Environmental migrants,structural injustice,and moral responsibility

Climate change and environmental problems will force or induce millions of people to migrate. In this article, I describe environmental migration and articulate some of the ethical issues. To begin, I give an account of these migrants that overcomes misleading dichotomies. Then, I focus attention on two important ethical issues: justice and responsibility. Although we are all at risk of becoming environmental migrants, we are not equally at risk. Our risk depends on our temporal position, geographical location, social position, and the kind of society in which we live. We all contribute to environmental problems, but we do not contribute equally. About 11% of the world population is responsible for 50% of carbon emissions. These inequalities raise issues of justice because many of the people who are at high risk have contributed little to the problems. Since the issues of justice are relatively clear and compelling, I focus more attention on issues of responsibility. I use Iris Marion Young’s account of responsibility for structural injustice to address four key questions about moral responsibility and environmental migration.     

Consequentialism, reasons, value and justice

Over the past 10 years, John Harris has made important contributions to thinking about distributive justice in health care. In his latest work, Harris controversially argues that clinicians should stop prioritising patients according to prognosis. He argues that the good or benefit of health care is providing each individual with an opportunity to live the best and longest life possible for him or her. I call this thesis, opportunism. For the purpose of distribution of resources in health care, Harris rejects welfarism (the thesis that the good of health care is well-being) and argues that utilitarianism in general may lead to de facto discrimination against groups of people needing health care. I argue that well-being is a superior theory of the good of health care to Harris' opportunism. Harris' concerns about utilitarianism can be better addressed by: (i) relating justice more closely to reasons for action; (ii) by conceptualising the relationship between reasons for action and the value of the consequences of those actions as a plateau rather than scalar relationship. Justice can be understood as satisfying as many equally rational claims on resources as possible. The rationality of a person's claim on health resources turns on the strength of that person's reasons to promote certain health-related states of affairs. I argue that the strength of that reason does not track the expected value of that state of affairs in a fully scalar fashion. Rather a person can have most reason to promote some state of affairs, even though he or she could promote other more valuable states of affairs. Thus there can be equal reason for a distributor of public resources to save either of two people, even though one will have a better and more valuable life. This approach, while addressing many of Harris' concerns about utilitarianism, does not imply that doctors should give up prioritising patients according to prognosis altogether, but it does allow that patients with lower but reasonable prognosis should have a share of public resources.     

Global sharing of COVID-19 vaccines: A duty of justice,not charity

Global scarcity of COVID-19 vaccines raises ethical questions about their fair allocation between nations. Section I introduces the question and proposes that wealthy nations have a duty of justice to share globally scarce COVID-19 vaccines. Section II distinguishes justice from charity and argues that beneficiaries of unjust structures incur duties of justice when they are systematically advantaged at others expense. Section III gives a case-based argument describing three upstream structural injustices that systematically advantaged wealthy countries and disadvantaged poorer countries, contributing to global disparities of COVID-19 vaccines. Section IV examines more closely the duties of justice owed, including a duty to relinquish holdings, restitute victims, and restore relationships. Section V concludes that wealthy nations have a duty of justice to share COVID-19 vaccines with poor nations and to restore relationships damaged by injustice. All nations should take steps to transform unjust structures.     

On the Even Greater Need for Precaution Under Global Change

The greater the potential for disastrous, large-scale, or catastrophic impacts on health, the greater the case for precaution. The imperative for precautionary action, critical also for downstream determinants of health, is at least as compelling where macro-level concerns about the sustainability of life on Earth are at issue. In this context, I propose that a higher threshold of uncertainty is needed where large-scale harms to health and well-being are possible. Initial efforts must focus on the training of researchers and risk managers for competencies in complexity, and in systems approaches to transdisciplinary enquiry. Revisiting the intent behind Bradford Hill on causation is an essential first step. Focus on the more proximate causes of diseases, such as those related either to occupational exposures or to more downstream environmental exposures, is left to others in this collection.     

