Andrew Jameton

Public Health Implications of Urban Agriculture

The article presents the case for stronger public policies in support of urban gardening as a means to improve public health. It considers several beneficial aspects of gardening, such as food security, economic development, exercise, psychological and community well-being, and environmental stewardship. It also considers some of the public health problems associated with urban agriculture and suggests policies to ameliorate them. In the balance, urban gardening has potential as an important element of urban public health.

A Reflection on Moral Distress in Nursing Together With a Current Application of the Concept

The concept of moral distress can be extended from clinical settings to larger environmental concerns affecting health care. Moral distress—a common experience in complex societies—arises when individuals have clear moral judgments about societal practices, but have difficulty in finding a venue in which to express concerns. Since health care is large in scale and climate change is proving to be a major environmental problem, scaling down health care is inevitably a necessary element for mitigating climate change. Because it is extremely challenging to discuss these concerns in health care settings, those concerned about climate change and health care experience distress. This article outlines some philosophical concepts and perspectives that may be useful in mitigating this distress.

The ethics of environmentally responsible health care

1. The Challenge of Environmental Responsibility 2. Linking Health and Environmental Change 3. Population and Consumption 4. Environmental Aspects of Health Care 5. The Green Health Center 6. At the Bedside 7. Global Ethics and Justice 8. New Ways of Thinking About Bioethics

Toward sustainable health‐care services: principles, challenges, and a process

Sustainable health care combines three key factors: quality patient care, fiscally responsible budgeting and minimizing environmental impact. Although pollution is well understood as a health problem, US health planners have not fully recognized the need to reduce health‐care pollution. Minimizing health‐care pollution, moreover, requires reducing the throughput of energy and materials. Ultimately, sustaining healthy ecosystems requires that health‐care material and energy utilization be limited. However, traditional conceptions of health‐care ethics maintain a philosophy of rescue that makes limiting life‐saving resources, except at a patient’s request, morally worrisome. Moreover, the media image of health care as technologically intensive, together with the common medical view that nature is the enemy, render suspect philosophical perspectives respectful of Earth’s limits. Nevertheless, academic medical centers have advantages as sites for pursuing sustainability: students often uphold environmental ideals, a public health perspective, and an interest in providing services universally; basic biomedical research on campus permits innovative research combining health and environmental considerations; opportunities exist for including environmental concerns in health professional education; some academic medical centers have already stated environmental criteria for purchasing contracts; and health‐care professionals and institutions are increasingly addressing such environmental concerns as mercury use, latex allergies, dioxin pollution, and waste volume. To address these challenges, a visioning process is proposed, designed to formulate a practical plan by means of public, local, and professional participation in the process of articulating creative and morally sound proposals for change.

TOWARD A SUSTAINABLE US HEALTH POLICY: LOCAL CONGRUITIES AND GLOBAL INCONGRUITIES

The United States health care system is congruous with the US economy and with prevailing local values: it is resource intensive, technology-focused, consumer-oriented, individualistic, and unequally available. However, the US health system is incongruous not only with other health care systems around the world, but also with the increasingly global nature of health care concerns. Indeed the US system, according to the World Bank, stands out as strikingly expensive and ineffective in its public health impact.The article first identifies several significant incongruities, and then argues that there is an increasing obligation for the US health system to become more ethically responsive in light of global concerns. Sustainable health should be sought as a significant goal of US health services. Health services need to be fully and accurately assessed for their environmental costs, which need to be made explicit. Actual, universal access to basic health care services needs to take priority over scarce high-tech therapies when resource allocations are made. Traditional health values such as individualism, autonomy and privacy must be placed within a context of global interdependence and responsibilities to community. Public health fundamentals such as adequate nutrition, clear water, and a biologically intact ecosystem must be emphasized. Innovations in health technology need to be made with attention to their potential international use and impact. Finally, a longer time horizon for planning is needed, taking into account environmentally caused health problems arising fifty years or more in the future.

