Preparing for the degrowth transition in healthcare: Understanding the challenges and opportunities

Martin Hensher ^a 

Healthcare is not only an essential human right; it is one of the largest and most complex industries in the world. Maintaining access to effective healthcare while reducing harm to both human and planetary health is a central task for a successful voluntary degrowth transition. Safely transforming large, complex and often for-profit healthcare organisations and systems will pose significant challenges for degrowth planners and policymakers, yet this transition may also offer important opportunities to address hitherto intractable problems common to most high income healthcare systems. A range of organisational options for local, democratically controlled health services exist including small-scale local enterprises, cooperatives and social enterprises, yet most nations already run extensive public healthcare systems, suggesting that more straightforward nationalisation and public ownership may also be feasible. Meanwhile, preparations are required to improve healthcare system resilience against risks of collapse and unplanned, involuntary degrowth. This discussion of healthcare illustrates important tensions within the broader degrowth paradigm: a focus on organic, bottom-up re-localisation will frequently be in tension with the need for complexity and scale in several crucial aspects of modern healthcare delivery, risking economic dualism if not adequately resolved. There is no alternative to acknowledging the central role of the state in leading and driving a safe and effective degrowth transition in healthcare. Degrowth thinkers need to develop more pragmatic, practical policy visions if their theoretical models are to be capable of realisation.