Structuring policy problems for plastics,the environment and human health: reflections from the UK

How can we strengthen the science–policy interface for plastics, the environment and human health? In a complex policy area with multiple stakeholders, it is important to clarify the nature of the particular plastics-related issue before trying to understand how to reconcile the supply and demand for evidence in policy. This article proposes a simple problem typology to assess the fundamental characteristics of a policy issue and thus identify appropriate processes for science–policy interactions. This is illustrated with two case studies from one UK Government Department, showing how policy and science meet over the environmental problems of plastics waste in the marine environment and on land. A problem-structuring methodology helps us understand why some policy issues can be addressed through relatively linear flows of science from experts to policymakers but why others demand a more reflexive approach to brokering the knowledge between science and policy. Suggestions are given at the end of the article for practical actions that can be taken on both sides.     

Inclusion and human rights in health policies: comparative and benchmarking analysis of 51 policies from Malawi, Sudan, South Africa and Namibia

While many health services strive to be equitable, accessible and inclusive, peoples' right to health often goes unrealized, particularly among vulnerable groups. The extent to which health policies explicitly seek to achieve such goals sets the policy context in which services are delivered and evaluated. An analytical framework was developed--EquiFrame--to evaluate 1) the extent to which 21 Core Concepts of human rights were addressed in policy documents, and 2) coverage of 12 Vulnerable Groups who might benefit from such policies. Using this framework, analysis of 51 policies across Malawi, Namibia, South Africa and Sudan, confirmed the relevance of all Core Concepts and Vulnerable Groups. Further, our analysis highlighted some very strong policies, serious shortcomings in others as well as country-specific patterns. If social inclusion and human rights do not underpin policy formation, it is unlikely they will be inculcated in service delivery. EquiFrame facilitates policy analysis and benchmarking, and provides a means for evaluating policy revision and development.     

Human Health, Well-Being, and Global Ecological Scenarios

This article categorizes four kinds of adverse effects to human health caused by ecosystem change: direct, mediated, modulated, and systems failure. The effects are categorized on their scale, complexity, and lag-time. Some but not all of these can be classified as resulting from reduced ecosystem services. The articles also explores the impacts that different socioeconomic–ecologic scenarios are likely to have on human health and how changes to human health may, in turn, influence the unfolding of four different plausible future scenarios. We provide examples to show that our categorization is a useful taxonomy for understanding the complex relationships between ecosystems and human well-being and for predicting how future ecosystem changes may affect human health.Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position of the World Health Organization. This article has been subjected to EPA review and approved for publication but does not necessarily reflect EPA policy.     

Issues in Human Particulate Exposure Assessment: Relationship between Outdoor,Indoor, and Personal Exposures

The recent review of the National Ambient Air Quality Standard for particuslate matter and the resultant new health-based PM_2.5 standard was in part motivated by findings from epidemiological studies. These studies reported significant associations between adverse health effects and concentrations of ambient particulate matter at levels below the previously existing PM₁₀ standard. Interpretation of these results has been hindered by our relatively poor understanding of the relationship between personal exposures and concentrations in the indoor and outdoor environments. Individuals spend the majority of their time in indoor environments. Therefore, it is important to understand where and how they may be exposed to the contaminants which may be causing the health effects, and which activities place them at a higher risk of exposure to these agents. In addition, since particulate matter is a complex mixture of contaminants, further research is required to examine its formation process, sources, composition, and health effects. Without an improved scientific understanding of these issues, it is difficult to assess whether the new PM_2.5 standard will be implemented, and if so, whether it can be adequately protective of public health.     

On a tendency in health economics to dwell on income inequality and underestimate social stress

Social stress can cause physical and mental harm. It is therefore not surprising that public health policy makers have sought to identify and implement policies aimed at tackling this social ill. A frequently prescribed remedy is to reduce social stress by reducing income inequality, which is typically measured by the Gini coefficient. Decomposing the coefficient into a measure of a population’s social stress and a population’s income makes it possible to show that steps taken to lower the coefficient can actually exacerbate social stress. We formulate conditions under which lowering the Gini coefficient coincides with increasing social stress. If the aim of public policy is to improve public health and increase social welfare, and if social welfare is reduced by social stress, then lowering the Gini coefficient may not be the right course of action.     

