate its effects can be undertaken. The diet and Baylor demonstrates how climate change can affect cancer control along the continuum from etiology with its effects on cancer risk factors, through disruptions to all aspects of cancer care delivery. And, and we can see that climate change to wildfires and hurricanes has already increased the risk of developing cancer and other chronic diseases through, you know, it's a mission of, you know, these chemical toxicants and ultra violet radiation, etc. So, along with our partners at NIH and Dr. Warchick talked about this NCI has formed teams to tackle this very important issue. So cancer occurs through the interplay of genes and the environment, and it's molecularly heterogeneous genius. It isn't just one disease but many, and adding to its complexity within the same tumor type like breast for example. There are several molecular subtypes having potentially different etiologies and age is the strongest risk factor for cancer and latency of cancer makes it really difficult to study with respect to the environment. And the environment is also complex, broad and dynamic making its measurement challenging. There have been major advances in measuring the environment that include improvements in geospatial tools like remote sensing global positioning technologies, personal monitoring tools including wearable sensors and smartphones, and also new assays and advances in targeted and untargeted analysis to help us understand the body bird of environmental chemicals and biological responses to it. So take it together. These tools can help us more accurately predict individual exposures and their impact on health and disease. So the timing of exposure could be important, as I've mentioned before in my first slide and have lifelong consequences for risk of disease. And I think about government sanction racism in the form of redlining that limited black and brown people to the most undesirable neighborhoods exposing them to many environmental contaminants. This impact could still be realized today. Now the exposome first introduced by Christopher Wild in 2005 has been defined as the totality of environmental exposures throughout the life course. And this concept moves us beyond as you've heard earlier the notion of assessing the impact of one exposure at a time and considers multiple external and internal exposures that can impact disease risk. And this is an opportunity for us. So the challenge would be in collecting, managing and integrating this environmental phenotypic and biological data and incorporating them in models of disease risk and it really underscores the need for a collaborative approaches that include interdisciplinary and transdisciplinary designs. Relation-based cohorts have many advantages for the integration of multiple types of data. Chief among the advantages is that they are well characterized with pre-diagnostic measurements of lifestyle behaviors, some environmental exposures, biospecimens, and many are geocoded. I want to spend the next few minutes talking about existing resources and new initiatives supported by NCI that could be used to foster transdisciplinary collaborations with a focus on health equity. For example, the NCI consortium is a partnership to address the need for large scale collaborations to pool data and biospecimens necessary to conduct a wide range of cancer study. It includes 61 high quality large cohorts, each having 10,000 or more study participants. It represents diverse populations from at least 15 countries and four continents. It has extensive risk factor data that are available for more than 7 million study participants, and it has biospecimens including germline DNA collected at baseline that are available for more than 2 million study participants. On the right is the racial and ethnic distribution of the cancer epidemiology cohorts supported by NCI. Now these funded cohorts include about 1.1 million individuals that are largely white and it's an aging population. So information about these cohorts, including enrollment, cancer counts, and biospecimens can be found using the cancer epidemiology descriptive cohort database, which is on NCI's website. I've included in one of the slides at the end of this talk. So for many years, NCI has provided support to maintain the infrastructure of several risk and survivor cohorts. I'm pleased to announce that a new program announcement just released this month seeks to support hypothesis based research using data from established cohorts. Highly encouraged are research questions that include understudied populations. Joanne Elena is the scientific contact for this initiative. And while some resources exist, we recognize the need to build the next generation of population based cancer epidemiology cohorts that will exploit emerging and unique exposures in relation to cancer risk and outcomes, and we'll have understudied populations as one of the primary areas of focus. An important requirement is the addition of community partners who could inform research questions and contribute to dissemination of results. And because it encouraged this initiative encourages methodological studies, I see this funding initiative as an outstanding resource to integrate emerging technological advances and exposure assessment into population based cohort. Tram Kim Lam is the scientific cohort and these two do funding opportunity announcements will have multiple submissions with the first application due date on July 29, 2022. And I do want to let you all know and I know that it's somewhat overlaps with this meeting that there will be a webinar to discuss these two funding opportunity announcements at one o'clock this afternoon. So NCI and NIEHS recently funded five new cancer epidemiology cohorts to enable evaluation of emerging and important environmental exposures on cancer risk. And these cohorts are racially and ethnically diverse, they'll collect data on a wide variety of exposures and because of cancer is long latency will consider intermediate factors like association between environmental exposures and biomarkers that have been described as key characteristics of carcinogens. They also include community engagement to inform and enhance research and communities, and a coordinating center Dr. Maliki is