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The Issue Toxic chemical exposures begin before birth and co ntinue throughout our lives. Many of these chemicals have been linked to serious illnesses, including asthma, infertility, learning disabilities, Parkinson’s disease and cancer. The health care sector is a major consumer of chemicals including those well documented to cause serious impacts on health and the environment. Thus, a sector whose mission it is to protect human health is contributing to the burden of disease. By addressing chemical exposure in health settings, the health sector can not only protect  patient and worker health, but also actively demonstrate the safe management of chemicals thereby leading by example. Action Items Develop institution-wide chemicals and materials policy and protocols to protect patient, worker, and community health and the environment, while helping drive society wide demand for alternatives. Implement a facility -specific chemicals action plan with benchmarks and timelines. Participate in the WHO-HCWH Global Mercury-Free Health Care Initiative by substituting all mercury thermometers and blood pressure devices with safe, accurate, affordable alternatives. Address the use of chemicals of concern, including, for example, glutaraldehyde, halogenated fire retardants, PVC, DEHP and BPA, and seek safer alternatives and substitutes. Adopt policies that require disclosure of chemical ingredients in products and materials and seek to ensure that all ingredients have undergone at least basic toxicity testing. When products or materials are identified that contain Substances of Very High Concern — substances that have been identified as carcinogenic, mutagenic or toxic for reproduction, or that are persistent and bioaccumulative or warrant similar concern — hospitals should make it a high priority to replace them with safer alternatives.

The Issue Hospitals generate millions of tons of waste each year. Unfortunately, health care waste management is still poorly funded and implemented. The combined toxic and infectious properties of medical waste represent an underestimated environmental and public health threat. A recent literature review came to the conclusion that over half the world’s population is at risk from the health impacts of healthcare waste. Burning of medical waste generates a number of hazardous gases and compounds, including hydrochloric acid, dioxins and furans, and the toxic metals lead, cadmium, and mercury. The disposal of solid waste produces greenhouse gas emissions, including methane, a greenhouse gas twenty-one times more potent than carbon dioxide. Properly managed, healthcare waste should not cause any adverse impacts on human health or the environment. Medical waste management is complex and success is in large part dependent on changing the habits of hospital staff. A variety of non-burn technologies are available that can safely disinfect, neutralize or contain the wastes for landfill disposal. Information on alternative treatment technologies and waste Management is freely available. Action Items Reduce, treat and safely dispose of healthcare waste Protect public health by reducing the volume and toxicity of waste produced by the health sector, while implementing the most environmentally sound waste management and disposal options.

The Issue Greater energy efficiency and transitioning to clean, renewable energy sources, such as solar and wind, can both significantly reduce greenhouse gas emissions and protect public health from the myriad impacts of climate change, including increased heat-related illnesses, the expansion of vector borne diseases, increased droughts and water scarcity in some regions and storms and flooding in others. Moving away from fossil fuels also brings with it the health and economic co-benefit of reductions in hospital admissions and treatments for chronic illnesses such as asthma, lung and heart disease caused by the pollution created from the extraction, refining and combustion of coal, oil and gas. The health sector consumes significant amounts of fossil fuel energy, although there are no adequate figures for most countries. Health-care facilities can also significantly cut greenhouse gas emissions and energy costs over time by using alternative forms of clean and renewable energy – such as solar and wind energy, and biofuels that do not undermine public health. Action Items For existing buildings, implement an energy conservation and efficiency program that will reduce energy consumption by a minimum of 10% in a single year, and will continue to produce ongoing energy savings of 2% per annum, resulting in a 10% reduction in each five year period. For new buildings, design to achieve building energy performance targets of 320 kWh/sq m or less. Conduct regular energy audits and use the results to inform awareness and retrofit programs. Once efficiency measures are implemented, investigate the purchase of clean, renewable energy, and if available, purchase at least five percent at the next available opportunity. In existing plants, shift to cleaner boiler fuels. Investigate sources of onsite, clean, renewable energy and include its generation in all new building plans. Identify potential co-benefits of climate mitigation efforts that reduce greenhouse gas emissions and local health threats, while saving money at the same time. Integrate occupant education and awareness programs to reduce energy consumption related to occupancy. In mechanically conditioned spaces, turn thermostats down a few degrees in winter or cool climates, and up in summer or warm climates. Even a slight shift can create significant energy savings.