Genetics and personal responsibility for health

Advances in genetic medicine may have implications for how we should think about personal responsibility for health, because they may show how it is possible to exert some control over risk factors that were previously thought as beyond the individual's control. Although we cannot control the genes that we are born with, we can often make decisions concerning genetic testing, disease prevention, and treatment. One might argue, therefore, that individuals should be treated as morally responsible for taking effective action in response to genetic risks factors, since genetically based health risks are similar to other health risks. While this argument makes sense as an abstract, philosophical position, it is not a useful guide to public policy. Given these concerns, there is little society can or should do to encourage individuals to address their genetic risk factors, other than praising those who make prudent choices.     

Effectiveness of the public health policy for breast cancer screening in Finland: population based cohort study.

OBJECTIVE: To evaluate the effectiveness of screening for breast cancer as a public health policy. DESIGN: Follow up in 1987-92 of Finnish women invited to join the screening programme in 1987-9 and of the control women (balanced by age and matched by municipality of residence), who were not invited to the service screening. SETTING: Finland. SUBJECTS: Of the Finnish women born in 1927-39, 89893 women invited for screening and 68862 controls were followed; 1584 breast cancers were diagnosed. MAIN OUTCOME MEASURES: Rate ratio of deaths from breast cancer among the women invited for screening to deaths among those not invited. RESULTS: There were 385 deaths from breast cancer, of which 127 were among the 1584 incident cases in 1987-92. The rate ratio of death was 0.76 (95% confidence interval 0.53 to 1.09). The effect was larger and significant (0.56; 0.33 to 0.95) among women aged under 56 years at entry. 20 cancers were prevented (one death prevented per 10000 screens). CONCLUSIONS: A breast screening programme can achieve a similar effect on mortality as achieved by the trials for breast cancer screening. However, it may be difficult to justify a screening programme as a public health policy on the basis of the mortality reduction only. Whether to run a screening programme as a public health policy also depends on its effects on the quality of life of the target population and what the resources would be used for if screening was not done. Given all the different dimensions in the effect, mammography based breast screening is probably justifiable as a public health policy.     

Reinterpreting Responsiveness for Health Systems Research in Low and Middle‐Income Countries

The ethical concept of responsiveness has largely been interpreted in the context of international clinical research. In light of the increasing conduct of externally funded health systems research (HSR) in low‐ and middle‐income countries (LMICs), this article examines how responsiveness might be understood for such research and how it can be applied. It contends that four features (amongst others) set HSR in LMICs apart from international clinical research: a focus on systems; being context‐driven; being policy‐driven; and being closely linked to development objectives. These features support reinterpreting responsiveness for HSR in LMICs as responsiveness to systems needs, where health system performance assessments can be relied upon to identify systems needs, and/or responsiveness to systems priorities, which entails aligning research with HSR priorities set through country‐owned processes involving national and sub‐national policymakers from host countries. Both concepts may be difficult to achieve in practice. Country ownership is not an established fact for many countries and alignment to their priorities may be meaningless without it. It is argued that more work is, therefore, needed to identify strategies for how the responsiveness requirement can be ethically fulfilled for HSR in LMICs under non‐ideal conditions such as where host countries have not set HSR priorities via country‐owned processes. Embeddedness is proposed as one approach that could be the focus of further development.     

