Yesterday's discussion with Gary Cohen introduced us to Health Care Without Harm and the recent achievements of the green hospital movement in the United States. Today, Cohen speaks about green health care internationally, outlines the challenges facing the green hospital movement, and offers his both short- and long-term predictions for the movement's future.
Health Care Without Harm is part of a global movement; what lessons do you think the US health care system can learn from the international community?
Right now we’re learning a lot from Europe. A typical Northern European hospital uses half as much energy as a typical US hospital. That’s a very significant issue, because as we are entering into a period of global climate crises and reducing reliance on fossil fuels for health care is a public health imperative (this sentence needs better structure). There are very direct links between a hospital’s energy sources and community health; we have evidence that shows if a hospital is reliant on coal fire power plants, there will be increases in asthma, respiratory problems and increased hospital visits. This also offers the opportunity to move to renewable sources of energy.
Another reason hospitals in Northern Europe are using less energy is because of hospital room ventilation. In a typical US hospital the ventilation duct is at the top of the room and pushes air into the hospital, into the patient room, and it circulates out and then it goes back up. So it actually circulates a lot of the germs, and it goes against gravity. In Europe, the intake of the ventilation of the room is at the sidewall level. And so the air comes up and then goes out the top. As a result, you need 30 percent less energy to run such a system. And now there’s research to evaluate whether this type of ventilation actually decreases infection rates in the hospital. Instead of recirculating the air and reinfecting people, the Northern European systems draw the air up and out the top. If changing the ventilation in hospital design reduces infection and reduces energy it is a big win both for patients and for the environment.
What are the biggest barriers and challenges facing the green hospital movement in the US?
The health care systems that have made the most comprehensive changes always have buy-in from the executive level. Once the CEO says that we’re going to make this change happen, then the rest of the system gets in alignment and people are given a mandate to implement change, whether it has to do with their built environment or their purchasing or their operations.
Where we don’t have that high-level buy-in, we might have a lot of champions, either nurses or facilities managers or environmental coordinators. Their efforts are critical, but they are swimming upstream, against the priorities of the system. And while those champions may be doing great things in their small corner of the hospital, it’s hard, though not impossible, to diffuse those changes system-wide. The Luminary Project of HCWH has seen the power of nurses as change agents and is telling the stories of nurses who are working to human health by addressing environmental health.
Cost analysis is another barrier. Where we’ve been able to showsome intervention saves money or is cost neutral, it’s been very easy to make the case for green solutions. The places where it’s very cost competitive is around reducing waste, reducing water use and reducing energy use. There are immediate positive financial impacts and environmental impacts with those kind of interventions. We’re also in the midst of developing a business case around sustainable health care building. We are seeing that there’s quite a small differential up front for some of the pilot hospitals, in the neighborhood of 1-2%. But because it’s going to save over time we’re now trying to measure how quickly that investment’s recouped.
The medical education system in the U.S. does not address the links between environmental exposures and disease or health impacts, and this continues to be a significant barrier for our work. A typical doctor may get four hours of environmental education in four years, and that will include issues around smoking and diet. And yet the science suggests that there are incredibly strong links between a very specific set of illnesses and diseases and very specific set of environmental exposures. The science is way ahead of the medical education, and that’s a real impediment to the transformation.
Are there specific things you are looking to accomplish in the next 5 years?
In the next 5 years we’re hoping to get to change the way that hospitals operate so that they’re moving toward being toxic-free, carbon-neutral, with minimal waste and dramatic water conservation measures. To that end, we’re going to be helping hospitals develop their health care footprint, so they can measure where they are now, and then work with them over time to dramatically reduce that footprint.
We are working hard to link sustainable health care design with what’s called evidence-based design. Used by the Center for Health care Design, evidence-based design integrates patient and worker safety into the design process. Linking sustainability and evidence-based design to make green and healthy building practices the absolute standard in all future health care construction is a short-term goal for us. And it will be important for us to document how those changes in design and construction affect patient outcome and worker health and safety.
We also hope to collectivize the purchasing practices of all the major hospitals in the country to drive the marketplace for safer and healthier products across the whole sector. I think there is an enormous opportunity for the health care sector to define an economy and a society that is places health at the center of it all. We need to transform our society to one that supports healthy people, healthy communities and a healthy planet.
We are also going to be working with the UN and the WHO to eliminate mercury from health care globally and to use that as leverage for a globally binding treaty to eliminate mercury completely.
If the health care sector really decides to move in the green direction, what impact is it going to have 10-15 years down the line?
We will see that changes in the health care industry become a driving force in our society, it will help us move away from our addiction to oil and petrochemicals, it will move us toward preventive medicine and we’ll begin to see reduction of diseases in our society.
Now, we’re working on a wedge of a larger problem. The larger problem is that we need to be providing health care to everybody who needs it. And at the same time it needs to be as environmental responsible and supportive of safety as it can be. We are part of a larger confluence of consciousness in the planet around the need for health care and the kind of health care that will keep us and our planet healthy. It’s exciting and we’re happy to be part of this movement.