The Issue Much healthcare delivery in developing countries takes place in settings where there are inadequate or non-existent municipal water or treatment facilities. This lack of water and sanitation infrastructure is a major problem that directly impacts hospitals and health care systems – either overburdening them with more disease in the population, or because they cannot count on basic water, sewage and waste disposal services to carry out their mission, or both. When water is amply available, hospitals are often prodigious consumers in various facets of their operations. Overall, there are few reliable global water consumption benchmarks in healthcare. In general, health facilities can conserve water resources by closely metering water use, installing water-efficient fixtures and technologies, growing drought-resistant landscape, and making sure that leaks are quickly repaired. For even greater impact on overall usage, hospitals in a number of countries are harvesting rainwater. Others recycle water for process purposes Action Items Establish a framework that aspires to “net zero water use” within a hospital system. Implement water conservation strategies: install efficient faucets and toilets, routinely check plumbing and pipes to prevent leaks, eliminate seal and cooling water on medical air compression and vacuum pumps, and retrofit refrigeration systems. Switch from film-based radiological imaging equipment, which uses large quantities of water, to digital imaging, which uses no water and no polluting radiological chemicals. Landscape grounds using drought-resistant plants to minimize water use. Consider harvesting rainwater and/or recycling water for process water uses. Eliminate bottled water facility-wide if high quality potable water is available. Regularly analyze water quality. Where the health facility has access to potable water but it is not readily available in the community, develop programs to provide the community with potable water as a public health service. Implement on-site wastewater treatment technologies when no municipal service is available. Develop joint projects with the community to improve and protect water supplies; support initiatives for public systems to improve water quality, water delivery and wastewater systems for the entire population.

The Issue Transportation is a major source of air pollution throughout the world, creating significant health impacts, particularly in urban areas. Exposure to carbon monoxide, sulfur dioxide, and nitrógeno dioxide can cause respiratory illness and alter the lung’s defense systems. The health sector – with its fleets of ambulances, hospital vehicles, delivery vehicles, and staff and patient travel – is a transportation-intensive industry. Air pollution impacts from health care are concentrated near large-scale hospital facilities. Shifting to hybrid technologies, all-electric vehicles, as well as compressed natural gas or some bio-fuels all have the net impact of reducing emissions for fleet vehicles such as ambulances and vans. Encouraging hospital staff and patients to use bicycles, public transportation and carpools can also help reduce the air pollution emissions related to health care facilities. In summary, transportation choices have a huge impact on the communities within which hospitals are situated. Action Items Improve transportation strategies for patients and staff. Develop transportation and service delivery strategies that reduce hospitals’ climate footprint and their contribution to local pollution.

The Issue The globalization of a western diet based on excessive saturated fats, refined carbohydrates and processed foods, together with increasingly sedentary lifestyles, are contributing to epidemics in obesity, diabetes and cardiovascular disease in many countries. Health-care facilities in many countries are major consumers of food and can therefore model and promote health and sustainability through their food choices. A growing number of health-care facilities in developed and developing countries that purchase and serve food to patients and workers are reducing their environmental footprint and improving patient and worker health by making changes in hospital service menus and practices. These include limiting the amount of meat in hospital meals, cutting out fast and junk food, composting food waste, buying locally and sustainably farmed produce – thereby promoting local, sustainable production, producing their own food onsite, and holding farmers’ markets for local producers to sell healthy food to the community. By promoting and supporting nutritious, localized sustainable food systems, hospitals can both reduce their own immediate footprint while supporting food access and nutrition, thereby helping to foster the prevention of disease, a reduction in the health sector’s environmental health impacts and contributing to a longer-term reduction in the population’s need for healthcare. Action Items Purchase and serve sustainably grown, healthy food. Reduce hospitals’ environmental footprint while fostering healthy eating habits in patients and staff. Support access to locally and sustainably sourced food in the community.

