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“We provide truthful information without emotion or influence from the medical establishment, pharmaceutical industry, national organizations, special interest groups or government agencies.” Charles B Simone, M.MS., M.D.
HOW TO STOP THE HEALTHCARE CRISIS
Christopher C DeMuth, President of the American Enterprise Institute in 1992 said this about this work: “I found your paper highly persuasive.”
Despite spiraling costs, there is little progress in combating major diseases. Our focus on treatment, with minimal attention to prevention, creates a cost explosive situation that grows exponentially. The following need to be addressed simultaneously To Stop The Healthcare Crisis:
1) SIMONE HEALTHY START™PREVENTION PROGRAM
2) PERSONAL RESPONSIBILITY
3) MAKE AMERICA HEALTHY AGAIN PROGRAM
4) GOVERNMENT INTERVENTION
5) FDA REFORM
6) STOP BIG PHARMA
7) STOP HEALTH INSURANCE COMPANIES
8) STOP POLLUTION
Lawrenceville, NJ (Dr Charles B. Simone) – Against the background of ever-upward-spiraling healthcare costs, we have seen surprisingly little progress in combating major diseases. Our primary focus on treatment, with minimal attention to prevention, has created a cost explosive situation that will continue to grow exponentially. Our losing war against cancer illuminates this grave challenge.
Despite the hundreds of billions of dollars that have been spent on cancer research and treatment, the number of new cases of every form of cancer has increased. Despite all of our current treatments and technology, lifespans for persons afflicted with almost every form of adult cancer have remained constant – which means, tragically, that there has been no significant progress in the treatment of adult cancer.
The urgency of prevention requires individual self discipline that is not a readily popular formula. The myth of finding a silver bullet prevails while the results of treatment continue to be unimpressive:
Strict genetics have little to do with our chronic diseases
Approximately 60% of women’s cancers, 40% of men’s cancers, and 75% of cardiovascular diseases are related to nutritional factors
About 30% of cancers are caused by tobacco
These and other CONTROLLABLE risk factors account for 95% of all cancers and heart diseases.
Yet this continuing de-emphasis on causative factors, with a growing emphasis on treatment, is the root contradiction in American life that must be addressed before healthcare costs can be contained.
About 90% to 95% of all chronic illnesses are preventable. The logic that should follow this transcendent fact stares us in the face: Healthcare costs can be reduced and not just contained if people elect to modify their risk factors. This is a process that can come into being through individual behavior along with courageous initiatives by the federal government.
The following need to be addressed simultaneously To Stop The Healthcare Crisis:
1) SIMONE HEALTHY START™ PREVENTION PROGRAM
2) PERSONAL RESPONSIBILITY
3) MAKE AMERICA HEALTHY PROGRAM
4) GOVERNMENT INTERVENTION
5) FDA REFORM
6) STOP BIG PHARMA
7) STOP HEALTH INSURANCE COMPANIES
8) STOP POLLUTION
In 1992 and in 1994 I outlined many of these broad issues (published in The Mercury and Health Security) that still hold true that must be addressed if we as a nation seriously wish to contain and reduce healthcare costs.
“Health industry’s priorities must shift” – Interview of Charles B. Simone, M.D. by Herb Denenberg October 31, 1992 in The Mercury
HOW TO REDUCE AMERICA’S RUNAWAY HEALTHCARE COSTS – Charles B. Simone, M.D. July/August 1994 in Health Security
1) SIMONE HEALTHY START™ PREVENTION PROGRAM (click here for more)
The Simone Healthy Start Prevention Program™ was first started in 1983 by Charles B. Simone, M.D. It is described as the only prevention program in the country. The key to prevention is to teach our children early in life about a healthy lifestyle. Prevention with simple changes in lifestyle is the key to America’s soaring health care costs and soaring rates of cancer, cardiovascular disease, obesity, diabetes, etc.The National Academy of Sciences indicates that 60% of women’s cancers and 40% of men’s cancers and 80% of cardiovascular diseases are related to nutritional factors alone. The Simone Healthy Start Prevention Program™ is designed to teach children about healthful lifestyles early in life. The Program consists of planned lunches, newsletters sent home, assemblies to instruct about the “good” and “bad” foods as well as other lifestyle factors. Either with individual seminars or during a three-month period, we instruct young children about each aspect of the Ten Fascinating Stops on the Way to Good Health: 1) Nutrition 2) Overweight 3) Smoking 4) Alcohol 5) Drugs 6) Air and Water 7) Exercise and Relaxation 8) Safety 9) Work 10) Check-ups.