Community-Engaged Public Health Research to Inform Hospital Campus Planning in a Low Socioeconomic Status Urban Neighborhood

Objective: To compare sociodemographic and motivational factors for healthcare use and identify desirable health-promoting resources among groups in a low socioeconomic status (SES) community in Chicago, IL. Background: Disparities in health services and outcomes are well established in low SES urban neighborhoods in the United States and many factors beyond service availability and quality impact community health. Yet there is no clear process for engaging communities in building resources to improve population-level health in such locales. Methods: A hospital building project led to a partnership of public health researchers, architects, and planners who conducted community-engaged research. We collected resident data and compared factors for healthcare use and choice and likelihood of engaging new health-promoting services. Results: Neighborhood areas were strongly associated with ethnic groupings, and there were differences between groups in healthcare choice and service needs, such as, proximity to home was more important to Latinos than African Americans in choice of healthcare facility ( p adj = .001). Latinos expressed higher likelihood to use a fitness facility ( p adj = .001). Despite differences in vehicle ownership, >75% of all respondents indicated that nearby public transportation was important in choosing healthcare. Conclusion: Knowledge of community needs and heterogeneity is essential to decision makers of facility and community development plans. Partnerships between public health, urban planning, architecture, and local constituents should be cultivated toward focus on reducing health disparities. Further work to integrate community perspectives through the planning and design process and to evaluate the long-term impact of such efforts is needed.

Conversion and the defense engineer

The authors examine the issue of how transferable engineering skills are from the military to the civilian sector. They argue that engineers ought to get involved in forging links between technologys capabilities and societys needs. They consider ways to bring this about.<<ETX>>

Outline of the Ethical Implications of Earth's Limits for Health Care

In addition to good medical services, all aspects of an economy must work together to ensure a high level of public health. However, the abundant economies of the North are contributing heavily to global environmental disaster, with increasing concomitant damage to human health. Environmental health problems result from toxicity (i.e., pollution), scarcity (i.e., poverty), and energy degradation (i.e., entropy). Common to these three factors in environmental demise are the limits of the Earth. Production has evolved to a point where the Earth is no longer safe from radical depletion. Therefore, simple living is a necessary feature of global public health. Rarely do readers of this journal see these limits first hand, but they are real. Our limited perceptions and efforts hinder our ability to understand how to reduce the impact of production on natural ecosystems. Contrary to standard media portrayals, growth and technology cannot solve our public health problems, because they are unequally distributed across the world and neither can they solve the problem of limits. The need for modest consumption in developed nations is an essential and almost completely ignored element of the answer to environmental and associated health problems. A radical and rapid change to public health is needed in order to avoid abysmal global health consequences during the next century. These changes involve a restructuring of our economy, including the health care industry. In the short run, this is an ethical demand. In the long run, this is an inevitability. The actual and appropriate role of bioethicists in championing these changes is unclear. (Abstract by Bruce R. Smith)

Time Frames for Saving the Planet

Professor Brooks’ paper projects an aura of inevitable catastrophe. He correctly notes that the climate is always changing and that somewhere in the near or far future there will always be something awful ahead. But this atmosphere of philosophical inevitability bypasses two important concerns. (1) By casting inevitable disaster into an unspecified future, he softens the urgency of the current problem: climate catastrophes are likely in a relatively brief time frame (less than 200 years). And (2), by arguing for inevitable failure, he misses what might be done to blunt or delay the worst outcomes. So, my principle aim here is to supply some useful dates and time periods to the philosophical discussion.

Conflicts between Individual Health and Nature Preservation

The article by Jessica Pierce and Christina Kerby, “The Global Ethics of Latex Gloves: Reflections on Natural Resource Use in Healthcare,” raises some important but seldom asked questions about the use of natural resources in healthcare. They take for their example latex gloves, which are in wide everyday use, especially since the establishment of principles of universal precautions in infection control as a reaction to the spread of HIV. They trace the production of latex gloves back through rubber processing to their origins in Malaysian rubber plantations and elsewhere. They then ask, but do not answer, some hard questions about the ethics of our relationship as patients to the impact of the materials we use on communities and the environment. To draw out their theme more starkly, consider the rumor widespread in South America that some babies purportedly adopted by Northerners are sold and cut up for their organs. Suppose this story were true; suppose your donated organ were obtained in this way. You would probably be so revolted by the immorality of its acquisition that you would refuse to accept it. But now take a morally more ambiguous case, as Pierce and Kerby intend. Suppose that the process of obtaining latex gloves is part of the gradual erosion of the Malaysian environment, and that workers in latex factories are poorly paid. Now, should or would you refuse to use latex gloves? Should or would you even be more selective in their use? The practice of universal precautions presumes a virtually unlimited supply of gloves; yet to react to resource scarcity with selective precautions hazards discrimination. Is there any way philosophically to balance the local justice issue of discrimination in comparison to injustice on a global scale and to future generations?