Alvin Tarlov, Director of the Texas Institute for Society and Health, explained that ‘there are five major categories of influence on health:
- genes and associated biology;
- health behaviors, such as dietary habits, tobacco, alcohol and drug use, and physical fitness;
- medical care and public health services;
- the ecology of all living things;
- and social and societal characteristics’.
As stated by Stephen Leeder from the Menzies Centre for Health Policy in New South Wales, Australia, ‘the new public health makes considerable reference to sociological and anthropological insights and engages with the world of human behavior … in pursuit of better health’. As a result of these insights, physicians, nurses and public health practitioners have become an integral part and are, at times, at the forefront of social change. We now understand that how we interact with and treat each other, how we view others, how we share (or do not share) our resources, how we eat, how we work, how we play, how we shelter ourselves, how we think, how we govern ourselves, how we spend money, how we relate to our environment—in short, how we live—influences our health. Despite all that we have come to understand, however, we have yet to fully appreciate one of the major categories described by Tarlov: the ecology of all living things. It is true that we study in great detail the life cycle of mosquitoes and are applying greater attention to environmental changes. But we have always overlooked (with the few exceptions described earlier), and continue to overlook, a significant facet of human existence that has prevailed since our beginning: our relationship with and treatment of other animals.
Today, food security issues, limited health care resources, unsustainable consumption patterns, environmental degradation, bioterrorism, global warming, human population growth, obesity, novel infectious diseases, world hunger and violence are now emerging as the most urgent public health issues that we face. The complexity and multifactorial roots of these issues necessitate a public health strategy that goes well beyond the health sector. We have started to do this. Due to recent and significant changes in our climate, for example, the fields of public health and medicine have begun to acknowledge that how we treat our planet affects our health. To fully tackle these urgent issues head on, we must also acknowledge that many of them are inevitably linked with how we treat other animals. It is overly simplistic and inaccurate to say that every human–animal encounter that is connected with human illness is a result of our actions or is avoidable. Yet, a significant proportion of these connections are, at least in part, a result, directly or indirectly, of our disregard for or minimization of the welfare of animals.
If public health is concerned about the public’s health, then it must address a series of issues that it has so far largely avoided—and that affect the welfare of animals. If public health is concerned with how climate change endangers human health, it should also be concerned about factory farming’s impact on global warming. If public health is concerned about the threat of new and deadly infectious diseases, it should also be concerned about the wildlife trade’s potential to unleash a pandemic worse than HIV/AIDS. If public health is concerned about limited health care resources, it should also be concerned about how a significant portion of our health care dollars is diverted into animal experiments of dubious medical value. If public health is concerned about the alarming rise in antibiotic resistance, it should also be concerned about the ubiquitous feeding of antimicrobials to animals on industrial farms. If public health is concerned about violence, it should also be concerned about the connection between violence toward animals and violence toward people. If public health is concerned about the epidemic of obesity, it should also be concerned about obesity’s connection to our unprecedented consumption of animal products. If public health is concerned about the safety of our food, it should also be concerned about factory farming’s effect not just on the safety of animal food products but also on that of our fruits and vegetables.
In short, if public health is concerned about the protection and promotion of human health, and if public health acknowledges that every other facet of human existence plays a role in our health, it must also acknowledge that how we relate to animals is a major determinant of our health. If public health is concerned about public health, we must turn our attention to the elephant (and every other animal) in the room.