Generating power: gender,ethnicity and empowerment in India's Narmada Valley

Current analyses of issues relating to ethnicity and empowerment are silent about the significance of the environment in shaping and being shaped by human relations. For its part, environmental policy research, with few exceptions, has also ignored the dynamics of identity construction and cultural values that inform human relationships with the environment and thus affect environmental sustainability. I address this gap in the scholarship through an analysis of the Sardar Sarovar Project [SSP] in India. I explore the interweaving of the constructions of gender, ethnicity and empowerment and their implications for a new politics of the environment - the politics of environmental justice. I argue that discourses of modernization underpin the arguments of all those who discuss the SSP, whether in favour or against.     

Is LCC relevant in a sustainability assessment?

In a recent letter to the editor, Jørgensen et al. questioned that life cycle costing (LCC) is relevant in life cycle-based sustainability assessment (LCSA). They hold the opinion that environmental and social aspects are sufficient. We argue that sustainability has three dimensions: environment, economy, and social aspects in accordance with the well-accepted “three pillar interpretation” of sustainability, although this is not verbally stated in the Brundtland report (WCED 1987). An analysis of the historical development of the term “sustainability” shows that the economic and social component have been present from the beginning and conclude that LCSA of product systems can be approximated by LCSA = (environmental) LCA + (environmental) LCC + S-LCA where S-LCA stands for social LCA. The “environmental” LCC is fully compatible with life cycle assessment (LCA), the internationally standardized (ISO 14040 + 14044) method for environmental product assessment. For LCC, a SETAC “Code of Practice” is now available and guidelines for S-LCA have been published by UNEP/SETAC. First examples for the use of these guidelines have been published. An important practical argument for using LCC from the customers’ point of view is that environmentally preferable products often have higher purchasing costs, whereas the LCC may be much lower (examples: energy saving light bulbs, low energy houses, and cars). Also, since LCC allows an assessment for different actor perspectives, the producers may try to keep the total costs from their perspective below those of a conventional product: otherwise, it will not succeed at the market, unless highly subsidized. Those are practical aspects whichfinally decide about success or failure of “sustainable” products. Whether or not an analysis using all three aspects is necessary will depend on the exact question. However, if real money flows are important in sustainability analysis of product systems, inclusion of LCC is advisable.     

The current and potential role of urban metabolism studies to analyze the role of food in urban sustainability

Food supply chains are essential for urban sustainability. To reflect on the state of knowledge on urban food flows in urban metabolism research, and the actual and potential role of urban metabolism studies to tackle food sustainability in cities, we systematically review scientific research on food from an urban metabolism perspective and apply statistical and thematic analyses. The analysis of 89 studies provides insights as to the relation between food supply and (environmental and social dimensions of) urban sustainability. First, food is an important contributor to urban environmental impacts, if a consumption-based approach is adopted. Secondly, the social impacts of urban food supply remain scarcely studied in urban metabolism research, but emerging results on public health, malnutrition, and food waste appear promising. In parallel, we find that the findings of the studies fail to engage with debates present in the broader literature, such as that of food justice. Our analysis shows that most studies focus on large cities in high-income, data-rich countries. This limits our understanding of global urban food supply. Existing studies use innovative mixed-methods to produce robust accounts of urban food flows in data-scarce contexts; expanding these accounts is necessary to get a better understanding of how urban food supply and its diverse impacts in terms of environmental and social sustainability may vary across cities, a necessary step for the urban metabolism literature to contribute to current debates around food sustainability and justice.     

Social Determinants of Health in Environmental Justice Communities: Examining Cumulative Risk in Terms of Environmental Exposures and Social Determinants of Health

Residents of environmental justice (EJ) communities may bear a disproportionate burden of environmental health risk, and often face additional burdens from social determinants of health. Accounting for cumulative risk should include measures of risk from both environmental sources and social determinants. This study sought to better understand cumulative health risk from both social and environmental sources in a disadvantaged community in Texas. Key outcomes were determining what data are currently available for this assessment, clarifying data needs, identifying data gaps, and considering how those gaps could be filled. Analyses suggested that the traditionally defined EJ community in Port Arthur may have a lower environmental risk from air toxics than the rest of the City of Port Arthur (although the entire city has a higher risk than the average for the state), but may have a larger burden from social determinants of health. However, the results should be interpreted in light of the availability of data, the definitions of community boundaries, and the areal unit utilized. Continued focus on environmental justice communities and the cumulative risks faced by their residents is critical to protecting these residents and, ultimately, moving toward a more equitable distribution and acceptable level of risk throughout society.     

