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Health of People, Places and Planet

Health of People, Places and Planet: Reflections based on Tony McMichael’s four decades of contribution to epidemiological understanding OPEN ACCESS

COLIN D. BUTLER
JANE DIXON
ANTHONY G. CAPON
Copyright Date: 2015
Published by: ANU Press
Stable URL: http://www.jstor.org/stable/j.ctt1729vxt
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  • Book Info
    Health of People, Places and Planet
    Book Description:

    This book has three main goals. The first is to celebrate the work of a great public health figure, the late A.J. (Tony) McMichael (1942–2014). The second is to position contemporary public health issues in an interdisciplinary context and in ways that highlight the interdependency between the environment, human institutions and behaviours; a broad approach championed by Tony. The third is to encourage emerging and future public health leaders to advocate for policies and cultural change to sustain and improve human health, from a foundation of objective scholarship. The book’s foreword and 38 chapters were written by people who were inspired by Tony; many of whom worked with him at some point in the last 40 years. Its structure reflects five major public health domains, each of which Tony made major contributions to in an extremely productive academic life: occupational health and safety; environmental and social epidemiology; nutrition and food systems; climate change and health; and ecosystem change and infectious disease. The final section, ‘Transformation’, is dedicated to Tony’s desire for public health scientists to propose adaptive and mitigating solutions to the problems they were observing. Each section contains at least one key publication involving Tony. There is also a selection of artworks from an exhibition which formed part of the conference held to honour Tony at The Australian National University in 2012. This conference formed the first part of Tony’s festschrift, completed by this book.

    eISBN: 978-1-925022-41-4
    Subjects: Public Health, Health Sciences
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Table of Contents

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  1. FOREWORD (pp. xlv-xlviii)
    STEPHEN V. BOYDEN

    This remarkable collection of papers bears witness to the breadth, depth and originality of Tony McMichael’s outstanding contribution to the health sciences over the past four decades. Appropriately, contributions range from discussions of the results of epidemiological studies on specific health issues, many of which McMichael worked on himself, to the importance of a systems approach to epidemiology, and even to some philosophical issues such as how important the future really is. Many papers refer to or focus on an area that was of special interest to McMichael over recent decades – the impacts of climate change on human health.

    McMichael’s...

  2. Part 1: Introduction
    • ANTHONY J. MCMICHAEL

      The most serious potential consequence of global environmental change is the erosion of Earth’s life-support systems. Yet, curiously, the nature of this threat to the health and survival of the world’s living species - including our own - has received little attention.

      Over aeons, the evolution of life has gradually transformed the environment that clothes the planet’s surface. The lower atmosphere’s composition has changed; stratospheric ozone has formed from oxygen emitted by plants; soil has been created by oxidation, plants and microbes; and forests speed the recirculation of rainwater. Life’s genetic diversity confers a capacity for adaptive change. However, this...

    • COLIN D. BUTLER and ALISTAIR WOODWARD

      Two of the greatest 19th-century French health scientists were Claude Bernard and Louis Pasteur. At the end of his life, Pasteur was said to have conceded ‘Bernard was right – the microbe is nothing: the milieu is everything’ (James, 1982– 84; Goldstein, 2008). Clearly, the milieu is not everything – but it certainly matters, for people as well as for microbes. In this chapter, we outline the major political and social events of the past 40 years and consider their influence on Tony McMichael’s remarkable career.

      In 1972, smoking in Australian society seemed ubiquitous, and the lighted cigarette was prevalent in restaurants,...

    • BASIL S. HETZEL

      In the late 1960s, the National Health and Medical Research Council (NH&MRC;) was beginning to encourage academic development in the field of epidemiology and public health. In 1968, the NH&MRC; awarded me two NH&MRC; Fellowships as a newly appointed Foundation Professor of Social and Preventive Medicine at Monash University for this purpose. I was thus able to offer Tony a PhD Fellowship, and in the following year he joined my newly established Department of Social and Preventive Medicine to train in epidemiology and public health. Tony was the first student and was to become the first graduate.

      Prior to this,...

