U.S. and Non-U.S. Scholars

Fulbright New Century Scholars Program
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Spira, Alfred

Chairperson, Department of Epidemiology and Public Health
Hopital de Bicetre
Public Health Consequences of Environmental Disturbances in a Changing World
France

Alfred Spira (France) is Professor of Public Health and Epidemiology at the School of Medicine of Paris XI University. He is also Head of the Department of Public Health and Epidemiology at the Hospital of Bicetre, which is associated with Paris XI University. Untill last May, he was (since 1986) Head of a research unit in Public Health at Institut National de la Sante et de la Recherche Medicale (INSERM, the French Medical Research Coucil). His topics of interest are epidemiology and public health research and teaching, environment and health, diseases prevention and health promotion, human reproduction research, especially contraception, sexually transmitted diseases and infertility, Aids prevention and research on sexual behaviors, links between epidemiology and social sciences.

Dr. Spira received his M.D. from the Paris School of Medicine and his Ph.D. in Epidemiology from Paris II University. For the last five years, he has been working mainly on the reproductive effects of exposure to ionizing radiation and to pesticides, through various epidemiological studies He is particularly interested in the international development of public health teaching

and research. He has taught and undertaken epidemiological research in various countries, presently Lebanon, West bank in Israel (Palestine) and Denmark. He also taught in Sarajevo during the war in 1994, and has collaborated with WHO (mainly in Africa) for 15 years.

Dr. Spira is presently President of the Scientific Steering Committee of the Institut de Veille Sanitaire, a national institute of epidemiologic surveillance. He is very much involved in health promotion and health surveillance, nationally and internationally. Although a medical doctor and epidemiologist by training, he is very much interested in the social and behavioural sciences and has been in charge of coordinating the French national surveys undertaken to contribute to HIV infection prevention in the late 80's.

Selected Publications:

· Guizard, A.V., Boutou, O., Portier, D., Troussard X., Pheby D., Launoy, G., Slama, R. annd Spira, A. (2001) The incidence of childhood leukemia around the La Hague nuclear waste reprocessing plant (France): a survey for the years 1978-1998. J Epidemiol Community Health. Jul 55(7): 469-74

· Jensen, T.K., Keiding, N., Scheike, T., Slama R., Spira, A. (2000) Declining human fertility? Fertil Steril 73:421-23.
· Spira, A. and Multigner, N. (1998) The effect of industrial and agricultural pollution on human spermatogenesis. Human Reprod. Aug 13(8) 2041-42.
· Spira, A., Bajos N., Giami A., Michaels S. (1998) Cross-nationalcomparisons of sexual behavior surveys - methodological difficulties and lessons for prevention. Am J Public Health 88:730).

Agriculture and the energy industry are based on the use of resources to produce high-quality food in sufficient quantities and to facilitate industrial development and social activities. Both induce environmental disturbances, which may in turn affect human health, especially human reproduction, hampering the potential of future generations. Nations and governments are becoming increasingly concerned by the need to find a balance between the benefits to humankind of these activities and their potential hazards (including health risks), whether direct or resulting from environmental dissemination. It is also important to generate knowledge to improve our understanding of the social context within which societies, nations and the world community develop responses to potentially environment-related diseases in a period of increasing global interdependence and rapid socioeconomic change.

In the face of international agreements between governments from around the world, populations must have the necessary means to make informed choices. Scientists, environmental and health authorities should produce reliable and pertinent indicators concerning environmental exposures and their consequences, as well as their social tolerance and acceptability. Such indicators, regularly updated and published, could help to improve global health governance in this area. They could serve as a basis for discussion to help decision-makers adopt pertinent political, economic and industrial choices concerning development. This would make it possible to integrate worldwide standardized information into the premises of international agreements. Moreover, international technological, scientific and social surveillance/monitoring should help to prevent the potential negative effects of human activities on health by facilitating the early detection of threats to public health and the issuing of health alerts.

We propose to conduct an international study comparing 10 various different countries according to agriculture and the energy industry as well as the way in which they shape their response to potential health hazards. This will enable us to develop proposals for the collection of standardized information and the implementation of an international surveillance program including environmental (amount of chemicals produced/used, exposure to ionizing radiation), reproductive health (birth weight, sex ratio at birth, preterm birth, congenital malformations and the incidence of childhood cancers) and sociological (risk perception and representation, decision-making process) indicators. The results of this study will be discussed by international experts, using electronic communication networks, and will then be further developed in collaboration with the World Health Organization (WHO). Tools for worldwide epidemiological and sociological surveillance could then be developed to provide useful scientific information for populations and decision-makers, facilitating changes to take into account collective social behavior and to strengthen global governance and public health.

This program should allow to promote cooperation between nations concerning the information and surveillance tools on environment and (reproductive) health. It should also help in implementing cross-national policies, under the auspices of UN organizations. Finally, it should help to promote social interest and knowledge in this sensitive area. Public opinion is often confronted with highly sophisticated debates which take place between specialists, whereas common knowledge is very scarce and confused (given that the topic is a difficult one in itself and that information is rare). It seems important to allow society to have access to independent and reliable information. Such criteria impose that this information is produced under the authority of authorized sources, which can be only multinational, submitted to quality control procedures. Such a process should help decision makers to allow "science" to be part of their arguments. For instance, politicians often begin their talks on environment and health by saying that "it is well known that air pollution (or any other environmental modification) is a major public health concern". This "well known" knowledge needs to be demonstrated, especially because the balance between advantages and disadvantages of energy production means or agriculture chemicals need to be precisely weighted, which is a rather complicated task. It is hoped that decision in this area will take into account three dimensions, namely environmental exposures, epidemiological surveillance and social risk tolerance.

The implementation of this research within Fulbright NCS program will benefit from international scientific interest and recognition, financial support, confrontation (and collaboration) with other members of the program. Since such a research program is multidisciplinary and international, it is hoped that it will greatly benefit from the contribution of colleagues from various countries and from different disciplines. These contacts should also help to identify the adequate persons and administrations to be contacted in the 10 studied countries. Furthermore, it is hoped that Fulbright foundation will support the consequences of this research, i.e. the implementation of a worldwide surveillance protocol.