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Mountainous barriers to health of our own making have appeared lately. The most formidable is a cluster of human-induced changes to global ecosystems and the global commons – the atmosphere, the oceans, wilderness regions, stocks of biodiversity – that threaten all life and health on earth, not just the life and health of humans.

Another is perhaps an inherent flaw in the human character, that leads many individuals and national leaders to believe that disputes can be settled by violent means. Now we have so many terrible weapons that violence can and does cause immense suffering, innumerable deaths (80% or more of these deaths as well as a similar proportion of permanent maiming and disability are among non-combatants) and appalling damage to ecosystems, the environment, and the fabric of society. Sadly, this is rarely recognized as a public health problem. The very first essential ingredient, awareness of the problem, is lacking. Both these massive public health problems, in my view, are linked to the insatiable human craving for petroleum fuels, an addiction far more pervasive and dangerous than addiction to tobacco. So far in our only partially sentient and insightful civilization, this isn’t even recognized as a public health problem.

A public health problem that has been recognized is a worldwide pandemic of tobacco addiction and its many adverse effects on health and long life. Another is the global pandemic of HIV/AIDS. These are both associated with modern urban life and social behaviour, including the marketing practices of transnational corporations. Surmounting these barriers to health will require social, cultural, and behavioural changes and political action.

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