Professor Tony McMichael

National Centre for Epidemiology & Population Health, Australian National University

'The Right to a Healthy Environment: Advancing the Discourse from Individual to Population, from Reductionist to Ecological'

This is an unusual conference for me to speak at as an epidemiologist. However, I welcome the opportunity because it obliges me to develop some loosely-formed, intuitive, ideas about health inequalities in relation to the environment. This includes, particularly, the new challenges that human-induced climate change is bringing to this topic area. I also appreciate hearing different perspectives on cross-disciplinary issues that are becoming increasingly momentous in this environmentally water-shed world that we, the current generations, inhabit.

I have had long involvement with the UN’s Intergovernmental Panel on Climate Change (IPCC), chairing and assisting the coordination of health risk assessment for Working Group II over three five-year cycles, during 1993-2006. The Fourth Assessment Report of IPCC was published in 2007, and its scientific content underpins much of the international policy discussion at the December 2007 Bali Conference on Climate Change, organised by the UN. My involvement with IPCC reflects my interests, as medical graduate and epidemiologist, in the wider reaches of environmental health research.   

Excellent groundwork has been laid by previous speakers. Indeed, I was very interested to hear about the experiences of the American Inuit population in northern Canada. I attended an international health conference in Ottawa recently where disruption to the Arctic environment by global warming is having many adverse effects, including on human wellbeing and health. One example is that, with the climate-related decline in sources of traditional foods (especially marine animals, hunted seasonally), there is now an increased reliance on imported high-energy processed foods from industrialised southern Canada. This has contributed, along with the use of motorised snow-mobiles, to the rise of overweight, obesity, the increasing epidemic of diabetes and cardiovascular disease. This example underscores the many ways in which these larger-scale climatic and environmental changes will affect population health – if not immediately, then in the medium to longer term.

I will first tackle some issues to do with the concept of ‘rights’, particularly the tension between our tendency to focus on rights at the individual level versus the increasing need to think about rights at the whole community or population level – and, indeed, across generations.(1) That raises, in turn, questions about the responsibility and role of government or other social institutions. Subsequently I will discuss some examples of environmental exposures and health inequalities, including climate change impacts, and how these bear on issues of rights.

‘Rights’ – some issues of definition and scale; relationship to freedom of action

Liberal democracies put a high premium on ‘rights’, as instruments of protection, opportunity and equity. As we settle into a new century, and with a newly-elected federal government, it is  appropriate to review our general disposition towards the notion of individual rights and responsibilities. A closely related issue is the conceptualisation and role of freedom within democratic systems.

We have lived through several recent decades during which neoliberalism has been the ascendant political philosophy, championing the role of free-market forces and extolling individual choice and responsibility. This philosophical perspective was well illustrated by (then) Health Minister (Tony) Abbott’s prescription for dealing with today’s extraordinary, community-wide, public health problem of the rise in prevalence of overweight and obesity. It's primarily a matter, he stated, of self-discipline for individuals; responsible parents should, if necessary, lock the family fridge; government does not have a substantive role in such things as restricting the TV advertising of energy-dense processed foods.

This neoliberal, hands-off, approach by government prompts an interesting, basic, question about how our innate instincts manifest as patterns of behaviour – and what that means for ‘freedom’. Is freedom defined at the individual level, or is it a shared public good? There is a ‘nature and nurture’ issue here. Are we intrinsically selfish because of Darwinian evolutionary selection processes that, over hundreds of thousands of years, have favoured those individuals clever and cunning enough to survive and reproduce? Or do we have a real or latent capacity for cooperative behaviour? If the answer to the second question is No, then can our culture and its value system supplant, or over-ride, innate selfishness?

Consider the problem of ‘free riders’ – that is, individuals who take more than their fair share, who deceive and exploit others.(2) In small hunter-gatherer groups, free-rider individuals would generally have been easily identified and dealt with via immediate, culturally-based, sanctions. In the modern globalised world, however, with its much more fluid social structures and relations, its freedom of physical movement and long-distance travel, ease of moving financial capital around the world, and various deregulated processes, the opportunities for free riders abound, with little chance of detection. So we are left with the question: what, then, should be the role of government in our modern globalised society in relation to the rights and freedoms of individuals, communities and populations?

