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Special Issue "Sustainability Perspectives on Health Care: Exploring the Contours of a Novel Field"

A special issue of Sustainability (ISSN 2071-1050). This special issue belongs to the section "Health and Sustainability".

Deadline for manuscript submissions: closed (30 June 2021).

Special Issue Editors

Prof. Dr. Jacqueline Broerse
E-Mail Website
Guest Editor
Athena Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, Netherlands
Interests: public engagement in science; responsible research and innovation; health and food system innovation; sustainable development
Dr. Evelien de Hoop
E-Mail Website
Co-Guest Editor
Athena Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
Interests: transdisciplinary research; health and sustainability; knowledge politics; Science and Technology Studies (STS)
Dr. Tjerk Jan Schuitmaker
E-Mail Website
Co-Guest Editor
Athena Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
Interests: sustainable health and care; system innovations; reflexive monitoring and evaluation; patient engagement; shared decision-making

Special Issue Information

Dear Colleagues,

This Special Issue explores and proposes “health and sustainability” as a novel research field. When the field of “health and sustainability” is straightforwardly approached as the overlap between research on “health” and on “sustainability”, a wide array of intertwined or coupled health–sustainability challenges emerges. A few examples: pollution and toxicity and environmental health; increasingly intimate co-habitation of humans and animals in the context of deforestation and the risks on zoonosis; waste production and notions of hygienic healthcare and appropriate (end-of-life) care; transformations toward more sustainable cities and country sides and laying the foundations for better physical and mental wellbeing.

However, research on these topics often remains limited to understanding and remedying problems in either the (social and environmental) sustainability domain or the health domain. “Health” and “sustainability” are rarely mentioned and studied in conjunction in academic research, although it has been frequently observed that today’s sustainability challenges have profound and highly unequal health implications, on the one hand, and that health-care systems produce effects that can be considered unsustainable in multiple ways, on the other hand.

Building on this observation, this Special Issue explores “health and sustainability” by investigating (and transforming) health and health systems from a sustainability perspective. Doing so requires thinking about what sustainable healthcare might look like and how this may come to be defined. It also requires investigating both ongoing practices within systems as well as the introduction of new healthcare interventions beyond the narrow focus of the ongoing practice or intervention itself: How (socially, ecologically and economically) viable is it on the long-term, for the target population and other stakeholders, for the healthcare system as a whole, and for systems that are intertwined with the healthcare system?

Taking this a step further, a sustainability approach to healthcare has the potential to bring to the fore that transforming today’s healthcare system(s) toward more sustainable systems inevitably requires transformations of interrelated systems, as well. For example, facilitating preventive care in the form of healthier diets requires a transformation of the food system. Additionally, today’s systems of knowledge production and valuation are poorly equipped to produce knowledge on which diets are particularly healthy for whom and in which circumstances. Or: Where current mental healthcare predominantly focuses on ‘fixing’ an unhealthy individual, arguments are increasingly being voiced that addressing mental illness more effectively and justly requires a much stronger focus on changing societal structures that play an important role in the definition, emergence, and experience of mental illness.

This summary presents a glimpse of the many issues and topics that sustainability perspectives on healthcare may give rise to, with a threefold focus on (a) the sustainability of the health system itself; (b) coupled food systems–health systems transformations; and (c) coupled living environments–health systems transformations. It explores and draws together a variety of different engagements with health and sustainability as a research topic and field to chart new terrain to inspire future scholarly investigations of health and sustainability from a wide variety of (inter-/trans-)disciplinary perspectives. To do so, we invite papers that contribute to this ambitions on the basis of empirical investigations and/or theoretical innovations and/or in-depth literature reviews.

Prof. Dr. Jacqueline Broerse
Guest Editor

Dr. Evelien de Hoop
Dr. Tjerk Jan Schuitmaker
Co-Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Sustainability is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2000 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • health
  • sustainability
  • systems
  • transformations
  • sustainable healthcare

Published Papers (7 papers)

