Conversations with Pioneers: Gary Cohen of Health Care Without Harm

Jul 2, 2008, 9:35 AM, Posted by RWJF Blog Team

Last month, we kicked off Conversations with Pioneers, a series of interviews with Pioneer grantees. The series continues this week with an interview with Gary Cohen (photo at left), executive director of Health Care Without Harm.

Health Care Without Harm hosted its annual conference, Clean Med, last month and Susan Promislo and Theresa Kanter both posted updates from the conference. Working to drive environmental sustainability in health care, Health Care Without Harm has been on the forefront of efforts to accelerate the development, use, and diffusion of environmentally preferable products and practices in the health care system.

Abbey Cofsky spoke with Cohen recently about the organization and its work:

Health Care Without Harm’s mission is to transform the health care sector --why have you chosen to focus your efforts on the health care industry?

We’ve chosen the health care industry for multiple reasons. Increasingly it’s clear that in order to prevent diseases in the general public, we need to understand the environmental links to those diseases and do whatever we can to reduce environmental exposures. And of all the sectors of society who should understand this growing science, it should be the health care sector --they’re in the healing business. And they have a responsibility to clean up their own house. We think that one very important objective for the 21st century is ensuring health care facilities operate with the least amount of environmental exposure as possible, and to move to a model of a high-performance healing environment – an environment that actually promotes healing, as opposed to contributing to further disease or exposure or infection.

The second important reason to focus on the health care sector is because it’s such a big part of the economy. Health care is 16 percent of the gross domestic product and quickly increasing as the baby boomers get older. Transforming the way that hospitals build, buy and operate their facilities will have a broad transformative effect on the economy. That’s really important, because we need our general economy to move away from oil and chemicals made from oil. We’re approaching the end of the petrochemical age, and we need the health care sector to be a leading force in ushering in a new economy that’s based on green materials, green chemistry and green energy to promote healing and sustainability on the planet.

The third big reason that we are focusing on health care is because our society trusts health care leaders. And so by having nurses and doctors and hospital leaders serve as leading advocates for the larger transformation we need in our society, they’ll be increasingly important social change agents.

How have hospitals begun to adopt environmental sustainable changes and what successes have you seen?

When we started Health Care Without Harm in the mid-‘90s there were over 4,000 medical waste incinerators in the country. And the Environmental Protection Agency was reporting that medical waste incinerators were the largest source of dioxin emissions in the country. Dioxin is probably the most dangerous human-made chemical with known links to cancer, neurological damage, immune suppression, reproductive problems, diabetes and a whole host of other problems. In the last 10 years almost all of those incinerators have been shut down -- there are probably less than a hundred medical incinerators left in America today. Many hospitals have reduced their waste generation significantly and moved towards safer treatment technologies for their waste, and they’ve saved money in the process.

is another great success today. When we started Health Care Without Harm, the health care sector was seen as responsible for 10 percent of all mercury air emissions and a significant contributor to mercury in wastewater. And that was because hospitals were dumping mercury fixatives down the drain. In the last 12 years or so, more than 5,000 hospitals in the country have started to move dramatically toward mercury elimination across the board. All the major pharmacy chains in the country have stopped selling mercury thermometers. The European Union recently banned mercury thermometers, and they’re looking to do the same on mercury blood pressure devices. We are now working with the World Health Organization and the United Nations to support a global ban on mercury-based medical products. This is an example that exemplifies how it starts with a simple effort. This mercury initiative began with a simple thermometer exchange and education day at Beth Israel Hospital in Boston. We paid for a couple of hundred digital thermometers, and told hospital administrators that they should be educating people around mercury. We gave them replacement thermometers to share with their staff and encouraged them to educate staff about the dangers of dumping mercury. From that moment, the initiative mushroomed and cities across the country started to ban mercury thermometers and started instituting their own exchange programs.

