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Commentary: barriers and opportunities to changing
the research agenda to support precaution and primary
prevention
Joel A. Tickner
Department of Work Environment, University of Massachusetts, Lowell, MA, USA
Summary
Conceptual research to define the Precautionary Principle and its rôle in science,
science policy, and public health is making substantial progress. In September 2001,
participants at the International Summit on Science and the Precautionary Principle developed a vision for science to address the complexity of contemporary health
risks in a way that could lead to more precautionary, preventive decisions under
uncertainty. Its components include: (1) a more effective linkage between research
on hazards and research on primary prevention; (2) increased use of interdisciplinary approaches including better integration of qualitative and quantitative data;
(3) innovative methods for analyzing cumulative and interactive effects, populations and systems and vulnerable sub-populations; (4) systems for continuous monitoring to avoid unintended consequences of actions and to identify early warnings
of risks; (5) more comprehensive techniques for analyzing and communicating hazards and uncertainties; and (6) a more dynamic interface between science and policy. This article addresses barriers and opportunities to the practical application of
this vision for science. Scientists in many fields have recognized the need for innovative approaches and tools to address increasingly complex, uncertain risks of a
global scale. While opportunities to apply precautionary concepts in the research
agenda exist, public health scientists must be cognizant of current and emerging
barriers in the research agenda that balance the research focus on characterizing
proximate causal mechanisms of disease, to the detriment of research and policy to
support primary prevention.
Key words: precaution, primary prevention, research agenda, interdisciplinary
Introduction
The Precautionary Principle is critical to international disputes regarding appropriate
policies to address increasingly complex and highly uncertain risks such as those caused by
climate change, genetically modified organisms, and animal hormones. Many of these
Address: Prof. Joel A. Tickner, Research Professor, Department of Work Environment, University of Massachusetts, Lowell, One University Ave, Lowell, MA 01854, USA
Tel. 001/978/9342981 - Fax 001/978/9342025 - E-mail: [email protected]
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debates focus on the question of whether there is sufficient scientific evidence to justify preventive actions. Some analysts have argued that this is primarily a determination for risk
managers to make. We have argued elsewhere1 that the ability to make preventive, precautionary decisions under uncertainty is intrinsically linked to the ability of scientific methods
to characterize complex risks and uncertainties. If scientific tools are designed to achieve
standards of causal inference established by theoretical science; if scientific tools are not
adequately refined to identify early evidence of risks; or if uncertainties and limitations in
studies are not clearly communicated, precautionary actions may not occur until after health
and ecosystem damage has occurred. The tragic stories of asbestos, benzene, and PCBs
demonstrate the impacts on individuals and societies of the failures of science and policy2.
In this article, I argue that for precaution to take greater hold in science and policy, it must
be integrated into the scientific research agenda. This means adequate funding of research
to identify early warnings; encourage interdisciplinary collaboration; and redesign production systems, products, and other human activities to reduce risks. It means redirecting
research resources – which are primarily focused on more comprehensive characterization
of risks – to identify and develop options to address the root sources of risks, for exposure
reduction, and pollution prevention. I discuss barriers to these changes as well as opportunities for a more “precautionary” research agenda – one that more effectively addresses
complex risks and prevention. I conclude with recommendations for modifying the research
agenda. In particular, I argue that we must begin to ask prevention-oriented questions in the
research agenda – starting with a challenging question: “What would the research agenda
look like if we were to prioritize reduction of exposure to potentially harmful substances and
environmentally and occupationally related disease”.
Defining precaution
The Precautionary Principle encourages policies that protect human health and the environment in the face of uncertain risks. In this broad sense, it is not a new concept. Precaution is at the heart of centuries of medical and public health theory and practice. It is underscored by the concept of primary prevention and an ethical duty of beneficence – to do good
and not do harm.
The term “Precautionary Principle” is actually a translation of a much broader German
concept – Vorsorgeprinzip – literally translated as “forecaring” or “foresight” principle. This
alternative translation has the advantage of emphasizing anticipatory action – a proactive,
health-oriented idea, rather than precaution, which can sound reactive and negative. Vorsorgeprinzip was established in the 1970s as a social planning principle to support forwardlooking policies to achieve sustainable development, innovation, and job creation3.
