HEALTH AND THE ENVIRONMENT
IMAGINING
A BROADER HEALING FOR HEALTHCARE
| We live on a sick planet. Just like a patient, the signs are all there. Our life support systems—the air, oceans, and land —are under siege by a global economy driven by our societal addictions to fossil fuels, toxic chemicals, and industrial agriculture. As these addictions cause widespread and disastrous collateral damage to our environment and our health, we need to rethink the mission and responsibility of our healthcare system in preserving the health of individuals, communities, and the environment. Environmental factors, lifestyle choices, and our genes determine the vast majority of our health, and yet we spend nearly all of our resources focused on the clinical care we receive. Of the $2.6 trillion dollars spent annually on healthcare in the United States, 75% goes to treating preventable diseases like heart disease, cancer, and diabetes with expensive hospitals visits.1 We have built an entire system designed to pull drowning people out of the river, but we have failed to go upstream to see why they are being thrown into the river in the first place. Unsurprisingly, this system is ineffective and unsustainable. The United States spends more money than any nation on Earth on healthcare, and as an industry, the US healthcare sector represents nearly 18% of the entire US economy.2 Yet, according to the Social Progress Indicator, the United States ranks 70th in health and well-being. But the United States is not alone. This imbalance between cost of care and quality of health is a common problem all over the world. Governed by a moral imperative to “first, do no harm,” we rely on the healthcare systems to ensure the health and well-being of the individuals and communities they serve. Yet, health care represents all the contradictions of an industrial enterprise powered by fossil fuels, and toxic chemicals, and unhealthy
408
Health and the Environment
MISSION
Gary Cohen |
food that contribute to a range of diseases including cancer, respiratory disease, asthma, and diabetes. As our global economy stretches perilously beyond the boundaries of sustainability, it is time to acknowledge that our current definition of healthcare is too narrow to address the new environmental health realities of the 21st century. We must envision a new definition of healthcare—a restorative vision of what our health system could look like. We need to move beyond our current expensive and ineffective system to restoring the broken relationship between our health and the environment. Rather than contributing to the destruction of the environment that in turn exacerbates poor health outcomes, the healthcare sector has a moral responsibility to champion a sustainable and equitable vision of health. Built on this restorative philosophy, the UK's National Health Service offers an evocative picture of what such a health system might look like3: Imagine a time when going to hospital is seen as a failing of the health and social care system. Where most of the care and support you need can be offered at home. Where you can get instant medical help online, by phone or at a local health center. Where health inequalities are low and well-being is key. Imagine a place where the few buildings that support the health system are in tune with the environment. They use almost no carbon and are integrated into the community and with nature. They are inviting for patients and a pleasure to work in. Imagine a world where friends, family, and society help promote healthy living. Where we all support the local health and social care system to recycle, re-use, and minimize waste. Where we know that
delivery of services takes the longterm financial, social, and environmental costs into account. Imagine knowing that we have done our best to improve health and minimize our impact on the environment. Embracing this restorative approach with the care we provide and the communities we provide it in is at the same time deeply aspirational and resolutely achievable. And it begins with our hospitals. Hospitals are anchor institutions; people see hospitals as the frontline of health and places of refuge in their communities. Yet, sustaining life and health—rather, treating expensive, preventable diseases—is not enough. Situating themselves in the broader ecology of the communities they serve, hospitals need to make those ecosystems thriving places and build communities of wellness. Specifically, hospitals, and by extension the entire healthcare sector, can lead by example in addressing five key environmental health drivers that impact on all our health: climate change resilience, safer chemicals, healthy food, waste reduction, and clean and abundant water.4 First, hospitals need to minimize their impact on climate change. Thanks to the use of advanced medical technologies and the round-the-clock nature of operations, hospitals are the second most intensive user of energy in the US economy.5 Fossil fuels—the primary driver of climate change—are powering those facilities. And it is our addiction to fossil fuels that are driving a range of complex health impacts, including temperature-related illness and death, injuries and illnesses due to extreme weather events, the spread of infectious disease vectors, increases in waterborne illnesses, and wide-ranging impacts from air pollution.
