Earlier this month, the British medical journal the Lancet asked interested parties to register their support for a “manifesto for transforming public health calls for a social movement to support collective public health action at all levels of society.”
“This manifesto for transforming public health calls for a social movement to support collective public health action at all levels of society—personal, community, national, regional, global, and planetary…. Our goal is to create a movement for planetary health,” declares the Lancet.
In a response published in Forbes, Tim Worstall, a fellow at the Adam Smith Institute in London, argues that the manifesto was “a distortion of public health,” which he believes “is more about the health of the public than any bleatings about social justice and fairness.” The Lancet manifesto, he says, reads as a way to impose socialism. His view of public health is that it should be limited to addressing “specific technical problems.” While it is certainly “about vaccinations and making sure that the drains work,” he writes, public health is not about “social justice nor fairness.” Puzzled, we reached out to him on Twitter.
Worstall responded that “public health is about the public good of health, not the good health of the public.” Think reducing social inequalities is a noble public health goal? Think again. Not only are your intentions misplaced, you are most likely a Marxist.
Justice and fairness are at the heart of public health. The sole mission of the American Public Health Association is to “improve the health of the public and achieve equity in health status.” On a global scale, the World Health Organization’s first point on its agenda is promoting development. “Health development is directed by the ethical principle of equity: Access to life-saving or health-promoting interventions should not be denied for unfair reasons, including those with economic or social roots.”
As the Lancet manifesto notes, the harms that humans inflict on our planetary systems are problems with deep economic and social roots. For this reason, the manifesto advocates that we “make resilient the planetary and human systems on which health depends by giving priority to the wellbeing of all.”
On that note, we believe that Earth Day is an opportune time to make the conceptual and visual connection between public health and environmental problems—air pollution, ozone depletion, water pollution, flooding, drought, reforestation, and antibiotic resistance. —June Kim
Less than three weeks into 2014, Beijing experienced one of its “airpocalypse” days, when the air quality level from pollutants is so bad that it can no longer be measured, and it is recommended that people avoid going outside. The quick pace of industrialization and urbanization in Asia and Africa have brought with it all kinds of public health hazards, from vehicle exhaust, to factory emissions, to the dirty smoke produced by rudimentary cookstoves while regulation has been minimal to nonexistent. But even in places that are accountable to pollution standards, such as the United Kingdom, the government has been criticized in many quarters for its inaction. With overwhelming evidence that bad air quality leads to a variety of health problems and shortens life—last month, the WHO reported that one out of eight global deaths is the result of air pollution exposure—some countries are finally starting to talk about imposing air quality standards. Although China’s rapid industrialization used to be a source of fear in America, evidence that pollution is hurting China’s economy, causing social unrest, and affecting weather patterns, should give regulators here pause when they begin to talk about compromising on government regulatory authority. —Elaine Meyer
A tourist wearing the mask visits the Tiananmen Square at dangerous levels of air pollution on January 23, 2013 in Beijing, China. The air quality in Beijing hit serious levels again, as smog blanketed the city. (Photo by Feng Li/Getty Images)
View of the Forbidden City in Beijing, China, clouded by air pollution.
Air pollution in Kerala, South India.
Earth is covered by a stratospheric ozone layer that absorbs incoming ultraviolet radiation from the sun. Over the past decades, scientists confirmed that this layer was being destroyed by industrial chemicals such as chloroflourocarbons and methyl bromide. In the 1980’s, the depletion in this protective layer was recognized by governments as a health hazard and the Montreal protocol in 1987 was adopted to phase out ozone-damaging gases. The link between the increased exposure to ultraviolet radiation and the rapidly increasing rate of skin cancer has been studied extensively. Skin cancer is the most common cancer in the U.S. In Great Britain, the BBC reports that the incidence of malignant melanoma, one of the most serious forms of skin cancer, is five times higher than it was in the 1970’s. In addition to skin cancer, the increase in UV radiation has also been implicated in effects on immunity and eye damage. Let’s keep the suntan lotion applied, shades on and umbrellas up until we let this planet’s protective layer heal. —Ambereen Sleemi
Ozone, which absorbs UV rays emitted by the sun, has been depleted systematically over a number of decades.
Ozone depletion is associated with an increase in the incidence of skin cancer.
One of the most serious cases of drinking water contamination took place on January 9th, 2014, where 10,000 gallons of a coal-processing chemical spilled into the Elk River in Charleston, West Virginia. Though a ban was placed on tap water immediately after the incident (eventually lifted after nine days), the Centers for Disease Control (CDC) and state-hired toxicologists have gone back and forth for months regarding the current safety of this water supply that serves 300,000 West Virginians. CDC toxicologists have declared that chemical levels as of early April are far below concentrations that would be expected to cause health problems; however, there have been a slew of reported rashes, headaches, and gastrointestinal problems from citizens affected by the chemical spill.
