What do I want from health research and researchers when I am a patient?

I have attempted to adopt the perspective of a patient--albeit one with a rather atypical background--to explore what I want from health research and researchers. This has left me with the impression that health researchers could serve the interests of the public more effectively in a variety of ways, and that they would be helped to do so by greater lay involvement in planning and promoting health research.     

Health Security and Risk Aversion

Health security has become a popular way of justifying efforts to control catastrophic threats to public health. Unfortunately, there has been little analysis of the concept of health security, nor the relationship between health security and other potential aims of public health policy. In this paper I develop an account of health security as an aversion to risky policy options. I explore three reasons for thinking risk avoidance is a distinctly worthwhile aim of public health policy: (i) that security is intrinsically valuable, (ii) that it is necessary for social planning and (iii) that it is an appropriate response to decision‐making in contexts of very limited information. Striking the right balance between securing and maximizing population health thus requires a substantive, and hitherto unrecognized, value judgment. Finally, I critically evaluate the current health security agenda in light of this new account of the concept and its relationship to the other aims of public health policy.     

城市绿地与居民健康福祉相关性研究进展——基于生态系统服务供需匹配视角

城市绿地耦合了生态系统服务与人类福祉,兼顾公平与效率的城市绿地空间格局,是提升人居环境和改善民生的重要途径。在厘清相关概念内涵的基础上,基于Citespace软件对城市绿地生态系统服务与健康福祉及其相近概念进行关键词共现图谱与聚类分析,可以发现：研究集聚性强、各集群下研究领域重叠度高,研究尺度逐渐精细化,城市绿地与建成环境、休闲性体力活动与健康空间分异成为近几年研究热点。从供给侧：城市绿地绿地生态系统服务类型以及其估与测度方法,需求侧：居民健康福祉需求测度方法及时空表达,供需匹配：城市绿地生态系统服务供需匹配方法与空间公平,提升与调控：城市绿地时空结构优化与高效服务4个方面系统地综述了绿地生态系统服务与居民健康相关性研究,并指出目前城市绿地生态系统服务供需研究在研究内容、研究逻辑、研究方法及研究结果等方面还需进一步深化与提升。未来研究应重点关注城市绿地生态系统服务空间特征关系与居民健康需求层级的供需匹配程度,通过耦合新数据环境下精细化、规范性居民健康时空行为空间研究,总结供需平衡状态下多维度城市绿地高效服务的空间形态、功能结构与要素组织,并将其应用到城市绿地空间格局研究与绿地系统规划实践中,拓展人居环境优化提质的理论与方法。     

HOW TO CONNECT BIOETHICS AND ENVIRONMENTAL ETHICS: HEALTH, SUSTAINABILITY, AND JUSTICE

In this paper, I explore one way to bring bioethics and environmental ethics closer together. I focus on a question at the interface of health, sustainability, and justice: How well does a society promote health with the use of no more than a just share of environmental capacity? To address this question, I propose and discuss a mode of assessment that combines a measurement of population health, an estimate of environmental sustainability, and an assumption about what constitutes a fair or just share. This mode of assessment provides an estimate of the just and sustainable life expectancy of a population. It could be used to monitor how well a particular society promotes health within just environmental limits. It could also serve as a source of information that stakeholders use when they deliberate about programs, policies, and technologies. The purpose of this work is to focus attention on an ethical task: the need to fashion institutions and forms of life that promote health in ways that recognize the claims of sustainability and justice.     