EXPLORE November/December 2014, Vol. 10, No. 6
Addressing climate change begins with hospitals reducing energy consumption, increasing energy efficiency, and purchasing cleaner and healthier energy alternatives. As anchor institutions, hospitals can lead in developing resiliency programs that reduce the impact of climate change on their facilities and the communities they serve. Second, hospitals need to substitute harmful chemicals with safer alternatives. Chemicals are everywhere in hospital settings—many are defined and regulated by federal, state, and local laws, and yet, others are hardly regulated at all. In fact, the US healthcare sector is the single largest consumer of chemicals, spending more than double the second largest.6 Many of these toxins can lead to asthma, infertility, learning disabilities, cancer, as well as indoor air pollution. Over the last 18 years, we worked with the healthcare sector to eliminate mercury from their facilities as well as restrict PVC plastics from medical devices.7 We also helped them largely eliminate medical waste incineration that created dioxin contamination of our entire food supply. The hopeful lesson from these efforts is that if healthcare can be shown its negative environmental footprint, it can act to remedy the problem. Hospitals need to build on these efforts by continuing to detox their supply chain and increase the market for safer alternatives. By using its market leverage, hospitals can transform the materials economy so it is safe for people and the environment and position the healthcare sector as an early adopter of green chemistry innovations. Third, hospitals need to purchase and serve sustainably grown, healthy food. Healthy food is an essential connection between the health of patients, the preventative care provided by staff members, and the communities in which they serve. Yet, there is a McDonald's in 27 US hospitals,8 and a majority of hospitals continue to serve sugar-sweetened beverages to employees and patients. This disconnect is indicative of our broken food system. Driven by the food we eat and our sedentary lifestyles, preventable diseases like heart disease, diabetes, and cancer are now at epidemic levels. Completing the circle, the healthcare sector then needs to spend more
Health and the Environment
energy and resources in treating these conditions. Hospitals can transform the food environment of their facilities by introducing healthier foods to their patients, modeling healthier eating choices, and transitioning local economies toward sustainable agriculture. Leveraging their purchasing power, hospitals could pave the way for a sustainable food system that supports prevention-based healthcare and reduces the energy and resource burden required to treat chronic diseases. Fourth, hospitals need to reduce, treat, and safely dispose off healthcare waste. The healthcare sector generates millions of tons of waste each year. In fact, more than half the world’s population is at risk from suffering health impacts from healthcare waste, the majority of which is similar to regular municipal waste but also includes infectious waste, chemical and radioactive wastes, and even hospital wastewaters.9 Although a complex undertaking that is largely dependent on changing staff behavior, hospitals can protect public health by reducing the amount of waste generated, reducing the toxicity of waste by making smarter purchasing decisions upstream, and investing in safer, noburn technologies to treat and disinfect medical waste. Finally, hospitals need to reduce water consumption and pollution as well as ensure safe water supplies for the communities they serve. More than 780 million people lack access to clean drinking water,10 and 2.2 million people die each year of preventable diarrheal diseases.11 Without effective water and sanitation infrastructure, hospitals throughout the world can struggle without basic water, sewage, and waste services, which is required to adequately meet the health needs of their communities. By reducing its overall water consumption and pollution, hospitals can promote environmental health and assure safe water supplies for their communities. In areas where hospitals have limited access to clean water, hospitals should develop joint projects with their communities to improve and protect water supplies, as well as support initiatives for improved public systems to address water quality. We are already witnessing the transformative power of hospitals that
embrace a new vision of health, not only within their own facilities but also throughout all of society. Adopting environmentally friendly energy systems provides safer, healthier energy to the communities they serve. Serving sustainably produced, antibiotic-free food creates new markets for farmers and ranchers. Transitioning to safer chemicals, building materials, and furnishings impacts those markets for schools, businesses, and homes. Hospitals can lead society by modeling sustainable behaviors that embrace and heal the interdependent relationship between the environment and our health. When we talk about the health impacts of the environment, we often frame it using big picture terms like health systems, the health care sector, and environmental health drivers. We can forget that those terms—those numbers—represent individuals and families suffering every day from debilitating chronic illnesses. We experience these diseases as individual wounds within the confines of our family and friends. But we actually share these diseases within a larger social context: they represent our collective wounds driven by environmental factors. When we realize this deeper solidarity, we can begin to not only heal ourselves but also heal the environmental and social conditions that we face together. We can become wound healers, change agents for a vision of restorative health. Rather than treating our individual wounds, imagine a healthcare system that heals our collective wounds driven by the environmental crisis we face. REFERENCES 1. Trust for America's Health. A Healthier America: Top Priorities for Prevention. 〈http://healthyamericans.org/assets/files/ TFAH%202010Top10PrioritiesDisease Prevention.pdf.〉. 2. World Bank. 〈http://data.worldbank.org/ indicator/SH.XPD.TOTL.ZS.〉. 3. NHS Sustainable Development Unit. Route Map for Sustainable Health. 〈http://www.sduhealth.org.uk/policystrategy/route-map.aspx.〉; 2011. 4. Many of these concepts are further explained in Health Care Without Harm's Global Green and Healthy Hospital Initiative's environmental health agenda. 〈http://noharm.org/lib/down loads/building/GGHHA.pdf.〉.