Incorporating Sustainability into Community-Based Healthcare Practice

There is now irrefutable evidence that climate change and increasing environmental degradation negatively affect population health. Healthcare plays an important role in addressing these emerging environmental challenges, considering its core aim is to protect and promote health. Preliminary research in Victoria, Australia, suggests that healthcare practitioners are endeavouring to factor in environmental concerns into their practice. Health promotion, an integral part of the healthcare system, is considered an area of practice that can support action on sustainability. Based on five qualitative case studies and key stakeholder interviews, this article explores key barriers and facilitators to incorporating sustainability into community-based healthcare practice. The findings demonstrate that despite multiple barriers, including funding and lack of policy direction, health promotion principles and practices can enable action on sustainability.     

Sustainability,Health, and the Human Population

A sustainable human population (e.g., range, density, and total numbers) is essential to health and in management. The notion of sustainability applies to all species and ecosystems and to the biosphere. Sustainability involves the health not only of individual humans, but also of ecosystems and other species. Thus, sustainability of the human population is important because of the wealth of factors involved: both the elements of systems it affects and those that contribute to its size. In this article, I address the sustainability of the human population on the basis of the argument that other species serve as examples of sustainability at the species level—an example of an application of systemic management that simultaneously accounts for complexity and achieves measurable health for individuals, species, and ecosystems. I conclude that the human population is two to four orders of magnitude larger than is optimally sustainable when compared with the populations of other mammalian species of similar body size and that this is a significant contributor to health problems for our species, other species, and ecosystems—a systemic pathology.     

Early‐stage sustainability assessment of biotechnological processes: A case study of citric acid production

Sustainability assessment using a life‐cycle approach is indispensable to contemporary bioprocess development. This assessment is particularly important for early‐stage bioprocess development. As early‐stage investigations of bioprocesses involve the evaluation of their ecological and socioeconomic effects, they can be adjusted more effectively and improved towards sustainability, thereby reducing environmental risk and production costs. Early‐stage sustainability assessment is an important precautionary practice and, despite limited data, a unique opportunity to determine the primary impacts of bioprocess development. To this end, a simple and robust method was applied based on the standardized life‐cycle sustainability assessment methodology and commercially available datasets. In our study, we elaborated on the yeast‐based citric acid production process with Yarrowia lipolytica assessing 11 different substrates in different process modes. The focus of our analysis comprised both cultivation and down‐stream processing. According to our results, the repeated batch raw glycerol based bioprocess alternative showed the best environmental performance. The second‐ and third‐best options were also glycerol‐based. The least sustainable processes were those using molasses, chemically produced ethanol, and soy bean oil. The aggregated results of environmental, economic, and social impacts display waste frying oil as the best‐ranked alternative. The bioprocess with sunflower oil in the batch mode ranked second. The least favorable alternatives were the chemically produced ethanol‐, soy oil‐, refined glycerol‐, and molasses‐based citric acid production processes. The scenario analysis demonstrated that the environmental impact of nutrients and wastewater treatment is negligible, but energy demand of cultivation and down‐stream processing dominated the production process. However, without energy demand the omission of neutralizers almost halves the total impact, and neglecting pasteurization also considerably decreases the environmental impact.     

