A journey, a path, a garden, a book—these are all words commonly used to analogize the progression toward environmental excellence. Whatever the vehicle used to get there, the path taken is composed of increments (rungs, steps, chapters, ingredients). This column will highlight some of the signposts our sector has planted along the way (hard to avoid that road theme) as well as two health systems—Kaiser Permanente (see a PDF of Kaiser Permanente's Road to Sustainability at the bottom of this page) and Catholic Healthcare West—and the respective steps they took on their sustainability journey (Oh, I keep stepping on analogies!). In honor of these visual cues, let’s get off our bike, ladder, road, boat, or garden for a minute to reflect on how far we’ve come.



1987—Medical waste washes up on eastern shores, prompting negative media attention and fear.

1988—The Environmental Protection Agency (EPA) Medical Waste Tracking Act requires eastern states to red bag certain waste based on perceived, not actual, risk.

1988—The Intergovernmental Panel on Climate Change is established to, among other things, prepare comprehensive assessment reports about the state of scientific, technical, and socioeconomic knowledge on climate change, its causes, potential impacts, and response strategies.



1990—The Association for Operating Room Nurses publishes its “Statement on the Protection of the Environment.”

1992—Physicians for Social Responsibility expands its mission to apply its medical expertise to environmental health issues, in recognition that global climate change and toxic pollution also pose grave risks to human health.

1993—The Center for Health Design (CHD) forms.

1993—The American Hospital Association’s (AHA) “An Ounce of Prevention: Waste Reduction Strategies for Health Care Facilities” is published.

1994—An EPA Dioxin Assessment identifies incinerators as a dioxin source, due to burning of chlorinated plastics.

1996—The American Public Health Association passes a resolution on the prevention of dioxin generation from PVC plastic in healthcare.

1996—“Our Stolen Future” by Theo Colborn, Dianne Dumanoski, and John Peterson Myers examines certain synthetic chemicals and how they interfere with hormonal messages involved in the control of growth and development, especially in the fetus.

1996—Health Care Without Harm (HCWH) forms.

1997—EPA Mercury Study Report to Congress documents medical waste incinerators as a major source of mercury in the environment.

1997—“Living Downstream: An Ecologist’s Personal Investigation of Cancer and the Environment” by Sandra Steingraber is published.

1998—The Sustainable Hospitals Program at the University of Massachusetts Lowell pro­vides science-based technical guidance to the healthcare industry for selecting products and practices that promote occupational and environmental health and safety.

1998—EPA and AHA’s Hospitals for a Healthy Environment Program is kicked off.

1998—The Wingspread Consensus Statement on the Precautionary Principle is created.

1998—The U.S. Green Building Council (USGBC) and LEED rating system starts.

1998—The AHA and the EPA sign a Memorandum of Understanding asking hospitals to voluntarily eliminate mercury and other persistent chemicals, and to reduce waste volume.

1999—HCWH petitions the U.S. Food and Drug Administration to label medical devices that leach phthalate plasticizers and to establish a program to promote alternatives.



2000—CHD launches its Pebble Project.

2002—The term evidence-based design is coined during an interview by Colin Martin, a reporter for The Lancet, with healthcare design researcher Roger Ulrich.

2001—The ENERGY STAR certification for hospitals was created.

2001—The first CleanMed conference is held.

2002—The Green Guide for Health Care is established.

2002—The FDA Public Health Notification: PVC Devices Containing the Plasticizer DEHP is issued.

2002—The film “Blue Vinyl” is released.

2002—Hospitals for a Healthy Environment Environmental Excellence Awards are established.

2002—The first USGBC GreenBuild conference is held.

2002—EPA Region 2 Healthcare Compliance Initiative raises awareness of the Resource Conservation and Recovery Act regulations. This compliance and healthcare regulatory focus extends to other regions.

2002—Three of the largest group purchasing organizations implement mercury prevention policies.

2002—Environmental Health News, a foundation-funded journalism organization, is founded.

2002—The American Society for Healthcare Engineering (ASHE) releases the Green Healthcare Construction Guidance Statement.

2003—A first in the United States, a hospital earns a LEED-certified rating.

2003—“Having Faith—An Ecologist’s Journey to Motherhood” by Sandra Steingraber is published.

2004—HCWH kicks off its Healthy Food in Health Care Program.

2005—The first FoodMed conference is held.

2005—Environmental Working Group releases its newborn cord blood study, “Body Burden—The Pollution in Newborns.”

2006—The Business NGO Working Group for Safer Chemicals and Sustainable Materials starts.