    • JOHN REID, ANTHONY G. CAPON and JANE DIXON

      Professor Tony McMichael, Director of the National Centre for Epidemiology and Population Health (NCEPH) at ANU, took his seat at the Centre’s Lunchtime Seminar, as he had done many times. On this occasion, 15 September 2011, the speakers were John Reid, ANU School of Art, and Tony Capon and Jane Dixon, both from NCEPH. The seminar, titled ‘The Artist, the Scientist, a Basin and a Recipe’, outlined a collaboration between scientists and visual artists to raise community awareness about the contested landscapes in the western part of the Sydney basin, and the implications of these contests for the health and...

    • ANTHONY J. MCMICHAEL

      The past 3 decades have witnessed the methodological consolidation of “modem epidemiology,” with its particular orientation to studying the multiple risk factors for chronic noncommunicable diseases. That conceptual and methodological orientation arose from midcentury as epidemiologists formally engaged in the study of diseases of long latency, multiple causality, and apparently noninfectious etiology (1). (I will refer to such diseases as “chronic diseases,” while also noting the likely involvement of infectious agents in the etiology of some of them.)

      It is axiomatic that the theoretic framework within which we formulate our research questions determines the scope, content, and social relevance of...

  3. Part 2: Healthy Workers
    • ANTHONY J. MCMICHAEL

      The age-standardized mortality ratio (SMR) is a frequently used summary index of mortality in occupational epidemiologic studies. By expressing the observed mortality experience of the occupational study population relative to the mortality. that would otherwise by expected (in the absence of any mortality hazard within that occupational environment), an evaluative measure of the force of mortality is obtained.

      Certain basic limitations of the SMR have been discussed elsewhere. Firstly, since the SMR computation involves an indirect age-adjustment procedure,¹ hence SMR's calculated for two or more study populations, although using the same standard population death rates for calculating expected deaths, cannot...

    • SU MON KYAW-MYINT and LYNDALL STRAZDINS

      One of the first to recognise that the organisation of work could impact the mental and physical health of workers was Friedrich Engels. In 1845, he publishedThe Conditions of the Working Class, in which he described physical and mental health problems of workers thought to be caused by the organisation of work and its social and physical environments. A few years later, Karl Marx wrote about how capitalism treated workers as commodities and how this led to the alienation of workers (Marx, 1988). Their groundbreaking work informed subsequent research into the health effects of the organisation of work. However,...

    • HÜLYA GÜL and ZAHIDE CEREN ATLI

      Despite great scientific and technological advancement, many factors have created serious health problems in low-income, ‘developing’ countries. Industrialisation, irregular urbanisation and migration are associated with material and psychological distress, including from unemployment and income inequality. This process has been accelerated by the relocation of many polluting industries to less-developed countries, where labour is cheaper, regulation weaker and exploitation more systematic and ruthless.

      The characterisation and prioritisation of environmental health problems and their causes through epidemiological and scientific research is needed to guide and advance sustainability. Sustainable development requires social and administrative mechanisms, including regulated policies that reduce environmental harm.

      Although...

    • DEVRA DAVIS and COLIN D. BUTLER

      Hippocrates depicted, 2,500 years ago, a tumour as a muddled irritable cavity with spindly legs flaring out of control in all directions. Fascinated with its evil, animal-like appearance, he termed itkarkinoma, the Greek word forcrab.Like Hippocrates, we are drawn to things of menacing beauty.

      In the 1920s, cancer was rare. Nobel Laureate, Andre Cournand, recalled how, during his medical training in Paris, he and his colleagues rushed to see their first case of lung cancer. Today, however, cancer claims one in four persons in most industrial countries. In heavily industrialised areas of China, half of all deaths...

  4. Part 3: Environmental and Social Epidemiology
    • ANTHONY J. MCMICHAEL, P. A. BAGHURST, N. WIGG, G. VIMPANI, E. ROBERTSON and R. ROBERTS

      Although the health hazards of acute lead toxicity and occupational exposure to lead are well known, uncertainties exist about the adverse effects of environmental exposure to lower levels of lead. Recent epidemiologic studies have indicated that neuro- psychological development in children may be impaired by such exposure, but debate persists about methods for ensuring adequate control of the confounding effects of other covariates in such investigations.¹-⁴ The early epidemiologic research on the relation between lead and development, which consisted of cross-sectional or case—control studies, was inconclusive. In 1979 Needleman and colleagues, in a community-based study of children in Boston...

