Health of the last generation begins well before conception. It has been repeatedly demonstrated that if the parents’ health is good, or consciously improved before conception, many subsequent problems can be prevented. Given a minimum standard of living, preconceptional care is easy and can also be pleasant; exercise, fresh air and a healthy diet significantly reduce the social and health risks to the future child. When the factors associated with reduced reproductive potential are examined, it must be concluded that public healthcare and intensive education of the population most likely to be at risk are the most effective preventative measures. Governments should take the required measures giving special attention to the education of young people so that they can exercise a responsible attitude to themselves and their children. Translating preventative care into action requires an educational framework, which recognizes the ethical obligation that each of us is custodian of the next and subsequent generations. Practical principles of bioscience ethics might provide a satisfactory scientific framework activating the acceptance of reproduction as a privilege, rather than a right; a right all too often trivialized.
Importantly, health resources must be allocated on the basis of need, and Indigenous people must be involved in designing and implementing the solutions. All societies provide special rights to specific groups to ensure equal outcomes for all. That is why we have wheelchair access and designated parking for disabled people and diesel fuel subsidies for farmers. Health and living standards of Indigenous Australian people are the worst in the developed world, so special measures are required to address the underlying causes of such severe disadvantage. In order to destroy inequality there must be a ‘fair go’ for all Australians. Reconciliation is possible only when people make it their concern and actively work for it. In particular, medical and biological issues to do with health and wellbeing of parents and children need to be addressed and the provision of health and health education expanded for all citizens.
If society’s priority were to maximize avoidance of preconceptional prenatal/neonatal harm, the most efficient route would be through improvements to the general quality of life, by eliminating the worst environmental pollution and the stresses of poverty, which impair responsible parental care. An ecological model of care would concentrate on lifestyle factors such as diet, exercise, stress reduction, environmental quality, housing and work-place safety, which are crucial in determining our overall health and genetic resilience (Pollard 2002a).
The ecologically based model of care does not intend that educational reform be uniform; rather its framework should incorporate regional diversity and pluralistic problem-solving in tune with ethnically diverse populations. Part and parcel of raising consciousness is that all voices are heard, acknowledged and valued. Indigenous Australians have shown how it is possible to live in harmony with the natural environment incorporating ecological imperatives and values as well as providing and meeting the basic human needs through community-based social, economic and political structures. Indigenous Australians are an important source of wisdom because their values, social structures and cultural traditions clearly point the way to alternatives from which mainstream Western society has much to learn. This is being increasingly recognized within the ecological movement, and it is beginning to be acknowledged that in many cases Indigenous people’s spiritual and social values form a more solid basis for tackling social problems than do the conventional mechanism of the welfare state.
The 20th century experienced a giant leap in technological inventiveness and ruthless use of technological power. The anticipation for the 21st century is that a critical mass of humans will demand reconciliation by creatively engaging in social reform furthering human evolution toward emotional maturity. Since it is through a sense of control over our lives that we gain higher levels of personal achievement, health and wellbeing, it may be that the material wealth now enjoyed by a significant proportion of people, particularly in industrialized nations, will provide the necessary leisure for intellectual and spiritual development. Freedom from want may provide a breathing space for our further evolution.
Henry Marsh (Marsh 1997) realistically dubbed our recurring basic wants ‘the wheel of needs’. When our basic biological determinants of happiness or needs are not being met, the result is pain but pursuing our pain falsely by, for example, drug abuse, prevents us from confronting the source of our pain and enjoying being well. We have four basic biological needs; to live, to love, to have variety and to have self-worth (Fig. 5). To stay alive (need to live) is the most primal of all and represents the need for food, shelter and protection from the elements. The desire for intimacy (need to give and receive love) is the most basic of social needs. The need for variety represents interest and challenge – the spice of life. The need for self-worth assigns meaning to our lives and represents our quest for aesthetics, for spirituality. When we’re successful at meeting these basic needs, life has hope, enthusiasm and zest. If any one of these needs is not satisfied life becomes the opposite, risking depression, escapism, emotional distraction and disease.
In addition to the four basic biological needs, there are a further three social needs essential to the development and maintenance of health and wellbeing (Seligman 1995). The need to feel mirrored or empathized with first develops from the parents or other caregivers early in life. Empathy requires that one understands another’s experience from that person’s perspective and to communicate that empathy or understanding. The need to idealize others whose values and achievements we respect and aspire to provides the basis on which we build optimism and personal ethics later in life. The twinship or connectedness need provides us with the sense of belonging, of being part of a larger community of people (Fig. 5). These more-sophisticated social/cultural needs form the flexible basis of emotional intelligence, but can only be sustained in an environment where basic survival needs have been taken care of.
It seems that we have come full circle and could profit by reconsidering our biological origins. Scientists have drawn attention to the need for parental responsibility to commence well before the child is born. Commitment to the right of humans to express their full genetic potential free from preventable harm is fundamental to the mature society. This is where bioscience-bioethics can assist.
I am grateful to Roger Hiller for his interest and constructive evaluation of the manuscript, and to Ray Duell for the computer-generated illustrations. The authors declare that there is no conflict of interest that would prejudice the impartiality of this scientific work.
Received 23 November 2004
First decision 17 December 2004
Revised manuscript received 7 January 2005
Accepted 21 January 2005