Is our hospital green? Ethics committees ask

A look at the environmental impact of health care

Ethics committees frequently discuss clinical conflicts on a case-by-case basis, helping clinicians make treatment decisions that are consistent both with accepted standards of medical care and the values and beliefs of the patients cared for.

Some committees take their mandate a step further, examining the organizational ethics of their facilities — what values a hospital’s policies and procedures reflect.

But few committees are charged with looking at their hospital’s role in the health care system as a whole, and that system’s overall impact on our society. In particular, what are the environmental effects of our expensive health care system — which consumes almost 15% of this country’s gross domestic product (GDP) — on our population’s long-term health?

"An awareness is growing that the environmental impact of health care services is significant, and promoting health and saving lives within the health care system needs to be balanced against the harm done to the environment," says Christina Kerby Kessinger, MPA, MA, project coordinator of the Green Health Center (GHC) project at the University of Nebraska Medical Center in Omaha.

The project’s main goal is to ensure that concerns about the environment are addressed in the overall national debate about rising health care costs, says Kerby Kessinger.

Funded through a grant from the New York City-based Greenwall Foundation, the project created a panel of national experts on health care and the environment that met over the course of the 1998-1999 academic year, she says.

The panel developed a model plan for providing health care in a way that is respectful of the environment. They also identified and analyzed several case studies of basic health services to be provided, modified, or avoided by a "Green Health Center," she says.

U.S. health care costly in many ways

Not only does health care spending in this country consume almost 15% of our GDP, but also consumes more than 40% of the world’s dollars spent on health care.

One out of every seven dollars generated in the U.S. economy is spent on health care, and one of every nine workers is employed in the health care sector.

So where is all this money going?

Much of it is going to support an ever-expanding, highly technological system that consumes vast amounts of physical resources and produces large quantities of waste. And few hospitals and health systems are stopping to examine how their functions affect the environment, says Kerby Kessinger.

"There are a select few hospitals out there that are looking at this, but many are not," she adds.

Environmental hazards

Hospitals and other health facilities can adversely affect the environment in several ways:

  • resource and material consumption — use of polyvinyl chloride (PVC), mercury, latex, silver, needle devices, and energy;
  • pollution and waste — inefficient waste management, air emissions, water discharge;
  • patient and occupational exposure — infections from visiting hospitals, occupationally derived infections (HIV, hepatitis B and C);
  • material allergies and chemical exposures;
  • ionizing radiation — from high-tech medical procedures;
  • purchasing procedures — purchasing of products with extensive packaging, products that are not recycled or recyclable, and extensive use of building materials in new construction.

On the other end of the spectrum, hospitals can produce large amounts of products and resulting waste that the larger community must absorb, Kerby Kessinger explains.

Hospitals are the source of large quantities of pharmaceuticals, medical equipment and supplies, radioisotopes for nuclear medicine, and disposable medical supplies — not to mention the quantity of radioactive and biohazard "red-bag" waste that must be disposed.

Hospitals should examine overall effects

Hospitals need to examine the overall health effects of their way of doing business, she adds.

For example, PVC plastic is widely used in many hospital supplies, yet carries with it toxic residue that affects both the people making the devices, the hospital workers who routinely handle them, and patients who receive therapy using those products.

Phthalates from PVC plastic can leach into a person’s body and are particularly hazardous to infants, the elderly, and those with compromised immune systems.

Most PVC-containing hospital supplies are incinerated due to contamination with human bodily fluids. A by-product of CVC incineration is the production of dioxin, a known carcinogen, Kerby Kessinger illustrates.

Three million pounds of plastics are used in the U.S. health care industry each year, with PVC products accounting for 25% of all medical products, or 750 million pounds annually.

Use of mercury is another example of environmentally unfriendly hospital practices, Kerby Kessinger says. The element is found in many health care materials and supplies, including thermometers, blood pressure cuffs, esophageal dilators, batteries used to power equipment, and several different laboratory compounds.

The U.S. dental industry alone accounts for 10% of the mercury consumed in this country, the third-largest consumer.

In addition to striving to provide high-quality care to individual patients, health systems have a moral responsibility to examine how their practices affect the health of the environment and, therefore, the larger population, Kerby Kessinger says. "People in the medical profession espouse the principle of first, do no harm’ all the time," she continues. "What we want to do is take that a step beyond just the individual doctor-patient relationship."

What can hospitals do?

The University of Nebraska Medical Center is serving as a sort of demonstration site for the development of an environmentally and economically friendly Green Health Center.

A new grant project, Exploring Bioethics Upstream, is expanding the scope of the original GHC grant, says Kerby Kessinger.

"In our current hospital, environmental issues are fairly restricted to downstream’ aspects, such as waste disposal and recycling," she reports. "We want to expand the material flow conversation by learning who makes decisions within the hospital setting related to the environment."

Bioethicists involved with the GHC project will now sit on several different hospital committees that make decisions that influence how the hospital impacts the environment, she says.

"We have become involved with the product evaluation and standardization committee, the construction impact committee, and the pharmacy and therapeutics committee, for example," Kerby Kessinger says. "Our goal is to introduce and promote a sense of ethical responsibility for the environment, in hospital policies, education of providers, decisions regarding patient care, and the allocation of health care resources."

In general, hospitals must become more aware of where raw materials come from and where their products go after disposing of them, Kerby Kessinger advises. "Seminars should be held in hospitals on this very topic to educate doctors, nurses, lab technicians, and other individuals working in this setting."

Will there be a system left in the future?

Although the current health care system is not in danger of a collapse, Kerby Kessinger says many doubt whether the system we have now is sustainable for future generations.

"I don’t think the system we have is sustainable if we keep the current pace of using products and services without consideration of where they came from, where they are going, and all the impacts associated with their use," she says.

Suggested reading

• Brown LR, Flavin C, French H, eds. State of the World 2001: A Worldwatch Institute Report on Progress Toward a Sustainable Society. New York City: W.W. Norton & Co.; 2001.

• Davies T, Lowe AI. Environmental Implications of the Health Care Service Sector. Washington, DC: Resources for the Future; 1999.

• Haines A, Parry M. Climate change and human health. J R Soc Med 1993; 86:707-711.

• Hettenbach T. Greening Hospitals: An Analysis of Pollution Prevention in America’s Top Hospitals. Washington, DC: Environmental Working Group; 1998.

• McCally M, Cassel CK. Medical responsibility and global environmental change. Ann Int Med 1990; 113:467-473.

• McMichael AJ, Powles JW. Human numbers, environment, sustainability, and health. BMJ 1999; 319:977-980.

• Vitousek PM, Mooney HA, Lubchenco J, et al. Human domination of Earth’s ecosystems. Science 1997; 277:494-499.

• World Resources Report. World Resources 2000-2001: People and Ecosystems: The Fraying Web of Life. Oxford, UK: Elsevier Science; 2000.


  • Christina Kerby Kessinger, MPA, MA, Department of Preventive & Societal Medicine, 986075 Nebraska Medical Center, Omaha, NE 68198-6075.

For more information:

  • Health Care Without Harm: The Campaign for Environmentally Responsible Health Care. Web: