Are Farm Raised Fish Given Antibiotics? Health Risks and Seafood Safety Explained

Yes, farmed fish, especially salmon, are sometimes given antibiotics to prevent diseases. This raises health concerns about antibiotic residues in our food. However, many salmon farms, particularly in Norway, now raise fish without antibiotics, which lowers public health risks and enhances consumer awareness regarding safe seafood choices.

Due to these concerns, regulatory agencies closely monitor the use of antibiotics in aquaculture. In many countries, strict guidelines govern the administration of these drugs, limiting residues in seafood. Testing ensures seafood remains safe for consumption. However, consumers are encouraged to choose sustainably farmed fish and ask questions regarding their sources.

Understanding the implications of farm-raised fish and antibiotic use is essential for making informed choices. As seafood lovers continue to seek safe and healthy options, scrutiny of aquaculture practices intensifies. In the next section, we will delve deeper into specific regulations regarding antibiotic use in farm-raised fish, examine health implications further, and explore how these factors influence seafood safety for consumers.

What Are Farm Raised Fish and How Are They Produced?

Farm-raised fish are fish that are bred and raised in controlled environments, such as fish farms or aquaculture systems. These fish are produced to meet the increasing demand for seafood and are raised under specific conditions that include feeding, breeding, and habitat control.

  1. Types of Farm-Raised Fish:
    – Salmon
    – Tilapia
    – Catfish
    – Trout
    – Cod

  2. Production Methods:
    – Freshwater Aquaculture
    – Marine Aquaculture
    – Recirculating Aquaculture Systems (RAS)
    – Pen Culture
    – Cage Culture

  3. Environmental Concerns:
    – Habitat destruction
    – Water pollution
    – Overuse of antibiotics

  4. Nutritional Aspects:
    – Omega-3 fatty acids content
    – Protein levels
    – Feed composition

Farm-raised fish vary widely in type and production method, highlighting diverse approaches and perspectives within the aquaculture industry.

  1. Types of Farm-Raised Fish:
    Types of farm-raised fish include popular species such as salmon, tilapia, catfish, trout, and cod. Salmon is one of the most commonly farmed fish worldwide. Tilapia is favored for its fast growth and adaptability to different environments. Catfish is a staple in Southern U.S. cuisine, while trout is popular for recreational fishing and consumption. Cod farming has increased to meet the demand for this flaky white fish.

  2. Production Methods:
    Production methods for farm-raised fish include freshwater aquaculture, marine aquaculture, recirculating aquaculture systems (RAS), pen culture, and cage culture. Freshwater aquaculture occurs in ponds, lakes, and rivers, while marine aquaculture takes place in ocean environments. Recirculating aquaculture systems (RAS) use technology to recycle water, minimizing environmental impact. Pen and cage culture involves raising fish in netted enclosures within water bodies.

  3. Environmental Concerns:
    Environmental concerns related to farm-raised fish include habitat destruction, water pollution, and overuse of antibiotics. Fish farms can lead to the destruction of coastal ecosystems and natural habitats. Waste products and uneaten feed can pollute surrounding water bodies. Additionally, the overuse of antibiotics raises concerns about antibiotic resistance, impacting both fish and human health.

  4. Nutritional Aspects:
    Nutritional aspects of farm-raised fish highlight their Omega-3 fatty acids content, protein levels, and feed composition. Farmed fish often have a higher Omega-3 content compared to wild fish due to controlled diets. They are a rich source of protein, providing essential amino acids. The composition of feed used in fish farming influences nutritional value, with some farms using plant-based ingredients while others rely on fishmeal.

Farm-raised fish represent a significant part of global seafood production, offering various species and production methods. The potential benefits should be weighed against environmental concerns and nutritional factors.

Why Are Antibiotics Used in Farm Raised Fish?

Antibiotics are used in farm-raised fish to prevent and treat bacterial diseases that can impact fish health and production. They help ensure the health of the fish and improve overall yields in aquaculture.

According to the World Organisation for Animal Health (OIE), antibiotics are defined as chemical substances that inhibit the growth of bacteria. These substances are commonly used in veterinary medicine to manage infections within livestock and aquaculture.

The underlying reasons for using antibiotics in aquaculture include the high stocking densities of fish in farms and the increased risk of disease transmission in these environments. When fish are raised in crowded conditions, the spread of pathogens, which are harmful microorganisms that can cause illness, is more likely. Therefore, antibiotics serve as a preventive measure to maintain fish health.

