Intended for healthcare professionals


Global environmental change and health: impacts, inequalities, and the health sector

BMJ 2008; 336 doi: (Published 24 January 2008) Cite this as: BMJ 2008;336:191
  1. A J McMichael, professor1,
  2. S Friel, fellow1,
  3. A Nyong, director2,
  4. C Corvalan, coordinator3
  1. 1National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
  2. 2Centre for Environmental Resources and Hazards Research, Department of Geography and Planning, University of Jos, Nigeria
  3. 3Public Health and Environment, World Health Organization, Geneva, Switzerland
  1. Correspondence to: A J McMichael tony.mcmichael{at}

    Human pressures on the environment are damaging the world’s biophysical and ecological systems. A J McMichael and colleagues discuss the resulting unequal effects on health and set out strategies to help prevent and lessen the harm

    Human actions are changing many of the world’s natural environmental systems, including the climate system. These systems are intrinsic to life processes and fundamental to human health, and their disruption and depletion make it more difficult to tackle health inequalities. Indeed, we will not achieve the UN millennium development health goals if environmental destruction continues.1 Health professionals have a vital contributory role in preventing and reducing the health effects of global environmental change.

    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 …

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