November 22, 2009
UTNE READER

The Greening of Health Care

(Page 2 of 2)

November / December 2002
By Karen Olson, Utne magazine 
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Drug Administration released a report noting that DEHP, a softening agent used in pliable PVC products like IV bags and tubing, causes a range of adverse effects in lab animals, most notably to "the development of the male reproductive system." DEHP is a phthalate, a type of chemical that can leach out of PVC-based products into fluids that are then introduced into the blood during medical procedures. The FDA has yet to receive reports detailing a similar threat to human males, but the circumstantial evidence for such a risk is strong. In response, the FDA has instructed doctors not to use devices in various procedures that could lead to DEHP exposure in male infants, boys near puberty, and pregnant women carrying male fetuses.

For health care activists like Charlotte Brody who have been warning about phthalates for years-in the face of industry resistance-this public health notification was a major turning point. According to Brody, the FDA alert helped expand the way we think about toxic exposures-and the design of medical products. "To protect boys before puberty, you have to protect women of childbearing age, because exposures start in the womb," she says. "Thinking about the world with women of childbearing age in the center gives you all the arguments you need for clean production."

The good news is that alternatives to several PVC-based medical products are now available, as are alternatives to other devices with toxic substances that are common in hospitals, like blood pressure monitors and batteries made with mercury, a well-known neurotoxin. The bad news is that medical devices account for only 5 percent of PVC production in this country. Another 75 percent goes into building materials like flooring, window frames, and piping. Additives used to harden PVC in construction materials include lead, known to cause brain, kidney, and nerve damage, and cadmium, which is a carcinogen. As the toxicity of such materials becomes more widely documented, disposal costs are bound to rise. If health care companies end up picking up the tab to remove these harmful substances from existing hospitals and clinics, incentives to avoid using them in the first place will grow.

The effort to turn these ideas about green health care into actual building codes for medical facilities has just begun. Last February, the American Society of Healthcare Engineering released a groundbreaking statement calling for environmentally friendly construction practices that will protect the health of building occupants, the surrounding community, and the larger world. The U.S. Green Building Council has begun discussing construction guidelines for health care facilities. But some clinics and hospitals are not waiting for regulations before they act. Like Beth Israel's Continuum Center, they are making construction decisions that reflect a growing awareness of the health risks, and the long-term costs, associated with toxic materials.

The design of the Marshall Street Addition at Legacy Good Samaritan Hospital in Portland, Oregon, completed in 1998, called for no PVC and low or no VOCs as well as views of a garden, preservation of old trees, and a designated "urban wildlife habitat" on the grounds. The School of Nursing at the University of Texas in Houston, now under construction, is being built with 50 percent recycled materials, 50 percent sustainably harvested wood, a roof planted with trees, and no PVC piping. Green housekeeping-using cleaning materials that are low in solvents and other potentially toxic substances-is part of the construction plan. In addition, medical schools at Harvard University and at Emory University in Atlanta have green building projects in the works.

And at least two large national health care networks, Catholic HealthCare and California-based Kaiser Permanente, are starting to act as well. In addition to addressing dioxin, mercury, and phthalate concerns, Kaiser, a nationwide network that includes 29 hospitals and 423 medical offices serving 8.4 million members, is interested in phasing out the use of PVC materials, including vinyl-backed carpeting, in its buildings. Health considerations help inform the company's construction decisions as it prepares to build 12 new hospitals in the coming years. "The main thing that drives our decisions is quality of care," says Kathy Gerwig, Kaiser's director of environmental stewardship and national environmental, health, and safety operations. "If we have less toxic materials in our facilities, that helps the healing process. People intuitively get that connection. And people want to work in a greener environment."

One person in every nine in the United States works in health care, including more than 2.5 million registered nurses and more than 756,000 physicians. The industry accounts for roughly 14 percent of the nation's gross domestic product. If the health care sector as a whole moved toward using greener practices in design and building, it would generate the economic power to drive changes in product design and construction materials in many other fields.

What will the hospitals of the future look like? They could be quite different from today's giant, impersonal facilities, which operate more like megamalls or airports than neighborhood institutions. They promise to be smaller, healthier, more local in focus, and more inviting for patients and visitors. "Unlike other industries, health care is rooted in communities," says Health Care Without Harm co-coordinator Gary Cohen. "It's not picking up and moving to China or Mexico." So, as the greening of health care takes hold, it will move the industry toward an even deeper interdependence with local economies and concerns.

At the University of Nebraska Medical Center, an interdisciplinary working group has spent the past four years developing a model for a future facility they've named the Green Health Center. Two members of the group, bioethicists Andrew Jameton and Jessica Pierce, speculate that materials at such a clinic would be bought locally as much as possible, that therapies and medications would be ecologically sustainable, and that costs would be low to maximize everyone's access to care. Inside the facility there might be windows that actually open, an information center with brochures for local bike trails, and no blaring TVs or annoying Muzak.

For Tracey Easthope, who works with both community groups and hospitals as the environmental health director at the Ecology Center in Ann Arbor, Michigan, a truly green hospital is really more about biology than about architecture. "Instead of a vast, imposing structure set on a hill and bounded by walls," she says, "I see the architecture more like a cell in an organism, inviting in the surrounding landscape and people." The water treatment, cooling, and waste systems would be visible. The center would buy local organic food, provide transit options, and help efforts to revive local streams and lakes. It would also work to change the social systems-political and economic-that threaten health.

"Right now, we talk about people's health within the walls of a brick building," Easthope says. "But people come into the health care setting affected by the world. If we really want to talk about well-being and appropriate responses to disease, it means we have to go to where people live and work. In order to really address people's health, you have to engage outside of those brick walls."

This idea is a common theme in both the new green health care movement and wider efforts to bring an ecological awareness to all of society. As a recent statement from the Science and Environmental Health Network noted, "Whether it is in the way we build clinics and hospitals . . . or choose the means of maintaining our own health, we must do so with a commitment to enhancing life on this precious planet." The ultimate goal is not to turn hospitals into enclaves of healthy practice in an otherwise dirty world. It is much broader. Only by healing our relation to nature will we fully address the deeper ills that afflict us.
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