tors. For example, choosing safe cleaning agents or limiting the use of pesticides can reduce the potential for toxicity among those exposed. On the community scale, reducing the ecological footprint of a hospital reduces environmental hazards and protects natural resources. For example, linking a hospital to its community with pedestrian infrastructure and mass transit can reduce motor vehicle traffic and help achieve clean air. Reducing packaging in the hospital cafeteria or adopting biodegradable cutlery and plates can reduce the volume of waste sent to landfills. On the global scale, green practices help steward scarce resources and reduce environmental degradation. For example, a hospital that purchases food or supplies from local sources reduces the need for long-distance transport of goods, thereby reducing the associated greenhouse gas emissions that contribute to climate change. A hospital that installs flooring made from sustainably harvested wood helps slow deforestation, which in turn preserves biodiversity and the livelihoods of faraway rural populations.

WHAT IS GREEN HEALTH CARE?

Green building can be defined in many ways. According to the Office of the Federal Environmental Executive, “green or sustainable building is the practice of designing, constructing, operating, maintaining, and removing buildings in ways that conserve natural resources and reduce pollution” (OFEE, 2003). This definition is fully applicable to healthcare facilities at all stages of design, construction, and operation. The Green Guide for Healthcare (2006) identifies opportunities to enhance environmental performance in the following domains: site selection, water conservation, energy efficiency, recycled and renewable materials, low-emitting materials, alternative transportation, daylighting (the use of natural light in a space to reduce electric lighting and energy costs), reduced waste generation, local and organic food use, and green cleaning materials. Some decisions, such as site selection, occur during the planning and construction phases; other decisions, such as food sourcing and cleaning practices, are primarily questions of operation after a building is completed. Commitments to energy conservation, renewable resource use, and similar principles must be made and reinforced throughout the life cycle of a facility, from building conception through operation and replacement.

At the IOM roundtable workshop, an even broader perspective emerged. Participants discussed “natural” features of buildings, such as daylighting, gardens, and nature views, some of which may offer health benefits. They discussed functional aspects of hospital design, such as legibility, coherence, and way-finding cues, which are used to orient oneself within the built environment and may ease and humanize the experience of being a visitor or patient. They discussed health-promoting design features and messages, such as attractive staircases that lure people from using elevators. Characteristics such as these, taken together



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