Functional landscapes in cities: a systems approach

Human enterprise and endeavour increasingly influence global processes of change, from the planetary scale down to the very local. Cities are hubs of human activity, and as the places where the majority of the world’s population live we must, when looking into an uncertain future, consider how we think about urban design. Cities are densely inhabited, lived-in landscapes where human presence and perceptions are deeply enmeshed with biophysical and built infrastructures. As such, they present complex mosaics of different habitats and competing uses, ever changing in response to human and physical drivers. If designed properly, green infrastructure can contribute many important functions to a city. Efforts to strategically make use of green infrastructure can benefit considerably from a systems perspective where linkages and cross-boundary dynamics are at the very least as important as individual components. Design, planning and governance of requirements for green infrastructure also extend far beyond biophysical elements and components. Recognition of interconnections between individual green spaces, green infrastructure and the built environment, the physical environment and diverse actors, and formal and informal governance arrangements—as outlined in the four design principles in this article—is a first important step towards a more comprehensive and inclusive approach, not least to green infrastructure planning and design.     

城市景观功能的区域协调规划——以深圳市为例

城市景观功能的完善是城市可持续发展的重要保障之一,其与区域景观功能的相互协调是城市规划的重要组成部分,有利于城市和区域的整体持续发展。在分析城市景观基本特征的基础上,探讨了城市景观功能区域协调规划的基本思路,以城市景观为规划对象,以人类社会的功能需求为立足点,依据景观生态学理论,将城市景观的功能划分为生物生产功能、环境服务功能、文化支持功能和信息输运功能,对体现这些基本功能的景观类型进行区域协调规划。以深圳市为例,实证分析了其景观功能在珠江三角洲地区的协调规划。     

公共卫生伦理学简论

试图阐述公共卫生伦理学的基本概念、基本原则和概念框架,并通过例举多个公共卫生伦理的具体案例来阐明如何利用道德推理来解决公共卫生研究和实践中出现的伦理冲突,制定有效的公共卫生政策和措施。     

Guilt, fear, stigma and knowledge gaps: ethical issues in public health communication interventions

Public health communication campaigns have been credited with helping raise awareness of risk from chronic illness and new infectious diseases and with helping promote the adoption of recommended treatment regimens. Yet many aspects of public health communication interventions have escaped the scrutiny of ethical discussions. With the transference of successful commercial marketing communication tactics to the realm of public health, consideration of ethical issues becomes an essential component in the development and application of public health strategies. Ethical issues in public health communication are explored as they relate to eight topics: 'targeting' and 'tailoring' public health messages to particular population segments; obtaining the equivalence of informed consent; the use of persuasive communication tactics; messages on responsibility and culpability; messages that apply to harm reduction; and three types of unintended adverse effects associated with public health communication activities that may label and stigmatise, expand social gaps, and promote health as a value. We suggest that an ethical analysis should be applied to each phase of the public health communication process in order to identify ethical dilemmas that may appear subtle, yet reflect important concerns regarding potential effects of public health communication interventions on individuals and society as a whole.     

基于深度学习街景影像解译和景感生态学的视域环境定量解读

城市物理环境带给居民丰富而生动的视觉意象,目前许多文献结果表明其宜人性与公共福祉以及健康状况息息相关。景感生态为探究城市物理环境与居民感知信息之间的联系提供了指导依据,通过人本尺度的定量手段解读城市环境中视觉、听觉和味觉等多维度感知信息。秉承景感生态学的基本原理,引入一种结合街景大数据和深度学习的城市环境量化手段,以北京市六环范围为例,将景感视率作为测度对人本视角下的城市环境展开定量解读。在全面把控多维景感要素的同时,旨在实现以人为本的城市物理环境优化设计,从而满足人们对生活品质提升的实际需求。实验结果显示：（1）从视觉感受的宏观表现来看,北京四环路范围内建成环境的"闭合感"较强,而对绿植的感知程度相对偏弱,因而需要开展存量环境设计并优化视域界面结构;（2）以景感视率作为特征值进行聚类得出3类主导空间（绿色空间、灰色空间和蓝色空间）,可针对灰色空间着重部署垂直绿化资源,提高城市视觉绿化的可感知性,从而营造舒适宜人的绿色氛围、促进公众身心健康;（3）为景感生态学提供了基于大数据思维的数据集和定量方法补充。综上,以街景影像和景感生态视角对北京市中心城区的视域环境展开定量分析,采用了先进的深度学习框架（Detectron2）并结合经典的机器学习方法（K-Means）对人本视域内多维景感要素的空间分布特征进行解读。借助景感生态规划可以有针对性的改善城市视域界面的感知质量,提升智能管理水平,帮助城市规划设计人员和管理者从人本视角提升城市公共环境品质和风貌。     