The principle was characterized in the 1998 Wingspread Statement on the Precautionary
Principle as follows: “When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically”. The statement established four central components of the Principle, critical to its implementation: (1) taking preventive action in the
face of uncertainty, (2) shifting burdens onto proponents of potentially harmful activities,
(3) exploring a wide range of alternatives to possibly harmful actions, and (4) increasing
public participation in decision making4.
Based on the Wingspread and other more recent definitions and analyses, discussion of
precaution should thus not be just about thresholds of action and the appropriate actions to
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take under conditions of uncertainty. It should be equally about how we can use science and
technology more effectively to make the best possible preventive public health decisions in
the face of uncertainty and complexity.
Precaution and goals for the research agenda
Effective implementation of the Precautionary Principle requires that we address the ways
in which the conduct of science can hinder and better support precautionary policies. There
are ways in which the methods of scientific inquiry can impede precautionary action, making it more difficult for policy makers to take action in the face of uncertainty. Too often scientific research focuses on narrowly defined issues, though the problems we face are complex and require interdisciplinary research methods. Current scientific practice also often
attempts to minimize uncertainties and focus on those aspects of a problem that are quantifiable. This may mean narrowing the research focus so much that important aspects of the
problem are missed1. It can lead to type III errors, providing an accurate answer to the wrong
problem5. Addressing the rôle of precaution in environmental science requires that we consider: (1) what we study (scope of hypotheses and analyses); (2) how we study hazards (the
methods and tools we use); and (3) how we summarize and communicate results. The last
point is important because if the impossibility of achieving certainty (or substantially reducing uncertainty) is understood, it becomes easier to understand why action is essential,
because the failure to act can result in further damage to health and the environment.
Environmental science has a critical rôle in implementing the Precautionary Principle, by
providing insights into the normal functioning of natural systems, the ways they are disrupted by technologies, opportunities for prevention and restoration, and gaps in our understanding of phenomena. To support the Precautionary Principle, science and policy must be
able to identify and anticipate harm to health or the environment and support the development of options for precautionary action. This requires scientific methods, tools, and institutions that are adequately adapted to decision making problems that policy makers face.
Precaution creates opportunities and challenges for scientists to think differently about the
way they conduct studies and communicate results1. It calls for more and better science to
understand, characterize, and prevent complex risks to health and ecosystems.
In September 2001, the Lowell Center for Sustainable Production convened an interdisciplinary group of 85 scientists, lawyers, and policy analysts from 17 countries to discuss
how the conduct of environmental science can more effectively support precautionary, preventive decisions. These discussions resulted in a consensus statement – the Lowell Statement on Science and the Precautionary Principle - that outlines a vision for the research
agenda to improve the capacity of science and policy to prevent environmental and health
risks. The signatories stated that: “We contend that effective implementation of the precautionary principle demands improved scientific methods, and a new interface between science and policy that stresses the continuous updating of knowledge as well as improved
communication of risk, certainty, and uncertainty. With these objectives in mind, we call for
a re-evaluation of scientific research agendas, funding priorities, science education, and science policy. The ultimate goals of this effort would include:
– a more effective linkage between research on hazards and expanded research on primary prevention, safer technological options, and restoration;
– increased use of interdisciplinary approaches to science and policy, including better
integration of qualitative and quantitative data;
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– innovative research methods for analyzing the cumulative and interactive effects of
various hazards to which ecosystems and people are exposed; for examining impacts
on populations and systems; and for analyzing the impacts of hazards on vulnerable
sub-populations and disproportionately affected communities;
– systems for continuous monitoring and surveillance to avoid unintended consequences
of actions, and to identify early warnings of risks; and
– more comprehensive techniques for analyzing and communicating potential hazards
and uncertainties (what is known, not known, and can be known)6”.
