Bioethics in India: Proceedings of the International Bioethics Workshop in Madras: Biomanagement of Biogeoresources, 16-19 Jan. 1997, University of Madras; Editors: Jayapaul Azariah, Hilda Azariah, & Darryl R.J. Macer, Copyright Eubios Ethics Institute 1997.
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63. Bioethics of Health and Environment

S. Palanichamy
PG. Department of Zoology, APA College of Arts & Culture, Palani 624 602 Tamil Nadu


Abstract

The maintenance and improvement of health of human beings and environment should be the main concern during the development of industry, energy and agriculture. Yet health is not given due priority as an important item in the development programs. The immediate problems in the world are ill health and premature death by biological agents. Health also depends on whether people can obtain food, water and shelter. It is a requirement of health that global systems and cycles on which all life depends are sustained. For maintenance of health and ecological sustainability the natural resources should not be depleted and natural systems should not damaged or degraded. At the same time human population of different countries should be taken into account, where in equality of population of different countries reflect different patterns of consumption and emission of pollutants. Even though the output of world food production has been greatly enhanced over the past few decades and global shortage of food lessened; still a large population of world suffers from hunger or under nutrition and other associated infections. Certain strategic principles can promote health and more sustainable patterns of food production; however, agricultural chemicals are widely misused, especially in developing countries. The resources of the world (Freshwater, metals, petroleum, forest produce etc.) are fast depleting and hence their judicious sustainability can bring prosperity. Due to overall development of various sectors like industries, energy, agriculture etc.; the domestic and global pollution are caused and the human population starts suffering from the effects of acid rain, ozone depletion, global warming and hazardous wastes. There is wide spread urbanization throughout the world and as a result the population inhabiting in these centres suffer from housing and other basic amenities. People need safe food and water, fuel and a secure shelter. People should share responsibility, individuals, governments, international agencies etc.; and they should give higher priority to developing a sustainable basis for the health of the people and countries.

The maintenance and improvement of health of human beings and environment should be the main concern during the overall development of agriculture, energy and industry. Yet health is not given high priority as an important item in the development programs. However, the quality of environment and nature of the development are the major determinants of health (Strader-Frechette 1990).

The most immediate problems in the world are ill health and premature death caused by biological agents in the human environment: in water, food, air and soil. They contribute to the premature of millions of people and to the ill death or disability of hundreds of millions more. The problem is more acute in the developing countries where:

- four million infants or children die every year from diarrhoeal diseases

- over a million people die from malaria each year and 267 million are infected

- hundreds of millions suffer from debilitating intestinal parasitic infestations

Serious environmental health problems are shared by both developed and developing countries, affecting hundreds of millions of people who suffer from respiratory and other diseases caused or exacerbated by biological and chemical agents, and those who are exposed to unnecessary chemicals, and physical hazards in their home, workplace, or wider environment. Health also depends on whether people can obtain food, water and shelter. Over 1000 million people lack the income or land to meet such basic needs. Hundreds of millions suffer from undernutrition.

It is a requirement of health that the global cycles and systems on which all life depends are sustained. Population growth and the way resources are exploited and wastes generated threaten the environmental base on which health and survival depend and transmit the growing costs to future generations. The ethical management of human health and natural resources and systems could bring better environmental management and prosperity.

Development, environment and health

Health depends on our ability to understand and manage the interaction between human activities and the physical and biological environment. We have the knowledge for this, but have failed to act on it, although we have the resources to meet current and future needs sustainably.

Two concerns are vital: development addressing people's needs, especially for health and ecological sustainability so that natural resources are not depleted and natural systems not damaged or degraded. Meeting the needs of the present and future world population for food, water and energy without depleting or damaging the global resource base, while avoiding the adverse health and environmental consequences of industrialization and uncontrolled urbanization, can be achieved only if people have the knowledge and the means to influence action. This calls for changes in the way governments plan and manage development. In agriculture, research and extension services are required that are more participatory and more responsive to the needs of poor farmers. In urban areas participatory partnerships between local authorities and community organizations need to be developed. People dependent on natural resources should be fully involved in decisions about their use and protection. All groups, including those who are living and working in the least healthy environments or are currently excluded from decisions about how resources should be used, should share in decision­making and action.

