Reconciling Subsistence Emissions and Prevention in Environmentally Sustainable Healthcare

With healthcare systems worldwide committing to reduce their greenhouse gas emissions, policymakers must navigate how to reconcile emissions reduction with the delivery of high-quality care. Two main distributive ideals have emerged to guide a just transition to decarbonized healthcare: subsistence emissions and prevention. The subsistence view holds that healthcare emissions that are necessary to meet a threshold of "enough health" are permissible, while emissions exceeding this threshold should be mitigated. The prevention approach, in contrast, prioritizes the most efficient uses of limited emissions through emphasizing measures to prevent the onset of illness and to promote healthy living. Although both frameworks aim to reconcile pursuing the goals of healthcare with reducing the sector's carbon footprint, their approaches to that end appear to conflict. Subsistence emissions tend to prioritize those below the threshold of enough health, whereas prevention focuses on maintaining health in the already relatively well off. As subsistence emissions offers a compelling strategy for decarbonizing healthcare fairly, the question arises: can it accommodate prevention? This paper argues that these two perspectives can be reconciled by detailing how a subsistence emissions approach can also endorse emissions for measures that prevent individuals from falling below a health threshold.