    • SHILU TONG

      In the late 1970s and early 1980s, another important but unanswered question was whether environmental lead exposure might affect young children’s health and development. Lead, from old house paint flakes, car exhaust and some industrial activity was a widespread pollutant. Many cross-sectional studies examined whether exposure to environmental lead at levels previously believed to be innocuous affected neuropsychological development and most of them found an inverse association between exposure measures and neuropsychological performance (Needleman et al., 1979; Smith et al., 1983; Winneke et al., 1983; Harvey et al., 1984; Schroeder et al., 1985; Lansdown et al., 1986; Fulton et al.,...

    • ROBYN LUCAS, ASHWIN SWAMINATHAN and KEITH DEAR

      In the 1920s, researchers observed that multiple sclerosis, a debilitating degenerative neurological disease, was more common in regions at higher latitude. This finding, replicated in both the northern and southern hemispheres, is an unusual but important feature of the epidemiology of multiple sclerosis. It suggests that environmental factors may play a role in its aetiology. Recent work indicating that the incidence of multiple sclerosis has increased over the past 30 years, after accounting for improved diagnosis, also indicates a role for changing environmental determinants.

      A key feature of Tony McMichael’s work was to discern and quantify the links between human...

    • ADRIAN SLEIGH and SAM-ANG SEUBSMAN

      In this chapter, we introduce our longitudinal multidisciplinary international study of the health-risk transition under way in Thailand. The project received critical administrative and intellectual support from Professor Tony McMichael – as Director of the National Centre for Epidemiology and Population Health (NCEPH), as one of the initial Chief Investigators, as advocate for multilevel epidemiology and as a leader of multidisciplinary regional public health research. The legacy of health transition theory established at NCEPH in the 1990s by Professor Jack Caldwell, The Australian National University’s (ANU) celebrated demographer, also helped to inspire the work. Another seminal influence arose from the doctoral...

    • GRAEME HUGO and JANET WALL

      Tony McMichael’s contribution extended beyond epidemiology and public health disciplinary boundaries to influence the social sciences more broadly.His work linking the dynamics of change in people, place and health and the impacts of climate change was influential in geography and demography. He drew attention to the health implications of climate change and their potential effects on population distribution and redistribution, and provided insights into how particular types of climate change would have both direct and indirect impacts on health (McMichael, 2001; McMichael et al., 2006, 2010). In this context, the spatial dimensions of climate change, the location of ‘hotspots’ of...

    • PAOLO VINEIS

      The evolution of living organisms is the expression of different and sometimes opposing forces. The main tension is between the need for stability and the need for change. The first is expressed, for example, by the great structural stability of DNA and of its coding system, conserved almost intact across all species. However, without the ability to change, organisms would not be able to adapt to changing environments and their continuous threats. Transposons (transposable elements), crossing over at meiosis and epigenetic changes, are some of the mechanisms that ensure the variety of genetic configurations that allow variation, adaptation and evolution....

    • ALISTAIR WOODWARD

      This chapter is concerned with Tony McMichael’s contribution to epidemiology, the study of diseases and their causes in populations. I do not attempt to tell the full story – there is not space, and I know that others will have more to say elsewhere in the book. I will focus on epidemiology close up, research into environmental and behavioural factors that are proximal to the disease of interest. This is ‘micro’ epidemiology, as distinct from the study of the big picture phenomena that are high up in the causal chain.

      I will tell of one court case, of great importance to...

  5. Part 4: Nutrition and Food Systems
    • JOHN D. POTTER and ANTHONY J. MCMICHAEL

      Subjects.—All those with newly incident cases of cancer of the colon and rectum who were reported to the South Australian Cancer Registry during 1979 and 1980, with additional inclusion of those with rectal cancer during early 1981, who resided in Metropolitan Adelaide, who were between the ages of 30 and 74 years, and who are alive at the time of reporting, made up the eligible case series. Of these 576 cases, 70 died before being contacted. Of the remaining 506, permission to interview was refused by the attending surgeon for 55 (10.9%), usually because the patient was terminally ill....

    • JOHN D. POTTER

      Humans began as gatherer-hunters.¹ At varying times in the past 10–15,000 years and in various parts of the world, we began to domesticate animals and cultivate specific crops (Ponting, 1992). For much of our subsequent history, cultivated grains (sometimes as mixed-crop agriculture, sometimes more extensively planted as a single crop) have provided the majority of human energy intake, often supplemented by hunting, fishing and gathering, as well as by raising domesticated sources of animal protein in the form of eggs and dairy products and, relatively less importantly until quite recently, meat.