a PI there that will identify common themes across the cohorts will facilitate collaborations, explore emerging scientific opportunities and promote team science. Collectively these cohorts will include close to 200,000 participants. We know that people living in persistent poverty areas have a higher disease burden, and its effects have not been fully investigated. And these areas are largely minority have more children under the age of 18 making them quite vulnerable to the conditions in those areas. These areas also experienced environmental degradation degradation and and face structural racism. So a new funding opportunity announcement seeks to fund specialized centers aimed at supporting transdisciplinary teams focused on the cancer experiences and persistent poverty areas. And the locations for this are due July 6 so I just discussed three new emerging funding opportunity announcements where we can begin to think about integrating environmental health sciences and form teams that are necessary to to carry out the science. One thing I want to highlight is the here initiative this is led by in IHS. This provides analysis of environmental chemicals and metabolites for investigators interested in adding environmental exposures to their analysis. NCI is participating in this initiative and we can leverage this resource to to incorporate more environmental health sciences into the studies that we support. So, in summary, through my experience with the breast cancer and environment research program. You know, I believe that transdisciplinary science can help accelerate the pace of scientific discovery, formation of groups and development of collaborations take time. Different investigators from different disciplines have to learn the language of the other and that can be quite challenging. There are several existing and new resources available to integrate multiple types of data and foster collaboration. And then there are opportunities to go beyond etiology and prevention to understand the impact of environment on cancer survivors, and I also see an opportunity for NCI to continuous collaboration, not only with in IHS, but with the other partners on this panel as other ICs within NIH. And so with that, I'll stop. Thank you for your time. And I'll turn it over to Gary. So now we will open it up to questions we've had questions coming in on the Q&A, you can please continue to send those in. Let's start with this question about what to do next. I mean, so from an NIH perspective, we often think about therapeutics and drug interventions. And it may be that the mitigation of some of the effects of exposures could have that sort of medical intervention. But the prevention of those exposures really falls more into the sort of public health or regulatory agencies like CDC and EPA. So this is kind of for all the panelists, do we have a sufficient level of dialogue among these agencies, and what could be done to strengthen those connections to improve decision making? Anyone want to jump right in? Well, maybe I can start. That's okay, Richard and Shannon and Gary. I think one of the first things we can do is just bring greater awareness to the general public of the importance of these environmental exposures and greater awareness of the importance of the environmental exposures as we study the etiology of human disease. I have a lot of colleagues, I'm a geneticist, so I can actually point to a number of geneticists. They study the connection between allelic variants on genomes and the development of the neurological disorders, a number of other things, cancer. And becoming more conscious of the role of environmental exposures, and then having a broad based initiative to get this information out into the general population so that people are more conscious of, you know, what do you do on those bad air days? And what do you do about potential exposures within your home environment? So just increasing awareness, I think is a very important first step. Okay. Other comments? I think NIH, as others are recognizing solutions, and we need evidence to inform solutions at multiple levels. And certainly that involves collaborating across agencies in the federal government, but as well as across sectors. And I think some of the new initiatives being developed at NIH, we mentioned a couple of common fund programs really recognize the need for a broader perspectives on what solutions are needed and partnering in multiple ways to get there. Yeah, and I'd like to contribute to that as well. I think that it's increasingly our awareness has increased that we do need to partner with other organizations outside of NIH, and I'd like to highlight a particular collaboration that NCI has with the Center for Disease Control, whose team has done an outstanding job of conducting workshops and seminars focused on cancer prevention based on what is known about the exposures across the life course. And so it's taking the work that we've done and our partners in the extramural community have done and discovering what the risks are and taking that and applying it so that we can develop effective interventions. I'd reinforce all that's been said, you know, the role for us at NIH is to identify the questions conduct research to focus on problems and ideally on strategies that have the potential to address them and then to partner with other agencies as necessary as Shannon has particularly emphasized some of the interventions we're talking about are not those that are carried out by research investigators in isolation but require the other agencies and advocacy groups that need to be a part of the solution but for us I think the focus has to be on identifying the problems and a tenable approaches to them and involving affected populations and involve the agencies that are going to be have to be a part of the interventions themselves. Yeah, I think it is critical to is that the agencies have different needs like we tend to know what data to provide a drug company to develop a therapy but when you think about a public health intervention, you still need to do those trials to show that they work, and it really kind of changes the tenor of how we do some of these things. So one of the things that came up with various comments was the, it seemed that there were