Barriers to precaution in the research agenda
While the Lowell Statement outlined a vision for a more precautionary research agenda,
there are several research agenda barriers that must be addressed. These include: (1) lack of
funding for interdisciplinary, innovative, and preventive research, (2) unwillingness of agencies to experiment with new scientific methods until fully developed and widely accepted,
(3) lack of innovation and interdisciplinary approaches in education, and (4) efforts by the
regulated community to drive the scientific agenda away from precaution.
Funding limitations
Government and private funding for scientific research plays a critical rôle in defining
the types of problems and questions that are examined. Hypotheses are often formulated in
ways that are feasible to test with the time and resources available. Some analysts have
noted that scientific funding at the federal level for public health and environmental research
is targeted toward mono-disciplinary, short-term, uncontroversial, and often molecular-level
research instead of holistic and integrated approaches addressing large scale, long-term
problems7. Funding agencies and skeptical peer reviewers reinforce this tendency by favouring tightly focused proposals that repeat or incrementally build upon work in well-established areas – such as refining mechanisms of lead or asbestos toxicity rather than examining the effects of less studied toxicants1. Researchers whose work does not fall into the prevailing paradigm often have difficulties in securing funding8.
There is a tendency in environmental and public health research agencies to focus
resources on more elaborate characterization of risks rather than primary prevention. It
would not be an exaggeration to state that less than 20% of government research funding is
dedicated to exposure reduction, process redesign, pollution prevention, green chemistry, or
design for environment. Such prevention-oriented research is often considered too innovative or too broadly focused.
The lack of coordination between funding agencies exacerbates this focus on short-term
disciplinary risk-characterization research. Government research agencies have failed to
develop a coherent, integrated environmental health research agenda. While the National
Science Foundation is increasingly funding interdisciplinary, innovative approaches to characterize and prevent complex risks9, the agency tends to not fund health-related research. The
National Institutes of Health and the National Institute of Environmental Health Sciences are
focusing their research priorities on disciplinary, molecular research such as genomics and
gene-environment interactions10. While this work is important for understanding the etiology of disease and its treatment, there must be a better balance between molecular level
research on risks and interdisciplinary research on complex risks and prevention.
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A growing reliance on corporate-sponsored research in universities over the past 20 years
also presents a barrier to research incorporating innovative tools for primary prevention.
Universities are turning to corporate funding in part because the rate of growth of government funding is decreasing significantly11. While providing only a small portion of overall
university research funding, corporate funding has risen the most rapidly of any funding
source. From 1980 to 1998, industry funding for academic research grew by 8.1% per year
to $1.9 billion in 199812. This has the potential to increase the emphasis on narrow risk
research questions (framed by industry sponsors) and applied scientific research that leads
to or supports marketable products and technology.
The need for multi-investigator, interdisciplinary research to address complex environmental hazards and primary prevention requires fundamental changes in the way federal and
state requests for proposals are structured and reviewed13. Funding must be made available
for long-term, speculative, innovative, uncertain, complex, and cross-disciplinary research
that incorporates novel methods. Such research should be relevant to policy and should
allow investigators to examine to the extent possible the root causes of environmental risks
as well as potential solutions.
Government application of innovative methods
United States environmental law and policy addressing toxic chemicals, industrial pollution, and other risks has institutionalized a focus on disciplinary, causal research. Judicial review and constant challenges (a vast majority of US health regulations are challenged in the courts) have had a profound effect on how environmental and health agencies examine environmental threats and the amounts and type of evidence needed before
acting14. The threat of judicial scrutiny has caused agencies to develop formal, quantitative
records15 and to prioritize compliance with court decisions16. Rather than risk remand,
agencies prefer to develop evidence as fully as possible from the outset. This leads to protracted rulemaking periods17 and a reliance on formal quantitative procedures that systematize the assessment of scientific information, provide defensible numbers, and focus on
direct causal factors.
