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PLOS BLOGS Speaking of Medicine and Health

Towards Sustainable Health Care

Author: Maya Cosentino is a postgraduate Global Health Policy student at the London School of Hygiene and Tropical Medicine (LSHTM), and a child and adolescent psychiatrist in Bern, Switzerland. Maya attended medical school at Witten/Herdecke University in Germany and earned her undergraduate degree in psychology and neuroscience at St. Mary’s College of Maryland, where she graduated with honors and received the Human Services Award. Maya is a Planetary Health Alliance Campus Ambassador and a member of Think Tank 30, the young think tank of the Club of Rome in Germany.

PLOS Note: Maya’s blog is especially timely because PLOS Global Public Health and PLOS Climate are inviting you to submit your original research articles for our open Call For Papers, Climate Change and Human Health, which is accepting submissions until April 28, 2023. We welcome submissions of research that addresses all aspects of the intersection between climate and health, from the changing burden of communicable and non-communicable disease to the impacts of extreme events on health systems, as well as research that assesses potential adaptations to build healthier and more resilient societies.

Many of our current cultural norms, like our consumption habits, as well as the economic structures supporting them, stand in increasing conflict with the values of protecting human health and ensuring basic needs. Our growth dependent economy is definitively linked to the changing climate, biodiversity loss, soil degradation, ocean acidification, water scarcity, as well as pollution — the largest environmental cause of disease, responsible for about 9 million premature deaths a year (to put 9 million into perspective: an estimated 3.57 million people died of COVID-19 in 2021).

According to the Lancet Commission on Health and Climate Change, climate change projections indicate an “unacceptably high and potentially catastrophic risk to human health.” The health effects of climate change are diverse ranging from the impacts of food and water shortages to increases in heat, allergy, vector-born, and air-pollution related diseases, to the mental health effects of extreme weather, eco-anxiety, population displacement, and conflict.

The Role of Health Care

The health care carbon footprint is significant when compared to other sectors, accounting for over 5% of national emissions on average. Globally, the pharmaceutical industry alone has been found to produce higher greenhouse gas emissions than the automotive industry (on a production level). This means that health care system emissions are causing significant environmental strain that is paradoxically contributing to the rise of disease.

A lack of financial incentive to promote health and prevent disease within health care and medical research reflects a systemic flaw that partially explains why the most expensive health care systems worldwide (i.e., the USA, Switzerland, and Germany) aren’t the healthiest populations. Overdiagnosis and overuse of medical services is a problem in many health care systems and a growing number of countries have health care costs that are increasing faster than gross domestic product (GDP).

Without patients that have diagnoses associated with specific insurance payment rates, many health care providers around the world can’t make money. In other words: in a system that doesn’t provide financial incentive to protect and promote health, clinical health care professionals provide diagnosis-based ‘sick care.’

Locked into a business plan that leaves little time for patient contact, the meaning health care providers experience at work can erode, fueling frustration and resentment that dehumanizes health care. A concerning number of health care professionals (e.g., over half of physicians in the USA) suffer from symptoms of burnout partially attributed to moral injury caused by bureaucracy and insufficient time for patient care.

Moving Forward

Sustained, as opposed to short-lived, positive impact is needed to build sustainable health care systems. Fine-tuning a ‘sick care’ business paradigm is a short-term, insufficient approach. It will take systemic change to create health care systems that inherently value health and that aim to embrace changes that are capable of significantly reducing their environmental burden.

Given the positive influence of sustainable development on health, future strategies should go hand in hand with a health care narrative that is informed by the interconnections between environmental and human health. To move towards this goal, transdisciplinary approaches like Planetary and One Health, which recognize the complex relationships between the health of living things and their environments, offer crucial entry points for developing resilient health care systems.

Decoupling economic growth and environmental harm will be necessary to prohibit the further transgression of planetary boundaries and worsening of health inequities. Health promotion and sickness prevention have the potential to increase public health, decrease health spending, and reduce the health care sector’s ecological footprint. In addition, health care models that incentivise health but not overtreatment whilst creating work environments that enable health professionals to best serve and care for their patients are urgently called for.

There is increasing awareness of the role that health care plays in the context of sustainability. In 2021, over 50 countries committed to building climate resilient and low carbon health systems. The success of revolutionary health care models that value ‘humanity over bureaucracy’ is also encouraging. Despite this, more efforts are needed to create health care systems that prioritize physical, mental, social, and planetary well-being.

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