In 1994 Dr. Per Fugelli, a physician working at the Institute of Social Medicine of Oslo, published a paper titled “In Search of a Global Social Medicine”. Its abstract neatly summarizes his call to action for the medical profession: “Patient earth is sick. A large team is trying to help, including ecologists, economists, environmental activists, and politicians, but physicians are mainly absent. The impact of the disruption of natural ecosystems on human population health may be profound. It is, therefore, essential for doctors to give a world diagnosis and help with the treatment.”
In proper medical fashion, Dr. Fugelli described the diagnosis, the prescription, and some final behavioral changes needed to avoid relapsing: A Global Social Medicine. Already 30 years ago, the diagnosis was clear: over-population and over-consumption were changing the environment negatively affecting human health. Some effects are still happening and worsening today: increasing temperatures lead to more heat stress and heat strokes, vector-borne diseases are spreading in more temperate climates, and extreme weather events are becoming more common. Fortunately, in other cases, humanity has been able to respond, for example by preserving the ozone layer. Finally, in most cases, actions have been taken with moderate success: reducing pollution (at least in wealthier nations), nuclear safety, and protecting biodiversity. The most interesting insight, in my opinion, is the truly interdisciplinary approach that in a few lines, tying together economy, ecology, sociology, and health shows how poverty, especially in developing countries, is a health and environmental danger.
Despite such a bleak diagnosis, Dr. Fugelli remained optimistic in his prognosis believing that “[a] dismal future is not preordained”. He believed that four extensive, but feasible changes were necessary and sufficient to save patient earth. The first change concerns ethics, in particular how the old moral code that gives precedence to what is closer to me (i.e., myself, my family, my town, my country) needs to change in a world where acid rains, climate change, rising sea levels do not respect borders or geography: “we must shift the unit of concern and commitment from me to us, from nation to planet, from now to the future.” Secondly, the wealthiest countries need to be at the forefront of any attempts to save patient earth: even though they might be less affected, they are also the main responsible. Thirdly, Dr. Fugelli predicted the necessity of better and stronger international cooperation to provide resources to developing countries, reduce consumption in wealthier countries, share information, research, and technologies among countries to promote green energy, recycling, and reuse, and to implement policies to deter countries and companies from engaging in environmentally damaging behaviors. Fortunately, over the past thirty years, humanity has progressed towards these objectives as shown by the adoption of the Sustainable Development Goals. The prescription closes with a call to individual change: “It is the sum of the values, actions, and lifestyles of each one of us that creates policies and shapes future development”.
In the final section of his papers, Dr. Fugelli addressed what he saw as the main obstacles to the medical professions contributing to saving patient Earth, in particular, the hyper-specialization and narrow focus of its approaches. For this reason, he called for medicine to pay more attention to the whole rather than the parts, considering their ecological space, and using a truly interdisciplinary approach. Almost what Circular Health is about!
While many steps have been taken to address the issue, the Sustainable Development Goals being the most famous example, patient Earth is not yet out of the woods and a greater effort is needed. However, as Dr. Fugelli insisted, it is important to remain optimistic and maintain hope, to avoid the Titanic syndrome and, more importantly, because there are good reasons for hoping: “Humankind has outlawed slavery, eradicated smallpox, and reversed the nuclear arms race.”
“Let there be no doubt: sustainable development is achievable. The question is: how to do it?”
Since 2014 a Per Fugelli lecture is organized to discuss and present updates to the state of patient earth.
Are you interested in all the ways you can help patient Earth? The United Nations Act Now campaign is a good starting point.
By: Dr. Luca Mantegazza | Research Program Coordinator
 “[G]lobal disaster is closing in on us unavoidably, so why not enjoy the last moments on the first-class deck?”