Population: Any discussion of health, the environment and development must include consideration of the size of the population and its consumption level, since this combination largely determines the impact that the human population makes on the environment. It must include the distribution of income and assets, the prime concern being for people whose health is impaired by lack of them. It must also include the macroeconomic framework within which governments set their economic, social and environmental policies. While the priority is to change the sectoral policies of governments and international agencies so as to promote health and sustainability, macroeconomic policies affect all sectoral policies.

The population of world grew more than fivefold between 1800 and 1990 to reach over 5000 million; projections suggest 8000 million by 2020 (UN 1989). In developing countries, where populations are still expanding, pressure on scarce resources has made it difficult to improve living conditions; in the towns and cities the authorities have rarely been able to provide the extra services required by the rapid growth in population. In developed countries, where population levels are largely static, prosperity has given rise to increased consumption and even overconsumption with insufficient regard being paid to their possible planetary impact: the depletion of non­renewable resources, the degradation of soil and water resources and the emission of gases that threaten climatic stability and the stratospheric ozone layer. Such consumption levels raise the question of sustainability, especially as a growing proportion of the world's population aspires to comparable levels of consumption (Worl. Res. 1991).

Poverty: At least 1115 million people were classified as poor in 1985 and 630 million of these were living in extreme poverty. Such statistics cover only those with an inadequate income. The number lacking a minimum standard of living is much higher. Those who cannot read, obtain clean water, or avoid environmentally induced disease and who are permanently under the threat of physical violence and the effects of crime are invariably poor, whatever their income. So too are those who cannot participate in community life or expect to live beyond the age of 60. If poverty is measured by the number of people lacking a standard of living that includes adequate food, safe and sufficient water, sanitation, a secure shelter and access to education and health care, over 2000 million people live in poverty-some 40% of the world's population. A high proportion are women and children, who are more vulnerable to environmental health risks. Within house holds, it is generally women who look after the children, manage the household and care for the sick; as such, they suffer more from the diseases associated with inadequate water and sanitation and from the defects in the provision of basic services. Women who head households also usually face discrimination in looking for jobs and in obtaining access to public services, housing and credit.

Resource use: The impact of any population on the environment depends on the type and level of its resource use and on its waste generation and management. Most of the world's consumption of non­renewable resources is concentrated in Europe, North America and Japan. Per capita consumption levels in the richest countries are 50 or more times higher than in the poorest countries. The organization of European cooperative development nations, with 15% of the world's population, are responsible for 77% of all hazardous industrial waste. More than 80% of the gases in the atmosphere that contribute to the greenhouse effect arise from production or consumption in the developed world.

Macroeconomic policies: Macroeconomic policies are major influences on the state of health and of the environment within all countries. But they are usually established with little or no consideration given to their health or environmental consequences. For example, trade and fiscal policy or agricultural or energy pricing may influence health either by their effect on income levels and distribution or by the effect on the quantity and quality of land, air and water resources. Macroeconomic policies influence the extent to which health care and health related services are funded.

Macroeconomic policies should minimize conflicts between economic, environmental and health goals. With increased knowledge of the social and environmental effects of macroeconomic policies the effects can be limited, including those which arise from structural adjustment and special programs can be established for those whose health might otherwise suffer from loss of income or cuts in services for instance health care or nutrition programs or employment projects.

Food and agriculture: Agriculture, forestry and fishing provide not only the food and natural resources on which human society depends, but also the livelihood of about half of the world's population. Their output can only be sustained if the ecological systems on which they draw are not overexploited.

The output of the world's food producing systems has greatly increased over the past few decades. As yet there is not global shortage of food or the capacity to produce it in the world, but for a large part of the world's population undernutrition and the infections associated with it will remain the main cause of ill health and premature death because they do not have enough land to grow the food they need or the income to purchase it (Paulino 1986). Food borne diseases are among the most common diseases in every country, although they are far less often life­threatening in developed countries. Most disease agents that contaminate food and water are biological and come from human or animal excreta, although food contaminated by toxins produced by plants and moulds and those present in fish and shellfish, can be a serious problem.

