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Environment Magazine September/October 2008

 

January/February 2008

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Population, Human Resources, Health, and the Environment: Getting the Balance Right

In the middle of the 20th century, we saw our planet from space for the first time. Historians may eventually find that this vision had a greater impact on thought than did the Copernican revolution of the 16th century, which upset the human self-image by revealing that the Earth is not the centre of the universe. From space, we see a small and fragile ball dominated not by human activity and edifice but by a pattern of clouds, oceans, greenery, and soils. Humanity’s inability to fit its activities into that pattern is changing planetary systems, fundamentally. Many such changes are accompanied by life-threatening hazards. This new reality, from which there is no escape, must be recognized—and managed.

—WCED, “From One Earth to One World,” Our Common Future

The UN’s World Commission on Environment and Development (WCED)—the “Brundtland Commission,” chaired by Gro Harlem Brundtland—released its seminal report Our Common Future in 1987.1 Much has changed on the global environment front since then, only some of which was (or could have been) anticipated by that report. As human population continues to grow and as human societies, cultures, and economies become more interconnected against the background crescendo of “globalization” in recent decades, the collective human impact on the biosphere has increasingly assumed a global and systemic dimension. While issues like climate change, freshwater deficits, and degradation of food-producing systems and ocean fisheries were appearing on the horizon in 1987, they have now moved to the foreground. Today, it is evident that these momentous changes pose threats not only to economic systems, environmental assets, infrastructural integrity, tourism, and iconic nature, but also to the stability, health, and survival of human communities. This realization—along with the fact that human-induced global environmental changes impinge unequally on human groups—heightens the rationale for seeking sustainable development.

While the WCED report explored the rationale and the path toward sustainable development, the extent of subsequent large-scale environmental problems arising from the scale and the energy and materials intensity of prevailing modes of development could not have been fully anticipated in 1987. Indeed, paradoxically, concern over world population growth had temporarily receded in the mid-1980s, reflecting the prevailing mix of politics and optimism. The optimism derived from the apparent alleviation of hunger that had been achieved by the Green Revolution of the 1970s and 1980s in much of the developing world, and from the downturn in fertility rates in at least some developing regions. Today, however, the population issue is reemerging in public discussion, reflecting renewed recognition that population growth, along with rising consumption levels, is exacerbating climate change and other global environmental changes.2

If the commission’s assessment were re-run this decade, its updated terms of reference would necessarily focus more attention on the social and health dimensions of the “development” process, both as inputs and, importantly, as outcomes. The charge to the commission, which focused on the often-conflicted relationship between economic activity and environmental sustainability, was framed at a time when the orthodox Rostovian view (that economic development occurs in five basic stages from “traditional society” to “age of high mass consumption”) still remained influential.3 Today, human capital and social capital—both of which were first properly understood and factored into the development calculus in the 1990s, along with the need for sound governance—are better recognized as prerequisites for environmentally sustainable development. At the same time, realization is growing that the attainment of positive human experience is the core objective of human societies.4 In contrast, the commission’s primary mandated focus was on how to reconcile environmental sustainability with social-economic development. That orientation afforded little stimulus to considering why, in human experiential terms, achieving such a balance is not an end in itself, but is a prerequisite for attaining human security, well-being, health, and survival. Why else do we seek sustainability?


People, Resources, Environment, and Development

The UN General Assembly Resolution A/38/161 of 1983 establishing the WCED specified that the commission would “take account of the interrelationships between people, resources, environment and development.”5 The full text of the resolution emphasized—as did the commission’s name—the dual need for long-sighted environmental management strategies and greater cooperation among countries in seeking a sustainable development path to the common future. Two words in the quoted phrase are of particular interest: “people” and “resources.”

Reference to “people,” rather than to “populations,” seems to emphasize the human dimension. However, it also distracts from issues of fertility and population size—a distraction that probably reflected two prevailing circumstances. In the 1980s—when world population growth was at its historic high—the United States’s conservative Reagan Administration withheld international aid from family planning because of its perceived links with abortion counseling. This ill-informed and culturally high-handed approach, coming from a powerful country with great financial influence over UN policies, was complemented by the fact that many low-income countries considered that issues of fertility and population size were their own business. Nevertheless, and to its credit, the WCED report directly addressed the question of population size and its environmental consequences, urging lower fertility rates as a prerequisite for both poverty alleviation and environmental sustainability.