This program needs to be expanded across the United States.
HEALTHY FOODS COST LESS THAN LESS HEALTHY FOODS (click)
HEALTHY FOODS COST LESS THAN FAST FOODS (click)
PROTEIN – WHAT AMOUNT, WHAT SOURCE, WHAT COST(click)
Consuming the correct amount of PROTEIN and from the proper source is healthier and less expensive than consuming fast food protein or less healthy protein sources.
2) PERSONAL RESPONSIBILITY Today, a person who is healthy and constantly modifying his/her disease risk factors is actually subsidizing someone else who goes through life with risk factors and does nothing to modify or change them. Healthcare costs can be reduced, not just contained, if everyone elects to modify his/her controllable risk factors as per our patented program:
3) MAKE AMERICA HEALTHY PROGRAM (click here)
Employees pay an increased portion of health insurance premiums AND can voluntarily participate in a patented program that quantifies costs for controllable risk factors that they can modify and thereby pay less, or take personal responsibility for the increased cost attributable to the risk factors by paying more for insurance. People feel twice as bad about losing $100 compared to feeling good about winning $100. Our Program uses a monthly financial incentive to encourage long lasting health.
4) GOVERNMENT INTERVENTION – Some examples:
The government should intervene to encourage a healthy diet that will decrease diseases, decrease methane the potent greenhouse gas, decrease carbon footprint by about 30%, and decrease the risk of war and piracy
By 2050 the world’s population is predicted to be 9 billion people and crop yields must increase by 50%. The global market supplies most of the world’s food supply and relies on three crops: corn (maize), wheat, and rice. Most of this goes to feed livestock. The publication called Chokepoints and Vulnerabilities in Global Food Trade by the Chatham House shows that the global food system relies on getting through 14 chokepoints like the Panama Canal, Suez Canal, Black Sea ports, Strait of Hormuz, US inland waterways and rail network, and Brazil’s road network. These chokepoints are subject to weather, war, piracy, and other vulnerabilities.
Healthy foods result in better health outcomes and lower carbon production. However, the current world’s population has demanded a more westernized diet that dramatically increases the risk for cancer and other chronic diseases: high in meat, cheese, processed foods, high in sugar and saturated fats, and low in fiber. This was the subject of our first book in 1980, Cancer and Nutrition.
When people take personal responsibility for their health by eating low-fat, low sugar, high-fiber foods, their health will improve, there will be less risk for war and piracy because there will be less demand for these foods, and the carbon footprint can be reduced by 30% because there will be a reduction in the consumption of meat and cheese and hence a reduction in the production of a major greenhouse gas, methane.
Greenhouse gases warm the atmosphere and include water vapor, carbon dioxide, methane, nitrous oxide, and ozone. Carbon dioxide has been considered to be the leading cause of global warming but methane is 25 to 30 times more potent than carbon dioxide as a greenhouse gas. Methane rises into the air, reacts with hydroxyl radical to form water vapor and carbon dioxide. Methane’s lifespan in the atmosphere is about 9.6 years. The U.S. Food and Agriculture Organization says that methane output could increase by 60 percent by 2030 [Source: Times Online].
SOURCES OF METHANE
COWS AND OTHER GRAZING ANIMALS – Globally there are about 1.5 billion cows (65% are in Brazil, China, and India) and billions of other grazing animals that emit massive amounts of methane through belching, with a lesser amount through flatulence. Two-thirds of all ammonia comes from cows. The release of about 100 kg methane per year for each cow is equivalent to about 2,500 kg carbon dioxide per year. Some experts say the average dairy cow expels 100 liters to 200 liters a day (or about 26 gallons to about 53 gallons), while others say it’s up to 500 liters (about 132 gallons) a day.
Methane production is decreased by more than 50% when cows eat their normal diet mixed with seaweed (red macroalga Asparagopsis taxiformis) because more halogenated methane analogues are produced. The seaweed did not change the taste of milk or ice cream.
LANDFILLS – ROTTING FOOD: FOOD WASTE, “EXPIRED FOOD” – each person throws away about 1/2 pound of food every day accounting for about 34% of all methane emissions. About 33% of the world’s agricultural land area grows food that ultimately is wasted.
