Networks of influence: Linking capitals and agency to understand actors’ roles in sustainability interventions

Despite substantial focus on sustainability issues in both science and politics, humanity remains on largely unsustainable development trajectories. Partly, this is due to the failure of sustainability science to engage with the root causes of unsustainability. Drawing on ideas by Donella Meadows, we argue that many sustainability interventions target highly tangible, but essentially weak, leverage points (i.e. using interventions that are easy, but have limited potential for transformational change). Thus, there is an urgent need to focus on less obvious but potentially far more powerful areas of intervention. We propose a research agenda inspired by systems thinking that focuses on transformational 'sustainability interventions', centred on three realms of leverage: reconnecting people to nature, restructuring institutions and rethinking how knowledge is created and used in pursuit of sustainability. The notion of leverage points has the potential to act as a boundary object for genuinely transformational sustainability science.

Study question How can waste be reduced during medically assisted reproduction (MAR) procedures, including oocyte retrieval and embryo transfer, through sustainable interventions without compromising safety? Summary answer Sustainability interventions reduced material waste by 60% for oocyte retrieval and 8% for embryo transfer, with no infections recorded. What is known already Climate change poses a significant threat to human health, while health care is responsible for 7% of the yearly carbon dioxide emissions in the Netherlands, highlighting the urgent need for sustainable medical practices. Waste reduction has been shown to decrease environmental impact in other specialties. However, research focussing on strategies for improving sustainability of fertility treatments has been limited. Study design, size, duration A quality management initiative was conducted over a 12-month period (October 2023 to October 2024), with sustainability interventions implemented during a 3-month pilot phase. Participants/materials, setting, methods Through a multidisciplinary approach, sustainability initiatives were developed aiming at reducing material and medication waste generated during oocyte retrieval and embryo transfer procedures. Waste generation was measured before and after implementation of these interventions. Infection rates were evaluated at baseline and after completing the pilot. Main results and the role of chance During the study, a total of 234 oocyte retrievals and 291 embryo transfers were performed. The proposed interventions resulted in a material waste reduction of approximately 60% for oocyte retrieval and 8% for embryo transfer, with no clinical or laboratory infections recorded. Limitations, reasons for caution The absence of detailed life cycle assessments for products and carbon dioxide emission measurements suggests the need for more comprehensive environmental data in future studies. Wider implications of the findings This study revealed the possibility for significant waste reduction in MAR techniques through targeted sustainability interventions. These findings underscore the feasibility of integrating sustainability practices in MAR procedures. Trial registration number No

Given the increasingly grave environmental crisis, governments and organizations frequently initiate sustainability interventions to encourage sustainable behavior in individual consumers. However, prevalent behavioral approaches to sustainability interventions often have the unintended consequence of generating consumer resistance, undermining their effectiveness. With a practice–theoretical perspective, the authors investigate what generates consumer resistance and how it can be reduced, using consumer responses to a nationwide ban on plastic bags in Chile in 2019. The findings show that consumer resistance to sustainability interventions emerges not primarily because consumers are unwilling to change their individual behavior—as the existing literature commonly assumes—but because the individual behaviors being targeted are embedded in dynamic social practices. When sustainability interventions aim to change individual behaviors rather than social practices, they place excessive responsibility on consumers, unsettle their practice-related emotionality, and destabilize the multiple practices that interconnect to shape consumers’ lives, ultimately leading to resistance. The authors propose a theory of consumer resistance in social practice change that explains consumer resistance to sustainability interventions and ways of reducing it. They also offer recommendations for policy makers and social marketers in designing and managing sustainability initiatives that trigger less consumer resistance and thereby foster sustainable consumer behavior.

Minimizing waste in medically assisted reproduction: a study on sustainability initiatives for oocyte retrieval and embryo transfer.

