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.

When Health Care Without Harm began supporting studies on PVC, the issue of its danger was not on anyone’s radar screen, says Cohen. But by the summer of 1999, medical plastics made with PVC were being hotly disputed.

Former Surgeon General C. Everett Koop led a panel of scientists who argued that PVC products were perfectly safe. He presented a report to Congress conducted by the American Council on Science and Health, which caused outcry among scientists associated with Health Care Without Harm who argued that the Koop panel's finding was "an incomplete, deceptive and misleading analysis of the scientific literature."

Then HCWH started digging. They disclosed that Koop had trivialized the concerns of scientists doing research on PVC, when previously he received $650,000 in consulting fees from WRP Corporation, a major latex glove manufacturer. HCWH also argued that the views of American Council on Science and Health were often biased, as 76 percent of the nonprofit's funding came from corporations with a stake in ACSH’s review of their products. ACSH, HCWH reported, had attacked public warnings about toxic substances at the same time that it had accepted funding from Dow, Dupont and other chemical manufacturers. Moreover, HCWH pointed out that ACSH was serving as the main content provider to, Koop's publicly traded health Web site.

To continue its campaign, HCWH shifted gears and started putting pressure on the very forces that support the market: medical purchasing groups. Armed with reports on the toxic effects of PVC, HCWH approached Continuum, Kaiser, Tenet Healthcare and Universal Health Services to try to get them to change their medical purchases.

As a result of this effort, Continuum is no longer buying PVC products. Kaiser has ceased using PVC latex gloves. And Tenet and Universal have pledged to develop a purchasing preference for non-PVC products. In its latest coup, HCWH has helped to negotiate a shareholder agreement with Baxter Healthcare, the largest U.S. manufacturer of IV bags, to commit to phasing out the use of PVC in its medical products.

"With Baxter we succeeded in a stockholder resolution because of our allies in the Interfaith Center for Corporate Responsibility," says Brody. "The fact is faith-based and other social change-oriented groups tend to have a lot of health care stock. We could come in and say, 'Here are the reports. Here's our point-by-point challenge to the manufacturing industry's take on the science.' And that mattered."

A multi-pronged offense has proved successful for Health Care Without Harm's other lead initiative: reducing mercury poisoning.

Mercury is usually associated with thermometers, but it also can be found in blood pressure devices, dilation and feeding tubes and fluorescent lamps. Like PVC products, when mercury is disposed of through incineration it is released into the air, where it causes the contamination of lakes and rivers and poisons humans and animals.

According to a 1997 EPA Report to Congress, 39 states have determined that all or some of its bodies of water are too contaminated with mercury to allow people to eat the seafood that live there. Studies have shown that infants of women who ate mercury-contaminated fish or grain while pregnant were born with nervous-system damage and, in the worse case, mental retardation.

Since knowledge of mercury poisoning is widespread, HCWH has had a fairly easy time convincing its constituencies that change is in order. People know that when you break a thermometer on a carpet floor, the carpet pretty much has to go. So when HCWH began pushing to ban the sale of mercury thermometers, they saw quick results.

In the past few months, HCWH has organized mercury thermometer "swaps," or exchanges for digital thermometers, in Massachusetts, Michigan, Minnesota and California. Duluth, Minnesota has banned the sale of mercury thermometers and the same resolution is pending before the San Francisco City Council. Rite Aid has agreed to stop the sale of mercury fever thermometers in its more than 4,000 pharmacies.

"We have been the catalyst for what has now become a stampede away from mercury in health care," says Cohen. "We facilitated a memorandum of understanding between the EPA and the American Hospital Association, which calls for the phasing out of mercury in hospitals by the year 2005 and the reduction of mercury-related waste by half by the year 2010. With the city bannings, the issue is taking off."

