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Book excerpt: a healthy planet, healthy people

There's a natural connection between environmental stewardship and promoting good health, this Kaiser Permanente Vice President writes in her book.

An excerpt from Greening Health Care: How Hospitals Can Heal the Planet, by Kathy Gerwig.

The very nature of health care is changing. Health care reform, clinical innovations, electronic medical records, social connectivity, technological advances, baby boomers’ expectations about quality of life, demands for price to align with value, and ways the environment contributes to disease are some of the factors behind the changes.

These changes offer profound, new opportunities to address environmental issues across the health care sector and beyond.

In this changing landscape, what does environmentally sustainable health care look like? Let’s take an imaginary visit to a hospital for a routine doctor visit. Approaching the medical facility, the first thing we notice is that the building is smaller than we expected. There is a convenient transit stop at the front entrance. And the parking lot pavement allows rainwater to filter through to be cleaned and returned to the aquifer. We notice that instead of lawns there are native plantings that minimize water and pesticide use.

There is a garden path that takes us by a stream that was brought back to life from where it was hidden in a concrete culvert decades ago. We enjoy the birds that have rediscovered this tranquil place. You notice a labyrinth and take a meditative respite.

Once inside, we are walking on nonvinyl, nonpolluting material on the carpets and floors, and we notice how much natural light floods into the lobby and hallways from specially designed window glass, shades, and blinds that allow sunlight in while minimizing afternoon heat. The walls are painted in soothing colors and patterns that mimic the adjoining landscape. The energy-efficient lighting fixtures glow with a pleasing hue. You see a plaque on the wall indicating that the building is carbon neutral.

In the bathroom, the toilets and sinks are water conserving, and the soap does not contain harmful antibacterial agents. The paper towels are made from 100 percent recycled, postconsumer waste, and the used towels go into a compost container. In the waiting room, the fabric on the chairs was selected to avoid harmful chemicals that can cause adverse health effects.

In the exam room, your temperature and blood pressure are taken with mercury-free devices. You notice the purple exam gloves used by the clinical staff. These are latex-safe for worker and patient safety, and they are environmentally preferable.

If you are here for a biopsy, your doctor will use a rigid endoscope (for minimally invasive surgery) which is steam sterilized to avoid the use of chemicals that are hazardous to the environment and to staff. Patients’ X-rays are processed through a digital system that supports quality care by enhancing image analysis and transmission, and it is environmentally friendly because each machine eliminates the use of thousands of gallons of potable water annually as well as the chemicals and heavy metals needed for film processing.

As the housekeeping staff makes their routine rounds, we notice the absence of any chemical smells. This is because they use cleaning products that are free of harmful chemicals. And you see a cleaning system that supports zero waste through recycling, remanufacturing, and composting.

When we stop for lunch in the cafeteria, we have a selection of healthy options that are delicious, locally sourced, and sustainably produced, just like most of the patient meals. When we pass by the vending machine, we see a selection of healthy, nonsugary snacks and drinks.

This feels to us like a place of emotional and physical healing. We are better able to handle the medical issue that brought us here. We appreciate the sense of total health that surrounds us.

Everything we see on our trip exists somewhere in the US health care system today. In the future, we will see more of these features embedded in all care locations.

In my work as an environmental advocate in health care, I am often asked how people can best contribute to a healthy environment. There is much we can and should do to lessen our impact on the environment, such as reducing reliance on fossil fuel, preferring products that do not contain harmful chemicals, and being mindful about consumption and waste.

I believe, however, that the best thing we can do for the environment is to reduce our own health risks, or if we are healthy to stay that way.

The main causes of poor health in the United States are preventable: unhealthy eating, insufficient physical activity, tobacco use, and too much alcohol. One third of Americans are obese, and there is a tsunami of diabetics headed our way because millions of Americans are prediabetic today. Sedentary behavior increases the odds of cancer, stroke, depression, loss of bone density, and a host of other illnesses. The resulting response from the health care system to diagnose and treat these illnesses is environmentally intensive.

Health is determined by many social and economic factors, including education, community safety, employment, and culture. It is determined by physical environments that include food, media, and environmental quality. And it depends on access to quality clinical care and prevention.

As individuals, we can work to reduce our own health risks by eating healthy foods, moving more, and finding our joy. As members of our local and global communities, we can promote policies, programs, and innovations that make healthy behaviors the easier behaviors.

The greening of health care is a lesson of hope. And the future of health care holds a promise of planetary healing that extends far beyond the system of health care.

From Chapter 2: The Health Implications of Climate Change

Anthony Costello, the lead author of the exhaustive 2009 Lancet study on climate change and its health consequences, proposed that health professionals should be spearheading three areas of action: First, they should be speaking out forcefully about “the threat to our children and grandchildren from greenhouse-gas emissions and deforestation”; second, they should be addressing and mitigating the “massive inequality in health systems throughout the world” in their ability to deal with climate change; and third, and most optimistically: “We must develop win–win situations whereby we mitigate and adapt to climate change and at the same time significantly improve human health and wellbeing.”

Dr. Dana Hanson, the incoming president of the World Medical Association, seconded those views in even stronger terms: “Climate change represents an inevitable, massive threat to global health that will likely eclipse the major known pandemics as the leading cause of death and disease in the 21st century. The health of the world population must be elevated in this discussion from an afterthought to a central theme around which decision-makers construct rational, well informed, action-orientated climate change strategies.”

Chapter 3: The Business Case for Total Health

In the beginning of Kaiser Permanente’s environmental stewardship efforts, our cost structure was less of a driver than our health care mission, so long as our program was cost neutral in the long run. Actually, what we had in the early days was not so much a stewardship “program” as a shared understanding about the link between environmental health and human health and a belief that, as a major health care provider, we had a great opportunity, and a responsibility, to act on that link. We understood that the health and sustainability of the environment—the natural environment, the built environment, and even the social environment—is a necessary condition for human health and well-being. We think of our mission in terms of what we call “total health,” which has multiple, interrelated dimensions. It includes the physical, emotional, and spiritual health of every individual, supported and sustained by the health of our total environment—our families, neighborhoods, workplaces, cities, the air we breathe, the food and water we consume, and all the delicate ecological balances that sustain life on this planet. While medical care is typically focused on the physical health of patients and members, our approach to health and wellness must support this larger reality.

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All proceeds from the sale of Greening Health Care: How Hospitals Can Heal the Planet will go to Health Care Without Harm. Visit Oxford University Press to learn more about the book and purchase a copy. Electronic and print copies of the book are also available on Amazon.

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