Ecosystem Services in Life Cycle Assessment while Encouraging Techno‐Ecological Synergies

Life cycle assessment (LCA) has enabled consideration of environmental impacts beyond the narrow boundary of traditional engineering methods. This reduces the chance of shifting impacts outside the system boundary. However, sustainability also requires that supporting ecosystems are not adversely affected and remain capable of providing goods and services for supporting human activities. Conventional LCA does not account for this role of nature, and its metrics are best for comparing alternatives. These relative metrics do not provide information about absolute environmental sustainability, which requires comparison between the demand and supply of ecosystem services (ES). Techno‐ecological synergy (TES) is a framework to account for ES, and has been demonstrated by application to systems such as buildings and manufacturing activities that have narrow system boundaries. This article develops an approach for techno‐ecological synergy in life cycle assessment (TES‐LCA) by expanding the steps in conventional LCA to incorporate the demand and supply of ecosystem goods and services at multiple spatial scales. This enables calculation of absolute environmental sustainability metrics, and helps identify opportunities for improving a life cycle not just by reducing impacts, but also by restoring and protecting ecosystems. TES‐LCA of a biofuel life cycle demonstrates this approach by considering the ES of carbon sequestration, air quality regulation, and water provisioning. Results show that for the carbon sequestration ecosystem service, farming can be locally sustainable but unsustainable at the global or serviceshed scale. Air quality regulation is unsustainable at all scales, while water provisioning is sustainable at all scales for this study in the eastern part of the United States.     

Teaching global bioethics

We live in a world with enormous disparities in health. The life expectancy in Japan is 80 years; in Malawi, 40 years. The under-five mortality in Norway is 4/1000; in Sierra Leone, 316/1000. The situation is actually worse than these figures suggest because average rates tend to mask inequalities within a country. Several presidents of the IAB have urged bioethicists to attend to global disparities and to broaden the scope of bioethics. For the last six years I have tried to do just that. In this paper, I report and reflect on my attempts to teach bioethics in ways that address global health and justice. I then discuss ways to address key ethical issues in global health: the problem of inequalities; the nature of the duty to assist; the importance of the duty not to harm; the difference between a cosmopolitan and a political view of justice. I also discuss how teaching about global health may help to shift the emphasis in bioethics--from sensational cases to everyday matters, from autonomy and justice, and from access to healthcare to the social determinants of health. At the end of my paper, I reflect on questions that I have not resolved: how to delineate the scope of bioethics, whether my approach over-politicises bioethics, and how to understand the responsibilities of bioethicists.     

Socioeconomic and Racial Disparities in Environmental Health: Is Risk Assessment Part of the Problem or Part of the Solution?

The term “environmental justice” is a relatively recent addition to the lexicon of public health and risk-based decision making. Although it is currently a prominent public policy issue, there is no consensus-derived definition, nor is there general agreement about viable mechanisms for putting worthwhile social goals (e.g., fairness, equity, and justice) into operation. Nevertheless, the concept of environmental justice has focused attention on important questions of whether economically and politically disadvantaged communities bear a disproportionate burden of environmental pollution, and whether past environmental policies, programs and practices have been fair and equitable. Among individuals and organizations involved with issues of environmental justice there is a spectrum of strong and often contradictory convictions about the nature and role of risk assessment. Critics are convinced it is part of the problem and are inclined to see it as an ethically suspect, resource-intensive, elitist, never-ending process used to maintain the status quo. Advocates, on the other hand, contend that risk assessment is an essential policy and regulatory tool for identifying, evaluating, and resolving instances of environmental injustice, and that it provides a unifying conceptual framework and a common language for constructive dialogue on the issue. This article argues that, in practice, risk assessment has contributed to both the reality and the perception of environmental justice problems because of the overly narrow and restricted manner in which it has been applied. In principle, however, risk assessment is part of the solution to environment injustices because it provides a beneficial construct for framing key questions and fostering constructive debate about how to answer them. Well-designed research studies and high-quality risk assessments are necessary to define the dimensions of the problem, to understand the root causes, and to identify effective, efficient, and equitable solutions. Ultimately, attaining the goal of environmental justice depends on putting risk assessment principles into practice.     

