Abstract
Most integrative clinicians are keenly aware that our health is intimately tied to the health of our environment. For that reason, clinicians may be interested in the nonprofit membership organization, Practice Greenhealth, which is leading efforts to transform health care with the goal of sustainable individual, community, and planetary health. As the Practice Greenhealth website stated, “The health and well-being of all life depend on social and ecological systems that are intact and functioning.” 1 Practice Greenhealth also recognizes, however, that our world is in a crisis. Human activities are interfering with life-sustaining systems that have led to the degradation and decline of the health of the planet, and the organization is in the business of aggressively addressing such issues.
Janet Howard, Sustainability Solutions Director for Practice Greenhealth, oversees the management of the organizations that become members. In an interview, she commented: “What is health care for? The healthcare sector is both a significant contributor to the global planetary health crisis and uniquely burdened by it. Efforts aimed at protecting and improving our health will not succeed without addressing the social, economic, and ecological catastrophes that largely underpin the health, safety, and happiness of individuals and communities worldwide.” Some of the current challenges in health care systems, and the solutions that Practice Greenhealth helps provide, include waste reduction strategies; minimizing chemical exposure to patients, health care workers, communities, and the environment; promoting the procurement of clean renewable energy in health care; and promoting, purchasing, and serving sustainably grown healthy food to improve environmental health; and much more.
Gary Cohen, president and founder of Practice Greenhealth and president and cofounder of Health Care Without Harm, in an interview commented: “We are leading the global healthcare sector to effectively address the climate crisis as core to its mission to heal. Our fundamental innovation is that the healing process needs to expand beyond individuals to healing communities and the planet, which sustains us. In order to meet this challenge, health care needs to heal itself from its unhealthy reliance on fossil fuels, toxic chemicals and industrial agriculture—the very things that destroy the planet's resilience and the health of billions of people worldwide. We also need to heal the economy if we are to have any hope of supporting healthy people on Earth. We are catalyzing this transformation that is underpinned by the Hippocratic Oath, to ‘first, do no harm.’”
Practice Greenhealth has been doing this work for decades and was born out of a collaborative effort with organizations such as Health Care Without Harm, the American Hospital Association, Environmental Protection Agency, and the American Nurses Association in September 2001 to create the Hospitals for a Healthy Environment (H2E) program, according to the website. 2 In 2008, H2E became Practice Greenhealth—“a membership organization representing healthcare organizations committed to the integration of sustainability principles and practices as a means to better protect the health of patients, staff, the communities served, and the environment.” 2
Practice Greenhealth offers annual memberships to individual facilities or entire systems including hospitals and health care systems, health care providers, manufacturers and service providers, architectural, engineering, and design firms, group purchasing organizations, and affiliated nonprofit organizations, according to the website. 2 Howard stated that health care organizations get involved with Practice Greenhealth sustainability because of a variety of reasons including grassroots interest from health care workers, senior leadership level interest, and risk avoidance.
Examples of Improving Sustainability Within Medical Systems
A commitment to the environment is a commitment to people, so when you switch to a greener approach, this affects everyone in a health care setting, according to Howard, who stated that health care workers are the greatest asset to such efforts. She added, “Most doctors believe that climate change is a public health issue, and hospitals are beginning to use sustainability as a recruiting retention and satisfaction strategy. Clinicians want a purpose-driven career and have a lot of power in healthcare organizations to initiate change. It is extremely helpful when clinicians state what they want for the organization, and healthcare workers who voice the need for these efforts, helps significantly. Every healthcare organization needs to consider identifying a Sustainability Director and an Energy Manager—leading sustainability efforts.”
