Sustainability in health care
Sustainability is a bit of a buzz word these days. To be sustainable means that you only use what you need, leaving the rest to be used by you or others in the future. For example, sustainability is a popular topic in environmental sciences and refers to renewable agriculture, good stewardship of natural resources and recycling of waste. What about sustainability in health care?
How do we grapple with the concept of sustainability in health care? In health care, we often describe The United States health care system as unsustainable. The skyrocketing costs of US health care simply cannot continue on their current trajectory. The World Bank describes total US health expenditures in 2012 as 17.9% of GDP, higher than any other single country. (1) If the reality is that the rate of spending in the US health care system is indeed unsustainable, how then do we implement changes that will bring about sustainability?
Lesson learned from permaculture
I've been a student of permaculture for several years. Permaculture is the science of growing food in ways that give back to the earth. In permaculture, natural resources are conserved and food production is possible without artificial pesticides and fertilizers. My personal garden is a very important source of food in my diet. To me, it's important to know where my food comes from and how it has been cared for. Through permaculture, my goal is to live a sustainable lifestyle.
There are a lot of bright minds in health care, but sometimes bright minds evaluate problems exclusively from the standpoint of macroeconomics. Through the use of meta-analysis, surveys and white papers, bright minds look for trends that will address the problems in health care. But successful, sustainable health care isn't about trends, it's about people. Individual people and the choices they can voluntarily make. Unfortunately, in many cases, it's also about people and the involuntary choices that they are forced to make.
Practicing sustainability in healthcare
In permaculture, there are two fundamental principles. First, we each need to make a personal, lifestyle choice. To live a permaculture lifestyle we need to choose a permaculture lifestyle. Rainwater? Save it in a barrel. Kitchen scraps? Compost or feed them to your chickens. Waste? Recycle it. It's a choice - a personal choice.
The second principle is transparency. Transparency is the ability to see and understand all that goes into your personal choice. Transparency of methods, tools that are used and the outcomes of your actions all need to be transparent. For instance, in permaculture, many people will choose to eat locally grown foods. Locally grown foods have not been shipped from afar, using fossil fuels. Locally grown foods will also be known to the consumer. The local rancher who raised that cow for which you now have a hamburger can tell you what went into raising that cow. The local farmer who raised those turnips can tell you about the chemicals (or lack of) that went into raising your food.
In health care, personal choice and transparency are the two building blocks of sustainable health. I'll address each in upcoming blog posts.
Jeffrey A. Oster, DPM