'Thinking Green' on Behalf of Patients and Workers

July-August 2009


In Burlington, Vt., Fletcher Allen Health Care has its own honey-making beehives and plans to cultivate a vegetable garden atop a new "green" oncology building.

In Cleveland, the Cleveland Clinic serves 6,000 meals daily with healthy food grown by area farmers. It is replacing floor tiles and wallpaper that contain potentially harmful polyvinyl chloride.

And in Santa Maria, Calif., the Marian Medical Center's power plant burns methane that is piped nearly two miles from a local landfill for an annual energy savings of $250,000.

For Gary Cohen, a determined and energetic environmentalist, those developments are welcome strides in a long march. Cohen is co-founder and co-director of Health Care Without Harm, an organization that is dedicated to making the health care industry environmentally sound and healthier for patients and workers.

Since its founding in 1996, the organization in Arlington, Va., has been a fountain of ideas, encouragement and prodding to health care leaders, whose institutions already make up 16 percent of the U.S. economy. He wants them to lead by example.

"Health care is the only sector in society that is built upon the ethical principle to do no harm," Cohen said. "Other industries consider pollution to be a cost of doing business. But the health sector knows that you can't poison people if your mission is to heal them."

Health Care Without Harm (www.noharm.org) has grown into a network of more than 400 health systems, environmental groups, labor unions, churches and others, with a worldwide staff of 40. Cohen spreads the word through speeches, conferences and writings.

"He's everywhere," said Christina Vernon Ayers, director of the Office for a Healthy Environment at Cleveland Clinic. "He is incredibly collaborative and generous with his knowledge."

The home of the Cleveland Clinic system is its original hospital east of downtown Cleveland, a 140-acre campus of 37 buildings. Ayers, an architect, oversees green projects ranging from building design to an urban garden.

At Fletcher Allen in Vermont, the first hospital to join Health Care Without Harm, Ayers' peer is Dawn LeBaron, vice president for hospital services and chair of its sustainability council. LeBaron said the hospital has used information from Cohen's organization to buy linseed-based floor coverings, switch to energy-saving lights and serve locally grown food in cafeterias and patient rooms. All that, and nurture its own colonies of bees.

LeBaron said hospitals can be environmentally healthy without breaking their budgets.

"I've always been fiscally conservative," she said. "It does no good to embark upon green initiatives that drive up costs for patients. The idea that green is expensive is an urban myth."

With health care leading the way, Cohen said, "We can move the whole market. Our society is addicted to chemicals. It should be the right of that baby in the womb to be born toxin free."

Cohen, 53, grew up in West Orange, N.J., one of two sons of an accountant father and a mother who ran an independent-living program for senior citizens. Cohen's own political sensibilities grew in high school, where he helped publish an alternative newspaper that explored some of the issues then unsettling American society.

"I grew up during the tail end of the Vietnam War," he said. "Those were tumultuous times, and we were trying to connect."

He graduated from Clark University in Worcester, Mass., with a degree in philosophy, and landed a young person's dream job as an international travel writer, churning out economy tour guides. His work took him to India and a personal transformation.

He studied Eastern philosophy and religion. He walked a pilgrimage in the Himalayas. He saw the horror of the Union Carbide Corp. disaster in Bhopal, India, in 1984, when a chemical release killed at least 5,000 and injured many more.

Returning to the United States, he joined the National Toxics Campaign and interviewed families whose neighborhoods were endangered by industrial pollutants. In time for Earth Day 1990, he and John O'Connor published a book, Fighting Toxins, a Manual to Protect Your Family, Community and Workplace. He became director of the Toxics Campaign. "The issue hooked me at a deep level," he said.

Cohen immersed himself in studies linking common industrial chemicals and health problems, especially regarding early childhood development. A pivotal document was the U.S. Environmental Protection Agency's report that medical-waste incinerators were the nation's leading cause of dioxin pollution.

"To consider that hospitals were such a large source of dioxin was amazing and disturbing," he said. "We needed to do something about it."

Closing the nation's more than 4,000 incinerators became the new first cause for Health Care Without Harm. While louder activists marched in Detroit, St. Louis and Oakland, Cohen knocked on the doors of hospital administrators and bureaucrats, lobbying for safer alternatives.

Today, fewer than 100 medical-waste incinerators operate in this country. Cohen said a combination of recycling and treatment by autoclave allows for safer disposal of much smaller volumes in landfills.

His organization then focused upon mercury, a dangerous heavy metal. In the 1990s, hospitals poured tons of it down drains and caused almost 10 percent of the nation's mercury pollution. He preached against mercury thermometers and again offered not just criticism but a way out — donations of digital thermometers to a few hospitals, which soon helped to spread the word. Few hospitals use mercury thermometers today.

Health Care Without Harm urged hospitals to buy healthy food from local growers, especially from those who avoid using field chemicals and animal food with antibiotics. It warned against using materials with polyvinyl chloride, which can gasify and leach into medicines. Polyvinyl chlorides are common in vinyl floor tiles and IV bags, both of which hospitals use by the truckload.

As the organization grew, its widening network of hospital-employee members helped to lobby their executives for better purchasing practices, green-friendly designs for new and renovated buildings and reduced energy consumption.

Cohen said hospitals are second only to the food-service industry in energy use per square foot. American hospitals, he said, burn through twice as much energy as do European hospitals, often largely because of inefficient air-circulation systems that have the doubly bad affect of spreading germs through the air.

Health Care Without Harm helped to create Hospitals for a Healthy Environment, an organization of more than 2,000 hospitals, the Environmental Protection Agency, the American Hospital Association and the American Nurses Association. And in 2008, Cohen's group helped to create Practice Greenhealth, an association of health centers that promise to engage in green practices. Cohen lives in Boston and directs Practice Greenhealth there, at least when he's not on a plane or in a conference. Anna Gilmore Hall, a former executive of the American Nurses Association, co-directs Health Care Without Harm from its suburban Washington, D.C., office.

Sr. Susan Vickers, RSM, vice president of community health for Catholic Healthcare West, serves on the boards of Heath Care Without Harm and Practice Greenhealth. She describes Cohen as energetic and committed.

"He can communicate his passion in a way that is contagious, that conveys a sense that all of this is doable," she said.

Catholic Healthcare West, with 41 hospitals in California, Arizona and Nevada, was the first system to join Heath Care Without Harm. It operates the hospital in Santa Maria, Calif., where the piped landfill methane saves on energy. Cohen cites the health system as a "real leader" and proof that health care can be a beacon for good practices.

"We have made environmental health a mainstream issue in health care," Cohen said. "We have moved from individual hospitals to broad networks, and we're getting results."

That's vital, he said, for people like his 10-year-old daughter, Asha, whose name is an Indian word for hope.


Copyright © 2009 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Thinking Green on Behalf of Patients and Workers

Copyright © 2009 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.