Gary Cohen has assembled an international coalition that is transforming the global health sector by reducing health industry practices that harm the environment and contribute to disease.
The New Idea
Health Care Without Harm (HCWH), co-founded by Gary in 1996, encourages hospitals and healthcare providers around the world to become more responsible stewards of the environment and the public’s health. HCWH challenges the health industry to adhere to its principle of “Do No Harm” by looking inward at its own negative environmental footprint—including everything from its disposal of medical waste to its intensive energy use to its toxic cleaning supplies—and the negative health effects of that footprint. HCWH then works with groups of providers to commit to improved practices—for example, eliminating the use of mercury—and leverages hospital purchasing power to pressure medical suppliers to develop greener, safer products.
Gary’s innovation lies in moving the healthcare industry from an environmental hazard to a steward of new practices that support rather than work against overall societal health and are aligned deeply with the Hippocratic Oath. He leverages the industry’s mission as well as its size and global reach to position it as an emerging leader in environmental sustainability, linking environmental health with human health, and incubating a robust green economy in the process. Indeed, Gary is confident that the health sector can help shift the entire economy toward more sustainable, healthier products and practices.
HCWH is a coalition of more than 500 member organizations in fifty-three countries. It also operates Practice Greenhealth, a U.S.-based membership organization with over 1,100 hospital members and eighty businesses. Over the last fifteen years, it has nearly eliminated the market for mercury-based medical equipment in the U.S. and the E.U. and has closed 90 percent of medical waste incinerators in the U.S. responsible for releasing cancer-causing toxins into the atmosphere. HCWH has also stimulated demand for safer health products around the world. Perhaps most important, it has developed a hybrid value model in which businesses play a central role in delivering social value, and where market power drives its success and expansion across the globe. Moving forward, Gary is increasingly focused internationally and on reducing the healthcare industry’s contributions to climate change and transforming the sector to lead the global economy toward renewable energy, green chemicals, and healthy food systems.
In many respects we are living in the midst of a 21st century ecological crisis, much of which is brought on by climate change, and much of which is also having detrimental effects on human health. A warming planet is responsible for increasing water-borne diseases, asthma, and infectious diseases like malaria, not to mention heat waves and other extreme weather that are especially dangerous for the young, old, and sick. Loss of biodiversity has led to migration of diseases, and water scarcity will bring about increased health risks. In addition, increasing numbers of chronic diseases are linked to toxicity, with new evidence emerging each year about the harmful effects of chemical and toxic exposure on human brains and bodies. Only recently is the health field considering the full effects of environmental degradation on human health, and the many challenges posed by living on a stressed planet.
Despite its mission to heal and to promote health, the healthcare industry is a major contributor to this crisis. Hospitals generate millions of tons of waste each year, for example, much of which until recently was burned in incinerators, releasing mercury, lead, dioxin, and other toxins that are linked with human disabilities and chronic diseases like cancer, asthma, Parkinson’s disease, and infertility. This problem remains especially acute in the developing world. Meanwhile, hospital products—including syringes, plastic IV bags, thermometers, vinyl floors, and even cleaning supplies—are made with plastics and chemicals that can be particularly harmful to small children, and that release toxins into the air when burned. In addition, healthcare is an energy-intensive enterprise—relying heavily on fossil fuels for everything from product packaging to air conditioning—and is thus a significant contributor to climate change. Due to building design alone, hospitals in the U.S. are half as efficient as those in Europe.
Paradoxically, therefore, many hospital products and practices contradict the health industry’s goal of improving health and saving lives because they negatively impact the quality and safety of the environment that we live in. At a time when the presence of chronic diseases like cancer, asthma, obesity, and diabetes are at historic highs, and when the costs of treating such diseases threatens to cripple economies across the globe, it is essential that healthcare is provided sustainably. This means being more conscious of the environmental determinants of health, and it means adopting policies, procedures, and innovations that focus on the protection of the environment and on the prevention of illnesses that are linked to environmental factors.
In order to transform the healthcare industry from environmental hazard to environmental steward, Gary and HCWH rely on a four-part strategy of engagement. Central to his success is his ability to convene a broad coalition of hospital systems and medical professionals around common goals, and his keen sense of the market power of the healthcare industry as a driver of environmental responsibility.
The first part of HCWH’s strategy is to educate and inform. HCWH gives providers information on the links between health and the environment—what Gary calls “environmental health literacy”—and often to their surprise, highlights the role they play in contributing to environmental harm and disease onset. He then encourages these providers to “clean house,” for example, by reducing energy, water, and chemical use in their own institutions, and by considering the merits of greener products and practices, including from the perspective of preventive healthcare. Gary first approached Catholic Healthcare West in San Francisco and in just over a decade has expanded his coalition to more than 500 provider organizations all over the world, including some of the largest in the U.S. like Kaiser Permanente.
As HCWH’s network grew, Gary recognized an opportunity to leverage the marketplace and use the healthcare industry as a driver for green energy, green buildings, green products, local agriculture, people-centered design, and other ways that contribute to the well-being of individuals and the planet. This is the third part of his strategy: HCWH uses the tremendous purchasing power of hospitals and health providers (for everything from plastic bottles to carpeting) to stimulate demand for new kinds of products from medical suppliers. For example, many hospital products contain polyvinyl chloride, or PVC, which is an environmental problem not only when it’s burned but also when it’s manufactured and when it’s used. Gary wanted hospitals to move away from PVC, but he recognized that there were few alternatives on the market. With the support of major buyers like Kaiser Permanente and Catholic Healthcare West, he approached suppliers and told them there would be demand for safer products if they were developed. Kaiser subsequently launched a carpet challenge, promising a major bid to whoever could develop industrial strength carpets without PVC. Today such carpets have been developed and are being installed in hospitals and schools around the country.
