The healthcare sector is the leading employer in both the Philadelphia region and Pittsburgh, the two largest cities in the Commonwealth of Pennsylvania. Given the nature of their 24/7 operations, and the fact that all of us will use medical resources throughout our lives, health care has a significant impact on the health of surrounding communities and on the environment at large.

Consider these other facts:

• "First, do no harm." The first line of the Hippocratic oath for physicians. Inadvertently, hospitals are sources of potentially significant harm, with the use of copious chemicals, many toxic to people, and disposal of over two million tons of waste each year.
• One out of every five health care professional in the US receives training in Philadelphia. Yet, less than 5% receive training around environmental health issues, other than asthma, lead and infection control.
• In both the Philly Region and in Pittsburgh, the health care sector is the number one employer. This sector is expected to grow both regionally and nationally, with healthcare accounting for 20% of the domestic GNP within a few years.

Partnering with leading hospitals and healthcare systems and the local hospital association, since 2000, WHEN created and implemented the Environmentally Responsible Health Care initiative to impact this highly polluting industry, which surprisingly is not aware of many of their effects on human health. Medical waste incineration was identified by the US EPA in 1994 as one of the highest sources of dioxin, mercury and lead air emissions.

Our efforts are focused on toxins reduction, pollution prevention and environmental health education in health care by providing scientifically-based information and education, helping healthcare institutions to go beyond just meeting regulations, developing innovative and effective projects to assist these facilities, and providing resources and tools for them to manage independently. Each component of the initiative builds on others and are linked to environmental exposures resulting in harming people's health, albeit unintentionally. As such, workers, patients and community members, as well as the environment and wildlife, can be protected from polluting actions and policies.

Working with the major healthcare facilities in the Philadelphia Region and Pittsburgh enables us to impact one of the largest sectors in our state, helping to transform hospitals into healthier places of healing. "These regions are recognized nationally as models for environmentally responsible healthcare, demonstrating the sustainability efforts that we have successfully engaged in for the past 7 years.

• Mercury-Free Philly Campaign: Recognizing that mercury, like lead, is a heavy metal that affects cognitive development and organs, and is more ubiquitous, WHEN has worked with the health care sector to replace mercury containing medical devices (thermometers, blood pressure cuffs, thermostats, bougie tubes, fixatives, and 20+ other sources) and recycle those sources that currently cannot be eliminated (fluorescent lamps, dental amalgam, computers). We have offered the public free digital replacements in exchange for mercury fever thermometers, partnering with hospitals and healthcaresupport legislation on mercury pollution prevention such as air emissions from power plants, labeling offish in supermarkets, and dental amalgam patient notifications.
  
  
• Health Care Without Harm: Hospitals routinely throw from 50-70% of their waste into the biohazardous waste stream, although a large portion of it is mostly paper, cardboard and food waste, yet paying up to 10 times as much to dispose of infectious versus solid waste. In fact, the Centers for Disease Control and Prevention (CDC) suggests that only 2-3% of hospital waste needs to be disposed of as infectious waste. WHEN works with hospitals in reducing medical waste and eliminating specific toxins from patient care. We coordinate roundtables and workshops on various topics (medical waste minimization, recycling, redbag reduction, environmentally preferred purchasing (EPP), electronics, sustainable food, nursing leadership), promote green building in health care through the use of the Green Guide for Health Care (now poised to become LEED for Health Care by Fall 2007), and develop and implement projects to engage hospitals in environmental stewardship. Our survey of local practices found 44% of responding hospitals tossed electronics in the trash. PA is ranked 4th in the number of landfills in the US and remains 7th nationally for total releases of toxic substances. The Electronics Recycling Cooperative helped them to properly recycle electronic waste (computers, TVs, heart monitors). Computers, televisions, lab analyzers, EKG monitors and other equipment contain lead in monitors, chlorinated plastics in cable wiring, brominated flame retardants in circuit boards and mercury in LCD displays, many linked to cancer, birth defects, and hormone disruption.
  
