The debate about the appropriate standards for upstream corporate social responsibility of multinational corporations has been on the public and academic agenda for some three decades. The debate originally focused narrowly on “contract responsibility” of MNCs for monitoring of upstream contractors for “sweatshop” working conditions violating employee rights. The authors argue that the MNC upstream responsibility debate has shifted qualitatively over time to “full producer responsibility” involving an expansion from “contract responsibility” in three distinct dimensions. First, there (...) is an expansion of scope from working conditions to human rights and social and environmental impacts broadly defined. Second, there is expansion in depth of this broader responsibility to the whole upstream supply chain without regard to contracting status. Upstream responsibility now includes all suppliers, including direct contractors and the chain of suppliers to such contractors. Finally, the change in CSR scope and depth has led to an evolution of CSR management practice. (shrink)

For the first time, entrepreneurs are aggressively developing new technologies and business models designed to improve individual and population health, not just to deliver specialized medical care. Consumers of these goods and services are not yet “patients”; they are simply people. As this sector of the health care industry expands, it is likely to require new forms of legal governance, which we term “upstream health law.”.

This article analyzes a deliberative forum on nanotechnologies, organized in Portugal within the scope of the research project DEEPEN—Deepening Ethical Engagement and Participation in Emerging Nanotechnologies. This event included scientists, science communicators and members of the “lay public”, and resulted in a position document which summarizes collective aspirations and concerns related to nano. Drawing upon our previous experience with focus groups on nanotechnologies—characterized by methodological innovations that aimed at suspending epistemological inequalities between participants—this paper delves into the performativity of the (...) deliberative event, exploring some of the tensions and power/knowledge asymmetries generated by the forum. Recognizing that the design of participatory assemblages matters, we reflect on our role as facilitators and explore the difficulties in organizing exercises of upstream engagement with emerging technologies. (shrink)

The idea of conducting “upstream public engagement,” using nanotechnology as a test case, has been subject to criticism for its lack of any link to the political system. Drawing on the theoretical tools provided by Habermas, this article seeks to explore such a “link”, focusing specifically on the capacity of civil society organizations to distil, raise and transmit societal concerns in an amplified form to the public spheres at the European Union level. Based on content analysis and semi-structured interviews (...) with relevant actors, this article examines the evolution of CSO approaches towards nanotechnology over the past decade and investigates whether and how upstream public engagement could contribute to more vibrant public spheres and facilitate the formation of communicative power. The answer to these questions is twofold: on the one hand, moving public engagement “upstream” enables CSOs to be better informed and to become part of the debates more quickly. A “green alliance” is taking shape, which calls for more stringent regulation on nanomaterials. On the other hand, upstream public engagement has turned out to be unsuccessful in generating substantial and sustained interest. A number of CSOs have quit this field in frustration at the tokenistic engagement and out of fatigue after the intense lobbying battle for Registration, Evaluation, Authorisation and Restriction of Chemicals. (shrink)

Conserved upstream open reading frames (uORFs) are found within many eukaryotic transcripts and are known to regulate protein translation. Evidence from genetic and bioinformatic studies implicates disturbed uORF‐mediated translational control in the etiology of human diseases. A genetic mouse model has recently provided proof‐of‐principle support for the physiological relevance of uORF‐mediated translational control in mammals. The targeted disruption of the uORF initiation codon within the transcription factor CCAAT/enhancer binding protein β (C/EBPβ) gene resulted in deregulated C/EBPβ protein isoform expression, (...) associated with defective liver regeneration and impaired osteoclast differentiation. The high prevalence of uORFs in the human transcriptome suggests that intensified search for mutations within 5′ RNA leader regions may reveal a multitude of alterations affecting uORFs, causing pathogenic deregulation of protein expression. (shrink)

The vision of global health with justice which Larry Gostin articulates in his book Global Health Law envisages a switch to ‘upstream’ priority-setting for expenditure on health, with a focus upon social determinants and a goal of redressing health inequalities. This article explores what is meant by this proposal and offers a critical evaluation of it. It is argued that difficulties arise in respect of the ethical and evidential bases for such an approach to the setting of priorities, while (...) significant challenges may also arise in the necessary modification of structures of governance. (shrink)

The upstream framework presented in public health and medicine considers health problems from a preventive perspective, seeking to understand and address the root causes of poor health. Medical-legal partnerships (MLPs) have demonstrated the value of this upstream framework in the practice of law and engage in upstream lawyering by utilizing systemic advocacy to address root causes of injustices and health inequities. This article explores upstreaming and its use by MLPs in reframing legal practice.

