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Health of People, Places and Planet


Stephen V. Boyden

This remarkable collection of papers bears witness to the breadth, depth and originality of Tony McMichael’s outstanding contribution to the health sciences over the past four decades. Appropriately, contributions range from discussions of the results of epidemiological studies on specific health issues, many of which McMichael worked on himself, to the importance of a systems approach to epidemiology, and even to some philosophical issues such as how important the future really is. Many papers refer to or focus on an area that was of special interest to McMichael over recent decades – the impacts of climate change on human health.

McMichael’s quantitative epidemiological studies on the relationships between life conditions, environmental factors and patterns of health and disease are highly regarded for their rigour and innovativeness. However, his contribution and influence extend well beyond this, and lie especially in what I will call his panoramic approach.

There are two facets to McMichael’s panoramic framework. First, he discussed human health against the background of the story of life on Earth and our own evolutionary history. The medical profession, and even that part of the health sector which specialises in public health and epidemiology, has been slow to wake up to the fact that this biohistorical perspective is essential for the proper understanding of issues of human health in the modern world.

The second characteristic of McMichael’s panoramic approach was his transdisciplinarity. The evolution of the culture of academia over the past century or so has led to a situation in which different groups of scholars focus on different aspects of the total situation – giving rise to the various so-called academic disciplines. Attempts to study the system as a whole are typically met with indifference, and even disdain, from specialists in conventional disciplines; and yet, in reality, human situations always involve a constant and highly significant interplay between elements in the different parts of the total system – biological, physical, cultural, economic, sociological, and so on.

McMichael defied this academic tradition. He recognised that the kind of understanding we need for making wise decisions in public health, and in society in general, requires knowledge of this interplay between these different parts of the total system.

He drew our attention to the fact that the health and well-being of human populations was linked inexorably with the health of the living systems around us. Climate change is at present the most critical illustration of this, although there are many other examples, past and present.

McMichael also highlighted the recent explosive increase in the scale and intensity of human activities on Earth and the fact that they were unsustainable ecologically, and thus socially. In other words, the future health and well-being of humankind will require big changes in society that will ensure the health of the ecosystems which underpin our existence.

In fact, McMichael advocated a shift to what has been called elsewhere a ‘biosensitive society’ – that is, a society that is in tune with, sensitive to and respectful of the processes of life within us and around us (Boyden, 2004).

In a biosensitive society, the dominant culture (e.g. world-view, priorities), societal arrangements (e.g. economic system, governmental regulations) and human activities (e.g. resource and energy use) would promote the health of both humans and the ecosystems of which they are a part.

The notion of biosensitivity is encapsulated in the ‘triangle of biosensitivity’ in Figure 1.

Figure 1 The ‘triangle of biosensitivity’.

Source: Author’s work.

Certainly, for ecological reasons, the future well-being of humankind will depend on big changes in the patterns of human activity on Earth. However, these changes will not come about unless and until McMichael’s panoramic vision spreads well beyond the epidemiological and medical fraternity. The survival of civilisation needs this vision to become centrally embedded in the dominant cultures of human society all over the world.


Boyden, S. 2004. The Biology of Civilisation: Understanding Human Culture as a Force in Nature. UNSW Press, Sydney, Australia.

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