Does Health Promotion Harm the Environment?

Health promotion involves social and environmental interventions designed to benefit and protect health. It often harmfully impacts the environment through air and water pollution, medical waste, greenhouse gas emissions, and other externalities. We consider potential conflicts between health promotion and environmental protection and why and how the healthcare industry might promote health while protecting environments. After probing conflicts between promoting health and protecting the environment we highlight the essential role that environmental resources play in health and healthcare to show that environmental protection is a form of health promotion. We then explore relationships between three radical forms of health promotion and the environment: (1) lowering the human birth rate; (2) transforming the food system; and (3) genetically modifying mosquitos. We conclude that healthcare and other industries and their institutions and leaders have responsibilities to re-consider and modify their priorities, policies, and practices.

Riqueza de mosquitos en La Habana: su importancia para fomentar la participación comunitaria en su control / Species mosquito richness in Havana: its importance to promote community participation in its control

Introducción: La identificación de las especies de mosquitos a nivel de cada municipio forma parte del Programa de Vigilancia y Control de Aedes aegypti y Aedes albopictus vigente en Cuba. Objetivo: Identificar las especies de mosquitos en sitios de crías artificiales y naturales y relacionarlo con el papel de la comunidad en el control de sus poblaciones en la provincia La Habana. Métodos: Se identificaron las muestras larvarias de mosquitos enviadas al laboratorio provincial de Entomología, colectadas en depósitos artificiales y en sitios naturales en los municipios de La Habana desde enero del 2000 hasta el 2016. Resultados: En el estudio se identificaron un total de 48 especies de mosquitos. Aedes aegypti, Gymnometopa mediovittata, Culex quinquefasciatus y Culex nigripalpus, estuvieron presentes en todos los municipios de La Habana. Los depósitos abandonados en los alrededores de las viviendas y terrenos baldíos como: latas, bebederos, chatarra metálica, neumáticos de autos usados, entre otros, relacionados con actividades humanas, aportaron la mayor riqueza de especies al ecosistema urbano, seguido por los huecos de árboles y sitios de cría naturales. Los depósitos artificiales de almacenamiento de agua con fines domésticos en las viviendas, tales como: tanques, cisternas, cubos, entre otros, fueron los de menor riqueza, pero fundamentales para la presencia de Ae. aegypti. Conclusiones: Disponer de datos actualizados sobre la distribución de las especies de mosquitos y sus sitios de cría en La Habana constituyen una información valiosa para fomentar la participación de la comunidad en la eliminación de estos en momentos de epidemias en que se involucren estos vectores(AU)

Introduction: Identification of the mosquito species present in each municipality is part of the Aedes aegypti and Aedes albopictus Surveillance and Control Program currently in place in Cuba. Objective: Identify the mosquito species in artificial and natural breeding sites and relate that information to the role played by the community in the control of their populations in the province of Havana. Methods: Identification was performed of mosquito larval samples submitted to the Provincial Entomology Laboratory and collected from artificial containers and natural breeding sites in Havana municipalities from January 2000 to 2016. Results: A total 48 mosquito species were identified in the study. Aedes aegypti, Gymnometopa mediovittata, Culex quinquefasciatus and Culex nigripalpus were found to be present in all Havana municipalities. Unused containers scattered around households and in uncultivated fields, such as cans, troughs, scrap metal and used car tires, among other items related to human activities, contribute the greatest species richness to the urban ecosystem, followed by tree holes and natural breeding sites. Artificial water storage containers in households, such as elevated and underground water tanks and buckets, among others, contributed lesser richness, but were fundamental for the presence of A. aegypti. Conclusions: Updated data about the distribution of mosquito species and their breeding sites in Havana is valuable information to foster community participation in their elimination in the event of epidemics involving these vectors(AU)

Informed consent and community engagement in open field research: lessons for gene drive science.

