Abstract
We reflect on the interrelations of two important societal concerns: sustainable development and health. In this field of research, the key notion of ‘health co-benefits’ has been coined. Health co-benefits aim to utilize synergies between both respective strategies. This approach is mainly applied in climate change mitigation and is intended to inform policies. ‘Cross-cutting’ issues, such as energy, agro-food systems and transport, are receiving increasing international recognition. However, the significant case of the health care system has rarely been addressed. While responsible for the reproduction of human health , with its energy- and material-intensive forms of therapy, it contributes to environmental problems. Therefore, the health care system itself threatens human health. In a transdisciplinary series of hospital projects involving scientists and health care practitioners, we asked how sustainability can be conceptualized for hospitals in line with both a socioecological understanding of sustainable development and ‘hospitals’ reality’. Our approach aims to avoid unintended long-term and side effects of health care—hospitals’ core business—by expanding quality criteria for decision-making to include sustainability and health gain improvement. The results of the testing phase convinced political actors in the health care system, and they demonstrate that health co-benefits are a valuable additional argument within the sustainability debate.
The German version of this chapter is part of the lead author’s dissertation, which contains more comprehensive literature references than is possible to include here (see Weisz 2015).
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Notes
- 1.
The origins of the New Public Health movement can be traced to the Ottawa Charter for Health Promotion, which takes a broad approach to health policy (WHO 1986).
- 2.
The attempt at linking the ‘healthy cities’ and ‘sustainable cities’ programs represents an exception in this context [e.g., Dooris 1999, see also www.who.int/healthy_settings/en (accessed on March 1, 2013)].
- 3.
- 4.
This research thus links to an earlier tradition that predominated at the beginning of industrialization, where health and environmental problems were addressed together. This integrated approach evidently came to a halt when environmental problems began to go far beyond the bounds of hygiene problems and acquired a global dimension, characterized by a spatial and temporal distance between cause and effect (cf. Smith and Ezatti 2005). Environmental medicine approaches and research into ‘environmental (public) health’ are an exception in this context, although they have what we would regard as a too ‘narrow’ epidemiological focus in most cases.
- 5.
A trend that is also observable in the developing world (cf. Tilman and Clark 2014).
- 6.
Consumption-based survey including import-related emissions (for methodological details, see SDC-SEI 2008).
- 7.
Including preliminary services. The share of other emissions, such as NOx, or toxic waste, at 4–7 %, is thus on a similar scale (Weisz et al. 2011).
- 8.
In this sense, these organizations also belong to the few social function systems that continue to concern themselves with aspects of social metabolism (interacting directly with nature) and to co-organize these. The nature with which the health system is directly confronted is human nature.
- 9.
Furthermore—and here, too, hospitals play a special role—they act as ‘social organs of perception’, registering changes in public health (cf. Fischer-Kowalski 1997).
- 10.
Perhaps the most wonderful definition, which we wish to share with readers and which emphasizes the function of health, is generally credited to Sigmund Freud: ‘Health is the capacity to be able to work and love’. In the original, however, Freud provides a more ‘dry’ definition, describing the aim of psychoanalytical treatment as: ‘Nach Möglichkeit leistungs- und genussfähig zu machen’ (‘Rendering a person, as far as possible, capable of both work and enjoyment’, author’s own translation, Freud 1923, p. 226 as cited in Nedelmann 2009, p. 338).
- 11.
The socioecological approach (the model of interaction between society and nature, which positions the human population at the ‘hybrid’ interface) also does not focus any further on the ‘special case of human nature’, and it can be of no further help to us here.
- 12.
The ‘Brundtland definition’ (WCED 1987) is often used, although it is too vague to be used as a guide for action.
- 13.
These exist within the context of an evidence-based medicine, which has been introduced partly to control the cost efficiency of services (Weisz et al. 2011).
- 14.
From an interview with a chief hospital physician from a project on ‘sustainability monitoring in hospitals’ (project MOKA, cf. Weisz 2015).
- 15.
This extension beyond the direct system boundaries also finds expression in the concept of corporate social responsibility (CSR).
- 16.
In the transdisciplinary research process, however, the differentiation between science and practice is shown to be unsuitable for medical practitioners who themselves participate in research (indeed, often with greater success than researchers in a transdisciplinary setting) (Weisz et al. 2014).
- 17.
This approach may be interpreted as an ‘anti-progress model’, as a critique of a now untenable idea of progress that depicts the prospect of economic growth, increased living standards and the simultaneous conservation of nature through the ‘three-pillar model’ (cf. Fischer-Kowalski 1997).
- 18.
Intensive care units fall within the highest category of intensive care (Class 3), and respiratory care units fall within Classes 1 and 2.
- 19.
This affects ca. 9 % of all ventilated patients and 30 % of those patients with underlying chronic obstructive pulmonary disease (COPD).
- 20.
‘Transmural’ refers to the interface between hospital and home care.
- 21.
To estimate material use, we surveyed 80 % of the most expensive consumer goods (excluding investment goods, pharmaceuticals, infusions and (blood) transfusions). For methodological details, see Weisz et al. 2009. Surveying energy use at the ward level was not possible.
- 22.
Misallocation of beds refers here to instances in which patient care does not take place in the optimal setting.
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Weisz, U., Haas, W. (2016). Health Through Socioecological Lenses—A Case for Sustainable Hospitals. In: Haberl, H., Fischer-Kowalski, M., Krausmann, F., Winiwarter, V. (eds) Social Ecology. Human-Environment Interactions, vol 5. Springer, Cham. https://doi.org/10.1007/978-3-319-33326-7_29
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