Saturday, September 27, 2014

AJ (Tony) McMichael: a champion for environmental health

This blog was started on Sept 27, 2014, the day after the sad and untimely passing of Professor Emeritus AJ (Tony) McMichael, MBBS, PhD. Another version is here and also in the Guardian. There is also one in an NPR blog.

The essay below has two sections – the first part is a conventional description of Tony’s academic achievements, the second is intended to try to convey how Tony emerged, and why his work is so honoured, important, and still far from complete, in a world in which so many powerful people,  especially in the land of Tony’s birth, deny limits to growth and other evidence of what he called  Planetary Overload.

Tony, born in 1942, was an eminent, world-famous Australian epidemiologist who retired in 2012 from the Australian National University, where most recently he held an National Health and Medical Research Council Australia Fellowship (described as “Australia’s most prestigious award for excellence in the fields of health and medical research”).

He graduated in medicine in 1967 from the University of Adelaide, but rather than follow his colleagues into internship or general practice he was elected as president of the National Union of Students, during the globally tumultuous year of 1968. After a short stint (about 18 months) in general practice, McMichael then became the first doctoral student in epidemiology at Monash University, in Melbourne, supervised by Prof Basil Hetzel.

Following a suggestion from the world famous microbiologist turned planetary health ecologist and Pulitzer Prize winning author Rene Dubos Tony first did post graduate work at the School of Public Health at the University of North Carolina in Chapel Hill, where he achieved early success with his recognition and coinage of the term the Healthy Worker Effect (later extended by others to similar phenomena such as the Healthy Migrant effect.) Returning to Australia he first worked on nutrition, again with Prof Hetzel, but this time for the CSIRO. He then became the Foundation Chair in Occupational and Environmental Health at the University of Adelaide, recruited by Professor Bob Douglas.

From 1994-2001 he was Professor of Epidemiology at the London School of Hygiene & Tropical Medicine, before returning to Australia to follow Prof Douglas as director (2001-2006) of the National Centre for Epidemiology and Population Health. In 2011 he was made an Officer of the Order of Australia, and in the same year was elected to the US National Academy of Sciences. Soon after, an insightful open access profile of Tony was published in the Proceedings of the National Academy of Science. There is also a tribute in The Lancet (also open access) from 2006, appropriately called “Tony McMichael: a visionary of the environment–health interface”. Obituaries are planned for The Lancet, BMJ, Environmental Health Perspectives and EcoHealth.

Tony published well over 300 peer-reviewed papers and 160 book chapters and two sole-authored books: Planetary Overload: Global Environmental Change and Human Health (1993), and Human Frontiers, Environments and Disease: Past Patterns, Uncertain Futures (2001). He co-authored two more, including The LS Factor, whose first author was Basil Hetzel.  A third sole-authored book (When Climates Change. Famines, Fevers and Fates of Populations – Past and Future) was in an advanced stage of preparation at the time of his passing. Tony also co-edited nine books, including Climate Change and Human Health, published in 1996 by the World Health Organization.

In 2012 a Festschrift was held to commemorate his career. An associated book, called Health of People, Places and Planet. Reflections based on Tony McMichael’s four decades of contribution to epidemiological understanding should appear next year; its 39 chapters (and 9 re-prints) will be available for free download. I am senior editor for this book.

Tony is also a Fellow at Chatham House on Global Health Security. He held honorary positions at the University of Copenhagen and the London School of Hygiene and Tropical Medicine. He was a long-standing advisor to the World Health Organization and had significant roles in three Intergovernmental Panel on Climate Change assessment reports and in the Millennium Ecosystem Assessment. He was also a Fellow of the Australian Academy of Technological Sciences. He had many other Fellowships: the Australasian Faculty of Public Health Medicine (1996), the UK Faculty of Public Health Medicine (1994-2002), the UK Academy of Medical Sciences (1999-2003) and the Public Health Association of Australia (2007).

He made many contributions to epidemiology, beyond occupational health and climate change. These include to lead and its harm to cognitive development, to smoking (including highly praised court appearances as an expert witness), to cancer, to nutrition, to infectious diseases and to global ecological and environmental change, including, but well beyond that of climate change. He chaired and co-chaired numerous technical working groups across a very broad range of public health topics including national enquiries into water fluoridation and the health effects of passive smoking, both of which set the scene for national public health action. Later he co-chaired a programme for the Special Programme on Research and Training in Tropical Diseases, leading to a WHO Technical Report on the relationship between environmental change and infectious diseases of poverty.