Introducing Templates for Sustainable Product Development

We have previously developed a method for sustainable product development (MSPD) based on backcasting from basic sustainability principles. The MSPD informs investigations of product‐related social and ecological sustainability aspects throughout a concurrent engineering product development process. We here introduce “templates” for sustainable product development (TSPDs) as a complement. The idea is to help product development teams to arrive faster and more easily at an overview of the major sustainability challenges and opportunities of a product category in the early development phases. The idea is also to inform creative communication between top management, stakeholders, and product developers. We present this approach through an evaluation case study, in which the TSPDs were used for a sustainability assessment of televisions (TVs) at the Matsushita Electric Group. We study whether the TSPD approach has the ability to (1) help shift focus from gradual improvements of a selection of aspects in relation to past environmental performance of a product category to a focus on the remaining gap to a sustainable situation, (2) facilitate consensus among organizational levels about major sustainability challenges and potential solutions for a product category, and (3) facilitate continued dialogue with external sustainability experts, identifying improvements that are relevant for strategic sustainable development. Our findings indicate that the TSPD approach captures overall sustainability aspects of the life cycle of product categories and that it has the above abilities.     

Integrating triple bottom line input–output analysis into life cycle sustainability assessment framework: the case for US buildings

Purpose

With the increasing concerns related to integration of social and economic dimensions of the sustainability into life cycle assessment (LCA), traditional LCA approach has been transformed into a new concept, which is called as life cycle sustainability assessment (LCSA). This study aims to contribute the existing LCSA framework by integrating several social and economic indicators to demonstrate the usefulness of input–output modeling on quantifying sustainability impacts. Additionally, inclusion of all indirect supply chain-related impacts provides an economy-wide analysis and a macro-level LCSA. Current research also aims to identify and outline economic, social, and environmental impacts, termed as triple bottom line (TBL), of the US residential and commercial buildings encompassing building construction, operation, and disposal phases.

Methods

To achieve this goal, TBL economic input–output based hybrid LCA model is utilized for assessing building sustainability of the US residential and commercial buildings. Residential buildings include single and multi-family structures, while medical buildings, hospitals, special care buildings, office buildings, including financial buildings, multi-merchandise shopping, beverage and food establishments, warehouses, and other commercial structures are classified as commercial buildings according to the US Department of Commerce. In this analysis, 16 macro-level sustainability assessment indicators were chosen and divided into three main categories, namely environmental, social, and economic indicators.

Results and discussion

Analysis results revealed that construction phase, electricity use, and commuting played a crucial role in much of the sustainability impact categories. The electricity use was the most dominant component of the environmental impacts with more than 50 % of greenhouse gas emissions and energy consumption through all life cycle stages of the US buildings. In addition, construction phase has the largest share in income category with 60 % of the total income generated through residential building’s life cycle. Residential buildings have higher shares in all of the sustainability impact categories due to their relatively higher economic activity and different supply chain characteristics.

Conclusions

This paper is an important attempt toward integrating the TBL perspective into LCSA framework. Policymakers can benefit from such approach and quantify macro-level environmental, economic, and social impacts of their policy implications simultaneously. Another important outcome of this study is that focusing only environmental impacts may misguide decision-makers and compromise social and economic benefits while trying to reduce environmental impacts. Hence, instead of focusing on environmental impacts only, this study filled the gap about analyzing sustainability impacts of buildings from a holistic perspective.     

The Health Risk Assessment Approach,a Tool for Managing Risks on the Scale of a Territory: A French Experience

In France, regulatory analysis of the environment and human health potential consequences is implemented for an isolated industrial activity that requests an authorization to operate using the health risk assessment method. To date, the question is enlarged to the impact of the combination of multiple sources of pollution on the same territory. The main conclusions of the work launched by the French High Council of Public Health focus on four key points: (i) the utility of conducting such an analysis at a territory scale, (ii) the delimitation of the area, (iii) the conditions for the different stakeholders’ involvement, and (iv) the methodological specificities of the “zone health risk assessment.” The work encompassed literature reviews, seminars, and interviews of stakeholders. The utility of a Z-HRA is the central objective for the management of risk. It can no longer be conducted only for itself. The delimitation of the zone entails economic, political, environmental, and population aspects. Stakeholders become key actors in a steering and monitoring committee. Among methodological specificities, cumulative exposure comes first. Interpretation of the results should focus on risk management objectives. Finally, inclusion of Z-HRAs in flexible regulations that can be adapted to the local context is recommended.     