The nitrogen cycle, scientific uncertainty and policy relevant science

Much of the research on the nitrogen cycle aims to improving scientific understanding but is not focused specifically on removing or reducing the scientific uncertainties that constrain policy makers in the formulation of appropriate responses to old or emerging environmental problems. Policy makers, for example, commonly find it difficult to assess the spatial or temporal importance of the various risks to human and ecosystem health that stem from man's interference with the natural N cycle. This paper will justify this conclusion by reference to the findings of a recent study on non-point pollution from crop production in China. The findings concern the perceived risks of groundwater nitrate to human health; uncertainties about critical NOx levels and their interactions with other pollutants; various other dimensions of man's impact on the N cycle. The paper will go on to suggest a more systematic process or pathway by which scientists can select and design their research in a manner that could give more effective support to policy makers.     

The nitrogen cycle,scientific uncertainty and policy relevant science

Much of the research on the nitrogen cycle aims to improving scientific understanding but is not focused specifically on removing or reducing the scientific uncertainties that constrain policy makers in the formulation of appropriate responses to old or emerging environmental problems. Policy makers, for example, commonly find it difficult to assess the spatial or temporal importance of the various risks to human and ecosystem health that stem from man’s interference with the natural N cycle. This paper will justify this conclusion by reference to the findings of a recent study on non-point pollution from crop production in China. The findings concern the perceived risks of groundwater nitrate to human health; uncertainties about critical NO_x levels and their interactions with other pollutants; various other dimensions of man’s impact on the N cycle. The paper will go on to suggest a more systematic process or pathway by which scientists can select and design their research in a manner that could give more effective support to policy makers.

     

Reflections on the development of health economics in low- and middle-income countries

Health economics is a relatively new discipline, though its antecedents can be traced back to William Petty FRS (1623–1687). In high-income countries, the academic discipline and scientific literature have grown rapidly since the 1960s. In low- and middle-income countries, the growth of health economics has been strongly influenced by trends in health policy, especially among the international and bilateral agencies involved in supporting health sector development. Valuable and influential research has been done in areas such as cost–benefit and cost-effectiveness analysis, financing of healthcare, healthcare provision, and health systems analysis, but there has been insufficient questioning of the relevance of theories and policy recommendations in the rich world literature to the circumstances of poorer countries. Characteristics such as a country''s economic structure, strength of political and social institutions, management capacity, and dependence on external agencies, mean that theories and models cannot necessarily be transferred between settings. Recent innovations in the health economics literature on low- and middle-income countries indicate how health economics can be shaped to provide more relevant advice for policy. For this to be taken further, it is critical that such countries develop stronger capacity for health economics within their universities and research institutes, with greater local commitment of funding.     

The nitrogen cycle, scientific uncertainty and policy relevant science

Much of the research on the nitrogen cycle aims to improving scientific understanding but is not focused specifically on removing or reducing the scientific uncertainties that constrain policy makers in the formulation of appropriate responses to old or emerging environmental problems. Policy makers, for example, commonly find it difficult to assess the spatial or temporal importance of the various risks to human and ecosystem health that stem from man's interference with the natural N cycle. This paper will justify this conclusion by reference to the findings of a recent study on non-point pollution from crop production in China. The findings concern the perceived risks of groundwater nitrate to human health; uncertainties about critical NOX levels and their interactions with other pollutants; various other dimensions of man's impact on the N cycle. The paper will go on to suggest a more systematic process or pathway by which scientists can select and design their research in a manner that could give more effective support to policy makers.     

The nitrogen cycle,scientific uncertainty and policy relevant science

Much of the research on the nitrogen cycle aims to improving scientific understanding but is not focused specifically on removing or reducing the scientific uncertainties that constrain policy makers in the formulation of appropriate responses to old or emerging environmental problems. Policy makers, for example, commonly find it difficult to assess the spatial or temporal importance of the various risks to human and ecosystem health that stem from man’s interference with the natural N cycle. This paper will justify this conclusion by reference to the findings of a recent study on non-point pollution from crop production in China. The findings concern the perceived risks of groundwater nitrate to human health; uncertainties about critical NO_x levels and their interactions with other pollutants; various other dimensions of man’s impact on the N cycle. The paper will go on to suggest a more systematic process or pathway by which scientists can select and design their research in a manner that could give more effective support to policy makers.     