Agricultural chemicals are widely misused, most seriously in developing countries where pesticide regulations and their enforcement are less strict and products that have been banned or restricted in developed countries are still widely available (Copplestone 1985). Agricultural chemicals are damaging water resources. Drainage water often contains high levels of salts and nutrients, the latter causing blooms of algae in lakes, reservoirs and shallow coastal waters.

Health and its environmental determinants are closely related to land tenure. Farmers with secure tenure of adequate amounts of fertile land usually avoid extreme poverty and the ill health that accompanies it. Those with little security and too little land or holdings of only marginal productivity are often poor; so is their health. Many small farmers have developed a sophisticated knowledge of how to sustain yields in difficult circumstances. However, environment degradation is common where high concentrations of poor farmers have only land of poor quality to exploit.

Certain strategic principles can promote health and more sustainable patterns of food production. They include the promotion of good agricultural practice (for instance, crop rotation, avoidance of excessive fertilizer application, use of correct dosage of chemicals or pesticides, reduction of food losses before and after harvesting). They also include wider use of integrated pest control and better integration of farming, forestry and water resource management (Rolston 1996). Several major innovations are likely to prove of particular importance for increased food production or better preservation; they include food irradiation and the use of modern biotechnology to improve productivity and processing.

Water: Fresh water is considered a renewable source, but there are limits on the supplies available (UNICEF 1987). In many countries or regions, shortages of fresh water are the main obstacle to agricultural and industrial production. Some of the shortages (or seasonal or annual variations in supplies) lead to poverty and soil degradation. Many cities and agricultural regions are now drawing supplies from underground aquifers at a rate far above their natural rate of recharge.

Fresh water is essential to health not only for its part in production but also for domestic consumption and use (drinking, cooking, washing, laundry). A high proportion of life­threatening and health­threatening infections are transmitted through contaminated water or food (Clarke 1991). Nearly half the world's population suffer from diseases associated with insufficient or contaminated water, mostly the poor and virtually all in developing countries.

Water shortages usually lead to problems of water quality since sewage, industrial effluents and agricultural and urban run-off overload the capacity of water­bodies to break down biodegradable wastes and dilute non­biodegradable ones. Water pollution problems are most serious in cities in developing countries where controls on industrial emissions are not enforced and sewers, drains or sewage treatment plants are lacking. Sewage and industrial effluents can be treated before disposal if sewers exist and the regulatory authorities are effective. Agricultural and urban run off cannot be treated and in many areas in both developed and developing countries, it is a growing threat to the quality of lakes, rivers and the groundwater. Fisheries have been damaged and drinking­water sources contaminated by pollution in many areas of the world. These are major determinants of health. Many die every year from diarrhoeal diseases.

Energy: People in developed countries use roughly ten times more commercial energy than those in developing countries and burn 70% of all the fossil fuel used, most of it for electricity generation, industry, transport and domestic heating. To strengthen their economies and so provide the economic basis for good health, most developing countries will need to increase their fossil fuel consumption.

Fossil fuels are the single largest source of atmospheric pollution; when burnt, they release in the air particulate matter, carbon monoxide and dioxide, oxides of nitrogen and sulfur and metal compounds. More than 1000 million city dwellers are now exposed to high levels of air pollution (OECD 1991). High levels of sulfur dioxide and particulates in urban areas have been associated with respiratory disease and increased mortality. Vehicle exhausts pollute the air in large cities with carbon monoxide and with lead (except where lead additives to petrol are no longer used). Exposure to the latter may impair mental development in children. Vehicle emissions also contribute to the formation of ozone and photochemical smog, which may decrease lung performance. Several studies have shown an association between levels of air pollution and respiratory symptoms, but it is still uncertain whether protracted exposure to low levels of air pollutants, such as occur in many cities of the developed and developing worlds, has any long­term effects on health. However, policies, regulations and incentives can greatly reduce air pollution and increase the efficiency with which fossil fuels are used. Their adoption in many developed countries has improved air quality in a number of cities in recent years.

