Environmental Engineering Reference
In-Depth Information
of many of the ocean's great fisheries, and the global dispersal of various per-
sistent (mostly chlorinated) organic chemicals (Raven 2002; McMichael
2001b).
Meanwhile, in modern Western society in which the combination of
individualism, consumerism and market economics is the predominant
ethic, we have also a commodity-like view of 'health'. That is, we see our
health as being largely transacted at a personal level via individual choice,
behaviour, and access to health care. Yet it is actually the population-level
shifts in human culture, technology and environmental impacts that, over
the centuries, have repeatedly altered the patterns of well-being, disease and
survival. That is, the levels and types of disease in a population are predom-
inantly determined by larger-scale ecological and social influences.
Epidemiologists have been caught up in this same shift of focal length,
moving from group-level to individual-level emphasis. The original disci-
pline, in mid-19th century Europe, focused on describing and explaining
health differentials between geographic regions and population subgroups.
Subsequently, as infectious diseases were replaced by non-communicable
diseases (mostly of later adulthood) in Western populations during the latter
years of the 20th century, epidemiologists have refocused their research
attention on elucidating individual behaviours and experiences as the
'causes' of disease. Populations have thus come to be viewed primarily as
unstructured aggregations of individuals exercising free choices as consum-
ers and citizens.
Recently, there have been corrective influences to this narrowed orienta-
tion of epidemiological research. In particular, there has been a restitution of
interest, led by the 'social epidemiology' subdiscipline, in studying the more
'upstream' influences on disease causation: that is the social, economic and
cultural factors that determine the actual distribution of disease within pop-
ulations, and the overall population rate of disease (Eckersley
2001).
The resurgence of infectious diseases has re-emphasised population-level
phenomena, including cultural practices and technological choices. The dra-
matic downturns in health and life expectancy in the ex-Soviet bloc countries,
following the collapse of communism, highlighted the fundamental impor-
tance of social, economic and political conditions and institutions. The rise of
obesity in modern urban populations everywhere provides a ready example.
We cannot sensibly tackle it at the level of individual genes, eating behaviours
or personal activity levels since it is a manifestation of radical changes in
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