Discourse on the idea of sustainability: with policy implications for health and welfare reform

This is, in some senses, a strong statement. While major international organizations and collaborative efforts, as the essay will show, have recognized the legitimacy and emergency of the sustainability issue, many question it as well. The differences are due to a variety of social, political, economic factors, which however is not the subject of this essay.

As the author is originated from Taiwan, the development of the concept of sustainability in the country could be briefly noted here. Since Taiwan, internationally recognized as the Republic of China, was expelled from the United Nations and replaced by the People's Republic of China (PRC) in 1971, the country has very limited space in global participation. However, the country has managed to incorporate the concept of sustainability into its national institutions parallel to the global trend. In 1992, the Second Amendment of the Constitution of Taiwan included a new article (Article 10) stating that “environmental and ecological protection shall be given equal consideration with economic and technological development”(MOJ 1992/2005). In 1994, the executive branch of the Taiwanese government commissioned the Task Force on Global Transition, which was later promoted as part of the formal administrative institution, the National Council for Sustainable Development, as mandated by the Basic Environment Act of 2002 (Article 9) (MOJ 2002). The definition of sustainable development adopted by the Basic Environment Act is “satisfying contemporary needs without sacrificing the ability of future generations to satisfy their needs” (Article 2) (MOJ 2002), which is identical to that found in the Our Common Future report.

These essential human needs, however, are still unbounded needs, for they include almost every aspect of human activities and are too broad to be operationalized. This unbounded needs problem will be further addressed later.

We could even put aside the “equality of what” question for now.

This intentional vagueness is a common strategy in international collaborations.

The issue of the time scales of sustainability is beyond the scope of this essay. Please refer to Handoh and Hidaka’s work for more discussion (Handoh and Hidaka 2010).

This collectivist notion of solidarity is different from the aggregation of minds of individuals. Individuals might form minds that correlate one with another in different aspects through direct interpersonal connections, and these individualist sentiments are sometimes also referred as solidarity. Collectivist solidarity might be related to these individualist sentiments, but is a sentiment at the population level. It could be, but not necessarily, derived from direct interpersonal connections. In many cases, it is derived from connections between members of a “imagined” collectivity, or, a community (Anderson 2016).

Consider what political philosopher John Rawls has well argued. A stable just institution will require people to have a sense of justice to sustain (p. 453–458) (Rawls 1971). These people see each other as free and equal moral agents. They make collective political decisions and social cooperation to maintain the public institution according to the conception of justice (p. 472–476). Their sense of justice attached to the public institution is derived not from self-interests or other emotions, but from their recognition of the conception of justice. However, Rawls’s argument is based on the presumption that people are already situated in a well-ordered society with just institutions (p. 453–458), while we are clearly situated in a society that is far from well-ordered, let alone the conception of justice people believe in. Under these circumstance, solidarity might be an alternative to sense of justice as the psychological grounds to sustain the stability of public systems.

Even for the members of a family is not blood related, their legal relationship is modeled as if they are in a blood family.

For policymakers under different contexts in different countries to steer these sentiments, we are certainly not satisfied with this undefined account of normative solidarity. Country case-based empirical researches are needed to investigate the values of the health systems and the sentiments shared by the peoples.

For instance, scholars have proposed global solidarity and human solidarity as concepts to address solidarity in health sector (Reichlin 2011; West-Oram and Buyx 2017; West-Oram 2018).

Like the ones in Taiwan, South Korea, (Wong 2004), and in the provinces in Canada (Marchildon 2013). The insurer in a national health insurance program is often a single-payer insurer run by the government. Contributions are made by employers, employees, and the government from general tax revenues. For a fuller list of countries adopting national health insurance programs and the discussion of the typology of NHI, please refer to the analysis proposed by Cuadrado and colleagues (Cuadrado et al. 2019). This hypothetical scenario presented here is, in a sense, also applicable to countries with national health service systems, like England (Miller 1995).

“Equitable access to health services” used here is just an example. It is closer to Solow’s definition of sustainability, which emphasizes the future generation’s enjoyment of a standard of living at least as good as our own (Solow 1993). If we were to adopt the definition of the Our Common Future report, the value upheld by the system would be “health needs” that are essential to human life (WCED 1987). If we were to adopt Sen’s definition, it would be “health services related to the building of capabilities” to enable people to enjoy substantive freedoms (Sen 2009). Of course, these are very simplified notions of values for the simplicity of discussion. In real-world cases, health systems are built for different purposes in different contexts, which would be worth investigating but is beyond the inquiry of this essay.

As Stone has rightly put, policy-making is all about the struggle of ideas (Stone 2002).

If we are not proponents of democracy, it may be much easier to convey the idea of sustainability. For instance, if we are policy elites believing in the concept of sustainability but do not believe in democracy, we may easily adopt a top-down approach that pushes the three sets of ideas of sustainability, regardless of the general public’s will.