A third area of progress is the green building movement being led by the U.S. Green Building Council. Using their metric leadership guide called LEED, which stands for Leadership for Energy and Environmental Design, we and the Center for Maximum Potential Building Systems developed a similar framework for health care facilities: the Green Guide for Health Care. Based on the success of the Green Guide (150 hospitals have piloted its use), we have been working directly with the U.S. Green Building Council, and in 2009 the new LEED for Health Care, which is based on our Green Guide, is coming out. Hospital CEOs realize that they need to develop more environmentally responsible and healthier hospital facilities in the midst of this huge building boom. And so it’s bound to be quite ascendant as the sort of de facto standard in the country for future health care construction.

We’ve also spent a lot of time around developing environmentally preferable product specifications. When hospitals decide to purchase a device, a computer, a cleaning product or building materials and there’s not a performance trade-off, we want them to ask is there an environmentally superior product? We’ve developed specifications around over 50 products used in health care to inform hospital systems and we are working with all the largest group purchasing organizations in the country, which control about 90 percent of all health care purchasing, equivalent to $100 billion, to help them develop environmental preferable product strategies. We have seen a great deal of success here around PVC-free IV systems. Once we highlighted the toxic impacts of using PVC IV systems that contained DEHP, a reproductive toxin, we were able to convince the Food and Drug Administration to issue a health care warning to hospitals about the dangers of DEHP-containing PCV IV systems. Then, working with manufacturers we were able to develop safer alternatives to PVC IV systems. One company in particular, Hospira, has started a whole new line of PVC-free medical devices and we are beginning to see the market being completely transformed as a result of these interventions.

Lastly, we’ve made a very strong case that hospitals should be aligning themselves with sustainable agriculture in their communities and serving healthy food to their patients and staff. We know there’s an important link between food and health and hospitals should be using meals as an opportunity to educate people about the essential connection between healthy food and healthy lives. And more than that, if hospitals are supporting organic and sustainable agriculture in their community, it’s an extension of what we call community benefit. By using their purchasing power to support sustainable agriculture, it means less environmental exposures in the larger society – an example of the kind of transformation around food production that we need to see broadly in our society. Today, there are well over a hundred hospitals who have taken a healthy food in health care pledge, and are on a journey to transform the way they purchase food and feed their patients and staff. This is another example where the health care sector can really maximize its clout in the marketplace.

How does the environmental sustainability link to patient safety?

It is critical for us to link patient safety and worker safety with environmental sustainability. To address this issue, Health Care Without Harm joined with 20 of the most influential healthcare systems nationwide, as well as their Group Purchasing Organizations, to launch the Global Health and Safety Initiative to identify and promote sector-wide initiatives that link patient safety, worker safety and environmental issues. PCV flooring is an example of one such initiative. If a hospital switches from PVC flooring, which is used a lot because it’s so cheap, to synthetic rubber and other flooring materials, you eliminate the off-gassing of toxic materials from the PVC floor into the health care environment. This cuts down on patient exposures to what is thought to be a contributor to respiratory problems. The synthetic rubber floor also cuts down on worker exposures as well as trips and slips and falls. And it has a very strong environmental performance factor. Now our challenge is to find other interventions that cut across all three safeties and encourage hospitals around the country to implement and standardize these interventions.

Check back tomorrow to read more from our interview with Gary Cohen, and to learn more about Health Care Without Harm, visit

Gary Cohen
is a founder and Co-Executive Director of Health Care Without Harm and is also the Executive Director of the Environmental Health Fund, which works on domestic and global chemical safety issues. Mr. Cohen has been working on environmental health issues for twenty years and has published numerous articles on environmental health issues in the United States and India.  He is an advisor to the John Merck Fund on issues of environmental health and a co-founder of Green Harvest Technologies, a bio-based materials start up. Mr. Cohen was awarded the Skoll Global Award for Social Entrepreneurship in 2006 and the Frank Hatch Award for Enlightened Public Service in 2007.

This commentary originally appeared on the RWJF Pioneering Ideas blog.