EXPLORE November/December 2014, Vol. 10, No. 6 409
5. US Energy Information Administration. Consumption & Efficiency. 〈http://www. eia.gov/emeu/efficiency/cbecstrends/cbi_ html/cbecs_trends_6b.html.〉; 2004. 6. Safer Chemicals. 〈http://saferchemicals. org/wp-content/uploads/sites/3/2014/05/ Health_Care_Sector_TSCA_letter_4_2010. pdf.〉; 2010. 7. For more information visit: 〈https:// noharm-uscanada.org/issues/us-canada/ toxic-materials.〉. 8. Elana Gordon. Fast Food Chains in Cafeterias Put Hospitals in A Bind. 〈http://www.npr.org/blogs/thesalt/2012/ 04/05/150091951/fast-food-chains-incafeterias-put-hospitals-in-a-bind.〉; 2012.
9. Harhay MO, Halpern SD, Harhay JS, Olliaro PL. Health care waste management: a neglected and growing public health problem worldwide. Trop Med Int Health. 2009;14(11):1414–1417. 10. Water.org. 〈http://water.org/water-crisis/ water-facts/water/.〉. 11. UNICEF. 〈http://www.unicef.org/ media/media_21423.html.〉.
Greenhealth, and he was instrumental in bringing together the NGOs and hospital systems that formed the Healthier Hospitals Initiative. The White House presented him with the Champion of Change Award for Climate Change and Public Health and the Huffington Post named him a Game Changer in Healthy Living.
Gary Cohen has been a pioneer in the environmental health movement for 30 years. He is Co-Founder and President of Health Care Without Harm and Practice
410 EXPLORE November/December 2014, Vol. 10, No. 6
Health and the Environment
IMAGINING
A BROADER HEALING FOR HEALTHCARE
| We live on a sick planet. Just like a patient, the signs are all there. Our life support systems—the air, oceans, and land —are under siege by a global economy driven by our societal addictions to fossil fuels, toxic chemicals, and industrial agriculture. As these addictions cause widespread and disastrous collateral damage to our environment and our health, we need to rethink the mission and responsibility of our healthcare system in preserving the health of individuals, communities, and the environment. Environmental factors, lifestyle choices, and our genes determine the vast majority of our health, and yet we spend nearly all of our resources focused on the clinical care we receive. Of the $2.6 trillion dollars spent annually on healthcare in the United States, 75% goes to treating preventable diseases like heart disease, cancer, and diabetes with expensive hospitals visits.1 We have built an entire system designed to pull drowning people out of the river, but we have failed to go upstream to see why they are being thrown into the river in the first place. Unsurprisingly, this system is ineffective and unsustainable. The United States spends more money than any nation on Earth on healthcare, and as an industry, the US healthcare sector represents nearly 18% of the entire US economy.2 Yet, according to the Social Progress Indicator, the United States ranks 70th in health and well-being. But the United States is not alone. This imbalance between cost of care and quality of health is a common problem all over the world. Governed by a moral imperative to “first, do no harm,” we rely on the healthcare systems to ensure the health and well-being of the individuals and communities they serve. Yet, health care represents all the contradictions of an industrial enterprise powered by fossil fuels, and toxic chemicals, and unhealthy
408
Health and the Environment
MISSION
Gary Cohen |
food that contribute to a range of diseases including cancer, respiratory disease, asthma, and diabetes. As our global economy stretches perilously beyond the boundaries of sustainability, it is time to acknowledge that our current definition of healthcare is too narrow to address the new environmental health realities of the 21st century. We must envision a new definition of healthcare—a restorative vision of what our health system could look like. We need to move beyond our current expensive and ineffective system to restoring the broken relationship between our health and the environment. Rather than contributing to the destruction of the environment that in turn exacerbates poor health outcomes, the healthcare sector has a moral responsibility to champion a sustainable and equitable vision of health. Built on this restorative philosophy, the UK's National Health Service offers an evocative picture of what such a health system might look like3: Imagine a time when going to hospital is seen as a failing of the health and social care system. Where most of the care and support you need can be offered at home. Where you can get instant medical help online, by phone or at a local health center. Where health inequalities are low and well-being is key. Imagine a place where the few buildings that support the health system are in tune with the environment. They use almost no carbon and are integrated into the community and with nature. They are inviting for patients and a pleasure to work in. Imagine a world where friends, family, and society help promote healthy living. Where we all support the local health and social care system to recycle, re-use, and minimize waste. Where we know that
