Elsevier

The Lancet

Volume 356, Issue 9228, 5 August 2000, Pages 495-499
The Lancet

Public Health
The changing global context of public health

https://doi.org/10.1016/S0140-6736(00)02564-2Get rights and content

Summary

Future health prospects depend increasingly on globalisation processes and on the impact of global environmental change. Economic globalisation—entailing deregulated trade and investment—is a mixed blessing for health. Economic growth and the dissemination of technologies have widely enhanced life expectancy. However, aspects of globalisation are jeopardising health by eroding social and environmental conditions, exacerbating the rich-poor gap, and disseminating consumerism. Global environmental changes reflect the growth of populations and the intensity of economic activity. These changes include altered composition of the atmosphere, land degradation, depletion of terrestrial aquifers and ocean fisheries, and loss of biodiversity. This weakening of life-supporting systems poses health risks. Contemporary public health must therefore encompass the interrelated tasks of reducing social and health inequalities and achieving health-sustaining environments.

Section snippets

The advent and consequences of globalisation

“Globalisation” refers to various interrelated processes of global interconnectedness.16 Two core components are economic globalisation and the associated ascendancy of deregulated markets in international trade and investment. Two other important domains are technological globalisation, especially of information and communication technologies, and cultural globalisation where popular culture is increasingly dominated by the USA and the English language. There is also an emerging globalisation

Globalisation and population health

From a public-health perspective, globalisation appears to be a mixed blessing.16, 17 On the one hand accelerated economic growth and technological advances have enhanced health and life expectancy in many populations. At least in the short-to-medium term, these material advances allied to social modernisation and various healthcare and public-health programmes yield gains in population health. On the other hand, aspects of globalisation jeopardise population health via the erosion of social

Global environmental change and health

A major manifestation of the increasing scale of the human enterprise is the advent of global environmental changes. Whereas not directly caused by the globalisation processes discussed above, global environmental change reflects the increasing magnitude of population numbers and the intensity of modern consumer-driven economies.34 Humankind is now disrupting at a global level some of the biosphere's life-support systems,8, 35 which provide environmental stabilisation, replenishment, biological

Global climate change

Climate scientists forecast that the continued accumulation of heat-trapping greenhouse gases in the troposphere will change global patterns of temperature, precipitation, and climatic variability in the coming decades.38 A rise of 1–3°C during the next half-century, greater at high than at low latitudes, would occur faster than any rise encountered by man since the inception of agriculture around 10 000 years ago. The UN's Intergovernmental Panel on Climate Change and various other national

Stratospheric ozone depletion

Depletion of stratospheric ozone by man-made gases such as chlorofluorocarbons has been occurring during the past few decades and is likely to peak by about 2020. Ambient ground-level ultraviolet irradiation is estimated to have increased by up to 10% at mid-to-high latitudes during the past two decades.43 Scenariobased modelling, integrating the processes of emissions accrual, ozone destruction, ultraviolet irradiation flux, and cancer induction, indicates that European and US populations will

Biodiversity loss and invasive species

As man's demand for space, materials, and food increases, so populations and species of plants and animals are being extinguished increasingly rapidly. An important consequence for human beings is the disruption of ecosystems that provide “nature's goods and services”.35 Biodiversity loss also means that we are losing, before discovery, many of nature's chemicals and genes, of the kind that have already conferred enormous medical and health benefits. Myers estimates that five-sixths of tropical

Impairment of food-producing ecosystems

Increasing pressures of agricultural and livestock production are stressing the world's arable lands and pastures. We enter the 21st century with an estimated one-third of the world's previously productive land seriously damaged by erosion, compaction, salination, waterlogging, and chemicalisation that destroys organic content.32, 47, 48 Similar pressures on the world's ocean fisheries have left most of them severely depleted or stressed.49 Almost certainly we must find an environmentally

Other global environmental changes

Freshwater aquifers in all continents are being depleted of their ancient “fossil water” supplies. Agricultural and industrial demand, amplified by population growth, often greatly exceeds the rate of natural recharge. Water-related political and public-health crises loom in some regions in the next few decades.32

Various semivolatile organic chemicals (such as polychlorinated biphenyls) are now disseminated world-wide via a sequential “distillation” process in the cells of the lower atmosphere,

Conclusion

The mix of rapid processes of socioeconomic change, demographic change, and global environmental change in today's world requires a broad conception of the determinants of population health. A deficiency of social capital (social networks and civic institutions) adversely affects the prospects for health by predisposing to widened rich-poor gaps, inner-urban decay, increased drug trade, and weakened public-health systems. The large-scale loss of natural environmental capital—manifested as

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