Abstract
This paper critically reviews the expanding literature on applications of sustainability to healthcare policy and planning. It argues that the concept has been overgeneralized and has become a buzzword masking disparate agendas. It ignores the insights of the newest generation of systems theory on complex systems on the ubiquity of far-from-equilibrium conditions. Yet, a central meaning often ascribed to sustainability is the level continuation of healthcare programs and their institutionalization. Sustainability is only coherent in health care when it is more narrowly delimited to involve public health and treated as only one of several evaluative criteria that informs not only the continuation of programs but more often their expansion or contraction as needs dynamically change.
Highlights
Some commentators complain that sustainability has become a buzzword, even an oxymoron [1], and argue that the “sustainable development” of healthcare policies and programs is a logical impossibility
Carson’s classic The Silent Spring [10] about environmental degradation is often cited as the single most important stimulus for the environmental movement which has sought to protect the physical environment from unrestrained growth and to assure intergenerational equity in the extraction of its resources
The focus of this paper is on the meaning of sustainability in public health under inherently unstable and changing conditions, involving the phenomenon known as the “edge of chaos.”
Summary
Some commentators complain that sustainability has become a buzzword, even an oxymoron [1], and argue that the “sustainable development” of healthcare policies and programs is a logical impossibility. The growth in scholarly interest in these applications is part of a broader interest in grounding healthcare policy and planning in social ecology, and in incorporating the concerns and insights of the environmental movement [3] The sources of this interest are diverse; the increasing vulnerability of healthcare organizations is no doubt fueling an interest in organizational survival, even more than the continued development, fine-tuning, and targeting of healthcare services. This paper critically reviews selected applications of sustainability in healthcare, regarding both their limitations and possibilities It does this, in part, by drawing on insights from complex systems theory which has introduced a paradigmatic shift towards thinking about policy systems as necessarily operating at far-from-equilibrium conditions, in a dynamical regime referred to as the “edge of chaos”, where systems adapt and thrive only when there is a finetuned balance between periodic and chaotic processes [5,6,7,8]. The forty-nine (49) sources selected for inclusion in this paper were chosen not so much as a representative sample, but more for their ability to illustrate the major arguments and approaches to the subject
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
