02 June
The Endocrine Society presented a statement at the second international Plastics Treaty negotiation meeting on the adverse effects of plastic pollution due to EDCs, endorsed by 36 national and international endocrine societies.
- PFAS on our shelves and in our bodies
- Fractured
- Exposed: BPA science
- Agents of Change
- Cutting edge of science
- Climate catastrophe in the South
- Cancer risk in Pittsburgh
- PFAS contamination
- Breathless: Childhood asthma
- Peak Pig: The soul of rural America
- Sacred Water
- Winged Warnings
- Pollution, Poverty, People of Color
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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?”
Countries should negotiate a rights-respecting treaty that fully encompasses the impacts of plastic production, use and disposal on human health and the environment.
Delegates should push for a treaty that takes a full-lifecycle approach to plastic pollution, including specific and time-bound steps to end the production of unnecessary virgin plastics, like single-use packaging, and to establish a cap on plastic production.
The treaty should also ban the use of toxic chemical additives in plastics, like the 3,200 plastic chemicals known to harm human health.
Petrochemical industry problems
Shell's new petrochemical complex in southwestern Pennsylvania.
Credit: Nate Smallwood for Environmental Health News and Sierra Magazine
Almost all plastics are made from a combination of noxious chemicals and fossil fuels: oil, gas and even coal. Communities living near plastic and petrochemicals plants are exposed to air and water pollution that contribute to high rates of cancer, respiratory diseases, and other illnesses. They are disproportionately located in low-income communities and communities of color, including on the U.S. Gulf Coast, where the chemicals in the disastrous February Ohio train-derailment were made.
Plastics are not just a threat to human health, but also a major contributor to the climate change crisis.
The petrochemical industry is rapidly becoming the largest driver of global oil consumption, projected to account for roughly half of the growth in oil demand by 2050. At its current rate of growth, petrochemical production will account for an astonishing 15% of the global carbon budget by 2050. If plastic and petrochemical production continue to increase, it will be difficult, if not impossible, to avoid the most catastrophic consequences of climate change.
The plastics plague is a relatively new problem. Since plastics became a common product in the 1950s, their popularity has skyrocketed, with global plastic production growing from 2 million metric tons in 1950 to 400 million metric tons in 2022.
As global energy systems transition away from fossil fuels, oil and gas companies are increasing investments in plastics and petrochemical production in attempts to protect their profits and continue extracting fossil fuels.
Perversely, in the midst of the climate crisis public financing of fossil fuels and petrochemicals continues to prop up the plastics sector. A recent study found that governments provided $33.4 billion to large-scale petrochemical projects from 2010 to 2020. More broadly, from 2019 to 2021, G20 countries and multilateral development banks provided at least $55 billion per year for fossil fuels.
Big polluters in attendance
Negotiations over the Global Plastic Treaty provide a key moment for countries to shift the tide away from toxic, climate-destructive plastics. For example, the High Ambition Coalition to End Plastic Pollution, a group of roughly 50 countries, is calling for the treaty to “restrain plastic consumption and production to sustainable levels,” as well as promote a circular economy that protects the environment and human health and achieves environmentally-sound management of plastic waste.
In March 2022, countries agreed to negotiate an international, legally binding mechanism on plastic pollution by the end of 2024. This week’s convening of negotiators at UNESCO headquarters will be the second of five meetings of the International Negotiating Committee.
Unfortunately, this second round of treaty negotiations is off to a rough start. The Secretariat overseeing the treaty negotiations announced that only a small number of the registered observers – including scientists, Indigenous Peoples, and civil society groups – would be allowed into the building. This is unfortunate, as a strong plastics treaty requires that scientists, experts and impacted communities can meaningfully participate in the process. The UN should prioritize those voices over the big polluters in attendance by taking steps to increase public participation in Paris, including by providing overflow rooms from which representatives of civil society can actively participate.
While many industries are making significant, if unrealized, commitments towards renewables and away from fossil fuels, the plastics industry blithely carries on making the problem worse. To protect human health and address the climate crisis, it is imperative for governments to step up and negotiate a strong Global Plastic Treaty that respects human rights and protects our environment.
