From her vantage point on the northern wall of the Gold Room in Stockholm Town Hall—the same venue where Nobel Laureates receive their prizes every year—the “Queen of Lake Malaren” (her portrait, that is) witnessed the coming of age of Europe's green healthcare movement at the first-ever CleanMed Best Practices Awards.

Six hospitals, chosen from a field of 70 entrants, were recognized for exceptional environmental practices at the May 2006 event. The winners illustrate the ambitious efforts underway in Europe to reduce the healthcare industry's environmental impact:

In Italy, the medical facilities of Emilia Romagna reduced infectious waste in district hospitals by as much as 20%—and saved more than 3 million Euros.

In the Czech Republic, Olomouc Hospital eliminated 95% of PVC plastic products from its neonatology unit in order to protect infants from exposure to the chemical additive DEHP.

Other winning hospitals were Otto Wagner Hospital in Austria, for using innovative green building design and technologies; Stockholm County Council, for exceptional environmental-protection policies (described below); and Karolinska Hospital in Sweden for communicating good practices to their workers, including basic environmental training for all employees, education for pharmacists on the environmental effects of drugs, and the introduction of environmental performance factors into annual fiscal reports.

A special award was spontaneously created for The Korean Federation for Environmental Movement, a nonprofit organization, to acknowledge a campaign that resulted in the South Korean government committing to the total phase-out of PVC devices from the country's healthcare facilities. “This entry was such a fantastic example of the impact that a well-organized grassroots activist campaign can have,” says Jamie Harvie, member of the awards jury and Director of the Institute for a Sustainable Future in Duluth, Minnesota.

The awards ceremony was the culmination of CleanMed Europe 2006, the largest healthcare conference on environmentally preferable purchasing and green building. Four hundred participants from 20 countries gathered in Stockholm for three days last May for the event, which was organized by Health Care Without Harm (HCWH) in collaboration with Sweden's nationally-owned pharmacy Apoteket and the Stockholm County Council (SCC).

The involvement of such prestigious healthcare partners was critical to the success of CleanMed, says Cestmir Hrdinka, executive director of HCWH Europe: “As an authority responsible for one of the most progressive healthcare systems in the world, the Stockholm County Council is key to furthering the sustainability agenda in Europe.”

The Stockholm County Council (SCC) was one of the first organizations in Europe to explicitly adopt the precautionary principle—the idea that, when an activity or substance poses a possible health risk, safer alternatives should be substituted as a preventive measure. In 1991, the SCC began phasing mercury out of its healthcare facilities, and is now introducing a system-wide effort to integrate environmental concerns into healthcare. As a result, decisions about products to buy and processes to use are being made in the context of minimizing the environmental impacts.

Apoteket recently profiled more than 140 pharmaceutical drugs for their environmental properties to create a precautionary approach aimed at reducing the environmental impact of pharmaceuticals in the environment.

Other highlights of CleanMed Europe 2006 included a presentation by Professor James Clark from the Green Chemistry Centre of Excellence at the University of York about its pioneering work in green chemistry. Green chemists are working to minimize the hazards of chemicals for human health and the environment, and develop safer alternatives. One example of the University's work is investigating exactly how a chemical catalyst works in order to develop a less toxic substitute.

From large efforts to small, green healthcare projects were recognized in a special poster session. “The poster I'll always remember was of a toilet,” says Michael McKeon, a nurse from Dublin University, Republic of Ireland. “It featured a set of simple instructions on how to clean a bathroom, put together in order to minimize the environmental damage of an everyday task. It turned the concept of sustainability into housekeeping.”

Ingrid Eckerman, from Swedish Doctors for the Environment, adds, “People at ground level tend not to have the time or necessarily the expertise to think about what sustainability considerations mean for what they do every day in their jobs. That doesn't mean they aren't interested—they just need the broad concepts to be translated into something that applies to their work.”

By sharing practical tools and building models for sustainable healthcare in this manner, HCWH is helping to forge a vibrant movement for sustainability throughout European healthcare. With 56 members in 23 countries, some of HCWH's Europe-oriented achievements include:

Perhaps the biggest sign of the success of the green healthcare movement is that its concepts are no longer new. “Organic food, for example, isn't just a fad anymore—it's seen as an essential part of a healthy diet and environment, and therefore of primary concern to healthcare institutions,” says McKeon. “By providing a place for healthcare professionals to discuss how things like food can contribute to patients' and public health, CleanMed has helped make these issues just another part of healthcare.”

And it has made the issues global. “One thing is for sure, CleanMed is bigger than us now,” says Josh Karliner, international team coordinator for HCWH, which began in the United States in 1996 and now has offices on four continents. “It used to be that we were one of the only the driving forces behind environmental changes in healthcare, but that's not true anymore. Healthcare providers are leading the way. That has been our biggest win in the United States—that we've got the idea across and it's changing the face of healthcare. Now we've got to replicate that success on every continent.” n

Paul Whaley, based in Prague, Czechoslovakia, provides administrative and communications support for Health Care Without Harm campaigns in Europe.

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  • A Europe-wide ban on the purchase of new mercury thermometers;

  • Waste segregation and minimisation programmes in dozens of hospitals across Europe;

  • Improved waste-treatment policies encouraging the use of non-incineration waste-treatment technologies in Central and Eastern European countries, including Slovakia, the Czech Republic, Moldova, and Belarus;

  • Closing dozens of medical waste incinerators and halting plans to build others;

  • Garnering support from the European Parliament Environment Committee for a legislative proposal to ban the use of Di(2-ethylhexyl)phthalate (DEHP) and other hazardous substances from medical devices, following a number of Parliamentary recommendations to limit children's exposure to DEHP; and

  • PVC phase-outs in hospitals in France, Austria, the Czech Republic, Slovakia, Sweden, and Denmark.