Operation organic

Three manufacturing plants sit side by side in a black-and-white cartoon illustration. On the right is Acme Chemical Co. In the middle is Acme Cancer Cure Inc. And on the left is Acme Hospital Corp. Tall chimneys atop each plant billow black smoke toward a town on the horizon. In the foreground, hospital orderlies cart patients on stretchers from the town to the hospital, bypassing the chemical and cancer research factories along the way.

At once, the cartoon is black comedy and a political statement: An unhealthy health care industry equals unhealthy people. Experts on the effects of pollution on human health say it’s no laughing matter.

People exposed o toxic air pollutants at sufficient concentrations and durations may have an increased chance of getting cancer or experiencing other serious health effects, according to the U.S. Environmental Protection Agency. And it’s not only what you breathe. Mercury and other toxic air pollutants can deposit onto soils or waters, where they are taken up by plants and ingested by animals all the way up the food chain to humans.

Such stark realities are spurring the multibillion-dollar medical industry to pay increasing attention to improving human health inside and outside of the hospital. A growing number of health care providers are changing their food purchasing practices to support pesticide-free agricultural products that are grown close to home — sometimes even in hospital gardens.

At the same time, doctors, architects and environmental advocates are integrating innovative green building strategies into hospitals while eliminating the facilities’ medical waste and use of toxic chemicals. Such efforts are not only changing the environmental footprint of hospitals but broadening their role in communities as advocates of healthy living.

“The health care industry is looking at this in terms of prevention — how do you address issues before they become a problem?” says Mark Rossi, co-coordinator of CleanMed 2006, a conference scheduled this month in Seattle.

The three-day conference, sponsored by Kaiser Permanente, Catholic Health Initiatives and other health care providers and advocates, is devoted to making hospitals healthier places to work and treat patients. More than 500 medical equipment manufacturers, group purchasers, health care system administrators and other representatives from throughout the entire health care chain are expected to attend the conference, which features entrepreneur and author Paul Hawken and other speakers.

The conference marks the 10th anniversary of what some regard as the watershed moment in the modern healthy hospitals movement, and it will serve as a key indicator of where the industry is headed next.

Cleaning up an industry

In 1996, the U.S. Environmental Protection Agency identified medical waste incinerators as the leading source of dioxin, a potent carcinogen.

In the wake of the report, 28 environmental and health groups formed Health Care Without Harm to urge health care providers to use cleaner products. During the ensuing decade, the Bolinas, Calif., organization has emerged as a lynchpin in worldwide efforts to end hospitals’ use of medical devices containing mercury, polyvinyl chloride (PVC) and other chemicals believed to pose threats to human health.

By many measurements, the results are impressive. More than 5,000 medical waste incinerators have closed in the United States during the past decade, as hospitals have switched to non-burn disposal methods, according to Health Care Without Harm. Additionally, more than 1,100 health care systems, representing 5,548 medical facilities, have collectively committed to eliminate mercury, cut waste in half and reduce the use of toxic persistent chemicals.

An emerging trend is the integration of green building elements into new medical centers and clinics. Participation by the influential health care industry in the budding green building market could prove to be a boon for manufacturers of cleaner and more energy-efficient building materials, contends Stacy Malkan of Health Care Without Harm, coordinator of the CleanMed conference.

“The industry has the potential to shift the market as a whole because hospitals have such huge buying power,” she adds.

Green building’s healing arts

This spring, the Providence Newberg Medical Center near Portland aims to become one of the first hospitals in the nation to earn certification under the U.S. Green Building Council’s LEED (Leadership in Energy and Environmental Design) rating system.

The 180,636-square-foot hospital, set to open in June and designed to earn a LEED Silver rating, is projected to consume 28 percent less energy and 40 percent less water than a like-sized hospital built to regular code standards. The efficient design could deliver almost $180,000 in annual operating savings, according to estimates by Providence Health System, the hospital’s operator. But it’s the ancillary environmental health benefits that impress Mark May, Providence Newberg’s executive director for new hospital and physician development.

High-performance glazing on large windows will allow natural light to penetrate the lobby and other common areas, and an efficient ventilation system will filter outside air through all parts of the hospital. Filtering fresh air throughout the facility will create an optimal environment for controlling infections, May says. What’s more, optimizing natural daylight, or “daylighting,” will contribute to a “comfortable environment that enhances both patient healing and employee productivity,” according to a study conducted for the hospital by BetterBricks, a network of energy-efficiency information and services supported by the Northwest Energy Efficiency Alliance.

