What makes a health service ‘sustainable’?
In the quest for truly ‘sustainable’ health services, health and social care must be viewed within the wider context of the Sustainable Development Goals. The ‘sustainability competencies’ that will enable countries to meet their commitments under the SDGs, and the ‘education for sustainability’ that is needed to achieve this, are no less applicable to health care providers than to any other large institution.
In a report published earlier this year on the UK Government’s implementation of the SDGs, the International Development Committee of the House of Commons highlights the need for multi-sector partnerships. The roles of civil society and the private sector are just as important as the roles of government. Within government, synergies between different departments must be identified and developed as a matter of urgency, and potential policy conflicts resolved.
In shifting its focus from acute care to sustainable well-being, in the sense of well-being that is sustained not only through the years of productive employment but also into old age, the UK National Health Service cannot work alone. It may serve as the hub, or merely as one player, in a vast and interconnected network of organisations contributing to the well-being of people, places, and communities – in full recognition that it is impossible for one of these to be healthy if the others are chronically unwell.
As an academic turned social entrepreneur, I am directing most of my attention towards the integration of diverse approaches to human wellbeing, and the creation of effective multi-sector partnerships. Much of what has been learned through research funding schemes such as the Arts and Humanities Research Council’s innovative Connected Communities programme, in terms of the benefits and challenges of collaboration and the essential requirements for a positive experience of co-creation, can be applied equally to the construction of partnerships between the NHS and other stakeholders. Many of the lessons from evidence-based integrative health care initiatives, which have recently become widespread in the United States and Israel but have also been a reality of health care provision for many decades in India and China, could be systematically applied within the context of the transformation of the NHS.
Antibiotic resistance is only one example of a problem that biomedicine has found difficult to overcome, while traditional and complementary health care systems have effective strategies to hand. Indeed, it could be argued that the entire process of extracting the ‘active ingredient’ from a plant or fungus, which has been the cornerstone of the biomedical and ethnobotanical research enterprise for many decades, is perfectly designed to produce antibiotic resistance. The holistic approach of traditional and complementary health care, by contrast, will typically involve treating the patient with a polyherbal preparation in which each herb may contain multiple active substances, often with synergistic effects. At the same time, the patient is subjected to a treatment regime that may include recommendations on diet, rest, exercise, and many other interventions that have been shown to increase immune function.
Another important aspect of traditional systems of health care, often overlooked by researchers, is the use of outdoor sites such as ‘sacred groves’ and other places that are specifically dedicated to the restoration of health. In India, for example, even the National Ayurvedic Hospital has an outdoor area with seating where patients are encouraged to spend time among the sacred trees.
It is encouraging to see the growing interest in ‘connection to nature’ within the NHS and elsewhere, which is exemplified by – among others – the Ecominds initiative, the excellent work of the South Region Sustainability and Health Network, the Nature Connections Network based at the University of Derby, the work of the Wildlife Trusts and the National Trust, and the Valuing Nature Network that brings together several of the UK Research Councils. These initiatives, individually and collectively, are amassing a large body of research evidence relating to the physical, psychological, emotional, social, practical and spiritual benefits of reconnection with nature.
There is enormous scope, at a policy level, for building on these promising initiatives. ‘Health walks’ and ‘green exercise’ schemes cost almost nothing, but have enormous benefits for people with mental health challenges, obesity and a number of physical health conditions. It would be entirely feasible to require all hospital inpatients to have a ‘daily dose of nature’, weather permitting, and for GPs to consider prescribing these interventions as a first line of treatment.
In establishing the Re:Connecting Global Partnerships Initiative, I have acknowledged that what we might term ‘reconnection therapy’ involves far more than nature alone. The Initiative seeks to promote and encourage reconnection not only with the natural environment, but also with the arts (and especially engaging patients in creative practice), with the body through practices such as dance and yoga, and with community-building initiatives – in recognition of the importance of the social dimension in wellbeing.
This post is adapted from Gemma Burford’s written statement to the House of Lords Committee on the Long-Term Sustainability of the UK National Health Service, in response to the theme on ‘Prevention and Public Engagement’, which was submitted on 23 September 2016.