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Why would the healthcare industry
need a doughnut?
tech nology, policy makers, and medical writers
Kate Silverthorne example, global carbon dioxide levels, a control
Silverthorne Communications Limited and comm uni cators. variable for climate change, were nearly 410 parts
Ramsey, Isle of Man per million [ppm] in 2019, considerably above
What is doughnut the safe upper limit of 350
economics? The circular ppm.2,4 Meanwhile, a sub -
Correspondence to The doughnut economics stantial proportion of the
Kate Silverthorne frame work was developed by economy aims to world’s population is falling
kate@silverthorne.im eminent economist Kate eradicate waste short of the social boundaries.
Raworth and is a simple through careful The challenge to 21st century
representation of the social and design. The economists, and to all of us, is
Abstract planetary boundaries that to bring ourselves inside the
Doughnut economics provides a new frame - underpin human well-being biological or doughnut – into the safe and
(Figure 1).2, 3 just space for humanity.
work for sustainable development, by The inner ring technical
balancing the ecological boundaries of the represents social boundaries, components of a
planet with the social boundaries of below which no-one should product are designed The current situation
humanity. The framework provides a valuable fall; these are the 12 social The prevailing mindset and
opportunity for the healthcare industry to dimensions derived from the for disassembly and priorities of governments and
1
transition to a sustainable way of working – UN SDGs. The outer ring is re-purposing with businesses alike do not align
and for policy makers and health technology the ecological ceiling that we minimal energy, with with the doughnut framework.
assessment to drive the healthcare industry must avoid overshooting if we high-quality resultant Endless financial economic
towards this future. This article discusses what are to live within Earth’s life- growth is a very commonly
doughnut economics and the circular sustaining systems. The nine products. used target; however, infinite
economy system can mean for the healthcare planetary dimensions, rep re - growth is not possible in a
industry, policy makers, and health tech - sented by the outer ring of the system with non-infinite
nology assessment, and the role that medical doughnut, have been proposed by an resources (such as our planet Earth). The primary
writers and communicators can play in the international group of Earth-system scientists.2 goal for many businesses is economic growth to
change to a sustainable future. Currently, we as a species are overshooting satisfy short-term profits and shareholder return
nearly all of the planetary boundaries; for rather than improved human prosperity. In
addition to linear growth, the linear economy is
the norm, which can be described as “take
Introduction (energy, materials), “make (a product), “use
A s global citizens, many of us are becoming (consume), and “dispose (leading to waste)
nincreasingly aware of the environmental (Figure 2). However, this approach is incredibly
crisis unfolding around us. Fundamental changes wasteful of raw materials and finished
2,5
are required across human society for us to thrive products. The benefits ecosystems provide in
as a species. Global economic policy and models supporting humans have been described as
are at the heart of the current situation and are “ecosystem services (for example, carbon
central to fixing it, as recognised through the sequestration) and their monetary value has been
6
United Nations (UN) 2015 Sustainable Develop - calculated; this has highlighted the importance
1
ment Goals (SDGs) and the essential ecological of the natural world on human well-being,
changes that are required.2 Doughnut but there is the risk that this
economics is a new way of economic approach reduces the living
thinking that could provide the world to a price or asset on a
radical changes needed to tackle balance sheet in a finance-
2
the environmental crisis. This centric economy.
article focuses on those elements Attitudes and priorities are
of this doughnut economics starting to change. The UN
frame work that particularly apply has set out 17 SDGs as a
to the health care industry, health call to action to promote
76 | September 2021 Medical Writing | Volume 30 Number 3
Silverthorne | Why would the healthcare industry need a doughnut?
A doughnut economy for the healthcare industry
The doughnut represents the social and ecological boundaries that underpin human well-being.
Humans are currently
overshooting nearly all of
the planetary boundaries,
while a part of the world’s
population is falling short
of the social foundation.
The challenge is to bring
ourselves into the safe
and just space for
humanity that lies inside
the doughnut.
What can the healthcare industry do?
Adapt your business to a Reprocess and recycle medical
circular economy instruments.
Move your
Promote reprocessing of single- business from
use devices. money to people-
centred.
Don’t sell a product, sell the
service to repair it.
