Every once in a while, it's good to take stock. Why are we doing what we're doing? And is it working? Here we review two large trends.

I. Public health is in decline

Many chronic disorders are on the rise (diabetes; asthma; attention deficits and hyperactivity; autism; certain cancers, especially childhood cancers; certain birth defects; Parkinson's disease, others). More than half of all Americans -- adults and children -- are now living with a chronic disease.

The U.S. spends more per capita on health care than any other nation (almost 17% of Gross Domestic Product [GDP]), yet is 42nd among nations in longevity and 41st among nations in infant mortality. An important component of this poor performance is racial disparities: Blacks die 5 years earlier, on average, than whites; and infant mortality among Blacks is twice the rate among whites (13.7 per 1000 live births among Blacks vs. a national average of 6.8 per 1000). "It really reflects the social conditions in which African American women grow up and have children," says Dr. Marie C. McCormick, of the Harvard School of Public Health. "We haven't done anything to eliminate those disparities."

About half the U.S. population lives with the ever-present possibility that a medical emergency will cost them their job, drain their bank account, and perhaps even render them homeless. The number of medically uninsured in the U.S. is now 47 million, 8.7 million of them children. But another 73 million people are underinsured. All told, 40% of Americans -- many of them middle class -- lack adequate health insurance.

Within this general picture of decline, the urban poor are suffering the most. As a writer in the New York Times described the situation in 2003, "Something is killing America's urban poor, but this is no ordinary epidemic. When diseases like AIDS, measles and polio strike, everyone's symptoms look more or less the same, but not in this case.... Even teenagers are afflicted with numerous health problems, including asthma, diabetes and high blood pressure. Poor urban blacks have the worst health of any ethnic group in America, with the possible exception of Native Americans.... It makes you wonder whether there is something deadly in the American experience of urban poverty itself." And poverty itself has been rising for the past decade.

II. Our human technologies (and our human numbers) are destroying the earth as a place suitable for human habitation. We are wrecking our only home.

1. Many industrial chemicals have turned out to be far more potent and dangerous then even most environmental health activists imagined.

The recent discovery of a second genetic code (the "epigenetic" code) is radically altering our understanding of the role of the environment in human health (and the health of other creatures). It is beginning to become clear that inheritable diseases can be caused, and handed down to offspring, without any genetic mutations. Just 15 years ago, this would have seemed a scientific heresy. Now it is widely accepted as a reality, with far-reaching consequences. It means that your disease today may have been caused by your grandmother's diet decades ago, and that your grandchild's health may depend on the environment you inhabit and how you choose (or are forced) to live within it. Epigenetics "...introduces the concept of responsibility into genetics," says Dr. Moshe Szyf of McGill University, a pioneer in epigenetics. "Epigenetics may revolutionize medicine," said Dr. Szyf, "and it also could change the way we think about daily decisions like whether or not to order fries with a meal, or to go for a walk or to stay in front of the television. You aren't eating and exercising for yourself, but for your lineage." Suddenly "the environment" has taken on a much more central role in human health.

2. The concept of "fetal programming" reached the scientific mainstream this year with the publication of the Faroes Statement. Fetal programming traces many adult diseases back to low-level chemical exposures (and other stresses) in the womb or shortly after birth. It means that low-level exposures to industrial poisons are far more important than previously realized.

3. Electromagnetic fields have emerged in Europe as a major source of concern, and to a lesser extent in this country. High-voltage power lines, cell phone towers, and saturation by city-wide wi-fi systems have changed the electromagnetic environment in which we live, and there is accumulating evidence that disease patterns are changing as a result.

4. The nuclear genie is out of the bottle in ways that few anticipated even 15 years ago. It is now apparent that any country that acquires a nuclear power plant can within a few years make a crude but effective nuclear bomb. Israel, India, Pakistan, and North Korea have proven the point. Iran and a half-dozen other mid-east nations have now announced plans to acquire nuclear power. A new arms race is under way. To understand the nature of the threat, one need only ask, "If General Musharraf suddenly loses political power in Pakistan, who will end up controlling that nation's stockpile of nuclear weapons?"

