Can healthcare adapt to a world of tightening ecological constraints? Challenges on the road to a post-growth future

Hensher, Martin; Zywert, Katharine

doi:10.1136/bmj.m4168

Cited by 10 publications

(7 citation statements)

References 30 publications

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“…There is significant potential to re-tool existing approaches for sectoral cost-effectiveness analysis for healthcare (long used in low and lower middle income countries) to support targeted degrowth of lower value healthcare while retaining and strengthening essential and high value services. Hensher and Zywert (2020) and Zywert and Quilley (2018) consider the challenges of maintaining essential functional levels of complexity in healthcare systems while wider societal complexity may be reducing, recognising that difficult choices and prioritisation will be inevitable.…”

Section: Degrowth and Post-growth Healthcare -The Current Literaturementioning

confidence: 99%

Preparing for the degrowth transition in healthcare: Understanding the challenges and opportunities

Hensher

2023

Degrowth

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Healthcare is not only an essential human right; it is one of the largest and most complex industries in the world. Maintaining access to effective healthcare while reducing harm to both human and planetary health is a central task for a successful voluntary degrowth transition. Safely transforming large, complex and often for-profit healthcare organisations and systems will pose significant challenges for degrowth planners and policymakers, yet this transition may also offer important opportunities to address hitherto intractable problems common to most high income healthcare systems. A range of organisational options for local, democratically controlled health services exist including smallscale local enterprises, cooperatives and social enterprises, yet most nations already run extensive public healthcare systems, suggesting that more straightforward nationalisation and public ownership may also be feasible. Meanwhile, preparations are required to improve healthcare system resilience against risks of collapse and unplanned, involuntary degrowth. This discussion of healthcare illustrates important tensions within the broader degrowth paradigm: a focus on organic, bottom-up re-localisation will frequently be in tension with the need for complexity and scale in several crucial aspects of modern healthcare delivery, risking economic dualism if not adequately resolved. There is no alternative to acknowledging the central role of the state in leading and driving a safe and effective degrowth transition in healthcare. Degrowth thinkers need to develop more pragmatic, practical policy visions if their theoretical models are to be capable of realisation.

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Section: Degrowth and Post-growth Healthcare -The Current Literaturementioning

confidence: 99%

Preparing for the degrowth transition in healthcare: Understanding the challenges and opportunities

Hensher

2023

Degrowth

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“…A set of key scientific articles about the health consequences of climate change have already been directed to related disciplines in recent years, including geography [18], education [19], anthropology [20], economics [21], nutrition [22], psychology [23,24] as well as other medical specialities (e.g., oncology [25], epidemiology [26], psychiatry [27], digital medicine [28]). Some reflection papers are also emerging in outlets directed at clinicians [29][30][31][32]. The current narrative review presents an original synthesis of the bi-directional associations between major healthrelated behaviors and climate change consequences and proposes key actions for the field of behavioral medicine.…”

Section: The Present Articlementioning

confidence: 99%

Thinking health-related behaviors in a climate change context: A narrative review

Chevance¹,

Fresán²,

Hekler³

et al. 2021

Preprint

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Background: Human activities have changed the biosphere so profoundly over the past two centuries that human-induced climate change is now posing serious health-related treats to the current and future generations. Rapid actions from all scientific fields are needed to contribute to both the mitigation and adaption to climate change. Purpose: This article aims to identify bi-directional associations between climate change effects (i.e., rising average temperatures, natural disasters, air pollution, rising sea level) and health-related behaviors, as well as a set of key actions for the behavioral medicine community. Methods: We synthetized the existing literature about (i) the effects of rising average temperature, natural disasters, air pollution, and rising sea level on the food system and eating behaviors, physical activity, sleep, substance use, access to safe water, and preventive behaviors; and (ii) the concurrent positive and negative roles that health-related behaviors can play in mitigation and adaptation to climate change. Results: Based on this literature review, we propose one of the first model of the complex, occasionally bi-directional, associations between climate change and health-related behaviors. Key actions are proposed with particular consideration for health equity (i.e., between and within-countries, at the intergenerational level, as well as between men and women) of future behavioral interventions. Synergies are also proposed between the field of behavioral medicine, the study of complex systems and planetary health science. Conclusions: We contend that climate change is among the most urgent issue facing all scientists, and should become a central priority for the behavioral medicine community.

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“…SDG 3 embodies a paradox inherent to all the sustainable development goals: if sufficient absolute decoupling of economic growth from ecological destruction is impossible or at the very least extremely unlikely Meadows et al 2004; also see Chapter 2), pursuing health and well-being goals by generating economic growth unintentionally undermines the ecological foundations of health by contributing to planetary ecological change (see Whitmee et al 2015). Moreover, as ecological crises intensify and the need to transition toward a post-growth political economy becomes increasingly urgent, health systems that are dependent upon growth will become even more vulnerable to political-economic crises, as we have already witnessed during the COVID-19 pandemic (Hensher and Zywert 2020;.…”

Section: Human Health Is Dependent On Planetary Healthmentioning

confidence: 99%

Ecological Limits of Development

Kish¹,

Quilley²

2021

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Embracing the reality of biophysical limits to growth, this volume uses the technical tools from ecological economics to recast the Sustainable Development Goals (SDGs) as Ecological Livelihood Goals -policy agendas and trajectories that seek to reconcile the social and spatial mobility and liberty of individuals, with both material security and ecological integrity.Since the 1970s, mainstream approaches to sustainable development have sought to reconcile ecological constraints with modernization through much vaunted and seldom demonstrated strategies of 'decoupling' and 'dematerialization'. In this context, the UN SDGs have become the orchestrating drivers of sustainability governance. However, biophysical limits are not so easily sidestepped. Building on an ecological-economic critique of mainstream economics and a historical-sociological understanding of state formation, this book explores the implications of ecological limits for modern progressive politics. Each chapter outlines leverage points for municipal engagement in local and regional contexts. Systems theory and community development perspectives are used to explore under-appreciated avenues for the kind of social and cultural change that would be necessary for any accommodation between modernity and ecological limits. Drawing on ideas from H.T. Odum, Herman Daly, Zigmunt Bauman, and many others, this book provides guiding research for a convergence between North and South that is bottom-up, household-centred, and predicated on a re-emerging domain of Livelihood. In each chapter, the authors provide recommendations for reconfiguring the UN's SDGs as Ecological Livelihood Goals -a framework for sustainable development in an era of limits. This book will be of great interest to students and scholars of ecological economics, socio-ecological systems, political economy, international and community development, global governance, and sustainable development.

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Can healthcare adapt to a world of tightening ecological constraints? Challenges on the road to a post-growth future

Abstract: Martin Hensher and Katharine Zywert examine some of the difficult changes that healthcare systems will need to make in the Anthropocene epoch

Cited by 10 publications

References 30 publications

Preparing for the degrowth transition in healthcare: Understanding the challenges and opportunities

Preparing for the degrowth transition in healthcare: Understanding the challenges and opportunities

Thinking health-related behaviors in a climate change context: A narrative review

Ecological Limits of Development

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