The following is based on the dedication of my edited book “Climate Change and Global Health” (CABI, 2014). The dedication is to the late Dr Paul Epstein who died in the early stages of its planning.
I first became aware of Paul’s work in 1992, when I was a solo general practitioner in a small Tasmanian country town. Before the internet, one of my few connections with international health was The Lancet, delivered weekly by the postman. In one such issue, soon after the Earth Summit, I read Paul’s report of a symposium also held in Rio, which led to the Heidelberg Appeal, and reminded me that Gross National Product needs adjustment for loss of “natural” capital.
Paul was the first U.S.-based health worker that I knew of who so clearly recognised the links between adverse planetary change and the risk to future human well-being, connections stressed by Ehrlich and Suzuki. These changes include the relentless conversion of forests and wetlands to fields and farms, with resultant loss of biodiversity, and the inexorable rise in climate changing gases. Both phenomena are underpinned by ongoing rise in levels of human population, aspiration and consumption, issues that the Australian epidemiologist Tony McMichael calls “Planetary Overload”. These risks accumulate, driven by high-level denial of “limits to growth” and "human carrying capacity".
I first met Paul in 1997, in London, with a group of physicians active in the International Society of Doctors for the Environment. Paul was active in the then U.S. affiliate, Physicians for Human Rights. The other encounter, six years later, was in New York City, for an inaugural meeting of the work that led to the report on climate change and disasters, led by Paul and funded by the UN Development Program (UNDP) and Swiss Re, a leading global re-insurer. Paul invited me because of my involvement with the Millennium Ecosystem Assessment, whose conceptual framework linked human well-being to ecosystem services. At that meeting, Paul arranged for Mark Malloch-Brown, then head of the UNDP (and substantially responsible for the text of the Millennium Development Goals, including its hasty phrases about sustainability), to talk to us; we met the next day at the UN Headquarters building. Paul’s connection with extremely influential people also included Al Gore, who consulted with Paul when preparing his Nobel-Prize-winning movie “An Inconvenient Truth”. My final contact with Paul was when I invited him to write a chapter for this book. He sadly had to decline, due to his illness.
Accessible articles about Paul's life include obituaries in the New York Times and in PLoS Biology. These reveal a dedication to issues of social justice and health care, evident from his student years in the U.S., later extending to Mozambique, Nicaragua, and El Salvador. Paul linked the breakdown of sanitation in parts of Latin America to structural adjustment and the onerous conditions imposed by international lending agencies such as the International Monetary Fund (IMF) on national governments in developing countries. The resulting disinvestment in public health infrastructure led to unsafe sewage management, contaminated water, and, ultimately, the cholera outbreak in Latin America in the early 1990s. This opportunity for cholera was also facilitated by warmer sea surface temperatures associated with El Nińo, as well as the unregulated transfer of bilge water from Asia to the Peruvian coast.
There is a recent tribute to Paul contained within the fascinating commencement address to new Harvard School of Public Health students, by Dr Larry Brilliant. It's highly recommended if Martin Luther King, the Grateful Dead, and the eradication of smallpox are of any interest!
1. Epstein PR. Brazil: climate of change? Lancet. 1992; 339: 1529.