Laces, buckles, interior textiles and more were receiving a PFAS treatment before becoming part of a sandal or hiking boot.
“PFAS were being applied to styles that were meant to go in the water, and a water shoe doesn't need to be waterproof,” Lauren Hood, KEEN sustainability manager, told Environmental Health News (EHN).
The company started by asking suppliers to stop using unnecessary PFAS, which removed about 65% of this type of chemicals in their products. It took four years for KEEN to phase out PFAS in all products, through finding and testing chemical water-proofing alternatives.
Now apparel companies will need to follow KEEN’s example to comply with upcoming bans on PFAS in consumer products, including outdoor clothing, passed in at least three U.S. states. With varying timelines, the bans apply to all types of PFAS chemicals (researchers have documented more than 9,000), and cover industries specified in each state’s bill, such as food packaging or textiles.
PFAS is short for per-and polyfluoroalkyl substances, a family containing thousands of chemicals with at least one strong carbon-fluorine bond. The bonds allow PFAS to repel water from clothing, but it also makes the chemicals extremely persistent in humans and the environment. Research has linked PFAS to health harms including reproductive issues, cancers and developmental delays in children, according to the Environmental Protection Agency (EPA).
California and New York are first up — both states banned PFAS in food packaging starting in 2023, and have a 2025 deadline for removing PFAS from apparel. Maine has targeted 2030 to ban PFAS from nearly all products sold in the state. The bans in California and New York will have a wide impact, Avinash Kar, senior director of NRDC’s Health and Food, People and Communities Program, told EHN. “Larger states can drive the overarching marketplace,” he said. Companies are likely to make uniform changes for their product line, so that the same items can be sold in states with or without PFAS bans, Kar added.
Some companies are ahead of the regulatory curve and have already phased out all PFAS from their products, including Jack Wolfskin and Nikwax. Others have voluntary policies to phase out PFAS ahead of the 2025 deadline, including REI, which announced in February it won’t carry products included in the California PFAS ban starting in the fall of 2024. This standard applies to hundreds of outdoor brands that sell items through the co-op.
PFAS are often applied to products like rain coats and other water-resistant items used outdoors, so the upcoming bans will have a big impact on the outdoor apparel industry. To comply with the law, companies need to hunt down and remove the chemicals from their products. This means having conversations with suppliers and testing materials, then redesigning items if PFAS are present. These changes will likely ripple out to places beyond current PFAS-ban adopters, as companies remove PFAS across their supply-chain. Experts say this will cut down on people’s exposure to PFAS beyond the states enacting the bans, from factory workers and communities surrounding production sites, to consumers across the globe.
State by state bans
It took four years for KEEN to phase out PFAS in all products, through finding and testing chemical water-proofing alternatives.
Credit: looseends/flickr
Enacted and proposed PFAS bans across U.S. states target different industries and include varying enforcement methods, but most cover a broad range of consumer products. In March, New York amended its law to better align with California’s regulation timeline and broadened the ban to include outdoor apparel and other industries. The synced timeline “makes planning much easier for companies,” James Pollack, an attorney who specializes in consumer product regulation at Marten Law, told EHN. “California and New York are two pretty big markets.”
Some states carve out exemptions or longer timelines for personal protective equipment and outdoor gear used in extreme conditions. For example, the California bill notes that there are currently no PFAS-alternatives for firefighting gear and exempts it from the ban.
One-at-a-time bans create a patchwork of regulation that can be difficult for companies to comply with, Pollack said. For the outdoor apparel industry, “the design phases for this [gear] are often years in advance,” he pointed out.
Enforcement methods for PFAS bans differ by state. California’s ban could be administered through lawsuits from the attorney general’s office or city and district attorneys. “We purposely did not put very stringent enforcement in there,” said California Assemblymember Phil Ting in a webinar about the PFAS ban he introduced. “The point of the bill is really to provide a timeline. We know that many retailers are already moving in this direction.” New York’s ban, on the other hand, introduces monetary penalties and assigns a department to administer the new regulations.