delivery of services takes the longterm financial, social, and environmental costs into account. Imagine knowing that we have done our best to improve health and minimize our impact on the environment. Embracing this restorative approach with the care we provide and the communities we provide it in is at the same time deeply aspirational and resolutely achievable. And it begins with our hospitals. Hospitals are anchor institutions; people see hospitals as the frontline of health and places of refuge in their communities. Yet, sustaining life and health—rather, treating expensive, preventable diseases—is not enough. Situating themselves in the broader ecology of the communities they serve, hospitals need to make those ecosystems thriving places and build communities of wellness. Specifically, hospitals, and by extension the entire healthcare sector, can lead by example in addressing five key environmental health drivers that impact on all our health: climate change resilience, safer chemicals, healthy food, waste reduction, and clean and abundant water.4 First, hospitals need to minimize their impact on climate change. Thanks to the use of advanced medical technologies and the round-the-clock nature of operations, hospitals are the second most intensive user of energy in the US economy.5 Fossil fuels—the primary driver of climate change—are powering those facilities. And it is our addiction to fossil fuels that are driving a range of complex health impacts, including temperature-related illness and death, injuries and illnesses due to extreme weather events, the spread of infectious disease vectors, increases in waterborne illnesses, and wide-ranging impacts from air pollution.
EXPLORE November/December 2014, Vol. 10, No. 6
Addressing climate change begins with hospitals reducing energy consumption, increasing energy efficiency, and purchasing cleaner and healthier energy alternatives. As anchor institutions, hospitals can lead in developing resiliency programs that reduce the impact of climate change on their facilities and the communities they serve. Second, hospitals need to substitute harmful chemicals with safer alternatives. Chemicals are everywhere in hospital settings—many are defined and regulated by federal, state, and local laws, and yet, others are hardly regulated at all. In fact, the US healthcare sector is the single largest consumer of chemicals, spending more than double the second largest.6 Many of these toxins can lead to asthma, infertility, learning disabilities, cancer, as well as indoor air pollution. Over the last 18 years, we worked with the healthcare sector to eliminate mercury from their facilities as well as restrict PVC plastics from medical devices.7 We also helped them largely eliminate medical waste incineration that created dioxin contamination of our entire food supply. The hopeful lesson from these efforts is that if healthcare can be shown its negative environmental footprint, it can act to remedy the problem. Hospitals need to build on these efforts by continuing to detox their supply chain and increase the market for safer alternatives. By using its market leverage, hospitals can transform the materials economy so it is safe for people and the environment and position the healthcare sector as an early adopter of green chemistry innovations. Third, hospitals need to purchase and serve sustainably grown, healthy food. Healthy food is an essential connection between the health of patients, the preventative care provided by staff members, and the communities in which they serve. Yet, there is a McDonald's in 27 US hospitals,8 and a majority of hospitals continue to serve sugar-sweetened beverages to employees and patients. This disconnect is indicative of our broken food system. Driven by the food we eat and our sedentary lifestyles, preventable diseases like heart disease, diabetes, and cancer are now at epidemic levels. Completing the circle, the healthcare sector then needs to spend more
Health and the Environment
energy and resources in treating these conditions. Hospitals can transform the food environment of their facilities by introducing healthier foods to their patients, modeling healthier eating choices, and transitioning local economies toward sustainable agriculture. Leveraging their purchasing power, hospitals could pave the way for a sustainable food system that supports prevention-based healthcare and reduces the energy and resource burden required to treat chronic diseases. Fourth, hospitals need to reduce, treat, and safely dispose off healthcare waste. The healthcare sector generates millions of tons of waste each year. In fact, more than half the world’s population is at risk from suffering health impacts from healthcare waste, the majority of which is similar to regular municipal waste but also includes infectious