In this context, “pathogens” refers to the bacteria or viruses that can lead to infections in fish. For example, Vibrio species are common bacterial pathogens in aquaculture that can cause severe diseases in fish. Using antibiotics can help manage these infections and reduce mortality rates in farm-raised fish.

The mechanisms involved in antibiotic use typically encompass the administration of the drugs through feed or water. This process allows for the targeted treatment of fish populations and aims to quickly reduce bacterial loads in fish. Effective antibiotic therapy can enhance fish welfare and productivity by decreasing disease outbreak occurrences.

Specific conditions, such as poor water quality and high stocking densities, contribute to the need for antibiotics. For instance, if the water is not adequately aerated or contains high levels of ammonia, fish become stressed and more susceptible to infections. This scenario increases the likelihood that antibiotics will need to be employed to control diseases effectively.

What Health Issues Do Antibiotics Address in Fish Farming?

Antibiotics address several health issues in fish farming, primarily related to infections and diseases.

  1. Bacterial infections
  2. Viral infections
  3. Parasitic infestations
  4. Specific diseases (e.g., columnaris, vibriosis, furunculosis)
  5. Stress-induced illnesses

While antibiotics play a crucial role in managing fish health, there are differing opinions about their use. Some argue that antibiotic use in aquaculture can lead to antimicrobial resistance, affecting both fish and human health. Others emphasize the necessity of antibiotics for maintaining fish health and productivity.

Antibiotics address health issues in fish farming by targeting specific infections and diseases that can affect fish populations.

  1. Bacterial Infections: Bacterial infections are a common issue in fish farming. These infections can occur due to poor water quality or overcrowding. Antibiotics, such as oxytetracycline, effectively control diseases caused by bacteria like Aeromonas and Edwardsiella. A study by McDonald et al. (2019) demonstrated that using antibiotics reduced mortality rates by up to 50% in infected fish populations.

  2. Viral Infections: Viral infections present a significant challenge in aquaculture. These infections often lead to high mortality rates and can spread rapidly among fish. Antibiotics do not treat viruses; however, they can prevent secondary bacterial infections that occur alongside viral infections. The importance of a comprehensive health management plan is emphasized in research by Pold et al. (2020), which discusses the management of viral diseases in aquaculture.

  3. Parasitic Infestations: Parasitic infestations, caused by organisms like worms and protozoa, are damaging to fish stocks. Antibiotics can help mitigate the effects of bacterial infections that occur alongside these infestations. However, the World Health Organization (WHO) cautions against over-reliance on antibiotics for these issues, recommending integrated management practices, including improved water quality and husbandry.

  4. Specific Diseases: Some diseases require specific antibiotics for treatment. Columnaris, caused by the bacterium Flavobacterium columnare, requires targeted antibiotics for effective control. Vibriosis, another concern, is treated with antibiotics like florfenicol. Case studies indicate that the timely use of antibiotics can save substantial stock losses. The Aquaculture Foundation reports that untreated outbreaks of these diseases can lead to losses of over 30% in fish farms.

  5. Stress-Induced Illnesses: Fish experience stress from various factors, including environment and handling. Stress can lead to disease susceptibility, requiring antibiotics to manage resulting infections. The use of antibiotics in times of stress is a debated topic. Some experts argue that improving fish welfare is a more sustainable solution than relying solely on antibiotics.

Overall, the use of antibiotics in fish farming is essential for disease management, but it must be balanced with practices that minimize resistance and promote fish health.

What Types of Antibiotics Are Commonly Used in Aquaculture?

Commonly used antibiotics in aquaculture include a range of medications that target bacterial infections in fish and shellfish.

  1. Oxytetracycline
  2. Florfenicol
  3. Sulfonamides
  4. Amoxicillin
  5. Sensitivity to alternative treatments

The use of antibiotics in aquaculture raises various perspectives. While they are essential for disease control, their overuse can lead to antibiotic resistance.

  1. Oxytetracycline:
    Oxytetracycline is a broad-spectrum antibiotic that targets various bacterial infections in aquatic animals. This antibiotic is often used for treating diseases such as columnaris and furunculosis. Studies show that it helps in reducing mortality rates in fish affected by such infections.

