GREEN HEALTHCARE INSTITUTIONS Health, Environment, and Economics

WORKSHOP SUMMARY

Howard Frumkin and Christine Coussens, Rapporteurs

Roundtable on Environmental Health Sciences, Research, and Medicine

Board on Population Health and Public Health Practice

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page R1
Green Healthcare Institutions Health, Environment, and Economics: Workshop Summary GREEN HEALTHCARE INSTITUTIONS Health, Environment, and Economics WORKSHOP SUMMARY Howard Frumkin and Christine Coussens, Rapporteurs Roundtable on Environmental Health Sciences, Research, and Medicine Board on Population Health and Public Health Practice INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

OCR for page R1
Green Healthcare Institutions Health, Environment, and Economics: Workshop Summary THE NATIONAL ACADEMIES PRESS 500 FIFTH STREET, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by contracts between the National Academy of Sciences and the National Institute of Environmental Health Sciences, National Institutes of Health (Contract N01-OD-4-2193, TO#43); National Center for Environmental Health and the Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention (Contract No. 200-2000-00629, TO#7); National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention (Contract 0000166930); National Health and Environment Effects Research Laboratory and the National Center for Environmental Research, U.S. Environmental Protection Agency (Contract 282-99-0045, TO#5); American Chemistry Council (unnumbered grant); ExxonMobil Corporation (unnumbered grant); and Institute of Public Health and Water Research (unnumbered grant). The views presented in this book are those of the individual presenters and are not necessarily those of the funding agencies or the Institute of Medicine. Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, N.W., Box 285, Washington, DC 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu. International Standard Book Number-13: 978-0-309-10592-7 International Standard Book Number-10: 0-309-10592-7 Copyright 2007 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Cover photo: Reprinted with permission, from Guenther 5 Architects, PLLC. Copyright (2005) by David Allee. Suggested citation: Institute of Medicine (IOM). 2007. Green healthcare institutions; Health, environment, and economics (Workshop summary). Washington, DC: The National Academies Press.

OCR for page R1
Green Healthcare Institutions Health, Environment, and Economics: Workshop Summary “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES Advising the Nation. Improving Health.

OCR for page R1
Green Healthcare Institutions Health, Environment, and Economics: Workshop Summary THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

OCR for page R1
Green Healthcare Institutions Health, Environment, and Economics: Workshop Summary ROUNDTABLE ON ENVIRONMENTAL HEALTH SCIENCES, RESEARCH, AND MEDICINE* Paul Grant Rogers (Chair), Partner, Hogan & Hartson, Washington, D.C. Lynn Goldman (Vice Chair), Professor, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland Jacqueline Agnew, Professor, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland John Balbus, Director of Health Program, Environmental Defense, Washington, D.C. Roger Bulger, Advisor to the Director, National Center on Minority Health and Health Disparities, Bethesda, Maryland Yank D. Coble, Immediate Past President, World Medical Association, Neptune Beach, Florida Henry Falk, Director, Coordinating Center for Environmental and Occupational Health and Injury Prevention, National Center for Environmental Health/Agency for Toxic Substances and Disease Registry, CDC, Atlanta, Georgia Baruch Fischhoff, Howard Heinz University Professor, Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania John Froines, Professor and Director, Center for Occupational and Environmental Health, Southern California Particle Center and Supersite, University of California, Los Angeles Howard Frumkin, Director, National Center for Environmental Health/ Agency for Toxic Substances and Disease Registry, CDC, Atlanta, Georgia Paul Glover, Director General, Safe Environments Programme, Health Canada, Ottawa, Ontario Bernard Goldstein, Professor, Department of Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pennsylvania Myron Harrison, Senior Health Advisor, ExxonMobil, Inc., Irving, Texas Carol Henry, Acting Vice President for Industry Performance Programs, American Chemistry Council, Arlington, Virginia John Howard, Director, National Institute of Occupational Safety and Health, Washington, D.C. Peter Illig, Consultant, Association Internationale pour l’Ostéosynthèse Dynamique, Trauma Care Institute, Nice, France Richard Jackson, Adjunct Professor, Environmental Health Services Division, University of California at Berkeley * Membership current as of December 31, 2006.

