Antimicrobial use and planetary health: developing a framework for priorities.
Antimicrobial use and planetary health: developing a framework for priorities.
复制标题
抗菌药物的使用和地球健康：制定优先事项框架。
DOI：
10.1016/s2542-5196(18)30137-2
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Moran D
中科院分区：
文献类型：
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作者：
Moran D
需要加强对抗菌素使用和抗菌素耐药性（AMR）的战略思考，这已被称为典型的“同一个健康挑战”，并与减缓或减少温室气体排放（GHG）进行了比较。这些邪恶的问题之间的相似之处确实是惊人的。抗菌素耐药性的特点是市场和制度失灵，就抗菌素使用者的外部化成本而言，缺乏全球监管或治理架构。存在多种人类和动物的抗菌素污染来源，并且由于复杂的环境相互作用、池化和持久性而进一步复杂化。多个潜在切入点可用于修改药物的临床和兽医用途，并检测和诊断抗菌素耐药性。许多干预措施以意想不到的方式进行补充或相互作用，而人的层面对抗菌药物的使用提出了尚未解决的行为挑战。最后，政治经济维度会造成公共和私营部门利益、发达国家和发展中国家利益之间的冲突。这些冲突可能会阻碍创新和采取甚至是技术上最有效的措施。总的来说，科学政策话语似乎是不连贯和压倒性的。诉诸同一个健康、地球边界或生态系统服务的说辞只能到此为止。一个迫在眉睫的问题是首先要做什么，或者如何在对已知和未知的共识的基础上确定行动的优先次序。这种情况让人想起气候变化的经验。十年前，围绕不同的温室气体减排措施进行了大量非结构化的讨论，但人们对避免一吨二氧化碳当量排放的相对成本的理解并不清楚。一些政府主动采取更合理的方法来解决这个问题，利用环境经济学和污染控制的相关理论来制定边际减排成本曲线（MACCs），对具有成本竞争力的干预措施进行排名。3 .这一信息为通过比较边际减排成本估算各部门的碳预算提供了基础。这一比较包括农业，这是一个寻求温室气体减排的生物物理复杂部门。可以采取类似的方法吗
Increased strategic thinking is needed about antimicrobial use and antimicrobial resistance (AMR), which has been termed the quintessential One Health challenge1 and compared to greenhouse gas emissions (GHG) mitigation or abatement. 2 The parallels between these wicked problems are indeed striking. AMR is characterised by market and institutional failures in terms of externalised costs by antimicrobial users and the absence of global regulatory or governance architecture. Multiple human and animal sources of antimicrobial pollution exist that are further complicated by complex environmental interactions, pooling, and persistence. Multiple potential entry points could be used to modify clinical and veterinary uses of medicines and detect and diagnose AMR. Many interventions complement or interact in unanticipated ways and the human dimension to antimicrobial use raises unresolved behavioural challenges. Finally, political economy dimensions can create conflicts between public and private sector interests and the interests of developed and developing countries. These conflicts can inhibit innovation and the adoption of even the most technically effective measures. Overall, the science policy discourse can seem incoherent and overwhelming. Recourse to One Health, planetary boundary, or ecosystem service rhetoric can only go so far. An immediate question is what to do first, or how to set priorities for action, on the basis of a consensus of what is and isn’t known.This situation is reminiscent of the climate change experience. A decade ago, much unstructured discussion occurred around different GHG abatement measures, but an understanding of the relative cost of avoiding a tonne of carbon dioxide equivalent emission was unclear. Some governments took the initiative to develop a more rational approach to the problem, drawing on environmental economics and related theories of pollution control to develop marginal abatement cost curves (MACCs) to rank cost competitive interventions. 3 This information provided a basis for estimating carbon budgets sector by sector by comparing marginal abatement costs. This comparison includes agriculture which is a biophysically complex sector for seeking GHG mitigation. Could adopting a similar approach