Making health care healthy
One of the greatest challenges facing humanity in the coming decades is to heal the relationship between industrial civilization and the environment that sustains us. In the context of this larger healing, the role of healthcare needs to be transformed and enlarged. Not only do we need to heal individual patients, but also the surrounding environment and the communities that are served by health care delivery systems. Moreover, health care itself is a major industrial enterprise and suffers from all the same contradictions of a system powered by fossil fuels and toxic chemicals. It is a significant source of pollution and related public-health impacts.
We need to transform this disequilibrium at a scale that matches the social and ecological crises that we face. First, we need to educate health care professionals around the world to understand the importance environmental conditions in disease onset; second, we need to help the health care sector clean up its own house by reducing its environmental and public-health footprint; third, we need to utilize the enormous purchasing power of health care to drive markets and create stimulus for greener energy, greener chemicals, and safer products and technologies. And finally, we need to activate health care leaders to advocate for broader societal policies that are more protective of everyone on the planet and the ecosystems that sustain us.
This transformation will require more than just money (although it will require plenty of that). The United States spends more on health care than any nation on earth, yet its health statistics are worse than most industrialized countries and many developing countries. Its hospitals have the most advanced medical technologies, yet its citizens have the highest cancer rates. According to the American Cancer Society, one in three women will get cancer in her lifetime and almost one in two men. Among children under fourteen, cancer is the leading cause of death by illness. As a society, we have begun to accept high rates of cancer as a normal consequence of living in our industrialized economy.
There are other troubling signs as well: obesity now affects almost 90 million Americans, contributing $147 billion a year to the nation’s bulging health care budget. Learning disabilities impact one in six children and infertility impacts one in six couples. How can we explain this epidemic of diseases and health conditions in the richest country on earth?
Over the last 15 years, the science implicating environmental threats to health has become impossible to ignore. The evidence linking toxic chemical exposures to learning disabilities, cancer, asthma, Parkinson’s disease, endometriosis, infertility, and a host of other conditions gets stronger every day. The mounting drama of obesity-related diseases is increasingly understood as a consequence of a failed industrial food system and not just the result of poor individual food choices. And as the slow-motion crisis of climate change continues to unfold, we are learning that global warming will usher in an era of pandemics, infectious-disease migration, respiratory disease, heat-related deaths, and a tide of environmental refugees of biblical proportions. As Yogi Berra once said, “suddenly the environment is all around us.”
As long as we continue to ignore the environmental determinants of health, we will continue to medically intervene only after the onset of chronic disease. It’s as if we have designed an entire healthcare system to pull drowning people out of a river, rather than moving upstream to see why they are being thrown into the river in the first place. Seventy percent of all health expenditures in the United States are devoted to treating chronic disease; only 4% of the healthcare budget is focused on primary prevention. Meanwhile, children are being born with up to 100 toxic chemicals in their bodies, already poisoned before birth. Climate change continues unabated, amid scientific consensus that it will lead to millions of new asthma cases and a plague of other conditions. In the early years of the 21st century, we are learning that it is becoming increasingly difficult to support healthy people on a sick planet.
Is there evidence that a transformative program to detox our economy is even possible? When we started Health Care Without Harm (HCWH) 14 years ago, mercury thermometers were the gold standard in health care. Mercury is a toxic metal that escapes into the environment and never breaks down, poisoning the food chain and damaging the brains of developing children. Today, mercury thermometers have been replaced with safer alternatives in most US and European hospitals. Every major pharmacy chain has stopped selling them. We are confident that within the next decade mercury medical products will be phased out at a global scale.
When we first launched our campaign, there were over 4,200 medical-waste incinerators in the United States, making health care the biggest source of dioxin pollution in the country. Today, there are fewer than 80 incinerators left, while hospitals are reducing their waste streams, utilizing safer treatment technologies and saving money in the process.
Across the country and the world, architects are now building cancer centers without carcinogens and pediatric centers without chemicals linked to birth defects. Hundreds of hospitals in the United States and Europe are replacing the fast-food joints in their lobbies with farmers’ markets and hospital kitchens are buying local and sustainably produced food. Major hospital systems are committing to build and operate climate neutral facilities and install solar and other renewable energy systems onsite.
All over the world, there is a growing movement for environmentally responsible healthcare. Physicians are sounding the alarm about the urgency to address climate change in order to protect the health care of billions of people. Hospitals are aligning their food purchasing in urban food deserts to support local and sustainable food systems as a community wellness intervention. Together with nurses and health-affected groups, we are building the critical mass for a race to prevent cancer, rather than a race for a cure. There is a growing consensus that we need to defend the rights of children to be born toxic-free and the rights of women to protect the purity of their breast milk. These are fundamental human rights that we need to fight for if we are to have any chance of protecting future generations.
Over the last decade, HCWH has shown that the health care sector can be a catalytic force linking health issues with the greening of the economy. No other sector has the same standing to accomplish this linkage. With minimal resources, we have demonstrated that large-scale change is not only possible, but also cost effective and in alignment with health care’s core mission to do no harm.
We are entering an era of global triage, where we will struggle to provide basic health care to everyone on a planet in crisis. In this critical mission, we need to make environmentally responsible health care the global standard and create markets for safe and affordable medical technologies and products that address the basic needs of billions of people. We have shown that environmental protection, preventative health care and the greening of the economy can be powerfully linked to achieve all three objectives. It is now time to get to work and bring these solutions to scale.