According to the FDA, oxytetracycline is effective against both gram-negative and gram-positive bacteria, making it a versatile choice in aquaculture. For example, a case study from the University of Washington in 2020 indicated that aquaculture facilities saw a 40% decrease in fish mortality rates after introducing oxytetracycline to their treatment protocols.

  1. Florfenicol:
    Florfenicol is an antibiotic approved for use in fish to treat bacterial infections. It is particularly effective against Renibacterium salmoninarum, a pathogen responsible for bacterial kidney disease in salmonids.

Research by the University of Florida in 2019 highlighted that florfenicol reduced bacterial counts significantly, leading to better health outcomes in affected fish populations. The convenience of administering florfenicol through feed or via injection makes it a popular choice among aquaculture farmers.

  1. Sulfonamides:
    Sulfonamides are a group of synthetic antibiotics often used in aquaculture. They work by inhibiting bacterial growth and are effective against various pathogens, particularly in shrimp and fish.

A study conducted by the Journal of Aquatic Animal Health in 2021 revealed that sulfonamides effectively treated vibrio-induced infections in shrimp. Though they are beneficial, the study also discussed the potential risks of developing resistant bacterial strains if used excessively.

  1. Amoxicillin:
    Amoxicillin is a penicillin-type antibiotic used to treat bacterial infections in aquaculture. It is effective against a range of pathogens, including Aeromonas species.

Research from the Oceanic Institute demonstrated that amoxicillin administration led to reduced incidences of disease in farmed tilapia, supporting its use as a treatment option. However, there is ongoing concern over the development of resistance, highlighting the need for cautious application.

  1. Sensitivity to alternative treatments:
    There is a growing sensitivity towards using alternative treatments instead of conventional antibiotics in aquaculture. Probiotics, prebiotics, and phytogenics are being explored as potential substitutes.

The International Council for the Exploration of the Sea reported in 2022 that such alternatives not only reduce reliance on antibiotics but also improve the overall health of aquatic organisms. This shift reflects a larger movement towards sustainable practices in aquaculture, prioritizing animal welfare and environmental concerns.

What Are the Health Risks of Consuming Antibiotic-treated Farm Raised Fish?

Consumption of antibiotic-treated farm-raised fish poses health risks, primarily related to antibiotic resistance, harmful chemical exposure, and potential allergic reactions.

  1. Antibiotic Resistance
  2. Chemical Exposure
  3. Allergic Reactions
  4. Nutritional Profile Changes
  5. Environmental Impact

Antibiotic Resistance:
Antibiotic resistance arises from the use of antibiotics in aquaculture. These drugs can create resistant bacteria that survive treatment and can spread to humans. A study by the World Health Organization (WHO) revealed that antibiotic-resistant infections cause over 700,000 deaths globally each year (WHO, 2019). A report by the European Food Safety Authority indicated that residues from treated fish can contribute to antibiotic resistance in humans.

Chemical Exposure:
Chemical exposure refers to the ingestion of harmful substances used in fish farming. Various chemicals, such as pesticides and growth hormones, may be present in treated fish. The Environmental Protection Agency (EPA) monitors many of these chemicals, yet some are still found in farm-raised fish. According to the Natural Resources Defense Council (NRDC), some studies have shown elevated levels of harmful substances in farmed fish, posing health risks for consumers.

Allergic Reactions:
Allergic reactions can occur from consuming fish that have undergone antibiotic treatment. Some people may develop sensitivities to residual antibiotics. The American College of Allergy, Asthma, and Immunology states that seafood allergies can lead to severe reactions, including anaphylaxis. This risk highlights the need for labeling and safety regulations in fish farming.

Nutritional Profile Changes:
Nutritional profile changes can happen due to the farming conditions and the use of antibiotics. Farmed fish may contain lower levels of omega-3 fatty acids compared to wild-caught fish. A study published in the journal “Food Chemistry” indicated that the nutritional content of farmed fish can vary significantly based on their diet and farming practices adoptions (Zhou et al., 2020). This variability may affect the overall health benefits of consuming fish.

Environmental Impact:
Environmental impact is a concern due to the practices used in antibiotic-treated farms. Antibiotics can leak into waterways, affecting local ecosystems. The FAO reported that antibiotic use in aquaculture can create imbalance in aquatic ecosystems and disrupt natural food chains. This environmental issue not only affects fish populations but can also have broader effects on aquatic life and human health through contaminated water sources.

