Andersen Martin Marchman, Hauschild Michael Z, Lauridsen Sigurd
National Institute of Public Health, University of Southern Denmark, Odense, Denmark.
Department of Environmental and Resource Engineering, Technical University of Denmark, Kongens Lyngby, Denmark.
Health Care Anal. 2025 Jun;33(2):97-108. doi: 10.1007/s10728-025-00511-8. Epub 2025 Mar 4.
In this paper we discuss whether effective public health interventions and policies are environmentally sustainable. First, we suggest that the environmental impact from public health interventions and policies should be considered in the perspective of a human lifecycle. Second, we spell out in greater detail what we take it to mean for a public health intervention or policy to be environmentally sustainable. Third, environmental sustainability regards not only environmental impact, but also shares of our environmental "budgets", also referred to as environmentally safe operating spaces. Such budgets represent the limits of the sustainability of a group of individuals, e.g. a population. Each individual is assigned a share of the budget for each category of environmental impact, which represents how much the individual may impact the environmental category in question without doing so unsustainably. We discuss whether individuals ought to have a larger share of these budgets as a function of their ongoing life as this would make a better case for thinking that public health interventions and policies are environmentally sustainable. But we argue that this is incompatible with maximizing health within our environmental budgets and therefore mistaken. Instead, individuals ought to be ascribed a share of these budgets for life, a share that does not increase as individuals get older. We conclude that while some public health interventions and policies might be environmentally sustainable, we cannot merely assume that public health and sustainability are win-win; indeed, we have positive reason to think that some interventions and policies are not environmentally sustainable. Finally, we elaborate on how we ought to think about and react to this conclusion.
在本文中，我们探讨有效的公共卫生干预措施和政策是否在环境方面具有可持续性。首先，我们建议应从人类生命周期的角度来考虑公共卫生干预措施和政策对环境的影响。其次，我们更详细地阐述了我们认为公共卫生干预措施或政策在环境方面具有可持续性意味着什么。第三，环境可持续性不仅涉及环境影响，还涉及我们环境“预算”的份额，也称为环境安全操作空间。这些预算代表了一群人（例如一个人群）可持续性的限度。对于每一类环境影响，都会为每个人分配一份预算份额，这代表了个人在不造成不可持续影响的情况下可以对相关环境类别产生多大的影响。我们讨论个人是否应该根据其当前的生活状况在这些预算中占有更大的份额，因为这将更有力地支持公共卫生干预措施和政策在环境方面具有可持续性的观点。但我们认为，这与在我们的环境预算内实现健康最大化是不相容的，因此是错误的。相反，应该为个人分配一份终身的这些预算份额，且该份额不会随着个人年龄的增长而增加。我们得出结论，虽然一些公共卫生干预措施和政策可能在环境方面具有可持续性，但我们不能仅仅假设公共卫生和可持续性是双赢的；事实上，我们有充分的理由认为一些干预措施和政策在环境方面是不可持续的。最后，我们详细阐述了我们应该如何思考并应对这一结论。