Rotting food (Food Waste and “Expired” Food) is from:
34% – Consumers in America, Europe, China, Japan, South Korea – they often buy more than they need and let it rot before they use it; or throw away good food that has a date that indicates it is expired thinking the expiration date is related to safety when in reality it is related to quality of taste. For the average family of 4 in America, food waste costs between $1500 and $2200 per year.
U.S. school cafeterias waste about 530,000 tons of food per year that equals 1.9 million metric tons of greenhouse gases, 20.9 billion gallons of water, and $1.7 billion.
33% – Agriculture itself
33% – Handling/storage, Processing, Distribution
Landfill Methane Capture is already successfully in use. https://archive.epa.gov/climatechange/kids/solutions/technologies/methane.html
TERMITES globally produce about 20 million tons of methane each year. Get rid of the dead wood on the ground in our forests to decrease the termite population and also to decrease the risk of forest fires.
THAWING PERMAFROST releases equal amounts of carbon dioxide and methane that come from decomposing dead animals and plants. Water-saturated permafrost soils without oxygen can be twice as harmful to the climate as dry soils because methane is 25 to 30 times more potent than carbon dioxide as a greenhouse gas.
FRACKING releases methane but a study from the University of Texas at Austin, looked at 190 fracking sites across the U.S. and found two-thirds had equipment in place that captured and reduced methane emissions by 99%. We must ensure that the other one third of fracking sites install this equipment.
The government must intervene to encourage a healthy diet which therefore will decrease the demand for meats, fats, and sugar, and increase the consumption of high fiber foods.
In 2018, Centers for Medicare & Medicaid Services spent $1.4 billion on peg-filtrastim (aka Neulasta – Cochrane analysis shows that it does not reduce mortality) compared to the estimated $2.4 billion spent on radiation…all of radiation. DRUGS THAT COST THE MOST, EFFICACY, GLOBAL PRICES
Negotiate all prescription medications DRUGS THAT COST THE MOST, EFFICACY, GLOBAL PRICES
The tables in the pdf file DRUGS show: the Ten Most Costly Drugs in 2017 for Medicare Part D (Outpatient Prescriptions) and the Ten Most Costly Drugs in 2017 for Medicare Part B (Physician Administered Drugs); drug efficacy as determined by Cochrane Reviews, and comparative global prices obtained from internet sites. The patient and taxpayer pay for these drugs. If they are beneficial, we should use similar or identical drugs from other countries that cost significantly less.
Sometimes there are financial conflicts that arise when one treatment is considered over another treatment. And sometimes Big Pharma makes a drug that alters something like the amount of hepatitis C virus in the blood, but the drug does not extend life or improve the quality of life. It has been said that the chief beneficiaries of treatments that don’t change survival and cause harm, including cancer and death, are often some in the medical community, pharmaceutical companies, and their stockholders.
We really need to start thinking in terms of effective or noneffective treatment and tell patients about treatments in those terms. Doctors are considered unimpeachable in the eyes of the public and, according to some, “easy prey” whose behavior could be easily swayed by marketing.
Big Pharma sometimes promotes their drugs as being effective by using the same playbook – obtain science/medical information funded by U.S. taxpayers, pay doctors to do studies, pay for the studies, review medical manuscripts before they are submitted to desirable medical journals, get published, pay “thought leader” doctors to read verbatim the seminar slides provided by Big Pharma touting the drug’s positive effects, pay doctors to listen to these “seminars,” and get those drugs into pharmacies. The doctors who attend these seminars promoted by Big Pharma are more likely to write prescriptions for the drug being discussed.
And perhaps, as I have written in the past, aggressive treatment to keep a person alive in the last several weeks of his or her life would stop if the patient and the family were truly informed about the futility of such efforts. The costs of health care provided to a patient in terminal stages in a hospital are enormous and consume anywhere from 20 to 30 percent of all the health-care dollars. The patient and the family may be responsible for this because they “want everything done.” The physician is partly responsible because “our technology should help these patients.” And the legal profession may, in part, be responsible as well; if everything is not done, will the family sue the physician?
I have used Cochrane Reviews for evaluation of each drug’s efficacy and some published articles when Cochrane has not. Cochrane reviewed the available published medical papers, but some of these papers compare the drug only to placebo and not to existing inexpensive treatments, thus conferring a favorable outcome for the drug.
