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Purpose

The research aims to describe the foundation of healthcare organizations’ past and present sustainability endeavors; describe the direction of a health-care organizations’ sustainable development; reveal and characterize what determines the foundation and direction in a public health-care sector; and provide some insights into social marketing for sustainability endeavors.

Design/methodology/approach

Based on a semi-inductive approach, judgmental sampling was applied to select relevant health-care organizations. Informants were identified according to their knowledge of their organizations’ sustainability initiatives.

Findings

Offer insights into the foundation of sustainability endeavors and the direction of sustainable development for upstream social marketing in the studied public sector. The social marketing perspective is a common factor of relevance for the studied public hospitals.

Research limitations/implications

The foundations of sustainability endeavors undertaken across the studied health-care organizations have not so far been homogenous. The direction of sustainable development has also varied across the studied public healthcare organizations and there is a need to move beyond individuals and shift from a micro to a macro/structural environment of sustainable development, so as to observe the effectiveness of any social marketing intervention.

Practical implications

This study highlights the importance of applying an upstream social marketing approach and programs, as part of a social marketing strategy, to promote and stimulate sustainable change in health-care organizations.

Social implications

Contrary to the common sense predominating in many societies nowadays regarding sustainability endeavors and sustainable development, we conclude that neither the foundation of such endeavors nor the direction of sustainable development has progressed adequately in the studied public healthcare sector. As social marketing is intended to benefit society and foster social change, the macro level of intervention of the upstream approach clearly reveals its usefulness in the public health area.

Originality/value

Reveals two axes based on a social marketing approach. One is of micro and macro determinants characterizing the direction of sustainable development in a public sector. Another is of homogeneous and heterogeneous foundations of sustainability endeavors.

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