Life in a changing world

I lived through three quarters of the 20^th century and (so far) the first eighth of the 21^st. It’s been a period in which the world has changed in more remarkable ways than ever before in history. What an exhilarating, ominous, wonderful, frightening time it has been! How lucky I’ve been, to observe so many historically memorable events, many of them horrible it has to be said, mostly as a distant bystander well out of harm’s way, unscathed while wars, genocides, massacres killed and maimed millions in other parts of the world – millions who included increasing proportions of non-combatant children, women and frail elderly people. At least 100 million people have died in wars, genocides, massacres, in my lifetime. So has a great deal of the natural world died.  I’ve seen crystal-clear seas teeming with life turn into turbid, dead zones in which only jellyfish survive. Tropical rain forests, boreal forests, green and pleasant land everywhere has been wantonly destroyed. I’ve seen the London and Edinburgh air transformed from murky sulfurous smog to crystal-clear skies with distant horizons clearly visible – although the air may be unpleasant to breathe because of the diesel emissions with which it is heavily contaminated. I’ve reaped the benefit of the inventions, social innovations, and changes in values and behaviour that, like a recurrent gold rush, have made the world a better place for those with the money and leisure time to enjoy it.    

Professionally I chose a mix of acquired epidemiological skills and hands-on clinical experience, a combination of epidemiological know-how and clinical competence that was scarce and in great demand just as I was ready to supply it; and I had a wholly supportive wife, compliant children, and the courage, faith in my own ability, recklessness or willingness to take chances, follow leads, seize passing opportunities while they were there for the taking, that led to success. In that way I rose to a prominent position in my chosen field, so I became well known to and a friend of my peers all over the world.

Occasionally I’ve fantasized about having a time machine that could take me to other interesting times and places. To go with the time machine I’d be magically fluent in the colloquial speech of the group into which I would blend: Athens in the circle of young men who gathered around Socrates; Renaissance Florence (with antidotes to Lucrezia Borgia’s delectable but deadly recipes); Paris at the height of Louis XIV’s regime; London when William Godwin and Mary Wollstonecroft flourished, or a half century and more later when the London Epidemiological Society’s members were exchanging ideas about causes and control of epidemics; or where and when a few dozen other game-changing groups of unconventional innovators strode the world’s stage, did and said things that changed the world for the better. But no matter how exciting it would have been to be a bystander or a participant in those events, I always conclude when I reflect on it, that there has never been a period in history as exciting, as eventful, as laden with technical innovations and transformations of values and behavior, as the time I’ve been alive.  Every aspect of life, every facet of society and culture has been affected, often transformed beyond recognition, by social innovations, new discoveries, technological ingenuity, and (perhaps most important) changes in values and behaviour.

Consider my profession, medicine, medical care, and public health science and practice. We can prevent and effectively treat and cure dozens of conditions that were rapidly and invariably fatal when I was a medical student in the 1940s. My own youngest son was born with a congenital heart defect that would have reduced his life expectancy to 10 years or less before advances in heart surgery, anesthesia and intensive care only a few years before his birth made possible the complicated operation he had at age 7. Financial barriers between sick people and the care they need have been greatly reduced, and in a few nations have been obliterated. Jonathan’s open heart surgery would have cost several hundred thousand dollars in the USA. It was done in Auckland, New Zealand, by one of the two best experts in the world at the time, and fully paid for by Canadian ‘medicare’ because it cost a little less there than if it had been done in Canada. The medical profession was almost exclusively restricted to white men in suits in the 1940s.  Now the medical profession attracts more women than men, and skin colour other than white is no longer a barrier to entry. Other professions too have opened their doors to women and to people who are visibly different from white folk of European ethnicity: law, banking, engineering and the church (many denominations, but not the Church of Rome) admit women – although a glass ceiling often blocks their way to the top.  Other changes for the better have sometimes been more subtle, often facilitated by technical innovations and inventions. The greatest of these is reproductive freedom for girls and women. This revolution, facilitated by the contraceptive pill was just too late for Wendy and me, and is still in progress and incomplete, obstinately resisted and obstructed in patriarchal societies and conservative Christian sects, but girls and women have the momentum, ultimate victory will come, I’m confident, within a generation or two, even in culturally confused nations like the United States. A small but significant effect of this newfound reproductive freedom that young women enjoy is that nowadays it’s often the women, not the men, who take the initiative in selecting a mate. I believe two of my grandsons have benefited from this social and cultural change: both were chosen by their young women, and the partnerships appear stable, secure and happy.

I’m fascinated by other changes in values and behavior that have transformed the society into which I was born 87 years ago. I’ve observed these changes in values and behavior in myself as well as in other people and in society at large. As a young man in the 1950s I had no sympathy for homosexuals. Without knowing any, having only vague notions of ways they express affection for each other, the very idea filled me with revulsion. As my friendship and acquaintance networks expanded, my professional and collegial horizons widened, I met some gays and lesbians; my knowledge of their contributions to medical science, literature, music, visual arts, grew wider and deeper and I developed empathy. Now I support without reservations the complete equity and equality of the LGBTQ community with the rest of humanity. My conversion to this cause occurred over several years in the 1960s, well ahead of public opinion. It was gratifying to see public opinion catching up with me. My views on reproductive freedom, on the right of girls and women to choose whether to become and remain pregnant, have moved in the same direction and at about the same pace.  In Canadian society these have become majority views. Likewise as a young man I believed in harsh punishment of violent criminals. I even supported the death penalty. My conversion to a lenient, tolerant view may resemble Saul’s conversion on the road to Damascus, and was evidence-based – literally so, when DNA evidence demonstrated unequivocally that alleged perpetrators had been wrongfully convicted. Here also Canadian society has caught up with me, and a substantial majority now shares my view that the death penalty is barbaric, has no place in civilized society.

