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Change comes hard to healthcare institutions, but a growing movement of doctors, nurses, medical school students and hospital system executives are working to clean up the industry.
Around 650 health care professionals from around the world gathered in Pittsburgh last week to strategize about ways to reduce waste and air pollution, disinvest from fossil fuels, better integrate communities, drive down the industry’s climate-warming emissions and hear success stories from people on the front lines of this work.
“[This] is not just a conference — we’re intentionally building a movement,” said Gary Cohen, president and co-founder of Health Care Without Harm, the organization that hosts the CleanMed conference, during his opening remarks. “This is the work of our lifetime. Are we ready to get going?”
Healthcare’s environmental toll
Ironically, the healthcare industry takes a significant toll on the environment in ways that negatively impact human health. The sector accounts for an estimated 4.4% of total global greenhouse gas emissions and up to 9.8% of U.S. greenhouse gas emissions.
Related: Visiting health care professionals take “environmental justice tour” of Pittsburgh
Health damages from the U.S. healthcare sector’s pollution – including greenhouse gasses, carcinogenic emissions and other toxic air pollutants – from 2003-2013 are estimated to have cost Americans more than 400,000 years of full health, defined as years lived free of disease or disability. It’s estimated that nearly eight million, or one in five deaths globally, are caused by air pollution — more than the number of deaths caused by AIDS, malaria and tuberculosis combined.
Institutional investments are also problematic: The U.S. has more than 1,200 private hospital systems, which invest an estimated $10 billion in fossil fuels.Cleaning up the healthcare sector
People who have successfully initiated new sustainability programs or policies at their organizations shared tools and tips.
Credit: Kristina Marusic for Environmental Health News
The doctors and nurses attending CleanMed were joined by operations managers, sustainability directors, budget analysts, medical device providers and health-care-strategy consultants, along with people in numerous other roles.
People who have successfully initiated new sustainability programs or policies at their organizations shared tools and tips.
Elizabeth McLellan was one of those people. In the early 2000s, while working as a nurse administrator at Maine Medical Center, she was troubled by the huge volume of unused supplies like gloves, gowns, gauze, bandages and masks going into the trash because they’d been left in a patient’s room or opened in an operating room.
McLellan had lived and worked abroad and knew there was a dire need for these supplies in other parts of the world, so she started collecting them. There was nowhere on site at her hospital to store the supplies she saved, so she took them home.
By 2009 the bottom floor of her house was filled with about 11,000 pounds of rescued medical supplies, which she eventually figured out how to warehouse, ship and donate to hospitals in need around the world. After running the project entirely by herself for years, McLellan scaled the operation into a regional nonprofit, Partners for World Health, with 10 staff members and 800 volunteers, that has saved more than 180,000 pounds of medical supplies from landfills and shipped them to countries in need including Ukraine, Syria, Turkey, Zambia, Haiti, Ethiopia, South Sudan and Kenya.
“It’s easier to ask for forgiveness than for permission,” she said in a session about hospitals making progress toward becoming zero-waste. “That has worked my whole career, and it worked for this project, too.”
In one of two talks about reducing single-use plastics, Dr. Sara Angelilli, director of perioperative education at the Allegheny Health Network, talked about implementing reusable respirators. Dr. Preetri Preeti Mehrotra, a senior medical director at Beth Israel Deaconess Medical Center, shared tips on finding the people who “can help pull the levers,” and discussed both infection control and financial benefits in switching to reusable products. And Daniel Vukelich, president of the Association of Medical Device Reprocessors, cautioned about the false promise of “chemical recycling” of single-use plastics, which is associated with a host of climate and environmental health concerns. Health Care Without Harm is also calling for the global plastics treaty currently in its second round of talks this week in Paris, to not allow medical exemptions.
Other health care professionals shared advice about incorporating environmental justice and community health advocacy into clinical care by setting and meeting renewable energy goals, managing hazardous pharmaceutical waste, getting clinicians involved in climate action and increasing patient access to healthy and sustainable foods inside hospitals and at home. Health Care Without Harm partners with hospitals around the world to help them meet these types of goals through its Practice GreenHealth program.
