Healthy Environment
According to the Agenda 21 statement from the UNCED (1992) Rio de Janeiro environment summit, 60% of the Earth’s population will live in cities in the year 2050. The critical issues facing these populations and their governing bodies are numerous and include the following: Water/air quality and pollution; nutrition and food supplies; congestion of communication and transportation systems; energy resources and consumption; noise, stress, and access to open spaces and recreation areas; responsive education, social, and criminal justice systems; sufficient employment and housing opportunities; and brutal commercial and residential development. Without proper intervention, the daily news will discuss the ecocatastrophe of the greenhouse effect, the rise of sea level, and perhaps unrelenting air pollution. Looking more carefully at the data, one finds that the sea level 20,000 year ago was 124 meters below the current level. The increase during the last century was 15 cm. The expectation is that sea level will increase 50 cm from the 1900 level by 2100. The increase could have an effect on societies located along the deltas of large rivers, such as the Ganges, Nile, or Mississippi. Some of the islands in the Caribbean and in Polynesia are having difficulty because of storms, and they may disappear. This may require fast mobile health care teams. The catastrophes, as difficult as they might be for an individual, might not affect the increased world population. Beyond natural catastrophes are epidemic diseases, such as HIV, which produce dramatic effects south of the equator in Africa or in large cities in Eastern Europe. Of equal magnitude are new strains of tuberculosis that are resistant to modern drug regimens and that could turn into large, worldwide epidemics as larger numbers of the world’s citizens travel the globe. Although the WHO and the United Nations are currently developing standards for treatment and consensus statements on such problems, a more uniform acknowledgement of their authorities should take place. Universal funding of worldwide problems would strengthen defense against the health care problems of the world. Man-made air pollution will increase the incidence of lung diseases and will continue to cause serious problems to individuals. On the other hand, many people who live together with smokers will suffer, but with a relatively long life expectancy. There are many reports available from London, rural areas, and Tokyo demonstrating ways in which clean air has reduced health problems. We have to remember that the incidence of tuberculosis was reduced by improvement of urban sanitation systems well before effective treatment with curative drugs. These famous, well-documented success stories indicate the importance of a healthy environment also in the future. To plan healthy, urban environments in a future metropolis is perhaps the most effective tool in preventive medicine