Introduction
The concept of sustainable development emerged as a guiding principle in the formulation of policies to address health and development issues around the world. Health is an international development agenda, and different steps have been taken to reduce mortality and morbidity by employing disparate strategies. For instance, the Rio Declaration of 1992 puts human beings at the centre of sustainable development (Nunes, Lee, & O’Riordan, 2016).
Similarly, Chapter Six of Agenda 21 by the United Nations (UN) shows the commitment of the world governments to protect and promote health as part of the sustainable development agenda. In 2000, 8 Millennium Development Goals (MDGs) were adopted, and three of them covered health objectives to be achieved by 2015. Goal 4 sought to reduce mortality for children less than 5 years old, while Goal 5 intended to reduce maternal mortality and improve access to reproductive care (Galvao et al., 2016).
On the other hand, Goal 6’s objective was to reverse the spread of malaria, tuberculosis, and HIV/AIDS. However, the majority of countries, especially in the developing world, did not achieve these goals. Therefore, in 2015 when the set period of MDGs elapsed, the international community came up with the Sustainable Development Goals (SDGs), which should be realised by 2030. The SDGs were formulated to address the evident gaps in MDGs. While all the SGDs will affect health indirectly, Goal 3 seeks to “ensure healthy lives and promote well-being for all at all ages” (Chapman, 2017, p. 1099).
Despite the failure of different attempts to achieve global health objectives under sustainable development, important progress has been achieved. Additionally, there are numerous opportunities that can be exploited to realise the benefits of pursuing global health goals within the framework of sustainable development. However, the available opportunities and benefits come with equal challenges as addressed in this commentary.
Opportunities and Benefits
In the context of sustainable development, health means more than the absence of diseases (Koivusalo, 2017). Health is a social dynamic component that entails lifestyles, social organisation, and patterns of consumption. All these factors are subject to the biophysical environment, socioeconomic systems, and personal behaviours. Therefore, health promotion under this context integrates socio-ecological understanding into the bio-medical approach to health. In order to understand this line of argument, there needs to be a clear definition of sustainable development.
According to Kjaergard, Land, and Pedersen (2014), sustainable development “is a process towards a new normative horizon, and it implies a paradigm shift from a development based on inequity and overexploitation of natural resources and environmental services to one that requires new forms of responsibility, solidarity, and accountability” (p. 559). This understating opens up the opportunities and benefits of addressing sustainable development by different players in the health promotion sector.
The number of national and international initiatives undertaken to promote health and sustainable development has been on the rise. However, Pettigrew, De Maeseneer, Anderson, and Haines (2015) argue that there is an exponential increase in the prevalence of chronic diseases, mental health problems, and other health conditions. Kjaergard et al. (2014) posit, “The simultaneous deterioration of public health and the state of the environment is partly linked to the inadequate integration of health promotion and sustainability dimensions at local, regional, and global levels” (p. 558). This assertion provides the first opportunity for the health promotion sector to address sustainable development.
For instance, in Malaysia, Colombia, Nigeria, Cameroon, and Indonesia, tropical rainforests are being cleared to advance the production of palm oil, which is used as cooking oil and fuel (Kjaergard et al., 2014). In this case, the intention has been to address health problems because palm oil is affordable food oil, and it lacks trans-fats. However, clearing rainforests leads to soil degradation and loss of biodiversity, which is ultimately unsustainable. Therefore, the health promotion sector should focus on how to mitigate the unintended negative effects, and thus foster sustainable development, while at the same time addressing health needs for the involved communities (Nabyonga-Orem, 2017). The benefits of this approach are many because communities will achieve reasonable health standards without advancing practices that threaten the sustenance of future generations.
Another opportunity for the health promotion sector is to use convergent and integrative strategies to address sustainable development (Buse & Hawkes, 2015). This strategy will allow the application of the model of human development. This model captures the three arms of sustainable development, which include health, economy, and the environment (Kjaergard et al., 2014). These three factors converge to create a form of interdependence that results in human development as opposed to the conventional economic development driven by capitalistic endeavours. Votruba, Eaton, Prince, and Thornicroft (2014) point that based on this model, any form of economic development must ensure the preservation of the environment sustainably, and at the same time factor in social sustainability.
Therefore, in the distribution of world resources and wealth, the equity should be observed to meet the objective of health for all, which is part of the SDGs (Buss, Fonseca, Galvao, Fortune, & Cook, 2016). As such, health promotion and sustainable development are placed at the core of the model. One of the best examples of how such models can be applied is the Healthy Cities Project. According to Cole et al. (2017), this project places different health aspects at the centre of urban interventions.
The benefit of such an approach is the creation of cities with adequate housing, transportation, secure spaces for exercise and play, and quality health care. Ultimately, sustainable development is taken care of, while at the same time addressing health issues. Unfortunately, the majority of these models and strategies have failed in different areas around the world. Therefore, the health promotion sector should take this failure as an opportunity to strategize again by addressing the gaps that have been noted in the earlier projects.