“In the last year or two, hospitals are increasingly looking beyond their four walls when talking about community resilience and environmental health,” Paul Bogart, executive director of Health Care Without Harm, told EHN. “They’re starting to think about economic drivers of community health and social determinants of health — things like housing, transportation, employment and exposure to polluting facilities.”
“That type of work, for many health care institutions, is just beginning,” Bogart added. “Those relationships with community leaders are just beginning.”
Why Pittsburgh?
Walking along the Allegheny River with scenic views of the city’s iconic yellow bridges, the group learned about how pollution from the steel industry was once so bad that Pittsburgh was nicknamed “hell with the lid off."Credit: Kristina Marusic for Environmental Health News Attendees representing at least 15 countries, including Argentina, Australia, Belgium, Brazil, Japan, Nepal, South Korea and Taiwan attended the CleanMed conference.
Previous conferences have been held in cities across the U.S. and across the world, and conference organizers connect what’s happening locally with the broader movement.
Related: A guide to environmental health in southwestern Pennsylvania
In Pittsburgh, that meant acknowledging the city’s industrial history, discussing ongoing problems with air pollution and childhood lead exposure and addressing the significant role that extractive industries, particularly fracking and petrochemical development, play in shaping the region’s health. It also meant asking questions about the health care industry’s obligations to communities impacted by these problems.
“The fossil fuel and petrochemical industries require externalizing harm,” said Cohen during a plenary on building partnerships between health care institutions and community advocacy. “We need to understand who is harmed by an economy that’s based on fossil fuels and toxic chemicals … What does it mean for the health care industry to truly partner with these communities to help build community health, wealth and resilience?”
Their eyes widen and their smiles beam as they admire how the seeds we planted earlier in the season are now full-grown plants. The scent of summer rain is in the air and I’m excited to begin harvesting okra, which I will freeze to make gumbo in the fall. Although gardening was not part of my childhood, I reclaimed the connection to the land to continue that legacy for my family. My maternal great-grandparents in Opelousas, Louisiana, grew sweet potatoes, okra, watermelon and other produce to sell at the French Market in New Orleans. My paternal great-grandparents owned vegetable and dairy farms in Mansfield, Louisiana. Local agriculture was not only a source of food and income, but a means of community, partnership and connection.
While my youngest daughter is chasing butterflies that frequent the marigolds in a neighboring garden plot, my oldest daughter is examining a ladybug on a cucumber vine. “Mom, what do ladybugs eat? Why are ladybugs good for our garden? But how?” This space is a living classroom that can teach us to question the “what?” “why?” and “how?” of partnerships that benefit all of its members.
Community gardening and other types of urban agriculture can be powerful tools to advance food sovereignty, build community connections and educate. As described in Dr. Ashley Gripper’s Agents of Change essay, people of color and grass-root environmental justice organizations have transformed vacant lots and other sites into community gardens and farms that foster spiritual healing, strengthen community-building and combat food apartheid – discriminatory policies and practices that prevent marginalized groups from accessing affordable, sustainable, nutritious, high-quality and culturally connected food.
This essay is also available in Spanish
Unfortunately, the same communities impacted by food apartheid often live in areas where disinvestment, racial segregation and other inequalities result in disproportionally high exposures to harmful chemicals in air, water and soils – which might be used for urban agriculture. Communities of color are more likely to be near hazardous waste sites, highways and other pollution that may result in elevated heavy metal soil concentrations, such as lead. Data show children from racial and ethnic minority groups and children in low-income communities are more likely to have higher blood lead levels. Some garden practices can introduce chemicals into the garden like pesticides, and gardening materials such as landscape fabrics can be a source of microplastics.
I want to be clear: the benefits of gardening in communal settings should not be stifled by potential contaminant risks. Rather, we should look for ways to reduce chemical exposures in gardens. To do that, we need to ensure effective collaborations exist involving every sector interested in community gardens, including education, nutrition, urban planning, research and government.
Potential pollution in community gardens
Community garden in metropolitan Atlanta where author Candis Hunter serves as a member and volunteer.
