Are hospitals making tiny babies sick?
That question troubled Kathy Gerwig, an executive at Kaiser Permanente, the big US healthcare provider, when she visited a Kaiser neonatal intensive care unit in San Francisco back in 2001, to take an inventory of medical equipment including IV tubing, blood bags and feeding tubes. She and her colleagues wanted to find out if they contained a chemical substance known as DEHP, a phthalate used in polyvinyl chloride (PVC) plastics to make them soft and flexible. Studies of animals had suggested that DEHP could be harmful to a fetus, especially to the reproductive systems in males.
The science around the health effects of DEHP was far from clear-cut, but Gerwig and her colleagues at Kaiser plowed ahead. They asked equipment suppliers to provide DEHP-free products where possible, and subsequently sought to remove other so-called chemicals of concern from Kaiser’s facilities, even amidst scientific uncertainty.
“The fact that so many (chemicals) are not well understood, to me, is a red flag,” Gerwig told me in an interview at Kaiser’s Washington office. “Our bar has never been proof of harm. Our bar has been when there is ‘credible evidence.’ And credible means credible.”
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A pioneer in the healthcare industry’s sustainability movement, Gerwig devotes a chapter of her new book, Greening Health Care: How Hospitals Can Heal the Planet, to the challenge of “detoxing healthcare.”
It’s just one example of a troubling paradox: an industry devoted to health produces more than its share of waste, greenhouse gases and toxic air emissions – all of which make people sick. What’s more, some hospitals still feed sugary soft drinks and Jell-O to patients and employees alike.
That makes no sense, argues Gerwig, who has worked on sustainability issues at Kaiser for more than 20 years. Fortunately, she reports, the healthcare industry is getting serious about going green.
Remember mercury thermometers? They’re all but gone from hospitals, after the industry was shown that the incineration of medical wastes contributed about 10% of the nations’s mercury air emissions. (Burning coal produces most of the rest). Most of America’s 5,000 hospitals used to have their own incinerators to burn hazardous waste, which made hospitals the biggest emitter of dioxin; now medical waste is more likely to be sterilized, then sent to landfill, which is better. Hospitals are also turning to greener chemicals, building LEED-certified buildings and hosting farmers’ markets on their grounds.
“A truly green healthcare system may be a distant goal, but at least today it really is a goal,” Gerwig says.
Much of the credit goes to Gerwig, Kaiser and other industry leaders, including Gary Cohen, an activist who co-founded Health Care Without Harm in 1996 and still leads the group. Dignity Health, a California-based healthcare system, published the industry’s first environmental report, and switched to PVC-free tubing ahead of Kaiser. Wisconsin-basedGunderson Health System formed a for-profit subsidiary that has invested in wind turbines, a biomass boiler and a manure digester in an effort to go carbon-neutral. Fletcher Allen Health Care, the academic medical center for the University of Vermont, pledged to stop buying beef, poultry, pork, fish and cheese that contain antibiotics, in part because of worries about the growth of antibiotic-resistant infections.
It’s only logical that hospitals should lead the way when it comes to environmental stewardship because their purpose, at least in theory, is to improve the health of the communities where they operate. Kaiser is well-positioned to take an expansive view of its role because of its focus on preventative care. The Oakland-based nonprofit, which had revenues of $53bn last year, provides health insurance, operates hospitals and employs about 17,000 doctors who serve about 9.5 million members.
Gerwig, who is 58, has a particular interest in chemicals. In 2005, she asked to be tested for the presence of industrial chemicals in her body. “There are 27 chemicals commonly used in industry, and all 27 are in me,” she says, including DDT, which was banned years ago. This is typical, she was told: “It was sort of alarming.”
Twice, Gerwig has testified before Congress in favor of strengthening TSCA, the woefully weak federal Toxic Substances Control Act. Meantime, Kaiser has sought out greener chemicals for its medical devices, cleaning products and, most recently, its furniture.
In June, Kaiser became the first health system in the country to tell its suppliers that it would stop buying furniture treated with flame retardants; the firm spends about $30m a year to furnish its hospitals and medical offices. Chemicals used as flame retardants have been linked to reproductive, neurocognitive and immune system impacts, according to the Healthier Hospitals Initiative, a nonprofit coalition.
“We have credible evidence that these chemicals are harmful, and they’re not providing the benefits that are claimed,” Gerwig says.
The chemical industry was displeased. The American Chemistry Council – which, by coincidence, shares an office building with Kaiser in Washington – asked Kaiser to reverse its decision, saying that that the flame retardants help prevent fires and are “subject to review by the EPA” and other regulators.
This month, though, four other big hospital systems – Advocate Healthcare, Beaumont Health Systems, Hackensack University Medical Center and University Hospitals – said they, too, would stop buying furniture treated with flame retardants.
Because the healthcare sector is such a large part of the economy, its actions could help shift the furniture marketplace – and thus benefit public health.
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Date: October 01, 2014