The extraordinary economic growth rates of the twentieth century are historically exceptional and a continuation into the future seems neither possible nor desirable. Consequently, it is in the interest of public health to actively shape a socio-economic transformation towards a system that is not based on growth. “Degrowth” provides coherent guidelines for such a system. Combining existing scholarship from the degrowth and the public health fields, this paper makes seven suggestions for a public health agenda towards sustainable health: (1) to develop an index of health status in relation to present and future health burden; (2) to reduce the resource burden of medical therapy; (3) to translate increased productivity to fewer working hours and more free time instead of more income and material consumption; (4) to make use of non-conventional knowledge and non-commercial forms of work and product exchange; (5) to make knowledge freely available, making use of innovative research frameworks such as open source drug research; (6) to relocalize economic life and health-related organization and to reshape citizen participation and (7) to reduce socio-economic inequality through redistribution. Generally, this paper argues that it is time for discussions on degrowth to enter the mainstream medical and health community and for doctors and other health workers to acknowledge that they have a significant role to play and important experience to contribute when our societies face the upcoming challenge of no-longer-growing economies.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Aillon, J.L., Dal Monte, P., Ferrari, C. and Gardini, A. (2012) Special session on health and degrowth. In: Third International Conference on Degrowth for Ecological Sustainability and Social Equity, Venezia, 19–23 September. http://decrescitafelice.it/wp-content/uploads/11-J.Aillon.-doctors-for-degrowth.pdf. Accessed 5 May 2016
Aillon, J.L. and Dal Santo, E. (2014) ‘Health and Degrowth’, a new paradigm in the field of sustainability. Paper presented at the Fourth International Conference on Degrowth for Ecological Sustainability and Social Equity, Leipzig 2014. http://co-munity.net/system/files/3503.pdf. Accessed 5 May 2016.
Anand, S. and Hanson, K. (2004) Disability-adjusted life years: A critical review. In: Sudhir, A., Fabienne, P., Amartya, S. (eds.) Public Health, Ethics, and Equity. Oxford: Oxford University Press, pp. 183–200.
Årdal, C. and Røttingen, J.A. (2012) Open source drug discovery in practice: A case study. PLoS Neglected Tropical Diseases. doi:10.1371/journal.pntd.0001827.
Asara, V., Profumi, E. and Kallis, G. (2013) Degrowth, democracy and autonomy. Environmental Values 22: 217–239.
Berwick, D.M. and Hackbarth, A. (2012) Eliminating waste in US Health Care. JAMA 307(14): 1513–1516.
Bezruchka, S. (2009) The effect of economic recession on population health. Canadian Medical Association Journal 181(5): 281–285. doi:10.1503/cmaj.090553.
Borowy, I. (2013) Degrowth and public health in Cuba: Lessons from the past? Journal of Cleaner Production 38: 17–26.
Borowy, I. (2014) Sustainable health. Why WHO should get involved in discussions on new developmental models. WHO Bulletin 92: 699.
Borowy, I. (2017) Economic growth and health: Evidence, uncertainties and connections over time and place. In: I. Borowy and M. Schmelzer (eds.) History of the Future of Economic Growth. Milton Park: Routledge, pp. 129–153.
Cassel, C.K. and Guest, J.A. (2012) Choosing wisely: Helping physicians and patients make smart decisions about their care. JAMA 307: 1801–1802.
Castoriadis, C. (1997) The Imaginary Institution of Society. Cambridge: Polity Press.
Commission on Social Determinants of Health. (2008) Closing the gap in a generation: Health equity through action on the social determinants of health. Geneva: WHO. http://www.who.int/social_determinants/thecommission/finalreport/en/. Accessed 12 July 2015.
Costello, A., Abbas, M., Allen, A., et al (2009) Managing the health effects of climate change. The Lancet 373(9676): 1693–1733.
D’Alisa, G., Demaria, F. and Kallis, G. (eds.) (2014) Degrowth: A Vocabulary for a New Era. London: Routledge.
Daly, H. (1973) Toward a Steady-State Economy. San Francisco: W. H. Freeman.
Daly, H. (2013) Top 10 Policies for a Steady-State Economy. CASSE. 29 Oct 2013. http://steadystate.org/top-10-policies-for-a-steady-state-economy/. Accessed 1 Feb 2017.
Deininger, K. and Squire, L. (1998) New ways of looking at old issues: Inequality and growth. Journal of Development Economics 57: 259–287.
Demaria, F. et al (2013) What is degrowth? From an activist slogan to a social movement. Environmental Values 22: 191–215.
De Vogli, R. and Owusu, J.T. (2015) The causes and health effects of the Great Recession: From neoliberalism to ‘healthy de-growth’. Critical Public Health 25/1: 15–31.
Doran, E. and Henry, D. (2008) Disease mongering: Expanding the boundaries of treatable disease. Internal Medicine Journal 38: 858–861.
Engel, G.L. (1977) The need for a new medical model: A challenge for biomedicine. Science 196: 129–136.
