The history of the relations between health and the environment is rooted in longstanding traditions, some of which are even at the origins of the very discipline of history: in his Methodus ad facilem historiarum cognitionem (Method for the Easy Comprehension of History, 1566), Jean Bodin made climatic determinism one of the explanations for understanding the living conditions of populations, body characteristics, the evolution of health, and the link between nature and society. This idea was based on the fortunes of theoretical and practical neohippocratism, as medical knowledge was largely based on the history of diseases, both individual and collective (epidemics, pandemics, etc.), caused by the quality of water, air, soil, and diet. However, this historicity of medical thought—which receded into the background after 1850 with the development of first clinical and later microbial and genetic medicine—has garnered renewed interest since the late twentieth century among historians, as well as national and international health organizations.
For historians, it is primarily a matter of understanding how environmental conditions interacted with the actions of society, with the American historiography playing a major role in this field by emphasizing microbial collisions during colonization and by using global history approaches, which in a certain way reconnect with the principles of cosmography during the Renaissance. The analyses of William Hardy McNeill and Alfred W. Crosby have had a global impact. For health organizations, chief among them the World Health Organization—founded in 1948 after succeeding the League of Nations (1919-1946) Health Section in the aftermath of the Second World War—the struggle against diseases involved taking into consideration medical and social contexts, issues relating to power, and the effects of globalization, with special monitoring for diseases connected to pollution and the circulation of viruses and microbes, whose topicality has been intensified by global warming.
Nature: threat or asset? The example of wetlands and forests
Mephitism and harmful miasmas were related to age-old fears of wetlands, which were considered unhealthy and dangerous. The particularity of intermittent fevers was a commonplace in the medical literature, before its identification with malaria thanks to the research of Alphonse Laveran, who published his Treatise on paludial fevers in 1884. These fevers, which were more or less virulent and deadly depending on the type of Plasmodium responsible, affected all of Europe up through Scandinavia, before gradually ebbing beginning in the late nineteenth, doing so more quickly in Northern Europe. They were endemic not only to wetlands such as the Pontine Marshes, the Ebro Delta, Camargue, Dombes, Sologne, Flemish and Dutch polders, and the counties of South East England, but also to cities, whose sites were often comparable to marshes for military and economic reasons. Today we know that environmental conditions are essential to understanding the mechanisms of this disease, which remains the most serious global endemic in the twenty-first century (approximately 200 million cases according to WHO estimates from 2012). After ravaging the continent, malaria has practically disappeared from Europe due to the elimination of some of the conditions for its transmission: wetlands and anopheles are necessary conditions, but insufficient on their own. In early modern medical representations and knowledge, emanations from humid zones were a danger that justified drainage and sanitation efforts. This could strengthen certain economic interests, such as those connected to intensifying agricultural and urban development, or on the contrary weaken others, thereby prompting resistance, conflict, and debate regarding potential operations. Today, an inhabitant’s responsibility over his or her everyday environment is singled out, namely through the creation of micro-spaces favorable to the tropical mosquitos that have arrived in Europe (such as the tiger mosquito, a carrier of dengue fever).
The traditional image of forests is largely opposed to that of marshes: zoonoses (diseases transmitted from vertebrates to humans) were overlooked, and wooded areas were associated with healthy environments, with their disappearance proving problematic due to the disequilibrium that resulted. Beginning in the final third of the eighteenth century—even before the birth of ecology—botanists became aware of deforestation’s impact on both climate and the quality of the air, water, and soil. However, these modifications also resulted from the salubrity of places, in addition to health. While contemporary studies partially covered colonial territories—especially islands in the example of Pierre Poivre and the Mascarene Islands—their scope was more general. In France, under the Bourbon Restoration and the July Monarchy, parliamentary debates focused on the economic utility of deforestation against a backdrop of heightened health considerations, as tree mass was considered at the time as a way of combatting harmful gases. The law of July 28, 1860 and the reforestation operations that grew out of it, such as those of the Landes de Gascogne, were one of the results of this vision seeking to reconcile economic interest and the healthiness of places. All European states pursued reforestation policies, but it was in Southern Europe, and Spain and Italy in particular, where the stakes were the most important. The idea that forests could absorb some carbon dioxide and combat the mephitism attributed to this gas were part of European medical arguments during the second half of the nineteenth century.
Urbanization, pollution, diet: health amid insalubrity and toxic substances
Worries were expressed regarding the urban environment throughout the nineteenth and twentieth centuries, with a growing number of Europeans nevertheless converging toward cities. In 1800, the number of Europeans living in cities was 20 million (urbanization rate of 11.5%); a century and a half later, urban inhabitants number 259 million, or nearly one European out of two. Rural emigration continued throughout the second half of the twentieth century. The immediate postwar generations took part in an urban, automotive, and consumerist civilization, which was the subject of early criticism, and whose health effects were not—or were only tentatively—addressed by public authorities. The products that were gradually added to the list included automobile exhaust emissions, phytosanitary products (ranging from DDT to glyphosate), and the molecules used by the consumer goods industry (formaldehyde, glycol ethers, parabens). Industrial research laboratories have fashioned a largely invisible chemical environment across the planet.
