The Greening of Health Care

Following ancient advice first, do no harm hospitals are being transformed from danger zones to healing environments

November / December 2002

By Karen Olson, Utne magazine

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A flotilla of medical syringes washed up on the New Jersey shore 15 years ago and awakened the world to the hazards of medical waste. Since then, thousands of health care practitioners, scientists, ecologists, designers, architects, and activists have been trying to figure out what to do with the 2.4 million tons of medical waste the health care industry generates each year. Their efforts have gradually shifted from cleaning up the mess to examining its cause. Now they're scrutinizing the entire environmental impact of hospitals-and what they've found is troubling. Those needles were only a small part of a much bigger problem.

The health care industry is now awakening to the deep irony that while people go to hospitals to get well, hospitals themselves are making people sick. In addition to the well-documented threat of hospital infections-now the fourth leading cause of death in the United States-patients in hospitals may be exposed to a host of dangerous materials: dioxins, phthalates, mercury, and the volatile organic compounds (VOCs) found in many solvents and paints. In fact, potentially harmful substances can be found in everything from IV bags to carpeting to the very walls of the facilities in which healing is supposed to occur. Patients, many of them in vulnerable conditions, are inhaling poisons-and, in some cases, receiving them directly into their blood.

But a revolution is underway that not only will lead to a safer and radically different hospital in the future but also could point the way to a healthier world.

Walk into the Continuum Center for Health and Healing, a two-year-old Manhattan medical clinic that's part of Beth Israel Medical Center, and the first thing you notice is how much it doesn't feel like a hospital. Everything in the clinic, from chairs to curtains to plumbing, has been designed and constructed with a healing environment in mind. The offices are filled with natural light, plants, stone, and cork flooring. The air smells of wood and wool rugs.

This approach is aimed at something deeper than creating an inviting environment: It is meant to support the health of patients and hospital employees. The Continuum Center's focus is "integrative" healing-an approach that combines the best of mainstream medicine with alternative practices. Many of its patients come in search of help for what they believe are environmentally related illnesses that Western medicine has not been able to treat, like chronic fatigue syndrome and multiple chemical sensitivity. Those patients' needs, along with evidence of the wider effects of buildings on people's health (as many as one in five office workers report symptoms associated with either sick building syndrome or other building-related illnesses) helped determine the clinic's construction plan, which reveals a central tenet of the green health care movement: detoxify.

While the planners of the Continuum Center may have been ahead of the curve in using environmentally sound architecture because of its medical philosophy and patients, the growing trend toward sustainably designed health care facilities is in the interest of everyone who wants to avoid poisons.

As buildings are tightened up to improve energy efficiency, ventilation decreases. So at the Continuum Center, materials were selected to keep the air clean with low VOC levels, no formaldehyde, and no polyvinyl chloride (PVC), a petroleum-based material. PVC piping is illegal in New York City, but Robin Guenther, the New York architect who designed the center, had another reason for excluding PVC in the plan: "I tell my clients I don't want to put PVC in my building specifications because I don't know what they're going to do with it in 20 years," she says.

Polyvinyl chloride has become a focal point of the movement toward safe and healthy hospitals. A highly adaptable material used to make shower curtains, plastic wrap, children's toys, piping, and other familiar products, PVC is ubiquitous in most modern health care facilities-a key ingredient in medical devices, furniture, building materials, a wide variety of other products. But it poses so many environmental risks that the staff of the Ecology Center in Berkeley, California, calls it "Satan's resin."

From the toxins released when petroleum is extracted from the ground to problems associated with manufacturing, installing, using, and disposing of it, "PVC is in a class of chemicals in which there is no threshold for safety," says Tom Lent of the Healthy Building Network.

Polyvinyl chloride didn't really become an issue until hospitals, attempting to solve the medical waste disposal problem, which came to light with those needles on New Jersey beaches, started to burn their waste. "Most of us thought that the more we burned, the safer we were making our patients," says Charlotte Brody, a former nurse who now co-coordinates the Washington, D.C.-based campaign Heath Care Without Harm. But in 1996 the EPA released a study showing that medical incinerators were one of the nation's largest sources of dioxin. A known carcinogen that also affects reproduction, dioxin is emitted when products containing chlorine, like IV bags made of PVC, are burned. "That was a big wake-up call," says Brody. "We didn't know that medical waste incineration was making people sick."

While the number of medical incinerators in operation has decreased rapidly in the last few years, medical devices made from PVC are still causing problems in hospitals. In July 2002 the Food and

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