T McMichael. Cambridge University Press, 2001. (Pp 413; price not stated). ISBN 0-521-80311-X hardback; ISBN 0-521-00494-2 paperback.

• McMichael T. Human frontiers
• environments and disease. Past patterns
• uncertain futures

Human frontiers, environments and diseases goes beyond the alarm raised by Silent spring by R Carson and continued by The stolen future by T Colborn. Toni McMichael gives a broad picture of health ecology. A picture that tells how during the 20th century, average life expectancy has doubled, the population has increased by four, the global food yield and water consumption by six, the production of carbon oxides by 12, and the level of economical activity 20 times, how the natural capital is being consumed, and what will be the future costs for human health.

The book is about determinants of health, from the perspective of the ecological framework. Health as a product of ecological circumstance, a mismatch between human biological inheritance and current way of life. Of special interest is the erudite journey through the human adaptation of unfamiliar environments from history and prehistory resulting in the current range of genetic makeup. The book is thus primarily aimed at health professionals, but also at politicians, economists, and the public in general.

Central in the current thinking of McMichael is the extension of the environmental health concerns to those attributable to changes of the planet's great biophysical and ecological systems. The impact of these hazards is displaced in time and space, and thus will affect the health of future generations. Science then is going beyond the empirical observations about the present and the past world and is giving as much weight to the future as to the present.

How to curb the process of overstepping the world limits and borrowing future health? McMicheal provides some answers: seeking a different economy, with the concept of fairness, ecology and equity; implementing sustainability in human activity in order to achieve cooperative and equitable stewardship of the ecosphere; and constraining human numbers (4 billion) and levels of waste generating consumption. I recommend that epidemiologists should read it despite being rather long.