The word “resources” is ambiguous; it could be taken to refer to natural environmental resources or to human resources (human capital, including education and health status). To what extent did the WCED consider human well-being and health in relation to changing environmental conditions, population size, and resources? “Many such changes are accompanied by life-threatening hazards,” stated the WCED in its overview of the report,6 suggesting that the report would indeed explore how the state of the natural environment, our basic habitat, sets limits on human well-being, health, and survival, both now—and of particular relevance to sustainability—in future. Indeed, in launching the report in Oslo, on 20 March 1987, Chair Brundtland said:

Our message is directed towards people, whose wellbeing is the ultimate goal of all environment and development policies. . . . If we do not succeed in putting our message of urgency through to today’s parents and decision makers, we risk undermining our children’s fundamental right to a healthy, life-enhancing environment.7

Despite these promising statements, the report itself gave only limited attention to considering how environmental degradation and ecological disruption affect the foundations of human population health. The report focused primarily on the prospects for achieving an “ecologically sustainable” form of social and economic development that conserves the natural environmental resource base for future human needs. It paid little attention to the fact that the conditions of the world’s natural environment signify much more than assets for production, consumption, and economic development in general; the biosphere and its component ecosystems and biophysical processes provide the functions and flows that maintain life processes and therefore good health. Indeed, all extant forms of life have evolved via an exquisite dependency on environmental conditions.

This somewhat restricted vision on the part of the WCED is not surprising. Indeed, such a perspective has been reflected often in subsequent forays of UN agencies into the rationale and objectives of sustainable development—forays that have consistently overlooked or sometimes trivialized the role of sustainable development as a precondition to attaining well-being, health, and survival (the UN Millennium Development Goals are one example).8 In defense of the report, however, it does state:

It is misleading and an injustice to the human condition to see people merely as consumers. Their well-being and security—old age security, declining child mortality, health care, and so on—are the goal of development.9

In the 1980s and early 1990s, there was little evidence and understanding of the relationship between environmental conditions, ecological systems, and human health. For example, the First Assessment Report of the Intergovernmental Panel on Climate Change (IPCC), released in 1991, contained only passing reference to how global climate change would affect human health.10 The IPCC report reviewed in detail the risks to farms, forests, fisheries, feathered and furry animals, to settlements, coastal zones, and energy generation systems. In contrast, it glossed cursorily over the risks to human health (and gave undue emphasis to solar ultraviolet exposure and skin cancer, which is very marginal to the climate change and health topic).

There was, then, only a rudimentary awareness that the profile and scale of environmental hazards to human health were undergoing a profound transformation. For instance, the human health risks due to stratospheric ozone depletion, first recognized during the late 1970s and early 1980s, had been easily understood. They belonged to the familiar category of direct-acting hazardous environmental exposures. An increase in ambient levels of ultraviolet radiation at Earth’s surface would increase the risks of skin damage and skin cancer and would affect eye health (for example, cataract formation). Recognition of this straightforward risk to human biology facilitated the ready international adoption of the Montreal Protocol in 1987, requiring national governments to eliminate release of ozone-destroying gases (mostly chlorofluorocarbons, nitrous oxide, and methyl bromide).

In contrast, the great diversity of (mostly) less direct-acting but potentially more profound risks to human health from changes to Earth’s climate system, agroecosystems, ocean fisheries, freshwater flows, and general ecosystem functioning (such as pollination, nutrient cycling, and soil formation) were only dimly perceived in the 1980s. Those health risks received relatively little attention in the WCED report, which focused instead on health hazards related to inadequate water supply and sanitation, malnutrition, drug addiction, and exposure to carcinogens and other toxins in homes and the workplace.


An Incomplete Model of Health Determinants

In discussing population health, the WCED report took a largely utilitarian view, discussing good health as an input to economic development and, specifically, as stimulus to the reduction of fertility and poverty. In this respect it was in good company: both the pioneering sanitary revolution of nineteenth-century England and World Health Organization’s International Commission on Macroeconomics and Health, established in 2000, espoused the same rationale: good health fosters national wealth. To the extent that the WCED report addressed the determinants of population health, it focused mainly on the contributions of economic development, health care systems, and public health programs—and not on the fundamental health-supporting role of the natural environment and its ecosystem services.

