Medical profession should give more decisive leadership

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7035.907a (Published 06 April 1996) Cite this as: BMJ 1996;312:907
  1. John Last
  1. Emeritus professor of epidemiology and community medicine University of Ottawa, Ottawa, Canada K1H 8M5

    EDITOR,—A J McMichael's editorial in the Christmas issue of the BMJ1 and my commentary in the corresponding issue of the Lancet2 say essentially the same things about the present human situation and the philosophical, moral, cultural, and political problems confronting the world at the end of the 20th century. A great deal more needs to be said and done.

    I believe that thoughtful women and men everywhere must clear their minds of cant, denial, and obfuscation and engage in dialogue about possible solutions to the unprecedented situation we face. One child families are common in many Western industrial nations as a consequence of recent changes in attitudes towards families and childbearing. One child families were encouraged at least for a time in Singapore by taxation policies (with higher taxes on the income of people with several children) and are achieved in China by coercion. Abundant empirical evidence shows that education of girls and adult female literacy are powerful determinants of fertility. In rural agrarian and patriarchal societies values must change before girls are allowed to become educated.

    Only changes in attitudes or values seem likely to help us. In my commentary2 and elsewhere I have spelt out what I believe are the essential steps in resolving any public health problem: awareness that the problem exists, understanding of what causes it, a capability to deal with it, a sense that it matters, and political will to deal with it. In this instance we lack, for the most part, the final two elements, but there are difficulties with the first three as well.

    Many religious leaders, industrial and commercial interest groups, and governments continue to deny that the problem exists. There is a sense of helplessness, in the face of what seem to many people to be insurmountable obstacles, that leads some people who perceive that a problem exists to believe that we are incapable of doing anything about it. More than values come into play. The urge to reproduce is surely at least partly instinctive in humans, with much overlay of religious beliefs and human values.

    The United Nations conferences on the environment, population, and women did not adequately come to grips with reality. Their deliberations did not recognise that the irresistible force of population growth will soon run headlong into the immovable object of the earth's carrying capacity. Can members of the medical profession give more decisive leadership in discussing this and searching for solutions?


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