Medicine and health are surprisingly separate. In the introduction to his 1963 master work on medical economics, Kenneth Arrow acknowledged that “the subject is the medical-care industry, not health.” In the 50 years that followed, researchers, policymakers, and public health professionals generated valuable and varied insights into health, impacting both behaviors and environments while addressing social determinants and demographic trends. Yet medical care has followed an even steeper upward trajectory, growing rapidly in scientific precision, public esteem, and technical sophistication.As a (...) result, the economic gap between the two domains has widened. The U.S. health care system spends almost $3 trillion annually. Preventive screening and early intervention bridge medical care and health, as do nutrition, behavioral health, aging, and a few other fields. But the money is overwhelmingly in medical care, particularly rescue care for those with acute illnesses or serious complications of chronic disease. (shrink)

Important scientific, ethical and sociological debates are emerging over the trans-humanist goal to achieve therapeutic treatments to ‘cure’ the debilitation of age-related illness and extend the healthy life span of individuals through interventive biogerontological research. The scientific and moral discourses surrounding this contentious scientific field are mapped out, followed by a normative argument favouring ‘strong’ deliberative democratic control of human life extension research. This proposal incorporates insights from constructive and participatory technology assessment, upstream public engagement and back-casting analysis; to (...) outline a programme of participatory approaches to encourage two-way dialogue between scientific and citizen perspectives, and foster the long-term deliberative democratic governance of this developing field. (shrink)

A discussion of what operates from "within" formal agency as irreal surplus to artworks and how otherwise discursive systems become abstracted by the artwork. Text by Gavin Keeney. Images by Parsa Khalili.

Volume 20, Issue 8, August 2020, Page 1-4.

Volume 20, Issue 2, February 2020, Page 22-24.

Philosophical discussions of positional goods typically focus on parties competing for shares of such goods and on the inequalities among them that both shape and arise from these competitions. Les...

The diversity of nanotechnologies and of the governance challenges that their applications raise calls for exploration and learning across different cases. We present an Upstream Oversight Assessment (UOA) of expected benefits and potential harms of nanoparticles made of a synthetic polymer (PLGA) to improve vaccines for farmed salmon. Suggested by Jennifer Kuzma and colleagues, an UOA may help identify and prioritise research needs, and it may support evaluations of the adequacy of relevant existing regulatory frameworks. In this work, the (...) UOA approach is modified and supported with elements from the uncertainty analysis framework developed by Warren Walker and colleagues. Empirically, we draw on relevant available published literature and insights generated in an ongoing nanoparticle salmon vaccine project, in which one of the authors participates. Nanotechnologies have not previously been encountered in the regulatory context of fish vaccines, which in part raises unique challenges due to prospective large scale vaccine use in semi-open aquatic systems. Strengthened through cooperation between ELSA and technology researchers we found the UOA useful for an early mapping of benefits and concerns, and for identifying areas in need of further research prior to a nanoparticle based salmon vaccine is developed and taken into use. We consider our approach to represent one among several complementing initiatives that seek to contribute to early stage evaluations of possible negative side effects, broadly conceived, in order to facilitate a more robust nanotechnology development. (shrink)

(1994). Why do salmon go upstream in fresh water from oceans: Evolution of the global recycling of nutrients through higher organisms. World Futures: Vol. 42, No. 3-4, pp. 259-263.

