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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Human health and human population
With creativity we find ways to make a difference
prevention and greed
Don't I have enough to do?
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Kenneth J Vinciquerra, Cleveland OH Computer Technolgy, Kent State University
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It is interesting to note that many in the environmental community are using almost identical language in voicing their concerns over a related matter, i.e., the failure of society in controlling human population and promoting sustainability. You state that "everything that we have accomplished in the fields of medicine and public health could be undermined if we do not pay attention to these rapid environmental changes." While certainly agreeing with that, many environmentalists would also adhere to a variation on that theme, to wit, "everything that we have accomplished in the fields of conservation and environmental law could be undermined if we do not pay attention to the effects of a rapidly growing human population that is outstripping the resources of the planet." The two issues are intricately related. The more humans there are, the more consumption of finite resources, the more waste, and the greater overall degradation of the environment. And as your article points out, the more severe this degradation, the greater will be the impact on human (and nonhuman) health. As Amy L. Gilbert pointed out in her posting, there are no easy macro -level solutions to such "huge issues," but each and every one of us can integrate sustainability into our professional and personal lives on a daily basis. The first step is always the raising of awareness, and I applaud you for bringing this dialog to the family medicine community. Competing interests: None declared |
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Amy L. Gilbert, MD, St. Paul, USA Family Physician, Family Tree Clinic
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I appreciate Dr. Roger Rosenblatt’s Reflections on Ecological Change and the Future of the Human Species (ref). Although it is daunting to confront the huge issues raised in the essay, he is right: despair is unacceptable. It will take creativity and attention to integrate this concern into our professional lives and practices, but there are many possibilities. We can integrate this awareness in small but consistent ways. One example is provided by Dr.Fagnan, in his responding letter, of talking with patients about bird watching, and connecting that to environmental concerns. Physicians who place a bike rack by the office, and post bus maps on the wall, can show patients their support environmental causes - with no increase in the length of the visit. Dr. Rosenblatt wrote that prevention of unintended pregnancies is an vital area where physicians have an important impact. A practical and helpful resource for this is the renowned text Contraceptive Technology, 18th ed by Hatcher et al. ( There is also a website, managingcontraception.com, where you may leave written questions on contraceptive topics and receive answers from Dr. Robert Hatcher and colleagues.) Physicians also have a strong voice in supporting access to contraception and advocating for family planning policies in the U.S. and the world. Rapid population growth effects the environment and effects human health in myriad ways. From the sprawl of metro areas and the time spent in traffic, to world political conflict related to water scarcity and oil, population pressure effects our lives and our world TODAY. We physicians must use our creativity and our professional credibility to advocate for the health of our patients and the earth we all call home. Competing interests: None declared |
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rory m. laughery, seattle, usa family physician
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Of the 1.7 trillion dollars spent on health care in the US in 2003, I believe it was 2-4% that went to the prevention of illness and suffering. As family healers, the family of man and his environs is indeed on all of our radar screens. Yet, to slip this "health maintainance" item onto the check list at the time of our patient's visit is challenged by competing interests for a vastly diminished resource...that is, preventive medicine. Perhaps many of our really important discussions of these profound issues could go to our patients in our email/listserve practices. Many of my community clinic patients, like many in the world without a meaningful piece of that 1.7 trillion, have only the will to support themselves and/or their families in a very practical, survival mode. We will indeed be challenged to carefully choose those patients able and willing to listen to this extremely important ecological health maintainance message. Competing interests: None declared |
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Lyle J. Fagnan, Portland, Oregon Oregon Health & Science Unversity
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4 April 2005 Don’t I have enough to do without taking care of planet Earth? Where do I find the ICD-9 code and billing code for services rendered to the patient Dr. Rosenblatt describes in the March/April 2005 Annals of Family Medicine? Where does planet earth fit in with our other priorities? I currently work with rural primary care practices in Oregon as part of a practice-based research network. The ecosystem health ills are not on our patients’ or practices' list of presenting complaints. Issues of practice survival are interposed with network discussions about potential areas for research and quality improvement projects. On Maslow’s hierarchy of needs, family medicine is looking for safety, love and esteem. Little attention is paid to reaching our full potential as a discipline. We need to move beyond the discussions of redesigning the office, the chronic care model of illness, and information technology to have the voice of family medicine heard and understood by our communities and medical students. The call to action in Dr. Rosenblatt’s article brought me back to the passion I felt when I was in medical school in the late 1960’s and listened to the voices of early leaders of the new specialty of family practice, Lynn Carmichael and Ted Phillips. Family physicians are connected to their patients and communities, exerting a respected sphere of influence. Each of us has a responsibility for promoting the health of Earth’s ecosystem as a foundation of all health. As an avid birdwatcher, I think I will spend more time talking to my patients about the birds I am seeing in my backyard. I am sure I will be able to bill a 99214 for these visits. Lyle J. (LJ) Fagnan, MD Portland, OR Competing interests: None declared |
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