The report noted the success of some relatively poor nations and provinces, such as China, Sri Lanka, and Kerala State in India, in lowering infant mortality and improving population health by investing in education (especially for girls), establishing primary health clinics, and enacting other health-care programs. The report extended this analysis, citing the history of the well-documented mortality decline in the industrial world—which preceded the advent of modern drugs and medical care, deriving instead from betterment of nutrition, housing, and hygiene. Progressive policies, strong social institutions, and innovative health care and public health protection (especially against infectious diseases), without generalized gains in national wealth, the report’s authors said, can be sufficient to raise population health markedly.

This important insight, though, makes no explicit reference to the role of wider environmental conditions. While the control of mosquito populations with window-screens and insecticides certainly confers some health protection, for example, land-use practices, surface water management, biodiversity (frogs and birds eat mosquitoes), and climatic conditions can affect mosquito ecology and mosquito-borne disease transmission more profoundly. The issue must be tackled at both levels.
In fairness, understanding the patterns and determinants of human population health within a wider ecological frame has been impeded by strong cultural and intellectual undercurrents. The rise of modern western science and medicine, in concert with the contemporary ascendancy of neo-liberalism and individualism, has recast our views of health and disease in primarily personal terms. The Christian biblical notion from two thousand years ago of the Four Horsemen of the Apocalypse as the major scourges of population health and survival—war, conquest, famine, and pestilence—has been replaced by today’s prevailing model of health and disease as predominantly a function of individual-level consumer behaviors, genetic susceptibility, and access to modern health care technologies.

In addition to this cultural misshaping of our understanding, our increasing technological sophistication has created the illusion that we no longer depend on nature’s “goods and services” for life’s basic necessities. In this first decade of the twenty-first century, however, we are being forcibly reminded of that fundamental dependence. Hence, a repeat WCED report, written now, would give much higher priority to the relationship between biosphere, environmental processes, human biological health, and survival.


Footprints, Environmental Conditions, and Human Well-being

It is interesting that the WCED report was being drafted at about the time when, according to recent assessments, the demands and pressures of the global human population were first over-reaching the planet’s carrying capacity.11

Table 1In the time since the publication of the report, the “ecological footprint” has become a familiar concept. For any grouping of persons, it measures the amount of Earth’s surface required to provide their materials and food and to absorb their wastes. Collectively, humankind reached a point in the mid-1980s when it began to exceed the limit of what Earth could supply and absorb on a sustainable basis. Since then, the human population has moved from having a precariously balanced environmental budget that left nothing in reserve to a situation today in which we are attempting to survive on a substantial, growing, overdraft: our global standard-of-living is estimated to be at the level that requires approximately 1.3 Earths (see Table 1 at left).12 We are therefore consuming and depleting natural environmental capital. This explains the accruing evidence of climate change, loss of fertile soil, freshwater shortages, declining fisheries, biodiversity losses and extinctions. This is not a sustainable trajectory, and it is what, generically, the WCED report exhorted the world to avoid.

In the 1980s, there was more ambivalence about the population component of the “footprint” concept. The absolute annual increments in human numbers were at a historical high, and many demographers and some enlightened policymakers were concerned that population growth needed constraining. That view faced an emergent western political ethos that eschewed family planning, abortion counseling, and governmental intervention. In the upshot, population growth has begun to slow in a majority of countries. Meanwhile, this is being offset by the rapid rise in wealth and consumption in many larger developing countries, including China, India, Brazil, and Mexico.

This planet simply cannot support a human population of 8 to 10 billion living at the level of today’s high-income country citizens. Each of those citizens, depending on their particular country, needs 4 to 9 hectares of Earth’s surface to provide materials for their lifestyle and to absorb their wastes. Meanwhile, India’s population of 1.2 billion has to get by with less than 1 hectare per person. With an anticipated world population of 8 to 10 billion living within Earth’s limits, there would be no more than about 1.5 hectares of ecological footprint per average-person—and this arithmetic would limit the resources available for other species. To comply equitably with this limit will necessitate radical changes in value systems and social institutions everywhere.


Global Environment: Emerging Evidence

The Brundtland Commission foresaw at least some of the impending serious erosion of large-scale environmental resources and systems. Indeed, the WCED report judged that by early in the twenty-first century, climate change might have increased average global temperatures sufficiently to displace agricultural production areas, raise sea levels (and perhaps flood coastal cities), and disrupt national economies. This apparently has not yet happened, although very recent scientific reports point strongly to an acceleration in the climate change process,13 as the global emissions of carbon dioxide from fossil-fuel combustion and of other greenhouse gases from industrial and agricultural activities alter the global climate faster than previously expected.

