Ethical and social difficulties of addressing environmental harms related to health research.

Health research is vital to advance human well-being, but it is also a contributor to climate change and other environmental degradation. A growing bottom-up advocacy movement is engaged in developing measures (often called tools) to help researchers better understand the ways in which they can mitigate the environmental harms associated with research. While some evidence suggests benefits of using these tools, ethical and social challenges remain. These challenges include questions about: whether these tools will place undue burdens on researchers; whether the tools will be effective in supporting large-scale mitigation of environmental harm; whether using these tools to comply with mandatory requirements will divert attention away from wider discussions about what it means to conduct research in an environmentally sustainable way; and whether these tools, which have been developed in high-income countries, reinforce existing power imbalances between high- and low-income settings and/or fail to address the needs of more marginalized research communities. In this paper, we identify and describe these ethical and social issues surrounding the use of these tools. Our aim is not to discourage their use but to urge policy-makers to reflect on these challenges as they become clearer so that tools are implemented in a way that is both effective and just.