I will not, here, attempt to answer that question. However, a brief historical summary of the changing ideological and social context of ‘freedom’ over the last few decades might go as follows. In the 1960s-1970s there was a contrast between the Old Left and the Old Right in their perspectives on freedom – they espoused, respectively: freedom with equal opportunity, and freedom to act (with decency) within an ordered society. Subsequently, there has been the rise of neoliberalism and neoconservatism – the latter well exemplified by the George W Bush administration in the US, with emphasis on the need for strong central vigilance by big and, if necessary, intrusive government. These philosophical and ideological developments provide backdrop for how we have recently thought, and now think, about rights and freedoms.

‘Rights’ in practice: preoccupation with the individual

Do rights inhere in the individual, or are they a cultural construct conferred by social contract? The corresponding question can be posed in relation to rights of whole communities, populations and future generations. Origins aside, the ‘right to life’ is readily construed at individual level; the ‘right to a healthy environment’ can be applied at multiple scales; and the ‘right to inherit a sustainable biosphere’ makes most sense as a shared right of future generations, a right of the future population at large.

The World Health Organisation, at its inception in 1946, defined ‘health’ in terms that refer to the fundamental right to good health of individuals, of every human being: “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being.”

This same individual-oriented flavour is evident in the wording of the UN Universal Declaration of Human Rights of 1948. That Declaration states, in Article 25:

“Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”

Clearly, there exists a generally-shared agreement that we should protect the interests and needs of individuals. Meanwhile, how should we think about the rights of the community at large? And does that presage a different role for governments, a role entailing more formal responsibilities for the environmental conditions of communities at large, and those of future generations?

Several of those phrases refer to components of the ‘environment’. Within our type of wealthy, open, consumer-based, society, the choices made in relation to food, clothing and housing can, to some or even a large extent, be exercised at individual or family level. But there is much more to the environment than these items.

Environmental ‘public health goods’: a collective entitlement?

Reference to the need to ensure individual rights in relation to food, clothing, housing and jobs recurs repeatedly in diverse UN agency declarations and covenants. Meanwhile, there are larger-scale and more pervasive aspects of ‘environment’ that are well beyond the control of individuals and local neighbourhoods. That is, meaningful choice does not exist at that lower, more personalised, scale.

Three examples will illustrate this point:

  • Local air quality can affect a whole city, increasing the risks of asthma, other respiratory disorders, and cardiovascular diseases.
  • Noise, a familiar component of the environment, often exists at neighbourhood or whole-community level, arising from industrial activity, traffic and so on. Noise is not something over which an individual has much control.
  • Drinking water, too: consider the effects (such as raised blood pressure) of saltiness in drinking water, particularly in present-day Adelaide which sits uncomfortably at the lower end of the River Murray. That river’s water is becoming increasingly salty from the accumulation of recycled irrigation water that returns, via soil and surface water, to that now-depleted river system.

These and other collectively shared aspects of the natural world’s geophysical and ecological systems constitute a larger dimension of ‘environment’ that impinges on whole urban populations, whole regions, and affects human wellbeing, health and survival. The management of these natural life-support systems extends well beyond the frame of individual rights, choices and actions. They are environmental public goods, in relation to which human communities and populations have collective needs and expectations.   

Widening the agenda: global environmental changes and the ‘right’ to health

A further dimension must now be included in this discussion. Various recently-emerging environmental changes (each of which poses diverse risks to human health) are of global scale.[3]) Human societies have not previously had to deal with environmental issues at this level. Consider the ongoing (and currently accelerating) human-induced change in the world's climate, due to greenhouse gas accumulation in the lower atmosphere (troposphere). Meanwhile, higher in the atmosphere the re is destruction of stratospheric ozone, the gas that filters out much of the incoming, biologically damaging, ultraviolet radiation. Newly detected changes to the world’s oceans – warming and acidification – pose great risks to the future vitality and productivity of marine fisheries, worldwide. Do we wish to live in a nuclear-radiation-free world? Those are all systemic global environmental issues, posing new challenges to our concepts of rights and freedoms. Indeed, there is a further serious question, now, as to whether liberal democratic systems can solve such problems, especially given shortness of time.(4)

To date, our thinking about individual rights in relation to the environment has focused on those ‘environmental’ factors that, at least in principle, are amenable to individual action, opportunity, choice. Today, however, we must take more account of the emerging, unfamiliar, larger-scale environmental conditions that impinge at supra-individual level.

