The Corona pandemic of recent years has, on the one hand, brought the essential importance of health for all areas of life back into the collective consciousness, and, on the other hand, has thus highlighted the urgent need to integrate the issue of sustainability in healthcare into politics and society. The 2030 Agenda, adopted by the 193 member states of the United Nations on September 25, 2015, already formulated the maximum of ensuring a healthy life for all people of all ages and promoting their well-being as the third of 17 overarching global goals for sustainability policy in the coming 15 years. In a general sense, sustainability means that the satisfaction of the needs of present generations must not jeopardize the satisfaction of the needs of future generations. In the context of health policy, the sustainability principle of intergenerational equity means maintaining or ensuring both the quality of healthcare and the financing of the healthcare system for all the people of the country in future generations as well. The further principle of sustainability means ensuring the performance and innovation capability of the institutions of the healthcare system and can be achieved in particular through modernization, digitization and networking. Each of the 193 member states is attempting to implement these interdisciplinary and comprehensive goals based on the respective status quo.

An important issue in the question of sustainability in healthcare is the question of the interaction of healthcare/health and the environment.

Healthcare accounts for approximately 4.4% of greenhouse gas emissions globally. The U.S., China and Europe alone account for about half of these emissions. However, the influences go far beyond greenhouse gas emissions. Items to mention here include infrastructure and energy, food service, medications, chemicals and disposable materials, and waste. Against this backdrop, the UK’s National Health Service (NHS) published a statement in October 2020 to become the first healthcare system in the world to become carbon neutral.

At the intersection of public health and medicine, academic approaches that postulate and explore a close relationship between people and the environment have been established for quite a few years. The best known of these are the One Health approach.

A comparable, but more practice-oriented development can also be observed on the side of ecological sustainability in healthcare (Sustainable Healthcare). The National Health Service (NHS) in the United Kingdom has established a Centre for Sustainable Healthcare for this purpose. In the Scandinavian countries, a similar institution exists in the form of the Nordic Centre for Sustainable Healthcare.

On March 10, 2021, the German government published a position paper on the further development of the German sustainability strategy, in which concrete political measures and contents were named in order to make the German healthcare system future-proof and sustainable. Against the background of increasing life expectancy and low birth rates, Germany’s economy and society are faced with the task of managing demographic change. This has a direct impact on the financing of the statutory health insurance system, as the proportion of young contributors continues to fall and the proportion of contributors of retirement age, whose contributions cannot cover the expenses they cause, continues to rise, so that young contributors must steadily co-finance people that are more elderly. For a long time, therefore, a reform of the statutory health insurance system through the introduction of a so-called citizens’ insurance system has been discussed as an effective instrument against rising contribution rates and a possibility for sustainable financing of the statutory health insurance system and thus sustainable financing of the German health care system.

In the international context, solidarity is needed between the industrialized nations and poor countries. Urgently needed medications, strategies and vaccines must be further developed and, above all, made available to these countries in order to combat poverty-related diseases and deadly epidemics, which are more likely to occur there. To achieve this, the healthcare systems of developing and emerging countries must be given sustainable support. This can only be achieved through cross-border commitment and international exchange. International cooperation and collaboration pool material, financial and human resources and can accelerate medical progress. This should already be implemented in internationally networked medical teaching and should be continued in all areas of the health care system. Intensive efforts on the topic of sustainability in healthcare are on the agenda at both national and international level in the coming years in order to achieve the ambitious goals that have been set. Overall, ensuring sustainability of the healthcare system globally is a major challenge, and good education as promoted by the SAFETY project is an essential part in this.

Written by Konrad Huppert, M.Sc. Public Health, Dr. Marc Lazarovici, Dr. Katarina Grujic, LMU Munich




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