Problems of focus

In 2000 the United Nations set out eight development goals to improve the lives of the world’s disadvantaged populations. The goals seek reductions in poverty, illiteracy, sex inequality, malnutrition, child deaths, maternal mortality, and major infections as well creation of environmental stability and a global partnership for development.2 One problem of this itemisation of goals is that it separates environmental considerations from health considerations. Poverty cannot be eliminated while environmental degradation exacerbates malnutrition, disease, and injury. Food supplies need continuing soil fertility, climatic stability, freshwater supplies, and ecological support (such as pollination). Infectious diseases cannot be stabilised in circumstances of climatic instability, refugee flows, and impoverishment.

The seventh millennium development goal also takes a limited view of environmental sustainability, focusing primarily on traditional localised physical, chemical, and microbial hazards. Those hazards, which are associated with industrialisation, urbanisation, and agriculture in lower income countries, remain important as they impinge most on poor and vulnerable communities.3 Exposure to indoor air pollution, for example, varies substantially between rich and poor in urban and rural populations.4 5 And the World Health Organization estimates that a quarter of the global burden of …