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Welcome to PSR's Environmental Health Policy Institute, where we ask questions -- then we ask the experts to answer them. Join us as physicians, health professionals, and environmental health experts share their ideas, inspiration, and analysis about toxic chemicals and environmental health policy.


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Prevention at Work: Reducing Hazardous Chemicals in Health Care

Posted on April 18, 2014

By Rachel Gibson

With the closing of the Affordable Care Act’s enrollment period, I was reminded of the words of my organization’s president and co-founder, Gary Cohen, in a recent blog post: “We manage chronic disease. We don’t prevent it.” He went on to tell us, “For every dollar spent on health care, 70 cents is spent treating diseases and 4 cents is spent on prevention. Moreover, we spend more money on health care per capita than any nation on earth, yet our health statistics are worse than those of 17 other industrialized countries.”[1]

Recent reports highlight these trends:

  • Although mortality is declining, leukemia, brain cancer, and other childhood cancers have increased by more than 20% since 1975.[2] 
  • Nearly 1 in 6 children has a learning or developmental disability.[3]
  • A woman’s lifetime risk of breast cancer is 1 in 8.[4]
  • Nearly 1 in 12 Americans suffer from asthma.[5]

The single, most important way to reverse these alarming health trends and reduce the associated health care costs is through prevention. In addition to personal lifestyle factors, exposures to harmful chemicals on the job, at home, in the outdoors, and even in utero are increasingly recognized as important and preventable contributors to human disease.

It is within this context that Health Care Without Harm has been working for the past eighteen years to ensure that the healthcare sector embeds environmental health into its core operating strategy. For us, this is prevention.

Healthier Hospitals Initiative

Our most recent effort—the Healthier Hospitals Initiative (HHI)—is a sector-wide campaign sponsored by thirteen of the largest, most influential U.S. health systems and designed to “mainstream” proven sustainability strategies into the way American hospitals operate. HHI invites hospitals to participate in six challenge areas: Safer Chemicals, Leaner Energy, Less Waste, Smarter Purchasing, Healthier Food, and Engaged Leadership. HHI has enrolled more than 800 hospitals across the country, over 200 of which have committed to working on the Safer Chemicals Challenge.

The Safer Chemicals Challenge includes four opportunities for a hospital to reduce the use of hazardous chemicals, prioritizing areas where the chosen chemical poses a particular hazard to people and the environment and where there are viable alternatives on the market. These include: 1) the virtual elimination of mercury, 2) adopting greener cleaners, 3) reducing the use of medical products containing polyvinyl chloride (PVC) and di-ethylhexyl phthalate (DEHP), and 4) purchasing furnishings free of PVC, formaldehyde, perfluorinated compounds (PFCs), and halogenated flame retardants (HFRs).

Through its purchasing practices and policies, the healthcare sector can influence chemical selection for medical products and the amount of information available about product ingredients; in so doing, it can ultimately help shape the broader market of products. For many hospitals and health systems, the HHI Safer Chemicals Challenge provides them with the opportunity to take the first step along the path to a more informed and comprehensive approach to buying and using safer products in their institutions. For some, such as Dignity Health and Kaiser Permanente, enrollment in the HHI Safer Chemicals Challenge is part of their ongoing and extensive journey to reduce the use of harmful chemicals in their healing environments.

PVC/DEHP Reduction: Eliminating Known Hazards from Medical Products

Kaiser Permanente (KP), one of the nation’s largest not-for-profit health systems, has worked with HCWH for many years and is a key partner in the Healthier Hospitals Initiative. KP’s significant progress in eliminating PVC and DEHP from its medical supply chain saves money while serving as an important case study for other institutions working to reduce PVC/DEHP.

HCWH has long been working to eliminate PVC, which creates the carcinogen dioxin when manufactured or incinerated. DEHP is a plasticizer that is added to PVC to make it pliable, but it can leach out of the material into patients and is recognized as a reproductive toxicant by the U.S. Food and Drug Administration and National Toxicology Program. Alternatives to these problematic materials are readily available on the market but require increased demand to make them the standard of care.

Several years ago, Kaiser Permanente partnered with its suppliers to target PVC and DEHP for elimination from the IV administration sets it purchases. In 2012, KP committed to purchasing PVC- and DEHP-free IV solution bags and tubing that is DEHP-free. With the 4.9 million IV administration sets and 9.2 million solution bags KP purchases each year, this conversion affects nearly 100 tons of medical products. It is expected to save almost $5 million annually.

