Can healthcare heal our communities and the planet?

This was the challenge that Gary Cohen, a US leader in sustainability issues, presented to delegates at the European Healthcare Design Congress this week.

 

Gary CohenCohen, founder and president of Health Care Without Harm, a US-based campaign group and policy think tank, told the congress that the delivery of care in healthcare facilities results in an ever-increasing environmental footprint, which is damaging to health. His road-to-Damascus moment came in the mid 1990s, when the US Environmental Protection Agency confirmed medical waste incinerators to be the largest source of dioxin emissions in the country, as well as a significant source of mercury.

 

“Dioxin is linked to cancer, birth defects, neurological damage, and reproductive toxicity. Mercury is linked to brain damage, especially for the developing child. I thought: ‘How could this be? How could the one sector of our economy that is devoted to healing be, itself, contributing to the very diseases that it’s organised to address.’”

 

Contrary to common perception, he explained, measures by hospitals to become more environmentally sustainable can yield significant savings rather than incur additional costs. Health and environmental sustainability – the natural, built and social environments – are a necessary condition for human health and wellbeing.

 

“If we can move upstream and address environmental and social factors, we can have better health outcomes, and faster, more refined treatment technologies and resources,” Cohen told the audience.

 

“I believe that healthcare has a moral obligation and good business reasons to lead on environmental health, and if we can amass the power – the economic power, the moral power, the clinical power, and the business power – that we have toward this end, we can have a very, very large impact, and we can change the way we think about and address health.”

 

Evidence of how the tide of opinion and changing practice can force a worldwide change can be seen in the way Health Care Without Harm helped secure a ban on mercury devices. The movement began with one hospital in Boston, which agreed to replace their mercury thermometers with digital ones. As other hospitals in the US began to do the same, the American Hospital Association pledged its support and a critical mass of hospitals signed up to make the switch to digital thermometers. With support from other partners, Cohen’s movement spread to Europe, where a ban on mercury devices was eventually achieved. Momentum took the campaign to South America, and, eventually, the World Health Organization, with the securing of a global treaty to phase out all mercury measuring devices by 2020.

 

But it is just one area, and there is still much work to do to reduce healthcare’s environmental footprint, said Cohen. Taking cancer as an example, he described it as a social wound. “To understand its full causes and attribution, we need to move upstream,” he said, “upstream to the dawn of life, where children today are being born with, typically, 100 toxic chemicals in their bodies.”

 

Moreover, it’s not only the dosage but also the timing of the exposure that can be crucial, with the potential for hormones vital for a child’s development effectively ‘switching on or off’ depending on the point of chemical exposure.

 

“How are we going to make healthy people if we can’t even protect kids in the womb being pre-polluted?” he asked. “In many societies, we’ve ceded the public space to companies that are trying to sell products that actually hurt us and our health. Our kids are exposed to advertising of inexpensive food, which is barely food, and which actually contributes to obesity and diabetes.”

 

Health Care Without Harm is working with hospitals to change their purchasing practices, encouraging them to support and invest in renewable energy, as well as procure products with chemicals that aren’t toxic to patients or workers. The organisation is also working with hospitals to change how they buy food, so they can support sustainable farmers in the community.

 

Cohen’s message to the congress was that food is medicine and healthy housing can act as a vaccine against illness. Healthcare, he added, through its procurement and community investment agendas, can adopt a broader and more effective healing strategy – one that not only heals individual patients but also heals the communities that hospitals serve, and heals the planet in the process.

 

On top of these issues is the threat that climate change poses to public health, with Cohen presenting a vision – and one that is already developing – of extreme weather events, increased allergies, the spread of dengue fever and malaria northwards, spikes in heat stress, and the possibility of more water-borne diseases, such as diarrhoea. He also pointed out that coal is not only an enormous emitter of greenhouse gases but is also linked to increased respiratory disease, heart attack, stroke, and even neurological damage.

 

Said Cohen: “When we took the pulse of the healthcare sector, we found that it embodied all the same contradictions of an economy built on fossil fuels, toxic chemicals and industrial agriculture.

 

“Healthcare is an enormous user of energy, most of which is derived from fossil fuels. And studies have shown that poor air quality is one of the reasons that there is occupational-related asthma; nurses have some of the highest asthma rates of any profession.”

 

Climate change will inevitably have an impact on the built environment, too. Hospitals must become an anchor for community resilience and be designed in a way so as they can withstand extreme weather events. They must also be designed within a system that can predict and reach out to those communities and individuals most vulnerable to extreme weather events before they happen, in order to mitigate the worse effects.

 

If design is to be truly healthy, then upstream, again, is the way to travel, with procurement and supply chains an obvious target.

 

“We thought ‘what if we could aggregate the power of all these hospital systems and accelerate the marketplace for low carbon sustainable products?’ So we’ve created this co-op. And we’re going out to the marketplace and putting manufacturers on notice that we want safer products.”

 

This is sustainability’s equivalent of preventive and public health. “It’s not really about greening hospitals,” said Cohen. “It’s how do we move healthcare upstream. How do we take all this power, and actually redirect it towards the communities we serve.

 

He challenged the healthcare design and planning sector to be vocal in rebranding climate change as an issue that’s about the health of our families and communities, and defend our rights for clean air, healthy food, clean water.

 

“These are the fundamentals of what it takes to make healthy people,” concluded Cohen. “Just remember this: you can’t have healthy people on a sick planet. If we have a healthy plant, we can also have healthy people.”