I summarized some health-related ways the world has changed during my lifetime in “Human Health in a Changing World” which was Chapter 11, pp 395-425 in the second edition of my book  Public Health and Human Ecology (New York: McGraw Hill, 1997). That chapter was as much about human well-being and contentment as health, about the varieties of changes that can disrupt the even tenor of a contented life. In many talks and formal lectures since that book was published I refined my ideas about our changing world, emphasized the fact that these changes are ongoing, that humankind must adapt to the changes or risk extinction, just as many other species have become extinct because they failed to adapt to the changes in the world around them.

The global changes I discuss in seminars are: Physical (the atmosphere, the air we breathe, the pH of lakes, seas and oceans); Biological (ecosystems, distribution and abundance of species, pathogens); Demographic (numbers, distribution, migrations of people); Social (family structure and function, occupations); Cultural (media have replaced faith-based institutions as the main driver of our values); Political (volatile, frequently changing rather than prolonged stable regimes, makes long range planning difficult if not impossible); Economic (widening gaps between wealthy and poor people); Industrial (new players, India, China, Brazil etc. add to energy demands); Technological (electronic innovations from photocopiers, TV, computers and word processors to the internet and the web have transformed the worlds of work and leisure).

These are the most obvious changes. Some have had more profound impact than others. Probably the demographic changes matter most. When I was born in 1926 there were about 1.8 billion people in the world. In 2013 the world’s population passed 7 billion, more than a fourfold increase in one lifetime, an increase that is obviously unsustainable. More than half live in cities, compared to one in 20 when I was born. Half or more of those who didn’t live in cities when I was born were engaged in producing food for themselves and for the rest of us; it was a predominantly youthful population, half or more below the age of 30, in contrast to the present in which half or more are over age 50. Families are smaller too, reproductive rates are lower than replacement level, which worries economists but gladdens me. This is one of a very small number of social trends that bodes well for the future of the human species.

Some of these ways the world is changing have greater impact than others, some are at least partly a consequence of more fundamental, more basic changes.  All are inter-connected. Moreover there are other changes not included or even implied in the above list.  The most obvious of these is the amazing series of recent technological changes that I’ve observed, taken part in, and benefited from. When Wendy and I and Rebecca and David were preparing to go to England from Australia in 1961 I wrote down a list of valuables to be insured, and took it to my insurance company. The young woman behind the counter took my list, thanked me for it, and a few minutes later, gave it back to me. I asked her, “Don’t you want to keep this on file?” She answered, “Oh, I made a photocopy” and she showed me a flimsy, slightly brownish sheet of paper with my hand-written list faithfully reproduced. That was the first time I encountered a photocopy, which I soon learnt to call a Xerox. It was among the first of the astonishing range of technological innovations that changed the world in the second half of my life. After experimenting with a few electric typewriters in the late 1970s, I bought my first word processor in the early 1980s and launched into the internet, sent and received my first email in 1985. By the time I started work on the 4^th edition of the Dictionary of Epidemiology in 1987, the internet was becoming the main, almost the only line of communication between me, my associate editors and the other contributors.  In the Epilogue to the second edition (1997) of Public Health and Human Ecology, I wrote (p. 429):  “I have made the revisions for this book in the comfort of my office at home. I have hardly set foot in the medical library except to socialize with colleagues. Seated at my computer I have visited medical libraries and other rich learning resources all over the world, restricted only by my lack of imagination and energy, and unfamiliarity with the key words required to find all, rather just some, of the information that could have made this book as current as today’s newspaper.” I went on to say that a textbook, even a monograph as provocative as I tried to make this one, doesn’t need to be as current as today’s newspaper: it’s the ideas in it, the questions it raises rather than the questions it answers, that make it worth reading. A few years after that edition was published I had a letter from a young woman in a provincial city 300 Km from Montevideo, Uruguay, just beginning her career as a rather lonely public health specialist, the only one in her city.  She wrote to thank me for what I had written, said how my words had encouraged her to use the Internet and the Web to stay connected.  I love getting feedback like that! It makes all the hard work worth while.

Scanning newspaper headlines is a habit I’ve had since I was about 10. Now I scan a widening range on my computer screen or my iPad every day: the New York Times, the Guardian, le Monde, Al Jazeera, the Globe and Mail, the 100% electronic Daily Beast, Huffington Post and Slate and often a few others. I don’t think these make me any wiser but at least they persuade me that I’m getting several viewpoints on events that matter. Without doubt the ability to do all this in a few minutes every day is another of the beneficial changes in the world in my lifetime.