In this way, HCWH sees the potential to broker larger market shifts with the health sector acting as a green economy multiplier in the center. In the U.S., the healthcare industry amounts to 17 percent of GDP. As it takes steps to become greener, it can become a powerful messenger in the broader society on how to detox the entire economy. Another case in point is Gary’s work to phase out mercury thermometers. HCWH began by making a small investment to switch from mercury to digital thermometers at a single Boston hospital. After dozens of hospitals followed suit, they targeted national drug store chains who agreed to remove all mercury thermometers from their shelves. HCWH then worked to get bans at the city, state, and in some cases national levels—including Sao Paolo, the first Latin American city to phase out mercury completely from its health sector. Now he is partnering with the World Health Organization to eliminate mercury from healthcare worldwide, and the UN is negotiating a treaty banning mercury from commerce. “In that treaty process, the progress of the healthcare sector in eliminating mercury is being held up as the leading edge,” Gary says. “That’s exactly what we had in mind from the beginning.”
Importantly, many of the changes Gary advocates are either cost neutral or cost saving. For example, reducing, sterilizing and disposing of medical waste is not only less harmful but also less expensive. In addition, health providers are receptive to many of the proposed changes because once they grasp the link between the environment and human health, they are motivated by the preventive heath benefits of environmental stewardship. Providers and insurers alike want people to be healthy and not grow up with cancer, diabetes, and obesity, and HCWH provides them with both the motivation and the means to make a positive impact.
What began with a focus on eliminating toxins has evolved into a more comprehensive strategy for building what Gary calls “environmentally responsible healthcare.” As hospitals in the coalition eliminated mercury and incinerators and switched to safer plastics, HCWH began speaking with them about greening their cleaning supplies, reducing their energy use, and building with environmentally friendly materials and designs. Today, rather than simply improving their environmental footprints, Gary is confident the healthcare industry can evolve into promoters of personal and environmental health in the fullest sense—doing everything from supporting community farmers’ markets in low-income neighborhoods to purchasing renewable energy. His vision is of a health sector that is environmentally responsible, resilient, and regenerative, and that serves as a beacon for other industries to follow suit.
In his pursuit of these more comprehensive goals, Gary implements his fourth strategy of mobilizing health practitioners to become involved with public policy. He feels strongly that doctors and nurses in particular—as some of the most trusted members of society—should advocate for the environment from a health perspective and vocally support policies that are more protective of everyone on the planet and the ecosystems that sustain us. Because of his efforts, representatives of major health insurers and practitioners recently testified in Congress in support of reforming the Toxic Substances Control Act, a law that is notorious among environmentalists because it allows companies to keep confidential chemical ingredients in consumer products.
HCWH has had broad and deep impact across the global healthcare industry. The organization has an annual budget of $4 million and focuses less on increasing its own size and more on building a resilient movement. It has built a collaborative network of over 500 organizations to raise awareness, create new messengers for environmental health, and develop tools and strategies to transform the healthcare industry. HCWH helped close more than 90 percent of medical waste incinerators in the U.S. and virtually eliminated mercury medical products from U.S. and European hospitals. It has developed a framework for building healthy and green hospitals that was adopted as the basis for the LEED for Healthcare by the U.S. Green Building Council. HCWH is currently working to assist hospitals to reduce their greenhouse gas emissions and purchase a greater percentage of renewable energy to run their facilities, part of a larger effort to develop a comprehensive “Healthier Hospitals Initiative.”
In many ways, HCWH is at an inflection point. With support rapidly building in the health sector, and as the industry becomes greener and more responsible, Gary recognizes the opportunity for this to fuel a global green economy and environmental best practices across a range of industries. Now, as the values of environmental stewardship become embedded into healthcare, Gary will shift his attention to leverage a global move for corporate accountability and for justice and health in the global supply chain.
Gary is recognized as a global leader in field of environmental health and justice. A longtime environmental activist, he was Executive Director of the National Toxics Campaign of the 1980s and early 1990s, a grassroots organization that helped citizens organize to hold industry and government responsible for damages to the environment and human health. Following the Union Carbide chemical plant explosion in Bhopal, India, Gary joined the push for the passage of the Emergency Planning and Community Right-to-Know Act, a 1986 U.S. law that requires companies operating in American communities to report what chemicals they use and to maintain emergency plans. He also spent significant time in India with his wife and participated in several anti-toxic campaigns there, including one that prevented a DuPont nylon factory from opening in the Indian state of Goa. In 1996, Gary founded HCWH on the heels of an EPA report citing hospital incinerators as the country’s number one source of carcinogenic dioxin emissions. For Gary, the irony was too great: How could the industry tasked with promoting health and saving lives have such a poor environmental record?
Gary’s success as a social entrepreneur comes from his combination of a clear, ambitious vision and a creative strategy designed for scale. At the center of that strategy is not a single organization or individual, but rather an “ecosystem of collaboration” with a central role for industry and business. Gary is known as a master convener, always able to find common ground and sell it effectively. As his network of collaborators grows, he continuously leverages its power and influence to grow it further, and uses its purchasing power in the marketplace to spur a green economy that weds innovation and smart business with environmental justice and health.