BACKGROUND: The development of the CRISPR/Cas9 gene editing system has generated new possibilities for the use of gene drive constructs to reduce or suppress mosquito populations to levels that do not support disease transmission. Despite this prospect, social resistance to genetically modified organisms remains high. Gene drive open field research thus raises important questions regarding what is owed to those who may not consent to such research, or those could be affected by the proposed research, but whose consent is not solicited. The precise circumstances under which informed consent must be obtained, and from whom, requires careful consideration. Furthermore, appropriate engagement processes should be central to any introduction of genetically modified mosquitos in proposed target settings. DISCUSSION: In this work, international guidance documents on informed consent and engagement are reviewed and applied to the genetically modified mosquito research context. Five analogous research endeavours that involve area-wide / open field experiments are reviewed. The approach of each in respect to the solicitation of individual informed consent and community engagement are highlighted. CONCLUSIONS: While the solicitation of individual informed consent in host settings of gene drive field trials may not be possible or feasible in some instances, local community and stakeholder engagement will be key to building trust towards the proposed conduct of such research. In this regard, the approaches taken by investigators and sponsors of political science field research and weather modification field research should be avoided. Rather, proponents of gene drive field research should look to the Eliminate Dengue field trials, cluster randomised trials, and pragmatic clinical trials for guidance regarding how the solicitation of individual informed consent of host communities ought to be managed, and how these communities ought to be engaged.

Driven to extinction? The ethics of eradicating mosquitoes with gene-drive technologies.

Mosquito-borne diseases represent a significant global disease burden, and recent outbreaks of such diseases have led to calls to reduce mosquito populations. Furthermore, advances in 'gene-drive' technology have raised the prospect of eradicating certain species of mosquito via genetic modification. This technology has attracted a great deal of media attention, and the idea of using gene-drive technology to eradicate mosquitoes has been met with criticism in the public domain. In this paper, I shall dispel two moral objections that have been raised in the public domain against the use of gene-drive technologies to eradicate mosquitoes. The first objection invokes the concept of the 'sanctity of life' in order to claim that we should not drive an animal to extinction. In response, I follow Peter Singer in raising doubts about general appeals to the sanctity of life, and argue that neither individual mosquitoes nor mosquitoes species considered holistically are appropriately described as bearing a significant degree of moral status. The second objection claims that seeking to eradicate mosquitoes amounts to displaying unacceptable degrees of hubris. Although I argue that this objection also fails, I conclude by claiming that it raises the important point that we need to acquire more empirical data about, inter alia, the likely effects of mosquito eradication on the ecosystem, and the likelihood of gene-drive technology successfully eradicating the intended mosquito species, in order to adequately inform our moral analysis of gene-drive technologies in this context.

View point: Ethical dilemmas in malaria vector research in Africa: making the difficult choice between mosquito, science and humans.

Malaria vector studies are a very important aspect of malaria research as they assist researchers to learn more about the malaria vector. Research programmes in various African countries include studies that assess various methods of preventing malaria transmission including controlling the malaria vector. Various institutions have also established mosquito colonies that are maintained by staff from the institutions. Malaria vector research presents several dilemmas relating to the various ways in which humans are used in the malaria vector research enterprise. A review of the past and present practices reveals much about the prevailing attitudes and assumptions with regard to the ethical conduct of research involving humans. The focus on the science of malaria vector research has led some researchers in African institutions to engage in questionable practices which reveal the ethical tensions inherent in the choice between science and the principles of justice, nonmaleficence and respect for individuals. The analysis of past and present choices in malaria vector research has relevance to broader questions of human dignity and are in line with the current emphasis on ethical research worldwide.

Scientists and public involvement: a consultation on the relation between malaria, vector control and transgenic mosquitoes.

Among the hopes for vector-based malaria control, the use of transgenic mosquitoes able to kill malaria parasites is seen as a potential way to interrupt malaria transmission. While this potential solution is gaining some support, the ethical and social aspects related to this high-tech method remain largely unexplored and underestimated. Related to those latter points, the aim of the present survey is to determine how scientists working on malaria and its vector mosquitoes perceive public opinion and how they evaluate public consultations on their research. This study has been performed through a questionnaire addressing questions related to the type of research, the location, the nationality and the perception of the public involvement by scientists. The results suggest that even if malaria researchers agree to interact with a non-scientific audience, they (especially the ones from the global North) remain quite reluctant to have their research project submitted in a jargon-free version to the evaluation and the prior-agreement by a group of non-specialists. The study, by interrogating the links between the scientific community and the public from the perspective of the scientists, reveals the importance of fostering structures and processes that could lead to a better involvement of a non specialist public in the actual debates linking scientific, technological and public health issues in Africa.

