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by Tony McMichael, National Centre for Epidemiology and Population Health, The Australian National University.
Wealth, power and influence have long been the dominant, universal, motifs in national aspiration and identity. Those values die hard. Indeed, they probably are an expression of the evolutionary hardwiring of the human species. Over hundreds of millennia, “fitness”, in the value-free survival stakes, has accrued to the family groups, tribes and societies that have found ways of maximizing those three attributes.
Today the world comprises approximately 230 nation-states, many of them relics of nineteenth-century power-plays and others the sometimes artificial products of twentieth-century decolonisation. These nation-states persist with this abovementioned ancient competitive tradition, primarily in pursuit of materialist objectives, and often tinged with aggression and self-righteous ideological fervour. While the world’s national and subnational populations are a wonderful manifestation of human historical and cultural diversity, they also perpetuate longstanding tensions and competitive strivings. They thus facilitate a world of winners and losers, as free “globalised” markets become the organising principle of inter-national trade and relationships. We live in such a world; a world where, according to most criteria, economic and political inequality persists – indeed, even increases – despite the rhetoric and the sometimes specious international statistics.
Australia is caught up in the prevailing paradigm of “economic growth”, with little heed being paid to social, environmental and spiritual costs. Our Prime Minister, in recent times, stated that the national government’s main objective for this first decade of the 21st century is to achieve an average annual economic growth rate of 4%. This has been described recently by Clive Hamilton as a “growth fetish” – a preoccupation with material acquisition, to the neglect, often the detriment, of other emerging social concerns. The agendas of environmentalism, urban planning, social and spiritual wellbeing, and sustainability-at-large all remain sidelined while we persist with the politics of wealth creation, (competitive) consumerism, traditional notions of “battlers” and “disadvantage”, and, now, homeland security.
Richard Eckersley and others have shown that a plethora of data reveals that levels of happiness have not increased, and may even have receded in recent decades in Australia (and in other developed nations), while psychosocial problems such as depression, drug abuse and suicide have increased among young people. We are consuming more, but enjoying life a bit less. Further, unthinkingly, we have now ventured deep into an unprecedented level of household consumer debt. Australian families have, in the past half-decade, been spending against as-yet unrealised (and unguaranteed) capital gains on property. Harvey Norman stores report escalating annual profits.
As this consumerism rises, so does our collective ecological footprint. The value that we extract from nature is now greater than can be naturally replaced. Hence, we have moved into ecological debt. Evidence for this is now all around us, including: (i) our contribution to global climate change via the excessive emissions of greenhouse gases, (ii) the continued decline in freshwater availability and quality, (iii) salinization of much arable land, (iv) depletion of various coastal fisheries and shell-fisheries, (v) the extinction of plant and animal species, and (vi) the inexorable spread of exotic species (such as the cane toad, river carp, African grasses throughout the Top End, etc.).
So, how does an epidemiologist relate to this? Well, viewed fulsomely, epidemiology is about understanding the determinants of human wellbeing and health at a whole-of-population level. While most epidemiologists address questions that pertain to the recent past (has the introduction of hormone replacement therapy affected breast cancer rates?) or the present (is obesity associated with increased blood pressure?), there is growing recognition of the need to elucidate and estimate the impact of today’s trends on tomorrow’s health outcomes. The perspectives of ecology have recently fostered the subdiscipline of “ecological economics”. Similarly, an increasing minority of epidemiologists are addressing larger and more complex questions about current and future changes in human ecology and in the natural ecosystems upon which we depend for “life-support”. Those “ecological” epidemiologists (I number myself among them) are registering concern and research interest in studying how these ongoing social and environmental trends affect, or will affect, human wellbeing and health.
Some of our current public health concerns need to be understood within this framework. We now are, according to mainstream statistics, the second fattest nation on Earth – after the “fast-food nation” Americans. While the stomach-banding surgeons, the multinational drug companies, and the gene therapists line up to profit from the medicalisation of Australian obesity, the real explanation for this expanding problem lies in the radical shifts in social diets and daily patterns of physical activity. We have, through wealth creation, transformed the way that we live. We have achieved that elusive nirvana which, for all of history up to modern times, has lain beyond the horizon from the rigours of natural selection – the capacity to find and consume a high level of food energy while expending minimum energy in so doing. Obesity is not a problem of aberrant individual behaviour. It is a manifestation of a collective social lifestyle that has become increasingly out of kilter with basic human biology.
On the environmental front there is much evidence that the prospects for good nutrition and health, for harmonious social existence, and for freedom from conflict and warfare depend on societies living within the constraints of the natural environment. Repeatedly, in past societies and civilizations that attempted to live beyond Nature’s means, the levels of health and survival have been adversely affected. As a clever (though not obviously wise) species, we have many ways of expanding the human carrying-capacity of the natural environment – through agriculture, fossil fuels, synthetic chemical additives, trade, introduced food species and so on. However, this expansion must be carried out within the capacity of the natural world. In Australia it is evident that our irrigation practices have exceeded this natural capacity. As a major agricultural exporter we are, inadvertently, exporting our stocks of soil nutrients (trace elements). Our dietary dependence on cloven-hoofed European mammals has occasioned great damage to our topsoils and to woodland and forest. In the long run this is not a wise way to manage our (relatively fragile) natural resource base. We must, therefore, reorganize our priorities and practices in ways that sustain the Australian resource base for future generations.
Population size is another, obvious, determinant of human society’s environmental impact. Similarly, the demographic distribution of population affects the pattern of impact. Australia’s high level of coastally-based urbanization intensifies the pressure on particular regions and ecosystems. There is no certain answer to the perennially controversial question about Australia’s optimal population size. The answer depends on several things: (i) levels of consumption, (ii) choice of technologies or production methods, (iii) whether we do the “human carrying capacity” arithmetic for Australia on its own or for the whole world, (iv) notions of security, (v) etc. The point is not to argue about which criterion should prevail. The first-order need is to get the several main interest-groups and academic disciplines to engage constructively in a discussion about how to balance competing and complementary criteria.
Of course, no such local intra-Australian strategy makes sense if we continue to live in a “fortress world” wherein the problems of population density, poverty, tension and strife persist or proliferate in the world’s poorer countries. We Australians should strive to temper our fears and anxieties over “terrorists” and queue-jumping refugees with a recognition that, internationally, a stitch in time will save nine. That stitch can only be via a paradigm-shifting shakeup in aid and trade regimes, entailing the (barely thinkable) levelling up of material conditions and opportunity between nations and regions, and by collective commitment to environment-friendly technologies.