Floud, R., Fogel, R., Harris, B. and Hong, S.C. (2011) The Changing Body. Health, Nutrition, and Human Development in the Western World Since 1700. Cambridge: Cambridge University Press.
Fogel, R. (2012) Explaining Long-term Trends in Health and Longevity. Cambridge: Cambridge University Press.
Forgacs, I. and Loganayagam, A. (2008). Overprescribing proton pump inhibitors. BMJ 336(7634): 2–3.
Fotopoulos, T. (1997) Towards an Inclusive Democracy. London/New York: Cassell.
Frohock, F. (2002) Moving lines and variable criteria: Differences/connections between allopathic and alternative medicine. The ANNALS of the American Academy of Political and Social Science September 583:214–232.
Gagne, J. and Choudhry, N. (2011) How many ‘me-too’ drugs is too many? JAMA 305(7):711–712.
Gagnon, M.A. and Lexchin, J. (2008) The cost of pushing pills: A new estimate of pharmaceutical promotion expenditures in the United States. PLoS Medicine 5(1): e1. doi:10.1371/journal.pmed.0050001.
Georgescu-Roegen, N. (1971) The Entropy Law and the Economic Process. Cambridge: Harvard University Press.
Gertham, U.G. and Ruhm, C.H. (2002) Deaths rise in good economic times: Evidence from the OECD. NBER Working Paper Series, 9357. http://www.nber.org/papers/w9357.
Grady, D. and Redberg, R.F. (2010) Less is more: How less health care can result in better health. Archives of internal medicine 170(9): 749–750.
Hales, S., Kovats, S., Lloyd, S., Campbell-Lendrum, D. (2014) Quantitative Risk Assessment of the Effects of Climate Change on Selected Causes of Death, 2030s and 2050s. Geneva: World Health Organization.
Hall, M.A. and Schneider, C. (2008) Patients as consumers: Courts, contracts, and the new medical marketplace. Michigan Law Review 106: 643–689.
Herman, P.M. et al (2012). Are complementary therapies and integrative care cost-effective? BMJ Open, 2:e001046. doi:10.1136/bmjopen-2012-001046.
Hyatt, J. (2014) Down with Sustainable Development! Long Live Convivial Degrowth! Inter Press Service. http://www.ipsnews.net/2014/11/down-with-sustainable-development-long-live-convivial-degrowth/. Accessed 24 February 2017.
Illich, I. (1973) The Tools for Conviviality. New York: Harper and Row.
Illich, I. (1976) Medical Nemesis: The Expropriation of Health, New York: Pantheon Books.
Jackson, T. (2009) Prosperity without Growth. London: Earthscan.
Kallis, G., Kerschner, C. and Martinez-Alier, J. (2012) The economics of degrowth. Ecological Economics 84: 172–180.
Kickbusch, I. (2015) The political determinants of health—10 years on. BMJ 350: h81.
King, C. and Bertino, A.-M. (2008) Asymmetris of poverty: Why global burden of disease valuations underestimate the burden of neglected tropical diseases. PLOS. Neglected Tropical Diseases. doi:10.1371/journal.pntd.0000209
Krausmann, F., Erb, K.-H., Gingrich, S. et al (2013) Global human appropriation of net primary production doubled in the 20th century. PNAS 110(25): 10324–10329.
Kuznets, S. (1955) Economic growth and income inequality. American Economic Review 45: 1–28.
Lakner, C. and Milanovic, B. (2013) Global income distribution: From the fall of the Berlin wall to the great recession. World Bank Policy Research Working Paper 6719.
Latouche, S. (2006) Le pari de la décroissance. Paris: Fayard. (engl: A Farewell to Growth. Cambridge: Polity Press, Cambridge, 2009).
Lawn, J. et al (2008) Alma-Ata 30 years on: Revolutionary, relevant, and time to revitalize. The Lancet 372(9642): 917–927
Macfarlane, J. et al (1997) Influence of patients’ expectations on antibiotic management of acute lower respiratory tract illness in general practice: Questionnaire study. BMJ 315: 1211–1214.
Martinez-Alier, J. et al (2010) Sustainable de-growth: Mapping the context, criticisms and future prospects of an emergent paradigm. Ecological Economics 69(9): 1741–1747.
McNeill, J. (2002). Earth, Wind, Water and Fire: Resource Exploitation in the Twentieth Century. Global Dialogue, 4(1). http://worlddialogue.org/print.php?id=177.
Meadows, D., Meadows, D., Behrens III, W. and Randers, J. (1972) The Limits to Growth. New York: Universe Books.
Missoni, E. (2015) Degrowth and health: Local action should be linked to global policies and governance for health. Sustainability Science 10/3: 439–450.
Mont, D. (2007) Measuring health and disability. Lancet: 369, 1658–1663.
Moynihan, R., Heath, I. and Henry, D. (2002) Selling sickness: The pharmaceutical industry and disease mongering. BMJ 324: 886–891.
Moynihan, R. and Smith, R. (2002) Too much medicine?: Almost certainly. BMJ: British Medical Journal 324: 859.
