By Lisa M. Belisle, MD, MPH
Originally published in The Maine Switch, March 17, 2009

Health and the environment: we hear these words paired together often these days. This is how it should be.  From the air we breathe to the food we eat—we can’t escape the fact that our surroundings have a significant impact on our well-being.

Hospitals and medical providers also realize the link between individual and environmental health.  This is a relatively new phenomenon. Once upon a time (during my “medical lifetime”), patients were allowed to smoke in their rooms, while doctors quelled their nicotine habit in the physicians’ lounge. People were just becoming familiar with the dangers of secondhand smoke. Now we are well aware that tobacco can damage a non-smoker’s body as easily as it damages the body of the person smoking nearby.

We’re also aware of many other environmental issues that can influence our health:
mercury, pesticides, food contamination. Medical providers and their patients are becoming increasingly concerned about these external factors—and they are starting to take action. In 1996, 28 organizations came together to form “Health Care Without Harm (HCWH).”  According to the HCWH website, “Just as the Hippocratic Oath promises to, ‘first, do no harm,’ HCWH is based on the premise that health care providers have a responsibility to eliminate practices that harm people and the environment.” HCWH now represents 473 organizations in more than 50 countries. Over 2,000 U.S. hospitals have joined this program.

The HCWH coalition has several areas of interest. These include:

• Minimizing use of Mercury—a substance that negatively effects the brain, spinal cord, kidneys and liver, especially in young children.
• Minimizing use of Polyvinyl Chloride (PVC)  and Bis(2-ethylhexyl) phthalate—compounds found in plastics that have been linked to birth defects, cancer and reproductive problems.
• Minimizing use of Brominated Flame Retardants (BFRs)—also linked to reproductive and developmental problems. American women have higher levels of BFRs in their breast milk than any other women in the world.
•  Minimizing Pesticides and Fragrances—these contribute to poor indoor air quality and numerous health problems, especially in vulnerable patients.
• Minimizing Medical Waste, which is full of infectious agents and other hazards.  Hospitals generate 2 million tons each year.
•  Disposing of Electronic Waste safely and ethically. Discarded electronics are often exported to underdeveloped countries, which are ill-equipped to handle their hazards.
• Creating Healthy Buildings—free of materials that can trigger asthma and potentially cause cancer in patients.
• Making healthy, safe, sustainably produced Food available to patients, staff and visitors.
• Engaging in Green Purchasing practices.
• Investigating the long-term consequences of Chemicals being used in medical care.

Clearly the HCWH and its participating organizations have their work cut out for them. However, it’s gratifying to realize that we are finally making the connection between individual and environmental health, and trying to effect change. It began with taking tobacco out of the treatment room, and will continue with careful monitoring and use of questionable chemicals. We simply need to remember: “first, do no harm.”