Several other adverse environmental trends have emerged since 1987. Accessible oil stocks may now be declining—thereby stimulating an (ill-judged) scramble to divert food-grain production into biofuel production as an alternative source of liquid energy.14 It has also become apparent that human actions are transforming the global cycles of various elements other than carbon, particularly nitrogen, phosphorus, and sulfur.15 Human agricultural and industrial activity now generates as much biologically activated nitrogen (nitrogenous compounds such as ammonia) as do lightning, volcanic activity, and nitrogen-fixation on the roots of wild plants. Meanwhile, worldwide land degradation, freshwater shortages, and biodiversity losses are increasing. Those environmental problems were all becoming evident in the mid-1980s and were duly referred to in the WCED report, albeit without particular connection to considerations of human health.

Some other large-scale environmental stresses, however, were not evident in the 1980s. The scientific community had not anticipated the acidification of the world’s oceans caused by absorption of increasingly abundant atmospheric carbon dioxide. This acidification—global average ocean pH has declined by a little over 0.1 points during the past several decades—endangers the calcification processes in the tiny creatures at the base of the marine food web. Nor was much attention paid to the prospect of loss of key species in ecosystems, such as pollinating insects (especially bees). Both those processes are now demonstrably happening, further jeopardizing human capital development, poverty alleviation, and good health.

During 2001–2006, the Millennium Ecosystem Assessment (MA) was conducted as a comprehensive international scientific assessment with processes similar to those of IPCC. The MA documented the extent to which recent human pressures have accelerated the decline of stocks of many environmental assets, including changes to ecosystems.15 The MA also projected likely future trends. This assessment documented how several other globally significant environmental graphs peaked in the mid-1980s. On land, the annual per capita production of cereal grains peaked and has subsequently drifted sideways and, recently, downwards. The harvest from the world’s ocean fisheries also peaked at that time and has subsequently declined slowly—albeit with compensatory gains from aquaculture. These emergent negative trends in food-producing capacity jeopardize attempts to reduce hunger, malnutrition, and child stunting—a key target area of the Millennium Development Goals. The WCED report, if rewritten today, would presumably take a more integrative and systems-oriented approach to the topic of environmental sustainability and would incorporate greater awareness of the risks posed to human well-being and health.

Trends in Human Capital and Population Health

As discussed, the original UN resolution calling for the WCED report referred ambiguously to “resources.” Within the overarching environmental context of the commission, the intended reference of that word may well have been to environmental resources (such as oil, strategic and precious metals, and water supplies). Interestingly, the WCED treated the word as referring primarily to human resources in chapter 4, titled “Population and Human Resources.”

The global population was 4.9 billion at the time the WCED report was published, and now exceeds 6.7 billion. It continues to increase by more than 70 million persons annually. Because overall fertility rates have declined a little faster than was previously expected, the current “medium” UN projection for population growth by 2050 is for a total of approximately 9.1 billion.16 Most of that increase will occur in the low-income countries, predominantly in rapidly expanding cities.

Population growth necessarily increases demands on the local environment. But as the WCED report correctly argued, “the population issue is not solely about numbers.”17 Population size, density, and movement are part of a larger set of pressures on the environment. In some regions, resource degradation occurs because of the combination of poverty and the farming of thinly populated drylands and forests. Elsewhere, per-person levels of consumption and waste generation are the critical drivers of environmental stress. Extrapolation of current global economic trends foreshadows a potential five- to tenfold increase in economic activity by 2050. But this looks increasingly unachievable without radical changes in world technological choices and economic practices. The current experience of China is salutary in this regard: that country’s rapid economic growth is engendering huge problems of freshwater supply, air quality, environmental toxins in food, desertification of western provinces—and, now, the world’s largest national contribution to greenhouse gas emissions.

Is there an upside to population? “People,” stated the WCED report, “are the ultimate resource. Improvements in education, health, and nutrition allow them to better use the resources they command, to stretch them further.”18 How have we progressed since 1987 in providing these improvements?