Climate change is pushing governments to implement sustainability regulations for the real estate sector. Together with the increased client demand to accommodate more sustainable buildings, corporate real estate (CRE) and facility managers are challenged to upgrade the offices that they use with more sustainable interventions. There are many different sustainability measures they could consider as potential interventions, which most likely would each deliver different types of benefits; both from the viewpoint of sustainability as regarding other important organizational outcomes that are influenced by them. This study first identified a list of potential sustainability-oriented interventions and potential benefits from a systematic literature review. Next, CRE/Facility managers were questioned on which interventions they are (considering) implementing and what short- or long-term benefits they are expecting to come out of them. This questioning was done through semi-structured interviews based on the laddering approach. Findings identified 33 potential measures, especially regarding services, skin, and the site. These were related to 18 different expected benefits. The economic, environmental, and social benefits were very diverse and there is no real consensus yet on their exact relationship with sustainable measures. The insights add to the gap in research on sustainability measures taken by CRE/Facility managers. In addition, they give other CRE/Facility managers in practice insight in current experiences and perceived benefits of interventions by their colleagues, to inspire and support their own decision making.

The implementation of higher standards for sustainability presents a challenge to the construction industry. Sustainable construction guidelines often emphasize the outcomes of a project rather than addressing the sustainability aspects of its delivery, management, and governance processes. Project management standards and frameworks recognize the significance of sustainability. However, they lack practical instructions for project managers on effectively integrating sustainability into their project management practices. This study addresses this gap in the literature by investigating the perceived effectiveness and ease of sustainability interventions, with the aim of developing a ‘minimum baseline’ set of interventions that managers of construction projects can make in order to develop more sustainable projects. From the existing literature, 42 sustainability interventions by a project manager were derived. A quantitative survey-based research approach utilizing a self-administrated online questionnaire was employed to assess their effectiveness and ease of implementation. The questionnaire was distributed to the project managers worldwide, and valuable input was received from 105 respondents globally. The findings indicate that a minimum baseline of interventions can be formed with ten interventions that focus on the themes of communication, guidelines and regulations, and the supply chain. By revealing this minimum baseline, the study provides practical guidance for project managers of construction projects and fills the gap in the literature regarding the lack of a practical framework for improving sustainability in construction projects.

BackgroundThe potential for interventions that target food environments to influence dietary behaviour has been explored for both healthier and more environmentally sustainable diets, but the extent to which health-focused and sustainability-focused interventions can inform each other is unclear. This overview of reviews compares the characteristics and effectiveness of micro-environmental interventions aimed at health versus sustainability and explores their mediators and moderators.MethodsWe searched 10 databases for systematic reviews including randomised controlled trials of micro-environmental interventions targeting healthier or more sustainable food choices. We conducted forwards and backwards citation tracking of included reviews. Review quality was assessed using AMSTAR2. We narratively synthesised results, categorising interventions using the TIPPME typology of micro-environmental interventions.ResultsWe screened 4154 records and included 31 reviews, of which 26 targeted health and 5 sustainability. Of 228 interventions, 31 (13.6%) targeted sustainability, 194 (85.1%) targeted health, and 3 (1.3%) targeted both. There was little overlap between the intervention types investigated by health and sustainability interventions. Size and position interventions were most common for health interventions, whilst information and presentation interventions were the most frequent sustainability interventions. Default, size, and menu positioning interventions appear particularly promising for both health and sustainability benefits, albeit with limited evidence for the latter in particular. Evidence of effect modifiers was scarce. Almost all reviews had a “critically low” or “low” confidence rating based on the AMSTAR2, limiting confidence in their estimates of intervention effectiveness.ConclusionsThere is more evidence for health-focused interventions than sustainability-focused interventions. Size and position interventions seem most promising, but evidence for sustainability is scarce. There is currently no evidence of differential responding to health vs. sustainability interventions, although we were unable to comprehensively assess this. More comparable evidence, and evidence on underlying mechanisms, is needed, prioritising the most effective interventions.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12916-025-04381-8.

Methodological framework for identifying sustainability intervention priority areas on coastal landscapes and its application in China


 Higher education offers several opportunities for faculty, administrative staff, and students to contribute to climate change mitigation and adaptation as well as promote sustainability within the areas where such institutions are located. Through training, research, and community engagement functions, higher education institutions can ably contribute to sustainability and climate change response. This paper presents part of the findings from a larger study conducted at University of Dar es Salaam in Tanzania. The researcher adopted a socio-constructivist perspective to explore the perspectives and views of lecturers, administrators, and students on climate change related programmes regarding the role that university governance and management can play in promoting climate change and sustainability interventions at their university. Data was generated using semi-structured in-depth interviews and focus group discussions (FGDs) from 33 participants. Data was analysed using thematic analysis based on Braun & Clarke (2006). Findings revealed several roles that their university’s governance has and continues to play in promoting climate change and sustainability interventions including integrating these aspects in the university strategy, adding climate change and sustainability to the university research agenda, and promoting sustainability practices in the management and governance processes and systems. The findings may be handy in supporting other universities to promote these aspects right from the governance levels.

