 Do you think we can make that in half an hour? This is an old physician, which will present now the paper. I was practicing medicine. I love medicine. I am deeply medical. I have a son, grandson and grand-nurse doctor. So that's really my job. And actually, I no doubt that we have a totally new medical landscape. And when you are speaking about the effect of climate change on health, you are firstly to consider how the health actually, and the health actually is completely different, has completely changed. And there are seven emerging risks. The first risk is emerging is age, ageing. Ageing is a good thing, ageing in good health. But ageing is generally associated with several diseases. And we double our medium lifespan recently. The sun is a second risk, but it's not major. Just the sun, the effect of sun on agriculture and so on, our risk. But the sun itself is not a major risk. Air pollution, so you have a list which could be very long. And I'm sure that you will lengthen it soon. The toxic, the most important is the endocrine disruptor. And I will say a word about that. But you see, you must realize also that every toxic is influencing the bacteria world. And the bacteria are extremely resistant to any toxic by changing bacteria. They can change their genome very easily just by introducing their gene in the neighbor. Not by going from papa to mama, but by changing the gene directly to the neighbor. And you have new bacteria. A new bacteria means new drug, new risk, new benefit, because you have a lot of benefit by the bacteria, new treatments. You have new infection. Jean-François will explain you that better than I did. The human risk, he has explained by Isabella to the previous talk, and the metabolic risk of obesity. The emerging disease, the first emerging disease in everywhere in the world, has been extremely well documented by a paper published in Nanset in 2015. On the Global Burden Disease Study Assessment, the GBDS. GBDS is an extraordinary paper which covers 135 different countries, and which really provide a new idea, a very new idea for everyone. Infectious diseases are not now the main source of mortality. The main source of mortality are non-transmissible chronic diseases, generally linked to age. And this non-transmissible chronic disease is a new transition in terms of epidemiology. It includes cancer, cardiovascular disease, diabetes, and neurodegenerative. And as an overall covering, the industrial pandemic. Because these diseases are not entirely caused, but they are all aggravated by tobacco, by abnormal food, by problem in food, by alcohol. In France, alcohol, you can't touch it without being qualified as a bad French, or Italian, probably the same also, and sedentary, the absence of exercise. That's the new, the new relay, the new medicines that we have to face with. If you, and it represents about 60 to 70% of the mortality. You have also an increase in the autoimmune and allergic disease, but this increase, some of them are very severe, but most of them are, as a responsible of an emergency service, I remember, of acute crisis of asthma, that's terrible. But it's not frequent, but acute myocardial infection, you see 10 or 20 myocardial infections for one crisis of asthma. The new infection disease, there are some, but they are well controlled, they could not, they could be not well controlled, but we don't know. But for the moment, Ebola, for example, has been arrested. The new metabolic disease, and the disease caused or aggravated, caused or aggravated by new polyurethane. This is a long category of disease that we have to include in that, the Alzheimer's and all the neurodegenerative diseases. Alzheimer, the incidence of Alzheimer is around 200% actually in our country. The incidence of Parkinson is about 150%, the incidence. And autism, but autism is a special, there is a special problem of definition, because autism is a disease of the relationship. And we, certainly you have to make S to say one autism, several of them. And that's not clear for the moment. But autism, there are a lot of evidence in particular, that the metabolic precursor, the metabolic precursor are the direct causes of autism. And they found a lot of these metabolic precursor in the uterus of mother waiting for a baby. Edging is an emerging risk and a new group of disease. Emerging, normal edging means progressive change in anatomical, physiological, and psychological change without any real disease. And pathological disease means it is associated with one and generally several chronic nontransferable disease. But this is, this is represent about 45% of the mortality in our country. Mingeal longevity is the mean life, you must remember that the mean longevity, or the mean life span is the same, but the maximum longevity is the maximum life span that a given special is able to live. For 10 minutes, for example, in some bacteria, to several hundred years in sequoia or sharks. The human maximum longevity is actually 120 years and it has not been changed at all. The human mean longevity has changed, the mean lifespan has been improved, but actually it reached the plateau and probably we are not so far to reach the maximum human longevity. The problem is that from with experimental model like those of Achillia, don't remember some several species, it's possible to change the longevity very easily by genetic manipulation. I hope that we never try