Sustainability is a bit of a buzz word these days. To be sustainable means that you only use what you need, leaving the rest to be used by you or others in the future. Sustainability is a popular topic in environmental sciences and refers to renewable agriculture, good stewardship of natural resources and recycling of waste. What about sustainability in health care?
In health care, we often describe The United States health care system as unsustainable. The skyrocketing costs of U.S. health care simply cannot continue on their current trajectory. If the reality is that the rate of spending in The U.S. health care system is indeed unsustainable, how do we implement changes that will bring about sustainability?
Lesson learned from permaculture
Permaculture is the science of growing food in ways that give back to the earth. In permaculture, natural resources are conserved, and food production is possible without artificial pesticides and fertilizers. My garden is a significant source of food in my diet. To me, it’s important to know where my food comes from and how it has been cared for. Through permaculture, my goal is to live a sustainable lifestyle.
There are a lot of bright minds in health care, but sometimes bright minds evaluate problems exclusively from the standpoint of macroeconomics. Through the use of meta-analysis, surveys and white papers, bright minds look for trends that will address the problems in health care. But successful, sustainable health care isn’t about economic trends, it’s about people — individual people and the choices they can voluntarily make. Unfortunately, in health care, it’s also about people and the involuntary choices that they are forced to accept.
Practicing sustainability in health care
In permaculture, there are two fundamental principles. First, we each need to make a personal, lifestyle choice. To live a permaculture lifestyle we need to choose a permaculture lifestyle. Rainwater? Save it in a barrel. Kitchen scraps? Compost or feed them to your chickens. Waste? Recycle it. It’s a choice — a personal choice.
The second principle is transparency. Transparency is the ability to see and understand all that goes into your personal choice. Transparency of methods and tools that are used and the outcomes of your actions all need to be transparent. In permaculture, many people will choose to eat locally grown foods. Locally grown foods have not been shipped from afar, using fossil fuels. Locally grown foods will also be known to the consumer. The local rancher who raised that cow for which you now have a hamburger can tell you what went into raising that cow. The local farmer who raised those turnips can tell you about the chemicals (or lack of) that went into raising your food.
What are the intentional choices that can be made to create a sustainable health care system? Weight loss, smoking cessation, and increased physical activity are a good starting point. For most of us though, if a choice has no immediate benefit, why should we opt for the more difficult choice? Why choose to exercise when you could be watching television? Why choose to grow your own vegetables when you can pick up prepared food that’s quick and easy? Intentional choices aren’t always easy choices. Deliberately choosing the more difficult pathway in your life may be more expensive or result in more work. But in the end, it’s just about feeling good about yourself — your life, your health and how you impact the world.
Transparency in health care is the ability to easily and clearly understand all of the transactions that take place with your health care. One of the most complicated aspects of receiving and providing health care is the intersection of health care coverage and the care itself. To understand what I mean, think about what it takes for you to access your primary care doctor. Are you part of a provider panel that your doctor accepts? Has your coverage changed as of the first of the year? Does your coverage comply with the minimal standards of the Affordable Care Act? What’s your co-pay? What labs are covered? What hospitals? This is just the short list of challenges that each of us faces when trying to access health care — each which detracts from the transparency of the interaction and ultimately detracts from the quality and affordability of your health care.
Where do health care and permaculture intersect? My garden teaches me many lessons. I see the gardener and health care provider as acting in very similar roles. As the gardener, I till the soil and nurture my seeds until such time that I can enjoy the fresh flavors and nutrition that I’ve created over the growing year. As a doctor, I strive to enrich my patient’s health and make a positive contribution to their lives and to my immediate health care system.
Sustainability in health care is possible, but it depends upon providers helping patients make intentional choices and navigate a very opaque, non-transparent system of health care. With intentional choices and transparency, there may just be a little bit of this health system left for future generations.
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