Do we face a third revolution in human history? If so, how will public health respond?

Abstract

Hanlon and Carlisle prompt debate about increasing awareness of a world going pear-shaped, characterizing public health as: ‘prioritis(ing) epidemiological studies of relatively proximate causes of disease, at the expense of synthesis from a wide spectrum of fields which might help us grasp the sheer breadth of the emerging challenge.’ These overlooked challenges are both breathtaking and imminent. Corporations, obliged to maximize profit, are therefore legally prohibited from charitable, ‘good’ acts or modifying their behaviour for social, moral, environmental or health ends. Big Tobacco epitomizes dispassionate maximization of shareholder return. Legally, corporations must pursue profit growth above all else, maximizing sales through increasing consumption. Advertising and public relations industries synergistically create demand promoting convenience, comfort and choice (the 3 ‘Cs’), and ensure good public image, pre-empting attempts to limit corporate activity by media and legal means. Governments and business ‘revolving doors’ ensure fruitful merging of decision-makers and lobbyists so that policy almost always favours corporate over public interests, even to the point of war. Up to 30% of daily newspaper stories originate as press releases. Media editorial policy is top-down and stories are selected and spun to fit policy and powerful interests. Advertising enables newspapers to survive, and advertisers dictate terms, ensuring a steady diet of uncontroversial ‘news’, sometimes about global warming, sandwiched between adverts for SUVs and cheap flights, ‘lifestyle and fashion’. Similarly, television, juxtaposing a thousand scientists advocating action on global warming with a few, corporate-funded dissenters for ‘balance’. Once the 3Cs are obtained, hard-wired resistance to loss keeps us hooked to this system. To prevent collapse—loss of growth means loss of jobs, opportunity, motivation to study, of life, taxes as well as profit—we must keep consuming, but this is destroying the biosphere we depend on: the rate of species extinction currently averages 2 per hour. This economic model requires profit growth, dictating increasingly aggressive means to meet shareholder expectations. By 1995, the average income ratio between the richest and poorest 20% had increased from 30:1 to 82:1. In 2008, the world’s 8.7 million millionaires controlled US$40 trillion (T) of assets, in a world economic output of $65T. During two decades of economic growth, the world has bifurcated into few who have gained vastly and most who have gained only desire, ignited by distant promise of the 3Cs for their 1 US$/day. Wealth is generated, but is sequestered by elites. Enrollment into this unsustainable system for the 5 billion wide-eyed potential consumers that are targeted is a disastrous scenario if it unfolds. Public health cannot afford to wait 45 years for change, as with tobacco; we have, perhaps, until 2020. This is a critically urgent situation. The danger is as always, that, as a species, we will ‘adapt’. A ‘business-as-usual’ approach would see overshoot and collapse. As resources diminish, public health will face shifting challenges: aggression characterizes overpopulated mammal societies. Are we prepared to face this? How can we best help to engineer a rapid shift away from high consumption lifestyles in the face of the corporate juggernaut? Most professional schools and health