The coal industry is one of the powerhouses of West Virginia’s economy and the spill has been dubbed “an accident with no clear ending” as residents of the nine affected counties are left without an answer to one of the most crucial questions, “Is the water safe?” Moreover, political support in West Virginia has wavered as much as environmental experts’ analysis of the safety of the water supply. West Virginia Governor, Earl Tomblin told residents, “It’s your decision,” regarding whether they should feel safe using the drinking water emphasizing that if they do not feel comfortable, they should resort to bottled water. —Chris Tait
Testing contaminated water.
Near Augusta, Maine, water for drinking and cooking predominantly come from household wells. A study led by researchers at Columbia University investigated arsenic exposure in schoolchildren in this region, finding a negative association between arsenic in drinking water and child intelligence. In addition to this finding, researchers identified almost one-third of all samples taken in the study as exceeding both the World Health Organization’s (WHO) and the Environmental Protection Agency’s (EPA) maximum contaminant level guideline for arsenic.
Elsewhere around the world, other environmental exposure are causing further reasons for concern. Nigeria experienced a crisis in 2009 and 2010 that saw 400 children die as a result of lead poisoning released during mining in the northwestern region. The situation has been attenuated such that the proportion of families who previously processed the lead-laden gold ore in their own yards has decreased from seventy-one to five percent since the CDC and Doctors Without Borders have intervened. However, children who survived are burdened with the consequences of severe exposure including mental retardation, blindness, and developmental delays. Back in the U.S., home improvement giant Lowe’s is facing the heat after a federal investigation found the company in violation of safety standards for lead paint in nine states. —Chris Tait
Well water, a reservoir of risk.
Rising sea levels are expected to increase coastal flooding across the globe, and flooding has numerous, complex effects on human health. Deaths and injuries sustained during the flood represent the most immediate impact on human well-being. Physical trauma, heart attack, stroke, dehydration, and lack of access to necessary medical supplies can all be fatal consequences of flooding conditions. But victims also suffer long-lasting physical and mental health effects in the aftermath of the disaster. These include dermatitis, asthma, chest infections, stomach illnesses from exposure to contaminated water, depression, and anxiety. These ailments can be exacerbated by loss of social contact, geographic displacement, and loss of possessions. Efforts to address climate change, to improve flood forecasting, and to develop appropriate land use measures could all help mitigate the harmful health effects of flooding. —Kathleen Bachynski
Historical records since the 1950s and analyses of current trends suggest an increased risk of drought in the 21st century across the globe. This will pose a major public health challenge, because drought leads to critical water and food shortages. In the United States, the Dust Bowl during the 1930s was an especially dramatic historical example of the hunger, disease and death that drought can cause. Some observers fear that with climate change, future “dust-bowlification” could have a devastating impact on food security. Drought can also negatively impact air quality, exacerbate asthma and other respiratory conditions, and increase the risk for wildfire and dust storms. —Kathleen Bachynski
Disruptions to the ecological balance of a geographic area can set off a chain of events leading to human health risks and disease as the last link. Although tropical populations are more vulnerable to such effects, they are seen throughout the planet. In the U.S., a period of drought in the southwest followed by heavy rain and snowfall resulted in a surge in deer mice in 1993. The mice were carrying a hantavirus that infected 17 people, killing 13 of them. A more direct result of human involvement has led to a tremendous increase in the incidence of Lyme disease. While deforestation has had a massive impact on global health, reforestation in the U.S. is credited with the spike in Lyme disease infections. Deer carrying the infecting ticks have flourished in former farmlands that have reforested, resulting in 35,000 reported cases each year. —Patches Magarro
Lyme disease is associated with reforestation, an effort to repopulate trees that have been cut down.
Every year in the United States, at least 23,000 people die of infections directly caused by antibiotic resistant bacteria. Antibiotic resistance is even making ancient diseases, such as tuberculosis, increasingly difficult to treat with currently available medications. To respond to this growing global public health threat, we need to understand the ecology of antibiotic resistant genes and how they spread through the environment. Overuse of antibiotics, whether for treating human disease or for supplementing animal feed, contributes to antibiotic resistance. The spread of these resistant bacteria is also upsetting the delicate balance of microorganisms in our environment, and contaminating public water supplies. Careful stewardship of our food and water systems, natural resources, and currently available antibiotics are necessary to respond to this public health threat. —Kathleen Bachynski
Antibiotic resistant bacteria are on the rise as a result of overuse of antibiotics.
Edited by Dana March, with Elaine Meyer