Our (Cochrane) mission [is] to provide accessible, credible information to support informed decision-making…for improving global health. Cochrane produces systematic reviews of primary research in human health care and policy. Each Cochrane Review addresses a clearly formulated question. In the Internet age, people have much greater access to health information, but little way of knowing whether that information is accurate and unbiased. Cochrane is committed to independence, transparency, and integrity in healthcare research. We do not accept commercial or conflicted funding. This is vital for us to generate authoritative and reliable information, working freely, unconstrained by commercial and financial interests. https://www.cochrane.org/evidence
Allow Americans to purchase from reputable international pharmacies DRUGS THAT COST THE MOST, EFFICACY, GLOBAL PRICES
Stop the Big Pharma “freeloading” – the taxpayer contributes a significant amount to a new drug BIG PHARMA SAYS NEW DRUG COSTS $1.3 BILLION, BUT REALLY LESS THAN $125 MILLION
GlaxoSmithKline chief executive officer Andrew Witty said the pharmaceutical industry’s estimate of $1+ billion in average cost to develop a drug is “one of the great myths of the industry,” according to Reuters March 15, 2013. Cost to discover new drugs is about 15% of what is estimated and 1.3% of revenues after deducting taxpayer subsidies.
People are outraged by the high costs of medicines. These high costs will break health systems’ budgets. Big Pharma companies are raising drug prices higher and higher, not because of costs or of curing or controlling diseases, but because they can get away with it, especially in the United States. These companies are not developing better drugs for these higher prices. In fact, most new drugs provide no clinical advantage and one of five cause serious harm. In 2012, 11 of 12 cancer drugs cost more than $100,000 per year and only one of them extended life for only a few weeks.
In 2016, Big Pharma aired 1.3 million ads on television for prescription and over-the-counter drugs and other health messages costing about $4.6 billion (iSpot.tv) that you, the taxpayer have subsidized because Big Pharma deducts that cost from their income tax.
Stop Big Pharma companies from receiving exclusivity and tax discounts under the auspices of the US Orphan Drug Act (ODA) of 1983 and Defense Advanced Research Projects Agency (DARPA) for developing narrowly targeted treatments for cancers instead of neglected diseases for which these programs were intended.
Stop price supports and restrict advertising for disease causative products
Stop cost inflating government medical services and programs
Stop “gag-order” clauses – The pharmacist must tell the patient if a generic equivalent drug is less expensive than paying for a prescription using insurance.
Stop higher costs for mail order drugs – Medicare/Medicaid found that more than a third of the mail order drugs cost more than if you went into a pharmacy.
Stop Big Pharma from using the Citizen-Petition Pathway that allows Big Pharma to delay competition that, for even a few months, can generate millions of dollars. This Citizen-Petition Pathway was started in the 1970s by the FDA to allow the ordinary citizen to voice his/her concerns about a drug. But in recent years, the majority of the “concerned citizens” turn out to be Big Pharma companies invoking frivolous or questionable claims to delay generic drug competition.
Stop PBMs Pharmacy Benefit Managers
Open free markets to hospital development and stop hospital monopolies.
NIH FUNDS $20 billion RESEARCH WITH FOREIGN TIES -requires reporting. Offenders have many NIH grants, are ethnically Chinese, work in US institutions, cite foreign funds in fine print, double dip salaries. Some review grants/confidential ideas which they send to other nations.
Close veterans administration hospitals and let our veterans go where they want for free medical care.
Medical malpractice reform.
Prohibit any federal government employee (FDA, DEA, etc) from ever working for Big Pharma or its distributors in ANY capacity. Prohibit ANY complicit activity of a federal employee with Big Pharma.
Expand “sin” taxes but that money must be directed to healthcare
Tax all healthcare fringes
Punish polluters – fines should be 10 times the cost of keeping the environment pollution free
Uninsured money earners must pay for health insurance according to income reported and or hidden
Terminally ill patients should enjoy physical and medical comfort at home
5) FDA REFORM – Some examples:
Approve effective treatments that extend life. Drugs that decrease a blood level of something like hepatitis C virus for instance has been shown not to extend life or improve the quality of life. Cost for 12 week treatment of hepatitis C: $96,000 in USA; $77,000 in United Kingdom; $78 in India – that’s right seventy-eight dollars.