Courts in the United States in the 1970s provided great room for agencies to use innovative scientific approaches to characterize risks and take action (even forcing development
of new technologies) in the face of uncertainty. However, the famous US Supreme Court
benzene case in 1980 increased “the legal pressure on agencies to perform detailed, scienceintensive risk assessments in support of regulations”, resulting in slower development of
standards, the regulation of far fewer substances and other hazards, and little initiative to
engage in innovative science and policy18, a.
Another problem inhibiting the government’s ability to experiment with innovative scientific approaches is the single media approach to problems. Toxic chemical and industrial
pollution policies are largely fragmented, leading to narrowly framed policy questions and
answers. With some exceptions, problems are segmented into individual substances and
media (air, water, waste, workers, etc.), with little cross-programme communication. This
a
The Supreme Court struck down an occupational health standard for benzene on the grounds that the
agency had not demonstrated significant risk with substantial evidence. The case ushered in a requirement
for agencies to demonstrate that a hazard represented a significant risk before establishing an occupational
health standard with the Court, stating that Congress was not concerned with absolute safety but elimination
of significant harm and that the standard must be supported by a body of reputable scientific thought.
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lack of integration results in a slow and static relationship between science and policy and
a situation where complex problems are simplified and policy is based on fragments of
knowledge19.
The regular challenges to environmental and health policies, judicial scrutiny, and fragmentation of agencies result in a lack of willingness (and capacity) to use innovative scientific tools, such as those to study root causes of disease, cumulative effects, interactions, or
vulnerable subpopulations or to better characterize uncertainty and ignoranceb. Agencies
require defensible, uncontroversial tools that can quantify causal relations, provide precise
answers such as point estimates or risk figures and avoid the muddling effects of uncertainty or qualitative information. Because of these high thresholds for action, agencies must
place priority on developing a strong scientific basis for regulation for well-established hazards (for example, dioxins) at the expense of addressing less-established hazards or broad
classes of hazards.
A more precautionary approach to science may be “messier”, more controversial, and
more difficult to defend, but this should not discourage environmental and health agencies
from undertaking these challenging but necessary changes to enhance their ability to anticipate and take preventive, precautionary action on environmental hazards. Agencies must
be creative and interdisciplinary in examining and addressing problems, often with a wider
lens than that provided by the legislation or policies they enforce. However, Krimsky8 finds
that a shift to a more systems-oriented approach to assessing health effects will require
restructuring of the legal foundations and regulatory framework guiding the prevention of
risks.
Lack of innovation in education
Educational institutions are among the most difficult institutions to redirect towards new
educational approaches21. Universities have been slow to establish interdisciplinary environmental health programmes and to update curricula to respond to the complexity of environmental risks. This is largely due to the dependence of academic centres on outside funding that directs the research (and hence educational) priorities. Academic reward systems
also provide little incentive for innovation. To achieve tenure, professors are expected to
have a strong publishing record in the field, which encourages focusing on well-established
methods rather than experimenting with new approaches. Academics also tend to avoid
“rocking the boat” by undertaking methods, making statements, or engaging in collaborations that might draw scrutiny from colleagues or others.
The lack of innovation in new scientific approaches in education also has to do with an
evolving view of the university as a “service” provider, with students as clients21. Under this
view, universities provide students with “marketable” skills, which results in a focus in traditional scientific methods to the detriment of new tools and collaborations. For example,
epidemiologists have been debating limitations in their tools to address complex risks for
almost a decade7, 22. Yet in a review of 25 epidemiology texts, Bhopal23 found that the majority addressed traditional “black box” epidemiology focusing on individual risk factors and
For example, the author was involved in a Massachusetts Department of Environmental Protection scientific committee developing guidance for assessing the cumulative risks of solid waste facility siting.
Agency officials noted that perhaps they should not apply cumulative risk methods because they are too
complex and not widely accepted. However, the fact that such risks are difficult to study does not mean that
they are not occurring.
b
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causality. Few discussed population-level methods or the rôle of epidemiology in public
health policy.
Further, despite some academic calls for educating students about the implications of
their research and the products they create24, schools do not train students in real world decision making. Educational processes should provide opportunities to students to understand
the science-policy relationship, to be involved in decision making processes and to interact
with communities affected by environmental degradation.
