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March 2020 (Volume 98)
Quarterly Article
David Rosner
September 2023
The Future of Population Health
Back to The Milbank Quarterly
Two decades ago, seeing a windmill while driving through the countryside was a rare, special event. I can remember my 11 year‐old daughter announcing from the backseat of our car when she spotted one across an open field. When I bought my hybrid car in 2005, I remember waving at the few others who owned them when we stopped for traffic lights or happened to find ourselves at the same gas station.
Today, it is commonplace to see electric cars, windmills, and solar paneled houses, street lights, and signals in virtually every community in the country. In the coming decade, hydro, wind, and solar energy sources will replace coal as the major source of electricity. Efforts to capture the power of the oceans and tides promises another hope for truly limitless clean energy.
There is a movement pushing these dramatic changes. Despite the US retreat from the Paris Agreement, the Trump administration’s promises to bring back coal and lower the corporate average fuel economy standards, and its demand that California retract its air pollution controls, we see communities finding ways around the administration’s efforts. For example, the administration announced that it formally withdrew from the Paris Agreement, but cities around the country vowed to abide by it. The administration announced that it will no longer promote the use of efficient LED lighting, and even lightbulb manufacturers protested.1 The US Environmental Protection Agency revised the Toxic Substances Control Act standards, and states banded together to challenge lowering the bar on the emission of chemicals in the air.2 Young people around the world have mobilized, staging huge rallies in their nation’s capitals and demanding that those in power act now to reverse what we know is a coming environmental catastrophe. The change overtaking us is enormous and undeniable, and can give us hope that sometime in the future we will find the political will to encourage and even mandate changes that may save humans around the planet.
Yet, as the recent 800‐page United Nations study, the World Energy Outlook 2019, somberly documents, the transformation to clean energy is not enough and, because of a decade of inaction and stalling on the part of world governments, what once required a decades‐long international effort has emerged as a crisis with a window of merely ten years.3 While the number of all‐electric cars is expanding and the cost of efficient batteries used to power them is dropping dramatically, fossil fuel use continues to rise. In the United States, which accounts for the largest percentage of greenhouse gas emissions, political will has stalled. Worldwide, the gas guzzling SUV has emerged as the hottest selling automobile on the market. In 2000, only 18% of cars sold throughout the world were SUVs. Today, 42% are.4 Even the move to what has been marketed as “natural” gas has clouded our understanding that natural gas is a major contributor to CO2 emissions. In Asia, hundreds of coal‐powered plants still operate and many of them are newly built, portending decades of future pollution. Globally, greenhouse gas emissions have grown by 1.5% per year, despite the growth in green technologies.
The climate crisis is being felt in both industrialized and less‐industrialized societies now. Year‐round fire seasons are now the norm in California. Unexpected droughts and ever more severe storms in Midwestern communities auger a stark future for expanding cities in the Sunbelt and Midwest. Infectious diseases previously limited or rarely seen in modern America are now being identified. Regular flooding in Miami, powerful hurricanes in the Gulf, and disabling storms in New York are but a few of the problems that can be linked to warming ocean waters and rising sea levels. A recent report that was soporifically headlined, “New Elevation Data Triple Estimates of Global Vulnerability to Sea‐Level Rise and Coastal Flooding,” contained hair‐raising graphics showing that by mid‐century, South Vietnam; major portions of Thailand, including Bangkok; and major cities such as Jakarta, Indonesia and Mumbai, India; as well as coastal Bangladesh, the Pearl River Delta in China, Alexandria, Egypt, and other locales with populations of over 150 million people would be uninhabitable.5
There are a few willing to close their eyes to the current impacts of climate change and the dire predictions of what may occur in the next two or three decades. But, it is not really a “debate” about the reality of the change anymore. Rather, there is a political struggle going on that has been supported and abetted by the petrochemical/oil industry and its political allies. Through this unholy alliance, even the most basic efforts to document the impacts of climate change are stymied: Oil and gas companies are no longer even required to report methane emissions and hydrofluorocarbons, the greenhouse gas banned in 2015 and identified as a potent cause of ozone depletion, are once again allowed into use in refrigerators and air conditioners.6
We can only hope that the forces promoting attention to global warming will prevail. But the question really is: why is it even in doubt we will do what we have to do? How did our politics get to a point where we as a society cannot address what virtually everyone can see? Are oil company executives’ economic interests so powerful and shortsighted that they would put their own children at risk? Some think so.
But there is another even more terrifying answer: those who perpetuate the inaction may not see it as a crisis for them or their families. After all, the people of south Asia are far away; gated communities and wealth may make some believe they will never personally feel the impact. That is truly a terrifying idea. But one that explains the willful ignorance and resistance to change that we witness today.
References
Published January 2020 DOI: 10.1111/1468-0009.12447
David Rosner is the Ronald H. Lauterstein Professor of Sociomedical Sciences and professor of history at Columbia University and codirector of the Center for the History of Public Health at Columbia’s Mailman School of Public Health. He is also an elected member of the National Academy of Medicine. In addition to numerous grants, he has been a Guggenheim Fellow, a recipient of a Robert Wood Johnson Investigator Award, a National Endowment for the Humanities Fellow, and a Josiah Macy Fellow. He and Gerald Markowitz are coauthors on ten books, including Deceit and Denial: The Deadly Politics of Industrial Pollution (University of California Press/Milbank, 2002; 2013) and Lead Wars: The Politics of Science and the Fate of America’s Children (University of California Press/Milbank, 2013). He also testifies for plaintiffs in lawsuits on industrial pollution and occupational disease.
