We welcome the additional perspective from the occupational safety and health field about using risk control as another approach to choosing health-related interventions. If the target health problem can be controlled by attention to a specific hazard, that method might be the most appropriate and most sustainable intervention. Certainly, in the spirit of comparative effectiveness research, the evidence concerning different types of approaches and their potential risks and benefits should be considered when potential adopters are deliberating what to do about a health problem or situation.
This example illustrates the need for approaches to the study of health program sustainability that match the context and type of interventions being implemented. No single approach for research on sustainability is likely to be applicable to all types of interventions.
Card’s example raises another important issue, that of unintended consequences that might accompany the elimination or engineered reduction of a health hazard, such as filling in a tidal swamp that is breeding mosquitoes. Is that swamp also breeding fish that are an essential local food supply? Is it providing a key water supply to either humans or animals? An upstream environmental change might be more easily sustainable than is an intervention program requiring continuous human effort, but it might also have more serious and not easily reversible consequences, ones that are difficult to foresee when planning an environmental change.