to do that. But I hope that we never try to do that because when you manipulate the genes responsible for the longevity, you also manipulate the same genes responsible for cancer. And there is a sort of discussion between the two. All the geriatricians, and I am a geriatrician, know that severe cancer in very very old persons are probably less severe than in people younger. Because you have the genes against a gene which are the genes for against a gene which are equally active against the cancer geneal. Contemporary aging is a unique phenomenon in the world history. It's entirely caused by human activity. On this curve you see the age and the time and the increase in lifespan is regular with two or three peaks due to the to the European stupidity. The war in the French was participating in that a lot. And you can extrapolate of course but you will reach the maximum longevity of our species without genetic manipulation except if you have a nuclear, a viral or a climate disaster. Climate disaster must be very severe to change the mortality. Life span and LCI gene does not correlate with climate but it represents the background of any approach concerning health and the major problem for physicians. Human aging is unique in the evolutionary story of life. It concerns mainly the developed country and has major consequences on economic point of view. Aging in good health is a problem of prevention. Chronic age related non-translatable disease are biological consequences of the senescence cellular. This is well documented. When the cells become senescence and unable to to multiply it also produce secretome which is responsible for several groups of disease. This is from the global burden disease study. It shows you the mortality in 134 countries from traumatism. You see a mortality by traumatism, by infectious disease and by non-translatable disease. And out there the non-translatable disease are the main cause of mortality in every country including China, US and Europe. An infectious risk I will say just a few words. Saint-François will do that better and we both together agree since about 10 years together at that point. But I want to remind you a problem which is perhaps a little bit different of the problem of Saint-François. Gems the problem is too much or too enough. Not too enough. I know that Isabella does not agree with the egenic hypothesis but I will say a word because egenic hypothesis is at least probably very likely to be good in some diseases. Too much. Too much. This is the mortality curve due to infectious disease. Since 19 to now infectious disease has decreased acutely with just a small increase due to AIDS. But AIDS is in a horrible disease extremely but it's not a major cause of mortality actually in our country. Another slide that Saint-François knows very well from his friends with ours showing that the category of driver associated with the emergence and re-emergence of human pathogen ranks and you see that the climate change is one of the last ones. The first responsible of the change in the re-emergence of human pathogen are certainly the change in lines and the contamination. The international travel, the point seven, is actually probably one of the major points but I will not go on further with that. One of the main problems with the infection is the appearance of genetic mutation. We have thousands of genetic mutations known for antibiotics. There is recently a new paper about antiviral, anti-elementic and the antiviral treatment of AIDS creates a new category of virus and so on. The human activity creates new genes, new microbes. But there is another possibility also that are too clean and this is certainly demonstrated in farms in several countries and especially there are good papers from Finland by an iconic, or showing that and this is based on the hypothesis which is an hypothesis which has been developed by a good friend of me which is Jean-François back in the New England Journal of Medicine years ago and Jean-François shows that the incidence of infectious disease, muscle, even viral, mumps, tuberculosis, hepatitis, rheumatic fever which is due to a streptococcus decrease since 1950 to 2000 and in the same in parallel you have an increase of asthma type one which is diabetes which is autoimmune diabetes, multiple sclerosis and the corn disease or the gut a lot a lot of by corn disease we include a lot several diseases of the gut which are very severe and the incidence of them incidence of asthma and the corn disease is about multiplied by 10 actually. And this was the basis of the eugenic hypothesis saying that we are too clean we suppress all these diseases and because of that there is this increase. There are a lot of other over the argument which are coated them and especially when the incidence of the autoimmune disease in a farm is much lower than in in the city. The main problem is probably to be the reduction of the relocation of the biodiversity of our gut that modified our immune system as for asthma and there are several embed also for atherosclerosis and remember that the stomach ulcer which was when I was a young student and a psychiatric disease is now an infectious disease which can be totally treated by by a antibiotic and probably the same for Parkinson's. So it's actually to be the main determinant of the increase incidence of autoimmune allergic and metabolic disease in our country. And this is