One such environmental issue picked up recently via UN agencies is water – quality, security, access, affordability. Those UN commentators have pointed out that various official declarations and covenants made several decades ago (e.g. the international covenant on economic social and cultural rights) all referred to housing, food and jobs, but didn't mention water, air, soil. The UN EcoSoc Committee, in 2002, said, in effect: “Let's get water into this mix, and ensure that it is understood that this is a fundamental resource for population health.” Their formal statement read:

“Water is a limited natural resource and a public good, fundamental for life and health. The human right to water is indispensable for leading a life in human dignity. It is a prerequisite for the realization of other human rights.”

Consider next the UN’s Millennium Development Goals (MDGs), adopted in 2000. The seventh goal is to do with achieving ‘environmental sustainability’, and it is listed after various other important goals to do with reducing poverty and malnutrition, improving education, lowering maternal mortality and early childhood deaths, reducing infectious disease risk. Then comes Goal No. 7, a seemingly free-standing goal to do with environmental sustainability. The notion that environmental sustainability could exist somehow separately from those other goals is of course nonsensical, and its itemised separateness, and associated text, indicates poor thinking, perhaps poor understanding, by the MDG drafters. True, one of the targets of Goal No. 7 is to increase access to safe drinking water, a prerequisite for wellbeing and health. But the general critique stands: we have not been good at integrating concerns about environmental conditions, about environmental sustainability, with the opportunities for, and the rights to, a health-supporting environment.

The proclamation, in 2000, launching the UN Millennium Development Goals (General Assembly Resolution 55/2: refers to making the right to development a reality for everyone:

‘We will spare no effort to free our fellow men, women and children from the abject and dehumanizing conditions of extreme poverty, to which more than a billion of them are currently subjected. We are committed to making the right to development a reality for everyone and to freeing the entire human race from want.’

Note, again, the wording: there is no explicit reference to communities or populations, although the phrase ‘the entire human race’ is used. We habitually talk about individuals and about ‘everyone’ and ‘every person’ – and seem not to understand, or at least acknowledge, the more ecological dimension of how environmental conditions impinge on population health.

Climate change, I anticipate, will make a big difference to our understanding of this issue of scale and systemic disturbance. As the issue gathers momentum it will force on us the need to think big and to understand that these larger-scale environmental changes that the human population is now causing to Earth’s natural systems, geophysical and ecological, are going to impinge on whole regions, whole populations, even worldwide. So, we cannot reasonably confine the rights discourse to considerations of the rights of each individual, each person, to a secure and health-supporting environment. That would belittle, misrepresent, the types of environmental problems we now face as a world community.

Inequalities in environmental exposures and health outcomes

Meanwhile, of course, we must contend with the continuing public health problem presented by more familiar, traditional, mostly localised environmental pollutants: heavy metals, chemical residues, local air pollution, water-borne infectious diseases. WHO estimates that about a quarter of the total global burden of disease, and more in children, is due to modifiable environmental factors – mostly localised chemical and microbiological pollutants. But there are great disparities between the low-income and high-income countries, even just comparing broad geographic regions. If you compare individual countries the disparity is markedly greater.

These disparities in the health impacts of environmental conditions between rich and poor populations and regions contribute to the great difference in their average life expectancy, particularly low in Sub-Saharan Africa, and in some of those countries actually falling. This reflects in large part the ravages in HIV Aids, but also endemic poverty, tuberculosis and serious malnutrition. Many of the world's 850 malnourished persons are in Sub-Saharan Africa, and most of those are in the southern part of that continent.

In November 2007, the UN Development Program issued its annual Human Development Report, focusing this time on climate change. This is a further stimulus from the UN system, and the report points out that climate change is becoming a very serious issue and will have very unequal impacts on wellbeing and health – and that it threatens to undermine the few modest steps we've taken towards achieving the Millennium Development Goals.

