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To the Editor: Drs Koplan and Fleming¹ proffer a list of 10 public health challenges for the decades ahead. But they do not go far enough in focusing on the greatest threat to human health: environmental degradation on a global scale. A growing human population consuming resources at an unsustainable rate has put humanity's future in jeopardy. Global warming, emerging infections, massive human migrations, and species extinctions all stem from our inability to confront or control our fertility and our appetite.

While no one would argue with the 10 challenges Koplan and Fleming have identified, physicians need to address the uncomfortable reality that global environmental change is a greater threat to human health than any other factor, short of world war. The challenge is to leave future generations a world in which physicians can meaningfully address the important issues identified by Koplan and Fleming.

Roger A. Rosenblatt, MD,MPH
Department of . . . [Full Text of this Article]