  
• Environmental Health Education: Target medical practitioners on ways to reduce harm to vulnerable children in the Neonatal Intensive Care Unit from poly vinyl chloride (PVC) medical devices and educated pediatric residents on environmental exposure assessments. Outreached to nursing groups to engage them on current issues relating to environmental toxins and health, and nominated local nurses for The Luminary Project (www.theluminaryproject.org) which features nurses in the US working in environmental efforts. Hosted CleanMed 2004, the national healthcare conference on environmentally preferred purchasing, green building and toxins reduction with 400 healthcare attendees from across the US.
  
  
• Healthy Food in Health Care: A hospital in the US, on average, serves a million meals each year. Linking hospitals with sustainable agriculture, educating institutions on food production practices that impact human health through industrial food processes, and supporting their efforts at healthier options. We connect hospitals to local resources and provide roundtable programs on non-synthetic hormones in milk, no pesticides in produce, and no use of non-therapeutic antibiotics in animals, as well as supporting local farmers.

With initial funding from William Penn Foundation, Health Care Without Harm, and other grantmakers, WHEN has established itself as a national leader in helping hospitals make environmentally safer decisions, from purchasing through end-of-life. Other local funders, such as the Claneil Foundation and the Heinz Endowments, have helped us expand and build on our efforts, leading to our statewide efforts in working with hospitals.

Escalating healthcare costs, malpractice insurance and little interest in waste, hospitals have traditionally not been focused on these issues and the public is unawares of the consequences of these practices. We have prompted healthcare institutions to save millions of dollars, change their practices, and become better citizens within their communities. By maximizing our limited funding and very small staff, our outsider/insider approach has helped to move the healthcare industry to become better stewards of the community's health by partnering with them on these critical environmental issues, making the Philadelphia region renowned for its healthcare and environmental leadership.

 

Among the nationally recognized successes, WHEN has accomplished the following:

• Diverted from landfills more than 10,000 grams of mercury through thermometer exchanges held at over 30 facilities and six county healthcare centers, reaching 12,000+ households in the five Southeast PA counties and Harrisburg and distributing over 11,000 digital replacements. These exchanges prompted hospitals to begin mercury elimination efforts, with more than 30 sources of mercury in any facility.
• Worked with over 50 healthcare facilities on environmental issues and held roundtables for hospitals since 2002.
• Encouraged 20 hospitals to publicly commit to removing DEHP from Neonatal Intensive Care Units and thereby decreasing the potential for reproductive health issues for children who must use these facilities. (DEHP is a plasticizer that can leech out of PVC medical devices which has been shown in human research studies. In animal studies, it's been linked to reproductive harm. During manufacturing PVC plastics create dioxin, which is a PBT - persistent, bioaccumulative toxin. PVC is used in medical devices, furnishings, and supplies.)
• Supported two pediatric facilities in the state who are building green to adopt best practices for green healthcare including one of which has also committed to PVC-free interiors.
• Implemented cooperative for hospitals to recycle electronics at discounted rate with local recycler, diverting from landfills 467 pounds of lead, 233 pounds of combined heavy metals, 1,788 pounds of plastics in six months. Prompted 10 other facilities to make responsible recycling and purchasing decisions.
• Championed more than 30 hospitals to sign on to Hospitals for a Healthy Environment (H2E), committing themselves to reduce mercury, waste and PBTs.
• Assisted three hospitals to receive the Making Medicine Mercury-Free Award from Hospitals for a Healthy Environment (partnership among US EPA, American Hospital Association, American Nurses Association and Health care Without Harm) through WHEN's guidance and assistance in assessing and implementing programs for mercury reduction within these institutions.
• Reduced medical waste in more than 10 institutions through strategies such as reducing redbags, segregating, selling corrugated cardboard, thereby saving these institutions > $500,000 .
• Expanded the curriculum on environmental health at a premier local nursing school in Philadelphia, reaching 250 nursing students, increased environmental advocacy, and a poster presentation at the American Public Health Association conference in 2006 in Boston.
• Trained over 50 pediatric residents (MDs) and over 450 nurses on environmental health issues relating to health care, and reaching 5,500 subscribers to Pediatric Nurses Specialty Guide and Nursing Spectrum through published articles in the Tri-State region. Monthly columns on environmental issues in the Hospital Fire Marshals Association newsletter, reaches 400 members throughout the US.