Let us look briefly at global climate change. The IPCC's recent Fourth Assessment report is not only (of political necessity) a consensus document, but it is conservative and already a little out of date. The IPCC science review process dealt with papers published up to early 2006. Now, nearly two years on, the science is advancing rapidly. In particular, the trends in climate parameters that are emerging this decade are showing more rapid change than was predicted with existing models back in the 1990s. For example, a paper published in October 2007 reported a dramatic increase in the annual percentage release of greenhouse gases, carbon dioxide in particular: a 3.3% increase per annum this decade versus 1.3% last decade.(5) This is a big increase and of course, among other things, it reflects the entry of China, India and Brazil and other rapidly industrialising countries, entering the climate change landscape without benefit of international treaties and agreements about cooperative transfers of technology, advice, trading agreements and such like that would provide effective incentives. Basically, a huge market failure underlies our climate change predicament.

A recent paper published in the journal EcoHealth shows, in cartoon form, the well-known huge disparity between the major national and regional emitters of greenhouse gases and the geographic distribution of  estimated adverse impacts on health.(6) The health impacts of climate change are estimated for the year 2000, restricted to changes in risks of malnutrition and its health consequences, malaria, diarrhoeal disease, injury and death from flooding and thermal extremes (especially heat waves). The adverse impacts are concentrated in Sub-Saharan Africa, South Asia, much of lower-latitude Latin America and the Eastern Mediterranean.

Likewise the mapping of global malnutrition and hunger reveals the world’s unequal distribution of food insecurity. Further, most of the adverse impacts of climate change on food yields are predicted to occur in much of Sub-Saharan Africa, North Africa, parts of the Middle East and West Asian region, parts of South Asia, Central America and down the west coast perhaps of South America. The IPCC’s Fourth Assessment Report concluded that crop yields could increase by 20% in East/Southeast Asia, but decrease by up to 30% in Central and South Asia, and that rain-fed agricultural output could drop by 50% in some African countries by 2020.(7, 8)

Thinking ecologically about environmental changes – tensions, conflicts, health outcomes

Another ominous example comes from a 2007 report by the UN Environment Programme on the strife in Sudan, particularly in Darfur.(9) The report points out that, while traditional tribal, ethnic and political tensions are an important part of the mix, there has also been long-term drying in that region, including neighbouring Chad. The Foreword to the report concludes that the Darfur conflict is “a tragic example of the social breakdown that can result of ecological collapse.” We need to begin to understand today’s world more in these terms – that is, how these large-scale environmental changes (to which we humans are the major contributor if not the sole contributor) are now impinging on the rights to a healthy environment of whole sections of the world.

There is, now, suggestive evidence that several vector-borne infectious diseases are beginning to change their geographic range and seasonality in response to regional climate change. For example, there are concerns in some highland regions in Eastern Africa that (mosquito-borne) malaria is occurring in areas where the disease has not previously been reported.

Ocean fisheries provide another salutary example, with enormous implications for the rights of various communities, regions and generations. The sobering story of the trends over the last half century is illustrated most starkly by the once-prodigious Grand Banks cod fishery off the Newfoundland coast: a disastrous collapse occurred in the 1980s, and the fishery (despite an international moratorium) has not recovered. More generally, the world fish catch has turned down over the past 20 years, primarily reflecting the huge impact of industrial fishing. But, meanwhile, other things are starting to happen – including the documented geographic shift in fish populations as oceans become warmer, and the even more serious concern about the increasing acidity of the world's oceans as CO2 is taken up. Carbonic acid forms, and endangers the calcification processes in tiny creatures that are critical to the base of the marine food web.

So these three environmental pressures on the ocean fisheries are acting in combination: over-fishing, ocean warming, ocean acidification. This composite threat to the world’s fisheries is a compelling example of global non-sustainability.(10) And it raises many questions about whose rights are being infringed. Do we have the unfettered right to catch wild fish? What of the right to a livelihood as fisher-persons, in big mechanised boats – or even as traditional fisher-persons? Our generation – what is its right to eat seafood? Does the future generation have a right to still have some seafood left to eat? These are challenging questions about contending rights. Many daunting configurations of this kind arise within the global climate change context, including in particular the question of rights that extend across generations.