Aids, Policy and Bioethics: Ethical Dilemmas Facing China in HIV Prevention

The present situation of the HIV/AIDS epidemic is very grim in China. The probability of China becoming a country with a high prevalence of HIV/AIDS cannot be excluded because there have been factors which promote the wide spread of HIV if we fail to take timely action to prevent it at the opportune moment. However, China's HIV prevention policy is inadequate. Health professionals and programmers believed that they could take a conventional public health approach to cope with the HIV epidemic. They simply ignored the fact that HIV infection is an epidemic so special that their approach is not effective to deter the epidemic. Many health professionals and programmers bypassed ethical issues that had emerged in the prevention of the HIV epidemic. Even some health educators, sexologists and officials believe that `AIDS is the punishment for promiscuity', and this belief has led to discrimination and stigmatization of AIDS patients, HIV positive people, their family members and high risk groups. Although homosexuality is not illegal, the police can always find any reason to detain homosexuals. A difficult ethical issue is about the laws prohibiting prostitution and drug use in China which force prostitutes and intravenous drug users underground, giving them no chance to access information, education and the services needed to protect them. The dilemma facing China is whether to stay with a restrictive policy for the reason of ideology cleansing or to turn to a more supportive policy. It is necessary to have some change in the ethical framework to evaluate the action in HIV prevention. Tolerance should be the first ethical principle.     

Facing an unfortunate trade-off: policy responses,lessons and spill-overs during the COVID-19 pandemic

Although COVID-19 emerged as a global shock, governments adopted non-pharmaceutical policy responses that were rather heterogeneous, depending on cultural and institutional characteristics. At the country level, the stringency of ‘lockdown’-type policies should be set to achieve the best possible trade-off between economic and fatality dynamics, obviously accounting for possible cross-border influences. To allow for policy learning, I assume that the first country implementing a policy initiative that is worth emulating must either get the best possible health or the best possible economic outcome. I propose a combination of sign and magnitude restrictions, embedded in a global VAR model, to identify idiosyncratic policy shocks that spill over and influence policy responses abroad. Once policy shocks are identified, I run a comparison exercise between two model specifications, i.e. with and without policy emulation. Within a given a sample, this methodology can be used to find when and where policy lessons can be identified. I find that, among 17 developed and developing countries, few can offer lessons based on their policy initiatives, but several others might get better trade-offs through policy emulation, although in reality this outcome is not guaranteed to have occurred.     

Health, justice, and the environment

In this article, we argue that the scope of bioethical debate concerning justice in health should expand beyond the topic of access to health care and cover such issues as occupational hazards, safe housing, air pollution, water quality, food and drug safety, pest control, public health, childhood nutrition, disaster preparedness, literacy, and many other environmental factors that can cause differences in health. Since society does not have sufficient resources to address all of these environmental factors at one time, it is important to set priorities for bioethical theorizing and policy formation. Two considerations should be used to set these priorities: (1) the impact of the environmental factor on health inequality, and (2) the practicality of addressing the factor.     

Aging, evolution and individual health span: introduction

The effect of autologous and environmental wear and tear on genes and gene products will be considered in systems renewed by self-replicating stem and precursor cells as well as in systems that do not have the capacity for self-renewal. Aging will be discussed in terms of speciation and in terms of health-span differences between individuals of the same species. The analysis of speciation involves early as well as late-acting genes. The intraspecies analysis is primarily concerned with the second half of life and thus is not affected by selective pressures. Analysis of individual aging is concerned with health span, qualified by identification of the particular system that is responsible for the limit of health span in subpopulations; it depends on a subset of allelic products of many genes and their relative functional capacity. The identification of such alleles can provide the starting point for reverse genetics. Results will be presented, which have been obtained by analysis of age-related events in inbred mice, where regulation, involved in degenerative disease of old age, can be studied in groups of individuals with a relatively constant genetic background. It should be possible to identify appropriate probes for degenerative diseases of old age that can be used for detection of corresponding human genes. Worldwide demographic changes have created the need for a new type of public health policy. To respond to this need, we should learn how to identify individuals at risk from degenerative diseases of old age and how to treat them preventively.     

