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Analysis Building Healthy Communities

How healthcare can help heal communities and the planet

BMJ 2019; 365 doi: (Published 17 June 2019) Cite this as: BMJ 2019;365:l2398

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  1. Damon Francis, chief clinical officer,
  2. Gary Cohen, president and cofounder2,
  3. Jay Bhatt, president3,
  4. Charlotta Brask, sustainability director4,
  5. Mahesh Devnani, assistant professor5,
  6. Gael Surgenor, director of community and social innovation6
  1. 1Health Leads, Oakland, CA, USA
  2. 2Health Care Without Harm, Boston, MA, USA
  3. 3Health Research and Educational Trust, Chicago, IL, USA
  4. 4Region Stockholm, Stockholm, Sweden
  5. 5Department of Hospital Administration, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  6. 6Southern Initiative, Auckland Council, Auckland, New Zealand
  1. Correspondence to: D Francis dfrancis{at}

The gains from healthcare are often undermined by the sector’s contributions to social inequity and environmental damage, but it doesn’t have to be that way argue Damon Francis and colleagues

Over the past few decades, the world has made substantial progress on health outcomes, with large improvements in life expectancy and childhood mortality and many breakthroughs in treatments. Although progress has not been evenly distributed, some of the biggest improvements have been in countries with the most difficult health challenges.1 At the same time, however, the healthcare sector is contributing to poor health by exacerbating social inequity and environmental damage, both of which are major factors in the growing burden of non-communicable diseases such as cardiovascular disease, chronic respiratory diseases, and diabetes.234

The 17 sustainable development goals (SDGs) adopted by world leaders in September 2015 recognise that human wellbeing depends on reducing social inequity and protecting the environment. A recent study showed that the global healthcare sector is critical to achieving the SDGs and the comprehensive vision of health behind them.5 It concluded that healthcare is the most important sector for achieving six of the 17 goals, including those related to poverty, education, and employment. Healthcare is also in the top three for another seven goals and is cited more often than any other sector.5

We consider how healthcare is harming social inequity and causing environmental damage and present examples of healthcare organisations that are working to achieve healthy people living in equitable and resilient communities on a sustainable planet.

Sustainable energy and production

Climate change has rapidly become a critical driver of global morbidity and mortality. The World Bank estimates that climate change could exacerbate existing health inequities by putting more than 100 million people back into extreme poverty by 2030.6 Another recent study conservatively estimates …

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