To restore what has been degraded, Practice Greenhealth believes that industrial systems—land development, food, chemicals, and energy—must be reimagined and communities rebuilt with resilience to new and emerging health threats. Through their efforts, the organization has demonstrated a return on investment, improved worker engagement, mission demonstration, and more. Here are some examples of the important work that Practice Greenhealth has helped achieve or is working toward: Asthma is a significant condition in terms of emergency room visits around the world and is one of the highest reasons for admission at Seattle's Children's Hospital, Seattle, Washington. In one cleaner energy movement, Seattle Children's Hospital created an Employee Commute Program to reduce single vehicle car use by literally paying people not to use the parking lot and instead provide them with free transit passes and bicycles, etc. This helps to provide cleaner air in the area around the facility and an effort to address their number 1 reason for the visit. Howard reported: “When you can connect the environmental issue to a health outcome and then connect that outcome to an area where there is clinical engagement, then we can help systems move forward with progress.” Regarding waste management, there is a significant focus on surgical services, which generates up to 70% of a facility's waste and consumes three to six times more energy per square foot than other departments, according to Howard. She stated: “When you have clinical champions in an operating room who understand that certain products, practices and anesthetics contribute to higher global warming compared with others, we begin to have success. When clinicians are on board they move away from such products and re-evaluate their clinical practice or make behavior changes, which then reduces greenhouse gases and expenses.” Another Practice Greenhealth strategy is to help organizations forge ahead with a plant-forward diet and menus. The website stated that “A plant-forward diet supports patient, employee, and community health. Six in 10 adults have a chronic disease and 4 in 10 have two or more. Community health needs assessments frequently identify diet-related health conditions among the priority health needs in communities.”
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Howard stated that cardiologists and all clinicians can be leaders in this effort by sharing the benefits of a plant-forward diet with their patients. Michigan Medicine has opened a cooperative laundry services facility, which will bring significant savings by replacing disposable gowns with reusable gowns. According to the Michigan Medicine website, “The new state-of-the-art Metropolitan Detroit Area Hospital Services (MDAHS) plant has the capacity to process up to 78 million pounds of linen each year, serving St. Joseph Mercy Health, Henry Ford Health System and Michigan Medicine.”
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Local resource partners work on this project and, therefore, sustainability efforts stay right in the community for resilience and investing, according to Howard. Boston Medical Center (BMC) planted a 2658 square foot rooftop farm with more than 25 crops. According to the BMC website, “The farm not only provides fresh, local produce to our hospitalized patients, cafeterias, Demonstration Kitchen, and Preventive Food Pantry, but is also part of BMC's commitment to going green.”
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They added, “The farm reduces the hospital's carbon footprint, increases green space, and reduces energy use, including the energy required to transport food.”
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Of course there are obstacles to improvements as well. For example, although Practice Greenhealth can help hospitals identify and utilize reusable products in the operating room, it is not always easy to convince facilities to make the change. Howard said, “We don't have the infrastructure to recycle many supplies in hospitals. We need manufacturers to come up with solutions for the products they create.”
Moving Forward
In terms of the future, Cohen commented: “Our hope is that Practice Greenhealth is able to embed environmental health and equity into the DNA of health care. We want to show the sector that if they leverage all their assets—their purchasing power, political clout, moral standing, communications capacity, community outreach, clinical innovation and can address the upstream conditions in communities that contribute to the chronic diseases that we suffer from in society. If we can clean up the air by transitioning to renewable energy, provide healthy housing and food to all, invest in sustainable transportation, fund mental health support, and provide jobs to people, we can help heal the wounds in our communities as well as solve the climate crisis.”
Healthcare Anchor Network launched an Impact Purchasing Commitment in collaboration with Practice Greenhealth to leverage the purchasing power of hospital systems to double their racial diversity spending, increase their local procurement, and target other purchasing decisions to reduce their climate footprint and detoxify their supply chains. Cohen stated: “To date, 12 healthcare systems have made this commitment, and together they have committed to increase their racial diversity spending by $1 billion. Soon we will be able to report how they will leverage their collective purchasing to transform the market toward more environmentally responsible purchasing, including sustainably produced food, energy efficient technologies and toxic free products.”
Practice Greenhealth also recently launched a global roadmap to decarbonize health care (
Practice Greenhealth and Health Care Without Harm also present an annual conference, CleanMed (
Conclusion
Health care systems' practices (both positive and negative) cannot be considered separately when considering planetary, community, and individual health. Cohen concluded: “We strongly believe that we can solve issues of climate, health, equity and sustainable economic development together. The core of the strategy is creating a new social contract between the health sector and the rest of society, so that we are all bringing our assets, wisdom and gifts to the table and together addressing the challenges we face in our communities. Our hope is that we can model this transformation and scale it throughout the healthcare sector.”▪