This paper problematizes the precision medicine approach embraced by the All of Us Research Program (US) and by Genomics England (UK) in terms of benefits distribution, by arguing that current “diversity and inclusion” efforts do not prevent exclusiveness, unless the framing and scope of the projects are revisited in public health terms. Grounded on document analysis and fieldwork interviews, this paper analyzes efforts to address potential patterns of exclusion upstream (from participating in precision medicine research) and downstream (from benefitting (...) from precision medicine outputs). It argues that efforts for inclusion upstream are not corresponded downstream, and this unbalance jeopardizes the equitable capacities of the projects. It concludes that enhanced focus on socio-environmental determinants of health and aligned public health interventions as precision medicine outputs would be to the benefit of all and especially of those who are most at risk of (upstream as well as downstream) exclusion. (shrink)

In this article, we will first give a historic overview of the concept of benefit sharing and its appearance in official agreements, particularly with respect to crop genetic resources. It will become clear that, at present, benefit sharing is primarily considered as an instrument of compensation or exchange, and thus refers to commutative justice. However, we believe that such a narrow interpretation of benefit sharing disregards, and even undermines, much of its (historical) content and potency, especially where crop genetic resources (...) are concerned. We argue that benefit sharing should not be based merely on commutative justice but rather on a broader model that is also grounded in the concept of distributive justice. This has repercussions for the application of benefit sharing, which we try to clarify by distinguishing between downstream and upstream benefit sharing. Upstream benefit sharing is not so much inspired by compensation for actions done, or the distribution downstream of benefits developed, but by the idea of shared decision‐making on the research and development of resources fundamental to human welfare. Going upstream in the research process of crop genetic resources, and determining research agendas and improving crops according to the needs of the poor, benefit sharing may well be a tool to contribute to world food security and global justice. We concretize our ideas on upstream benefit sharing by introducing a set of criteria that determine the success of consultations on agricultural research agenda setting. (shrink)

How to embed reflexivity in public participation in techno-science and to open it up to the agency of publics are key concerns in current debates. There is a risk that engagements become limited to “laboratory experiments,” highly controlled and foreclosed by participation experts, particularly in upstream techno-sciences. In this paper, we propose a way to open up the “participation laboratory” by engaging localized, self-assembling publics in ways that respect and mobilize their ecologies of participation. Our innovative reflexive methodology introduced (...) participatory methods to public engagement with upstream techno-science, with the public contributing to both the content and format of the project. Reflecting on the project, we draw attention to the largely overlooked issue of temporalities of participation, and the co-production of futures and publics in participation methodologies. We argue that many public participation methodologies are underpinned by the open futures model, which imagines the future as a space of unrestrained creativity. We contrast that model with the lived futures model typical of localized publics, which respects latency of materials and processes but imposes limits on creativity. We argue that to continue being societally relevant and scientifically important, public participation methods should reconcile the open future of research with the lived futures of localized publics. (shrink)

Medical-legal partnership (MLP) embeds attorneys and paralegals into care delivery to help clinicians address root causes of health inequities. Notwithstanding decades of favorable outcomes, MLP is not as well-known as might be expected. In this essay, the authors explore ways in which strategic alignment of legal services with healthcare services in terms of professionalism, information collection and sharing, and financing might help the MLP movement become a more widespread, sustainable model for holistic care delivery.

This study examines the independent and combined influences of internal and external antecedents to upstream environmental practices. Proactive environmental strategy is considered as an internal antecedent and competitive pressure as an external antecedent. Multiple hierarchical regression analysis is used to test the hypothesized relationships using data from a sample of 149 manufacturing companies located within the U.K. food industry. The results suggest that proactive strategy and competitive pressure exert both independent and combined influences on environmental supply chain practices. Proactive (...) strategy appears to be a stronger driver of these practices, suggesting that internal stakeholders such as directors, managers, and employees may be more influential in the adoption of certain practices than external stakeholder pressures. This article builds upon the recent wave of research highlighting the potential for internal and external factors to generate a combined influence on the adoption of environmental practices within companies and their supply chains. (shrink)

The time is ripe for innovation in global health governance if we are to achieve global health and development objectives in the face of formidable challenges. Integration of global health concerns into the law and governance of other, related disciplines should be given high priority. This article explores opportunities for health policymaking in the global response to climate change. Climate change and environmental degradation will affect weather disasters, food and water security, infectious disease patterns, and air pollution. Although scientific research (...) has pointed to the interdependence of the global environment and human health, policymakers have been slow to integrate their approaches to environmental and health concerns. A robust response to climate change will require improved integration on two fronts: health concerns must be given higher priority in the response to climate change and threats associated with climate change and environmental degradation must be more adequately addressed by global health law and governance. The mitigation/adaptation response paradigm developing within and beyond the United Nations Framework Convention on Climate Change provides a useful framework for thinking about global health law and governance with respect to climate change, environmental degradation, and possibly other upstream determinants of health as well. (shrink)