2006—ASHE’s Energy Efficiency Commitment initiative is launched.

2006—The 2030 Challenge kicks off and is adopted by the American Institute of Architects and others.

2006—The AORN Position Statement on Environmental Responsibility states that the perioperative registered nurse should serve as a steward of the environment.

2006—The U.S. National Toxicology Program Expert Panel reaffirms that the phthalate DEHP poses a risk to human development and fertility.

2007—The Intergovernmental Panel on Climate Change released a summary of the Fourth Assessment Report. According to this summary, the Fourth Assessment Report found that human actions are “very likely” the cause of global warming, meaning a 90% or greater probability.

2007—The Intergovernmental Panel on Climate Change and Al Gore were awarded the Nobel Peace Prize “for their efforts to build up and disseminate greater knowledge about manmade climate change, and to lay the foundations for the measures that are needed to counteract such change.”

2007—CHD’s Ripple database is released.

2007—American Nurses Association’s Principles of Environmental Health for Nursing Practice with Implementation Strategies are published.

2007—The Climate Registry is established.

D's Evidence-Based Design Accreditation and Certification program launches.

2008—Hospitals for a Healthy Environment transitions to the Practice Greenhealth membership organization.

2008—“Sustainable Healthcare Architecture” by Gail Vittori and Robin Guenther is released.

2008—The Associated Press investigates pharmaceuticals in drinking water.

2008—The Robert Wood Johnson-funded Health Care Research Collaborative starts.

2008—European Union bans mercury thermometers; HCWH and the World Health Organization launch the global Mercury-Free Health Care initiative; The Philippines issues a national policy to phase out mercury thermometers and blood pressure devices.

2008—The IRS issues Form 990 Schedule H for hospitals, which includes “environmental improvement” in activities reportable as “community building” but excludes activities for reducing a hospital’s environmental impact.

2008—“60 Minutes” features “The Electronic Wasteland” on toxic trash dumping.

2009—The Lancet and the University College London release a report about the health impacts of climate change, calling climate change the biggest global health threat of the 21st century.

2009—The Green Guide for Health Care Version 2.2 Operations Section is released.

2009—Argentina issues national policy to phase out mercury-based medical devices.

2009—Practice Greenhealth releases its first Sustainability Benchmark Report.

2009—Physicians for Social Responsibility, in partnership with the American Nurses Association and HCWH, release the “Hazardous Chemicals in Health Care” report.

2009—The American Medical Association approves a new policy resolution in support of practices and policies that promote and model a healthy and ecologically sustainable food system.

2010—American Hospital Association’s Association for the Health Care Environment, ASHE, and Association for Healthcare Resource and Material Management team up to provide the Sustainability Roadmap for Hospitals.

2010—HCWH announces its Healthier Hospital Initiative.

2010—HCWH and the Johns Hopkins Center for a Livable Future release “Balanced Menus—A Pilot Evaluation of Implementation in Four San Francisco Bay Area Hospitals,” the first U.S. examination of the impact that reduced-meat menus in hospital food service have on climate change.

2010—HCWH and the World Health Organization together lead a global initiative to achieve virtual elimination of mercury-based thermometers and sphygmomanometers over the next decade and their substitution with accurate, economically viable alternatives, a measure that impacts more than 5,000 hospitals in 18 developing countries.

2010—The President’s Cancer Report is released, stating “the true burden of environmentally induced cancers has been grossly underestimated.”

2010—Safer Chemicals, Healthy Families releases “The Health Case for Reforming the Toxic Substances Control Act.”

2011—HCWH releases its Global Green and Healthy Hospitals Agenda, a comprehensive framework for greening healthcare around the world.

2011—HCWH co-organizes the first Global Climate & Health Summit in conjunction with United Nations climate negotiations and in partnership with major health groups around the world.

2011—The EPA’s Greenhouse Gas Reporting program comes into effect, requiring facilities that emit 25,000 metric tons or more per year of greenhouse gases to submit annual reports to the EPA.


And for those who are reading this and thinking, “But what about?!!” ... let’s take a moment to honor and value every critical conversation, article, study, pitch, sketch, negotiation, thought, doodle, dream, rendering, hissy fit, implementation, assessment, research, drawing, graphic novel, challenge, celebration, report, presentation, nightmare, tear, meeting, pondering, connection, physical work, healing touch, and plan that led to these and many other important events around healthy environments for healthcare workers, patients, visitors, and their communities.

Here’s looking to another step, paddle, page, tablespoonful, rung … FORWARD. HCD


Janet Brown can be reached at jbrown@practicegreenhealth.org