Transitions in Human Health: Surviving This Millennium by Learning from the Past One Hundred Millennia

We have been living through several decades of great and rapid changes in the human condition. Life expectancies increased markedly during the twentieth century; populations are becoming 'older'; disease profiles are changing. The world is connecting up economically and electronically, market forces have become increasingly dominant, the post-Cold War political landscape has been transformed, cities are expanding rapidly, and material wealth is accruing — albeit unevenly. Meanwhile, however, a range of large-scale environmental changes is occurring, of which the most apparent is global climate change. This reflects a more fundamental process: the biosphere and its life-support systems are straining under the weight of human numbers, intensified food production, escalating carbon-based energy use and the spread of mass consumption behaviours. This revised version was published online in September 2006 with corrections to the Cover Date.     

Global Change and Health — The Good, The Bad and The Evidence

Debates over the merits and demerits of globalisation for health are increasingly polarised. Conclusions range from globalisation being essentially positive for health, albeit with a need to smooth out some rough edges, to one of utter condemnation, with adverse effects on the majority of the world's population. Anyone wading into this debate is immediately confronted by seemingly irreconcilable differences in ideology, opinion and interests. Both camps agree that global changes are occurring, and with them many of the determinants of population health status. While some skepticism persists about whether “globalisation” has value beyond being a fashionable buzzword, most agree that we need better understanding of these changes. Two difficult questions arise: (i) What are the health impacts of these changes; and (ii) how can we respond more effectively to them? To move beyond the stand-offs that have already formed within the health community, this paper reviews the main empirical evidence that currently exists, summarises key points of debate that remain, and suggests some ways forward for the research and policy communities. In particular, there is need for an informed and inclusive debate about the positive and negative health consequences of globalisation.