some tools that people would like to have like some technology user abilities. And because we're thinking about the future of environmental health, if we can not think so much about feasibility, but if just in kind of a dream world what sort of tools would you want to get a better analysis of the environmental drivers to disease. Again, maybe I can just reinforce the points that I was making during my presentation, and Gary I know that this is near and dear to your heart is, you know, better understanding the totality of exposures what are what are the tools that the environmental health sciences community needs to do an exposomics experiment. And how do we get this information out there and how do we develop the, the, the, the, you know, the data repositories where people will then integrate this data into, you know, these repositories for the benefit of the global environmental health sciences. Well, the global biomedical community it's not just about environmental health sciences. It's about the dream solution I guess it can occur at two levels the first is actually monitoring longitudinally the exposures directly. But the other dream I suppose is to try to identify the, the signatures and individuals epigenetic and the broadest sense that can be the documentation of their exposures and take advantage of that by a step even better than what's actually out there in the air or water but the impact is had on individuals. And I would add to that. I think that you know monitoring the exposure of individuals over time is important, incorporating these new advances that I mentioned in my talk like the geospatial approaches, new methods for measuring and analyzing chemical chemicals and incorporating them into our large longitudinal studies and assessing the methodological issues associated with that I think that that's something that we haven't done so much particularly in our cancer epidemiology studies and I think that's an important thing to do. And why is that what haven't we done that. Dr. Allison. You know now is the time for us to do that I think that you know the different folks need to come together and begin to talk to each other understand where the resources are available so that we can begin to do those things and I think that this workshop is an important and doing that sharing the resources that I mentioned today that are available and and ready to begin to look at some of these things in our cohort and understand what the methodological considerations are. Dr. Zane. Yeah, I just wanted to reinforce from my own research. I know trying to measure environmental exposures as well as behaviors we don't have the technologies or the tools that are ease burden on participants so we'll have an accelerometer and a GPS unit and air quality monitor and all you know they're wearing like 10 pieces of equipment so trying to streamline our data collection approaches require some additional technological solutions to to our research I think. It is interesting to think about the various monitors we've had over the years and from Fitbit Apple watches I'm wearing one of these rings now and we have made it easier, but getting those into research quality is another step and so I think there's definitely need to develop more of that technology. If I could just add, I think one of the Richard alluded to this some of those developmental exposures, you mean I sure would like to know what my mother was exposed to during my field development. And so looking at those epigenetic markers. And I think we're beginning to understand I know you're very well aware of this that there are some of those epigenetic changes during development can actually persist much later in life so better understanding those developmental changes in the epigenome, and that may be influencing the future that comes later in life you know the dough hat and development origins of disease we, we need to be thinking about the better tools that we could be using for those purposes and, and thinking about how we might bring some of those epigenetic tools that are, you know, emerging and that are available and using them for developmental studies. A question that came in from the audience was how can investigators capitalize on these expanded relationships across the NIH institutes to advance the integration of environmental health sciences in the future. What do the investigators need to do to make some of these things happen. I would just turn it around a bit and point the responsibility on those of us at NIH to provide a focus on NITIS so that it is not left to the creativity of each investigator figure out how they take advantage of interactions and commonalities across the institute so those institutes here those are the larger group that are a part of an initiative like this, it ought to be the case it's our responsibility to make it the case and when there's an inquiry by investigator with an interest that the program officer the staff at any of our institutes, I can be responding and facilitating that by communication across all institutes so I think the burden needs to be very much on us not left to each investigator figure out how to make the connections. Yeah, if I could just reinforce Richard's comments I think the burden is on us, and I think the good news is that you know many of the IC directors across the NIH are recognizing the importance of developing these collaborative partnerships. And I thank Shannon and Richard and Gary for being at this meeting today. I will continue to work on this. I think a great success story that we've reached recently, where we're still involved in this is the whole Radix program around the reaching out underserved populations and we had an update this morning on some of the just the remarkable inventions and things that have happened in the whole development of testing tools for COVID-19. And this wasn't one IC that stepped forward. This NIB, IB and Busch-Chunberg was a major part of this, but I think it was a really remarkable how the NIH blurred the lines between institutes and came up with collaborative programs that that could really address a major public health issue. Does it take a pandemic to do that though? I mean, it's a great illustration of that, but don't we have other major problems like Alzheimer's