Tony, like Geoffrey Rose, favoured exploration by epidemiologists of the “causes of the causes”, or to use his phrase, to escape the “prison of the proximate” (cause).

Tony was an accomplished pianist, one of his daughters, Anna, is a professional violinist. A brother, Philip, is an eminent sociologist. Tony is also survived by his wife, A/Professor Judith Healy, a brother, Robert, another daughter, Dr Celia McMichael, and four grandchildren. His legacy includes many appreciative and grateful colleagues and students, in many places and countries. Some of them have become eminent in their right. Many groups also owe Tony a huge debt, including Drs for the Environment AustraliaThe Climate Institute, The Australia Institute and the Frank Fenner Foundation.

How did Tony reach this stage? He had a self-described idyllic childhood, in Adelaide, Australia’s only capital city not to be founded in part by convicts. Perhaps as a result, Adelaide (and South Australia) is regarded by some as having a greater stress on civil service, and less harshness than other major Australian cities and states. Tony’s dad was an architect, his mum a home-maker. Tony’s cleverness was evident in junior school and he took a leadership role, including as a prefect at one of Adelaide’s most prestigious high schools. Then came medical school, where he first encountered Professor Basil Hetzel, and which was marked by at least two trips overseas, one by boat to India (a highlight of which was a visit to a leprosy colony in Delhi, which Tony relocated and revisited almost 50 years later) and one to Australia’s then colony, Papua New Guinea, where he first encountered Judith Healy, who he was soon to marry.

His leadership role of the student union allowed McMichael to meet many Australians at a formative time who would later become influential. It is reasonable to surmise that this year was a wonderful springboard – but for what? Many NUS leaders have entered politics; instead Tony was to turn to the most political branch of medicine, public health. Being the very first doctoral student of Basil Hetzel at the newly created Department of Social and Preventive Medicine at Monash University (at the time a very young university) must have added to Tony’s sense of self-reliance. Tony was not necessarily bound by the opinions and dogmas of his peers, he could also set his own compass. And he had both the intellect and the courage to do this.

The late 1960s was a time of intense concern about global population growth. McMichael was influenced not only by Paul Ehrlich and Rene Dubos, but a wide cast of ecological leaders and concerns. These led to a series of essays called “Spaceship Earth” in Nation Review, a weekly newspaper. Two decades later, just when the “cornucopian enchantment” was at its peak (i.e. despite the Rio Summit the time when the concerns about global population and global environmental impact arguably reached their nadir) he published Planetary Overload. Of all his books, this is the most influential and important.

By then McMichael’s reputation as a leading epidemiologist was well-established, and this book may have seemed a gamble. Indeed, before its eager acceptance by Cambridge University Press (facilitated by Professor, later Sir Andy Haines) the same manuscript was dismissed by a reviewer for Oxford University Press.

At that time the integration of Earth System Science and health was scarcely beginning, though the foundation had been laid two decades earlier by Dubos. McMichael has clearly been the most successful and influential thinker to build on that legacy. Today, ecological public health courses are emerging as legitimate and indeed vital to global public health.

McMichael died less than a week after perhaps the greatest global climate protest so far in history. US President Obama, assisted by the recent steep fall in price of solar and some other forms of renewable energy appears to genuinely understand the job-creating, economy-saving and civilisation-preserving potential of a rapid transition to clean global energy. If we are to survive as an advanced, wise and compassionate  species, the work of people like Tony McMichael will increasingly be recognised as fundamental to the shift that we are engaged in.

The festschrift for Tony was published as an open access e-book in July 2015. The website is http://press.anu.edu.au/titles/health-of-people-places-and-planet/

Saturday, September 6, 2014

Climate Change and Global Health: WHO meeting, August 2014

This is an adapted version of my recent post on Croakey about the WHO (World Health Organization) conference on climate change and health, held in Geneva in late August 2014.

