The Western medical model often strives relentlessly to combat illness, aging, and death without establishing well-defined boundaries. This approach can result in potentially excessive treatments, especially towards the end of life, leading to suffering, squandered resources, and unnecessary costs. We endorse the notion that reintroducing the concept of limits and finitude into medical practice is pivotal. Engaging in discussions about death with our patients, working on hope, setting boundaries, and implementing a quality-of-life approach early on are all integral to ensuring that medicine remains accessible to the needs of future generations.
Overprescription of medications undermines patients’ quality of life and safety. It also impacts the healthcare system and the environment. According to the report “Decarbonizing Health for Better Care” published by The Shift Project in 2023, medication purchases constitute the leading source of greenhouse gas emissions in the healthcare sector, accounting for over 14.5 million tons of CO2. This represents 29% of the sector’s total emissions.
To implement a rational use of medication and in response to sustainable development challenges, deprescribing emerges as a solution. It is a process aimed at identifying, reducing, or even discontinuing overprescribed medications. However, its implementation in routine clinical practice remains limited.
In this article, we propose actions and strategies that could foster changes in the habits of current and future healthcare professionals regarding medication deprescribing, thus promoting the concept of sustainable healthcare.
From a systemic perspective, the healthcare system can be seen as an open system, involving flows of energy and materials, and producing greenhouse gases and waste besides healthcare. It is estimated that healthcare consumes between 4% to 7% mineral resources, metals, and fossil fuels used on earth each year, and produces more than 5% of all greenhouse gas emissions. To reduce this impact, it is necessary to combine an “item-by-item” approach with a more global and systemic one, which will require far-reaching changes. A few examples are given, particularly concerning the use of information and communication technologies
In 2022, the second section of the sixth report from the Intergovernmental Panel on Climate Change (IPCC) dedicated a full chapter to the impact of climate change on health, including physical, community, and mental health. In terms of mental health, the authors reported observations of various impacts related to direct and indirect exposure to extreme weather events (e.g., floods) and gradual chronic changes (e.g., air pollution). Adequately documented, such impacts require the rapid adoption of healthcare system action plans. Beyond these effects, anxiety linked to the anticipation of climate change impacts – also known as eco-anxiety – represents an underexplored field whose prevalence and consequences on mental health remain poorly investigated. Recent studies suggest that, when moderate in intensity, eco-anxiety may constitute an adaptive response that stimulates the adoption of environmentally friendly behaviors without harming mental health. Delimiting the existence and predictors of such a range represents a crucial challenge of scientific research in this field. Here, we present some potential clinical interventions derived from similar fields of psychotherapy.
Preventive healthcare, which generally decreases the need for medical treatment, is one of the levers for reducing healthcare’s environmental impact. Implementing preventive measures requires a global approach. This goes beyond the “disease” model, and simultaneously considers individual health, population health, and global/planetary health, from a systemic perspective that takes into account uncertainty and long term considerations. To tackle this challenge, we need to encourage dialogue and cross-fertilization of viewpoints, particularly among the three healthcare organization levels (micro level and its “health referent” function, meso level of catchment areas at which primary healthcare provision and its coordination with hospitals are established, macro level at which a country’s healthcare policies are defined). Sustainable development, prevention, and healthcare share numerous observations: we need to change our mindset, and in particular make more room for dialogue, deliberation, and uncertainty.
The health benefits of physical activities for children and adolescents are numerous and widely documented. While the World Health Organization recommendations for physical activity are clear, only 27 to 33% of children and adolescents worldwide achieve them. Belgium is no exception, with a very low percentage of children and adolescents having adequate levels of physical activity. In addition to various mental and physical health benefits of nature, the outside environment can play a role in promoting physical activities. Children and adolescents in contact with green spaces reportedly have higher levels of physical activity and less sedentary habits. In the outdoor environment, children exercise more intensively and spontaneously. Outdoor physical activities are likely to have a positive impact on young people’s health and general physical activity levels. Getting children outside more often and reconnecting them to nature can play an interesting role in the health of future generations.
This seminar summary is partly based on the work of Prof. Senn from the University Center for General Medicine and the research team from the University Center for General Medicine, University of Lausanne. Its purpose is to develop the notion of co-benefit for health and the environment. The latter is defined as the simultaneous impact on health and the environment of everyday choices and changes that people can undertake in their own lives (e.g. dietary or mobility choices). Rather than being a theoretical, abstract notion, it can be integrated into our daily practice, as illustrated by the clinical vignette presented in this article.
Three great challenges are having a huge impact on health: major health inequalities, insufficient recognition of the socio-economic determinants of health, and an ageing population. Despite these well-known realities, our institutions remain focused on curative care based on a negative definition of health (absence of disease). The concept of positive health defines health as the ability to adapt and gain control when facing life’s social, physical, and emotional challenges. With its six dimensions (physical function, mental well-being, meaning of life, quality of life, social participation, and daily functioning), it offers an alternative, global vision of health. This unifying concept encourages the commitment of all players (schools, local authorities, town planners, social services, associations, healthcare professionals, etc.) in concrete projects, some of which have already proved their worth. A few examples are described here.
The ecological transition is underway: This movement supporting the evolution towards a new model of society that embraces sustainability and solidarity calls into question our current healthcare system in particular. General medicine is also called upon to make this transition. This article highlights the concrete initiatives that have been put in place to educate, inform, and act in favor of planetary health at the front-line level. This article was presented during the “Teach the Teacher: Challenges and Perspectives” program on October 3, 2022, as part of the “University in Transition”.
Global crises related to environmental changes are undermining healthcare structures. Yet, the medical practice itself contributes to this situation by responding to a logic of consumption and by indiscriminately generating pollution. To what extent are these behaviors counterproductive by contributing to a global evil? A medical ethic for the future, which would integrate environmental care into the prerogatives of medical practice, seems necessary.
This ethic already exists and is embodied in what for decades has been referred to as “bioethics”. Van Rensselaer Potter considered this discipline to be a necessary wisdom for the use of techniques and knowledge specific to the life sciences, and Fritz Jahr saw it as a moral obligation towards all living beings. However, it is the most pragmatic but also the most individualistic application proposed by André Helleghers and, following him, Beauchamp and Childress that has been retained and widely applicated.