why the change in biodiversity has a consequence on the public health. The biodiversity change in the prokaryote kingdom at the level of the biotic and a biotic microbiota and its consequences is to my think a burning topic. And remember that the human you have in red the DNA of human genome but you have in blue, in green or in yellow the genome of our host of our microbiome, microbiome of the skin of the gut of the vagine of the of the mouse and several things there are linked and probably directly and we have not only epidemiologic proof but also experimental proof that there is a good link between this microbiota and the several of the chronic or non transmissible diseases. So the word about the toxic ricks and the pollution I would I think this slide probably is only one to show. You see that the increase incidence of the new cancer cases in France was not only due to aging you have the age to increase incidence of cancer but it was observed for all age you probably know that incidence of cancer is higher at 75 than 85 and you might you see that the increase in incidence of cancer in different type of cancer is the same what it doesn't matter the age. So that suggests clearly that a toxic component is involved. Which one? The incidence of the testicular cancer is particularly well documented. Another problem is the toxicity. Is that in France at least but certainly in every country in Europe the toxicity as a new product is extremely well controlled but the toxic curve the toxic curve is the toxicity against level of exposure. The toxic curve is not monotonic. Several toxic curves are like that and the law some doesn't specify in our country if we have to make a toxic curve in this in this or in this or in this range. So we don't know if this product is really not toxic. This has been several times observed by my friend Robert Barocchi for example. Just a word about the paper we have about the cardiovascular and the lung risk of pollution. The problem which is I don't understand how I still don't understand why how this has been observed and the reasons is if you consider there is two problems which are totally insolved. The first problem is the dessert without the urban pollution that you specify. If the pollution as a micro particle is due is something like tobacco because this particular GSL is like tobacco it's a plant origin I don't understand why the cardiovascular risk is higher with the dessert. Yeah yeah we don't know okay and but the second problem is that for tobacco research which I know very well I was studying that for years we don't know not only have epidemiological case observation but we have a strong lot of experimental data that we don't have for the moment with atmospheric pollution and I think it's a it's a request from a non no more practicing experimentator. There is an association recently discovered for between some pesticide and Parkinson's disease as it is strong for some organochlorine that's of her and and there are also some suggestions for the other diseases which is important because the disease actually is going to be the main cause of mortality in our countries. I will skip that. I will end my talk to respect the timetable of my friend Eric by a few examples of a result public health problem. In epidemiology free access to mortality but also morbidity register we don't have that in France at least. Independent detail analysis of toxic of every component a new component in the market the same the simple little dose in unknown is unknown but most of the chemicals are valuable and their toxicity on the ground as generally unknown also. To create a promote regional procedure in every European country at least indicating original the geographic diffusion of bacteria virus and emerging mutants organic or non-ganic polyurethane this is this doesn't exist for example moment in New York. To bring to justice the various crooks guru charlatans quakes paranoid who are responsible thanks to internet of doubt based on pseudo scientific data and to encourage journal there is in France a science and pseudo science a journal which tried to this decipher this fake news problem. This is important and we all have to react strongly not with with with symbol polite word but with the justice and finally the basic question is our brain is our brain made to understood and select some more information than the others remains remains open. We have to know how is our brain made. There are several priorities to attenuate or reduce social inequity and to control nuclear power if possible. In 2018 health politics requires an ecological approach and a global view of health and to consider the entire ecosystem in which we are living. I recommend a good book from the from minor on this point to subsidize in priority some elementary problem as the access to clean water the building of facilitation of sanitation facilitated facilities to eliminate open defecation to organize migration to develop aquaculture of river species not aquaculture of the same of fish which is just stupid to develop agricultural production using co2 dependent bacteria and there are co2 dependent bacteria and there is a good paper in a good review on that which I can give you easily the reference to severely augmented tax for sectors that are for the moment protector alcohol drug and flight companies to favor public investment in prevention tobacco alcohol vaccine and