Any prescription medicine on the market must be efficacious for the disease for which it is prescribed
Prohibit any FDA employee from ever working for Big Pharma in ANY capacity.
Prohibit ANY complicit activity of an FDA employee with Big Pharma.
FDA APPROVES CANCER DRUGS BASED ON TRIAL FLAWS Two-thirds of FDA cancer drug approvals from 187 trials had 1 or more of 4 flaws: non-randomized design; no survival advantage; suboptimal control arms; or inappropriate crossover! https://bit.ly/2PIEdNE
FIRE THE FDA COMMISSIONER FOR APPROVING ANOTHER OPIOID
6) STOP BIG PHARMA – Some examples:
Stop TV advertising
STOP MUSIC OF BIG PHARMA TV ADS The U.S. and New Zealand allow TV ads by Big Pharma. That should stop. But for now, stop the pleasant music played during the ads because it purposely distracts consumers from the list of side-effects that can range from rash to cancer to death.
Stop landfall profits
Stop arbitrary and capricious price hiking
Tax big Pharma regardless of site of incorporation or of site of manufacture etc.
Stop ineffective treatments
THE TRUTH ABOUT CANCER This interview was done in 1996. UNFORTUNATELY, THE INFORMATION IS TIMELESS – BOTH THE TRUTH ABOUT CANCER and THE CONFLICT OF INTEREST BETWEEN BIG PHARMA AND SOME CANCER CENTERS AND SOME PHYSICIANS.
BIG PHARMA IS PROTECTED BY U.S. TRADE AGREEMENTS BUT NOT AMERICANS Americans have lost pharmaceutical jobs, pay higher prescription drug prices, the American trade deficit grows costing the American taxpayer more money, and Americans continue to greatly subsidize Big Pharma.
BIG PHARMA PRICE-FIXING CONSPIRACY 43 states are suing 20 Big Pharma companies, 11 of which are in New Jersey, for price-fixing conspiracy accounting for billions of dollars profit in the United States.
BIG PHARMA MASK HIGH DRUG PRICES BY DONATING TO CO-PAY GROUPS – For every $1 million donated by Big Pharma to help patients get high priced drugs, $21 million can be generated back to Big Pharma.
PATIENT-ASSISTANCE PROGRAMS – BIG PROFITS FOR BIG PHARMA Patient-assistance programs effectively: (1) increase demand for the drug, (2) allow companies to charge higher prices and thereby gain higher profits, and, (3) enjoy tremendous public-relations benefits.
BIG PHARMA’S DRUGS FOR HEPATITIS C DO NOT EXTEND LIFE OR IMPROVE QUALITY OF LIFE Doctors are told in sponsored seminars that the hepatitis C drugs actually cure the disease. However, a 2017 Cochrane review of 138 randomized trials shows that these drugs do not extend life or improve the quality of life. Cost for 12 week treatment: $96,000 in USA; $77,000 in United Kingdom; $78 in India – that’s right seventy-eight dollars
BIG PHARMA RAISE PRICES USING TRICKERY Big Pharma raise prices each year, or when a new indication is granted by the FDA, or by trickery: Change the dose per unit sold forcing a higher price even though that dose is not needed.
LOW LDL DOES NOT PROTECT, BUT BIG PHARMA AND HARVARD SAY YES Amgen, the maker of evolocumab (Repatha) funded the research, paid EVERY author on the paper, led by Harvard researchers, and the findings were published in the prestigious New England Journal of Medicine May 4, 2017. If you take the drug, evolocumab (Repatha), your LDL will go down but you won’t live any longer. IT’S ALL ABOUT INFLAMMATION AND OXIDATION.
INFLAMMATION NOT LDL There are multiple lines of evidence that inflammation increases the risk for cardiovascular disease, cancer and other chronic illnesses
BIG PHARMA SAYS NEW DRUG COSTS $1.3 BILLION, BUT REALLY LESS THAN $125 MILLION GlaxoSmithKline chief executive officer Andrew Witty said the pharmaceutical industry’s estimate of $1+ billion in average cost to develop a drug is “one of the great myths of the industry,” according to Reuters March 15, 2013. Cost to discover new drugs is about 15% of what is estimated and 1.3% of revenues after deducting taxpayer subsidies. Please read entire Report.