Health research ethics in malaria vector trials in Africa.

Malaria mosquito research in Africa as elsewhere is just over a century old. Early trials for development of mosquito control tools were driven by colonial enterprises and war efforts; they were, therefore, tested in military or colonial settings. The failure of those tools and environmental concerns, coupled with the desperate need for integrated malaria control strategies, has necessitated the development of new malaria mosquito control tools, which are to be tested on humans, their environment and mosquito habitats. Ethical concerns start with phase 2 trials, which pose limited ethical dilemmas. Phase 3 trials, which are undertaken on vulnerable civilian populations, pose ethical dilemmas ranging from individual to community concerns. It is argued that such trials must abide by established ethical principles especially safety, which is mainly enshrined in the principle of non-maleficence. As there is total lack of experience with many of the promising candidate tools (eg genetically modified mosquitoes, entomopathogenic fungi, and biocontrol agents), great caution must be exercised before they are introduced in the field. Since malaria vector trials, especially phase 3 are intrusive and in large populations, individual and community respect is mandatory, and must give great priority to community engagement. It is concluded that new tools must be safe, beneficial, efficacious, effective, and acceptable to large populations in the short and long-term, and that research benefits should be equitably distributed to all who bear the brunt of the research burdens. It is further concluded that individual and institutional capacity strengthening should be provided, in order to undertake essential research, carry out scientific and ethical review, and establish competent regulatory frameworks.

Ethical, legal and social aspects of the approach in Sudan.

The global malaria situation, especially in Africa, and the problems frequently encountered in chemical control of vectors such as insecticide resistance, emphasize the urgency of research, development and implementation of new vector control technologies that are applicable at regional and local levels. The successful application of the sterile insect technique (SIT) for the control of the New World screwworm Cochliomyia hominivorax and several species of fruit flies has given impetus to the use of this method for suppression or elimination of malaria vectors in some areas of Africa including Northern State of Sudan. The research and development phase of the Northern State feasibility study has been started. Sudanese stakeholders are working side-by-side with the International Atomic Energy Agency in the activities of this important phase. Several ethical, legal and social issues associated with this approach arose during this phase of the project. They need to be seriously considered and handled with care. In this paper, these issues are described, and the current and proposed activities to overcome potential hurdles to ensure success of the project are listed.

Ethical dilemmas in malaria control.

Because the term "malaria control" specifies an anti-malaria activity rather than an outcome of that action, progress has been evaluated in terms of the effort expended. Plans that specify goals and time lines tend to lack irreversible endpoints. Anti-malaria interventions that are stimulated by economic considerations focus on sites in which the residents enjoy some employment advantage, while interventions based on humanitarian objectives serve the neediest residents of broad regions. Site-specific interventions are conducted by industrial or municipal agencies, while regional interventions are conducted by public agencies. Industry contributes an element of sustainability by injecting the possibility of gainful employment into the site. Efforts that distribute assets mainly to the richest-of-the-poor may fail to preserve lives that would otherwise have been preserved, while those that serve the poorest-of-the-poor may fail to create sustainable cycles of health and wealth. Progress in relieving the burden imposed by malaria requires economically motivated as well as humanitarian contributions, and both should specify realistically time-limited goals that ultimately permit deintensification.

[Fighting Nazis and mosquitoes: US military men in Northeastern Brazil (1941-1945)]. / Combatendo nazistas e mosquitos: militares norte-americanos no Nordeste brasileiro (1941-1945).

Malaria-control policies enforced at US military bases set up in Brazil during World War II serve as an example in this analysis of the associations between disease and war. Case studies of the three main US bases (located in Belém, Recife and Natal) show how malaria can be transformed into a matter of political-military security. An examination of the Natal case allows the reader to perceive the prejudices, political mistrust, and nationalistic tensions marking relations between the Brazilians and Americans.