Abstract

In addition to good medical services, all aspects of an economy must work together to ensure a high level of public health. However, the abundant economies of the North are contributing heavily to global environmental disaster, with increasing concomitant damage to human health. Environmental health problems result from toxicity (i.e., pollution), scarcity (i.e., poverty), and energy degradation (i.e., entropy). Common to these three factors in environmental demise are the limits of the Earth. Production has evolved to a point where the Earth is no longer safe from radical depletion. Therefore, simple living is a necessary feature of global public health. Rarely do readers of this journal see these limits first hand, but they are real. Our limited perceptions and efforts hinder our ability to understand how to reduce the impact of production on natural ecosystems. Contrary to standard media portrayals, growth and technology cannot solve our public health problems, because they are unequally distributed across the world and neither can they solve the problem of limits. The need for modest consumption in developed nations is an essential and almost completely ignored element of the answer to environmental and associated health problems. A radical and rapid change to public health is needed in order to avoid abysmal global health consequences during the next century. These changes involve a restructuring of our economy, including the health care industry. In the short run, this is an ethical demand. In the long run, this is an inevitability. The actual and appropriate role of bioethicists in championing these changes is unclear. (Abstract by Bruce R. Smith)