What can medical writers and medical communicators do?
Use energy from renewable Adapt regulatory documents to Align the company’s goals Apply the principles of regenerative,
sources and measure your office’s The European Green Deal’s to the UN’s Sustainable circular design to your use of resources
carbon and social footprint. guidelines. Development Goals. and to how your business is run.
Figure 1. The doughnut economics fr amework: the aim is to exist within the doughnut so that human activity does no t go
2
through the ecological ceiling and also ensures that no one is falling short of the social foundation.
Our work as medical writers and communicators could directly help reduce the shortfall in the social dimensions of “health” and “education”, and
improvements to one ecological or social dimension can positively impact the others.
"File:Doughnut (economic model).jpg" by DoughnutEconomics is licensed with CC BY-SA 4.0. To view a copy of this license, visit https://creativecommons.org/licenses/by-sa/4.0
www.emwa.org Volume 30 Number 3 | Medical Writing September 2021 | 77
Why would the healthcare industry need a doughnut? | Silverthorne
change to ones that are regenerative by design,
take i.e. restore and renew life cycles. A system central
recycle make to this is the circular economy, which provides an
make alternative to the linear economy (Figure 2). This
system has the potential to positively impact
multiple boundaries in the doughnut framework,
use both directly (such as reducing pollution and
dispose freshwater withdrawals) and indirectly through
remake use knock-on effects in other ecological and social
dimensions (for example, reducing air pollution
leads to healthier living conditions).
pollute The circular economy aims to eradicate waste
reuse through careful design. The biological or
technical components of a product are designed
for disassembly and re-purposing with minimal
energy, with high-quality resultant products.
Figure 2. The healthcare industry needs to move from a linear economy (left) to a Systems are run on renewable energy, and the
circular economy (right) to move to the centre of the doughnut. waste product actually provides a raw material for
5
"File:Linear versus circular.jpg" by Catherine Weetman is licensed with CC BY-SA 4.0. To view a copy of this license, visit a new process or product. Ideally, materials are
5
https://creativecommons.org/licenses/by-sa/4.0 reused in perpetuity. The European Union
published its Circular Economy Action Plan in
9 11
prosp erity while protecting the planet, and the than destroying and rebuilding them, corporate 2015, which is a key component of the
8
doughnut economics framework was instrumental businesses in clothing and retail are rethinking European Green Deal. Currently, European
in the negoti ations behind the develop ment of their corporate strategies in line with the policies are somewhat conservative and focus on
1,2 2
these goals. The European Green Deal is a doughnut framework, and cities such as the technical elements of the circular economy
roadmap towards sustainability; it draws on Amsterdam are striving to bring themselves rather than taking a more holistic and wide-
elements of the doughnut framework and seeks within the doughnut by protecting the environ - reaching view, for example aiming to reduce litter
7
to integrate the UN SDGs. This has been ment and natural resources, reducing social rather than tackling the wider issue of over -
8 12
detailed in a recent article in Medical Writing. exclusion, and guaranteeing good living consumption and materialism. However, as the
10
Moreover, a wide range of organisations and standards for all. circular economy gains more traction, policies
societies are already engaging with doughnut could become wider in scope and ambition.
economics. Two visionary architects recently The doughnut, the circular economy, Through her experiences with multiple
won the prestigious Pritzker Architecture Prize and business business leaders, Kate Raworth outlines five
through their work regenerating buildings rather Current, degenerative, linear practices need to corporate levels for stepping inside the doughnut
Figure 3. Corporate target levels for sustainability and business responses to the awareness of Earth’s planetary boundaries.2
Many healthcare industries have Level 4 as a target but should really aim for Level 5.
78 | September 2021 Medical Writing | Volume 30 Number 3
Silverthorne | Why would the healthcare industry need a doughnut?
