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MMMM This page intentionally left blank Human Frontiers, Environments and Disease This compelling account charts the relentless trajectory of humankind and its changing survival patterns across time and landscape, from when our ancestors roamed the African savannah to today’s populous, industrialised, globalising world. The expansion of human frontiers—geographic, climatic, cultural and technological—has entailed many setbacks from disease, famine and depleted resources. The changes in human ecology due to agrarianism, industrialisation, fertility control, social modernisation, urbanisation and modern lifestyles have profoundly affected patterns of health and disease. Today, while life expectancies rise, Earth’s ecosystems are being disrupted by the combined weight of population size and intensive consumption. The resultant climate change, stratospheric ozone depletion, loss of biodiversity and other environmental changes pose risks to human health, perhaps survival. Recognising how population health, long term, depends on environmental conditions can we achieve a transition to sustainability? Whilst the canvas that Tony McMichael covers is vast, the detail he brings to bear on this immense subject is both illuminating and dramatic. This account succeeds on many levels: as a chronicle of human colonisation and environmental impact; as a description of how recent technological changes have induced mismatches between our biological needs and our ways of living; and as an analysis of our rapidly changing demographic and social profile and its environmental and health consequences. As Tony McMichael argues in the Preface, ‘Humankind is now treading heavily upon the Earth. We have greatly increased the size of our “ecological footprint”. As we perturb Earth’s life-support systems, so we endanger the prospects for human population health and survival. The trail cannot continue much longer with footprints like these.’ Tony (A.J.) McMichael is Professor of Epidemiology at London School of Hygiene and Tropical Medicine. He has held positions in Australia, USA and UK, and has taught widely in Asia, Africa and Europe. He has advised WHO, UNEP, the World Bank and Intergovernmental Panel on Climate Change on dietary, environmental and climatic influences on health. He has enthusiasms for palaeoanthropology and social history. His previous book published by Cambridge University Press in 1993 was Planetary Overload (ISBN 0 521 55871 9), a widely acclaimed and influential account of global environmental change and health of the human species. Human Frontiers, Environments and Disease Past Patterns, Uncertain Futures Tony McMichael The Pitt Building, Trumpington Street, Cambridge, United Kingdom The Edinburgh Building, Cambridge CB2 2RU, UK 40 West 20th Street, New York, NY 10011-4211, USA 477 Williamstown Road, Port Melbourne, VIC 3207, Australia Ruiz de Alarcón 13, 28014 Madrid, Spain Dock House, The Waterfront, Cape Town 8001, South Africa http://www.cambridge.org © Anthony J. McMichael 2004 First published in printed format 2001 ISBN 0-511-03265-X eBook (Adobe Reader) ISBN 0-521-80311-X hardback ISBN 0-521-00494-2 paperback Central theme Humankind’s long evolutionary and historical experience shows how the social and natural environments affect patterns of disease and survival. Appreciating this ecological perspective on human population health—at a time when large-scale stresses are appearing in our world—is a prerequisite to achieving a sustainable future. Some comments on Human Frontiers, Environments and Disease ‘This impressive book by an eminent public health scientist explores our most important relationship: our interaction with the environment. It is essential reading for all concerned with assuring future human health—and our very survival.’ Robert Beaglehole Professor of Community Health, University of Auckland ‘This book achieves an unusual and important synthesis of the large-scale evolutionary, social and environmental influences on human health and survival. This ecological perspective, highlighting the history of disease and wellness, the state of our epidemiological environment, and the general impacts of recent cultural trends on well-being, is essential if we are to achieve a sustainable future.’ Paul R. Ehrlich Bing Professor of Population Studies, Stanford University, and author of ‘Human Natures’ ‘Human Frontiers, Environments and Disease is an innovative and constructive analysis of a problem fundamental to mankind, past, present and future. No one concerned with the bio-medical prospects of the human race could fail to find Professor McMichael’s accomplished account thought-provoking and eye-opening.’ Roy Porter The Wellcome Trust Centre for the History of Medicine at University College London ‘This is a splendidly written book—a revelation about human health over the millennia. From yellow fever to hypertension it underscores the larger framework of environment-health links. We will be better able to handle the future if more people read this insightful book.’ Thomas E. Lovejoy Smithsonian Institution, Washington, DC ‘Today, worldwide, most people live longer and are better fed than ever before. These benefits, however, have environmental and other costs. Tony McMichael’s book gives a well-organised and wide-ranging account of this human story and of its ecological underpinnings. The book concludes with a clear-eyed analysis of current threats to sustainability.’ Sir Robert May President, The Royal Society To Judith For lives shared Contents List of sources for illustrations Preface 11 Disease patterns in human biohistory 12 Human biology: the Pleistocene inheritance 13 Adapting to diversity: climate, food and infection 14 Infectious disease: humans and microbes coevolving 15 The Third Horseman: food, farming and famines 16 The industrial era: the Fifth Horseman? 17 Longer lives and lower birth rates 18 Modern affluence: lands of milk and honey 19 Cities, social environments and synapses 20 Global environmental change: overstepping limits 21 Health and disease: an ecological perspective 22 Footprints to the future: treading less heavily Notes Index Ключевые слова: interdependent self-regulating, pressure, science, carbon dioxide, industrial revolution, individual, autoimmune disorder, increasing, disease, africa, chapter, carrying capacity, sandy beach, subsequent recovery, infective agent, rate, raymond dart, mary leakey, journal, sri lanka, diabetes, selection, environment disease, cold wet, century, private sector, cultural norm, tsetse, specie, health, evolution, idea, infectious, yellow fever, modern, intellectual stunting, homo sapiens, agriculture, gain, land-dwelling arthropod, long, rmer footing, lymphoid tissue, expectancy, death, greenhouse gas, self, lancet, diet, local, easter islanders, sickle-cell anaemia, frontier, poetic licence, biological, kiple, york norton, infectious disease, year, chemical, age, guns germs, romani gypsies, york harper, ?rst, meat, socioeconomic disadvantage, york, complex, ultraviolet radiation, ecological footprint, stone tool, decade, western, genetic, life expectancy, heart disease, animal, infectious agent, capacity, amino acid, increase, risk, genetic code, dietary, congenital anomaly, arctic circle, number, ecological decit, change, environmental, evolutionary, notes, impact, waterlow, spread, land, growth, genetic trait, mental disorder, daily journey, nio, latin america, major contributor, urban commons, ha, genetic bottlenecking, society, agricultural organization, molecular structure, life, hurricane mitch, neanderthal relative, davey smith, nature, exposure, study, survival, john, mcmichael, spanish conquistador, natural, environmental geochemistry, york alfred, increased, germline therapy, cell, condition, lloyd ger, harp seal, evidence, dark ages, great, green revolution, type, pattern, step, roman empire, europe, czech republic, future, food, wa, infection, demographic entrapment, environmental trigger, nitrous oxide, fertile crescent, genetic adaptation, global governance, water, rise, ecological, hong kong, soviet bloc, famine, population, nitric oxide, genetic predisposition, early, pima indians, blood, allergic disorder, beringian land-bridge, problem, genetic modication, malaria, mortality, high, prefrontal cortex, socioeconomic dierentials, global, socioeconomic inequality, urban, nutritional status, gene, cancer, production, human frontier, homo ergaster, press, homo erectus, london, ecological imperialism, uterine cervix, energy, time, history, occurred, development, question, peripheral nerve, economic, people, hay fever, level, cystic brosis, city, fatty acid, stearns, living, frontier environment, le, strategy, process, heart, plant, human ecology, darwinian tness, worlds food-producing, social, brain, environment, country, virus, earth, porotic hyperostosis, triatomine bug, climate, large, human