      The following nutrients are rare in nature: sugar,...

    • COLIN D. BUTLER

      This chapter has a very broad scope. Lack of space prevents in-depth discussion of many issues it raises; I can thus only give impressions. From the argument that causation is rarely purely ecological or social, the chapter ranges to the Green Revolution, hunger targets and measures, and how impinging limits to growth threaten the attainment of hunger targets. It also touches on neoliberalism and the follies of conventional economists.

      Good nutrition is essential for health, both at the individual and population levels. Many health determinants are social, such as inequality and companionship, but many products of social factors manifest physically....

    • BASIL HETZEL and ANTHONY J.MCMICHAEL

      Awareness of the connection between health and lifestyle has increased greatly over the past two decades. In developed countries, this awareness has arisen in the light of findings from medical research since about 1960. Examples of lifestyle factors that have been studied extensively include diet, alcohol consumption, cigarette smoking, physical activity, sexuality and reproductive behaviour. Collectively, these personal behaviours are now thought to be related to about three-quarters of the premature illness and death that occurs in contemporary Western populations.

      The idea that health is related to lifestyle is not new. The Greeks and Romans recognised that health and disease...

    • MARK L.WAHLQVIST

      Reflections and aspirations in celebration of Tony McMichael’s career and contributions are bound to be rewarding. Our lives had been entwined in several ways. With my late wife, Dr Soo Sien Huang, we were medical students together at Adelaide University. We moved to Melbourne at about the same time, with a similar sociopolitical mindedness. Tony and his wife, Judy, lived with us in Parkville, Tony as President of the National Union of University Students and me as a National Heart Foundation Fellow and tutor at Melbourne University and St Vincent’s Hospital. We worked together in the evenings and on weekends...

    • JANE DIXON and PHILIP MCMICHAEL

      For more than 25 years, Tony McMichael examined population health, including nutritional health, impacts of lifestyle changes and widespread, escalating and deepening environmental change. He was particularly concerned with the health consequences of affluent lifestyles and the environmentally unsustainable nature of the international spread of industrial and meat-based diets (Hetzel and McMichael, 1989; McMichael, 2005a; McMichael et al., 2007).

      Underlying the diffusion of industrial foods is the global retailing revolution (Burch et al., 2013), whereby supermarket diets for the majority world (middle and working classes) converge on a narrowing base of staple grains, increasing consumption of animal protein, edible oils,...

  6. Part 5: Climate Change and Health
    • ANTHONY J. MCMICHAEL

      The envjronment debate is warming up. Tussles between conservationists, industrialists, unions and politicians over environmental policies and strategies are commonplace. The foci of concern are economics, aesthetics, preservation of amenity, and protection of foliage, fur, feathers and fins.

      A late — but hugely important — entrant to the debate is the health lobby. In the longer-term (and admittedly arthropocentric) view of macroenvironmental degradation, the “bottom line” will be dominated by adverse effects upon human health and survival.

      In July 1990, the Federal Government issued a draft Discussion Paper on "ecologically sustainable development”.¹ The Public Health Association of Australia, and others, protested that...

    • LACHLAN MCIVER and ELIZABETH HANNA

      While it may seem, to some, that the scientific community’s interest in and concern about the changing global climate is a relatively recent phenomenon, the reality is radically different. The concurrent rise in post-Industrial Revolution global greenhouse gas emissions and increasing ambient temperatures has been occurring for more than two centuries, and the causal link between the two was first hypothesised in the 19th century, when Arrhenius recognised the relationship between atmospheric carbon dioxide concentrations and the temperature at the Earth’s surface (Arrhenius, 1896), building on earlier work that explored the effect of gases and vapour on radiation and heat...

    • HILARY BAMBRICK and STEFANO MONCADA

      Since its very early days, successful public health has been a vehicle for social reform, driving fundamental changes to the human environment in order to understand and improve health, and to address inequalities. Much of what we think of as ‘public health’ could equally be called ‘environmental health’. It recognises the importance of context to the capacity for a population to be healthy. It strives to make our surroundings conducive to better health, optimising benefits for the population at large by making changes to the settings in which we go about our daily lives. The domain of public – or environmental...

