Last year, the Baltimore Medical System's new Highlandtown Healthy Living Center served nearly 15,000 patients—many of them uninsured immigrants for whom English is a second language—in a sparkling new $11.5 million clinical facility in East Baltimore. Sunlight stands in for fluorescent bulbs in patient-care spaces. Formaldehyde-free, low-VOC building materials reduce toxic exposures for staff and patients. Even the cleaning products are environmentally friendly, while the art on the walls—made from found and reused materials—explores the relationship between human health and that of the planet. A fourth-floor terrace garden promotes reflection and contemplation in the bustling inner-city neighborhood, and a rain garden along the sidewalk diverts stormwater from flowing into the Chesapeake Bay.
"We want to reduce the disparities and other causes that lead to poor health outcomes, such as asthma, diabetes, and obesity," says BMS President and CEO Jay Wolvovsky. "By designing a facility that focuses on health through environmental awareness, we hope to bring about another level of change in promoting a healthier Baltimore."
The United States' $2.6 trillion health-care industry generates more than 4 billion pounds of trash annually. Inpatient health-care facilities rank second only to food-processing facilities in energy consumption. A growing number of healthcare professionals see a fundamental conflict between their Hippocratic oath to "do no harm" and the environmental consequences of the industry's by-products, including discarded chemotherapy drugs, expired pharmaceuticals, caustic cleaning supplies, and dioxin generated by medical-waste incinerators, as well as the climate effects of intensive energy consumption. As a result, they're taking steps to transform the way they do business—reducing waste, improving indoor air quality, boosting energy efficiency, and promoting health through on-site farmers' markets and healthier cafeteria offerings.
"Hospitals operate 24 hours a day, seven days a week. They're resource-intensive, and they're subject to really strict regulations and fire codes," says architect Robin Guenther, a principal at Perkins+Will and author of Green Guide for Health Care.
"As a result, they tend to be buildings that contain a lot of petrochemical-based plastic materials laden with chemical flame retardants. They're beginning to discover that there are ways to both do good for patient care and do good for the environment at the same time."
Efforts to clean up the industry first made headlines in the late 1980s when medical refuse washed up on East Coast beaches. In 1998, the American Hospital Association, the American Nurses Association, and the Environmental Protection Agency made a joint pledge to cut medical waste in half by 2010, forming the organization now known as Practice Greenhealth. Health Care Without Harm, founded in 1996, helped shutter several thousand medical-waste incinerators nationwide and create tougher emissions standards for those that remain.
Today, the group boasts nearly 500 member organizations in 50 countries. Meanwhile, the nonprofit Teleosis Institute implores the industry to "do more good" through green pharmaceuticals management and low-impact clinical practices.
"Given that our mission is both to keep people healthy and to help them heal when they're unhealthy, it would be a complete contradiction for us to contribute to poor health—whether of employees, patients, or the community," says Barbara Sattler, director of the University of Maryland School of Nursing's Environmental Health Education Center.
"We want our healthcare institutions to be healing places."
In 2005, Sattler founded Maryland Hospitals for a Healthy Environment (MD H2E). Today, the organization boasts a membership comprising three-quarters of the hospitals in the state. Their efforts include recycling and composting, reduced reliance on toxic chemicals, and environmentally preferable purchasing policies. "We're seeing the hospitals begin to adopt an environmental ethic," Sattler says, "so it's part of the fabric of the decisions they're making."
That doesn't make it easy. "An institution with 7,000 employees and 800 patients on any given day, it's a huge operation," says Denise Choiniere, the sustainability manager at the University of Maryland Medical Center. In 2006, as a cardiac-care nurse in intensive care, Choiniere launched a recycling program that now diverts nearly 100,000 batteries annually from incineration. Other initiatives include a 50 percent reduction in regulated medical waste, high-efficiency vacuum pumps to reduce water consumption by 5 million gallons annually, and a program to divert discarded drugs from municipal wastewater treatment facilities that often can't remove them.
Louise Mitchell, MD H2E's sustainable foods program manager, promotes the Healthy Foods in Health Care Pledge by connecting hospital food-service directors and chefs with local farmers to increase their purchase of local, sustainable foods. She also provides technical support for other healthy food initiatives. One outcome of this support is that 17 health-care facilities statewide now host farmers' markets or farm stands on their campuses. This fall, she hosted a training program for kitchen staff interested in purchasing and preparing sustainably produced meat and poultry from small, local farms. "Hospitals have shifted toward having more food delivered that's already prechopped or precooked," says Mitchell. "They have the kitchens and the knives to prepare fresh foods, but they don't necessarily have the labor or the ovens."
The Maryland Pesticide Network and project partner Beyond Pesticides collaborate with MD H2E to promote the reduction or elimination of pesticides from hospitals and elder-care facilities. They advocate replacing conventional pest management that relies on chemical pest controls—many of which are linked to cancer, Parkinson's, autoimmune disorders, and reproductive dysfunction—with non-chemical pest prevention, using the least toxic pesticides only as a last resort. "Pests can carry disease, so pest management is really important," says psychotherapist and MPN executive director Ruth Berlin. "But so is protecting people from unnecessary exposure to hazardous pesticides."
Bringing greener solutions to health care demands a passion for questioning the status quo. Sattler compares it to weighing treatment options for a headache: Sure, you could take morphine to knock back the pain, but most of the time Tylenol will do the trick.
"The morphine is overkill," Sattler says.
"We began to look for the Tylenol—the least toxic but still effective option—throughout the industry."