Credit: Candis Hunter
Urban soils can harbor dangerous chemicals. It could be that current and historical land uses, like industrial activities or agriculture, exposed the soil to toxics and pesticides. Treated wood, burned tires or pollution runoff can leach chemicals into the soil. Chipping paint from older buildings and heavily trafficked roads might create lead soil deposits. People can be exposed to these chemicals by breathing in soil particles, eating tiny bits of soil that may not have been washed off from produce, or eating produce that has absorbed the contaminants (although this is an unlikely source of exposure, depending on factors such as the plant species and soil composition).
Children, however, are at a greater risk, because they often are putting things into their mouths and are more curious than adults. I think about my own toddlers, who enjoy playing in the garden soil and exploring the outdoors with all five senses. It’s scary to think about how even a tiny amount of ingested lead from the soil could damage their growing brains and nervous systems. I also wonder whether gardeners were aware of these chemical risks and what resources could help protect them.
These questions led me to focus on how community gardeners could reduce their exposures to heavy metals in soil for my doctoral thesis. Practices such as heavy-metal soil testing, composting, mulching and hand washing can reduce exposure – something that community gardeners are interested in, according to my results. While testing and hand washing are self explanatory, composting can contain organic matter that makes it more difficult for some plants to absorb contaminants and mulching helps to reduce contaminated soil from being redispersed in the air. However, I identified several barriers gardeners face when trying to protect themselves, like soil testing costs, concerns about property values and the legal implications of soil lead, a lack of training to interpret the results, among others. Although my research focused on individual gardener practices to reduce exposures, I became interested in how these findings could materialize into tools and policies that may be adopted in community gardens.
There are existing partnerships that address these barriers. For example, soil screening, health, outreach and partnership (soilSHOP) events provide free lead education and soil lead screening to communities in the U.S. As I dug deeper trying to understand how to make these partnerships work, I started to wonder, just like my curious child looking at the mutually beneficial relationships between ladybugs and cucumber vines, how we can make the diverse partners (gardeners, schools, faith-based communities, neighborhoods, non-profit organizations, government) invested in community gardens work together to advance environmental justice and health equity.Turning research into policy: Implementation science
Environmental justice researchers have shown communities of color are impacted by higher heavy metal soil concentrations and a lack of access to affordable, sustainable, nutritious, high-quality and culturally connected food.
Credit: Unsplash+
A possible answer could be implementation science, which means investigating the ways in which research results can become widespread practices and policies. A research study may show that free lead soil screening is an effective community-engagement tool to identify soil lead in gardens. How does this research finding get incorporated into everyday community garden practices? An implementation science approach would examine what makes that practice sustainable and how we can overcome challenges to adopt that practice? Implementation science can also bridge environmental health disparities research to environmental justice action.
For example, environmental justice researchers have shown communities of color are impacted by higher heavy metal soil concentrations and a lack of access to affordable, sustainable, nutritious, high-quality and culturally connected food. While the traditional approach focuses on understanding what gardening strategies can increase access to food and why they are working, an implementation science lens could push researchers to explore how policies, practices and diverse partnerships can reduce potential soil contaminant exposures. Just as gardens require careful cultivation to nurture the symbiotic partnerships for the plants and other organisms to thrive, so does understanding how different groups engaged in community gardens cultivate partnerships and practices to reduce harmful chemical exposures.
It is possible to ensure gardening spaces are safe, restorative and regenerative, especially for those who are most vulnerable to chemical exposures, such as children. To achieve that, we need to put communities at the forefront. We need to mentor and encourage students to push the boundaries of science, and explore ways to build a symbiotic relationship between research and practice of community gardening, akin to a thriving, interconnected garden.
All children should have the opportunity to play and grow food in soil that is free of toxics. As my daughter exemplified in her garden inquiries, a solution may be asking the why, what, and how.
This essay was produced through the Agents of Change in Environmental Justice fellowship. Agents of Change empowers emerging leaders from historically excluded backgrounds in science and academia to reimagine solutions for a just and healthy planet.
Disclaimer: This essay was written by Dr. Hunter in her personal capacity. The opinions expressed in this article are the author’s own and do not reflect the view of the Centers for Disease Control and Prevention, the US Public Health Service, or the United States government.