In conclusion, while the consumption of farm-raised fish offers benefits, awareness of health risks associated with antibiotic treatments is crucial for informed choices regarding seafood safety.

How Do Antibiotics Affect Human Health?

Antibiotics affect human health by treating bacterial infections, but their misuse can lead to antibiotic resistance and disrupt the microbiome. This dual impact highlights the importance of proper usage.

  1. Treatment of bacterial infections: Antibiotics effectively kill or inhibit the growth of bacteria. According to the World Health Organization (WHO), antibiotics prevent complications from infections like pneumonia and sepsis. They help reduce morbidity and improve survival rates for patients with serious bacterial diseases.

  2. Antibiotic resistance: Overuse and misuse of antibiotics contribute to the development of antibiotic-resistant bacteria. A study by Ventola (2015) in the P&T journal highlighted that over 2 million people in the U.S. are infected each year with resistant bacteria, leading to approximately 23,000 deaths. This resistance limits treatment options for common infections.

  3. Disruption of the microbiome: Antibiotics can adversely affect the diverse community of microorganisms in the gut. Research by Lange et al. (2015) in the journal Nature reveals that antibiotic treatment can reduce microbial diversity. This disruption may lead to gastrointestinal issues such as diarrhea, and increase the risk of infections like Clostridium difficile.

  4. Long-term health effects: The impact of antibiotics may extend beyond immediate effects. Long-term use can influence metabolic health. A study by Barlow et al. (2020) in Cell Host & Microbe found that antibiotics can alter weight gain and insulin resistance in mice, suggesting potential implications for humans.

  5. Informed decision-making: Due to these factors, careful prescription and adherence to guidelines are crucial for minimizing risks associated with antibiotics. Collaboration between healthcare providers and patients can enhance treatment effectiveness while preventing resistance.

Overall, antibiotics play a pivotal role in managing infections but must be used judiciously to safeguard human health.

How Can Antibiotic Resistance Develop from Consuming Farm Raised Fish?

Antibiotic resistance can develop from consuming farm-raised fish due to antibiotic use in aquaculture, the potential spread of resistant bacteria, and the transfer of these bacteria through the food chain.

Antibiotic use in aquaculture: Many fish farms use antibiotics to prevent or treat infections in crowded conditions. This practice promotes the survival of bacteria that can develop resistance to these drugs. A study by Kümmerer (2009) highlights that antibiotic residues can remain in the fish and their waste, contributing to environmental contamination.

Spread of resistant bacteria: When farm-raised fish are consumed, resistant bacteria may enter the human body. Research from the World Health Organization (WHO, 2016) indicates that these bacteria can cause infections that essential antibiotics cannot treat, making illnesses harder to manage.

Transfer of resistant bacteria through the food chain: Resistant bacteria can multiply and spread in ecosystems. When fish are eaten, the bacteria can transfer from fish to humans. A study by van der Meer et al. (2015) demonstrated that resistance genes can be passed along various species through environmental interactions, exacerbating the issue of antibiotic resistance.

In summary, the use of antibiotics in fish farming, the survival and spread of resistant bacteria, and their subsequent transfer to humans through consumption are key factors in the development of antibiotic resistance from farm-raised fish.

How Is Seafood Safety Monitored for Antibiotic Residues in Farm Raised Fish?

Seafood safety is monitored for antibiotic residues in farm-raised fish through several systematic processes. First, regulatory agencies, such as the U.S. Food and Drug Administration (FDA), establish guidelines for antibiotic use in aquaculture. These guidelines define approved antibiotics, their dosage, and withdrawal times, which are periods during which fish must not be harvested after antibiotic treatment.

Second, fish farms implement strict protocols. Farmers must record antibiotic administration and follow the guidelines for withdrawal times to ensure residues diminish before fish enter the market. Third, testing plays a crucial role. Regulatory agencies and independent laboratories regularly sample and test fish for antibiotic residues. They use methods like liquid chromatography-mass spectrometry to detect even trace amounts of antibiotics.

Fourth, if residue levels exceed safe limits, corrective actions are taken. This may include quarantining affected fish, conducting further investigations, or imposing fines on farms that fail to comply with regulations. Lastly, consumer safety is reinforced through labeling and traceability. This process allows consumers to know the sources of their seafood and ensures that they consume safe products.