Related: First-of-its kind testing points to dangers and unknowns of PFAS in clothing
In addition to California, New York and Maine, there are enacted PFAS bans in Vermont, Maryland and Colorado, though apparel is not included in these states. PFAS bans for some products have been proposed in Minnesota and Rhode Island, and Vermont and New York are considering bills to expand theirs. Washington state’s legislature directed its department of ecology to create a PFAS ban for aftermarket fabric treatments, carpets and indoor furniture as early as 2025, and has set a later date for banning PFAS in apparel. The European Union is also considering a measure to ban all uses of PFAS.
At the U.S. federal level, however, there’s been less action on PFAS in consumer products. A bipartisan bill introduced to the U.S. House and Senate in 2021 to ban PFAS in food packaging never reached a vote in either body. The EPA announced standards for six common PFAS compounds in drinking water in March, following 10 states that created their own enforceable limits on PFAS in drinking water.
“I've been doing this work for a long time. It is powerful how bipartisan PFAS is,” Sarah Doll, national director of Safer States, told EHN. This month Vermont’s senate unanimously approved the bill that expands the range of consumer products included in its PFAS ban, which will now move to the state’s house. PFAS bans have seen bipartisan support in other states as well.
PFAS exposure isn’t seen as an urban or rural issue, said Doll. PFAS can be found in products nearly all Americans come into contact with from food packaging to furniture, so many want to see them phased out.
Getting PFAS out
REI store in Denver. The outdoor gear company announced in February it won’t carry products included in the California PFAS ban starting in the fall of 2024.
Credit: jpellgen/flickr
Outdoor apparel brands and companies in other industries are now tasked with tracking down PFAS added to products and taking it out of their supply chain.
“In many cases, brands have no idea what's in the products that they sell,” said Mike Schade, director of Mind the Store at Toxic-Free Future. Figuring out what chemicals are present can involve working through layers of suppliers to learn what is added to components of a product. Companies can also test their products to look for fluorine, a component of PFAS, or specific PFAS chemicals out of the thousands in the family.
Fluorine testing has found evidence of PFAS in clothes, food and makeup, including in many so-called “green” and “organic” brands, EHN and Mamavation uncovered last year.
For some products, like KEEN’s water shoes, PFAS simply isn’t needed and companies can work with their suppliers to remove it from production. For others, like wet weather gear, brands have to find and test alternative chemicals to find new options that perform well outdoors.
“As companies move away from PFAS, we think it’s important…to evaluate the safety of alternatives to ensure they’re not moving from one bad actor chemical to another. We don’t want to repeat mistakes of the past,” Schade said.
Those mistakes include a transition from long-chain PFAS to short-chain PFAS, which contain fewer carbon atoms. Many companies transitioned their apparel to short-chain PFAS, including Patagonia, in 2016. But researchers say these chemicals still pose risks to the environment and health. GenX, one chemical produced as an alternative to long-chain PFAS by Chemours, a spinoff of DuPont, has been linked to impacts on the liver, kidneys, immune system and development in animal studies, according to the EPA. Now some companies have to go back to correct that “regrettable substitution.” (Patagonia plans to carry entirely PFAS-free products by 2025.)
In addition to use for water and stain repellency, PFAS can end up in textiles and products unintentionally. Machine lubricants and other materials used in manufacturing can contain PFAS and contaminate the items produced in factories. In these instances, textile producers and brands may not be aware that PFAS are present. Removing those sources of the toxic chemicals could require testing and finding alternative materials to use during manufacturing.
KEEN has removed all intentionally added PFAS chemicals from their products, explained Hood. But, “the work is sort of never done,” she said, “nothing is really PFAS-free. It’s in the ice in the Arctic and it’s in our bodies. It’s just everywhere now.”
PFAS-free ripple effect
KEEN’s work to remove PFAS from products has created a bigger supply-chain impact, said Hood. Some manufacturers KEEN worked with to phase out the chemicals now sell PFAS-free components to other companies as well. Brands that have phased out PFAS are able to share resources and information, such as a guide KEEN published that includes alternative water-proofing recommendations.
Tracking down intentional uses of PFAS and removing them from products is a good start at reducing the presence of this harmful class of chemicals, said Schade. But preventing unintentional PFAS contamination will be a challenge that could take industries longer to solve. Ultimately, “unless we cut off the manufacturing of PFAS, they’re going to continue to show up as a contaminant,” Schade said.