Moynihan, R., Doust, J. and Henry, D. (2012) Preventing overdiagnosis: How to stop harming the healthy. BMJ 344: e3502.
Nef (New Economics Foundation). (2010) The Great Transition. http://www.neweconomics.org/publications/entry/the-great-transition. Accessed 12 Jul 2015.
nef. (2010) Growth isn’t possible. Written by Simms, A., Johnson, V. and Chowla, P. London: nef.
Nef. (2016) The Happy Planet Index 2016. http://happyplanetindex.org/.
NIHCM. (2002) Changing Patterns of Pharmaceutical Innovation. The National Institute for Health Care Management Research and Educational Foundation. www.nihcm.org.
Paech, N. (2012) Befreiung vom Überfluss. [Liberation from Affluence] Munich: Oekom Verlag.
Palma, J.G. (2011) Homogeneous middles vs. heterogeneous tails, and the end of the ‘Inverted-U’: The share of the rich is what it’s all about. Cambridge Working Papers in Economics (CWPE) 1111. http://www.econ.cam.ac.uk/dae/repec/cam/pdf/cwpe1111.pdf.
People’s Health Movement. (2000) People’s Charter for Health. http://www.phmovement.org/sites/www.phmovement.org/files/phm-pch-english.pdf.
Piketty, T. (2013) Le capital au XXIème siècle. [Capital in the Twenty-First Century]. Paris: Éditions du Seuil
Rayner, G. and Lang, T. (2012) Ecological Public Health. London and New York: Routledge.
Rao, V.M. and Levin, D.C. (2012) The overuse of diagnostic imaging and the Choosing Wisely initiative. Annals of internal medicine 157: 574–576.
Roberti di Sarsina, P. and Iseppato, I. (2010) Person-centred medicine: Towards a definition. Forschende Komplementärmedizin 17(5): 277–278.
Ruhm, C.J. (2007) A healthy economy can break your heart. Demography 44: 829–848.
Schneider, F. et al (2010) Crisis or opportunity? Economic degrowth for social equity and ecological sustainability. Introduction to this special issue. Journal of cleaner production 18(6): 511–518.
Seeman, M., et al (2014) Social status and biological dysregulation: The ‘status syndrome‘ and allostatic load. Social Science and Medicine 118: 143–151.
Silenzio, V. (2002) What is the role of complementary and alternative medicine in public health? The American Journal of Public Health 92(10): 1562–1564.
Spence, M. (2009) Introduction. In: Spence, M. and Lewis, M. (eds.) Health and Growth. New York: World Bank.
Suls, J. and Rothman, A. (2004) Evolution of the biopsychosocial model: Prospects and challenges for health psychology. Health Psychology 23(2): 119.
Tapia Granados, J.A. and Diez Roux, A.V. (2009) Life and death during the Great Depression. PNAS. http://www.pnas.org/content/106/41/17290.
Tokic, D. (2012) The economic and financial dimensions of degrowth. Ecological Economics 84: 49–56
Trouiller O. and Olliaro, P.L. (1999) Drug development output from 1975 to 1996: What proportion for tropical diseases? International Journal of Infectious Diseases 3: 61–63.
Van Reybrouck, D. (2016) Against Elections: The Case for Democracy. London: The Bodley Head.
WCED (World Commission on Environment and Development) (1987, reprinted 2009). Our Common Future, Oxford: Oxford University Press.
WHO. http://www.who.int/countries/en/. Accessed 12 July 2015.
WHO. (1946) Constitution. http://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf?ua=1. Accessed 12 July 2015.
WHO. (2011) Consultative Expert Working Group on Research and Development: Financing and Coordination. http://www.who.int/phi/news/cewg_2011_background/en/. Accessed 12 July 2015.
WHO. (2012) All for equity. Meeting Report of the World Conference on Social Determinants of Health. http://www.who.int/sdhconference/resources/Conference_Report.pdf. Accessed 12 July 2015.
WHO. (2013) WHO Methods and Data Sources for Global Burden of Disease Estimates 2000–2011. Geneva: WHO.
WHO. (2014a) Safe Management of Wastes from Health-Care Activities. 2nd edition. Geneva: WHO.
WHO. (2014b) WHO traditional medicine strategy: 2014-2023. http://apps.who.int/iris/bitstream/10665/92455/1/9789241506090_eng.pdf. Accessed 12 July 2015.
WHO. (2014c) WHO Global Health Expenditure Atlas. Geneva: WHO.
Wilkinson, R. and Pickett, K. (2009) The Spirit Level: Why Equality is better for Everyone. London: Allen Lane.
Zheng, S. and Matthew, K. (2013) Understanding China’s urban pollution dynamics. Journal of Economic Literature 51(3):731–772.
About this article
Cite this article
Borowy, I., Aillon, JL. Sustainable health and degrowth: Health, health care and society beyond the growth paradigm. Soc Theory Health 15, 346–368 (2017). https://doi.org/10.1057/s41285-017-0032-7
- public health
- drug production
- social determinants of health