Policy on Synthetic Biology: Deliberation,Probability, and the Precautionary Paradox

Synthetic biology is a cutting‐edge area of research that holds the promise of unprecedented health benefits. However, in tandem with these large prospective benefits, synthetic biology projects entail a risk of catastrophic consequences whose severity may exceed that of most ordinary human undertakings. This is due to the peculiar nature of synthetic biology as a ‘threshold technology’ which opens doors to opportunities and applications that are essentially unpredictable. Fears about these potentially unstoppable consequences have led to declarations from civil society groups calling for the use of a precautionary principle to regulate the field. Moreover, the principle is prevalent in law and international agreements. Despite widespread political recognition of a need for caution, the precautionary principle has been extensively criticized as a guide for regulatory policy. We examine a central objection to the principle: that its application entails crippling inaction and incoherence, since whatever action one takes there is always a chance that some highly improbable cataclysm will occur. In response to this difficulty, which we call the ‘precautionary paradox,’ we outline a deliberative means for arriving at threshold of probability below which potential dangers can be disregarded. In addition, we describe a Bayesian mechanism with which to assign probabilities to harmful outcomes. We argue that these steps resolve the paradox. The rehabilitated PP can thus provide a viable policy option to confront the uncharted waters of synthetic biology research.     

AIDS, policy and bioethics: ethical dilemmas facing China in HIV prevention: a report from China

The present situation of the HIV/AIDS epidemic is very grim in China. The probability of China becoming a country with a high prevalence of HIV/AIDS cannot be excluded because there have been factors which promote the wide spread of HIV if we fail to take timely action to prevent it at the opportune moment. However, China's HIV prevention policy is inadequate. Health professionals and programmers believed that they could take a conventional public health approach to cope with the HIV epidemic. They simply ignored the fact that HIV infection is an epidemic so special that their approach is not effective to deter the epidemic. Many health professionals and programmers bypassed ethical issues that had emerged in the prevention of the HIV epidemic. Even some health educators, sexologists and officials believe that `AIDS is the punishment for promiscuity', and this belief has led to discrimination and stigmatization of AIDS patients, HIV positive people, their family members and high risk groups. Although homosexuality is not illegal, the police can always find any reason to detain homosexuals. A difficult ethical issue is about the laws prohibiting prostitution and drug use in China which force prostitutes and intravenous drug users underground, giving them no chance to access information, education and the services needed to protect them. The dilemma facing China is whether to stay with a restrictive policy for the reason of ideology cleansing or to turn to a more supportive policy. It is necessary to have some change in the ethical framework to evaluate the action in HIV prevention. Tolerance should be the first ethical principle.     

Phylogenetic Insight into Zika and Emerging Viruses for a Perspective on Potential Hosts

Global viral diversity is substantial, but viruses that contribute little to the public health burden or to agricultural damage receive minimal attention until a seemingly unimportant virus becomes a threat. The Zika virus (ZIKV) illustrated this, as there was limited information and awareness of the virus when it was identified as a public health emergency in February 2016. Predicting which virus may pose a future threat is difficult. This is in part because significant knowledge gaps in the basic biology and ecology of an emerging virus can impede policy development, delay decision making, and hinder public health action. We suggest using a phylogenetic framework of pathogens and their infected host species for insight into which animals may serve as reservoirs. For example, examining flaviviruses closely related to ZIKV, the phylogenetic framework indicates New World monkeys are the most likely candidates to be potential reservoirs for ZIKV. Secondarily, mammals that are in close proximity to humans should be considered because of the increased opportunity for pathogen exchange. The increase in human-mediated environmental change is accelerating the probability of another previously overlooked virus becoming a significant concern. By investing in basic science research and organizing our knowledge into an evolutionary framework, we will be better prepared to respond to the next emerging infectious disease.