Soskolne Colin L
Department of Public Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Int J Occup Med Environ Health. 2004;17(1):69-76.
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 the 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.
对健康造成灾难性、大规模或灾难性影响的可能性越大，采取预防措施的理由就越充分。预防行动的必要性对于健康的下游决定因素也至关重要，在涉及对地球上生命可持续性的宏观层面担忧时，这一必要性同样紧迫。在这种背景下，我提议，当可能对健康和福祉造成大规模危害时，需要更高的不确定性阈值。初步努力必须集中于培训研究人员和风险管理者，使其具备应对复杂性以及采用跨学科探究的系统方法的能力。重新审视布拉德福德·希尔关于因果关系的意图是至关重要的第一步。关注疾病的更直接原因，比如那些与职业暴露或更下游环境暴露相关的原因，留待本论文集的其他作者探讨。