As a direct consequence of the sophisticated arrangement of its intrinsic neurons, the gastrointestinal tract is unique among peripheral organs, in its ability to mediate its own reflexes. Neurons of the enteric nervous system are intimately associated with enteric glial cells. These supporting cells do not resemble Schwann cells, the glial cell found in all other parts of the peripheral nervous system, but share many similarities with astrocytes of the central nervous system. Ablation of enteric glial cells in adult transgenic (...) mice has demonstrated that these cells are essential to maintain the integrity of the small intestine. Acute loss of enteric glial cells induces massive pathological changes with similarities to necrotizing enterocolitis (NEC) and early Crohn's disease. These human conditions share some mechanistic similarities. Identification of enteric glial cell dysfunction/loss as sufficient to induce necrotic/inflammatory bowel disease may be important to understand the pathogenesis of both NEC and Crohn's disease. BioEssays 24:130–140, 2002. © 2002 Wiley Periodicals, Inc. (shrink)

ABSTRACT In this article, we will first give a historic overview of the concept of benefit sharing and its appearance in official agreements, particularly with respect to crop genetic resources. It will become clear that, at present, benefit sharing is primarily considered as an instrument of compensation or exchange, and thus refers to commutative justice. However, we believe that such a narrow interpretation of benefit sharing disregards, and even undermines, much of its (historical) content and potency, especially where crop genetic (...) resources are concerned. We argue that benefit sharing should not be based merely on commutative justice but rather on a broader model that is also grounded in the concept of distributive justice. This has repercussions for the application of benefit sharing, which we try to clarify by distinguishing between downstream and upstream benefit sharing. Upstream benefit sharing is not so much inspired by compensation for actions done, or the distribution downstream of benefits developed, but by the idea of shared decision‐making on the research and development of resources fundamental to human welfare. Going upstream in the research process of crop genetic resources, and determining research agendas and improving crops according to the needs of the poor, benefit sharing may well be a tool to contribute to world food security and global justice. We concretize our ideas on upstream benefit sharing by introducing a set of criteria that determine the success of consultations on agricultural research agenda setting. (shrink)

The fine‐structure analyses of the nopaline synthase (nos) promoter which is active constitutively in a wide range of plant tissues reveal that a portion of the upstream essential region for maximal transcription is a potential Z‐DNA‐forming element. Z‐DNA sequences are found in almost all plant‐promoter regions, suggesting that these structural elements may play important roles in plant gene expression.

The author challenges the canonical opposition of utopia vs. realism in political thought. Although this opposition traces back to the very origins of Western political theory, in the works of such authors as Thucydides and Plato, the author maintains that both ‘utopian’ and ‘realist’ thinkers of every age keep the reality of their society in the background of their political constructions. The real difference is in their view of human nature: ‘utopian’ thinkers have a more optimistic view of human nature, (...) they see it flexible and prone to be changed by education and institutions; whereas ‘realist’ thinkers have a more pessimistic vision of man and have less faith in the power of laws and education. Based on their anthropological view, political authors have different expectations to mould human nature and different hopes to create a perfect society. This view is supported by an examination of Thucydides, Plato and Machiavelli and by reference to some other classic political thinkers in the Western tradition. (shrink)

Shane Carruth's 2013 film Upstream Colour provides a model for considering identity and subject formation in what Steven Shaviro calls the “network society.” Shaviro argues that our contemporary mo...

