It’s no secret that our quality of life relies on basic necessities such as safe drinking water, clean air, and arable land. The interdependent relationship between the health of the environment and human health is well understood. Over the last 20 years sustainability, as a value for the future, has penetrated nearly every American industry, including transportation, agriculture, forestry and architecture. Business continues to reform to increase efficiency and productivity while minimizing risk to the environment. The EPA defines sustainability as “meeting the needs of the present without compromising the ability of future generations to meet their own needs.”1 As industries on a global scale embrace “green” values, medicine remains one of the last to embrace principles of sustainability into its business model.
First, we must acknowledge how the current medical system is economically unsustainable. In 2003, more than 109 million Americans had one or more common chronic conditions, for a total of 162 million cases. The total impact of these diseases on the economy was $1.3 trillion annually, lost productivity totals $1.1 trillion per year, while another $277 billion is spent annually on treatment (not including costs to treat the subsequent health consequences of these diseases)2. Often unrecognized is that this increase in spending does not correlate with a reduced incidence of preventable disease.
Medical sustainability in a social context suggests a provision of high-quality, affordable for health care to all Americans. Sustainability would result in an overall decrease in the number of preventable illnesses, disease and death, as well as reduced reliance on medical interventions. Recent data reminds us of the 47 million adults and 8.7 million children uninsured Americans in 2006, the highest rates since 1999.3
In order to consider ecological sustainability within the medical context, we also have to accept the reality of widespread environmental degradation and the presence of environmental health hazards, which pose a significant and increasing challenge to human health. Surprisingly, conventional medical practices have vastly contributed to the deterioration of the environment. Hospitals produce over 3.5 million tons of medical waste each year.4 The environmental consequences of medical treatments are widespread. For example, 80% of our rivers, lakes, and streams contain traces of commonly prescribed pharmaceuticals, such as antibiotics, steroids and hormones, blood pressure medications, and pain relievers.5 It is our responsibility as health professionals to understand this ecological crisis and limit the overall impact our current medical system has on human and environmental health.
This is a plea for a new kind of medicine that integrates sustainability in both the economic, social, and ecological sense of the term. Our ability to move towards a sustainable medicine relies on leadership. The overwhelming lack of environmental awareness in medical education calls for leaders who can guide our fellow professionals, clinical staff, and patients to a healthier future. Leadership requires commitment and strength to integrate values, social capital, and environmental integrity. With the support of healthcare leaders, a sustainable medical system is possible.
The subject of Sustainable Medicine is part of the growing movement called Green Health Care. This model of improved environmental and human health is comprised of three intrinsic parts: working in toxicfree buildings, developing literacy around local environmental health issues, and the practicing safe, effective, precaution-based medicine. Ultimately, health providers must make a commitment to prioritizing medical care that emphasize wellness, prevention, precaution, safety, and efficacy in order to effectively support individuals, communities and our natural world.
Green the Medical Workplace
Sustainable Medicine begins when health professionals take steps to work in toxic-free facilities that support personal and community health. During the past several years, green buildings and green practices have become more commonplace. As mentioned, more then 100 hospitals are in the planning or the building phase for green-certification. However, since the majority of primary care takes place in older medical buildings, we must recognize the significant impact associated with “greening” operations, while keeping the original facility intact.
Greening a clinic involves more then simply changing light bulbs, although a simple and significant step. In addition, providers and administration collaborate to develop common understandings of the built environment’s value to personal, community, and environmental health. The social benefits of promoting sustainable practices such as resource conservation, waste management, and environmental performance supports the health of the occupants of the building, the local community, and the environment.
Become an Environmental Health Advocate Practicing Green Health Care involves an ongoing and supportive dialogue between medical professionals, local environmental health organizations, and community members. The significance of a healthy environment cannot be understated. Twenty-five percent of all disease worldwide is caused by poor environmental quality.6 Sustainable Medicine requires health professionals understand and advocate for local environmental issues by partnering with civic and environmental leaders and organizations. Partnerships with environmental organizations and community activists support environmental justice through community health promotion. Making a commitment to promote the health of the environment improves human health by recognizing, treating and preventing environmental illness.
Practice Sustainable Medicine
Practicing sustainable healthcare in a clinical setting begins with first learning about the consequences of high tech and pharmaceutical medicine, and then valuing medicines that are ecologically sustainable. By choosing sustainable medical treatments first medicine offers more sustainable, costeffective care. Green healthcare providers value sustainability, equity, and ecology for long-term health goals. Sustainable medicine values the role of nature in healing and asks physicians, health providers, and administrators to invest personally in the local clinical setting by committing to the health of the community. This begins with offering medical interventions at portal-ofentry medical clinics that support prevention and wellness.
The future of medicine is in our hands as health providers. Emphasizing wellness through prevention and precaution, while continuing to rely on efficacy as the determinant for selection of treatment, represents a safe, effective, fair and just medical system. Sustainable medicine offers the most comprehensive vision of a universal health care for all citizens of our nation. Sustainable Medicine begins with responsibility for personal actions and lifestyle choices and moves others to prioritize medical care choices that effectively support individuals, communities and our natural world, which provides lifetimes of nourishment.
- Environmental Protection Agency. Sustainability website. December 20, 2007. Available at http://www.epa. gov/sustainability. Accessed January 7, 2008.
- DeVol R, Bedroussian A, et al. An Unhealthy America: The Economic Burden of Chronic Disease -- Charting a New Course to Save Lives and Increase Productivity and Economic Growth. Milken Institute. October 2007.
- Center on Budget Policy and Priority. Number and Percentage Of Americans Who Are Uninsured Climbs Again. August 31, 2007. Available at: http://www.cbpp.org/8-28-07pov.htm
- Medical waste disposal. Medical Waste Committee (WT-3). (1994). Technical Council Air & Waste Management Association. Journal of Air Waste Management Association. 44:1176-1179
- Kolpin, D.W., Furlong, E.T., Meyer, M.T., Thurman, E.M., Zaugg, S.D., Barber, L.B., and Buxton, H.T.(2002) Pharmaceuticals, hormones, and other organic wastewater contaminants in U.S. streams, 1999- 2000: a national reconnaissance: Environmental Science and Technology, v. 36, p. 1202-1211.
- World Health Organization. Almost A Quarter Of All Disease Caused By Environmental Exposure. Available at: HYPERLINK “http://www.who.int/mediacentre/ news/releases/2006/pr32/en/index.html” www.who. int/mediacentre/news/releases/2006/pr32/en/index.html. Accessed January 7, 2008