By systematically enforcing guidelines, monitoring practices, testing products, and taking corrective actions, seafood safety is effectively maintained concerning antibiotic residues in farm-raised fish.

What Regulations Exist for Antibiotic Use in Fish Farming?

Regulations for antibiotic use in fish farming primarily involve guidelines set by government agencies to ensure safety, efficacy, and environmental protection. These regulations vary by country and aim to manage the risks associated with antibiotic resistance and protect public health.

  1. Regulatory Bodies:
    – Environmental Protection Agency (EPA)
    – Food and Drug Administration (FDA)
    – European Medicines Agency (EMA)
    – National authorities (e.g., USEPA, USDA in the U.S.)

  2. Permitted Antibiotics:
    – Oxytetracycline
    – Florfenicol
    – Trimethoprim-sulfamethoxazole

  3. Withdrawal Periods:
    – Mandatory time before fish can be harvested after antibiotic treatment.

  4. Record-Keeping Requirements:
    – Documentation of antibiotic use by fish farmers.

  5. Compliance and Enforcement:
    – Inspections and penalties for non-compliance.

  6. Alternative Practices:
    – Use of probiotics and vaccinations as preventative measures.

  7. Global Perspectives:
    – Varying standards and regulations in different countries leading to discrepancies in antibiotic use.

These aspects highlight the complexity of antibiotic regulations in fish farming. Understanding these regulations helps ensure appropriate medication use while addressing the growing concern over antibiotic resistance.

  1. Regulatory Bodies:
    Regulatory bodies overseeing antibiotic use in fish farming include the Environmental Protection Agency (EPA), Food and Drug Administration (FDA), European Medicines Agency (EMA), and national authorities. The agencies set standards to ensure products are safe for consumers and the environment. These authorities define the scope of acceptable practices and enforce compliance to minimize risks associated with antibiotic misuse.

  2. Permitted Antibiotics:
    Permitted antibiotics for use in fish farming include oxytetracycline, florfenicol, and trimethoprim-sulfamethoxazole. These substances are approved based on specific criteria, evaluating their safety and efficacy in treating infections in aquaculture. For example, oxytetracycline is commonly used due to its effectiveness in controlling bacterial diseases in fish.

  3. Withdrawal Periods:
    Withdrawal periods refer to mandatory durations during which treated fish should not be harvested. The purpose of these periods is to ensure that antibiotic residues do not enter the food supply. For instance, if oxytetracycline is used, the FDA mandates a withdrawal period of several days before the fish can be consumed. This practice safeguards consumer health by ensuring antibiotic levels are reduced to safe limits before reaching the market.

  4. Record-Keeping Requirements:
    Regulations require fish farmers to maintain detailed records of antibiotic use. This includes documentation of the type of antibiotics administered, dosages, treatment duration, and fish stock information. Keeping accurate records helps regulatory agencies monitor compliance and trace any potential health issues back to their sources. This is critical in maintaining transparency and accountability in fish farming practices.

  5. Compliance and Enforcement:
    Compliance with antibiotic regulations is enforced through regular inspections and penalties for violations. Regulatory bodies conduct audits to ensure that fish farms adhere to established guidelines. Non-compliance can result in fines, revocation of licenses, or other legal actions, emphasizing the importance of adhering to prescribed regulations in ensuring safe aquaculture practices.

  6. Alternative Practices:
    Fish farmers increasingly explore alternative practices to antibiotics, such as using probiotics and vaccinations. Probiotics promote beneficial bacteria in aquaculture systems, enhancing fish health and reducing disease susceptibility. Vaccination programs can prevent outbreaks of specific diseases, reducing the need for antibiotic intervention.

  7. Global Perspectives:
    Global perspectives on antibiotic regulations in fish farming vary, leading to discrepancies in practices. Some countries impose strict regulations to limit antibiotic use, while others may have more lenient policies. This inconsistency can result in different standards of fish health and consumer safety. For example, the European Union has implemented stringent regulations banning certain antibiotics, whereas regulations may be less strict in regions without comprehensive oversight.

What Are Alternatives to Antibiotics in Aquaculture Practices?

Alternatives to antibiotics in aquaculture practices include several methods that help manage fish health and prevent disease.