In the future, educational training in environmental science and public health should
cover not only the tools and methods of specific disciplines, but also interdisciplinary
approaches25 as well as methods designed to address complexity, cumulative and interactive
effects, and uncertainty. Private foundation, university and government support for new
interdisciplinary academic programmes, such as those in conservation medicine, marine science, and climate science, will play a critical rôle in building a new generation of scientists
trained and grounded in these methods.
Limitations imposed by regulated entities
Regulated parties have a strong influence on the research agenda, through challenges to
health regulations, targeted funding of research to answer particular questions, and participation on research and decision-making panels. The influence of the regulated community
(or its third party-funded think-tanks) on the environmental health research agenda and policy has been widely documented26, 27. It has in part resulted in a research and regulatory focus
on proximate causes of disease and organ-by-organ, hazard-by-hazard research to demonstrate biological plausibility, causality, and relevance to humans. This creates an opportunity for those affected by public policy measures to raise uncertainty as a strategic smokescreen to avoid regulation28. Smokescreen uncertainty is created when the health effects of a
specific chemical or activity are not studied or are hidden from the decision makers or the
public, or when studies are undertaken purposely to increase the appearance of uncertainty26.
Some areas where the regulated community is influencing the research agenda to move
away from precautionary approaches, include:
– Good Epidemiologic Practices29. In response to growing evidence and concern about
the impacts of second-hand smoke, the tobacco industry funded an “independent”
panel on good epidemiologic practices to refine the methods and tools for causal inference. The panel advocated changes to epidemiology that would narrow the scope of
research and inhibit precautionary actions.
– Mechanisms of action and pharmokinetics. Over the past 20 years, regulated entities,
led by the Chemical Industry Institute of Toxicology, have argued that the mechanism
of toxicity for each substance must be demonstrated as relevant to humans before regulation occurs, despite evidence that every carcinogen identified in laboratory experiments has ultimately resulted in human cancer26, 30. This pressure can result in policies
that “discount” carcinogens based on mechanism and direct agency resources towards
developing complex mechanistic models, delaying precautionary action. Influence of
regulated entities on panels established by the International Agency for Research on
Cancer has resulted in several chemicals being downgraded on the basis of mechanism31.
– Hormesis. As the result of a regulatory challenge brought by the trucking industry, a
1999 US District court decision on ambient ozone standards elevated the notion that
agencies not only have to demonstrate the harmful effects of pollution but must also
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show that the beneficial effects of pollution do not outweigh the potential risks32.
Research on the concept of hormesis – that low doses of harmful exposures might
result in beneficial effects – in increasingly being advocated by regulated industries
and industry-sponsored researchers and other anti-regulatory analysts33-35. Given the
influence of the courts and increasing industry interest in this area, it appears inevitable
that government research agencies will be sponsoring research on hormesis in coming
years, resulting in a further narrowing of the research agenda.
These areas of research are interesting and important from a scientific knowledge perspective, but they also have the potential to make it more difficult to achieve causal significance or sufficient evidence to warrant preventive actions, tying up research and regulatory
policy in long debates over minute details of risk – all at the expense of primary prevention.
Opportunities for precaution in the research agenda
Despite the numerous barriers to precaution in the research agenda, there are also many
opportunities for better integration of precautionary goals into funding, research, and education. The precautionary principle is increasingly integrated into governmental, international, professional, and industry policies and regulations addressing complex and uncertain
risks, particularly those that threaten highly valued resources or future generations37. It is
gaining general acceptance as an overarching principle to guide environmental and health
policy. Vigorous international discussions are taking place on the changes that must be made
to science and policy in the support and implementation of the Precautionary Principle.
These discussions – such as those at the Lowell Summit – indicate that the Precautionary
Principle is here to stay and that momentum for modifying current practices is underway.
