Globalization and the Sustainability of Human Health

205 ozone, biodiversity, terrestrial and marine food-producing ecosystems, and the great cycles of water, nitrogen, and sulfur (Meyer 1996, Vitousek et al. 1997). These systems sustain the conditions on which life depends, and their weakening may therefore have profound long-term implications for human population health (McMichael 1993, Last 1997). Much of the recognition of how these unprecedented large-scale environmental changes may jeopardize human health has emerged, albeit tentatively, during this current decade. For example, the First Assessment Report of the Intergovernmental Panel on Climate Change (IPCC), published in 1990 (Houghton et al. 1990), paid scant attention to the risks to human health that are a consequence of climate change, although it dealt in detail with the potential impacts of farms, forests, fisheries, water catchments, and other systems. In contrast, IPCC’s Second Assessment Report (IPCC 1996) gave a much more detailed consideration to the potential health impacts of climate change. The report noted that “The sustained health of human populations requires the continued integrity of Earth’s natural systems.” This latter statement invokes an unfamiliar idea. The dominance of urbanism and individualism within modern Western culture has diminished people’s awareness of the dependence of continued good health on the natural world. We tend to focus instead on immediate, local, tangible influences on personal health, thus viewing health primarily as an individual asset to be transacted within the health care system and enhanced by prudent individual behavior (supplemented by regulatory protection). The ethos of modern epidemiological research, with its predominantly reductionist approach to studying disease causation by cataloging proximate risk-factor behaviors and exposures, has reinforced this individual-centered view of health and disease (Loomis and Wing 1990, Pearce 1996). There are, however, important influences on health that operate at the population level—some of which do not translate directly into individual-level factors. An awareness that the health of a population reflects ecological circumstances has long been applied by ecologists to nonhuman, especially wild, species (Anderson 1982, Odum 1992). To understand these larger-scale ecological influences on human health, Globalization and the Sustainability of Human Health