health organization Ebola. More than in medicine the example of Ebola is a good example of the simple organization of the of the health structure can stop an epidemic immediately and to favor that more than in medicine or surgery the looks which benefit may need to reach patients. I mean the cardiac transplantation is nice we're working in cardiology but it's extremely expensive with the money for one cardiac transplantation we can organize the tobacco prevention in one country like France completely free. The true question is finally the human able to continue to adapt to himself the question is clearly beyond the simple medical practice and finish if you don't if you want to read something more you can buy my book but it's in French I'm sorry for that there are a lot of references but these slides Eric the students have the slides you give them the slides and the reprints and the five reprints that I send you yeah we can they can have access to it yeah we put that on the long list of references yeah this would be on the internet side of the the event so everybody can download it it's not right now but it will okay so we have maybe time for one or two questions and there is my email address uh bernard. We should write it and please send them if you want any I can send you the reprint directly you just send me don't hesitate to send me even if you are if you are too young or to do that easily thank you very much yes ma'am just a really quick comment thank you very much bernard for the presentations the two and just to want to thank because you mentioned at the end the issue of equity because in this field and we are observing inequalities both in exposure because you know equity is an issue that you should take into account when we cope with this matter and also the inequalities in prevention strategies and inequalities in healthcare so the equity issue is something that we all have to take into account and in mind just just this comment I read a nice paper in italy inequality in italy between the north and the south and yes there is a good paper I don't know where but you have to thank you very much um doc usually when oncologists are I mean giving presentation on cancer they don't they are not explicit on the causes of cancer but they talk about predisposing factors for example like in the case of lung cancer if you smoke then you predispose yourself but I think in your presentation you were a bit you were intimating that a new polluance for example could be implicated in the cause of cancer what what are the likelihoods what are the probable and pollutants that could be involved thank you the probability of that cancer is due to a toxic there is an increase is absolutely certain but we don't know which and if we knew it we have it in the first page of the new york times immediately no my the only data I show you is that a cancer is related to age we have we have we have more chance to have a cancer than you for example no doubt about that but at the age of 65 70 which is a peak of the incidence of cancer in our countries the whole country like every country this increase every year to for the moment so if it increases every year it is you must have something else it's it's perhaps a toxic but it could be perhaps also an infection we don't know because for the moment the infectious diseases are more linked to cancer than toxic you we know a lot of cancer due to infection we all know very few of them due to toxic but we simply don't know can you talk just to comment actually the international agency for research on cancer has provided a list of many products or agents that are very bad for cancer obviously then why one individual got a cancer in another not these include taking to account other factors but what is important that now we will see in this day there are some models that allow you to identify the proper role of one factor taking the other into account so in some way for example you take all smokers and then you see whether those that were exposed to some special have a cancer compared to those that were not exposed and when you find this is because these factories playing a role okay but the genetic I mean as he said very well there are many factors I can also make a small remark a general remark which could be useful for you a disease is the result of our genetics and our environment when you meet a bus in the street you you can learn there is no genetics it's just a bus if you have a mucophysidose if you have some rare genetic disease and your mind is nearly nothing genetics is 100% but between them you have all the medicine you have every you see asthma, cancer, obesity and myocardial infarction, gut disease they are mixture of your genetics background and the environment and I think I like very much a good definition of our genome our genome is a way you respond to your environment we all have a different genome but we all have the same environment and we don't we don't suffer the same way our genome is our the definition of a person and the way is responding to its environment that's right you must keep that in mind when you're considering disease, medicine and other. Okay thank you professor Swindo so I propose that we continue this talk on the on the lunch break which is we need to rush now up to the first air and we we meet at 2.30 we're back in this room for the afternoon session lunch is upstairs cafeteria and first floor