# Is Public Health Environmentally Sustainable?

## TL;DR

This paper examines whether public health interventions and policies are environmentally sustainable, challenging the assumption that they are always win-win.

## Contribution

The paper introduces the concept of environmental 'budgets' and argues against increasing individual shares over time for sustainability.

## Key findings

- Environmental sustainability in public health requires considering both impact and budget shares.
- Increasing individual environmental shares over time is incompatible with maximizing health within sustainability limits.
- Some public health interventions may not be environmentally sustainable, contradicting the win-win assumption.

## Abstract

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.