www.thelancet.com/diabetes-endocrinology Vol 2 June 2014 437
A thought for World Environment DayIt is undoubtedly an attractive conceptour species seeming indestructability is one that few of us bother to question. Certainly, given that the average lifespan of a mammalian species is about 1 million years, and that our own kind has likely been in existence for a mere 200 000 years, it is no wonder that many of us insouciantly presume that Homo sapiens will survive for many millennia hence. Indeed, history has clearly shown that the most certain outcome of a doomsayers hypothesis is that it will be disproven. So, when James Lovelock (of Gaia theory fame) hypothesised in a recent BBC Radio 4 interview that human beings only had another 100 000 years left, the most reasonable, tried and tested thing for us to do as a species would be to continue as we are, ignoring this conjecture.
Globally, humans are living longer, and in less poverty (in absolute terms) than previously. In health terms, the great leap forward in mortality reduction as a result of introducing sanitation measures has been consolidated in recent years by major reductions in morbidity and mortality related to HIV/AIDS, malaria, tuberculosis, childbirth, and undernutrition. Many of these current improvements in health have been brought about by eff orts galvanised in pursuit of the millennium development goals (MDGs). As the 2015 deadline for achieving these ambitious goals approaches, the health community will increasingly be refl ecting upon its eff orts; although wholesale celebrations would be misplaced, we should congratulate those people and countries whose labours have yielded these positive results.
However, every advance brings into sharper focus the next set of challenges, and progress in tackling the health related goals of the MDGs has highlighted a suite of interconnected problems that humans will face in the future. Changing climate and weather systems mean that natural disasters are becoming worryingly common; income inequality within and between countries is increasing sharply; concerns about water security are a perennial problem; and where once there was undernutrition and communicable diseases, obesity and non-communicable diseases (NCDs) now dominate in many rapidly developing areas of the world.
Daily human existence is (for most of us) increasingly disconnected from the hunter-gatherer lifestyle of our recent evolutionary past. Humans are excellently adapted
to walking and running long distancesa fi t human will outpace a horse over a suffi ciently large distancebut most of us now struggle to do even the small amount of recommended exercise. Many people hardly walk further than from front door to car, car to offi ce, and desk to coff ee machine each day. In both developed and rapidly developing countries, an ever-increasing number of calories are consumedoften produced with intensive farming techniques, and fl own thousands of miles before they reach our platesand obesity rates are soaring.
Advances in healthcare and technology have off set some of the harm of inactivity and dietary excess, allowing us to continue to add years to life; but, when facing a middle and old age blighted by obesity, type 2 diabetes, and other NCDs, can we really say that we are adding life to years? Additionally, our collective corpulence is not without external eff ect, and our environment bears many of the scars of our indulgence. Will this environment continue to sustain us both physically and mentally if population growthin both senses of the wordcontinues?
As the MDGs draw to a close, and we look to future goals, those who set the global agenda have an opportunity to come together to fi nd ways to tackle the newest threats that our species face. The healthy continuation of our species is tightly intertwined with that of the planet upon which we live. Therefore, our future eff orts to improve health care will need to be much more interdisciplinary. Progress in health will depend on progress in economics, resource management, environmental science and policy, and architecture and planning, to name but a few key areas. Initiatives such as the Planetary Health Commission acknowledge this need, and the upcoming Sustainable Development Goals need to remain fi rm in their recognition of this relationshipwe cannot have health in its broadest sense without environmental sustainability.
World Environment Day on June 5, 2014, off ers an opportunity to remind us of the inseparability of our environment and our health. Even if Lovelock is correct, we need to ensure that the next 100 000 years are not lived in misery among the ecosystems that we have ruined, but are years lived well, sustainably, and in harmony with our planet. The Lancet Diabetes & Endocrinology
See Comment Lancet 2014; 383: 847
For more on World Environment Day see http://www.unep.org/wed/