This success story highlights the role health care can play in the material economy, sending a clear signal to the market that safer materials and chemicals must be used. It also points to the opportunity HHI provides hospitals for aligning purchasers and suppliers around the shared goal of removing hazardous chemicals from products.

Healthy Interiors: Eliminating Known Hazards from Furniture

Beaumont Health System, a regional healthcare provider that currently operates 1,728 beds at three locations, including the 20th largest hospital in the United States, committed to the Healthy Interiors goal of the Safer Chemicals Challenge. To achieve this goal, hospitals must ensure that at least 25% of their annual purchases of freestanding furniture and medical furnishings, including exam tables, patient recliners, mattresses, foams, cubicle curtains, fabric upholstery and more, do not contain PVC, formaldehyde, PFCs, and HFRs - chemicals associated with a wide range of negative health effects. These chemicals can escape from products, ending up in the air, dust, our bodies, and the environment.

Beaumont identified desk chairs as its largest volume product covered by the Healthy Interiors goal. Through a partnership between Beaumont and a furniture manufacturer, a chair was identified that met all of the specifications of the hospital and users at a very small 0.3% cost increase, while also avoiding the HHI-identified chemicals of concern. In working to achieve the Healthy Interiors goal, 26% of all Beaumont furnishings purchased in 2013 avoided the targeted chemicals of concern. Over $1 million of Beaumont’s 2013 spending was dedicated to avoiding these hazardous chemicals.

Modernizing Chemical Regulations

While many healthcare institutions invest significant time and resources to identify products free from known chemicals of concern, the current level of investment is not sustainable, nor is it feasible, for most institutions. This is why we’re working in partnership with organizations all across the country through Safer Chemicals, Healthy Families to update the Toxic Substances Control Act (TSCA)—the federal statute that should be protecting us all from harmful chemicals.

While several proposals to update TSCA have been introduced in the U.S. Senate and House of Representatives, neither would fix the problems that keep the U.S. Environmental Protection Agency from being able to effectively regulate chemicals. In fact, both of the major bills introduced to update TSCA -- the Chemical Safety Improvement Act in the Senate and the Chemicals in Commerce Act in the House -- would hinder U.S. EPA from obtaining necessary health and safety information on chemicals, assessing their toxicity, and taking action to protect public health and the environment.  At the same time, these bills would preempt health-protective measures in the states. This is unacceptable.

In the coming months, we hope to see meaningful and credible TSCA reform proposals introduced and considered in Congress. In the meantime, we’ll continue supporting and assisting our partners in the healthcare sector as they transition away from harmful chemicals and work within the existing regulatory limitations to create healing environments.

[1] Cohen G. The Elephant in the Waiting Room. The Huffington Post; [2014 January 16].

[2] America’s Children and the Environment: Measures of contaminants, body burdens, and illnesses. Washington, DC: Environmental Protection Agency; [updated 2011 March 8; cited 2003].

[3] Boyle C, et al. Trends in the prevalence of developmental disabilities in U.S. children, 1997-2008. Pediatrics 2011;127(6):1034-1042.

[4] State of the Evidence: The connection between breast cancer and the environment. San Francisco: Breast Cancer Fund; [2010 October 1].

[5] Vital Signs: Asthma prevalence, disease characteristics and self-management education – United States, 2001-2009. Atlanta: U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report 2011 60(17):547-552; [2011 May 6]. 


Devra davis said ..

Mobile wireless devices in healthcare are growing exponentially in their use an application. Many of these are life saving for acute problems. But young technicians are using devices directly on their bodies or around their necksin ways that are not tested for safety. Mobile phones today come with warnings that they should be kept some distance off the body. This is because there evidence of nonthermal effects on reproductive health for men and women has become especially strong. We now have in vitro and in vivo evidence showing that cell phone radiation damages spermatogenesis as well as sperm morphology & motility. Studies have also shown effects on ovarian Genesis and ovarian function

April 28, 2014
Ruth Berlin said ..

You have left out one of the most significant toxic exposures in health care facilities- namely pesticides from pest and land care management, food, aintimicrobials and more. Please see our IPM in Health Care facilities webpage: The Joint Commission and PESP newsletters have both written extensive articles about this project. We educated new moms at UMMC also on hazards of pesticides and safer alternatives . Patients have significant exposure to pesticides that are linked to the very illnesses they are being treated for

April 25, 2014

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