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Designing the 21St Century Hospital Environmental Leadership for Healthier Patients and Facilities

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Designing the 21St Century Hospital Environmental Leadership for Healthier Patients and Facilities Designing the 21st Century Hospital Environmental Leadership for Healthier Patients and Facilities Papers presented by The Center for Health Design® and Health Care Without Harm at a conference sponsored by the Robert Wood Johnson Foundation, September 2006. www.healthdesign.org The Center for Health Design is a nonprofit research and advocacy organization whose mission is to transform healthcare settings into healing environments that improve outcomes through the creative use of evidence-based design. We envision a future where healing environments are recognized as a vital part of therapeutic treatment and where the design of healthcare settings contributes to health and does not add to the burden of stress. For more information, visit www.healthdesign.org. Health Care Without Harm is an international coalition of 440 groups in 55 countries working to transform the healthcare industry so that it is ecologically sustainable and no longer a source of harm to people and the environ- ment. Since 1996, HCWH has been at the forefront of efforts to shift the healthcare sector toward safer, healthier products and practices. Major successes include: virtually eliminating the market for mercury fever thermometers in the United States; reducing the number of polluting medical waste incinerators in the United States from 5,000 in the mid-1990s to less than 100 today; shifting the medical-device market away from DEHP-containing PVC plastic; implementing the first green building system for hospitals, the Green Guide for Health Care; and working with hos- pitals to build markets for locally grown, sustainable healthy food. For more information, visit www.noharm.org. The Robert Wood Johnson Foundation focuses on the pressing health and healthcare issues facing the United States. As the nation's largest philanthropy devoted exclusively to improving the health and healthcare of all Americans, the foundation works with a diverse group of organizations and individuals to identify solutions and achieve com- prehensive, meaningful, and timely change. For more than thirty years, the foundation has brought experience, com- mitment, and a rigorous, balanced approach to the problems that affect the health and healthcare of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org. ©2006 The Center for Health Design Health Care Without Harm Robert Wood Johnson Foundation 1850 Gateway Boulevard 1901 North Moore Street Route 1 & College Road East Suite 1083 Suite 509 P.O. Box 2316 Concord, CA 94520 Arlington, VA 22209 U.S.A. Princeton, NJ 0854302316 925.521.9404 tel. 703.243.0056 tel. 877.843.RWJF (7953) 925.521.9405 fax 703.243.4008 fax www.rwjf.org [email protected] [email protected] www.healthdesign.org www.noharm.org Graphic design: Glenn Ruga/Visual Communications Copyediting: Lisa Richter, Richter Communications Table of Contents Foreword. iv Debra J. Levin First, Do No Harm . 1 Gary Cohen Values-Driven Design and Construction: Enriching . 15 Community Benefits through Green Hospitals Robin Guenther, FAIA, Gail Vittori, and Cynthia Atwood Creating Safe and Healthy Spaces: Selecting Materials . 55 that Support Healing Mark Rossi, PhD, and Tom Lent Preventative Medicine for the Environment: Developing and . 83 Implementing Environmental Programs that Work Laura Brannen Redefining Healthy Food: An Ecological Health Approach to . 97 Food Production, Distribution, and Procurement Jamie Harvie, PE Toward an Ecological View of Health: An Imperative . 123 for the Twenty-First Century Ted Schettler, MD, MPH TABLE OF CONTENTS / iii Foreword The American healthcare industry is in the midst of an impressive construction boom, the result of dimin- ished capital investment in new and replacement hospitals in the 1990s, the aging population, and the increasing number of hospitals experiencing bed shortages and capacity bottlenecks in their emergency rooms, surgical suites, and critical-care units. The forecast of annual capital spending on health facilities rising from $18 billion today to $35 billion in the year 2010 makes a discussion of better building impor- tant and timely. This healthcare construction boom presents a rare opportunity to use the emerging sciences of evidence- based design, materials assessment methodologies, and green building tools to build healthier healthcare facilities that benefit occupants, communities, and the global environment. Because they are responsible to the communities they serve and their environmental impacts span both oper- ations and construction, healthcare organizations are in a unique position when it comes