There are several reasons to be hopeful that precaution is slowly infusing its way into
research priorities and education. These include: (1) growing recognition of the complex
and highly uncertain nature of risks and the need for new scientific tools and approaches;
(2) increased recognition and use of innovative approaches to address complex risks; and
(3) growing recognition of the limits of tools in many fields.
Risks such as global climate change, endocrine disruption, destruction of biodiversity,
and impacts on marine ecosystems have challenged science and demonstrated that risks to
health and ecosystems are often more complex and multi-dimensional than current scientific tools and policies can currently address. There is increasing recognition in the scientific
community that addressing such complex risks requires a plurality of methods, disciplines,
approaches, and evidence in decision-making processes25. The challenge is often not so
much gathering and developing new types of information but finding ways to better integrate existing knowledge. The use of multiple sources of evidence can lead to scientific conclusions that are more robust, have greater probative power, and are more explicit about
uncertainty. In the policy arena, this requires better coordination and communication across
agencies to address emerging environmental threats13, 25.
The complexity of environmental hazards has forced integration of scientific knowledge
from various disciplines and establishment of new collaborations. Scientists, policy makers,
and activists are assembling “loose frameworks” to address such hazards as endocrine disruption, global change, and the challenge of ecosystem health. Groups of scientists are
beginning to view these problems through wide-angled lenses, gathering knowledge from
various disciplines and speculative hypotheses8.
For example, a comprehensive analysis of different types of evidence on the effects of
persistent pollutants on wildlife in the Great Lakes led Dr. Theo Colborn, of the World
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Wildlife Fund, to hypothesize that a common mechanism of action may be causing the
effects. Because of the fragmentation of scientific data, researchers had been unable to support suspicions using evidence from their individual disciplines. An interdisciplinary conference provided the opportunity for many different fields to meet and share insights38. The
conference organizers summarized the outcomes: “So shocking was this revelation that no
scientist could have expressed the idea using only the data from his or her discipline alone
without losing the respect of his or her peers”38.
The risks associated with global climate change have led to the establishment of transdisciplinary approaches, integrating the knowledge and contributions of different disciplines
– medicine, toxicology, epidemiology, ecology, veterinary science, meteorology, and more
– into a base of knowledge that can support the development of novel questions, hypotheses, and ideas, and more efficient problem solving. Transdisicplinary science supports precautionary decisions by developing early warning signs, improving interventions, and formulating anticipatory policies39.
Entirely new scientific collaborations and disciplines, such as earth systems analysis,
ecosystem health, and conservation medicine, have been founded to address the need for
interdisciplinary analysis. Conservation medicine is a new academic initiative linking
human and animal health with ecosystem health and global change. The initiative arose
from a growing understanding that human impacts on ecosystems are multiple and integrated, that ecosystems were becoming less resilient, and that professional preparation was
needed to deal with these impacts. Conservation medicine involves establishment of interdisciplinary problem-solving teams, interdisciplinary education and multi-institutional
research collaboration40, 41.
Complexity and uncertainty, coupled with the establishment of new collaborations, have
led to the development and increased use of innovative tools to more effectively characterize and prevent risks42, 43. These tools include: integrated modeling and assessment in climate
research44, health impact assessment45 and health and ecosystem indicators46, Bayesian-influenced analysis47, cumulative effects analysis48, community-based research49, and green
chemistry and design for the environment24. These tools are increasingly disseminated
through peer-reviewed journals, government reports, and professional conferences. Such
publication and professional and governmental discussion lends critical credibility to their
application, growth, and integration into research agendas and education.
People involved in many scientific disciplines increasingly recognize their limitations to
address contemporary risks, which are multidimensional and global in nature. As previously discussed, there has been a vigorous debate in epidemiology over the limits of individual
risk factor epidemiology and the need for more systems and population-level approaches7.