Contemporary food supply chains are generating externalities with high economic and social costs, notably in public health terms through the rise in diet-related non-communicable disease. The UK State is developing policy strategies to tackle these public health problems alongside intergovernmental responses. However, the governance of food supply chains is conducted by, and across, both private and public spheres and within a multilevel framework. The realities of contemporary food governance are that private interests are key drivers of food supply chains and (...) have institutionalized a great deal of standards-setting and quality, notably from their locations in the downstream and midstream sectors. The UK State is designing some downstream and some midstream interventions to ameliorate the public health impacts of current food consumption patterns in England. The UK State has not addressed upstream interventions towards public health diet at the primary food production and processing stages, although traditionally it has shaped agricultural policy. Within the realities of contemporary multilevel governance, the UK State must act within the contexts set by the international regimes of the Common Agricultural Policy and the World Trade Organization agreements, notably on agriculture. The potential for further upstream agricultural policy reform is considered as part of a wider policy approach to address the public health externalities issuing from contemporary food supply chains within this multilevel governance context. (shrink)

Fabi and Goldberg have helpfully shed some light on the wrongs perpetuated by the current funding architecture on research, sponsorship, and career development in the field of bioethics. The...

In line with the current trend toward sustainability and CSR, organizations are pressured to assume extended responsibility. However, taking such a responsibility requires serious and challenging efforts as it appears to involve a wider range of issues and increased need for close interaction between actors along commodity chains. Using a qualitative case study approach, the present article focuses on Swedish public and private procurement organizations with attention paid to textiles and chemical risks. It focuses on two crucial aspects of buyers’ (...) relationships with suppliers in their efforts to advance environmental responsibility-taking—monitoring and trust—as well as how they intersect. The aim is to demonstrate, both theoretically and empirically, the limits and possibilities of monitoring and trust for developing extended upstream responsibility. The article demonstrates the problems with, on one hand, simple ritualistic monitoring and, on the other, simple trust, and explores potentially constructive pathways to extended upstream responsibility at the intersection of monitoring and trust. In connection with the findings, the article argues that theories on responsible and sustainable supply chain management must also take the enormous variety of organizations into account: not only large, private, transnational companies, which the literature has until now been preoccupied with. (shrink)

This article introduces a special issue on the legal determinants of health, following the publication of the Lancet–O’Neill Institute of Georgetown University Commission’s report on the subject. We contextualize legal determinants as a significant and vital aspect of the social determinants of health, explain the work of the Lancet–O’Neill Commission and outline where consequent research will usefully be directed. We also introduce the papers that follow in the special issue, which together set out in greater detail the work of the (...) Commission and critically engage with different aspects of the report and the application of its findings and recommendations. (shrink)

With both the cost and quality of health care under scrutiny, many in the health care industry have turned to outcomes research and practice guidelines for answers. But many physicians have resisted, claiming their clinical judgment is a better guide. Both camps may be right.

The primary claim of this paper is that COVID-19 stigma must be understood as a structural phenomenon. Doing so will inform the interventions we select and prioritize for the amelioration of such stigma. Thinking about stigma as a macrosocial determinant of health driven by structural factors suggests that downstream remedies are unlikely to be effective in significantly reducing stigma. This paper develops and defends this claim, setting up a recommendation to use a “bundle” of legal and policy levers at meso- (...) and macro- levels to reduce the adverse and inequitable impact of COVID-19 stigma.Historians of public health have long pointed out that outbreaks of communicable disease track social fault lines (Rosenberg... (shrink)

Suppose someone (P1) does something that is wrongful only in virtue of the risk that it will enable another person (P2) to commit a wrongdoing. Suppose further that P1’s conduct does indeed turn out to enable P2’s wrongdoing. The resulting wrong is agentially mediated: P1 is an enabling agent and P2 is an intervening agent. Whereas the literature on intervening agency focuses on whether P2’s status as an intervening agent makes P1’s conduct less bad, I turn this issue on its (...) head by investigating whether P1’s status as an enabling agent makes P2’s conduct more bad. I argue that it does: P2 wrongs not just the victims of ϕ but P1 as well, by acting in a way that wrongfully makes P1 accountable for ϕ. This has serious implications for compensatory and defensive liability in cases of agentially mediated wrongs. (shrink)

The principle of openness is central to human science approaches to research where the researcher becomes closely involved with the phenomenon under study. This article addresses both the practical and theoretical challenges that confront the researcher who seeks to be open. It also clarifies the meaning of the concept of openness and considers its relationship to the ideal of objectivity. Openness, it is argued, is neither an enduring state nor a trait but requires an ongoing struggle and has different forms (...) at various stages in the research process. Integral to this process is the experience of "being in the dark" which makes it especially difficult for the researcher to remain open. Various ways of managing this experience are presented. (shrink)