U.S. American healthcare is a huge business. The U.S. “spends the most of any nation by far on its health care system, nearly one-fifth of GDP, “which makes it a trillion-dollar business (1). Dr. Elisabeth Rosenthal, author of An American Sickness, explains that “we’ve trusted a lot of our health care to for-profit businesses and it’s their job, frankly, to make profit…You can’t expect them to act like Mother Teresas” (2). Additionally, with the student debt that U.S. healthcare professionals take on in pursuit of their careers, it is often unrealistic to expect them to be altruistic, environmentally and socially conscious, and unconcerned about their annual income.
The Association for Medical Education in Europe (AMEE) suggests that health professional education highlights the practices and values of Indigenous civilizations. Indigenous People “across the world have long acted as custodians of the environment, recognizing the interconnectedness of all living things, including the impact of all elements of the planet on well-being, health and spirituality.” In contrast, Western medicine focuses on the biomedical model and neglects this Indigenous wisdom (3).
How do we integrate the values of indigenous cultures and reject economic growth as the most paramount progress marker? How do we start the conversation in a culture rooted in the ideals of capitalism, ‘the free world’, and a white-washing of history that makes the discussion of indigenous societies taboo? Every country has a unique relationship with its Indigenous People and its participation in colonialism. The U.S.A. tends to teach its history in a way that valorizes the conqueror, making them look like the more moral or intelligent side. This makes highlighting the values of Indigenous Peoples much more convoluted. So how do we re-envision the U.S. healthcare system in the scope of environmental sustainability and genuine investment in planetary health?
SPT, MSMU Los Angeles
When individualism and freedom are protected as sincerely as life and death, interdependence to each other and our earth is a hard sell. Environmental sustainability will not be obtainable without first addressing inequality and social injustices; respecting human rights; and becoming stewards of our planet’s ecological boundaries. With limited resources, we as local and global societies need “to challenge existing power structures that often perpetuate overuse of resources and exacerbate inequalities. For health professionals specifically, the values enshrined in the human rights discourse have the potential to lead the way within the social foundation necessary for the health of our planet” (3).
Environmental justice “action requires understanding, acceptance, and strategies for leading a major culture change – from the glorification of consumption and economic growth to working towards health and sustainability for all” (3). The seemingly impossible question to answer is: how do we accomplish this cultural change through specific and measurable actions? Education of health professionals requires understanding their organizational behavior and politics. That means U.S. healthcare providers must understand that American healthcare is a for-profit business. To change this, we need to understand that environmentally sustainable healthcare encompasses social and environmental accountability. Health education institutions must prioritize the health concerns of the societies which they serve and allocate resources to being socially accountable. Health education must ensure that research contributes to active development, promotion, and protection of environmentally and ecologically sustainable solutions (3).
Even once we have convinced everyone that climate change is real and carbon neutrality is a must-reach goal, the discussion of who is responsible and what needs to change will take over the public discourse and continue a shortcoming of necessary action. Centering economic growth as the predominant measure of sustainability receives more political support than other approaches. However, this centering of economic growth in sustainability is too intertwined with the colonial and capitalist model of development. Economic growth, carbon-fueled industrialism, and ongoing associated colonial practices are the major causes of environmental exploitation and today’s resulting medical emergency. Approaches that balance social equity, economic growth, and environmental sustainability as equally important are likely to favor economic interests (growth-as-sustainability) that will continue to override social questions of human health, equity, and fundamental environmental needs (4).
Health professionals are working to develop the evidence-base on interactions between environmental change and health; reduce negative environmental impacts of health systems; educate professionals and the public; lobby policymakers; and prepare health systems to manage the direct impacts of the ecological crisis (3). How do we implement these actions? What specific interventions will reduce the environmental impact of physical therapy? In the pursuit to recenter interconnectedness and dependence on our ecosystems, individual clinicians do not know how they can contribute to environmentally sustainable healthcare.
Not knowing where to start as a single clinician is a common sentiment. Yet, facilitating different ways to learn and nurturing transdisciplinary problem-solving introduces a path to promote the best possible outcomes for patients, communities, and the planet. When clinicians have the tools to think differently and access their range of knowledge regarding resource allocation, they can feel empowered to implement small-scale environmental interventions. From data collected from clinicians on the frontlines, more research will be reported back to the educational institutions. This way of education ensures a healthcare workforce that is informed about the interdependence of ecosystems and health; prepared to tackle social and ecological injustice; and possesses the skills, values, and capabilities to respond (3).
In the U.S.A., “environmental sustainability” is a disjointed buzzword used to seamlessly gentrify urban neighborhoods with the addition of public greenspaces and healthier grocery stores or pursued in isolation for those following plant-based diets and boycotting single-use plastics. Most commonly, it is elicited as a fruitless sentiment of despair and disappointment in our government and disdain of over-protected corporations. The public either ignores the racial and socioeconomic intersections associated with environmental injustice or it expresses feelings of overwhelming uncertainty at how to advocate for justice and hold corporations accountable. Where can we inspire hope and engagement within this culture? How do we foster learning without forcing lessons on individuals minding their own business? Will this learning be enough of a catalyst to dismantle the exploitative systems that protect corporations?
1) Eckelman, M. J., Sherman, J., & Ahmad, S. (2016, June 9). Environmental Impacts of the U.S. Health Care System and Effects on Public Health. PLOS ONE, 11(6). doi:10.1371/journal.pone.0157014
2) Gross, T. (2017, April 10). How U.S. Health Care Became Big Business. Retrieved from https://www.npr.org/sections/health-shots/2017/04/10/523005353/how-u-s-health-care-became-big-business
3) Shaw, E., Walpole, S., McLean, M., Alvarez-Nieto, C., Barna, S., Bazin, K., . ..Woollard, R. (2021, Feb. 19). Amee Consensus Statement: Planetary health and education for sustainable healthcare. Medical Teacher, 43(3), 272-286. doi:10.1080/0142159x.2020.1860207
4) Maric, F., Groven, K. S., Banerjee, S., & Michelsen, T. D. (2021, August 25). Essentials for sustainable physiotherapy: Introducing environmental reasoning into physiotherapy clinical decision-making. Retrieved from https://www.fysioterapeuten.no/fagfellevurdert-sustainable-physiotherapy/essentials-for-sustainable-physiotherapy-introducing-environmental-reasoning-into-physiotherapy-clinical-decision-making/131740