OCR for page R1
Green Healthcare Institutions Health, Environment, and Economics: Workshop Summary Lovell Jones, Director, Center for Research on Minority Health, and Professor, Gynecologic Oncology, University of Texas, M. D. Anderson Cancer Center, Houston Alexis Karolides, Senior Research Associate, Rocky Mountain Institute, Snowmass, Colorado Patrick Leahy, Acting Director, U.S. Geological Survey, Reston, Virginia Donald Mattison, Senior Advisor to the Directors of the National Institute of Child Health and Human Development and Center for Research for Mothers and Children, Bethesda, Maryland James Melius, Administrator, New York State Laborers’ Health and Safety Fund, Albany James Merchant, Professor and Dean, College of Public Health, University of Iowa, Iowa City Dick Morgenstern, Senior Fellow, Resources for the Future, Washington, D.C. John Porretto, President, Sustainable Business Solutions, Dewees Island, South Carolina Lawrence Reiter, Director, National Exposure Research Laboratory, Research Triangle Park, North Carolina Carlos Santos-Burgoa, General Director for Equity and Health, Secretaria de Salud de Mexico, Mexico D.F. David Schwartz, Director, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina Jennie Ward-Robinson, Executive Director, Institute for Public Health and Water Research, Chicago, Illinois Samuel Wilson, Deputy Director, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina Harold Zenick, Acting Director, Office of Research and Development, Research Triangle Park, North Carolina Study Staff Christine M. Coussens, Study Director Dalia Gilbert, Research Associate (until December 2006) Nora Hennessy, Research Associate (from February 2007) David Tollerud, Project Assistant Vera Diaz, University of California Intern Board Staff Rose Marie Martinez, Board Director Hope Hare, Administrative Assistant Christie Bell, Financial Associate

OCR for page R1
Green Healthcare Institutions Health, Environment, and Economics: Workshop Summary Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Ellen Dorsey, Program Officer, Heinz Endowments, Pittsburgh, PA Paul R. Fisette, Director, Building Materials and Wood Technology, Holdsworth Natural Resources Center, University of Massachusetts, Amherst Lt. Gen. Henry J. Hatch (Ret), Former Chief of Engineers, United States Army, Oakton, VA Susan West Marmagas, Director of Health Programs, Collaborative on Health and the Environment, Blacksburg, VA Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the report before its release. The review of this report was overseen by Ada Sue Hinshaw, Professor, University of Michigan School of Nursing, who was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

OCR for page R1
Green Healthcare Institutions Health, Environment, and Economics: Workshop Summary This page intentionally left blank.

OCR for page R1
Green Healthcare Institutions Health, Environment, and Economics: Workshop Summary Contents     PREFACE   xi 1   INTRODUCTION   1      What Is Green Health Care?,   2      Why Pursue Green Health Care?,   4      What Is the Evidence Supporting Green Health Care and What Further Evidence Is Needed?,   4      How Is Green Health Care Implemented?,   5 2   SUSTAINABLE HEALTHCARE FACILITIES   6      Green Building and Health Agendas: Points of Convergence,   6      High-Performance Healing Environments,   8      Building Green and Integrating Nature: Rikshospitalet University Hospital in Oslo,   12 3   ECONOMICS, ETHICS, AND EMPLOYMENT   18      Green Building: Economics,   18      Ethics of Green Buildings ,   23      Increasing Workplace Productivity,   26 4   THE HEALTH ASPECTS OF GREEN BUILDINGS   28      Health in Buildings: Indoor Air Quality,   28      Sustainability, Health Care, and Patient Wellness,   32      Design Research and the Business Case for a Better 21st Century Hospital,   35