A separate study prepared by the University of Oregon and Portland architecture firm Zimmer Gunsul Frasca Partnership, concludes that what’s good for patients is good for a hospital’s bottom line. The study, conducted at the university’s Energy Studies in Buildings Laboratories, notes that rooms with daylight and views have a proven ability to help control infections and energy use, as well as improve the psychological well-being of both patients and workers. Data cited in the study indicate that energy savings can be as high as 57 percent during daylight hours, when daylighting is used to reduce the use of electric lighting. The study goes on to note that experiments and clinical evidence demonstrate that daylight, even from overcast skies, is an “effective lethal agent” to infectious airborne microorganisms.

“Hospitals tend to be more profitable when the patients recover more quickly,” concludes the study, authored by G.Z. “Charlie” Brown, a professor of architecture at the University of Oregon’s School of Architecture and Allied Arts.

The growing body of evidence supporting the health and environmental benefits of green building is encouraging the medical industry to develop a construction best-practices guide specifically for hospitals and medical centers.

The American Hospital Association, American Nurses Association and Health Care Without Harm recently unveiled the Green Guide for Health Care, modeled after the LEED rating system. The Green Guide allows hospitals to self-certify their projects voluntarily and earn credits that explicitly address human health issues.

Oakland, Calif.-based Kaiser Permanente is conducting pilot-testing of the Green Guide on more than 30 of its hospitals. One such project, a Modesto, Calif., medical center set to open in 2007, will be built with PVC-free plumbing, rooftop solar panels and high-efficiency lighting, says Lynn Garske, Kaiser’s environmental stewardship manager. The Modesto facility will also have PVC-free carpeting that Dalton, Ga.-based Collins and Aikman Floorcoverings Inc. developed for Kaiser. The carpeting, made of recycled rubber from vehicle windshields, will also be used in 20 new medical facilities Kaiser plans to develop during the next decade, Garske says.

She points to the carpet as an example of the clout Kaiser — the largest nonprofit health care system in the United States — has to move building materials manufacturers in a new direction.

“Manufacturers and distributors are starting to see the value in putting research and development into these areas,” adds Garske, who says Kaiser’s procurement expenditures exceeded $10.7 billion in 2004.

San Francisco-based Catholic Healthcare West (CHW) is taking a similar tack with regard to the elimination of PVC and other chemicals. In November 2005, CHW awarded a five-year, $70 million contract to German manufacturer B Braun Medical Inc. to supply the Catholic nunsponsored hospitals with PVC-free intravenous bags. The IV bags are also void of di-2-ethylhexyl phthalate (DEHP), a chemical commonly used to soften PVC plastics. Studies suggest DEHP may cause reproductive harm to patients receiving intravenous care.

Sister Mary Ellen Leciejewski, Catholic Healthcare West’s ecology program coordinator, says CHW is also virtually mercury-free in its 40 hospitals and medical centers, the result of a five-year effort to replace mercury-containing thermometers and blood pressure cuffs with alternative equipment. Going forward, CHW aims to broaden its environmental efforts by reducing hospital greenhouse gas emissions and serving healthier food in cafeterias, she adds.

Healthy appetites

In the fall of 2005, CHW introduced a vision statement to supply its medical facilities’ cafeterias and vending machines with healthier foods. The goal, says Leciejewski, is to develop supply contracts with farmers of locally grown, organic and unprocessed foods.

The idea is already ripening in yet another way.

CHW’s Dominican Hospital in Santa Cruz, Calif., grows organic produce in an on-site garden and serves it in the hospital cafeteria. “You can’t get much more local than that,” Leciejewski adds.

Kaiser Permanente, too, is looking at ways to buy healthier foods through its supply contracts. By summer, Kaiser plans to have a pilot program in place where meals served to patients at Northern California hospitals would include more local, organically farmed foods, says Preston Maring, associate physician-in-chief at Kaiser's medical center in Oakland.

“Ultimately, sustainably farmed food is better for the environment, better for your health and better for farm workers than food grown with pesticides,” adds Maring, who in 2003 started the first of more than two dozen farmers’ markets located near Kaiser Permanente medical facilities.

Together, the farmers’ markets and procurement plans dovetail with Kaiser’s ongoing “Thrive” advertising campaign, which promotes healthy living. One such billboard advertisement tells drivers “You are what you eat,” and then asks, “What are you going to be today?”

Leciejewski, like Maring, says she considers promoting healthier eating and building consistent with the medical profession’s Hippocratic oath to “do no harm.”

“As we go forward and talk about a healthy community, we have to talk about the word community with a capital C,” Leciejewski says. “We need to look at not just what’s going on within the four walls of a hospital but what’s going on in the entire community.”