The Australian immigration officer was unusually friendly. What kind of conference is it? “Climate change” I answered. “Good” he said. “You tell them, tell them about Maurice Newman and the others”. What he did not have to say was “tell them how these businessmen (eg David Murray, Dick Warbuton (who claims to have an open mind about climate change but is sceptical of the role of carbon dioxide!) and former politicians (eg Nick Minchin) self-taught on the issue of climate change, and with little if any scientific training and even less understanding, not only are able to expound their opinions on national media, almost unchallenged by hapless hosts, but are even able to directly influence national policy, on matters from disinvestment in “Earth poisons” (coal and other fossil fuels) to the Australian renewable energy target.

Given the proximity to the release of my edited book on this topic (September 2014) I had been hoping I might be invited. Still holding my Australian Research Council Future Fellowship, I had funds to go; the meeting being relevant to my grant (“Health and Sustainability: Australia in a global context”). Although flights were not paid by WHO the flight carbon offsets were – this was the first carbon-neutral conference in WHO history.

The weather in Geneva was lovely. The Chernobyl and atomic energy protestors (who have maintained a presence just outside the WHO precinct for decades) are still there, but more visible as roadworks have temporarily closed the normal bus-stop, so we all walked nearer to them.

Inside we were greeted by a colourful sign, drawn by children, about climate change and health. More people than originally expected had arrived – 360, including several health and environment ministers (though none, as far as I could tell, from powerful countries). Australia sent a diplomat from the Geneva office who told me she found the proceedings unusually pleasant as there was so little overt politics. That may be so but there was still plenty of politics on display, e.g. ultra-deference to some, and the barely visible line that separates what can be said from what cannot be said.

The great German philosopher J├╝rgen Habermas has described “critical-emancipatory” knowledge, characterised in a recent article in Nature Climate Change by Noel Castree et al as “geared to challenging the status quo and creating a world predicated on new (or existing yet currently unrealized) ideals”. In some ways, the conference reflected this; in other ways, it seems to have reinforced old habits. Many delegates called for an end to fossil fuel subsidies, for technological leapfrogging, and for a fairer world. But I was less convinced of sufficient appreciation of global inequalities, of limits to growth, and of more radical steps such as carbon disinvestment (recently endorsed by Human Rights campaigner Mary Robinson) and civil disobedience. There were also some “no go” areas, including how climate change might aggravate the risk of large-scale conflict, migration and famine. As usual, the development-hindering role of rapid population growth was off the table.

There was also a noticeable tendency, especially by the government delegates, of over-attribution. For example, climate change may well make dengue fever outbreaks harder to control, but it is not the exclusive factor.

Some big names in global public health attended, including some not well known for their work in this area, such as Professor Ilona Kickbusch.

The opening sessions were so crowded that the overflow filled two peripheral halls. Ours had a slightly party atmosphere, as, at least at the beginning, the audio-visual system let us down. Livestream watchers in the outback may have had a better connection. But I did hear some – including by WHO Director-General Margaret Chan, Prince Charles and World Bank President – and public health expert – Jim Kim (the latter two by video-link). But we missed hearing Christine Figueres, of the UNFCCC.

Later the crowd thinned, on day two we were able to sit upstairs in the main hall, and for the very final session there was space downstairs for almost all. Downstairs, one certainly felt more a part of the main event than an observer.

This was the most hierarchical and diplomatic of the handful of WHO meetings that I have attended; that is because it had an unusually large number of people, and thus an unusually large number of politicians, diplomats and civil society representatives, including of medical student groups.

Naturally, at a UN-affiliated meeting, these dignitaries come first. But there were also brief summaries of the science, discussion about the conference statement, and a focus on sub-issues such as nutrition, health promotion and strengthening health resilience.

The final day included a session on the economics of climate change, presented by Jeremy Oppenheim, program director for the New Climate Economy project.

There is a detailed summary on the web – including nine pages of the WHO Bulletin. The background paper Strengthening Health Resilience to Climate Change repeated the three tier classification of health effects in the IPCC health chapter. My book uses a somewhat similar three way structure (not credited by the IPCC), and I’m very much hoping that classification will be cited in the next version of this paper.

I wish I believed more in the carbon offset industry, I would have less carbon guilt; even so, I’m glad I attended. It might even be seen as an historic event, one day. On the whole, WHO deserves great credit for its leadership in this vital area.