The other initiative that is taking off at HCWH involves the problem that first brought Cohen, Brody and Christensen together. In just four years, HCWH has exposed medical waste incineration as a largely failed technology. When the group formed in 1996, there were approximately 5,600 medical waste incinerators around the country; now several thousand have been closed. In 1997, HCWH pushed the EPA to release the first federal standards and guidelines regulating incinerators. Such efforts have even proved cost-effective for hospitals. Beth Israel Medical Center in New York now saves $900,000 per year by following HCWH's recommendations for reducing waste and recycling and reusing medical products.

"With the new EPA regulations, we created a crisis about waste," says Cohen. "We showed hospitals that if they didn't comply, it would be bad PR and bad for the environment. It's not even good for their budgets."

HCWH has helped shut down such toxic dumpers as the Bronx Lebanon incinerator and the incinerator at the Henry Ford Hospital in Detroit. "We met with them and said, 'You have an asthma outreach and education program in the inner city here and at the same time you're burning medical waste and putting all these chemicals into the environment. Don't you think there's a disconnect here?'" says Cohen. Cohen adds that the two-year effort in Detroit involved building public pressure through grassroots advocacy organizations that HCWH helped to financially support.

One would assume that given the breadth of HCWH's programs they are rolling in money. But the group raises a relatively modest $1.6 million a year solely from foundations, which goes to the scientists, activists and health and environmental nonprofits involved in their causes. "We have to be really careful about where the money comes from because we have to be able to talk about the products," explains Brody. "We have to be able to say, 'Here are the alternatives to mercury thermometers that work well.'"

HCWH's clean profile has solidified its reputation abroad as well. They have been one of the lead forces behind the International Treaty to Stop POPs -- or persistent organic pollutants, a group of pesticides, PCBs and dioxins that people are exposed to through the consumption of meat, fish and dairy products. Detection of POPs has been on the rise in breast milk, semen, placenta, the brain, blood and the liver, a fact which Brody explains makes it very difficult to talk about without leaving people devastated.

Although the POPs treaty is progressing through the bureaucratic bramble of the U.N., Brody argues it would be doing a lot better "except that the U.S. government seems to be taking orders from Jesse Helms' office." Brody says chemical companies are providing negotiating language to the U.S. government "as if they were elected officials" and that the U.S. government has been "bullying countries into throwing out NGOs fighting for POPs elimination from the negotations."

Cohen also pinpoints the links between the chemical industry and the U.S. government as a chief hurdle for HCWH's environmental health aims. "Congress is pretty much bought off by the chemical industries, so you can't really win at the Congressional level," he says. "The most you can win in Congress is money for testing or for right-to-know issues. But in terms of restricting chemicals that are poisoning people, government will not act. End of story."

Cohen gives the example of risk assessment on dioxins that the U.S. government has been sitting on for nine years. The reasons for this inordinate delay? "If you start telling people that every child born in this country has dioxin in their body," says Cohen, "if you show them the list of health effects and that every mother is passing dioxin onto her child, if you say we are all being exposed to hundreds of thousands of chemicals -- it's an explosive issue. And the chemical industry, particularly the chlorine section of the chemical industry, will be in trouble."

Cohen believes that Carol Browner of the EPA might release the dioxin risk assessment before the upcoming presidential elections. Japan published a similar report last year, which, after considerable public outcry, forced the Japanese government to take significant steps to reduce dioxin exposure. Yet Cohen adds that if the report is not released before November and if Gore does not win the presidency, "this report will never see the light of day."

This is the reason, says Cohen, that Health Care Without Harm and its coalition members must continue their marketplace strategies, convincing sectors of the health care economy -- hospitals, medical purchasing groups, stock holders -- to break away from the chemical industry independently and embrace safer products. "Then you can begin to show how you can win without hoping that the government is going to save us, which they are not," says Cohen. "Our task is to build a broad base of educated citizens that understand we need to defend our children and future generations from toxic poisoning."

Based on Health Care Without Harm's four-year track record, it seems that Cohen and his colleagues are off to a good start.

Take Action! Health Care Without Harm is constantly campaigning for environmental health and justice. Visit their Web site,, to find out how you or your organization can get involved.

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