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Bulletin of the History of Medicine 77.1 (2003) 213-214



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Tony McMichael. Human Frontiers, Environments and Disease: Past Patterns, Uncertain Futures.Cambridge: Cambridge University Press, 2001. xvi + 413 pp. Ill. $59.95 (cloth, 0-521-80311-X), $24.95 (paperbound, 0-521-00494-2).

A noted public health scientist and epidemiologist at the London School of Hygiene and Tropical Medicine, Tony McMichael takes up in this work very large and daunting questions of the determinants of human health—from the hunter-gatherer days, through the invention of agriculture, to the present, and then into a future made uncertain by our spectacular reproductive success on the one hand and our increasingly intensive economic activities on the other. In the author's words:

During the twentieth century we humans doubled our average life expectancy, quadrupled the size of our population, increased the global food yield sixfold, water consumption sixfold, the production of carbon dioxide twelvefold, and the overall level of economic activity twentyfold. In so doing we had, by the turn of the century, exceeded the planet's carrying capacity by approximately 30 percent. That is, we are now operating in ecological deficit. (p. 318)

This is, of course, a recent dilemma. Since the invention of tool-making, humans, thanks to their large brains, have been unique among species in their ability to expand the carrying capacity of the natural environment, and much of Professor McMichael's framework is an evolutionary ecological analysis of the interrelationships of climatic change, food production, microbial activity, and the evolutionary journey of humankind to show how our current predicament came about. He begins with an overview chapter: "Disease Patterns in Human Biohistory." In four succeeding chapters he then focuses on the reasons for, and consequences of, the invention of agriculture, which he views as one of the greatest changes in humankind's ecological relationship with the natural environment. These chapters extend from "Human Biology: The Pleistocene Inheritance" through "Adapting to Diversity: Climate, Food and Infection" and "Infectious Disease: Humans and Microbes Coevolving" to "The Third Horseman: Food, Farming and Famines."

The second half of the book (my arbitrary division, not his) deals with those other great changes in human history that McMichael finds laden with ecological consequences—industrialization and urban life. Seven chapters probe these consequences: "The Industrial Era: The Fifth Horseman?"; "Longer Lives and Lower Birthrates"; "Modern Affluence: Lands of Milk and Honey"; "Cities, Social Environments and Synapses"; "Global Environmental Change: Overstepping Limits"; "Health and Disease: An Ecological Perspective"; and "Footprints to the Future: Treading Less Heavily."

This part of the book becomes increasingly prescriptive as the author, after discussing many transitions such as those in agrarian ecology, human/microbe relationships, mortality, and natality, argues for another important transition. What he has in mind is a shift from air and water pollution, water shortages, [End Page 213] climatic change because of rising temperatures, and degraded soils to an ecologically sustainable world—not an easy accomplishment, in view of the fact that Western societies consume most of the planet's resources whereas the other three-quarters of the world's population, those peoples in developing countries, consume very little. McMichael calculates that if all consumption among the current six billion inhabitants of the planet were maintained at Western levels, it would require two extra planet Earths to sustain them, and four extra Earths to accommodate the ten billion we seem to be moving toward. Moreover, since all the earth's ecosystems are under human domination, the large brains that have created the problems confronting us are also those that must somehow resolve them.

Professor McMichael has drawn from a vast array of sources in many disciplines (including the history of medicine) to create this impressive and important book. It contains a number of useful illustrations (readers should find the graphs especially helpful) and a satisfactory index.

 



Kenneth F. Kiple
Bowling Green State University

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