Cleaning up healthcare

Hospitals and clinics committed to human health regularly expose patients and workers to hazardous chemicals, writes John Elkington. One entrepreneur is trying to transform the industry.

It truly wasn’t my fault. I was enjoying the Skoll World Forum in Oxford and Huffington Post publisher Arianne Huffington had to be interviewed early, so I was asked to come back for filming half an hour later. When I did so, one of the studio lights exploded right by my face. A thin stream of chemicals and smoke wound up towards the ceiling and fire alarms sounded out across the ultra-modern Saïd Business School. 

No doubt it proved another excellent networking opportunity for the social entrepreneurs, investors and business people forced to stand outside while the fire brigade worked out what had happened. But it reminded me of the ways in which our modern world exposes us to potentially hazardous chemicals, even when we think we are relatively safe – like in hospitals.

Flame-retardants are now added to a huge range of products used in institutions like hospitals, including televisions, computers, beds, waiting-room chairs and curtains. Unfortunately many of these chemicals slowly leak into the air, dust and water, entering our food and bodies. At least one group of chemicals, brominated flame-retardants (BFRs), are known to cause health problems in children. 

The breast milk of American women now contains the highest levels of BFRs in human breast milk worldwide. Yet whose bottom line accounts for this shadow side of health? All of this had also flashed into my mind the previous day after I walked into the wrong parallel session at the Oxford forum. 

I had intended to go to a discussion on new ways of thinking about how GDP should be calculated, but wound up hearing how social innovators are transforming the health economy. And my mistake proved to be another case of providence in action. Chairing the discussion panel was one of my favourite social entrepreneurs, Gary Cohen of Health Care Without Harm. The Skoll Foundation gave him one of its coveted awards in 2010 – and his extraordinary life story illustrates the accidental, serendipitous routes so many social entrepreneurs travel to success.

Cohen started out as a travel writer, but his life turned inside out when he researched a community guidebook about toxic chemicals. After meeting mothers fighting to protect their families against toxic dumps, he plunged into environmental health. Cohen served as co-director of the US National Toxics Campaign and co-founder of the Military Toxics Project, also helping launch a free clinic to help survivors of the Bhopal disaster in India. 

Health Care Without Harm (HCWH), which he founded in 1996, is now an international coalition of more than 500 organisations in over 50 countries, working to transform the healthcare industry, exploiting the leverage of combined purchasing and lobbying to drive the process of detoxification – all without sacrificing (indeed often improving) patient safety and treatment.

When the Huffington Post named Cohen as one if its 2011 Game Changers, the publication explained that his organisation “strives to create a more sustainable, ecological environment – at lower costs – in hospitals and clinics across the world. The good news is that the healthcare sector can play a leading role in solving these problems. Due to its massive buying power, and its mission-driven interest in preventing disease, the healthcare sector can help shift the entire economy toward sustainable, safer products and practices.”

“Market gatekeepers” like supermarkets increasingly pressure their suppliers to clean up their act. In the United States, the defence industry now pushes contractors on energy efficiency and toxics, with some clearly declared zero footprint targets. And leading sportswear brands are exploring ways to reach zero discharge of hazardous substances by 2020.

And so it’s a paradox that the healthcare industry, with so much of the medical profession committed to “do no harm”, continues to damage human health and the environment on such a scale.

To take just one example of the sector’s toxic footprint, the incineration of medical waste is a key source of dioxin and mercury. The giant and growing scale of the sector means that unhealthy practices – including poor waste management, use of toxic chemicals, unhealthy food choices and reliance on polluting products – have major negative impacts on health and environment.

Hospitals purchase thousands of different products, requested by dozens of different departments. Often unknowingly, they buy items that are toxic to workers or patients, or that have serious environmental impacts. HCWH helps purchasing people specify cleaner, greener products, which are safer for medical staff and patients, less toxic and polluting and more energy efficient. They also involve less packaging, have higher recycled content and are fragrance-free.

Reflecting on the implosion of the National Toxics Campaign, which closed down in 1995 due to organisational disagreements between Cohen and founder John O’Conner, he had concluded that a less confrontational approach was needed. “I knew it was important to create a situation where everyone could save face, so we could get beyond shame and blame and find ways to succeed,” he said in a recent interview.  “So it was a conscious choice not to blame the healthcare sector. We said the sector is environmentally illiterate, and if we can make them literate and make them understand the issues, they will change.” 

Cohen and his team helped hospitals move away from incineration by demonstrating that autoclaving medical waste – that is, sterilising it – and then disposing of it in a landfill was safer and cheaper than burning. Then he helped them reduce the amount of plastic waste they discarded by boosting recycling. After the forum closed, Cohen emailed me a slide that showed the number of US hospital waste incinerators had fallen abruptly from 5,000 in 1994 to 83 in 2006. I am sure there are other pressures at work, but the direction of change seems both clear and hopeful.

John Elkington is executive chairman at Volans and non-executive director at SustainAbility. He blogs at and tweets at @volansjohn.

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