disease and cancer and health inequities that could benefit from that? Is it something, do you feel that NIH writ large sees that value of coming together as it did around COVID? Do they want to now apply that to other problems? So, for one of the examples you mentioned around Alzheimer's disease, as we saw the enormous increase in resources and scientific opportunities, an example of the things we've done to try to encourage cooperation across all of NIH is to establish a program. And I think many of those listening will understand where, for any of the grantees, for any institutes at NIH who are doing research that is not Alzheimer's research, that using the funds we have available, we at NIA will fully pay for administrative supplements to their Alzheimer's research that brings their vision, their technologies, their approach to the field. And I think one can imagine the need for similar strategies to have people who are focused in one area of research, in this case around exposures, and natural disasters, and ask if there's a similar way, and I think Rick can speak to this already actively, to support supplements, for example, to investigators not within the field now to make it easier to bring their disciplines and their perspectives. That's a generalization that I make. It happened around COVID, but it's more generally true in many of our issues. We're realizing that bringing in not just more resources for the people in the field, but new and different perspectives more broadly is going to be a critical part for making this work best. I'll tell you what, I can speak a little bit more, but I think Shannon and Gary probably want to say something about this too. Yeah, yeah, I just wanted to mention that, you know, something that Shannon mentioned in NIH has a framework to have the ICs coalesce around scientific topics and that's a common fun. And also, you know, Rick, with your work and the other IC directors around climate change, we're galvanizing around that issue, bringing all of our resources to bear to tackle that very important question. But I do want to go back to one of the questions that was raised around the onus being on NIH to put together these partnerships and I agree with that. It's really important that we stay engaged with the extramural community and we always encourage investigators who are working in the field to stay in touch with us. We'd like to know what they're thinking, what their ideas are. And given the resources that we have at our institution, we can better think about how we can go about creating these collaborations, creating opportunities for us to have this transdisciplinary collaborative research. I actually was going to tip it back to Rick a little bit about the climate change initiative as an example. But I think a lot of the examples we've given shows that NIH is trying to do better in terms of our collaboration. For example, the social determinants of health research coordinating committee really calming together and having an intellectual space to coordinate and talk about how we can better collaborate to accelerate and advance science. We see even initiatives with funding going to individual ICs there's more collaboration so maternal mortality as one example, and then Rick has you know really reached out to involve other ICs related to climate change so I'll pass it over to you Rick. Well, and then Shannon I'll pass it back to you as a great example of the leadership that you're taking to bring the NIH as a whole together around the social determinants of health. And Richard I know that you've been very actively involved in the blueprints, I think that's another example of how it's not just an idea or the neuroscience institutes working. It's really about bringing different institutes of the NIH to develop plans and how we can be working more collaboratively together. And there are other the all of us program is not just about some program in the in the OD, it's about reaching out to all of the ICs. So actually, and to be honest part of the reason why I threw my hat in the ring to become the director of IHS was that I'm seeing emerging this collaborative approach to doing science blurring the lines between individual ICs. And then you're doing collaborative collaborative work that really enhances our ability to really get to fundamental mechanisms of health and disease. So, Richard you want to be elaborate more on the whole blueprint program. And actually I also want to take my hat off to you and your willingness to actually share the resources that have come into the National Institute of Aging around Alzheimer's. You have been a just a terrific partner and making resources available as you alluded to, to say some of the grantees at NIH us so you've been a terrific collaborative partner. Thank you it's been it's been a joy and necessity and when you think about it, really the only responsible way to carry out our mission blueprint. I don't know that if everyone is aware of this is the neuroscience blueprint. At NIH, which is a group that came together with a very small investment some years ago in which all of the institutes and it's most of the institutes with a substantial neuroscience investment. And then another look at areas of research ranging from training to health disparities to new technology approaches to look for commonalities and as Rick is looking to I think it's just one of the many examples of cross institute groups that allow us to communicate. Aspects, one of the great privileges of being at NIH these days is the ability to participate across institutes with leadership and so many talented people and. And we need your input constantly on additional padding ourselves on the back of how we're doing some areas to places where maybe you've got ideas about where communication across institutes. The ease of using the longitudinal studies that each of our institutes has been supporting to more generally serve multiple purposes something we try to do but always welcome the wisdom and input from the research community so. Hopefully it doesn't matter which one of us you contact the message we'll get through to the group of us and don't don't be don't be bashful we really want to need that kind of advice. And for those exposomics workshops that are happening this is