Photo: A Greener Hospital is a Healthier Hospital

By Dr. John Howard, MD

A couple of years ago, Canada's major health professional associations joined forces to call for an environmentally responsible health sector. This joint position statement expressed the following vision:

We envision the health sector as a leader in integrating environmentally responsible practices into the delivery of health care. We also see it as an advocate in sharing information on best practices and encouraging Canadians and Canadian organizations to limit their environmental footprint. In a green health sector, minimizing negative impact on the environment would be a priority for all organizations and individuals in their day-to-day practices and at all levels of decision-making.

Human health and the environment are inextricably linked, so it might seem obvious that the health sector should take an active interest in protecting the environment that sustains human life. Yet the reality is that hospitals produce waste at levels unequalled by most industries. Hospitals are also among the most energy-intensive buildings in many Canadian communities.

I work at the London Health Sciences Centre (LHSC), which has an ecological footprint equivalent to 631 square kilometres — an area much larger than the city of London itself. While there is potential damage from this large carbon footprint, there are also opportunities to make big reductions in hospital energy consumption and waste output.

As a physician, I make a conscious effort to consider the ecological consequences of my care for patients. Apart from the obvious options of using efficient transportation, turning off lights when not needed, unplugging computers when not in use, avoiding disposable containers, and minimizing paper use, I try to consider the impact on the environment in my everyday clinical decisions. For example, does a patient really need to come from 100 kilometres away for a follow-up appointment, or can I handle her issues on the phone? Could I do the whole consultation by videoconference? Since environmental degradation is a considerable determinant of health, I try to educate my patients and colleagues about ways to minimize their own carbon emissions and waste output.

I have also been impressed by the hospital engineering department's leadership in initiatives to consider environmental impacts in corporate decision-making. The hospital now has a waste-reduction strategy that is a component of every decision made. Beyond reducing waste, this strategy is saving the hospital money. For example, a big push has been "cogeneration", the generation of both heat and electricity at the same time. Once a second unit is in place, the hospital will be nearly independent of the Ontario energy grid and will produce 20,000 fewer tons of greenhouse gases, saving $2 million a year in energy costs. LHSC also has a strong energy awareness program that aims to educate and encourage every employee to reduce consumption at the hospital (and at home). The amount of waste the hospital sends to the landfill has decreased by 14 per cent over the past five years, too — even though we are now providing more health care to the community.

Other programs are proving successful as well.

LHSC was one of the first hospitals to stop using pesticides in its care of its green space. Grounds management has created four healing gardens to recognize the healing effect of the natural environment on both patients and staff.
"Green" hospital products are becoming increasingly available. LHSC has created "green criteria" that are now part of all requests for product proposals. Issues being considered in purchasing are packaging, methods of delivery, and the potential for vendor "take-back" of used products and packaging for recycling.

LHSC hosted the first annual Eco-Care conference in 2008, a national event with the aim of reducing the ecological footprint of health care. Delegates from across Canada gathered to discuss how to decrease energy consumption, reduce waste, reuse health-care equipment, and develop environmental stewardship programs for employees. It was an excellent forum in which vendors could showcase environmentally friendly hospital products (e.g., compostable bedpans) and services (e.g., the use of environmentally friendly cleaning products). See for more information.

Hospitals exist to benefit our communities, but they also consume and pollute. Not only do we need to provide optimal patient care but we also need to minimize the detrimental effect hospitals have on the environment. Given the considerable size of the health care "industry", small percentage reductions in energy use and waste output will result in large net reductions. At hospitals, like other workplaces and community institutions undertaking environmental initiatives, a few major changes combined with many small changes can have a huge impact. It can be done!!

Dr. John Howard, a Professor of Pediatrics and Medicine at the London Health Sciences Centre, is Chair of the Canadian Association of Physicians for the Environment.

This article is also being published in the spring 2011 edition of the Canadian Journal of Green Health Care.


March 15, 2011

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