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Systemic Sustainability

May/June 2020

By Karla Hignite

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To achieve sectorwide sustainability, leaders must articulate the economic and social benefits of pursuing a shared green future.

Idea in Brief

In the early 2000s, the health care sector was largely unengaged around concepts of healthy buildings, says Gail Vittori, co-director of the Center for Maximum Potential Building Systems. CMPBS designs and tests building systems and materials to assess their life-cycle potential and impacts on human and community health.

As a long-time advocate of green building policies, protocols, and prototypes, Vittori says that while growing evidence had brought to light concerns about sick building syndrome—caused by the off-gassing of problematic chemicals in building materials and products such as carpeting—a larger systemwide approach to truly understand and address health-related dimensions of the built environment was missing.

“There was an emerging case to make that health care facilities above all should be designed with optimum health outcomes in mind, but without a framework and structure to address these concerns, it was largely a fluid conversation without explicit focus,” Vittori says. Fast-forward 20 years, and the focus has shifted dramatically.

From 2010 to 2020 in particular, interest around health and well-being has come to the fore, crystalized in part by a sharper emphasis on health-promoting strategies in the LEED rating system, the WELL Building Standard, and other efforts that all coalesced for building practitioners, Vittori says. “The collective effort for market transformation was built on a consensus recognition that health and well-being are is intrinsic to green building.”

Those intervening years have also given rise to a number of evidence-based studies that indicate patient outcomes of reduced medication and lengths of stay correlate favorably to green building practices as a whole, Vittori says. All this has led to changes in the ways that hospital environments are conceived, with an orientation toward buildings that are conducive to maintaining the health of patients, employees, and the broader community.

Do No Harm

Gary Cohen co-founded Health Care Without Harm in 1996 out of what he calls “an abundant sense of urgency.” More than a decade earlier, at the request of a college friend, Cohen had turned his talent for writing guides to restaurants in Paris, pubs in London, and walking tours in New York City to developing a how-to guide aimed at organizing communities impacted by toxic chemicals, which he worked on for 10 years.

By the mid-1990s, the U.S. Environmental Protection Agency had published several sobering reports about medical waste incineration, Cohen says. “Not only were these incineration facilities the largest source of dioxin—associated with certain cancers—but they were also a leading source of mercury, known to harm the developing brains of children.” It struck Cohen then that there was no way to create healthy communities if the very industry devoted to healing was instead poisoning the environment.

When Health Care Without Harm was launched, there were 4,500 medical waste incinerators in the United States, Cohen says. “A decade later, that was down to 100.” His tactic? Bring regulatory and market pressures to bear.

“We were able to get the EPA to require more extensive testing for dioxin in these facilities and better training of personnel,” Cohen says. That added to hospital costs and helped change the economics by providing incentives to reduce medical waste and move toward safer treatments and products. Mercury thermometers—once the gold standard for measuring body temperatures—have likewise been replaced with safer alternatives in thousands of hospitals, in part due to the nonprofit’s aggregating of market demand to drive down their prices, Cohen says.

Bringing a mission imperative to the doorstep of health care leaders helped make the case that small but significant changes could not only mitigate specific health threats but also save their hospitals money in the process, Cohen says. He became convinced that the road to a healthier, more sustainable health care system included a broad array of industries—that there were linkages between not only chemicals and health, but also fossil fuels and industrial agriculture and health.

Adopt a Positive Message

Determined to tackle the full enterprise, Health Care Without Harm focused on everything from the disinfectants that hospitals use to the furniture in patients’ rooms and lobbies to food services and energy sourcing. “If as a sector we take to heart our mission of care, that should mean not serving food that contributes to obesity or burning fossil fuels that exacerbate respiratory diseases,” Cohen says.

“We saw early on that if we raised these sustainability concerns, this sector was receptive and would act,” he notes. “A big part of our strategy has been to focus on what contributes positively to health.” Cleaner air reduces asthma. Healthier food reduces Type 2 diabetes. Walkable and bikeable cities help prevent heart disease. And, in the process, all these things help reduce individual and societal health care costs, notes Cohen.

Achieving broader sustainable health care goals also requires reducing wasteful industry practices, says Cohen, which his organization has embraced with instrumental efforts to change segregation of medical waste and reprocessing of surgical equipment.

Take the Lead

While it’s important to tackle specific industry challenges, in order to build a culture of sustainable health care you need an ecosystem of leaders, Cohen says. He is also president and co-founder of Practice Greenhealth, a networking and membership organization focused in part on creating peer-to-peer networks across individual hospitals, health care systems, and the sector at large to encourage sharing of best practices and ideas for implementing change.

Cohen believes the next phase of building a sustainable health care sector centers on hospitals and systems internalizing their role of enhancing community resilience. Consider that in an extreme weather event or other crisis, your community’s hospital might be the last refuge standing, especially for physically vulnerable populations, Cohen says.

Moreover, the U.S. health care sector is realizing that within the cities in which a hospital operates, life expectancy in communities of color can be 20 to 30 years lower than in white communities. This “death gap” is largely the result of institutional racism, lack of economic opportunities, inadequate housing, and poor access to nutritious food, Cohen says. In the health care sector’s role as a community anchor, he believes it must help address those inequities through its purchasing and hiring practices; support of minority-, women-, and veteran-owned businesses; and advocacy for better housing, among other strategies. “When a community is more resilient, it will be healthier and will reduce its burden of disease,” Cohen says.

He believes the more that is done to reframe our climate crisis as a health crisis, the more we can change policies in cities and states across the country. This will require every sector working together to rapidly accelerate a transition away from fossil fuels, toxic chemicals, and industrial agriculture, says Cohen. “A big part of the leadership architecture going forward will take health care uniting with municipalities, with universities, and with businesses to accelerate what we know we must do for the sake of all humanity.”

KARLA HIGNITE, Fort Walton Beach, Fla., is a contributing editor for Business Officer.

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