    • DONNA GREEN and LEANNE WEBB

      To readers of this volume, it would come as no surprise that Tony McMichael was always at the forefront of strategic research on the relationship between human health and climate. Our first experience of his leadership in this area came during a presentation he gave at a meeting of Indigenous Elders and scientists in 2006, where he discussed the indirect health impacts of climate change in northern Australia (McMichael, 2006). Five years later, he had further developed his model, presenting some novel dimensions at the International Congress of Biometeorology (McMichael, 2011). One frequently overlooked area that Tony identified in this...

    • CATHY BANWELL, JANE DIXON, HILARY BAMBRI, FERNE EDWARDS and TORD KJELLSTROM

      Neither a complaint nor a boast, ‘It’s a scorcher!’, is a common Australian summertime vernacular. In this chapter, we describe how cultural approaches that favour ‘techno-fixes’ at the household level have evolved in response to hot weather in Australia. We then proceed to describe them in terms of inadequate adaptive responses to climate change. We consider as a contextual narrative how these approaches have evolved from the historical experiences of European settlers who arrived from the northern hemisphere with little physical or psychological understanding of hot weather and attempted to impose themselves on a foreign landscape. They developed a stoic...

    • COLIN L. SOSKOLNE, JUSTINE D. A. KLAVER-KIBRIA, KAREN M. MCDONALD, DONALD W. SPADY, J. PETER ROTHE, KAREN SMOYER TOMIC, KAILA-LEA CLARKE and GIAN S. JHANGRI

      Human health and well-being are linked closely to social, cultural, economic and physical environments, which in turn are shaped and sustained principally by the forces of nature and human action.

      The Fourth Assessment Report of the Intergovernmental Panel on Climate Change (IPCC, 2007) states that over recent decades the frequency and severity of extreme weather events have increased, reflecting a trend towards global heating (Hansen, 2009) and more systemic and extreme climate disruption (Lovelock, 2009; Rockström et al., 2009). These changes have profound implications for life-sustaining habitats.

      Extreme weather can disturb lives, livelihoods and physical and societal infrastructure profoundly. Direct...

    • ANDY HAINES

      Current trends of inequitable and unsustainable development, which are largely responsible for many of the environmental threats now confronting us, are related directly or indirectly to many risk factors responsible for major causes of ill health, particularly non-communicable diseases (NCDs). These now account for over half of the world’s disease burden. This chapter illustrates linkages between health and policies in a number of sectors responsible for large emissions of greenhouse gases (GHG) or short-lived, climate-active pollutants such as black carbon. It also makes the case that appropriately designed policies to reduce emissions, and thus mitigate climate change, can improve health...

    • KATHRYN BOWEN

      I first came across Professor McMichael’s work when I was assisting the Australian Greens develop their climate change and human health policy in the run-up to a federal election. I was at an intersection in my public health career; I felt that my choices were either to continue working on specific public health issues such as HIV, mental health and women’s health, or to follow my instinct to move away from public health and work in the environmental sustainability arena. On coming across Tony’s work, I realised that public health and sustainability dovetailed in a very powerful way. I was...

  7. Part 6: Ecosystem Change, Infectious Diseases and Well-being
    • ROBIN A. WEISS and ANTHONY J. MCMICHAEL

      Fifty years ago, the age-old scourge of infectious disease was receding in the developed world in response to improved public health measures, while the advent of antibiotics, better vaccines, insecticides and improved surveillance held the promise of eradicating residual problems. By the late twentieth century, however, an increase in the emergence and reemergence of infectious diseases was evident in many parts of the world. This upturn looms as the fourth major transition in human– microbe relationships since the advent of agriculture around 10,000 years ago. About 30 new diseases have been identified, including Legionnaires’ disease, human immunodeficiency virus (HIV)/acquired immune...

    • PHILIP WEINSTEIN and PENG BI

      Tony McMichael’s 1993 book,Planetary Overload, introduced ecological approaches to public health researchers and epidemiologists. The concept of carrying capacity was presented in such a way as to make many of these researchers rethink their approaches to a variety of pathogens, including RRV.

      This Australian arbovirus (arthropod-borne virus) causes symptomatic infection in up to 5,000 people per annum, resulting in rash, fever and rheumatic symptoms lasting several weeks. Epidemics were first described in the late 1920s (Nimmo, 1928), and the ecology and distribution of RRV is now known to be determined by climatic variables that impact mosquito biology, including temperature...

