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.

This talk is part of the Sustainability Health Care course, which forms part of the Translational Health Sciences programme. This event is free and open to all.