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Article
Countering the Tragedy of the Health Care Commons by Exnovation: Bringing Unexpected Problems and Solutions into View
Sustainability 2021, 13(23), 13082; https://doi.org/10.3390/su132313082 - 26 Nov 2021
Viewed by 358
Abstract
In the health sciences and policy, it is common to view rising health care costs as a tragedy of the commons, i.e., a situation in which the unhampered use of a resource by rational individuals leads to its depletion. By monitoring a set [...] Read more.
In the health sciences and policy, it is common to view rising health care costs as a tragedy of the commons, i.e., a situation in which the unhampered use of a resource by rational individuals leads to its depletion. By monitoring a set of outcomes, not only the costs but also patient experience and population health, simultaneously, it is claimed that the “triple aim” approach changes what is rational for health care stakeholders and, thus, can counter the rapidly rising health care costs. This approach has an important limitation: it reduces the monitored innovations to merely their outcomes; yet, how health care professionals and patients give shape to care delivery remains invisible. To get a more in-depth understanding of the consequences of adopting such an approach, in this article I use the method of exnovation instead. Exnovation foregrounds the everyday accomplishments of health care practices to enable reflection and learning. I draw on an ethnographic study into an innovation in care delivery aimed at rendering it more sustainable: Primary Care Plus. I reflected with both professionals and patients on what happened during 40 Primary Care Plus consultations. By presenting and analyzing three of these consultations, I foreground what is rendered invisible with the triple aim: improvisations, surprises and habits unfolding in practice. With exnovation, health care innovations can provide fertile soil for creating new forms of sustainable care that can help prevent the impending exhaustion of health care systems. Full article
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Article
Digitalization as an Engine for Change? Building a Vision Pathway towards a Sustainable Health Care System by Using the MLP and Health Economic Decision Modelling
Sustainability 2021, 13(23), 13007; https://doi.org/10.3390/su132313007 - 24 Nov 2021
Viewed by 302
Abstract
Grand social challenges, such as type 2 diabetes (T2D), are increasing, which creates sustainability problems for health care service systems. To reduce socio-economic burdens, changes are required in the socio-technical system. However, there is an uncertainty of the most cost-effective policy action that [...] Read more.
Grand social challenges, such as type 2 diabetes (T2D), are increasing, which creates sustainability problems for health care service systems. To reduce socio-economic burdens, changes are required in the socio-technical system. However, there is an uncertainty of the most cost-effective policy action that can create sustainability while providing health benefits. To find potential solutions to these challenges, the multi-level perspective (MLP) and health economic decision modelling was used to study socio-technical change and project potential health economic consequences of different scenarios. The study focuses on creating a vision pathway for reducing T2D in Finland. In total, 23 interviews were carried out and the results were analyzed utilizing the MLP model. As a result, five themes towards prevention of T2D were identified. Digitalization was found to be a cross-cutting theme for preventing T2D and was thus taken as the object of study and the main focus of this paper. As a result, this paper reports on the opportunities and barriers for using digital tools in a transition towards T2D prevention. A health economic decision modelling revealed that the highest expected savings could be obtained by prioritizing prevention programs based on T2D risk. Finally, the model was converted into a web-based online tool by combining vision pathway, transition-focused storylines and forward-looking health economic scenario analysis to give the policy makers an overall picture of the needed societal changes and support the impact assessment of alternative policies in a case of T2D prevention in Finland. Full article
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Article
Social Obstetrics as Niche-Development in Addressing Health Inequities
Sustainability 2021, 13(22), 12814; https://doi.org/10.3390/su132212814 - 19 Nov 2021
Viewed by 448
Abstract
We apply a transition research perspective to the Dutch obstetric care system to analyze historic, current, and future shifts and find ways to overcome persistent health inequities. We present social obstetrics as an emerging niche that addresses perinatal health inequities by acknowledging their [...] Read more.
We apply a transition research perspective to the Dutch obstetric care system to analyze historic, current, and future shifts and find ways to overcome persistent health inequities. We present social obstetrics as an emerging niche that addresses perinatal health inequities by acknowledging their multifaceted origins and fostering collaborations across the medical, social, and public health sectors. We conducted desk research, in-depth semi-structured expert interviews, and interactive group sessions with change-inclined professionals that are relevant for the implementation of social obstetrics in six Dutch municipalities. The outcomes are synthesized in a historical narrative and perspectives on current obstacles and future systemic shifts. We argue that social obstetrics can be considered a sustainable addition to what is already present, instead of a disruptive transformation of the current system. Social obstetrics is innovative as it connects various societal systems and offers a framework for cross-sectoral collaboration. These collaborations, in turn, can be the starting point for the transformation of the obstetric care system as well as other relevant societal systems. Full article
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Article
Institutionalizing Reflexivity for Sustainability: Two Cases in Health Care
Sustainability 2021, 13(21), 11712; https://doi.org/10.3390/su132111712 - 23 Oct 2021
Viewed by 430
Abstract
Unsustainability in health care comprises diminishing returns and misalignment between the health care regime and the needs of the population. To deal with complex sustainability problems, niche solutions can be collaboratively designed and implemented through reflexive methods. For second-order sustainability, however, the institutionalization [...] Read more.
Unsustainability in health care comprises diminishing returns and misalignment between the health care regime and the needs of the population. To deal with complex sustainability problems, niche solutions can be collaboratively designed and implemented through reflexive methods. For second-order sustainability, however, the institutionalization of the reflexive element itself is also needed. This paper aims to provide insight into the possibilities of embedding reflexivity into institutions to support second-order sustainability by reporting on two consecutive participatory research programs that sought to address unsustainability in terms of misalignment and diminishing returns. The first case study reflexively monitored the system’s innovation toward an integrated perinatal care system. Reflection within the project and implementation was supported successfully, but for stronger embedding and institutionalization, greater alignment of the reflexive practices with regime standards was needed. Building on these lessons, the second case study, which was part of the IMI-PARADIGM consortium, collaboratively built a structured tool to monitor and evaluate “the return on engagement” in medicine development. To institutionalize reflexivity, the creation of “reflexive standards” together with regime actors appears to be most promising. Broader and deeper institutionalization of reflexive standards can be attained by building enforcement structures for reflexive standards in the collaborative process as part of the reflexive methodologies for addressing complex sustainability problems. Full article
Article
Towards Sustainable Community-Based Systems for Infectious Disease and Disaster Response; Lessons from Local Initiatives in Four African Countries
Sustainability 2021, 13(18), 10083; https://doi.org/10.3390/su131810083 - 09 Sep 2021
Cited by 1 | Viewed by 654
Abstract
This paper explores the role of decentralised community-based care systems in achieving sustainable healthcare in resource-poor areas. Based on case studies from Sierra Leone, Madagascar, Uganda and Ethiopia, the paper argues that a community-based system of healthcare is more effective in the prevention, [...] Read more.
This paper explores the role of decentralised community-based care systems in achieving sustainable healthcare in resource-poor areas. Based on case studies from Sierra Leone, Madagascar, Uganda and Ethiopia, the paper argues that a community-based system of healthcare is more effective in the prevention, early diagnosis, and primary care in response to the zoonotic and infectious diseases associated with extreme weather events as well as their direct health impacts. Community-based systems of care have a more holistic view of the determinants of health and can integrate responses to health challenges, social wellbeing, ecological and economic viability. The case studies profiled in this paper reveal the importance of expanding notions of health to encompass the whole environment (physical and social, across time and space) in which people live, including the explicit recognition of ecological interests and their interconnections with health. While much work still needs to be done in defining and measuring successful community responses to health and other crises, we identify two potentially core criteria: the inclusion and integration of local knowledge in response planning and actions, and the involvement of researchers and practitioners, e.g., community-embedded health workers and NGO staff, as trusted key interlocuters in brokering knowledge and devising sustainable community systems of care. Full article
Article
The Process Leading to Physician Activism for Sustainable Change
Sustainability 2021, 13(18), 10003; https://doi.org/10.3390/su131810003 - 07 Sep 2021
Viewed by 727
Abstract
Health systems all over the world are in a process of transition and may even need a paradigm shift for sustainable development. This is where activism may play a role. This study focused on why some physicians become activists and how these physicians [...] Read more.
Health systems all over the world are in a process of transition and may even need a paradigm shift for sustainable development. This is where activism may play a role. This study focused on why some physicians become activists and how these physicians have either achieved successes or failed to do so. This study is inspired by grounded theory. Semi-structured, in-depth interviews were conducted to evaluate the experiences of seven purposefully sampled physician-activists from the Netherlands. Our research suggests that activism originates from an awareness of problems in the area of health inequalities, resulting in moral discomfort combined with a strong drive to speak up against perceived failings, even when personal risks may be involved. Activists that were most successful in achieving political and health changes meandered effectively along the borders of the system, taking care to preserve ties with supporters within that system and, at the same time, taking a relatively isolated position while using strategies to oppose the system. Diverging too much from the system resulted in measures taken by the system to silence them. Successful activism may be regarded as a social and professional skill that may be learned. Full article