Figure 1Access to primary schooling has increased since 1987 (see Table 1). In particular, the proportion of young girls completing primary school has increased (starting from a lower base than for boys). Figure 1 at left shows current proportions of the world’s children not in primary schooling by key categories. Impediments persist in the form of poverty, parental illiteracy, civil war, and Islamic extremism (banning female education).

Beyond environmental stresses and deficits, the task of improving population health faces other, systemic difficulties. As my colleague C. D. Butler and I wrote last year:

The gap between rich and poor, both domestically and internationally, has increased substantially in recent decades. Inequality between countries has weakened the United Nations and other global organisations and institutions. Foreign aid has declined, replaced by claims that market forces and the removal of trade-distorting subsidies will reduce poverty and provide public goods, including health care and environmental stability.19

Hunger and malnutrition persist at high levels. Famines in Africa remain frequent, and 300 million people in India are undernourished. Further, the almost 50 percent prevalence of underweight children in sub-Saharan Africa and South Asia causes widespread stunting of growth, intellectual development, and energy levels. Yet elsewhere, hundreds of millions of people in all continents are overfed and, via obesity, at increased risk of diabetes and heart disease.

Over the past two decades, demographic and epidemiological transitions have become less orderly than was anticipated by conventional demographic models. There has been considerable divergence between countries in trends in death rates (life expectancy) and fertility rates. National health trends, particularly in poor and vulnerable populations, are falling increasingly under the shadow of climate change and other adverse environmental trends.

In many, but not all low-income countries, fertility rates have declined faster than might have been predicted. However, in some countries (such as East Timor, Nigeria, and Pakistan) fertility remains high (4–7 children per woman). In some regions, the fertility decline has led to an economically and socially unbalanced age structure, especially in China, where in the wake of their “one-child policy,” the impending dependency ratio is remarkably high—many fewer young adults will have to provide economic support for an older, longer-living generation.

In some other countries, population growth has declined substantially because of rapid falls in life expectancy.20 Russia and parts of sub-Saharan Africa have very different demographic characteristics, and yet common elements may underlie their downward trends in life expectancy. Both regions lack public goods for health.21 In Russia there is a lack of equality, safety, and public health services—and many men have lost status and authority following the collapse of the Communist party structure. Meanwhile, in a number of sub-Saharan African countries, there is serious corruption in government, deficient governance structures, food insecurity, and inadequate public health services.

The conventional assumption, also evident in the WCED report, has been that a health dividend will flow from poverty alleviation. However, it is becoming clear that those anticipated health gains are likely to be lower because of the now-worldwide rise of various non-communicable diseases, including those due to obesity, dietary imbalances, tobacco use, and urban air pollution.22    


Conclusion

The WCED was commissioned to examine critically the relationship between environmental resource use and sustainable development and to propose solutions for the tensions between environment (including the pressures of population growth and urbanization) and development. A prime task for the commission was to formulate a “global agenda for change” within the frame of ecologically sustainable development, while recognizing the aspirational goals of people and communities everywhere.23

During the time that the commission was developing its report, a widely held view, reinforced by the Green Revolution successes of the 1970s and early 1980s, was that continuing population growth need not have adverse environmental impacts. The commission was hesitant to embrace that view, which has recently been re-evaluated,24 with renewed recognition of the adverse effects of rapid population growth, especially in developing countries, on both social and environmental conditions.25

In the 1980s, national governments and multilateral agencies began to see that economic development issues could not be separated from environment issues. Many forms of development erode the environmental resource base (including forests, fertile soils, and coastal zones) necessary for sustained development. And conversely, environmental degradation can jeopardize economic development. The WCED report rightly emphasized the futility of addressing environmental problems without alleviating poverty and international inequality. The report also recognized the needs for stronger social structures and legal processes to deal with tensions over environmental commons, and for more enlightened public agency structures at the international level to address these issues. It advocated partnerships with the private sector—a sector in which there is now a growing recognition that business-as-usual is no longer an option.

Those formulations remain important and valid, but they are an incomplete basis for future strategic policy. They overlook the fundamental role that sustaining an intact biosphere and its component systems plays in enabling the social and human developmental processes that can reduce poverty, undernutrition, unsafe drinking water, and exposures to endemic and epidemic infectious diseases. The report, if updated today, would seek a better balance between these sets of relationships.

