Social dilemmas of health and growth

Press, 29 July 1978, Page 17

Social dilemmas of health and growth

The Picture of Health: Environmental Sources of Disease. By Erik P. Eckholm. W. W. Norton and Co. 246 pp. $5.50. (Reviewed by Ralf Unger) Changes in the social structures and personal behaviour patterns which promote disease will do far more than doctors and drugs to reduce the burden of disease and the tragedy of earlv death. “A picture of health is ultimately the reflected image of the societv,” writes Erick Eckholm. Hea’lth is a result of the environmental pressures people are forced to live under, and of the manner of which people meet these pressures. This picture of health, sponsored jointly by the United Nations Environment Programme and

the World Watch Institute, is unabashedly a propaganda treatise that deals with the majority of mankind who have little choice in their suffering, and with the minority who, by changing their living habits, could improve the quality of their existence. While there have been rapid gains in the health of the population of the world, in 1975 the World Health Organisation commented: “It seems that after the rapid drop in mortality observed between 1950 and 1960 a consolidation period was needed and that a further decline in mortality would depend on conditions largely beyond the control of the health sector. Under-nutrition, infections spread by human excrement, and airborne infections together form the basic disease pattern of poverty.” Thus economic policies that leave people too poor and too ignorant to purchase an adequate diet, without access to safe water and without the rudiments of sanitation, increase and maintain disease levels. Similarly, individual’s eating, drinking, smoking and exercise habits form the roots of many major diseases and these, in turn, are influenced by cultural groupings, economic institutions and government policies. Apparent advances in cultural habits, such as moving away from

breast feeding in parts of Africa, Asia and Latin America, where the economic and sanitary prerequisites of hottie feeding do not exist, and where high quality protein is usually scarce, can lead to catastrophe. Going back to breast feeding in these countries may be of greater significance than any other form of nutritional intervention. The construction of reservoirs and irrigation canals in countries that lack proper sewerage controls may, in the process, create more new habitats for such parasites as those of schistosomiasis (bilharsia) and fila r i a s is . Increasing industrial production can generate diseases in work places from the pollution of technology. Japan has suffered more from this than any other country. The book concludes that a study of health conditions round the world turns up one basic truth: national economic growth and better health are not synonymous. Development is often equated with economic growth instead of with the progressive well-being of the people and major changes unnecessarily crush an enormous number of humans. This book is an excellent summary of the social dilemmas of health. It reaches over the boundaries of medicine and surgery into the sociology of large groups of people.