Said Shahtahmasebi, Ph.D.

Environmental changes including global warming over recent decades have stressed the reality that the earth’s resources are not infinite. Depleting resources has given additional importance to the idea of ‘sustainability’. To slow down global change world leaders have met and decided on targets and actions. We have seen sustainable housing, sustainable farming, and sustainable energy and so on. I guess the idea is that designing houses that run on renewable energy uses less power from the national grid thus leading to saving of resources.

This assumption will probably hold if our world was static, if the theory of evolution didn’t hold, if there were no social, environmental and economy processes, but then if that were the case we wouldn’t be discussing sustainability!  Unfortunately, this assumption appears to assume that human behaviour is not part of this evolutionary change. Social and economic dynamics suggest a process that is in line with human behaviour but defiesthe ethos and principles of saving the world.

On a global level, our politicians have also engaged ‘sustainability’ in their vocabulary. For example, quantifying carbon dioxide and agreeing on limiting emissions and deciding on a voucher system. The vouchers have since become part of the economic process and may be traded between countries.

Therefore, human behaviour through the economic and social processes prevents such ideas having an impact on reducing emissions or slowing down change. Perhaps the biggest influence on the process outcomes is through the feedback effect. For example, the feedback effect from social, economic and environmental policies of the last century has changed public perceptions and expectations worldwide and shifted the norms in behaviour.

In the wake of the United Nations Climate Change Conference in Copenhagen, a growing number of authors have highlighted the impact of environmental change on public health and questioned its absence from the climate change discussions e.g. see http://www.igi-global.com/campaign/symposium.asp.

What is lacking in these discussions are the implications of unsustainable policies on public health as well as on the economy. However, recent years have witnessed increasing attention for sustainable health care. For example, a Google search on ‘sustainable health care’ yielded 1,420,000 and Google Scholar resulted in 78,400 hits. On the other hand, to some extent, sustainable health care has been assumed to be directly related to holistic and alternative medicine models (e.g. [1-8]) which also include all the issues of conventional health care such as finance and resources [9]. As discussed elsewhere[10] holistic medicine, natural health and alternative medicine have been used interchangeably to refer to a method of treatment different to the conventional (orthodox) medical model. Furthermore, all these models are treatments in response to symptoms reported by an individual, and thus they form part of a secondary health care service. Shahtahmasebi[10, 11] argued that for a public health service to be sustainable it must adopt a holistic approach, and to be holistic, the public health service itself must be viewed as a social process. Social processes are by default dynamic. One of the major features of a dynamic process is the feedback effect. In other words, a process outcome is affected by the process’s own behaviour. For example, political priorities are directly related to changing governments and with each new government comes new priorities. By the same token, a health outcome may not only respond to the success or failure of a health care system but also to political variations. Therefore, given the dynamics of human behaviour, the substantive issues that arise are what is sustainability? What is sustainable health care? How sustainable are the sustainability initiatives (energy, housing,…)? Hence the prominence of a knowledge-based or evidence-based approach to decision/policy making which has its roots in science.

The emphasis on science and technology has led us to seek a scientific and technological solution to slow down global change. But, we could easily modify our behaviour, however, we have become subservient to our arrogance due to our ignorance. Therefore, for every technological advancement that we adopt we enslave ourselves and lose a certain number of degrees of freedoms. Examples are all around us: mobile technology has taken over, we drink the water we don’t want to drink, eat the food we don’t want to eat, are exposed to materials we don’t want to see, etc. “Choice” our most basic human necessity is being dictated. There is now talk of pills, drugs, genome manipulation and therapy and technology that can control behaviour, to create healthier humans, to rid society of crime. It suggests to me that it is the philosophy behind the science and technology that is misguided and has caused undesirable changes rather than the science itself. And as argued before, the scientists, researchers and all the stakeholders have become the problem.

Apparently, we have the knowledge and technology to predict global change but not the ability to understand the dynamics of change. And thus the only sustainable activity is our refusal to take responsibility for the change that we have caused. Science is in desperate need of God.

References

1. Bailie, R.S., et al., Indigenous health: effective and sustainable health services through continuous quality improvement. Medical Journal of Australia, 2007. 186(10): p. 525.
2. Berman, P., Health sector reform: making health development sustainable. Health Policy, 1995. 32(1-3): p. 13-28.
3. Braa, J., E. Monteiro, and S. Sahay, Networks of action: sustainable health information systems across developing countries. Management Information Systems Quarterly, 2004. 28(3): p. 3.
4. Coiera, E., Four rules for the reinvention of health care. BMJ, 2004. 328(7449): p. 1197.
5. Davies, H.T.O., S.M. Nutley, and R. Mannion, Organisational culture and quality of health care. Qual Health Care, 2000. 9(2): p. 111.
6. Stein, J., Empowerment and women’s health: theory, methods and practice. Journal of Health Politics, Policy and Law, 2000. 25: p. 607-611.
7. Taylor, J., I. Blue, and G. Misan, Approach to sustainable primary health care service delivery for rural and remote South Australia. Journal of Rural Health, 2001. 9(6): p. 304-310.
8. Verkerk, R., Can the failing western medical paradigm be shifted using the principle of sustainability? Australian College of Nutritional Medicine (ACNEM) Journal, 2009.
9. Mossialos, E., et al., Funding health care: options for Europe. 2002, Buckingham, UK: Open University Press
10. Shahtahmasebi, S., The Good life: A holistic approach to the health of the population. ScientificWorldJournal, 2006. 6: p. 2117-32.
11. Shahtahmasebi, S., Researching health service information systems development, in Handbook of Research on IT Management and Clinical Data Administration in Healthcare, A. Dwivedi, Editor. 2008, IGI Publishing: In press.