Swellengrebel lecture. Public health and the ethics of sustainability

Hitherto, the danger of population increase has never been a constraint on public health programmes. Do we need to rethink this, now that population increase is causing communities to destroy their local ecosystems? 'Sustainability' is now the critical goal. The influence of falling child mortality in reducing fertility, which has been much promoted by UNICEF, is disputed. Our ethical premisses, particularly the absolute value of each human being, and the integrity of the ecosystem, conflict. If public health programmes are desustaining, they need to be balanced by complementary sustaining ones. Desustaining public health programmes should not be introduced just because they are possible. WHO's definition of health should be amended so that "Health is a sustainable state of ...". If this were to happen, a healthy lifestyle would have also to be a sustainable one.