(Figure 3).2 Some of these are probably familiar thinking about financial targets and the linear many single-use products can be designed for
to us when we hear companies’ proclaimed degenerative design, towards assets centred reuse. Steel surgical instruments can be sterilised
sustainability goals. Figure 3 shows us that many around people and knowledge.2 Financial and reprocessed; non-infectious waste can be
such goals – for example, carbon-neutrality – in partners, such as investors, are a key part of recycled, and endoscopes or blood-pressure cuffs
21
fact can go further. The ultimate business. Regenerative enter - can be disinfected for reuse. Even devices that
solution to entering the dough - The move away prises need to move away from can only be single-use on safety grounds
nut is regenerative design, by from financial gain the old shareholder-prioritised (needles, catheters) could be recycled to recover
reconnecting and giving back as short-term profit and growth- the base materials.19 Many hospitals are already
much as possible to the natural to human prosperity based dividends model, to reusing products designated as single-use to
world that sustains us – making illustrated by longer-term investments with a decrease costs, and some manufacturers are
the world a better place than we fair financial return.2 21,22
doughnut economics One exam - starting to move towards this model.
found it.2 One initiative to help should resonate ple of such initiatives is paying a Furthermore, medical device manufacturers
businesses achieve regenerative particularly share of the income stream to could shift away from selling a product to instead
design is biomimicry, which investors in perpetuity instead of selling a service, where medical equipment is
18
looks to nature’s systems to strongly with the profit-related divi dends. maintained rather than replaced, such as refurb -
create more sustainable designs healthcare The circular ishment of imaging equip -
and prod ucts, from bio de - industry. health care econ omy The ment or resharpening of
gradable deter gents to factories system could be a pharmaceutical blades.21 This encourages
13
that function like a forest. In valuable oppor tunity industry is slowly manufacturers to design
addition, the Doughnut Economics Action Lab for the health care industry to step repairability into their
moving towards 19
(DEAL) works with busin esses, govern ments, towards the doughnut economic products. In fact, moving
and com munities world wide to turn doughnut framework. This system is based on environmental to a service model could
economics into action, via, for example, policy the circ ular economy design and has sustainability, help companies expand their
making, reframing economic narratives, and been applied to reprocess ing and drives towards markets by reducing up-
14 recycling of medical and pharma - 19
systemic trans formation. Also, a prediction front costs and help
tool, the EN-ROADS climate simulator, is being ceutical devices and instru ments. The green materials and businesses achieve both
used by organisations to design scenarios to limit move away from single-use materials cleaner production ecolog ical and economic
15 is attractive both environmentally and
future global warming. are showing balance.
financially. The COVID-19 pandemic progress, but other Health technology as -
Doughnut economics and the has highlighted supply chain vulner - sess ment (HTA) and policy
healthcare industry abilities of single-use equipment,19 issues such as waste makers are ideally placed to
The move away from financial gain to human evidenced by shortages in single-use management facilitate the drive towards a
prosperity illustrated by doughnut economics personal protective equipment currently lag more regenerative, circular
20 healthcare economy. HTA
should resonate particularly strongly with the resulting in their reuse. In fact, behind.
healthcare industry. The European Green Deal provides information that
sets out a roadmap for greener practices in the inform about the best use of
8 23
healthcare industry. The pharmaceutical industry health resources from a societal perspective,
is slowly moving towards environ mental sust - which corresponds with the social dimensions
ainability; drives towards green materials and of the doughnut framework. Furthermore,
cleaner production are showing progress, environ mental impact is already recognised as
although other issues such as waste management the unintended as well as the intended
16 24
currently lag behind. In addition, many consequences of a health technology. In
pharmaceutical companies are setting environ - addition, frameworks exist for incorporating
24-26
mental and sustainability goals such as carbon environmental impacts into an HTA. One
17
neutrality and water use reductions, although of the remits of HTA is to support innovation
23
as discussed above, targets could be more and help implement new technologies, so
ambitious; for example, a company could strive HTA can facilitate a shift towards a regenerative,
to become carbon-negative (i.e. removing carbon circular economy system, where we can “do more
dioxide from the atmosphere rather than adding good, rather than merely “do less harm.
it). When considering patient risk, regulatory
A key challenge for healthcare business is bodies and professional societies tend to lean
changing the ambitions at the very heart of towards favouring single-use medical devices
business models towards regenerative design. for the safety of the individual patient (e.g.
This means moving away from entrenched minimising risk of infection). If we expand our
www.emwa.org Volume 30 Number 3 | Medical Writing September 2021 | 79
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