Discover groundbreaking insights into the environmental impact of public health initiatives in the recent article, “Is Public Health Environmentally Sustainable?” published in Health Care Analysis. This paper challenges the common assumption that public health and environmental sustainability always represent a “win-win” scenario, asserting that this is not necessarily the case and that we have positive reason to think some interventions are not environmentally sustainable.
Key discussions and findings include:
- Rethinking Environmental Impact through a Lifecycle Perspective: The authors advocate for evaluating the environmental impact of public health interventions and policies from a human lifecycle perspective. This comprehensive approach considers impacts across an individual’s entire life—from raw material extraction to production, distribution, use, and final disposal or recycling of products and services—thereby reflecting the full environmental impact of the intervention. This perspective makes it less obvious that health promotion and environmental sustainability are automatically win-win.
- Challenging the “Win-Win” Narrative: While some policies, like a tax on animal fat, could be genuinely win-win by promoting healthier, more plant-based diets with lower environmental footprints, others might not be. For instance, an effective non-smoking intervention, by significantly extending healthy lifespans, would plausibly increase overall environmental impact when viewed over a complete human lifecycle, as longer and potentially wealthier lives tend to involve more consumption and thus greater environmental impact.
- The Concept of Environmental Budgets: The paper clarifies that environmental sustainability is not merely about relative environmental impact, but also about assigning and staying within shares of our environmental “budgets,” also referred to as “environmentally safe operating spaces”. An individual is considered sustainable if their environmental impact is smaller than or equal to their assigned share.
- A “Whole Life” Approach to Environmental Shares: A central argument is that individuals ought to be ascribed a share of these environmental budgets for their entire life, a share that does not increase as individuals get older. This approach implies that individuals should not receive a larger share based on their ongoing lifetime or per smaller time units like years. This “whole life” allocation is supported by:
- Maximizing Health: From the perspective of maximizing overall health or health-related quality of life within environmental budgets, assigning shares based on whole lives seems better. This is because younger years of life typically contain more health-related quality of life than older years, due to factors like disease prevalence and subjective time perception. Allocating shares for single years would give the same priority to less healthy older years as to more healthy younger years, which is argued to be incorrect if the goal is to maximize health.
- Fairness Considerations: Drawing inspiration from health care priority settings, the influential “fair innings” argument suggests giving priority to those who have not yet lived a normal healthy lifespan. Applying this rationale to environmental budget allocation, assigning shares to whole lives prioritizes years within a normal lifespan, whereas allocating to smaller units of time would give the same priority to life at all ages.
- Implications for Policy and Consumption: The paper concludes that it’s crucial not to merely assume sustainability in public health; indeed, there’s positive reason to believe some interventions are not environmentally sustainable. It suggests that if public health interventions lead to longer, healthier lives, individuals and societies must compensate by reducing overall consumption or increasing its environmental efficiency to avoid further over-drafting already environmentally unsustainable budgets. While the paper does not claim environmental sustainability is the sole moral aim or that unsustainable interventions are impermissible, it emphasizes the need to consider these trade-offs when making health policy decisions.
This essential reading provides a robust conceptual framework for evaluating the environmental sustainability of public health and calls for a nuanced understanding of its complex relationship with planetary boundaries.
Reference for the article:
Andersen, M. M., Hauschild, M. Z., & Lauridsen, S. (2025). Is Public Health Environmentally Sustainable? Health Care Analysis, 33(1), 97–108. https://doi.org/10.1007/s10728-025-00511-8