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Concept Paper
Dementia and COVID-19 in Chile, New Zealand and Germany: A Research Agenda for Cross-Country Learning for Resilience in Health Care Systems
Sustainability 2021, 13(18), 10247; https://doi.org/10.3390/su131810247 - 14 Sep 2021
Viewed by 1013
Abstract
The COVID-19 pandemic has revealed existing gaps in policies, systems and services, stressing the need for concerted global action on healthy aging. Similar to the COVID-19 pandemic, dementia is a challenge for health systems on a global scale. Our hypothesis is that translational [...] Read more.
The COVID-19 pandemic has revealed existing gaps in policies, systems and services, stressing the need for concerted global action on healthy aging. Similar to the COVID-19 pandemic, dementia is a challenge for health systems on a global scale. Our hypothesis is that translational potential lies in cross-country learning by involving three high-income countries with distinct geo-political-cultural-social systems in Latin America (Chile), the South Pacific (New Zealand) and Europe (Germany). Our vision is that such cross-country learning will lead to providing adequate, equitable and sustainable care and support for families living with dementia during a pandemic and beyond. We are proposing a vision for research that takes a multi-disciplinary, strength-based approach at the intersection of health care research, disaster research, global health research and dementia research. We present some insights in support of our hypothesis and proposed research agenda. We anticipate that this research has the potential to contribute towards strengthening and transforming health care systems in times of crises and beyond. Full article
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