Sustainable Health Care: Protecting Human Health

Given the financial stress hospitals are under, it makes sense that many sustainable solutions are sold to hospitals as moneymakers, or at least money-savers. But some green initiatives are being promoted primarily for their health benefits rather than their impact on the bottom line. Hospitals, after all, exist to care for the health of their communities, and doing so means following one of the most basic tenets of the medical profession: First do no harm.

Rx: Healthier Food

Poor food choices cause poor health, including obesity, Type 2 diabetes and heart disease. And while poor nutrition accounts for about $71 billion in yearly medical costs, according to the U.S. Department of Agriculture, hospitals speak almost entirely about patient health when it comes to greening their food service.

The American Medical Association, the American Public Health Association and the California Medical Association have all adopted sustainable food resolutions since 2007. A survey by Health Care without Harm and Physicians for Social Responsibility found that 127 medical facilities in California — a quarter of the total — are now committed to “putting sustainable food at the center of their healing mission.” In 2013, more than 80% of respondents had initiated a “healthy beverage program aimed at getting sugary drinks off the menu, and 70% were increasing their use of the tap to replace bottled water.

In its first year, 2012, enrollees in the three-year Healthier Hospitals Initiative (HHI) spent nearly $9 million on sustainable food options. Some medical centers stand out. “Fletcher Allen is now offering high-quality, healthy, affordable food,” says Seema Wadhwa, director of sustainability at Inova Health Systems in northern Virginia and a director of HHI. As a result, “the community now goes to the hospital to eat, rather than people moving away from hospital food.”

Henry Ford Hospital has gone so far as to have a greenhouse on campus, which not only provides fresh produce for the hospital but also helps educate the community about healthy food. The University of Maryland Medical Center has done much the same thing, working in partnership with the University of Maryland at Baltimore and the local community to create a weekly farmers market that provides sustainably farmed, locally grown food for hospital patients as well as the rest of the community.

“Fletcher Allen is now offering high-quality, healthy, affordable food. [As a result,] the community now goes to the hospital to eat, rather than people moving away from hospital food.” –Seema Wadhwa

Providence Health & Services, with 32 hospitals in five western states, is another leader in providing sustainably sourced food to its patients. Through relationships with local farmers, it buys local turkeys and chickens, as well as dried beans and other staples from, among others, a Hutterite community in Montana.

Inova, in addition to developing its own sustainable food program, sponsors the Northern Virginia chapter of Buy Fresh, Buy Local, and subsidizes fresh fruit and vegetable purchases by consumers in low-income communities. The result is a 75% increase in the amount of produce those consumers bought at local farmers’ markets, all of which reported sales increases.

Hospitals that have not yet started developing greener approaches to food don’t have to start from the beginning. HHI, which was launched by 12 hospital systems in 2010, and now has more than 800 enrolled, is providing health care facilities with the tools they need to “green” their operations, including “how-to” guides in many areas, data collection guidelines, webinars, hospital-to-hospital mentorship programs, case studies and success stories.

“We engage the leadership to talk about healthier food, cleaner energy, safer chemicals, reduced waste and smarter purchasing,” Wadhwa said. “We offer specific interventions with dedicated goals and measures.”

HHI convened a national meeting in early 2014 to focus on healthier food in hospitals. The meeting, which Wadhwa called “an industry-defining moment,” included 40 leaders from all links in the hospital food supply chain: distributors, food service providers, group purchasing organizations and major health systems. “Individually, these health systems, as large as they are, can create some ripples,” said Wadhwa. But, working together, the participants in the meeting hope “to create great waves of change in the hospital food supply system.”

Rx: Healthier Buildings

Coming Clean, formerly the Environmental Health Fund, is a nonprofit group that works on the intersection between the chemical industry, fossil fuels and environmental health, with a major focus on toxic chemical exposure in health care facilities. Judith Robinson, the group’s executive director, notes that the pharmaceuticals administered in hospitals “come under far more regulation and oversight than the chemical industry, which is involved in the making of many medical delivery devices, as well as the hospital wallpaper, the beds and the insulation.”

There are more than 100,000 synthetic chemicals registered for use in the U.S., and less than 10% have been tested for their effects on human health (and very few have been tested in combination with other chemicals). The medical environment is a source of exposure to those chemicals, and we carry many of them with us — a measure known as “body burden.” A survey by the Environmental Working Group and Commonweal, conducted in U.S. hospitals in 2004, found an average of 200 industrial chemicals in the umbilical blood of children studied. The chemicals included many likely carcinogens, as well as the brominated flame retardants that have been targeted in the health care environment.

A study led by Mount Sinai School of Medicine found 167 synthetic chemicals (76 of which have caused cancer in humans or animals) in the blood and urine of nine volunteers. The Mind, Disrupted Biomonitoring Project tested for toxic chemicals and heavy metals in the bodies of 12 leaders and advocates in the learning and developmental disabilities community, and detectable levels of bisphenol A (BPA), mercury, lead and pesticides were found.

