Population health as the ‘bottom line’ of sustainability: a contemporary challenge for public health researchers

Sustainability is now firmly on society's agenda. For five centuries, the West has proceeded on the assumption of continued progress, leaving a positive legacy to the next generation. This idea was enhanced by enlightenment thinking, the rise of market economics, and the cumulative wealth dividend that flowed from industrial capitalism. The dominant manifestation over the past two centuries has been growth—of population, wealth, knowledge, and our domination of the natural world. Inevitably, this burgeoning production, consumption, and waste generation eventually overloads many of the natural systems upon which we depend. Today there is evidence of overload: climate change, stratospheric ozone depletion, nitrification of the biosphere, acidification of oceans, accelerating loss of species, freshwater shortages, and so on. Clearly, our prevailing cultural values, technologies, and behaviours are not ecologically sustainable: on current trends the natural world cannot continue to furnish the ‘services’ upon which our societies, health, and lives depend. Therein lies a major challenge for public health researchers—undertaking research that will assist society understand and avert these systemic dangers to health. We have spent a productive half century elucidating individual-level causes of diseases, especially non-communicable diseases. This has been the proving ground of modern epidemiology. Meanwhile, in the background, ongoing population-level changes—demographic, social, trading system, and environmental—have gathered momentum. While these changes have yet registered little on the radar of mainstream public health research, they bear mightily on present and future health risks to populations. Over the past decade, WHO has paid increasing attention to these social and economic fundamentals, including convening international commissions on macroeconomics, and health and social determinants of health and coordinating reviews of the health risks from climate change and ecosystem disruption. A new generation of public health books and reports is beginning to address ‘global’ issues such as poverty, urbanisation, globalisation, and social and economic …