生态系统健康研究的一些基本问题探讨

目前有关生态系统健康研究的一些基本问题尚未达成共识。本文分析了健康、系统与生态系统3个与生态系统健康关联的概念,在此基础上,对生态系统健康的概念及其内涵、研究价值、研究的内容框架、研究的合理尺度以及生态系统质量诊断与质量等级评价进行了探讨。指出生态学上的生态系统是系统科学意义上系统的一类,整体性、稳定性和可持续性是生态系统的重要特征,生态系统健康可通过它的充分必要条件给出,即具备良好的整体性,能够维持较高的稳定性,并能实现良好的可持续性。生态系统质量标准分为质量诊断标准和质量等级评价标准,质量诊断是一种是与非的事实判断,而质量等级评价是一种价值判断。生态系统质量等级评价指标可分为限制可比型和非限制可比型两类。生态系统的复杂性决定了生态系统健康研究须借助于系统科学和非线性科学的理论与方法,生态系统病变的滞后性决定了生态系统健康研究必须加强生态系统质量预测与预警,而生态系统健康的跨学科性决定了生态系统健康研究需要生态学、环境学、医学、社会学以及经济学等领域研究人员的广泛合作。     

Community engagement in global health research that advances health equity

Community engagement is gaining prominence in global health research. So far, a philosophical rationale for why researchers should perform community engagement during such research has not been provided by ethics scholars. Its absence means that conducting community engagement is still often viewed as no more than a ‘good idea’ or ‘good practice’ rather than ethically required. In this article, we argue that shared health governance can establish grounds for requiring the engagement of low‐ and middle‐income country (LMIC) community members in global health research, where such research aims to help reduce health disparities. This philosophical basis has important implications for the ethical goals ascribed to engagement and the approach adopted to undertake it. We suggest the ethical goals of engagement in equity‐oriented global health research should include: (a) generating research topics and questions that reflect the key problems disadvantaged groups face in accessing healthcare, services and broader social determinants of health and (b) promoting the translation of research findings into policy and practice in ways that benefit the health of disadvantaged groups. We propose engagement practice should have the following features: deliberation with LMIC community members to make a range of project decisions, beginning with setting research topics and questions; inclusion of members of disadvantaged groups and those with the power to change policy and practice to benefit them; and purposeful structuring of deliberations to minimize the impact of power disparities between LMIC community members. Finally, we reflect on how these features differ from those typical of much current community engagement practice in LMICs.     

Protecting communities in health research from exploitation

Guidelines for health research focus on protecting individual research subjects. Yet several commentators have argued that protecting individual subjects, while undoubtedly important, is not sufficient to ensure ethical research. It is also vital to protect the communities involved in health research. In particular, a number of studies have been criticized on the grounds that they exploited host communities. Although these criticisms have received a good deal of attention, there has been no systematic analysis of what constitutes community exploitation in health research, nor an assessment of what safeguards are needed to protect against it. This is a serious deficiency. The absence of an analysis of community exploitation makes it impossible to ensure that host communities are protected against exploitation. The absence of an analysis also raises the possibility that charges of exploitation may block important research, without any way of assessing whether the charges are warranted. The present paper attempts to address these concerns by providing an analysis of community exploitation and, based on this analysis, determining what safeguards are needed to protect communities in health research against exploitation.