Most people today readily accept that their health and disease are products of personal characteristics such as their age, gender, and genetic inheritance; the choices they make; and, of course, a complex array of factors operating at the level of society. Individuals frequently have little or no control over the cultural, economic, and social influences that shape their lives and their health and well-being. The environment that forms the physical context for their lives is one such influence and comprises the places where people live, learn work, play, and socialize, the air they breathe, and the food and water they consume. Interest in the physical environment as a component of human health goes back many thousands of years and when, around two and a half millennia ago, humans started to write down ideas about health, disease, and their determinants, many of these ideas centered on the physical environment.
The modern public health movement came into existence in the 19th century as a response to the dreadful unsanitary conditions endured by the urban poor of the Industrial Revolution. These conditions nurtured disease, dramatically shortening life. Thus, a public health movement that was ultimately to change the health and prosperity of millions of people across the world was launched on an “environmental conceptualization” of health. Yet, although the physical environment, especially in towns and cities, has changed dramatically in the 200 years since the Industrial Revolution, so too has our understanding of the relationship between the environment and human health and the importance we attach to it.
The decades immediately following World War II were distinguished by declining influence for public health as a discipline. Health and disease were increasingly “individualized”—a trend that served to further diminish interest in the environment, which was no longer seen as an important component in the health concerns of the day. Yet, as the 20th century wore on, a range of factors emerged to r-establish a belief in the environment as a key issue in the health of Western society. These included new toxic and infectious threats acting at the population level but also the renaissance of a “socioecological model” of public health that demanded a much richer and often more subtle understanding of how local surroundings might act to both improve and damage human health and well-being.
Yet, just as society has begun to shape a much more sophisticated response to reunite health with place and, with this, shape new policies to address complex contemporary challenges, such as obesity, diminished mental health, and well-being and inequities, a new challenge has emerged. In its simplest terms, human activity now seriously threatens the planetary processes and systems on which humankind depends for health and well-being and, ultimately, survival. Ecological public health—the need to build health and well-being, henceforth on ecological principles—may be seen as the society’s greatest 21st-century imperative. Success will involve nothing less than a fundamental rethink of the interplay between society, the economy, and the environment. Importantly, it will demand an environmental conceptualization of the public health as no less radical than the environmental conceptualization that launched modern public health in the 19th century, only now the challenge presents on a vastly extended temporal and spatial scale.
Surgical Education in the 21st Century
