This article first appeared in Medical Observer and appears here with permission.
Dr George Crisp MBBS MRCGP
ACCORDING to conventional wisdom, we will keep living longer and enjoying ever healthier lives. After all, public health advances and technological pro gress over the past 150 years have delivered these improvements. So why shouldn’t this continue indefinitely?
Our perspective has been largely restricted to diagnosed illness and number of years lived, ignoring more meaningful measures of health and wellbeing.
Our time-poor, overstressed lives and iniquitous, fragmented communities have not made us any happier or healthier.
Modern living, with its material focus, over-consumption, poor dietary choice and inactivity, has become a major contributor to chronic disease while eroding traditional, spiritual and cultural values necessary for our non-material well being.
Rates of diabetes and obesity are escalating, worsening health outcomes, diminishing quality of life, and stretching health and welfare services and budgets.
Alcohol and drug use are compromising physical and mental health, damaging our social fabric. But rather than address the causes of societal ill health, we are instead focusing on increasingly expensive, technology-based, hospital-oriented and, inevitably, unsustainable solutions. Antibiotic resistance is a prime example of why this type of exploitative thinking is so short-sighted.
It is, however, our collective impacts that create the most challenging health risks.
In just 150 years, humanity’s environmental footprint has grown 150-fold. This has come at the expense of the other inhabitants of this planet. Through loss of habitat, over-harvesting, pollution and waste, we are driving a new mass extinction event.
Food, shelter, medicines, clean air and fresh water are all natural services we take for granted. At every level our health, and civilisation, is underpinned by the myriad, interdependent, mostly unidentified species that collectively constitute natural ecosystems.
The complex relationships between potential infectious organisms, vectors and hosts are also shifting, making unpredictable the patterns of known diseases – even producing entirely novel ones, such as SARS.
Agriculture is dependent on intact healthy ecosystems and soils. Additionally, the increased yields now required to provide adequate nutrition for billions of people have resulted in unsustainable use of resources, particularly fresh water, oil and phosphate, all of which are now diminishing.
We are approaching ‘peak oil’, with its volatile, rising prices which compromise food production and availability, disproportionately affecting the poorest and most vulnerable.
Our economy and health infrastructure are also highly energy-intensive. We cannot afford to keep repeating the 20th-century mistake of chasing ever more polluting and diminishing resources. We need instead to strive for clean, renewable energy, with the health and social benefits that it brings.
Overuse of fossil fuels and land clearance has produced atmosphere-altering quantities of greenhouse gasses. The ensuing climatic disruption and ocean acidification will have profound health effects, prompting the (Nov 2009) Lancet series “Climate change is the greatest threat to human health in the 21st century”.
Impacts may include heat waves, heavy precipitation and droughts, more favourable conditions for many microbes, pests and vectors, rising sea levels, fresh water depletion and food insecurity, plus, ultimately, large-scale population displacement and mass migration of refugees.
The timing and magnitude of these interrelated impacts may be uncertain, but the risks to human health at local, regional and global levels are at a scale not seen in human history.
All the more surprising, then, that they have been largely absent from our health expectations and planning. We are in danger of passing ‘peak health’, a time in human history where the best health outcomes recede into the past.
We cannot escape the finite planetary boundaries that define the optimal and safe conditions for humanity, but we can choose a fairer and a healthier future by living within our ecological means.
But only when we have recognised where we are going.
For more information, please contact Doctors for the Environment Australia at: www.dea.org.au