“We should eliminate children’s exposures to substances that we know can have these impacts by implementing stronger health-based policies requiring safer alternatives.” –Ted Schettler

Noting that exposure to certain chemicals can lead to permanent learning and development disorders, Ted Schettler, a physician who also is science director for the Science and Environmental Health Network, said: “We should eliminate children’s exposures to substances that we know can have these impacts by implementing stronger health-based policies requiring safer alternatives.”

And, of course, there’s a chemical body burden in health care professionals. Physicians for Social Responsibility sponsored a bio-monitoring investigation involving 12 doctors and eight nurses, two in each of 10 states, and tested the volunteers for 62 specific chemicals, including BPA, mercury, phthalates (the category of plasticizers that included DEHP) and others. “Each participant had at least 24 individual chemicals in their body, and two had a high of 39 chemicals detected,” the study said.

The green building movement, which has led to many new health care facilities being built to the Green Building Council’s LEED standards, has multiple aims, but Robinson said that one of them is to create healthier interiors with fewer chemical burdens in the medical workplace. That can mean the use of more natural materials, as well as increased fresh airflow to reduce the effects of chemical off gassing.

The Perelman Center for Advanced Medicine at the University of Pennsylvania has made a healthy indoor environment a priority, with low-VOC paints, adhesives, sealants, tiles and carpets used throughout. Non-toxic cleaners are also used. No urea-formaldehyde was used in furniture glues.

Another major issue, studied by Coming Clean and others, is flame retardants, which are widely present in health care furnishings. Some, such as penta, octa-BDE and deca-BDE, have already been phased out, but Coming Clean warns that “research is showing that equally hazardous flame retardants have taken their place.” A 2012 North Carolina State and Duke University study of “Firemaster 550,” widely used in the polyurethane foam of mattresses and infant nursing pillows, among many other uses, found it to be “an endocrine disruptor that causes extreme weight gain, early onset of puberty and cardiovascular health effects in lab animals” and is “capable of crossing the placenta during pregnancy, reaching infants via breast milk, or both.”

Rx: Healthier Medical Devices

When PVC plastic is used in medical devices that need to be flexible, such as IV bags, the plasticizer DEHP is often added, but the European Union pointed out in a 2002 opinion paper that DEHP “can leach out of PVC, resulting in exposure to body tissues and fluids.”

Robinson said progress is being made to get plasticizers out of the patient environment, and HHI’s 2012 Milestone Report notes that one of its member health systems with 35 hospitals has achieved a 95% rate of purchase for PVC/DEHP-free devices. While one system is “not necessarily reflective of where the industry is,” notes the Milestone Report, “it does show that the elimination of PVC/DEHP from nearly an entire product category is, indeed, achievable.”

“More and more of our customers globally are incorporating sustainable thinking into their business strategies.” –Erol Odabasi

Mercury is another dangerous substance hospitals are working to eliminate. At high levels, mercury can damage the brain, heart, kidneys, lungs and immune system. People can be exposed to the element if a medical device containing it breaks and if those devices are incinerated, releasing toxic vapor that ultimately ends up in the fish and shellfish we eat.

Issues like these led Spectrum Health in Michigan to adopt a purchasing policy favoring mercury-free products, such as blood pressure gauges. And it stopped distributing mercury-based thermometers to patients.

There are undoubtedly other chemical dangers that hospitals need to address, but they have not yet been identified. “HHI is doing good work with respect to disclosure of chemical use,” says Wadhwa. “Because what’s actually in medical products is not currently fully known by vendors, just to have disclosure by manufacturers of what chemicals are being used in place of [plasticizers] is important work.”

Erol Odabasi, director, sustainability at Johnson & Johnson, said that a regulatory push is underway, especially in Europe, to dictate what chemicals can and can’t be in medical products. And being ready for that regulation is definitely an economic driver for health care internationally. “My take is that these trends are in place,” Odabasi noted. “More and more of our customers globally are incorporating sustainable thinking into their business strategies.”

Takeaways

  1. Poor nutrition is responsible for some $71 billion in yearly medical costs, and health care facilities are “walking the talk” by adding more sustainable choices to the menu. Top priorities: Develop a sustainable food program, and locate local sources of fresh produce.
  2. Hospitals are working on healthier interior environments for patients, including construction of new green buildings and efforts to reduce patient exposure to toxic chemicals. Top priorities: Conduct an internal study of chemical use at your facility, and eliminate the use of harsh cleaners.
  3. In part anticipating new regulations, the push for healthier medical devices includes elimination of harmful DEHP plasticizers in products such as IV bags, plus mercury-free thermometers and blood pressure gauges. Top priorities: Stop using products with DEHP plasticizers and limit the use of devices that contain mercury.

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