There is a growing body of critical literature on health, development and environmental sustainability in a world of finite resources and overburdened ecosystems. The ethics of progress and perpetual development in pursuit of unlimited economic growth and ever-expanding markets are no longer viable, given the constraints imposed on the life-support systems of the biosphere and a finite resource base, which poses the most serious threat to life on Earth. Despite increasing evidence of the linkages between economic growth and environmental deterioration and a rhetoric expressed in a growing body of laws, regulations, accords and global "agendas" at the national and international level, there are all too few success stories in reversing or even slowing down the current trends of ecosystem degradation and decreasing cultural and biological diversity. On the contrary, there is evidence that environmental stress and deterioration are increasing, and the impact on the mental, physical and social health and well-being of populations is more significant now than in any previous time in history. The fragmentation of countries, the rise of nationalism and ethnic conflict, the decimation of indigenous nations and human rights abuses are often closely interrelated with environmental degradation and development initiatives. This paper reviews some of the concepts and underlying values of the main "models" developed by health and social scientists for interpreting this reality, with the aim of stimulating debate that could lead to the adoption of a larger and more comprehensive framework for analysing the interactions between human health, development and environmental change.
BACKGROUND: Pollution from industry assumed new dimensions when large-scale industry and mining were established in Norway towards the end of the nineteenth century. The present article discusses how the local health administration responded to the first extensive industrial pollution of air and water. MATERIAL AND METHODS: Two chemical factories producing wood pulp and one abandoned nickel mine are studied by means of information from court records and municipal archives. RESULTS: New forms of large quantity pollutants and their great spreading capacity were not anticipated in the Health Act of 1860. The legislation at the time had ambiguous points which made it difficult to apply in cases of industrial pollution. One major problem was reliable documentation of adverse health effects. INTERPRETATION: Neither central nor local medical authorities had adequate competence to exert the professional influence required. In spite of this, local health commissions acted with considerable authority in the early 1890s. Within a few years, however, the health aspects were down-played because of the strong economic and political interests behind the new industries. The principal difficulties emerging in the 1890s with industrial pollution eventually lasted for nearly one hundred years.
The role played by the health commissions in preventive health work in a major and a minor urban community in Telemark, Skien and Langesund respectively, is analysed by means of a classification method applicable to cases and decisions referred to in the proceedings of the health commissions. Increasingly, health commissions had to rely on their own initiative under the leadership of the district medical officer. After 1890, the decisions reached by the health commissions were increasingly recommendations to local authorities. Sanitation and waste processing were the principal problems. Regular house-to-house inspections in Langesund appear to have become effective, while the problems in Skien presumably were too great to permit similar improvements there. Even though practical work of preventing the spread of epidemic diseases had to remain the doctors' responsibility, the health commissions were active in providing the necessary resources. However, the commissions did not play a leading role in developing improved drinking water supplies or other major issues essential to health. Neither did they engage to any considerable extent in the distribution of public health information. On the other hand, the commissions acted as a controlling authority in cases brought before them, thus fulfilling the intentions of the Health Act of 1860.
Hazardous environmental factors in Norway have changed considerably over the last decades, often for the better. During the last five-year period, water-works serving 800,000 Norwegians have been renovated. The earlier high levels of sulphur dioxide and lead in urban air are now very low, whereas suspended particulate matter and nitrogen oxides continue to be at levels which can induce adverse health effects. Radon and tobacco smoke are now important indoor contaminants. Moisture-induced damage in dwellings may lead to health problems; the extent of such damage is, however, not known. A number of fjords are still contaminated with metals, PAH (polycyclic aromatic hydrocarbons), PCB (polychlorinated biphenyls) and dioxins, even though industrial discharge to water and air has been greatly reduced. Body burdens of DDT, PCB and dioxins have been markedly lowered over time. There is a continuous increase in the use of chemicals, though the chemicals are better tested and controlled than before. The total volume of pesticides used has fallen over the last three decades. There are no clear changes over the last 15 to 20 years in perceived noise exposure.