Feature

Growing up sustainable

Far from being a goal to strive for, uncontrolled economic growth may now present the greatest risk to the health of our children. Hugh Crombie explains

Damage to ‘the health of the planet’ is widespread, and includes examples ranging from fume-laden urban air, polluted water supplies and toxic waste tips to the loss of whole species and changes in the earth’s atmosphere. Such damage is rarely experienced by the polluters, or even by the current generation. And it is concern for future generations that lies at the heart of sustainability — meeting the needs of the current generation without compromising the potential for future generations to meet their own needs. Sustainability demands that our levels of consumption are limited by the capacity of our environments to restore themselves.

Our beliefs about health have changed over the years in parallel with our views of science. In the nineteenth century those concerned with public health realised that sanitary conditions such as housing and sewerage disposal had a profound influence on health. This led to the great Victorian achievements in public health policy, including the provision of sanitary engineering. This was followed by the Edwardian welfare reforms of provision of education, school meals and school health and nursing services. It is interesting to note that much of the impetus behind this concern for the health of the school populations arose from public dismay at the poor state of health of military recruits to fight the Boer war. As science and medicine progressed during the twentieth century the emphasis switched towards therapeutic interventions, greatly encouraged by the development of antibiotics and insulin during the 1930s. The feeling that science and technology could solve any problem became widespread. During the 1970s this view came under attack by authors such as Thomas McKeown and Ivan Illich, who suggested that the contribution of medicine to the defeat of the major killers of previous generations was not as large as was claimed. The WHO initiatives in primary care and public health which underpin the Health for All by the Year 2000 strategy form the basis of the new approach. Now the emphasis is firmly on the social and environmental milieu within which we all experience ‘health’.

Environmental impacts on health are widespread. They vary from direct impacts such as triggering of asthma in susceptible individuals by air pollution, damage from excess ultraviolet light due to loss of stratospheric ozone or road accidents to more subtle effects such as the damage to communities by roads and the loss of local shopping facilities due to the development of out of town shopping centres. Change in the global climate also threatens to cause human ill health, by direct physical factors such as floods and hurricanes, as well as through loss of land necessary for habitation and agriculture. The possible damage caused by loss of species and natural habitats cannot be assessed. At the very least, it is likely that the world’s forests contain a wealth of species which have potential benefit to humans, even without considering the less quantifiable questions of moral and aesthetic costs.

Economics have a major influence on health and the environment. National economic indicators such as GNP are considered in many quarters to be a proxy for the health experience of a nation. The higher the national income measured by GNP the better are indicators such as life expectancy, and so an increase in GNP (‘economic growth’) becomes a goal to strive for.

But the benefit of an increase in GNP levels off after a while. Doubling income per capita from $1,000 to $2,000 in 1990 resulted in an increase in life expectancy of 11 years. Starting from a level of per capita income of $4,000, the gain is four years. And there is evidence that the distribution of income within a country is of major importance overall levels of health. Looking at life expectancy in the UK and Japan demonstrates this. In 1970, the two countries had similar life expectancies and income distribution patterns. Since then they have diverged, and Japan, with a highly equitable pattern of distribution, has the highest life expectancy. In the UK, where income inequality has widened, life expectancy is now three years below that of Japan. Such evidence is also available from other countries. Those which have more egalitarian income distributions have achieved greater improvements in life expectancy than those where income distribution has widened.

Economic activity does not invariably damage the environment provided it occurs within the capacity of the environment to restore itself. But now increasing individual consumption has reached a level where damage is occurring. Collective effects, not necessarily chosen by any individual, exceed environmental capacity and so degrade the environment. It is essential to control human activities to prevent this occurring. Market forces are sometimes suggested as the most appropriate method of reducing environmental damage by including their costs in the price of the finished product or service. But because the damaging effects may not felt locally or even in the same generation, and the costs of environmental destruction are so often intangible or — literally — incalculable, market forces are insufficient to protect the environment.

The best available environmental information shows that the current state of the environment is already damaging people’s health. Environmental degradation is increasing and it is likely to continue. There is nothing inevitable about this: although economic activity can result in environmental degradation, it can also occur within the limits of environmental capacity. A move towards a sustainable state would result in improvements in both human and planetary health.

The Public Health Trust is currently examining these links with the intention of producing an action pack. This will examine examples of environmental schemes from a health perspective. If you know of examples of schemes which may show health benefits, please write to: Hugo Crombie, Public Health Trust, BVSC, 138 Digbeth, Birmingham B5 6DR.