OCR for page R1
Green Healthcare Institutions Health, Environment, and Economics: Workshop Summary            5   THE PROCESS OF CHANGE   38      University of Florida,   38      Emory University,   42 6   CHAMPIONS FOR CHANGE   45      Creating a Comprehensive Green Healthcare System,   45      Building Green on a Large Scale,   49 7   GENERAL WORKSHOP DISCUSSION   53      What Is Green Building?,   53      Advancing Green Building Research,   54      Translation of Research into Practice.   54      Addressing Gaps in Knowledge,   56      Economics,   56      Community Leadership,   56     PRESENTATION ABSTRACTS   59     REFERENCES   101     APPENDIXES     A   Workshop Agenda   107 B   Speakers and Panelists   112 C   Workshop Participants   114

OCR for page R1
Green Healthcare Institutions Health, Environment, and Economics: Workshop Summary Preface This workshop is the ninth in a series of workshops sponsored by the Roundtable on Environmental Health Sciences, Research, and Medicine since the roundtable began meeting in 1998. When choosing workshops and activities, the roundtable looks for areas of mutual concern and also areas that need further research to develop a strong environmental science background. When the Roundtable on Environmental Health Sciences, Research, and Medicine began its discussions, the roundtable members suggested that a broader concept of environmental public health needed to be established. The roundtable has built on other definitions of environmental health to include the natural, built, and social environments. Prior to these initial discussions, many roundtable members felt that there had been a focus on the toxicological effects of individual environmental agents to the detriment of understanding the larger picture of how environmental conditions impact health. The roundtable members acknowledged that the built environment—where and how communities and transportation systems are built—is very important and relevant to health. The roundtable’s first workshop, Rebuilding the Unity of Health and the Environment: A New Vision of Environmental Health for the 21st Century, examined and explored a broader definition of the environment as a very integral part of health. Where people live, work, and play impacts their health, and environmental policies must consider this relationship. In the past six years, the role of the built environment has received more attention in public health. Roundtable members Howard Frumkin, Lynn Goldman, Richard Jackson, Samuel Wilson, and others helped to shape the roundtable’s thinking on the built environment, bringing this issue to the forefront in public health leadership and planning communities. This workshop focused on the environmental and health impacts related to the design, construction, and operation of healthcare facilities, which are part of one of the largest service industries in the United States. Healthcare institutions

OCR for page R1
Green Healthcare Institutions Health, Environment, and Economics: Workshop Summary are major employers with a considerable role in the community, and it is important to analyze this significant industry. The environment of healthcare facilities is unique. It has multiple stakeholders on both sides, as the givers and the receivers of care. There are ill and injured individuals, their families and friends, and the employees that deliver care to them. Many of the most vulnerable individuals pass through the doors of healthcare facilities each day. In order to provide optimal care, more research is needed to determine the impacts of the built environment on human health. The scientific evidence for embarking on a green building agenda is not complete, and at present, scientists have limited information. There is general information that pleasant places that emit low levels of chemical materials are good for the environment and good for health, but, at best, science can make only vague statements. For example, there is no guideline to determine how much use of natural daylight as a source of illumination is necessary to realize benefits. Overall, the major point that I took away from the workshop is that the scientific community needs to think strategically about its funding in this area. There is an opportunity of great promise, yet more information about the complexities involved in building a green facility is needed. A number of speakers pointed out that hospitals, which regularly collect information on patient outcomes, are ideal living laboratories to advance knowledge as the United States embarks on replacing many facilities from the early postwar era. Through implementation of controlled studies, investigators can address the research gaps and discern the complexities of building green on human health. The challenge will be to conduct meaningful research in this area that examines the interplay of the built environment and health. Finally, the workshop participants discussed research directions that will help promote an environment for overall health. This workshop summary captures the discussions and presentations by the speakers and participants; they identified the areas in which additional research is needed, the processes by which change can occur, and the gaps in knowledge. The views expressed here do not necessarily reflect those of the Institute of Medicine, the roundtable, or their sponsors. Paul G. Rogers, Chair Roundtable on Environmental Health Sciences, Research, and Medicine