Despite the global call for sustainability transformations, researchers and practitioners struggle to achieve this goal. One promising avenue is to use concepts from systems theory, particularly system leverage points, to understand and accelerate transformation processes. This paper addresses how public decision-makers and politicians at different levels of local government understand sustainability transformations and the implications of this understanding for their governance. Furthermore, we investigate how the leverage point framework can aid in conceptualizing local governments’ transformation processes. The empirical basis is a series of focus group interviews with public decision-makers and politicians in Norway. Using system leverage points as a conceptual boundary object between transformation theory and practical sustainability interventions, we find that these interview subjects are addressing the urgency of the transformative change needed and view the gap between knowledge and action as a prominent challenge. We discuss and introduce the notion of a “space of leverage”—reflecting that sustainability interventions act in an interlinked space of possibility that spans sectors and governance levels. On this basis, we propose three recommendations for governing deliberate transformations: (1) establishing new means for collaboration that integrate system perspectives; (2) establishing a shared sustainability vision across government administration and politics; and (3) evaluating the current management system, emphasizing system leverage points. Our study responds to the calls for research that engages with the “how” of transformations and elucidates how the leverage point framework can be used to understand a current transformation process at the local level.

Connecting the Sustainable Development Goals to firm-level sustainability and ESG factors: The need for double materiality

Appropriate open defecation free (ODF) sustainability interventions are key to further mobilise communities to consume sanitation and hygiene products and services that enhance household’s quality of life and embed household behavioural change for heathier communities. This study aims to develop a logistic regression derived risk algorithm to estimate a 12-month ODF slippage risk and externally validate the model in an independent data set. ODF slippage occurs when one or more toilet adequacy parameters are no longer present for one or more toilets in a community. Data in the Zambia district health information software for water sanitation and hygiene management information system for Chungu and Chabula chiefdoms was used for the study. The data was retrieved from the date of chief Chungu and Chabula chiefdoms' attainment of ODF status in October 2016 for 12 months until September 2017 for the development and validation data sets respectively. Data was assumed to be missing completely at random and the complete case analysis approach was used. The events per variables were satisfactory for both the development and validation data sets. Multivariable regression with a backwards selection procedure was used to decide candidate predictor variables with p < 0.05 meriting inclusion. To correct for optimism, the study compared amount of heuristic shrinkage by comparing the model’s apparent C-statistic to the C- statistic computed by nonparametric bootstrap resampling. In the resulting model, an increase in the covariates ‘months after ODF attainment’, ‘village population’ and ‘latrine built after CLTS’, were all associated with a higher probability of ODF slippage. Conversely, an increase in the covariate ‘presence of a handwashing station with soap’, was associated with reduced probability of ODF slippage. The predictive performance of the model was improved by the heuristic shrinkage factor of 0.988. The external validation confirmed good prediction performance with an area under the receiver operating characteristic curve of 0.85 and no significant lack of fit (Hosmer-Lemeshow test: p = 0.246). The results must be interpreted with caution in regions where the ODF definitions, culture and other factors are different from those asserted in the study.

