So much of the news on health care in the United States is bad and getting worse. The per person cost of health care in this country, now $5,540 a year, is rising four times faster than wages. Currently Americans spend almost 15 percent of their income on health care, far more than other advanced countries.
According to the Census Bureau, almost 44 million Americans don’t have health insurance. That number has been increasing by roughly two million a year. Medicaid and Medicare are focused on cutting costs rather than expanding the number of people they serve.
The number of children with asthma has doubled since 1980. The percentage of women with breast cancer and men with prostate cancer is rising every year.
National problems need federal cures, but the White House and Congress don’t seem to know where or if to start. In the absence of national leadership, nurses and physicians and hospital environmental services managers and purchasing directors are figuring out what they can do to improve the health of their patients and their communities by improving the health of the environment.
A few examples
In 1994, the United States Environmental Protection Agency (USEPA) reported that the burning of hospital trash in medical waste incinerators was the largest source of emissions of dioxin. Dioxin is the cancer-causing, immune system-suppressing endocrine system-disrupting chemical that made the defoliant Agent Orange so harmful to the people of Vietnam and American soldiers. In 1996, a new coalition called Health Care Without Harm (HCWH) began to educate health care professionals about medical waste incinerator dangers and about safer ways to reduce waste and to treat what’s left. When HCWH began its educational outreach to the industry there were an estimated 4,000 medical waste incinerators in operation. Today there are less than 100, with an 81 percent decrease in dioxin emissions.
A decade ago, mercury was still the standard measuring liquid for thermometers and blood pressure devices. At the time, almost no one was connecting the silver column in these devices to mercury contamination of fish; the FDA and the tuna industry had nothing to say about how mercury in a can of tuna could impact a woman’s ability to bear a healthy child. Today 2,500 hospitals have nearly eliminated mercury devices through Hospitals for a Healthy Environment or H2E, a partnership of the American Hospital Association, the USEPA, the American Nurses Association and HCWH. All of the national drug store chains, including Wal-Mart, K-Mart, Albertsons, Walgreen’s and Rite-Aid, have taken mercury fever thermometers off their shelves, and cities and states have banned the sale of mercury-containing devices.
Hospitals have to try to be free of pests, but early exposure to pesticides has been linked to increased incidence of childhood asthma. Other respiratory problems, chemical sensitivity, nervous system reactions and cancer are also associated with pesticide exposure. The ten hospitals associated with Harvard University now have ten years of experience in using Integrated Pest Management (IPM) instead of routine pesticides. Other hospitals are also adopting IPM. Alternative controls include boric acid and sticky traps. Instead of pesticide sprays, mists or fogs, IPM relies on vacuum cleaners and caulk to fill in the cracks and holes where pests get in.
Healthy Innovations
New studies suggest that products used to build hospitals might contribute to asthma as well. Phthalates, which are industrial compounds used in vinyl flooring and wall covering, have been implicated in one study of asthmatic children. The carcinogen formaldehyde used in plywood and as a preservative has also been linked to asthma. But just this year, architects and designers and environmental health advocates have put together the first Green Guide for Healthcare Design, a best practices guide for healthy and sustainable design, construction, and operations for the healthcare industry.
Kaiser Permanente is hosting farmers’ markets in the courtyards of some of their facilities to provide fresh locally grown fruits and vegetables to community and staff. KP, Catholic Healthcare West and other health care systems are also trying to leverage their food purchases to move the market towards locally grown, sustainable and organic foods.
Group purchasing organizations (GPOs) that work with hospitals to leverage buying power are adopting environmentally preferable purchasing programs. Charlotte, North Carolina-based Premier has just launched a comprehensive web resource to help their 1,400 healthcare organization members in environmentally friendly selection, recycling, and disposal of computers and electronics. Consorta, a Shaumburg, Illinois-based GPO, whose membership includes more than 400 acute care facilities and more than 1,700 non-acute care sites, is developing a comprehensive policy to move away from dangerous or untested chemicals.
These successes result from the efforts of various individuals: nurses who didn’t want to send mercury thermometers home with new parents; hospital architects who thought it made sense to build cancer care units without cancer-causing materials; and purchasing professionals who recognized the problem of toxic chemicals.
None of these improvements in environmental health practices will solve the health care crisis. Pediatric units free of PVC and phthalates and medical clinics without mercury are not the same as insuring the uninsured. But health care professionals all over the United States are working to solve the part of the problem they have the power to solve.
When Washington is ready to deal with what’s broken in the health care system, men and women who are already finding better alternatives to incineration and pesticides will bring a lot of problem-solving experience to the table.