waste, chemical and radioactive wastes, and even hospital wastewaters.9 Although a complex undertaking that is largely dependent on changing staff behavior, hospitals can protect public health by reducing the amount of waste generated, reducing the toxicity of waste by making smarter purchasing decisions upstream, and investing in safer, noburn technologies to treat and disinfect medical waste. Finally, hospitals need to reduce water consumption and pollution as well as ensure safe water supplies for the communities they serve. More than 780 million people lack access to clean drinking water,10 and 2.2 million people die each year of preventable diarrheal diseases.11 Without effective water and sanitation infrastructure, hospitals throughout the world can struggle without basic water, sewage, and waste services, which is required to adequately meet the health needs of their communities. By reducing its overall water consumption and pollution, hospitals can promote environmental health and assure safe water supplies for their communities. In areas where hospitals have limited access to clean water, hospitals should develop joint projects with their communities to improve and protect water supplies, as well as support initiatives for improved public systems to address water quality. We are already witnessing the transformative power of hospitals that
embrace a new vision of health, not only within their own facilities but also throughout all of society. Adopting environmentally friendly energy systems provides safer, healthier energy to the communities they serve. Serving sustainably produced, antibiotic-free food creates new markets for farmers and ranchers. Transitioning to safer chemicals, building materials, and furnishings impacts those markets for schools, businesses, and homes. Hospitals can lead society by modeling sustainable behaviors that embrace and heal the interdependent relationship between the environment and our health. When we talk about the health impacts of the environment, we often frame it using big picture terms like health systems, the health care sector, and environmental health drivers. We can forget that those terms—those numbers—represent individuals and families suffering every day from debilitating chronic illnesses. We experience these diseases as individual wounds within the confines of our family and friends. But we actually share these diseases within a larger social context: they represent our collective wounds driven by environmental factors. When we realize this deeper solidarity, we can begin to not only heal ourselves but also heal the environmental and social conditions that we face together. We can become wound healers, change agents for a vision of restorative health. Rather than treating our individual wounds, imagine a healthcare system that heals our collective wounds driven by the environmental crisis we face. REFERENCES 1. Trust for America's Health. A Healthier America: Top Priorities for Prevention. 〈http://healthyamericans.org/assets/files/ TFAH%202010Top10PrioritiesDisease Prevention.pdf.〉. 2. World Bank. 〈http://data.worldbank.org/ indicator/SH.XPD.TOTL.ZS.〉. 3. NHS Sustainable Development Unit. Route Map for Sustainable Health. 〈http://www.sduhealth.org.uk/policystrategy/route-map.aspx.〉; 2011. 4. Many of these concepts are further explained in Health Care Without Harm's Global Green and Healthy Hospital Initiative's environmental health agenda. 〈http://noharm.org/lib/down loads/building/GGHHA.pdf.〉.
EXPLORE November/December 2014, Vol. 10, No. 6 409
5. US Energy Information Administration. Consumption & Efficiency. 〈http://www. eia.gov/emeu/efficiency/cbecstrends/cbi_ html/cbecs_trends_6b.html.〉; 2004. 6. Safer Chemicals. 〈http://saferchemicals. org/wp-content/uploads/sites/3/2014/05/ Health_Care_Sector_TSCA_letter_4_2010. pdf.〉; 2010. 7. For more information visit: 〈https:// noharm-uscanada.org/issues/us-canada/ toxic-materials.〉. 8. Elana Gordon. Fast Food Chains in Cafeterias Put Hospitals in A Bind. 〈http://www.npr.org/blogs/thesalt/2012/ 04/05/150091951/fast-food-chains-incafeterias-put-hospitals-in-a-bind.〉; 2012.
9. Harhay MO, Halpern SD, Harhay JS, Olliaro PL. Health care waste management: a neglected and growing public health problem worldwide. Trop Med Int Health. 2009;14(11):1414–1417. 10. Water.org. 〈http://water.org/water-crisis/ water-facts/water/.〉. 11. UNICEF. 〈http://www.unicef.org/ media/media_21423.html.〉.
Greenhealth, and he was instrumental in bringing together the NGOs and hospital systems that formed the Healthier Hospitals Initiative. The White House presented him with the Champion of Change Award for Climate Change and Public Health and the Huffington Post named him a Game Changer in Healthy Living.
Gary Cohen has been a pioneer in the environmental health movement for 30 years. He is Co-Founder and President of Health Care Without Harm and Practice
410 EXPLORE November/December 2014, Vol. 10, No. 6
Health and the Environment