The idea of “ecologically sustainable development” was, in the latter 1980s, ahead of its time. We had, then, neither the evidence nor the insight to know just how fundamental that framework was to achieving the other human goals that would be embraced over the next two decades. Today, the ongoing growth of the global population and—with economic development and rising consumer expectations—the increasingly great environmental impact of that population means that we may be less than one generation away from exhausting much of the biosphere’s environmental buffering capacity.26 Unless we can constrain our excessive demands on the natural world, the demographic and epidemiological transitions (faltering in some regions) will be further affected and human fulfillment will thus be eroded.

Twenty years on from the report of the World Commission on Environment and Development, we can see additional layers to the environment challenge that were little understood in the 1980s. Clearly, some fundamental changes are needed in how we live, generate energy, consume materials, and dispose of wastes. Population arithmetic will impose a further dimension of challenge: 4.8 billion in 1987; 6.7 billion in 2007; perhaps 8 billion by 2027. Beyond that, the numbers and outcomes will be influenced by what current and future “Brundtland reports” formulate, and how seriously and urgently we and our governments take their formulations and recommendations.

Anthony J. McMichael is a professor at the National Centre for Epidemiology and Population Health (NCEPH) at Australia National University in Canberra. From 2001 to 2007, he was director of NCEPH, where he has led the development of a program of epidemiological research on the environmental influences on immune disorders, particularly autoimmune diseases such as multiple sclerosis. Meanwhile, he has continued his pioneering research on the health risks of global climate change, developed in conjunction with his central role in the assessment of health risks for the Intergovernmental Panel on Climate Change. His work on climate and environmental change, along with longstanding interests in social and cultural influences on patterns of health and disease, also underlie his interests in understanding the determinants of the emergence and spread of infectious diseases in this seemingly “renaissant” microbial era. He may be contacted at Tony.McMichael@anu.edu.au.


NOTES

1. World Commission on Environment and Development, Our Common Future (Cambridge, UK, and New York: Cambridge University Press, 1987).
2. A. C. Kelley, “The Population Debate in Historical Perspective: Revisionism Revised,” in N. Birdsall, A. C. Kelley, and S. W. Sinding, eds., Population Matters: Demographic Change, Economic Growth, and Poverty in the Developing World (Oxford, UK: Oxford University Press, 2001), 24–54.
3. P. McMichael, Development and Social Change: A Global Perspective (Thousand Oaks, California: Pine Forge Press, 2004).
4. A. J. McMichael, M. McKee, V. Shkolnikov, and T. Valkonen, “Mortality Trends and Setbacks: Global Convergence or Divergence?” Lancet 363, no. 9415 (2004): 1155–59; and R. Eckersley, “Is Modern Western Culture a Health Hazard?” International Journal of Epidemiology 35, no 5 (2006): 252-–58.
5. United Nations, “Process of Preparation of the Environmental Perspective to the Year 2000 and Beyond,” General Assembly Resolution 38/161, 19 December 1983.
6. WCED, note 1 above, page 1.
7. G. H. Brundtland, speech given at the launch of the WCED report, Oslo, Norway, 20 March 1987.
8. D. G. Victor, “Recovering Sustainable Development,” Foreign Affairs 85, no. 1 (January/February 2006): 91–103.
9. WCED, note 1 above, page 98.
10. Intergovernmental Panel on Climate Change, Climate Change. The IPCC Scientific Assessment (Cambridge, UK: Cambridge University Press, 1990).
11. Ibid.; and C. M. Wackernagel et al., “Tracking the Ecological Overshoot of the Human Economy,” Proceedings of the National Academy of Sciences 99, no. 14 (2002): 9266-–71.
12. Worldwide Fund for Nature International (WWF), Living Planet Report 2006 (Gland, Switzerland: WWF, 2006), http://assets.panda.org/downloads/living_planet_report.pdf (accessed 23 Aug 2007).
13. S. Rahmstorf et al., “Recent Climate Observations Compared to Projections,” Science 316, no. 5825 (4 May 2007): 709.
14. See R. L. Naylor et al., “The Ripple Effect: Biofuels, Food Security, and the Environment,” Environment  49, no. 9 (November 2007): 30–43.
15. Millennium Ecosystem Assessment, Ecosystems and Human Wellbeing. Synthesis (Washington, DC: Island Press, 2005).
16. UN Department of Economic and Social Affairs, Population Division, http://esa.un.org/unpp/p2k0data.asp (accessed 1 November 2007).
17. WCED, note 1 above, page 95.
18. WCED, note 1 above, page 95. This statement has faint resonance with the ideas of the late U.S. economist Julian Simon, whose book The Ultimate Resource made the tendentious argument that the more people on Earth the greater the probability of occurrence of important new ideas. J. L. Simon, The Ultimate Resource (Princeton, NJ: Princeton University Press, 1981).
19. A. J. McMichael and C. D. Butler, “Emerging Health Issues: The Widening Challenge for Population Health Promotion,” Health Promotion International 21, no. 1 (2006): 15–24.
20. McMichael, McKee, Shkolnikov, and Valkonen, note 4 above.
21. R. Smith, R. Beaglehole, D. Woodward, and N. Drager, eds., Global Public Goods for Health (Oxford: Oxford University Press, 2003).
22. M. Ezzati et al., “Rethinking the ‘Diseases of Affluence’ Paradigm: Global Patterns of Nutritional Risks in Relation to Economic Development,” PLoS Medicine 2, no.5 (2005): e133.
23. Brundtland, note 7 above.
24. Kelley, note 2 above.
25. M. Campbell, J. Cleland, A. Ezeh, and N. Prata, “Return of the Population Growth Factor,” Science 315, no. 5818 (2 February 2007): 1501–2.
26. WWF, note 12 above.