Indoor air pollution from the combustion of coal or unprocessed biomass fuels (e.g., wood, crop wastes) represents perhaps the largest energy related source of ill health (Chen 1990). Biomass fuels are used to meet the energy needs of nearly half the world's population. They are often burnt in open fires or inefficient stoves in poorly ventilated houses and give off smoke and chemicals that contribute to respiratory disease, with long­term cardiovascular effects. Because of the presence of known carcinogens in the indoor air, an increased risk of lung cancer must be assumed. Women are generally responsible for cooking and looking after children in the home and they and their children are at greatest risk (UNICEF 1990).

There are a number of alternatives to fossil fuels and unprocessed biomass fuels, including hydropower, nuclear energy and solar power. Hydropower can bring extra benefits such as flood control and an increased supply of water for drinking and irrigation. However, dams can cause environmental changes that affect health.

Oceans: Large stretches of coastal waters, especially in semi-enclosed seas and where tidal flushing is limited, are heavily polluted by industrial and domestic wastes from rivers and out falls, land run-off accidental spills. Biological and chemical pollution is high near river mouths and sewage outfalls. Fishing beds and beaches in their vicinity are at particular risk of contamination. Seafood poisoning and epidemics such as the cholera epidemic in Latin America in 1991, may result from disposal of inadequately treated effluents into the sea (UNEP 1990).

The need to improve the quality of coastal waters and to preserve that of the open ocean has led to the adoption of a number of international agreements. Their extension to the many ocean areas that are not yet covered should be greatly accelerated and ways and means for their rigorous implementation should be provided.

If flooding occurs, people living in the flooded area must be resettled, the quality and reliability of the water supply downstream are often reduced and in the absence of appropriate control measures, the large area of water behind the dam can become a breeding ground for disease vectors (including those of schistosomiasis and malaria). Smaller hydro systems that draw power direct from flowing rivers can avoid most of these health, social and environmental costs.

Industry: Industrialization has made many positive contributions to health, among them increased personal incomes, greater social wealth and improved services, particularly transport and communications. But industrial activities carry the risk of adverse health consequences for the workforce and the general population, either directly, through exposure to harmful agents or practices, or indirectly, through environmental degradation. Industrial emissions and products also threaten the global environment (OECD 1991).

Industrial practices in both developed and developing countries produce adverse environmental health consequences through the release of air and water pollutants and the generation of hazardous wastes (Leonard 1984). Occupational disease include silicosis, pneumoconiosis, lead and mercury poisoning, hearing loss and skin diseases. Serious health risks are also faced by workers in small­scale or cottage industries, where exposure to toxic chemicals and accident rates are often higher than in large industries.

Industrial emissions have polluted many rivers, lakes and coastal environments, especially in developing countries where pollution control is rarely enforced. A number of major accidents in developing countries such as the release of chemicals or explosions have been dramatic reminders of the adverse health effects of inadequate attention to safety and prevention. Only in a minority of countries are potentially dangerous industries sited away from population concentrations. In most countries too little attention is given to controlling the disposal of hazardous industrial and commercial waste so as to prevent human exposure and leakage into the environment.

Urbanization and basic services: Environmental management is needed in all settlements to provide water, protect public spaces, remove wastes and protect air and water quality. Even in a small village, water sources must be protected and all house holds must be ensured sufficient water. Human and animal excreta must be disposed of in ways that minimize the possibility of human infection and of food and water contamination. As a settlement's population size and density increase from village to market down to major city, so too do the scale and complexity of the environmental management needed to ensure a healthy environment (WHO 1989).

Rapidly growing urban centres are a particular challenge for environmental health. Urbanization is usually associated with the development of a more productive economy and it can bring major benefits to health and the environment; the concentration of population and business lowers are unit cost of piped water and health services, sanitation and the collection and treatment of household and commercial wastes. But in the absence of government action to ensure that the infrastructure and services are in place and pollution controlled, environmental health problems are greatly exacerbated.

Housing should contribute to a sense of well­being and security. Poor housing is associated with social and psychological problems, including alienation, isolation, drug abuse, family break­up and urban violence. Strong community networks can act as a buffer against the psychosocial effects of poor physical environments (Marsella 1990). Action to improve psychosocial health often combines improved services and employment opportunities. A related issue is noise at home and work, which can result in hearing loss, sleep disturbance, impaired mental performance, increased anxiety and aggression.