  1. Vaccination
  2. Probiotics
  3. Natural compounds
  4. Prebiotics
  5. Improved husbandry practices
  6. Biosecurity measures

These alternatives showcase innovative approaches to sustainable aquaculture, emphasizing prevention rather than treatment, and encompass a range of practices that can differ in effectiveness and implementation depending on various factors.

  1. Vaccination: Vaccination in aquaculture involves administering vaccines to fish to protect them from specific diseases. This method significantly reduces the incidence of infections, thus minimizing the need for antibiotics. For example, in a study conducted by Karlsen et al. (2020), vaccinated salmon showed a 70% reduction in disease rates compared to unvaccinated groups. Regular vaccination protocols can lead to healthier fish populations and improved growth rates.

  2. Probiotics: Probiotics are beneficial microorganisms added to the aquaculture environment to enhance the health and immunity of fish. These probiotics can outcompete harmful bacteria, thus limiting disease outbreaks. Research by Ringø et al. (2016) found that fish fed with specific probiotic strains exhibit improved gut health and reduced pathogen colonization. Probiotics often lead to enhanced feed efficiency and growth performance.

  3. Natural Compounds: Natural compounds such as herbal extracts, essential oils, and nutraceuticals can support fish health. These substances may possess antimicrobial properties, thus reducing the need for antibiotics. For instance, a study by Abdel-Tawwab et al. (2017) demonstrated that the use of garlic extract improved the overall health and survival rates of tilapia infected with pathogenic bacteria, serving as an effective alternative.

  4. Prebiotics: Prebiotics are non-digestible food ingredients that promote the growth of beneficial gut bacteria. They enhance fish immunity and overall health. Research indicates that fish receiving dietary prebiotics show improved resistance to diseases and better nutrient absorption, as indicated in a study by Gómez-Gíguez et al. (2018). Incorporating prebiotics into fish diets represents a proactive approach to nutrition and disease prevention.

  5. Improved Husbandry Practices: Improved husbandry practices encompass better management of feeding regimes, water quality, and stocking densities. Properly managing these factors can significantly reduce stress on fish populations, making them less prone to disease. For instance, establishing optimal water quality parameters has been shown to improve fish health, as documented in various aquaculture management guidelines.

  6. Biosecurity Measures: Biosecurity measures are practices designed to prevent the introduction and spread of diseases in aquaculture systems. These measures include installing proper barriers, controlling access to facilities, and routine health monitoring. Effective biosecurity can dramatically lower infection rates, as evidenced by various aquaculture facilities that reported reduced disease incidents after implementing strict biosecurity protocols.

By employing these alternatives, aquaculture practices can reduce reliance on antibiotics, thereby promoting healthier fish populations and more sustainable production systems.

How Can Consumers Make Informed Choices About Safe Seafood?

Consumers can make informed choices about safe seafood by understanding sourcing practices, checking for certifications, staying informed about contaminants, and choosing sustainable options.

Sourcing practices: Know where your seafood comes from. Seafood can be wild-caught or farm-raised. Wild-caught fish often have a lower risk of antibiotics and hormones, while some farm-raised fish may receive these substances. A study in Environmental Science & Technology (Hussain et al., 2018) highlights that wild fish generally have lower levels of harmful residues.

Certifications: Look for seafood with certifications from reputable organizations. The Marine Stewardship Council (MSC) and the Aquaculture Stewardship Council (ASC) provide labels indicating sustainable fishing practices. These certifications ensure seafood is sourced responsibly, thus helping to protect aquatic ecosystems.

Contaminants: Be aware of potential contaminants in seafood. Some fish species can accumulate harmful substances like mercury and PCBs (polychlorinated biphenyls). The U.S. Environmental Protection Agency (EPA) recommends limiting consumption of certain fish, such as shark and swordfish, due to their higher mercury levels. Regularly checking advisories from local health departments can help consumers make safer choices.

Sustainable options: Choose seafood that is locally sourced or certified sustainable. This practice supports local economies and reduces the carbon footprint associated with transporting seafood. According to the World Wildlife Fund (WWF, 2020), choosing sustainable seafood can promote responsible fishing practices and support marine biodiversity.

By focusing on these aspects, consumers can make informed, safe choices when selecting seafood, ultimately contributing to their health and environmental sustainability.

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