The Issue Pharmaceutical waste can be found in trace amounts in soil and groundwater throughout the world. This waste comes from a variety of sources, including hospitals. Levels of pharmaceuticals in the environment are likely to rise in years to come, as the global demand for pharmaceuticals grows. In countries and hospitals where there are an abundance of pharmaceuticals, health systems can play an essential role in reducing pharmaceutical waste by reducing the amount of drugs prescribed, and by addressing the waste problem in their own facilities and at the policy level. Action Items Prescribe appropriately, safely manage and properly dispose of pharmaceuticals. Reduce pharmaceuticals pollution by reducing over-prescription practices, minimizing inappropriate pharmaceutical waste disposal, promoting manufacturer take-back, and ending the dumping of pharmaceuticals as part of disaster relief. The Problem of Pharmaceutical Pollution and Safer Pharma More than 600 pharmaceuticals and their metabolites have been found in the environment worldwide; this impact on the environment has implications for human health including antimicrobial resistance. Learn more in this new animated video from HCWH Europe  

The Issue The built environment influences health. A host of contemporary environmental health problems – climate change, toxic pollution, biodiversity loss and more – can be linked to the production and maintenance of the built environment. As development accelerates in many regions, the production of buildings becomes more resource intensive, stressing local and indigenous building material supplies and methodologies beyond their sustainable capacities. The health sector has the potential, through its market power, to influence the construction industry to develop safer, more resilient, greener and healthier building products and systems. The significant environmental and health impacts associated with hospital buildings have led to the creation and adoption of a wide variety of “green building” tools and resources related to healthcare. Action Items Aspire to carbon-neutral building operation. Protect and restore natural habitat; minimize the combined footprint of building, parking, roads and walks. Use high reflectance roofing and paving, or “green roof” systems and pervious paving, in order to reduce urban heat island impacts, manage stormwater and promote habitat. Design within local natural and social contexts in order to better integrate the building with the community and natural environment. Site facilities in accordance with solar orientation and prevailing wind. Employ passive systems wherever possible to provide increased resilience and redundancy – use narrow floor plates for daylighting and natural ventilation. Prioritize health impacts of material extraction, transport, use and disposal in assessing them for use in health care settings, and use materials that are replenishable and support human and ecosystem health in all phases of their life cycle. Support the use of local and regional materials (reducing transportation energy), utilize salvaged and recycled materials (reducing energy otherwise expended on new production). Avoid materials such as lead and cadmium-containing paint and coatings, as well as asbestos. Substitute materials containing persistent bio-accumulative toxic chemicals (PBT’s), including PVC, CPVC, and halogenated and brominated flame retardants, with safer alternatives. Create civilized built environments that foster inhabitant choice and control, advanced indoor air quality (through natural ventilation and mechanical systems), lighting and acoustical settings that reduce stress and support health and productivity. Refer to guidelines created by national or regional green building organizations. Advocate for policy guidelines and public funding that support green and healthy buildings.

The Issue Hospitals and health systems purchase a broad diversity of products ranging from chemicals, electronics and plastics, to energy, pharmaceuticals and food. Creating and implementing green and ethical purchasing policies can play a central role in implementing many of the goals of the Green and Healthy Hospitals Agenda. The health sector spends huge amounts of money on purchasing goods. Healthcare purchasing results in a significant environmental impact and can also have significant human rights impacts. By harnessing its tremendous purchasing power in many countries, the health sector can impact the supply chain, compelling manufacturers to provide safer, more environmentally sustainable products, produced under healthy working conditions and in accordance with international labor standards. Action Items Buy safer and more sustainable products and materials Source sustainably produced supply chain materials from socially and environmentally responsible vendors.