Urbanization, during a liberal age in which the government focuses on regalian functions (police, justice, foreign affairs), has given greater responsibility to local authorities. To combat childhood diseases and prevent epidemic illnesses, municipalities in the late nineteenth century organized and provided treatment for the poorest or “at risk” families. The experience of municipal hygiene offices, which were implemented in Brussels during the 1870s and copied in France initially in Le Havre, developed quickly. There were dozens of them when the public health protection law of 1902 made them mandatory for cities with more than 20,000 inhabitants, as well as for spas and seaside resorts. The most common operations were vaccinations, school-based healthcare, and the disinfection of homes in cases of contagious disease. In all industrialized countries (the United Kingdom, Germany, etc.), ancillary organizations both public and charitable oversaw milk distribution for children. Laboratories controlled the quality of the food sold in markets as well as that of water, which gradually became necessary to purify. Insalubrious housing was a factor of disease that was more difficult to combat, albeit one that prompted major studies by statisticians and hygienists. Housing policy regulations increased in Switzerland in the late nineteenth century. In Paris, a “sanitary record” implemented in 1894 described the state of buildings and housing, and led to the identification of unhealthy clusters. Limited investment in renovation on the part of owners—and the small percentage of the household budget (approximately 10%) allocated for rent by workers—explain the unhealthy state of a considerable portion of the French urban housing stock in the aftermath of the Second World War. Throughout the first half of the twentieth century, intense propaganda against social ills such as alcoholism, tuberculosis, and syphilis sought to reduce phthisic morbidity and venereal diseases. All modern means of communication were used, with sanitary education becoming a discipline in its own right. Philanthropic associations sent children from urban hovels to breathe the country air, for lack of being able to act of the state of their housing.
Advances in biomedicine, emblematized by the antibiotics developed after the Second World War, gradually led to the abandonment of prevention, which was synonymous with discipline over bodies and relegated as an archaic practice. The announcement of the eradication of smallpox in 1978 was seen as an advance made possible by a century of hygiene and medicine, before AIDS posed a challenge to public health system and put health prevention back on the agenda. Climate change, with its heat waves and the northern advance of disease-carrying mosquitos, is a new challenge for a hygiene weakened by various health scandals in the late twentieth century, ranging from the ticking time bomb of asbestos to uncertainty surrounding the risks of food production (“the mad cow crisis”).
Finally, the effects of urban life on health recurred throughout the period, with highs and lows in terms of media coverage and importance among public concerns. The Lyon doctor Pierre Delore, who belonged to the holistic movement—those attentive to both the physical state and the spiritual well-being of citizens—had the following to say in 1956, shortly before talk of a “mal des grands ensembles” (housing project disorder) emerged: “Correcting the disadvantages of the urban climate involves urban planning, decentralization, destroying slums, and creating free spaces, parks, gardens, avenues, plazas, and squares (the lungs of cities, the “green city”), as well as combatting noise, general hygiene, clean streets, municipal regulations, sufficiently high smokestacks, replacing fuel-burning cars with electric cars, diverting some urban traffic via beltways at the edges of cities, and workshop hygiene.” This series of levers for action, ranging from the physical to the social environment, were taken into consideration by public actors. For approximately three decades, the WHO has identified healthy cities network, while the French government has implemented four national “health and environment” plans since the beginning of the twenty-first century, with mixed results in terms of action directed toward (or driven by) citizens.
Health at work: a longstanding concern renewed by industrial revolutions
Beginning with the early modern period, the matter of occupational diseases was addressed by the medical community, as demonstrated by Ramazzini’s famous Treatise of the Diseases of Tradesmen (De Morbis artificum diatriba, 1700), although it remained dependent on the Hippocratic medicine based on the characteristics of “places.” The work was republished throughout Europe during the eighteenth century (Leipzig, Utrecht, London, Venice, Geneva, Leiden, Naples, Paris, etc.), but was nevertheless relatively isolated until the publications by the Lausanne doctor Samuel-Augustin Tissot, in addition to various papers sent to the learned societies, medical journals, and medical schools of Europe, especially after 1760. With economic liberalization in Western Europe, workers were in a weak position, with numerous observers emphasizing their poor health, especially in the textile industry. In France after the Revolution, child and women’s labor sparked mobilization on the part of charitable and Catholic networks, who added moral degradation to the risk of accidents and deteriorating physical health. A comparable phenomenon unfolded in Great Britain, where on the occasion of the first legislation protecting women, children, and young workers, exposure to pathogenic agents in connection with work remained a secondary concern.
It was not until the last third of the nineteenth century that a true “occupational hygiene” emerged. This was the period that saw an increasing number of Treatises on industrial hygiene (in France by the doctors Napias, Poincaré, Layet, etc.). It was much later, in the twentieth century, that lead poisoning—a well-known pathology that afflicted lead factory workers and house painters—was first classified as an occupational disease. The law for compensating workplace accidents (1898), which was extended to occupational diseases in a 1919 vote, made these intoxications part an insurance-based system departing from ordinary law, one that is characterized to this day by the great difficulty of ill persons in having the occupational origin of their illness recognized. A new era began of practitioners within an increasingly technical discipline dedicated to the sanitation of working environments. In Belgian mines, hookworms, a parasitical infection long endemic in Europe and widespread in most mining districts, was screened for upon hiring. In general, the occupational medicine implemented in the years before the Second World War sought to prevent the hiring of workers with diseases that could potentially be eligible for compensation, such as silicosis. Preventing was better than healing, an approach that flirted with eugenics. For both the company and the employee, accidents were much more of a threat than chronic illnesses. Occupational health was even more pronounced during the third quarter of the century, which saw a mass mobilization to combat pollution and protect the environment. The dust breathed in the workplace remained largely limited to circles of experts, while the soot emitted by coal-fired power plants sparked immediate complaints from local inhabitants. The impact of organizing work into three shifts of eight hours, in addition to the pace imposed by machines, were little understood by a society rushing to recognize the merits of household appliances and automobility. With the rising media and political importance of the “asbestos scandal” there finally emerged the issue of “workplace health,” which is sensitive and socially troubling due to the differing effects of toxic materials. While the cancer epidemic potentially caused by exposure to deadly fibers is not yet finished, a new breach has been made in the front against occupational diseases with the recognition of anxiety as a legal harm (France, 2019).