The following three points have underlain my comments:

  • We value rights greatly, as a basis for decent, diverse and equitable living. Liberal democratic societies, in particular, accord a high premium to ‘rights’.
  • In our respect for human rights, as a concept, we focus somewhat uncritically on the rights of individuals (which, of course, is a compelling legal perspective) rather than on the rights of communities. The latter dimension is becoming more important as the scale of environmental damage and change increases, often now attaining a systemic global character.
  • We may like to think of rights as being absolute and non-negotiable; however, their scope and scale need ongoing review to ensure that we are on track to optimising the mix of freedom, fairness and environmental sustainability.

How do we balance this complex equation? We have rights on one side; we have obligations and accountability on the other. And via what institutions will we achieve that balance? In the modern world we should ask this question not just in relation to nation-states, the prime locus of formal governance, but we must also ask it in relation to increasingly powerful international agencies like the World Trade Organisation and large transnational corporations.

More broadly, if we can agree that ‘sustainability’ is about achieving and maintaining environmental and social conditions that ensure a continuing high level of happiness, good health and survival for human populations everywhere, including future generations, then we will share an essential and instructive shared goal. With that goal in mind, the rights of individuals, communities, populations and the human species at large can be pursued effectively and balanced appropriately with other considerations.

Today’s emerging concerns about environment and health include questions about current and future food yields and availability, the unusually rapid emergence and spread of infectious disease, and unhealthy work environments arising because of the export of occupational hazard.  Rich western consumers should recognise that China’s massive urban air pollution problem and its high levels of unsafe working environments are incurred on our behalf to produce goods that we buy cheaply and gladly. We are, in effect, exporting occupational and environmental hazards to industrial and inner-urban China. Thus maximising the operational ‘right’ to choose, as a middle-class consumer, may be perversely linked to the denial of rights to a safe and healthy working environment in Chinese workplaces.

Consideration of ‘human rights’ in relation to the environment and environmental health risks, should be embedded within a larger consideration of bioethics principles (with agreed legal responsibilities) and with those principles of sustainability that hopefully will emerge in future as we get better at global governance. The challenge of sustainable development now looms as large and urgent. Hence, we should be alert to the need to modify, to update, our social views, policies and instruments of governance, in order to balance environmental rights with environmental responsibilities. Neoliberalism, unmodulated, cannot do the job.   

In closing, we would do well to recall Albert the Magic Pudding: Norman Lindsay’s iconic creation, a source of endless slices. Albert might well have said to us: “The world is not like me. On current trends, you’re going to run out of slices. Not just for individual diners, but for whole communities, societies and regions of the world – and mostly for those who have not yet arrived to seek a place at the table.”


1.         Chambers, J., Will medical ethics undergo a climate change? Brit Med J, 2008. 336: p.

2.         Lynch, T., Beyond left and right: freedom and security., in Dissent. 2006. p. 27-34.

3.         McMichael, A.J., Human Frontiers, Environments and Disease: Past Patterns, Uncertain Futures. 2001, Cambridge: Cambridge University Press. 430.

4.         Shearman, D. and J. Smith, The climate change challenge and the failure of democracy. 2007, Westport, Conn.: Praeger Press.

5.         Canadell, J., et al., Contributions to accelerating atmospheric CO2 growth from economic activity, carbon intensity and efficiency of natural sinks. Proc Nat Acad Sci, 2007. 104(47): p. 18866-18870.

6.         Patz , J., et al., Climate change and global health: quantifying a growing ethical crisis. EcoHealth, 2007. 4: p. 397-405.

7.         IPCC, Climate change 2007: Impacts, adaptation and vulnerability. Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change., ed. M. Parry, et al. 2007, Cambridge, UK: Cambridge University Press. 976pp.

8.         McMichael, A.J., et al., Food, livestock production, energy, climate change, and health. The Lancet, 2007. 370(9594): p. 1253-1263.

9.         UNEP, Sudan: post-conflict environmental assessment. 2007, Nairobi, UNEP:

10.       UNEP, Global Environmental Outlook: Environment for Development 4. 2007, Valletta: United Nations Environment Programme.