Adjusting the focus: A public health ethics approach to data research

This paper contends that a research ethics approach to the regulation of health data research is unhelpful in the era of population‐level research and big data because it results in a primary focus on consent (meta‐, broad, dynamic and/or specific consent). Two recent guidelines – the 2016 WMA Declaration of Taipei on ethical considerations regarding health databases and biobanks and the revised CIOMS International ethical guidelines for health‐related research involving humans – both focus on the growing reliance on health data for research. But as research ethics documents, they remain (to varying degrees) focused on consent and individual control of data use. Many current and future uses of health data make individual consent impractical, if not impossible. Many of the risks of secondary data use apply to communities and stakeholders rather than individual data subjects. Shifting from a research ethics perspective to a public health lens brings a different set of issues into view: how are the benefits and burdens of data use distributed, how can data research empower communities, who has legitimate decision‐making capacity? I propose that a public health ethics framework – based on public benefit, proportionality, equity, trust and accountability – provides more appropriate tools for assessing the ethical uses of health data. The main advantage of a public health approach for data research is that it is more likely to foster debate about power, justice and equity and to highlight the complexity of deciding when data use is in the public interest.     

The right to withdraw from controlled human infection studies: Justifications and avoidance

The right to withdraw from research without penalty is well established around the world. However, it has been challenged in some corners of bioethics based on concerns about various harms—to participants, to scientific integrity, and to research bystanders—that may stem from withdrawal. These concerns have become particularly salient in emerging debates about the ethics of controlled human infection (CHI) studies in which participants are intentionally infected with pathogens, often in inpatient settings with extensive follow-up. In this article, I provide support for preserving the right to withdraw from research without penalty and demonstrate that it is also typically justified in the specific context of CHI studies. The right is well aligned with individual freedoms outside the research setting, where autonomous individuals are permitted to engage in behaviors that will foreseeably cause them harm; where they cannot be compelled to satisfy contracts for their services, nor penalized for failure to do so; and where their behavior is not constrained by public health authorities except in extreme circumstances. These freedoms are supported by U.S. law, as well as by ethical analysis that is more globally relevant. The problems associated with the right to withdraw, however, remain. The best approach to addressing them is not to restrict the right but rather to avoid initiating research when withdrawal would be especially problematic. If research proceeds, steps can still be taken to minimize participant withdrawal without infringing the right. Investigators can avoid participant surprise through informed consent focused on a study’s most burdensome aspects and promote study completion through financial incentives. Should participants nonetheless seek to withdraw, investigators may attempt to persuade them not to do so by encouraging consideration of the range of potential harms that may result. Researchers conducting CHI studies and other research from which withdrawal might be especially problematic should prepare for the possibility of participant withdrawal, respect participant requests to withdraw without penalty, and incorporate various measures to avoid such requests.     

What is the matter with transcendence? On the place of religion in the new anthropology of ethics★

A focus on ordinary or everyday ethics has become perhaps the dominant concern in the rapidly developing anthropology of ethics. In this article, I argue that this focus tends to marginalize the study of the ways in which religion contributes to people's moral lives. After defining religion and transcendence in terms that make them less uncongenial to the study of ethics than many proponents of ordinary ethics suggest, I examine values as one sometimes transcendent cultural form that often informs ethical life. I draw on Victor Turner (along with Durkheim) to develop an account of how rituals often both present people with and allow them to perform transcendent versions of values. These encounters, in turn, shape people's ethical sensibilities, including those they bring to bear in everyday life, in ways we cannot understand unless we accord religion a more central role in the anthropology of ethics than it has played to this point. I illustrate my arguments with material drawn both from Turner's Ndembu ethnography and from my own research on Christianity in Papua New Guinea.     

