Prof Eivind Engebretsen discusses why sustainability in health care cannot be implemented.
Sustainability in health care is widely framed as a problem of implementation: policies are designed, evidence is assembled,
and failure is diagnosed when action does not follow. This lecture challenges that framing. Prof Engebretsen argues that
sustainability in health care cannot be implemented because it is not a stable programme but a contested, value-laden practice
that takes shape through mediation rather than delivery. Treating sustainability in health care as implementable is therefore a
category error—one that helps produce the very problem it seeks to resolve, by recoding alternative values as barriers and
situated practices as deficits requiring correction.
Drawing on a recent systematic review of grassroots indicators across fields and sectors—including sustainability indicators—
Prof Engebretsen shows that in these projects sustainability was not absent, waiting to be implemented, but already being
practised—through livelihoods, norms of resource use, and shared understandings of what could and could not be sustained.
What was missing was not action, but a language in which such practices could count as sustainability within policy
frameworks. What is commonly described as an “implementation gap” is therefore better understood as a space of ongoing
mediation, where knowledge, values, and authority are continually renegotiated. Sustainability in health care, on this view, is
always already happening—not as logistical rollout, but in grassroots initiatives, everyday practices of care, and irresolvable
disagreements over what should be sustained, for whom, and at what cost. The task is not to implement sustainable health
care more efficiently, but to recognise, engage with, take responsibility for, and strengthen the forms of sustainability already
in motion by rendering them visible and politically intelligible.
About the speaker:
Professor Eivind Engebretsen is a medical humanities scholar and professor of interdisciplinary health science at the University
of Oslo, serving since 2023 as Dean of the Open Campus at the European University Alliance Circle U, and founding head of the
Sustainable Health Unit (SUSTAINIT) and the Centre for Sustainable Healthcare Education (SHE), a Norwegian government-
funded Centre of Excellence in Education. His research explores how medical knowledge is generated, applied, documented,
evaluated, and communicated in clinical encounters as well as in broader societal contexts.