One of the ways that can be used to maximise health outcomes within the framework of the existing sustainable development is address gaps in previous strategies, and ensure that the involved stakeholders understand and execute their roles (Marimuthu & Paulose, 2016). The majority of opportunities for the healthcare promotion sector to address sustainable development are in the present challenges and previous failures. For instance, the world governments did not achieve the objectives for Health for All 2000, which were stated in 1978 in the Alma Ata Declaration (Warren et al., 2017). Similarly, the majority of the healthcare goals of the MDGs that expired in 2015 were not achieved. In the same way, the SDGs’ objectives for 2030 are unlikely to be realised due to challenges that faced previous attempts to address the issue. One of the problems has been the vertical integration of health services.
According to Carlin, Dowd, and Feldman (2015), while vertical integration has several benefits, it hinders sustainable development, especially in the healthcare sector, due to the short-term nature of the realised results. Liaropoulos and Goranitis (2015) posit that the current vertical programs target polio, malaria, tuberculosis, HIV/AIDs, and other preventable diseases. However, such programs stop the moment funding runs out.
For instance, Oleribe, Crossey, and Taylor-Robinson (2015) argue that the Roll Back Malaria program failed, and thus it could not achieve the intended objectives. Therefore, players in the health promotion sector should seize the opportunity to remove vertical health programs in places where they hinder sustainable development and embrace the integrated approach, which views health as a single holistic issue (Morgon, 2015). The benefits and implications of this move will be the destruction of vertical walls and the dismantling of standalone programs, which clears the way for integrative healthcare for all.
The foregoing argument highlights the need to have healthcare policies that promote sustainable development. Any health policy seeking to address sustainable development should focus on the duality of the two elements. According to Pedersen, Land, and Kjaergard (2015, “The concept of duality allows for an understanding of, and for developing a conceptual framework for, the integration of strategies for health promotion with strategies for sustainable development” (p. 6). As such, healthcare promotion and sustainable development should be tied together and addressed as one factor. Kjaergard et al. (2014) warn that the separation of the two ideas may have unintended socio-environmental consequences. In the worst cases, such a move could create new health problems.
For instance, in a bid to address food security in the developing world, the UN, in collaboration with the Food and Agriculture Organisation (FAO), came up with the Green Revolution initiative. In India, for example, this initiative meant the adoption of modern agricultural practices using herbicides, pesticides, and other inputs (Pingali, 2013). Additionally, the traditional varieties of grain were replaced by hybrid but barren seeds. Consequently, peasant farmers could not reproduce their native species, and those who could not afford the hybrid varieties were not in a position to farm after a few seasons. On the other hand, the health risks of exposing people to pesticides increased significantly. Carvalho (2017) argues that hundreds of thousands of individuals die annually from exposure to agrochemicals. Therefore, some policies have unintended negative consequences due to the failure to tackle critical issues.
The impact and benefit of addressing the duality of health promotion and sustainable development will be the elimination of inadvertent results (Dugani, Bhutta, & Kissoon, 2017). Consequently, communities will experience improved health outcomes by carrying out activities that are within the sustainable development framework.
Challenges
The main challenge facing healthcare promotion in addressing sustainable development is the failure to integrate the two aspects. Jelsoe et al. (2018) posit, “The strategies for health promotion are not sufficiently integrated with strategies for sustainable development, and that political strategies directed at solving (public) health problems or (environmental) sustainability problems may cause new, undesired and unforeseen environmental or health problems” (p. 103). This assertion is evident in the Green Revolution initiative discussed earlier in this paper. Conceptually, sustainable development has been loosely translated to mean environmental sustainability, which deprioritises the role of healthcare promotion (Rodgers, 2017).
The other problem is the definition of health as the absence of diseases. This worldview has created a complex challenge in establishing the important relationship between healthcare promotion and sustainable development. Another challenge has been the inability to provide evidence about the positive outcomes of integrating health promotion initiatives and sustainable development (Shapovalova, Meguid, & Campbell, 2015). Finally, in most political and administrative sectors, sustainable development, which mainly focuses on environmental sustainability and health promotion have functional divisions (Van de Pas, 2017). As such, attempts to come up with broad crosscutting objectives are hindered, and thus the integration of the two aspects becomes a challenge.
Conclusion
The concept of sustainable development seeks to address different issues including health, economy, and environment. Different attempts have been made to put health promotion in the context of sustainable development. However, the majority of these strategies, such as the Health for All and the MDGs, have failed to achieve the desired objectives. Nevertheless, players in the health promotion sector can capitalise on some opportunities to tackle this issue. The first opportunity for the health promotion sector is to use convergent and integrative strategies to address sustainable development. Similarly, bridging the gaps that have been highlighted in previous strategies will yield positive outcomes moving forward.
Finally, players in the health promotion sector should focus on making policies that tie health and sustainable development together, and thus address the two elements as one. The implications of these proposals would be the integration of health promotion into sustainable development to achieve the desired results. The main limitation of these suggestions is the conventional definition of health as the absence of diseases. This perception eliminates the possibility of integrating healthcare into sustainable development.
Additionally, the traditional assumption that sustainable development means environmental sustainability hinders the chance to incorporate the health aspect into policymaking. Finally, the inability to give evidence of positive outcomes of addressing health promotion in the context of sustainable development is another limitation. Moving forward, future directions for research and practice should focus on addressing the duality and the politics of integration of health promotion and sustainable development.
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