    • MELANIE BANNISTER-TYRRELL, DAVID HARLEY and TONY MCMICHAEL

      Infectious agents whose life cycle includes a life stage or extended periods exposed to ambient weather conditions (including time within vectors or hosts) are sensitive to climate variability. Anthropogenic (or human-induced) climate change will alter the patterns of many human infectious diseases, because the development rates, lifespan and reproductive capacity of climate-sensitive infectious agents, their vectors and hosts are influenced by higher temperatures and increased climate variability (Hoberg et al., 2008; Costello et al., 2009).

      Most research on climate change and infectious disease has focused on vector-borne diseases (Kovats et al., 2001; Gage et al., 2008). For example, evidence has...

    • RO MCFARLANE

      The past four decades have seen an unusually rapid and widespread increase in apparently new and changing infectious diseases in humans, domesticated animals, wildlife and plants. Some 335 novel or re-emerging infectious diseases of humans have been described since the 1940s (Jones et al., 2008). The majority of these ‘emerging infectious diseases’ (EIDs) – defined as infectious diseases that are novel or expanding in pathogenicity and range (Morse, 1995) – have occurred since the 1970s. The increase in EIDs has coincided with an acceleration of anthropogenic ecological change, defined as a change in interactions among living organisms with each other and with...

    • PIM MARTENS and CARIJN BEUMER

      As stated by the World Health Organization (WHO) in its report,Our Planet, Our Health, Our Future, ‘[he] alth is our most basic human right and one of the most important indicators of sustainable development (WHO, 2011). Intuitively, we know that nature affects human health. However, people are generally less well acquainted with the fact that biodiversity – the rich variety of species – is in every way essential, indeed, indispensable, to the maintenance of human health and well-being (Corvalán et al., 2005). Without the complex web of interrelations and functional connections between different species in the natural environment, there would be...

    • MICHAEL BENTLEY

      A marvellous thing about trees is that they solve their problems without moving. They are model citizens, decorative, quiet, calm and courageous. (Joignot, 2012, p. 28)

      The dynamic process of global urbanisation, what Rayner and Lang (2012) call the ‘urban transition’, is resulting in the rapid growth of urban areas with more than one million people (Sadler et al., 2010). In these urban areas, the external environment comprises two distinct, juxtaposed spaces: ‘grey space’ and ‘green space’, which can be broken down further, as Figure 28.1 depicts.

      The increasingly dense urban built environment is placing pressure on the infrastructure of...

    • ROBIN A. WEISS

      Medawar exhorts us to dismiss insoluble questions – when the intellectual and practical means to answer them are not yet available – as idle speculation. All too often, however, we take refuge in asking small questions that are too easily soluble and which will never lead to Kuhnian paradigm shifts (Kuhn, 1962). An exception was Tony McMichael, who had the art of asking penetrating questions before others had formulated them, but for which at least partial answers could be provided. I first met Tony when he was at the London School of Hygiene and Tropical Medicine and I had moved to University...

  8. Part 7: Transformation
    • ANTHONY J. MCMICHAEL, KIRK R. SMITH and CARLOS F. CORVALÁN

      As several of the papers in this special issue show, environmental health hazards are currently most prevalent in developing countries at the household level. Among the commonest hazards are indoor air pollution, arsenic and infectious agents in drinking-water, and local environmental exposure to lead. Finding ways to reduce these risks more quickly remains an important item on the global agenda because of the significant burden of disease they impose.

      At the United Nations Conference on the Human Environment in 1972, much of the concern was about chemical contaminants, the depletion of natural resources, and urbanization. This reflected problems resulting from...

    • TREVOR HANCOCK

      As a health futurist with a particular interest in alternative futures and preferable futures, I have long recognised that ‘decline and collapse’ is a plausible alternative future that we face (Bezold and Hancock, 1993, 1994). Indeed, we face the real option of both the decline and collapse of ecosystems and the accompanying decline and collapse of the societies and communities that are embedded in and depend on those ecosystems. Yet, it is in many ways the future whose name we dare not speak – or at least, that we prefer not to explore. In workshops, it is, of course, seen as...

