The European Journal of Public Health Advance Access originally published online on July 28, 2006
The European Journal of Public Health 2006 16(6):581-582; doi:10.1093/eurpub/ckl101
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Viewpoints |
Shipwrecks and sudden deaths
Jørn OlsenDepartment of Epidemiology, UCLA School of Public Health, Box 951772, Los Angeles, CA 90095-1772, USA
Correspondence: Professor and Chair Jørn Olsen, MD, PhD, Department of Epidemiology, UCLA School of Public Health Box 951772, Los Angeles, CA 90095-1772, USA, tel: +310 825 8579; fax: +310 206 6939, e-mail: jo{at}ucla.edu
In countries where we have good historical population statistics life expectancy has increased with a remarkable 3 months per year, year after year during the past 160 years.1 The main causes of this development must be improvements in social conditions, broadly defined. Only wars and pandemics of deadly infectious diseases have left visible marks on the life expectancy curve. So what is the problem? All is fine; it's fine, it's fine.
Except for a few things, which we may have overlooked. The remarkably long-lasting gain in life expectancy is seen in affluent societies. We do not have good data for poorer countries and the continuing increase may not be sustainable, although demographers may be right in concluding that we have not yet seen any sign of a maximum life expectancy. It is hard to believe we will not be caught up with biological realities that will slow down the future progress. And there may be environmental hazards, as pointed out by McMichael,2 which may dramatically change things. Maybe a society cannot sustain a thirst for oil, and most likely we cannot if our thirst for oil will be shared by people in China and India. At present people in Africa emit less than 1 ton of carbon dioxide, in the UK 10 tons, and people in the US 20 tons.3 Much of this stems from using oil to generate energy rather than using other clean sources of energy, and this practice comes with a price tag. We see that personally at the pump but that may just be the smallest part of the bill. Climate change and its potential health effects may carry a much larger bill. Good for us, we have skeptical environmentalists like Lomborg4 to tell us that all is fine; it's fine, it's fine.
The warning to epidemiologists is timely. Epidemiologists, at present, behave like kids being on a football field for the first time. All follow the ball and nobody thinks about a more strategic way of organizing the game. If the game is fighting poor health on a global scale, somebody should plan ahead, and be where the ball may come rather than where it is at present. All the hype is about biological mechanisms of diseases. That is where the ball is but we should not forget that diseases have more upstream causes. By following this present trend we will lose the big picture. We will become prisoners of the proximate—to use one of McMichael's terms.
We may excuse ourselves by saying that we are just following the ball because that is where the money is. A country like Denmark even has an official research policy called ‘from idea to invoice’. If we want to survive or even grow we have to follow the money but that is a poor excuse. Academic institutions are obliged to be independent of political trends, and part of our public health role is to make predictions although predictions are risky because the future will reveal mistakes. Time will tell whether climate change will continue and change the health conditions of millions of people but if we wait until we know, it will be too late. At present many things look fine; not counting the 10 million children who die every year, mainly in poor countries5 and that rich countries use >90% of all health care expenditures but carry <15% of the burden of diseases.6 Except for that; all is fine; it's fine, it's fine.
A change in climate will affect not only the usual victims of poor health but also affluent societies. We cannot change the development by buying rights to emit carbon dioxide from African countries. In the long run we have to do something about this problem if McMichael is right, also at the personal level. Some still believe the pessimisms reflect our fascination of disasters as described in one of Tom Kristensen's poems that starts with his longing for ‘shipwrecks and sudden deaths’. If McMichael is right and we are now overloading the capacity of the ecological system, we have passed the state of interesting dinner conversations. If so, some epidemiologists should change their focus from microepidemiology to macroepidemiology. Maybe we should start focusing on the big picture. Maybe not all is fine.
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1 Oeppen J, Vaupel JW. Broken limits to life expectancy. Science 2002;296:1029–31.
2 McMichael AJ. Population health as the ‘bottom line’ of sustainability: a contemporary challenge for public health researchers [comment]. Eur J Public Health (in press).
3 Stott R. Contradiction and convergence: healthy response to climate change. Br Med J 2006;332:1385–90.
4 Lomborg B. The Skeptical Environmentalist. Cambridge, UK: Cambridge University Press, 2001.
5 Lopez AD, Mathers CD, Ezzati M, et al. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006;367:1747–57.[CrossRef][Web of Science][Medline]
6 Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: global burden of disease study. Lancet 1997;349:1436–42.[CrossRef][Web of Science][Medline]
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