Biologist David Ehrenfeld has noted that despite important efforts and advances in conservation biology and our understanding of ecological systems, the field has rarely been able
to report measurable progress towards conservation goals50. These disciplinary discussions
on limitations in the field and the need for new approaches and collaborations have resulted in establishment of panels, working groups, and statements by professional organizations
such as the International Society for Environmental Epidemiology, the American Public
Health Association, the Society for Conservation Biology, the Society for Ecological Chemistry and Toxicology, and the Risk Assessment and Policy Association, among others. In
addition, cross-disciplinary workshops addressing particular complex risks such as genetically modified organisms, biodiversity protection, endocrine disruption, and climate change
are occurring on a more regular basis, funded by government agencies, private foundations,
and non-governmental institutions.
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Conclusions
Applying the Precautionary Principle provides a challenge and an opportunity for environmental science. As environmental science is an applied science for informing public policy, environmental and public health scientists must engage in scientific research and education that is relevant to the nature of risks being studied and communicate information that
can effectively inform decision making processes. One of the most important rôles the Precautionary Principle can play in environmental science is encouraging introspection in various disciplines. Applying the principle encourages scientists to ask whether our tools are
sufficient to characterize the risks we study and how can we improve their predictive capacity for earlier preventive policy interventions. In this sense, precaution should be viewed as
a compass to guide better decisions under uncertainty, rather than a hammer that compels
action at a specific point in time.
In order to increase the integration of precaution in the research agenda, I propose several recommendations:
– A more precautionary approach to research must not only focus on more holistic characterization of risks, but also more effective characterization of preventive opportunities, including new technologies and processes.
– Researchers must “push the envelope”– asking new questions to address real world
conditions, establishing new innovative tools, and new cross-disciplinary collaborations. The development of new research questions and approaches is a great benefit of
uncertainty. There is also a need for case studies and analyses to show how these methods and collaborations can be applied in practice.
– Scientists must develop a flexible array of scientific tools to characterize and prevent
risks. These tools will provide high quality information to inform decisions, instead of
a “cookbook” approach to analysis. Quantification and quantity of information has
minimal value if it does not address the root causes of the risk of concern.
– We need to develop a more dynamic relationship between science and policy – policy
must inform science and scientists must better communicate with policy makers. This
can improve the information basis of decisions and characterization of uncertainties,
and refine the types of questions asked and methods used, as well as the expediency of
preventive actions. It can create incentives for scientists to communicate early research
findings that, according to their expertise and judgement, are cause for concern51.
Scientists need to be more proactive in advocating for changes to research funding and
education that support a more precautionary approach. Additionally, scientists must be able
to champion ways to overcome barriers to these changes in the research agenda as well as
to defend against challenges to a more precautionary, public health approach to science from
the regulated community and others. Zoologist Jane Lubchenco has noted that contemporary complex and global health and ecological risks require a new paradigm for scientists –
that of a “social contract.” She states that scientists must address the most important needs
of society, communicate knowledge and understanding to inform decisions, and exercise
good judgement, wisdom, and humility52.
The ultimate goal of public health and precaution is to prevent disease, degradation, and
threats to human health and ecosystems, in addition to restoring conditions that foster health
– which, according to the World Health Organization definition, includes the complete state
of physical and social well-being. Precaution can serve as a compass to guide innovation in
science, technology and public policy to foster sustainability. It does not mean throwing
away the tools, approaches, and methods we have developed over the past 40 years, but it
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does mean that research funding and priorities must achieve a better balance between more
“reductionist” approaches, innovative systems-level approaches to characterize complex
risks, and research on prevention.
Lastly, the concept of “Foresight” inherent in the Precautionary Principle encourages
the establishment of long-term goals for protection of health from environmental degradation, a practice common in public health. Some examples include smallpox eradication
campaigns and smoking cessation goals. Goal-setting, coupled with development of public policies and metrics, focuses attention not on what futures are likely to happen but
rather on how desirable futures can be obtained53. This precautionary and preventive vision
for public health will require that we use our collective knowledge and experience to develop new scientific tools, policies, and collaborations that can lead us towards a more sustainable future.
Acknowledgements
This article was supported in part by grants from the V. Kann Rasmussen Foundation and the New York
Community Trust. The author acknowledges the assistance of Dr. David Kriebel and Ms. Sara Wright in
preparation of the manuscript.
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