    • MARTIN MCKEE

      It has been suggested that the reason why humans have never been contacted by inhabitants from other planets is because, long before sentient beings reach the stage when they can travel across space, they have already destroyed their own planets. For several decades, Tony McMichael was warning us that we risked repeating this mistake (McMichael, 1993, 2001). Blending insights from epidemiology, climate science and behavioural sciences, he rendered visible what would otherwise have remained invisible (such as how seemingly unconnected events such as landslides and forest fires in geographically dispersed lands were linked through man-made climate change), confronting us with...

    • DEVIN C. BOWLES

      Ecological systems necessary for human health are under increasing threat from diverse anthropogenic pressures. Threats of concern include biodiversity loss, disruptions to the nitrogen cycle and climate change, which has been labelled as the century’s greatest health threat (Costello et al., 2009). As A. J. McMichael elucidates, a subset of epidemiologists is responding by expanding the spatial and temporal scope of their enquiry beyond proximate health risk factors to include population-level influences on health (McMichael, 1999). While only a minority of epidemiologists are directly involved, the discipline’s overall understanding of the environmental and social systems that imbed health is increasing....

    • KRISTIE L. EBI

      Climate change will continue to alter weather patterns over coming decades, including more frequent and intense extreme weather and climate events; increases in the average and local variability of temperature, precipitation and other weather variables; and rises in sea level (e.g. IPCC, 2007, 2012). Projections of the magnitude and pattern of these changes offer an opportunity for public health (and other sectors) to modify current policies and measures proactively and develop new means to manage known and anticipated risks effectively and efficiently.

      While projections of how the climate could change are necessary, they are insufficient to project health impacts and...

    • KIRK R. SMITH

      The first two volumes of the McMichael trilogy served to pioneer and then frame modern understanding of the impacts of global change on human health (McMichael, 1993, 2001). The third puts it into a broad historical context (McMichael, in press). The challenge facing us now is to find ways to place these understandings within the continuum of human experience, extending also into the future. Without doing so, expecting society to alter behaviour today to reduce climate change a century away seems futile, given numerous, more immediate demands. Scholarly contributions from two entirely different fields, however, together offer a path to...

    • PETER TAIT

      Dire warnings of the deleterious human effects on ecosystems and their consequences have been made for decades (McMichael, 1993; Rockström et al., 2009; McMichael and Butler, 2011). The primary health-care approach and social determinants of health theory show that health is promoted, or not, by how we arrange society (World Health Organization, 1986; Marmot and Wilkinson, 2006; Commission on Social Determinants of Health, 2008). Extending this approach to seek common origins of and linkages between humanity’s health, social and environmental problems permits a strategic approach to address the causes of the causes. Indeed, humanity’s ability to survive requires working this...

    • ANTHONY G. CAPON

      … the prime role of societies is to create enduring conditions that promote the population’s wellbeing and health. (A.J. McMichael, quoted in Shetty, 2006)Homo sapiensis undergoing a radical transformation of its ecology (McMichael, 2000). Since 2008, cities have been the dominant habitat for the human species. The majority of the world’s people now live in cities and, for the foreseeable future, most population growth will be in urban areas (Figure 36.1). By the middle of the 21st century, two to three billion more people will need to be housed in the cities of the world – more than one...

    • BOB DOUGLAS

      Through more than 30 years of close professional association, Tony McMichael inspired a generation of epidemiologists and environmentalists. I argue in this paper that through his work, and others of his extraordinary ilk, we now know enough about what is threatening human futures to embark on a social engineering effort to change the human mindset in close collaboration with the up and coming generation, and especially schoolchildren.

      In 1968, the ecologist Paul Ehrlich 1 publishedThe Population Bomb(Ehrlich, 1968), in which he expressed grave doubts about the world’s ability to feed itself in view of the massive growth in...

    • GEOF RAYNER and TIM LANG

      In his essay, ‘Prisoners of the Proximate’, Tony McMichael gives an overview of the history and changing shape of epidemiology, concluding with an appeal for modern epidemiology to embrace an ecological public health conception (McMichael, 1999). We agree with that analysis and have argued the case from different starting points elsewhere (Rayner and Lang, 2012). In this chapter, we explore a key feature of ecological public health thinking – the centrality given to addressing complexity. The argument is that ecological thinking helps public health by accepting the normality of complex interactions while also explaining the necessity of multiple rather than single...