The healthcare sector in the United States has increased its greenhouse gas emissions by 6% since 2010 and today has the highest per capita greenhouse gas emissions globally. Assessing the environmental impact and material use through the methods of life cycle assessment (LCA) and material flow analysis (MFA) of healthcare procedures, products, and processes can aid in developing impactful strategies for reductions, yet such assessments have not been performed in orthopaedic surgery. We conducted an LCA and an MFA on an ACL reconstruction (ACLR). The ACLR served as a test case on the assumption that lessons learned would likely prove relevant to other orthopaedic procedures. (1) What are the life cycle environmental impacts of ACLR? (2) What is the material flow and material circularity of ACLR? (3) What potential interventions would best address the life cycle environmental impacts and material circularity of ACLR? First, we conducted an LCA according to International Organization for Standardization standards for quantifying a product's environmental impact across its entire life cycle. One result of an LCA is global warming potential measured in carbon dioxide equivalent (CO2eq), or carbon footprint. Second, we conducted an MFA of ACLR. Material flow analyses are used to quantify the amount of material in a determined system by tracking the input, usage, and output of materials, allowing for the identification of where materials are consumed inefficiently or lost to the environment. To contextualize the MFA, we calculated the material circularity indicator (MCI) index. This is used to measure how materials are circulating in a system and to evaluate the extent to which materials are recovered, reused, and kept within the economic loop rather than disposed of as waste. These three methods are widely used in other fields, especially engineering, but are more limited in healthcare research. Data collection and observations of ACLRs were made during ACLRs at the University of Pittsburgh Medical Center Bethel Park Surgical Center in Pittsburgh, PA, USA, between 2022 and 2023. Three sessions of data collection and observations were needed due to complexity and scheduling, ranging from understanding the sterilization procedures to weighing individual items. Data encompassing electricity usage; surgical equipment type; the use of heating, ventilation, and air conditioning (HVAC) systems; the production and reuse of reusable instruments and gowns; and the production and disposal of single-use surgical products were collected. Following data collection, we conducted the LCA and the MFA and then calculated the MCI for a representation of a single ACLR. To identify strategies to reduce the environmental impact of ACLR, we modeled 11 possible sustainability interventions developed from prior work and compared those strategies against the impact of the baseline ACLR. Our results show that the ACLR generated an estimated life cycle greenhouse gas emissions of 47 kg of CO2eq, which is analogous to driving a typical gasoline-fueled passenger vehicle for 120 miles. The total mass of all products for one ACLR was estimated at 12.73 kg, including 7.55 kg for disposable materials and 5.19 kg for reusable materials. Concerning material circularity, ACLR had a baseline MCI index of 0.3. Employing LCA for the carbon footprint and the MCI for 11 sustainability interventions indicated the potential to reduce greenhouse gas emissions by up to 42%, along with an increase in circularity (how materials are recovered, reused, and kept within the economic loop rather than disposed of as waste) of up to 0.8 per ACLR. Among the most impactful interventions are the reduction in the utilization of surgical pack products, reutilization of cotton towels and surgical gowns, maximization of energy efficiency, and increasing aluminum and paper recycling. ACLR has a substantial carbon footprint, which can meaningfully be reduced by creating a minimalist custom pack without material wastage, reusing cotton towels, and maximizing recycling. Combining LCA, MFA, and MCI can provide a thorough assessment of sustainability in orthopaedic surgery. Orthopaedic surgeons and staff can immediately reduce the environmental impact of orthopaedic procedures such as ACLR by opening fewer materials-via makingminimalist packs and only opening what is needed in the operating room-and by incorporating more reusable materials such as towels. Larger scale medical center changes, such as implementing recycling programs and installing energy-efficient systems, also can make a meaningful difference in reducing environmental impact.

Resilience and sustainability interventions in selected Post-Haiyan Philippines: MSMEs perspective

There is increasing recognition that sustainability science should be solutions orientated and that such solutions will often require transformative change. However, the concrete sustainability interventions are often not clearly communicated, especially when it comes to the transformative change being created. Using food and energy systems as illustrative examples we performed a quantitative systematic review of empirical research addressing sustainability interventions. We use a modified version of Donella Meadows' notion of ‘leverage points’ – places in complex systems where relatively small changes can lead to potentially transformative systemic changes – to classify different interventions according to their potential for system wide change and sustainability transformation. Our results indicate that the type of interventions studied in the literature are partially driven by research methods and problem framings and that ‘deep leverage points’ related to changing the system's rules, values and paradigms are rarely addressed. We propose that for initiating system wide transformative change, deep leverage points – the goals of a system, its intent, and rules – need to be addressed more directly. This, in turn, requires an explicit consideration of how scientific approaches shape and constrain our understanding of where we can intervene in complex systems.