Enough knowledge and resources exist in most developing countries to improve housing and basic services at a relatively low cost. New participatory partnerships between local authorities, non­governmental organizations and community organizations have shown this to be so and have proved cost­effective. Institutional frameworks at national and local level are needed to encourage and support these partnerships.

International issues: Certain environmental issues have health implications on a wider scale than the local or national level. They include the long­range transport of air pollutants, the transboundary movement of hazardous products and wastes, stratospheric ozone depletion, climatic change, ocean pollution and loss of biodiversity. Solutions are being sought mainly through intergovernmental agreements.

Acid rain: Sulfur and nitrogen oxides emitted from tall chimney stacks by fossil fuel fired power stations are transported over long distances, often across national boundaries. In the atmosphere they are converted to acids and eventually fall to ground as acid rain or snow. This has acidified many poorly buffered lakes and soils and contributed to forest dieback and in many places (especially Central Europe) to the destruction of large forests.

The ozone layer: The stratospheric ozone layer is being damaged by the release into the atmosphere of various chemicals, including chlorofluorocarbons used in refrigerants, aerosols, plastic foam blowers and other equipment, halons used by fire­fighting services and various organic solvents. Depletion of the ozone layer is likely to lead to higher levels of biologically active ultraviolet radiation at the earth's surface. At certain wavelengths, UV radiation increases the incidence of skin cancer and cataract in humans and probably affects other organisms that have no protection against it. Small changes in recreational habits, such as the avoidance of sunbathing at midday and the use of protective clothes and creams, could do much to reduce the health risks.

Greenhouse gases: A related issue concerns the build­up of greenhouse gases in the atmosphere, thought likely to lead to global warming and a rise in the sea level. During the 1980s, carbon dioxide emissions, mostly from fossil fuel combustion, were responsible for more than half of the total warming effect and chlorofluorocarbons for a quarter. Uncertainties about the magnitude, rate, timing and distribution of any future warming make it impossible to predict the health implications quantitatively.

The seriousness of the possible health and environmental consequences of global warming is such that every efforts should be made to reduce greenhouse gas emissions now, through individual efforts and through such measures as are now being developed by the United Nations.

Hazardous wastes: Hazardous wastes are exported from developed to developing to developing countries when the export cost is much lower than the cost of disposal in the country of origin. Disposal abroad is rarely accompanied by concern about the health of those involved or living near disposal sites. The growing concern about the health and environmental implications led to the Basel Convention on the control degraded.

Ethics and environment

People need to have the means to acquire the resources on which health depends: safe food and water, fuel and a secure shelter. They need to be protected not only from physical, chemical and biological hazards, but also from crime and violence, which are encouraged by poverty and the use of drugs and from injuries at their place of work. A healthy environment is not only a need, it is also a right; the right to live and work in an environment conducive to physical and mental health is enshrined in the Universal Declaration of Human Rights. Everyone shares the responsibility for ensuring that this right is duly acknowledged (Shrader­Frechette 1990).

Everyone also shares responsibility for health and for passing on to the next generation a world whose resources are not depleted and whose natural systems are not degraded. There is a powerful synergy between health, environmental protection and sustainable resource use (Rolston 1996). Individuals and societies who share the responsibility for achieving a healthy environment and managing their resources sustainably become partners in ensuring that global cycles and systems remain unimpaired.

The responsibility for action lies with individuals and with business. Governments have the responsibility of setting up the strategic and institutional framework within which action is taken. They should put in place the services, financial and other incentives and controls that encourage individuals, households, communities, business and bureaucracies to promote health and sustainable resource use. They should take the lead in ensuring that the levels of consumption and waste generation within their boundaries do not damage global systems and deplete resources known to be finite.

All governments and international agencies should give higher priority to developing a sustainable basis for the health of their people and countries. Achieving such a sustainable basis for health requires high priority in development policy to reducing population growth, over consumption and waste generation.

References
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Leonard, H.J Confronting industrial pollution in rapidly industrializing - myths, pitfalls and opportunities. Washington, D.C. Conserv, Foundation 1984.
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