Greening the Health Care Industry

In 1994, Charlotte Brody, a registered nurse and longtime health activist, came across a startling piece of information. While reading a draft version of a study commissioned by the United States Environmental Protection Agency, she learned that the incineration of medical waste was the single largest source of dioxin pollution.

Brody knew about the hazardous effects of dioxin -- an airborne class of toxins that settles in human fatty tissues and has been linked to birth defects, decreased fertility and immune system dysfunction. But she did not know that hospitals, the very institutions that aim to fight illness and maintain health, were contributing to sickness by releasing poisons into the air. The irony, she says, was overwhelming.

"I thought when you burn, all you have is ash," said Brody, who at the time was working for Planned Parenthood in Charlotte, North Carolina. "So when I read the dioxin reassessment and learned that every time we burned a red bag, we were putting dioxin into the breasts of women we were trying so hard to keep healthy, I was, simply put, shocked."

Jackie Hunt Christensen at the Institute of Agriculture and Trade Policy in Minneapolis and Gary Cohen at the Environmental Health Fund in Boston had similar reactions to the 1994 dioxin report. Both had been working to educate people about dioxin. And both were frustrated by what Cohen calls the "disconnects" between environmental and public health.

So when the three met up two years later at a conference devoted to dioxin research in Baton Rouge, Louisiana, they decided that a new kind of organization needed to be formed -- one that could bring together the hundreds of environmental and health care nonprofits to campaign against medical waste and the environmental hazards of the health care industry.

Health Care Without Harm (HCWH) is the result of their idea. The organization, which they founded in 1996, has proved to be a solution to the cookie cutter-like terrain of the nonprofit world. After a mere four years, HCWH has brought together over 260 organizations from 22 countries and has achieved victories not often seen by progressive nonprofits.

Many people in the nonprofit world, such as Colin Greer of The New World Foundation, attribute HCWH's success to its coalition work. HCWH's campaigns have the support of such diverse, powerful organizations as the American Public Health Association, Sierra Club, the United Methodist Church as well as hospital associations, labor unions and medical purchasing groups. Perhaps more importantly, says Greer, HCWH has proved that forcing change upon the increasingly profit-oriented public health industry requires the tactics of a nimble yet cohesive army.

"When HCWH come up with ideas," says Greer, "they really move on them. However, they follow no one formula. HCWH is the first organization I have seen in a long time that integrates their tactics, strategies and vision. They are seeking to create an international public health movement."

Since the chemical industry -- which has its own army of lobbyists and high-profile physicians -- is their primary target, HCWH has their work cut out for them. One of their most public campaigns to date has been to draw attention to the health risks of polyvinyl chloride plastic (PVC), a product used in IV bags, tubing for blood transfusions, mattress covers and even office supplies such as binders.

Dioxin is released both when PVC is manufactured and incinerated. And even while it is in use, PVC may be dangerous to patients, as di-ethylhexl phthalate, or DEHP -- the chemical used to make PVC products more flexible -- has been identified by the Environmental Protection Agency as a probable human carcinogen. In IV bags, for example, DEHP can leach into the solutions being administered intravenously, potentially damaging a patient's heart, liver, testes or kidneys.