Ecological Aging: The Settings Approach in Aged Living and Care Accommodation

As the proportion of older people increases within populations, financial demands related to the cost of health service delivery threaten global stability. This population trend challenges the traditional approach to health service delivery to older populations. This article presents the Australian context as a case study to argue that the application of a health promoting settings approach to aged care may lead to improved well-being for older people to the extent that the periods of chronic morbidity often associated with aging can be compressed into an ever shorter period of time. Promoting an ecological perspective to aged care suggests that there is no need to manage older people in isolation, as is common practice, but as integral to the way society lives, works, and plays. The article maps parallels between characteristics of health promoting settings such as Health Promoting Schools and the aged living and care industry, arguing that the setting encompassing services for the elderly is a prime location for the establishment of a new health promotion setting. Supporting life opportunities for our aged is central to such an approach. More broadly, an ecological approach orients us toward the connection between environment and health, and encourages increased attention and action within the aged living and care sector on reducing environmental impacts of this growing population. As such, the application of this approach to the aged living and care sector has the potential to reduce the threat that a dependant older population has on global sustainability.     

Analysis of the link between a definition of sustainability and the life cycle methodologies

Purpose

It has been claimed that in order to assess the sustainability of products, a combination of the results from a life cycle assessment (LCA), social life cycle assessment (SLCA) and life cycle costing (LCC) is needed. Despite the frequent reference to this claim in the literature, very little explicit analysis of the claim has been made. The purpose of this article is to analyse this claim.

Methods

An interpretation of the goals of sustainability, as outlined in the report Our Common Future (WCED 1987), which is the basis for most literature on sustainability assessment in the LCA community, is presented and detailed to a level enabling an analysis of the relation to the impact categories at midpoint level considered in life cycle (LC) methodologies.

Results

The interpretation of the definition of sustainability as outlined in Our Common Future (WCED 1987) suggests that the assessment of a product's sustainability is about addressing the extent to which product life cycles affect poverty levels among the current generation, as well as changes in the level of natural, human and produced and social capital available for the future population. It is shown that the extent to which product life cycles affect poverty to some extent is covered by impact categories included in existing SLCA approaches. It is also found that the extent to which product life cycles affect natural capital is well covered by LCA, and human capital is covered by both LCA and SLCA but in different ways. Produced capital is not to any large extent considered in any of the LC methodologies. Furthermore, because of the present level of knowledge about what creates and destroys social capital, it is difficult to assess how it relates to the LC methodologies. It is also found that the LCC is only relevant in the context of a life cycle sustainability assessment (LCSA) if focusing on the monetary gains or losses for the poor. Yet, this is an aspect which is already considered in several SLCA approaches.

Conclusions

The current consensus that LCSA can be performed through combining the results from an SLCA, LCA and LCC is only partially supported in this article: The LCSA should include both an LCA and an SLCA, which should be expanded to better cover how product life cycles affect poverty and produced capital. The LCC may be included if it has as a focus to asses income gains for the poor.     

Moral Distress: An Innovative and Important Subject to Study in Brazil

There have been recurrent reports of fragilities in the Brazilian health system, especially in public institutions. In this commentary, I argue that moral distress in nursing in Brazil can still be considered an innovative and important subject of study. I also highlight the relevance of engaging educational institutions in the development of policies about environmental sustainability. It is relevant to continue studying moral distress in nursing and in health care generally in order to contribute to the transformation of reality by confronting the multiple common situations in the work environment that are recognized by many as morally problematic because they infringe upon the rights of people, patients, and health care professionals and are an affront to environmental health.