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Rapid Responses: Rapid Responses published:
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The health of nations and ecology
- David L.J. Freed (23 December 2008)
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But we did see it coming ...
- David I Boorer (26 December 2008)
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The Health of Nations
- Harald M Lipman (5 January 2009)
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David L.J. Freed, allergist 14 Marston Road, Salford, M7 4ER
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McKee and McMichael paint a bleak picture of the prospects for human survival, but in truth their survey of mankind illustrates a universal law of population growth, whether the population be of bacteria, lemmings or humans. I imagine economists recognise the same law. Put an Escherichia coli on a petri dish on its own, with no competition, and it will shortly enter a logarithmic growth phase in which its number doubles every 20 minutes (almost as fast as the clonal expansion of bureaucrats in our brave new post-democratic Britain, as they battle to prevent all productive work). Such reckless growth can of course not be sustained very long; the population number soon reaches a plateau, as the resources are used up and toxic metabolites accumulate, then starts to fall again. The stronger individuals survive the longest, but eventually all die. We humans are just as subject to this law of population growth as E, coli, with the proviso that unlike E. coli we are capable of understanding our situation and manipulating our environment to a degree, to our advantage if not that of other earth inhabitants. Trouble is, as your editorialists acknowledge, our species shows little sign of sufficiently long-term vision. Competing interests: I am the Registrar to the Board of Governance,British Society for Ecological Medicine |
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David I Boorer, Retired banker HEXHAM, Northumberland, UK, NE47 0LD
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Dear Sir, As a retired banker, married to a practising doctor, I often turn to the BMJ for light relief and change of perspective. Your editorial 'The Health of Nations' misunderstands the heart of the financial crisis and, as a result comes to the wrong conclusion. Firstly, plenty of people did see it coming - and have been recording that view for more than a decade now. The problem in the UK is that three factors made it impossible, in practice, that these contrary voices would be listened to before the fact. Firstly, starting in the early 90s we had a worldwide trend to lower inflation rates (the so-called 'Great Moderation') after the various inflationary crises in the post-war years. Secondly, much of the UK's manufacturing capacity was transferred to China and other newly-industrialising countries. Thirdly, the government (under the leadership of Gordon Brown as Chancellor) saw this as an opportunity to keep interest rates low and stable. At the same time no one was ever going to direct banks to lend less and at higher rates of interest in order to reduce the access to credit that was making people feel better-off each year. All of these factors were seen as Good Things - entirely benign. They made growth easier to achieve by encouraging borrowing - why not if 'we have abolished boom and bust'? Only a fool would miss the chance to cash in on a one-way bet... And so we pulled ourselves up by our own boot- laces. One of the biggest beneficiaries of this boom was, naturally, the government; the more the City grew, the more tax revenues increased - and the more we borrowed, and pushed house prices ever higher, the better we felt and the more tax was raked in. It is difficult to imagine that, in these circumstances, any democratically elected government would have done anything differently - 'we'll make you feel poorer and cut government revenues; it'll be OK in the long run' is not a vote-winning slogan. And as it goes for financial decisions, so it does for all the other facets of our lives. We certainly are 'poor at understanding and planning for stable and health supporting human futures', but that is possibly something to do with the evolutionary niche we occupy. What benefits would our ancestors have passed on to us if they had actively sought 'stable and health supporting' tactics as their defining characteristic? Sounds a bit like 'health and safety on the savannah'... As Edward Greenspan (the previous Governor of the Federal Reserve Bank) once noted, it is never a popular move to take away the punchbowl when the party is in full swing. It would, though have been nice if someone had at least tried. The next few decades will indeed 'be crucial for the future health of nations'- they always have been! Unfortunately they are firmly stuck in the future, and we will always sell tomorrow and buy today. Doing otherwise would require us to accept a more authoritarian and intrusive approach by future governments, and for such intrusion to be entirely wise and selfless. Dream on. Yours faithfully David Boorer Competing interests: None declared |
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Harald M Lipman, Executive Director International Cardiac Healthcare & RiskFactor Modification (ICHARM) The Dutch House, 77a Fitzjohn's Avenue, London NW3 6NY
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Professors McKee & McMichael remind us of opportunities missed through Man’s lack of foresight and highlight our indecisive approach to understanding and planning for stable and health-supporting human futures. They make more than passing mention of divergences in life expectancy amongst nations. Contrasting increasing life expectancy in many developed countries, with significant reductions in the former Soviet Union. What messages, if any, can be learnt from these divergences? The reduced life expectancy in the Russian Federation is reducing their population by 0.5% per annum. Over 50% of these deaths are related to cardiovascular disease. A fertility rate of 1.7 children per woman, although rather higher than that in Western Europe, is not high enough to replace those early deaths. Thus, combined with an imbalance in the immigration/emigration ratio, their population size falls. Looking at the EU, it is estimated that by 2050 in 13 of the member states, including Germany & Italy, the population will have declined significantly from its present level. Following a small rise in the next 20 years, between 2030 & 2050 the EU population will fall by 4.3%. In the EU life expectancy is increasing and the population decrease will largely be due to the low fertility rate, 1.48 children per woman. Russia, potentially, could reduce its mortality rate and increase life expectancy, by life style modification and improved levels of cardiac diagnosis and care, by implementing legislative measures to limit tobacco and alcohol intake and educating the medical profession and the public in preventive medicine, and thus increase its population. Implementation of similar measures in the EU, where many of these measures are already in place, would, arguably, have less effect on future population levels. Increasing life expectancy does itself raise many questions. Amongst others, of a shrinking working population supporting an increasing aged population, which requires increasing levels of healthcare. We find ourselves in a dialectical cleft stick. How can a balance be attained? Increasing the childbirth rate, if that were possible, would create further strains on society’s resources, increase consumption and eco- pollution and further increase demographic imbalances. Maintaining present birth rates, and excluding the effects of significantly increased immigration, would, merely, perpetuate the present envisaged future scenario. We need now, whilst there is still time, to assess and evaluate all possible future population scenarios and devise and implement best case and worst case plans. Eurostat population projections 2006 Faced with demographic change, a new solidarity between the nations European Commission Green Paper 2005 Competing interests: None declared |
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