An urban university's ecological footprint and the effect of climate change

Ecological footprint analysis (EFA) has been used since the early 1990s as a measure of sustainability for geographical regions, products, and activities. EFA is used as a measure of land and water ecosystems needed to provide the resources for a given population and process the waste that it produces in a globalized metric (global hectares), generally on an annual basis. As institutions seek ways to become more sustainable they have used a variety of metrics, ranking systems, and indicators to evaluate their baseline and progress towards those goals. An EFA for a large urban public university, the University of Illinois at Chicago (UIC), was calculated as 97,601 global hectares (2.66 global hectares per total faculty, staff and students). The breakdown of sources is energy for the built environment (73%), transportation and commuting (13%), materials and waste (12%), and food (3%). UIC's ecological footprint to actual landprint ratio has a value of 1005 which is 1–2 orders of magnitude higher than the other campuses that have performed EFAs. This is an indicator of the urban nature of the campus since the land resources in an urban environment are limited and the activities tend to be denser. A sensitivity analysis to examine the effect of climate change events on the footprint indicated that, if all other factors are held constant, climate change will increase the ecological footprint of UIC.     

Thrushes now largely restricted to the built environment in eastern England

Abstract.  I studied the distribution and density of three thrush populations, blackbird Turdus merula , song thrush T. philomelos and mistle thrush T. viscivorus , in an urban and contiguous rural area, totalling 2636 ha, in eastern England. Populations of these species are declining and I found 826, 85 and 30 territories of blackbird, song thrush and mistle thrush, respectively. Significantly more territories of all species than expected were within the urban boundary. Significantly more territories than expected were found of all three species in the built environment (residential housing, factories, schools, etc. with their associated gardens and green-space), urban and rural areas combined. Farmland occupied 67% of the study area but held significantly fewer blackbird and mistle thrush territories than expected, associated mainly with the small amount of grass; song thrushes were not recorded on farmland. Rural woodland and scrub held more blackbird and song thrush territories than expected. Song thrush was significantly associated with scrub within the urban boundary. With all three species largely absent from farmland, residential habitats can be considered as habitat refuges. The consequences of this for conservation and planning are discussed.     

推进生物多样性保护与人类健康的共同发展——One Health

随着新冠肺炎(COVID-19)的暴发, 野生动物、生物多样性和人类健康的关系再次引起广泛讨论。近20年来, 国际社会对于生物多样性与健康的研究日益增多, 并将它作为生物多样性保护与研究的重要方向之一。One Health作为一个新的理念框架, 通过交叉学科的研究和行动来推动包括人、所有其他动物及环境的健康。这个理念被不同国家、国际组织及协定所接纳及推广, 包括《生物多样性公约》等。本文通过总结近些年生物多样性对健康的影响方式、One Health的定义与发展历史、进入生物多样性议程的过程, 提出中国应用One Health改进相关野生动物管理以降低公共卫生危机的可能性的建议, 以及One Health框架内增强生物多样性保护所需的研究方向。One Health在中国的应用与发展应重视生物多样性研究和保护在其中的作用, 利用在景观生态学、群落内物种关系动态变化、气候变化影响、土地利用变化模式与趋势的研究, 与人类健康相结合, 提高One Health在应对公共健康和环境健康风险方面的准确性与及时性。同时, 需要加强我国在野生动物管理方面的投入和力度, 增强生物多样性保护与公共健康的联系, 将预警与干预措施前移, 减少疾病暴发带来的社会经济成本。     

Moral Principles for Allocating Scarce Medical Resources in an Influenza Pandemic

