BY KATHLEEN NELSON
Gary Cohen, co-founder and executive director of Health Care Without Harm, is a 2015 MacArthur Fellow. Colloquially known as the MacArthur genius grant, the fellowships recognize individuals for "exceptional creativity" and great future promise. Cohen was selected for his track record as "an activist spurring environmental responsibility in health care both in the United States and abroad," according to the John D. and Catherine T. MacArthur foundation's website.
Gary Cohen
Using "Do no harm" as a starting point, Health Care Without Harm leads the global initiative for environmentally responsible health care. Its campaign against the use of mercury, found in thermometers and other medical devices, started in the U.S. and led to the Minamata Convention on Mercury, a global treaty that includes phasing out use of the heavy metal in health care by 2020. After learning that health care as an industry led the nation in dioxin emissions from burning waste, Cohen led an effort that reduced the number of medical waste incinerators at hospitals in the U.S. from 5,600 in the late 1990s to fewer than 70 in 2006. Now the organization is acting to spur the health care industry to help position climate change as a public health crisis and to lead by example with systemic carbon-reduction practices.
In 19 years, Health Care Without Harm has grown into an international coalition that includes organizations in 53 countries. Cohen also founded Practice Greenhealth, an organization of hospital systems that share best practices for sustainability and eco-friendliness. He talked with Catholic Health World about health care's role as stewards for the environment and its responsibility to continue to look for ways to combat the causes and effects of climate change to make hospitals and communities healthier.
Health Care Without Harm has advocated for ecologically sound practices since 1996. How has the organization's focus shifted over that time period?
The initial orientation stemmed from the fact that hospitals were polluting the environment. The first years were about how we could help health care clean up its own house: through supply chain, reducing waste, more energy-efficient facilities, better food choices. As we've matured and as the field has matured, we understood that we need to go beyond healing the facilities to healing the communities that hospitals serve, taking the innovative strategies that we've developed for the facilities and bringing them out into the community.
For health care systems that want to implement more environmentally sustainable practices, what are the first steps?
If an institution hasn't developed a mission statement around sustainability, it's a very important step. If you align your institution with your mission and your values, you have a moral compass from which to act.
Second, you can make a business case. Many of the interventions that we recommend also save the hospitals money. Starting with waste reduction and energy efficiency, these are things that are good for the environment but also save the hospital money in a relatively short amount of time. Getting early wins are important. One of the reasons we set up Practice Greenhealth was to hold the hands of hospitals to help them get early wins and get on the path. Then there's all sorts of other systems that they can learn from.
People also find the teamwork approach to be motivating, so you can set up a green team. Initiatives around sustainability have a huge amount of resonance with employees.
How does Practice Greenhealth complement or supplement the work of Health Care Without Harm?
Health Care Without Harm is the research and development arm. We'll identify issues that we think the health care sector needs to address. Then we'll work with a few hospitals to pilot solutions: Here's what you can do to provide sustainable food for your employees and your patients; or here's how you can reduce the amount of meat, and, in fact, save money.
Then once we proof it out on a limited scale, we rescale it to Practice Greenhealth because it has 1,400 members. So that's 20 percent of the health care market. If we can start to normalize a solution in a whole sector, we can then ask others, "Why aren't you doing it, whether you're a member or not?" For example, "Why are you still serving so many sugar-sweetened drinks when everyone else is moving away from it?"
Practice Greenhealth is also where we create a lot of opportunities for hospitals to learn from each other. As competitive as the health care landscape is, it's heartening to see how much people are willing to share what they've learned with their colleagues so that everybody gets better together.
What do you see as the next big challenge or opportunity for health care?
The grand transformation that health care needs to play a critical role in is addressing climate change. Climate change is a public health crisis. We've built programs along three different dimensions.
One is climate preparedness and resilience: taking the lessons from Hurricanes Sandy and Katrina and other extreme weather events and helping hospitals design and plan for climate change so they can respond and be places of refuge when these events happen, so they can stay open and operate. We've designed a resilience tool kit for the health care sector with the Department of Health and Human Services.
The second is around mitigation: healthier leading by example in this transformation to a toxin-free economy. How can we be early adopters of renewable energy or localized sustainable food or low-carbon diagnostic tools? Because health care is such a huge part of the economy in this country and globally, the industry can have enormous impact.
And in a way, the most important is as messengers, helping to rebrand climate change to be about public health, which it is: to help people understand that climate change is a medical emergency and a public health opportunity. If we address our addiction to fossil fuels, not only will we solve the climate crisis, we'll clean up the air and we'll support a transition to a much healthier economy. We'll create jobs and healthier communities. There's so many co-benefits to addressing climate change, and health care can have an enormous role.
How do Catholic health systems fit into the goals of environmental sustainability?
The last 20 years, the role of the Catholic hospitals in holding down a moral imperative for why the health care industry should have a major role in environmental sustainability has been absolutely essential to our work. Now, especially since the pope has stepped out in front on these issues, Catholic health care leaders have this incredible opportunity to help the rest of society understand climate change not just as a health issue but as a moral issue. There's no other sector in society that has such a critical role to play in addressing the issue and making this enormous transformation.