to being green. Since the mid-1990s, the industry has made considerable progress in reducing operational impacts and now stands poised to begin transforming design and construction practices. Moreover, as an industry that employs 1 out of 8 Americans, directly or indirectly, and drives upwards of 15 percent of the gross domestic product, the decisions that healthcare purchasers make can have a dramatic impact on the marketplace. In the area of operations, the healthcare industry is cleaning up its own house, which serves to make healthcare organizations better community-health advocates. The industry has dramatically reduced reliance on medical waste incineration, which the Environmental Protection Agency (EPA) identified as the largest source of dioxin contamination in the atmosphere in 1996. Since that time, the number of medical-waste incinerators in North America has fallen from close to 5,000 to less than 100. The American Hospital Association signed a memorandum of understanding with the EPA with a commitment to phase out the use of mercury altogether. Many hospitals are beginning to advocate for chemicals policies and reduced use of antibiotics in food sources, as they respond to the growing evidence around linkages between the health of the environment and the health of the communities they serve. With regard to sustainable building practice, the healthcare industry is slowly taking up the challenge and opportunities that green building presents. According to the U.S. Green Buildings Council, the num- ber of LEED (Leadership in Energy and Environmental Design) registered healthcare buildings in the United States has risen from twenty, just two years ago, to more than eighty today. Moreover, there are more than one hundred healthcare organizations participating in the Green Guide for Healthcare’s pilot program. This means that almost two hundred healthcare organizations in the United States are advanc- ing green design, construction, and operational strategies for their facilities. It is in the context of furthering this important dialogue that The Center for Health Design (CHD) and Health Care Without Harm commissioned the writing of these papers, which will be available for free download on the CHD website at www.healthdesign.org. Individually, these papers tackle very different aspects of this complex, intricate, and compelling subject. But together, they represent an incredible opportunity to move healthcare from the status quo to becom- ing more responsible stewards of the environment. Debra J. Levin President The Center for Health Design iv / DESIGNING THE 21ST CENTURY HOSPITAL First, Do No Harm Gary Cohen The challenge intrinsic to healthcare is how to provide high-quality treatment in an ever-changing environ- ment. New science and technological innovations constantly require healthcare providers to transform the way they deliver services. Over the last ten years, the new science linking chemical contaminants in the environment and the incidence of disease has created an additional impetus for the transformation of healthcare practice. This paper explores the implications of this new science linking contaminants and health and discusses the environmental innovations that hospitals are implementing to not only create more optimal conditions for healing in their institutions, but also to prevent disease in the general public. Our rising disease burden Chronic diseases and disabilities now affect more than 90 million men, women, and children, more than one-third of our population (CDC 2005a). In spite of the many advancements in medical practice, the best available data shows an increase in the incidence of asthma, autism, birth defects, childhood brain can- cer, acute lymphocytic leukemia, endometriosis, Parkinson’s disease, and infertility (Trasande and Landrigan 2004, Jahnke et al. 2005). Some of the highlights of Americans’ disease burden are summarized below. • The lifetime risk of getting cancer is 1 in 2 for men and 1 in 3 for women; 1 in 12 and 1 in 11, respectively, will develop invasive cancer before the age of 60 (ACS 2005). • The risk of breast cancer has almost tripled from more than 1 in 20 to 1 in 8 in the last forty years (ACS 2005). • Asthma rates doubled between 1980 and 1995 (Mannino et al. 2002). • Non-Hodgkin’s lymphoma has nearly doubled since the 1970s (RPCI 2005). • In America, 127 million people are overweight; 60 million are obese (AOA 2006). • Between 1997 and 2004, diabetes incidence increased 45 percent among 18-44 year olds (CDC 2005b). • Endometriosis, linked to dioxin exposure, now affects 10 percent to 15 percent of the US female population (Holloway 1994, Suchy and Stepan 2004). The picture is profoundly troubling. The human cost for families and communities is immeasurable, par- ticularly those already disadvantaged
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