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An epidemiologist takes a long view of our fraught relationship with the environment

Climate Change and the Health of Nations: Famines, Fevers, and the Fate of Populations

Anthony J. McMichael
Oxford University Press
390 pp.
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Last year’s adoption of the Paris Agreement signaled widespread political will to reach net-zero greenhouse gas emissions by midcentury while aiming to keep the rise in global average temperatures to well below 2°C above preindustrial levels. More than 100 nations ratified it, and the mood was optimistic as countries reconvened this year to talk implementation. That is, until the U.S. election put climate change denialism back on the table.

As political momentum slows, perhaps there is no better time to glance at the “rear-vision mirror of history,” as suggested by Anthony McMichael in Climate Change and the Health of Nations. The book’s goal is not to make predictions but to motivate change, which McMichael does by bringing into focus humanity’s sensitivity to fluctuations in the natural climate system throughout history.

McMichael, an epidemiologist, published prolifically on the relationship between changing climates and human health during his four-decade-long career. This is the last full-length work he completed before his unexpected death in 2014. True to his legacy, McMichael puts people front and center in the story.

The book weaves together historical threads, multiple fields of science, and references to art and literature, as if McMichael is gathering the strands of his knowledge. Its power derives from synthesis.


Just 6° separated the last glacial period from the era in which early farming began, notes McMichael.

Our journey through Earth’s evolutionary phases begins in the Cambrian explosion 540 million years ago and continues through the Pleistocene to the beginning of our current epoch, the Holocene, aka our “climatic comfort zone.” Cue the spread of farming and, as more food begets more people, the rise of towns, cities, and civilizations. Along the way, the book describes climate-enabled developments in agriculture, environmental pressures that caused the rise and collapse of empires, and the increase in natural resources demanded by ever-more-prosperous and complex societies.

We see how cooling temperatures forced early Europeans to abandon settlements and make do with less-productive farming and how unusually cool and humid conditions ushered in the bubonic plague and contributed to the fall of the Roman Empire. The Mayan civilization, we learn, met a similar fate, in part as a result of severe drought that brought food shortages, conflict, and migration. As we reach modern times, the information gets richer and more familiar: food and water shortages, extreme weather disasters, the first cholera pandemic, etc.

Food shortages emerge as the greatest recurring risk. But McMichael is careful to note that climatic variation does not act alone in major crises. More often than not, it gives an “extra punch” to other forces, such as environmental degradation, social unrest, and displacement.

Just 6°C separates the emergence of early farming 11,000 years ago from the end of the glacial period that preceded it, McMichael notes, giving context to the 3° to 4°C increase expected this century if current emission rates are maintained. And it’s not just ecological systems that are vulnerable to small variations in temperature: Human biology evolved in times of stability, slowly adapting to climatic variations through natural selection. The book calls on a framework for understanding the vulnerability of species and systems to climate change, categorizing the evidence according to exposure, susceptibility, and adaptive capacity.

Here, McMichael is at his most critical. He sees naiveté in arguments that human ingenuity will get the world out of trouble and laments the pursuit of incremental technical fixes. An instance of optimism about the rise of renewable energy soon fades under the weight of an array of perceived structural and scientific barriers. Ultimately, the book traces our failure to adapt and respond to climate change to an economic paradigm that equates material growth with progress, overlooking the value of natural wealth.

Scepticism, doubt, and denial don’t escape McMichael’s attention. He argues that not believing in climate change originates from a human tendency to favor urgent, survival-enhancing reactions over responding to gradual changes. Can the brainpower we evolved in times of climatic stability be channeled toward changing the behavior that undermines this stability? he asks.

McMichael concedes that change is not easy. He focuses on motivating action by speaking to the public about climate change not in the abstract but in terms that are closer to home, akin to everyday experience. Through education and informed discussion, let’s talk of debilitating heat, not emissions; parched crops, not scenarios; infectious microbes in the water we drink, not targets. This way, he says, there may be a chance to activate a “fight or flight” response that befits this threat to our survival.

About the author

The reviewer is a freelance writer and editor based in London.