One of the societal problems in a new influenza pandemic will be how to use the scarce medical resources that are available for prevention and treatment, and what medical, epidemiological and ethical justifications can be given for the choices that have to be made. Many things may become scarce: personal protective equipment, antiviral drugs, hospital beds, mechanical ventilation, vaccination, etc. In this paper I discuss two general ethical principles for priority setting (utility and equity) and explain how these principles will often point in diverging directions. Moreover, each of these principles can be understood in different, again often competing, ways. Notwithstanding these controversies and conflicts, in the context of pandemic response there are at least some points of convergence: several policies can be justified by appeal to different ethical principles and theories. Convergence may be found with respect to a focus on saving the most lives (instead of other aggregative accounts); giving priority antiviral prophylaxis and therapy for life-saving pandemic responders; and, partly depending on epidemiology of the pandemic, to prioritise vaccination of children. Although decision-making about access to intensive care will involve choices with immediate tragic implications, the ethical complexity of these choices is relatively modest (although decisions will not be easy): there are persuasive moral reasons for giving priority to patients who are expected to benefit most within the shortest time. Finally, in the last section I tentatively argue that constraints on people’s freedom, as necessary for an effective public health approach, may support giving somewhat more weight to saving the most lives, than to concerns of equity.

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.     

Bioethics and Climate Change: A Response to Macpherson and Valles

Two articles published in Bioethics recently have explored the ways that bioethics can contribute to the climate change debate. Cheryl Cox Macpherson argues that bioethicists can play an important role in the climate change debate by helping the public to better understand the values at stake and the trade‐offs that must be made in individual and social choices, and Sean Valles claims that bioethicists can contribute to the debate by framing the issues in terms of the public health impacts of climate change. While Macpherson and Valles make valid points concerning a potential role for bioethics in the climate change debate, it is important to recognize that much more than ethical analysis and reflection will be needed to significantly impact public attitudes and government policies.     

城市地域生态调控的空间途径——以深圳市为例

城市地域的可持续发展必须以生态环境的可持续发展为前提和保障。景观生态学主要研究地表各种景观空间格局与生态过程及其相互作用,其原理和规律为在实践中通过优化景观格局,提高生态系统稳定性提供了理论框架。以深圳市为例,尝试综合运用生态敏感性与适宜性分析和景观格局整体优化的方法,通过对生态系统的格局分析与问题诊断,构建合理、稳定的生态系统结构,保障生态系统服务功能的正常发挥。案例研究将深圳市域的整体生态结构分为自然生态空间、城镇发展空间和生态廊道3部分。城镇发展空间具有文化支持的生态功能,自然生态空间具有环境服务和生物生产的生态功能;生态廊道主要起到加强生态联系,提高生态系统稳定性,并防止城市发展空间无序蔓延的功能。城镇景观斑块镶嵌于自然生态景观基质中,并通过多种类型的生态廊道相连,形成区域生态系统的良性循环。案例研究表明,景观生态规划方法的综合应用,可以将景观生态学原理和规律比较合理的运用于实践。     

"Kissing a Baby Is Not at All Good for Him": Infant Mortality, Medicine, and Colonial Modernity in the U.S.-Occupied Philippines

Feminist scholars have begun to consider the ways indigenous practices of child rearing were and are challenged in (post)colonial discourse and practice, and how these practices have become a terrain on which definitions of nation, state, and economy are contested. In this article, I adopt a historical anthropological approach to consider how Filipino child-rearing strategies were described and stigmatized in educational, public health, and public welfare discourses in the U.S.-occupied Philippines in the early 20th century. I demonstrate how public health practices and discourses that were generated as part of a "benevolent" campaign against high rates of infant mortality were strategically used as a weapon against Filipino arguments for independence. I also consider how discourses constructing Filipino caregivers as overly indulgent were linked to metropolitan concerns about production of the "new industrial man" and were used to develop a racialized critique of the cultural practices of Filipinos.