not just an IHS but it's really broad based across the biomedical sciences community. So stay tuned you'll be hearing more of the details on that. Hopefully soon. There was a question about that and that's exactly right is still in the planning phase but the idea is there'll be a series of virtual workshops over the summer, leading up to that in person one in September but it'll be something that'll be accessible to all and we hope that many people participate. So, another comment that came up here was around grant review or reviews and the role of reviewers, and you know I've been involved in many applications and reviews and study sections. And we know that the, the minority voices in a study section, don't usually do well, and if you're starting to bring the environment into areas that have been dominated by genetics. It makes it very hard to get a foothold in those more unique areas and just one of the things like I was just thinking to myself and that question came in was, if you looked at all of the study sections and looked at the relative representation of people with environmental health expertise. I suspect it's lower than we'd want any comments on that. I think I can start out by circling back to the comments that I made at the beginning of this Q&A. It's about education and just awareness of the role of the environment. And I think that there's just increasing awareness now that the sequence, and again speaking as a geneticist, I've been a big proponent of sequencing genomes and identifying those sequence variants and identifying potentially somatic mutations that are rising cancer. It's better understanding the role of the environment to actually trigger some of those mutations or trigger some of the, you know, the biological interventions that can lead to adverse health effects. So just increasing awareness and I think we're seeing that, you know, some of the National Academy meetings over the last couple of years. There's a National Academy meeting on the role of the environment in mental health, National Academy meeting on the role of the environment in neurological diseases. I mean, for example, with neurological diseases, you know, Walter Korsche has been talking with me with great regularity. I think you're aware of this Gary. And it's, and I think Walter understands that there is a role from the environment and we need to better understand and the way to do it is not to create an environmental office within NINDS that works exclusively. We need to partner with NIH and other ICs to really take on the bigger challenges of studying the role of the environment. How do you get the sort of input from the NIH leadership from that Institute side down to the Center for Scientific Review? And now it's a different situation than it was when you used to house them within your own Institute is, if that's a signal to get more of the social and environmental determinants of health, how do we get CSR to respond to that? So I like to comment on that. I think that CSR is really responding to that right now. I want to make everyone aware that they've been conducting an evaluation of their study section, and it's called the Evaluating Panel Quality and Review, recognizing that science is changing rapidly and they want to make sure that the study sections also change with the science. And this review included folks from the extramural community, but also the community of program staff within NIH. And they evaluated the current study sections and proposed new study sections and one of those study sections is the social and environmental determinants of health. So I think that they are recognizing that science is changing. There is a role for the environment that hasn't been the primary focus of existing study sections and looking to change the study sections in a way that represents how science is conducted today. And I think that it is a challenge when you have an area in a particular study section that hasn't been working that area and really get them to change. So, Gary, if I could just add, I know we have just a couple of minutes left, but I'll just add a comment that you can also do what we've done in the climate change and health, be proactive. We've actually contacted CSR. We're making information available about the NIH-wide initiatives that are happening and discussing with them, you know, the possibility that there may be more grants coming in that have a climate or the health aspects of climate change. So they've been very receptive and very willing to work with us. And I really have to point to the leadership that Gwen Coleman has brought to the whole climate change and health program. She really knows how to work the extramural community and the grant community. And so just, you know, the bottom line is being proactive and making sure that you have good communication so that people understand what's happening. Okay. The last question, there's not really enough time to get to this, but I want to kind of throw it out for some people to think about, is the relative role of the longitudinal cohorts that we've heard quite a bit about today. And the sort of like all of us UK biobank sort of approaches is, you know, where, where will we get the most value when we're looking at the environmental drivers of certain diseases and health overall. I think we have time for one person to make a little comment and then we'll have to wrap it up and think about this afterwards. Anyone want to comment? If there's one, it ought to be Rick. Okay, well, I'm, I'm happy to comment on this. I think, and Gary, I think you're, you're well aware of this because you were on the advisory year for the all of us program. Just bring, bring a greater awareness. What are the environmental tools that we can bring to bear on a very large of your all of us program. Because I think it's, I think it was Shannon or Gary, you know, convention the geospatial tools, those maybe fine tune them and bring those to bear on the all of us program. And so, okay. All right, well, we have come to time I want to thank all of our panelists for a very enlightening conversation, we will reconvene at 1145 Eastern standard time. If you have any additional questions you can send them in and we can try to get back to you by posting in the chat. Okay, thanks a lot.