At the core of the Hippocratic Oath is the concept of "primum non nocere" - first, do no harm. In recent years, this concept has been expanded in a number of countries to include the ethical duty of the healthcare system to do no harm - or at least less harm - to the environment. Future issues of Hospital Quarterly will examine various aspects of this topic and keep readers appraised of developments in this emerging area of concern. In this introductory column, I provide an overview of the issue and of international and Canadian initiatives.

Healthcare's Environmental Impact

At close to 10% of GDP, Canada's healthcare sector is a large and important economic sector; hospitals alone are roughly one-thirtieth of the entire Canadian economy. And like any large economic sector, healthcare uses a lot of energy and other resources and produces a lot of wastes. Thus, albeit inadvertently, the healthcare system adversely affects the environment and, inevitably, human health. In particular, hospitals are very energy-intensive buildings, which means that they contribute significantly, both directly and indirectly, to greenhouse gas emissions and regional air pollution. The healthcare system also uses a lot of natural resources, especially paper and plastics, much of it single-use and disposable, thus generating large volumes of solid waste, while medical waste incineration is a significant source of dangerous pollutants such as dioxins and mercury. The healthcare system also uses a wide variety of toxic materials, which may pose a threat to the health of staff, patients, visitors and the surrounding community. Since all of these environmental impacts may have human health effects, the healthcare system has a duty to reduce its environmental and thus human health impact. The facts that in doing so it can make economic savings, improve its image and reputation in the community and avoid legal problems constitute added benefits.

International Activities

The U.S.-based international coalition known as Healthcare Without Harm takes its name and its inspiration directly from the Hippocratic Oath. This coalition is particularly focused on reducing dioxin and mercury emissions, phasing out PVC, and promoting environmentally responsible purchasing policies. A number of useful resources are available on its website (www.noharm.org) or as published reports. In May 2001, Healthcare Without Harm organized an international conference on environmentally responsible healthcare in Boston at which a number of major health systems, as well as group purchasing organizations representing some three-quarters of the U.S. healthcare system, described their growing commitment to environmentally responsible purchasing. A second very useful U.S. resource is the Sustainable Hospitals Project, part of the Centre for Sustainable Production at the University of Massachusetts, Lowell (www.sustainablehospitals.org).

In the United Kingdom, preliminary discussions have occurred between the U.K. Commission on Sustainable Development and the National Health Service (NHS) about a national strategy to make the NHS more environmentally sustainable. A number of health authorities have looked specifically at the relationship between the NHS and transportation (as many as one in five vehicle trips in the United Kingdom may be associated in some way with the healthcare system!). The NHS Estates has developed a report on sustainable development in the NHS (https://www.nhsestates.gov.uk/property_management/index.asp); while the King's Fund is preparing a report on the environmental impact of healthcare in London.

In Austria, the Vienna Hospital Association has been particularly active in implementing the city's policy of environmental responsibility. Among other things, it has reduced the amount of PVC in hospital waste streams to only 1%, rigorously screened cleaning and disinfecting products for their environmental impact, and has purchased locally grown organic food whenever feasible. Sweden and Denmark are other countries where environmentally responsible healthcare is a growing concern.

The Canadian Coalition for Green Healthcare

This Coalition of major national healthcare and environmental organizations and individual hospitals was formed in October 2000. Its presence will be strongly felt in a number of ways at the Ontario Hospital Association Convention in Toronto, November 4-6, 2001. Among the highlights:

• An educational session featuring Elizabeth Witmer, Minister of Environment and Charlotte Brody, Co-Director of Healthcare Without Harm.
  
• The Green Lane, a section of the exhibits area devoted to producers of environmentally responsible products and services.
  
• The Green Health Centre, the Coalition's own booth, featuring a display of case studies of hospitals practising environmentally responsible healthcare, as well as other resources.
  
• The release of "Doing Less Harm," a comprehensive overview of healthcare's environmental impact and how to reduce it.
  
• The presentation of the first Green Healthcare Awards, in four categories - overall leadership, energy conservation, pollution prevention and community partnership.

For more information, consult the Coalition's new website (www.greenhealthcare.ca) and join this new movement for greener, healthier healthcare.

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