Discourse on the idea of sustainability: with policy implications for health and welfare reform
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Discourse on the idea of sustainability: with policy implications for health and welfare reform Ming‑Jui Yeh1
© Springer Nature B.V. 2019
Abstract Sustainability has become a major goal of domestic and international development. This essay analyzes the transitions of normative ideas embedded in the notion of sustainability by reviewing the discourses in the representative reports and literature from different periods. Three sets of ideas are proposed: inter- and intra-generational equity, stability of public systems, and a sense of solidarity, which confirms the scope of community and functions as a precondition for the previous two ideas. This essay uses the case of a health system in a hypothetical country to illustrate that, besides securing financial sustainability, a genuinely sustainable public system must also meet the three normative ideas of sustainability. This essay also finds that these three ideas may create intrinsic tensions within the prevalent policy-making model—democracy. The pursuit of sustainability is not only the responsibility of a democratic government, but also a shared moral obligation of the body politic. Keywords Sustainability · Sustainable development · Generational equity · Solidarity · Stability
Introduction Ever since the publication of the Our Common Future report by the World Commission on Environment and Development (WCED), the concept of sustainable development, or sustainability, has gradually prevailed and become a mainstream in policy-making agendas around the globe. Both in the international and intra-national scopes, declarations, covenants, legal documents, and public policies take this concept into consideration. In civil society, sustainability has also become a major language used by political mobilization and social movements. The concept of sustainability seems to represent a moral high ground in the twenty-first century. People seldom contest its legitimacy or necessity (WCED 1987; UNCED 1992); at most, they debate about the most effective or efficient policies for pursuing sustainability.1 Nevertheless, do humans really know to what we have committed when we appeal to this idea of sustainability? Besides the rhetoric in those declarative documents and so * Ming‑Jui Yeh [email protected] 1
Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
forth, the idea of sustainability actually contains several normative value presumptions (Sachs 2015). That is to say, when we declare that sustainability is our common goal, we have already recognized and upheld these values and are ready to cooperate and take joint actions to pursue them. This is a serious commitment made by us, or by the citizens of a body politic, to impose the idea of sustainability as a collective obligation upon ourselves. This seriousness warrants further investigation of this puzzle. The purpose of this essay is, therefore, to analyze the idea of sustainability and the normative value
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