Millennium Development Goals: How Much Progress Has Been Made?

By coincidence, the 20-year anniversary of the Brundtland report nearly coincides with the halfway mark of another UN project, the Millennium Development Goals (MDGs), 2000–2015.1 The MDGs were launched in 2000 against a backdrop of increasing attention on what was termed “ecologically sustainable development,” in large part stimulated by the WCED report. They encompass eight goals (each with associated targets): to eradicate extreme poverty and hunger; achieve universal primary education; promote gender equality and empower women; reduce child mortality; improve maternal health; combat HIV/AIDS, malaria, and other diseases; ensure environmental sustainability; and develop a global partnership for development.

Achievement of the MDGs is becoming increasingly improbable as time passes. Some headway has been made in relation to poverty reduction and child school enrollment. But there has been little alleviation of hunger and malnutrition, maternal mortality, and infant-child death rates (which have declined by around one sixth in poorer countries, well short of the two-thirds reduction target).

Inevitably, progress toward the goals has varied between regions and countries. China, for example, has made social and health advances on many fronts, albeit at the cost of increasingly serious environmental degradation. In contrast, in sub-Saharan Africa, no country is coming close to halving poverty, providing universal primary education, or stemming the devastating HIV/AIDS epidemic. More than 40 percent of persons in sub-Saharan Africa live in extreme poverty.

One quarter of the world’s children aged less than 5 are underfed and underweight. This, as a proportion, is an improvement on the figure of one third in 1990. However, in sub-Saharan Africa and South Asia, nearly half the children remain underweight, and gains are minimal.

The total number of people living with AIDS has increased by nearly 7 million since 2001, to a total now of 40 million. Neither malaria nor tuberculosis is being effectively curtailed, with the attempt to reduce tuberculosis being threatened further by the recent emergence of strains with more extreme forms of antimicrobial resistance.
Perhaps this lack of progress is in part reflected in the UN’s failure to explore and emphasize the primary, interconnected role of Goal 7 for the achievement of the MDGs overall. Goal 7 seeks “environmental sustainability”—and achieving this particular goal is the bedrock for attaining most of the targets of the other seven goals. Without an intact and productive natural environment and its life-supporting global and regional systems and processes (such as climatic conditions, ocean vitality, ecosystem functioning, and freshwater circulation), the prospects are diminished for food production, safe drinking water, adequate household and community energy sources, stability of infectious disease agents, and protection from natural environmental disasters.

