Environmental Toxicants and Infectious Diseases: Understanding the Pivotal Correlation

Rehnuma Haque (ELP 2021) | Assistant Scientist & Fogarty Global Health Fellow, icddr,b & Stanford University, Bangladesh

In 1997, a team of researchers from Tokyo University visited my hometown, where the first Arsenic contaminated four tube wells were identified in Bangladesh. The contamination of groundwater by Arsenic in Bangladesh is one of the largest poisonings of a population in history. It is larger in magnitude than the accident at Bhopal, India, in 1984, and Chernobyl, Ukraine, in 1986*. I was too young (10 years old) to understand the scale of this environmental poisoning disaster; instead, I was happy to meet the Japanese professors who had dinner at our home after a day-long field visit and never forgot to bring ‘Hello Kitty’ gifts, candies, and origami papers. My father deserves acknowledgement for making this arrangement possible as he worked as a district hospital resident physician at that time and coordinated the arsenic research team. 

The Japanese researchers conducted a series of environmental health surveys in Bangladesh from 1997 to 2010 to examine the health effects of arsenic-contaminated drinking water. Before that, I had no idea water could carry an invisible toxin with the potential to kill an individual! My interest in water research heightened, but my father wanted me to be a pediatrician to alleviate child mortality in Bangladesh. So, I started to walk in my father's footsteps and prepared myself to get admitted to medical school. But my research interests were never realized. I kept in touch with the Arsenic researchers, and accompanied their field activities as a local guide and a Bengali to English translator. Gradually, I became a part of the survey team: helped them in registration of participants, administered the questionnaire, performed a minor physical examination, etc. I believe that my passion for public health research and practice grew in through those opportunities. 

Meanwhile, after completing medical school, I enrolled in a master's in public health course. In addition, research themes like multiple environmental risk factors, disease outcomes led by environmental risk and the importance of environmental health research were my top interests. 

My childhood inquisitiveness about what's in water that makes it fatal for human health kept coming up in my research. I focused on the role of environmental contamination in developing common diseases and how we could protect vulnerable groups from the toxic environment.  How can environmental stressors influence susceptibility to disease? Are we eating organic foods? Are we breathing clean air? Are the electronic devices we use safe for our health? Many scientific questions need to be answered to advance the field, especially in low to middle-income countries (LMICs). 

Photo 1: Performing aptitude test to assess the Arsenic effects on eyesight in 2010.

However, I was feeling excited about my PhD course and the research on conventional pesticides and, in particular, how they behave in food, house dust, human blood, and breast milk. I diversified my research interest to a comprehensive understanding of key developmental pathways of environmental exposure assessment in children and women in Bangladesh. Working as a scientist at icddr,b, and as a postdoc fellow at Stanford University helped me to research these problems in the environmental research arena. I become passionate about identifying the risk of heavy metals, pesticides, and emerging contaminants (PFAS, microplastics, etc.) that we are exposed to in our daily life via food, consumer products, air, water, and the pathophysiology. I also moved into research on exposure routes with detrimental effects on women and children to propose a way of withdrawal, prevention, and mitigation through policy implementation.  

On the contrary, if we take a look at the Coronavirus pandemic, the countries with high air pollution burdens face consecutive waves of infections. Bangladesh is the most polluted country globally with an average PM2. 5 concentration of 77.1 micrograms per cubic meter of air (µg/m3) in 2020, and India is in the next position with 55 µg/m3. The COVID-19 infection rate is highest in Bangladesh, following India as of August 10, 2021.  Nearly 90% of the population living in cities worldwide is breathing air that fails to meet the WHO air quality guidelines. People who live in cities are exposed to a range of environmental threats, such as those arising from the lack of adequate housing and transport and subpar food quality, water, sanitation, and waste management. The impact of environmental stressors has been underestimated in understanding the severity of diseases. 

As time has passed, I have realized that reaching out for an environmental health risk solution is challenging rather than identifying the problem. Communicating properly with the right people, authorities, and local communities to help them realize the risks of environmental contaminants to our health is challenging.  It demands strategic communication with relevant stakeholders and their active participation. Being a researcher, I look forward to the Beahrs Environmental Leadership Program and the opportunity to learn more about the strategic communications that I can use in future research so that I can become a better environmental researcher in this sector. 

Photo 2: Supervising Blood Lead Level on-site test to assess the Pb exposures among urban populations in 2021. 

Footnote: * AH Smith et al. Bulletin of the World Health Organization, 2000, 78 (9).