Intended for healthcare professionals

Education And Debate

Human numbers, environment, sustainability, and health

BMJ 1999; 319 doi: (Published 09 October 1999) Cite this as: BMJ 1999;319:977
  1. A J McMichael, professor of epidemiologya,
  2. J W Powles, university lecturer in public health medicine (
  1. a Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. b Institute of Public Health, University of Cambridge, Cambridge CB2 2SR
  1. Correspondence to: J W Powles

    The complex relationships between economic development, population size, environmental conditions, and health have long stimulated discussion Usually, however, health has not been regarded as the primary outcome of interest. For example, a prominent paper published in 1967, entitled “Health, population and economic development,” examined various inter-relationships between these three variables—with the exception of how population growth or economic development affected health.1 Similarly, the much quoted report of the World Commission on Environment and Development of 1987 paid little attention to how environmental and economic changes affect population health.2

    There is need for a more critical assessment of the ecological conditions under which health gains might be both generalised to the whole human population and sustained into the future.

    Summary points

    The rapid increase in population which began about two centuries ago has slowed since the 1960s, and stabilisation at around 10-11 billion is now expected

    The disruption of natural systems on a global scale now seems a more serious potential harm from excessive numbers than does the occurrence of local difficulties in subsistence

    The prospect of further intensification of ecologically disruptive economic activity means that paths to sustainability will require a shared radical “greening” of productive technologies and consumption habits

    The main practical need, in the short term, is for indicators of ecological and social sustainability

    There will be substantial scope for improving population health at any level of national income, by developing social and human, rather than material, resources


    We have familiarity with the scientific literature on population biology, the history of human ecology, and global environmental change and its potential health consequences. We consulted mainstream authoritative texts on these topics. The extensive literature on climate change was accessed through publications of the Intergovernmental Panel on Climate Change. Demographic, economic, and other characteristics for national populations are taken from …

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