BIG PHARMA AND FEDS BLOCKS GENERIC CANCER DRUGS Big Pharma uses several tactics: Pay-for-Delay, Product Hopping, no importation of prescription drugs.
FEDS LET BIG PHARMA LEGALLY LOOT AMERICAN TAXPAYERS Big Pharma can dodge paying their fair share of taxes while enjoying aggressively priced products in the United States. The U.S. Government has always protected Big Pharma.
BIG PHARMA AND THE TRANS PACIFIC PARTNERSHIP“data exclusivity provision,” “procedural obligations – the annex,” “investor-state dispute settlement”
BIG PHARMA INFLUENCES GOVERNMENT AND COULD HARM AMERICANS – The 21st CENTURY CURES ACT – would get drugs and devices approved with fewer patients, shorter times, and require the FDA to use nontraditional study designs; give hospitals a financial bonus for administering costly new but unproven antibiotics; allows a medical device maker to pay a third-party to assess its own product.
ANTIDEPRESSANTS ARE NOT EFFECTIVE AND CAN INDUCE VIOLENT BEHAVIOR
ONE OF AMERICA’S RICHEST FAMILIES, THE SACKLERS, INITIATED AND PROMOTES OPIOID CRISIS: HOW TO STOP THE OPIOID CRISIS
Non-24: $45 versus $60,000 per year to HELP BLIND PEOPLE’S CIRCADIAN RHYTHMS
GOVERNMENT INTRUSION SOARS CANCER COSTS FOR YOU The federal government, the biggest payer of cancer care, made cancer costs soar because Medicare pays an extra $6500 a year when chemotherapy is given to a patient in a hospital owned facility. Private insurers also pay a higher premium for care delivered in a hospital setting. The costs will keep spiraling upward because of Government intrusion and clever lobbyists, forcing cancer patients from private practitioners to hospital owned facilities incurring much higher costs.
7) STOP HEALTH INSURANCE COMPANIES – Some examples:
Stop using personal data from social media and data brokers (like Optum, IBM Watson Health and LexisNexis – they collect data about medical diagnoses, tests, prescriptions, costs and socioeconomic data of the majority of Americans going back decades to determine charges; IBM Watson Health includes 442 nonmedical personal attributes to predict a person’s medical costs. Its cache includes more than 78 billion records from more than 10,000 public and proprietary sources, including people’s cellphone numbers, criminal records, bankruptcies, property records, neighborhood safety and more. The information is used to predict patients’ health risks and costs in eight areas, including how often they are likely to visit emergency rooms, their total cost, their pharmacy costs, their motivation to stay healthy and their stress levels;
Remove all loop holes that permit unfair profits;
Stop hidden fees;
Reduce “Administrative Fees;”
Stop collecting additional revenue by adding certain mark-ups to hospital claims paid by its self-insured customers: provider network fees, contingency/risk fees, retiree surcharges, and other-than-group subsidy fees (83 percent of its self-insured customers were completely unaware of the fees);
Stop cost shifting;
Stop flouting regulations designed to protect consumers;
Stop skewing the political debate with multibillion-dollar PR campaigns to mislead the press and public;
Stop signing up healthy people and finding ways to avoid sick people — called “cherry-picking” and “lemon-dropping;”
Stop discriminating against people with certain costly diseases like HIV or hepatitis C, etc.;
8) STOP POLLUTION
All types of pollution have been written by me in Cancer and Nutrition.
HOW TO STOP CLIMATE CHANGE AND BE HEALTHY: COWS, ROTTING FOOD IN LANDFILLS, TERMITES, PERMAFROST
A healthy diet will decrease diseases, decrease methane the potent greenhouse gas, decrease carbon footprint by about 30%, and decrease the risk of war and piracy. Carbon dioxide has been considered to be the leading cause of global warming but methane is 25 to 30 times more potent than carbon dioxide as a greenhouse gas. Therefore, even though governments and Nobel Laureates focus on carbon taxes, the real emphasis should be on minimizing and eliminating methane sources rather than focusing on burning of fossil fuels like coal, oil and natural gas.
Air pollution kills and hardest hit are racial minorities and people with low income (Qian MS et al. NEJM. 2017; 376:2513-22). Asbestos, diesel exhaust, acid rain, ozone, CPUs, UVB light, radon.
Water pollution: synthetic organic chemicals, chlorination, some inorganic chemicals, etc.
Radioactive material, electromagnetic radiation, etc.