5. As we and others predicted (it was a no-brainer), genetically modified crops have proven to be unmanageable. Only 10 years after the initial deployment of agricultural biotechnology, new phrases have entered the language -- "genetic contamination," "genetic trespass," and "superweeds," among others. Genetically modified organisms have proven impossible to control -- they travel long distances in ways that are poorly understood. Once established in new locations they cannot be eradicated. It is apparent that as time passes we will genetically modify the biology of the entire planet in ways we cannot anticipate, if we maintain our present course. And the most powerful changes are yet to come: biotechnologists are now creating crops that embody pharmaceutical products. It seems certain that these products, too, will be carried on the wind (or by birds, insects, or humans) and will end up growing in places where they are not wanted. As time passes, some or all of our food crops may well end up permanently contaminated with pharmaceutical drugs that are designed to be biologically active.

5. And most worrisome of all, the field of "biotechnology" has given rise to the even newer enterprise called "synthetic biology" in which new life forms are being created that have never been seen on earth before. Biotechnology merely manipulates genes that exist in nature. Synthetic biology, on the other hand, intends to create new genes that have never existed before, then construct entirely new creatures. Already viruses have been constructed from raw chemicals.

Just last week Craig Venter, a U.S. biotech entrepreneur, claimed to have constructed an artificial chromosome. "We are going from reading our genetic code to the ability to write it. That gives us the hypothetical ability to do things never contemplated before," Venter said.

The next goal is to manufacture a simple bacterium from raw chemicals. This is a far greater challenge than creating a virus or even a chromosome, but the intention has been announced, and work is underway.

In synthetic biology, the hubris of the biotechnologist combines with the giddy optimism of "Damn the torpedoes, full speed ahead!" This line of inquiry promises to produce some marvelous and surprising inventions, no doubt -- accompanied no doubt by serious, irreversible mishaps of an unprecedented nature and scale.

6. Nanotechnology is being touted by investors as "the next big thing" -- but a stream of bad news about the hazards of nano-sized particles has flooded forth during the past three years. Despite this, dozens or hundreds of commercial products based on nanotechnology have entered the marketplace, entirely unregulated and unlabeled. It is only a matter of time before the dual nature of this grand experiment becomes clear. We seem determined to learn these lessons the hard way -- just as we did with chlorine-based chemistry, nuclear power, and biotechnology.

7. Because of all this rapid, unchecked innovation, our ignorance is growing. As the natural environment becomes ever-more modified by the built environment, our ability to discern what exactly is going on is steadily diminishing. Yes, we are leaning more about the details, but as the systems themselves grow more complex and are being rapidly modified, our ability to understand them is receding.

Despite the impression of "steady progress" that one gleans from newspapers and TV, our ignorance about the world we have created is growing, not shrinking. We add 750 new chemicals to the mix each year -- almost all of them untested for effects on human health or the environment. As the level of complexity rises, our understanding shrinks. We are flying blind this year and we'll be even more blind next year as the products of our technical wizardry mix, blend, and interact in ways we cannot measure or even imagine. Perhaps that is the lasting lesson of modern science: our ignorance is more vast and more intractable than we ever could conceive.

How are we doing?

In the face of all this, how are we doing? The trend that we see in environment-and-health activism is not promising. It seems clear to us that problems of public health and environmental destruction are the result of choices being made by a tiny elite (they number perhaps 50,000 individuals) -- those powerful few who sit on multiple boards of directors of large corporations.

These are the people who make the big decisions for the nation --

** Will our economy be powered by renewable sources of energy or will we continue giving multi-billion-dollar subsidies to coal, petroleum, and nuclear power?

** Will we allow global warming to develop, then try to fix it, or will we adopt a preventive approach?

** Will we commit our children and grandchildren to a perpetual global war on terror or will we develop non-military, preventive solutions?

** Will we provide care and nurture for all the nation's children during their early formative years or will we keep expanding the prison-industrial complex, warehousing more and more young people for life?

** Will we operate the economy to provide a job for everyone who wants to work, and a livable wage for everyone who works, or will we continue to operate the economy for the few at the expense of the many?

** Will we commit to preventing illness or will we allow diseases to increase as we continually expand the proportion of GDP devoted to drugs, surgery, and other costly (and often painful and debilitating) technical remedies?

** Will we make the investments needed to develop an economy that meets human needs without compromising the ability of the biosphere to renew itself, or will we continue to wreck our only home?

** And most importantly, will we develop a system for financing our elections that eliminates the influence of private wealth, or will we allow corporate elites to continue to choose who can run for office and therefore who we can vote for?

For environment-and-health activists, the central question is, will our work be guided by the recognition that imbalances of power lie at the heart of the problems we are tackling, or are we lowering our gaze, turning aside, and pretending we can ignore the steady growth of corporate power and still make a real difference?