NEWSLETTER

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Sustainable development is one of the most misunderstood and over-used concepts in environmental decision-making today. More often than not it leaves those tasked with implementing policy confused as to what course of action has actually been decided upon.

In my opinion the heart of the problem lies with the three pillars model of sustainable development. It draws a picture of three separate spheres: economic, social and environmental - each with its own set of values and working according to its own internal logic. The economic sphere is seen as aiming towards the creation of material wealth and ensuring growth; the social sphere as aiming towards improving the quality of life of people and ensuring equity between people, communities and nations. While the environmental sphere has to do with protection and conservation of our natural environment

This model of sustainable development strengthens the perception that aspects of economic activity fall outside of the social sphere and also outside of the environmental sphere, and that there is only some overlap in certain areas. But there is not a single aspect of social life that does not lie wholly in the environmental sphere, that does not have environmental roots and consequences. In the same manner, all economic activity essentially comprises social processes

Nothing is said in this model about the manner in which the three pillars interact with or affect one another, or how they are dependent on one another. In policy and decision-making, the interaction between the different spheres is usually reduced to making trade-offs within and between the different spheres – where costs in one sphere, for example the social or the environmental, are offset by benefits in the economic sphere.

A far more realistic model of sustainable development is one where the three separate pillars or spheres are embedded within one another. The widest circle being environmental, the second circle being social and the central one being the economic. From this point of view each wider circle serves as a holding space for the sphere embedded within it, making it not only possible but also sustaining it in the literal sense of the word.

This image further implies that activities in one sphere may have a negative impact, even to the point of disruption or destruction, on the larger sphere. The most important implication of the image of three embedded spheres, however, is that economic, socio-political and environmental considerations do not each have their own logic and values separate from the other spheres. Rather they are intertwined from the outset – to such an extent that a fundamental rethink is required of everything that we up until now have conceptualised as economic activity, socio-political engagement and the environment.

 PROF JOHAN HATTINGH

Another classic representation of sustainable development: The three pillars model

An alternative portrayal of sustainable development in terms of three embedded spheres

Debate has emerged in South African health research circles about what individuals participating in research studies should be paid and who should decide what that amount is. This is contentious because the payment should reflect a balance between  a rate of payment that is high enough not to exploit subjects and low enough that it does not create an irresistible inducement that encourages people to take risks that may be too high.

Views on participant remuneration range from thoughts that research should be a socially responsible activity with no payment at all to the view that a wage payment model should be used in which research subjects are paid an hourly wage based on that of unskilled workers. Most ethics committees in South Africa allow an amount of R50 per visit to be paid for travel and food expenses incurred by the participant for the study visit, and some committees prefer that this amount not be reflected in the patient information leaflet.

However, recommendations by the Medicines Control Council (MCC) require that participants should receive R150 a visit for expenses incurred in participation in research. The MCC states that the patient should be issued with an information leaflet with this amount reflected before deciding whether to participate in the research study.

Just how the money influences the patients decision to take part depends a lot on the community being researched. A study in the Bishop Lavis and Elsies River communities in the Western Cape who had participated in two pharmaceutical industry-sponsored trials of an intranasal flu vaccine said they used the money received primarily to purchase food for their families, to transport themselves or a family member to a clinic or hospital, or to meet cost-of-living expenses generally.

In this setting mentioned above, the standard of R50 per visit for three study visits spread over 12 months was deemed acceptable – yet it is likely that other communities with different economic backgrounds may have substantially different views. The blanket compensation policy that is being requested by the MCC ignores the complexities of each research project’s specific socio-economic context.

In general, health research ethics guidelines regard the issues of participant remuneration as residing fairly in the domain of the research ethics committee involved. We believe it should remain there to ensure that a decision that best protects the interests of the participants involved is taken.

Summary of article written by Keymanthri Moodley and Landon Myer and published in the South African Medical Journal on 23 September 2003