The subsequent treatment by the UN of Goal 7 in relation to its health implications has been rather superficial, and mostly in relation to familiar, localized, environmental health hazards. For example, the UN’s 2007 report on the MDGs focuses particularly on how Goal 7 relates to child diarrhoeal diseases. It states:
The health, economic and social repercussions of open defecation, poor hygiene and lack of safe drinking water are well documented. Together they contribute to about 88 per cent of the deaths due to diarrhoeal diseases—more than 1.5 million—in children under age five. Infestation of intestinal worms caused by open defecation affects hundreds of millions of predominantly school-aged children, resulting in reduced physical growth, weakened physical fitness and impaired cognitive functions. Poor nutrition contributes to these effects.2
More encouraging is the recent, wider-visioned approach taken by the UN Millennium Project, undertaken for the Commission on Sustainable Development.3 This project’s definition of “environmental sustainability” refers explicitly to the health impacts of environmental changes, and states as follows:
Achieving environmental sustainability requires carefully balancing human development activities while maintaining a stable environment that predictably and regularly provides resources such as freshwater, food, clean air, wood, fisheries and productive soils and that protects people from floods, droughts, pest infestations and disease.4

NOTES

1. UN Secretary General, Millennium Development Goals (New York: United Nations, 2000), http://www.un.org/millenniumgoals/goals.html (accessed 23 August 2007).
2. United Nations, The Millennium Development Goals Report 2007 (New York: United Nations, 2007).
3. J. Sachs and J. McArthur, “The Millennium Project: A Plan for Meeting the Millennium Development Goals,” Lancet 365, no. 9456 (2005): 347–53.
4. Y. K. Navarro, J. McNeely, D. Melnick, R. R. Sears, and G. Schmidt-Traub, Environment and Human Wellbeing: A Practical Strategy (New York: UN Millennium Project Task Force on Environmental Sustainability, 2005).


Recent Trends in Population Health


Human health experienced unprecedented gains last century. Globally, average life expectancy approximately doubled from around 35 years to almost 70 years.1 Rises in life expectancy have slowed a little in recent years in high-income countries. Meanwhile, rises are continuing (from a lower base) in much of the rest of the world. However, the regional picture is very uneven, and some divergence has occurred. The rise in life expectancy has stalled in much of sub-Saharan Africa, various ex-Soviet countries, North Korea, and Iraq (see the figure below). Meanwhile, health inequalities persist both between and within countries and reflect, variously, differences in economic circumstance, literacy, social institutions, and political regimen.

Sidebar figureImproved food supply is the likely cause of much of the health gain in modern western populations. The second agricultural revolution, which began in eighteenth-century Europe, brought mechanization, new cultivars, and, eventually, fossil fuel power. Consequently, the millennia-old pattern of subsistence crises diminished and then disappeared. The greater security and abundance of food apparently explains why adult males in northern European countries have grown around 10 centimeters taller and 20–30 kilograms heavier than their eighteenth-century predecessors.2 Others have argued that improved food quality and safety raised the resistance of better-nourished persons to infectious diseases.3

Despite these gains, an estimated 850 million persons remain malnourished. In absolute terms, that figure has grown since the time of the WCED report, including over the past decade.4 Meanwhile, it has become increasingly evident in both high-income and lower-income countries that an abundance of food energy, especially in the form of refined and selectively produced energy-dense (high fat, high sugar) foods, poses various serious risks to health.

In the 1980s, the general assumption was that these non-communicable diseases appear in the later stages of economic development and would increase with further gains in wealth and modernity. However, it has become clear in the past two decades that these diseases, particularly heart disease, hypertensive stroke, and type 2 diabetes, are increasing markedly in lower-income populations as they undergo urbanization and dietary change. The burden of cardiovascular disease—which accounts for around 30 percent of all deaths in today’s world—will continue this shift to low- and middle-income countries. This, plus the persistent infectious disease burden, particularly in poorer subpopulations, will further increase global health inequalities.5

NOTES

1. A. J. McMichael, M. McKee, V. Shkolnikov, and T. Valkonen, “Mortality Trends and Setbacks: Global Convergence or Divergence?” Lancet 363, no. 9415 (2004): 1155–59.
2. R. W. Fogel, The Escape from Hunger and Premature Death, 1700-2100: Europe, American and the Third World (Cambridge: Cambridge University Press, 2004).
3. T. McKeown, R. G. Brown, and R. Record, “An Interpretation of the Modern Rise of Population in Europe,” Population Studies 26, no. 3 (1972): 345–82.
4. Food and Agriculture Organization of the United Nations (FAO), The State of Food Insecurity in the World 2004 (Rome: FAO, 2005).
5. M. Ezzati et al., “Rethinking the ‘Diseases of Affluence’ Paradigm: Global Patterns of Nutritional Risks in Relation to Economic Development,” PLoS Medicine 2, no.5 (2005): e133. doi:10.1371/journal.pmed.0020133.

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