Turning Healthcare Green: A Case for Sustainable Healthcare
Greg L. Roberts, AIA, CSI, CSS, ACHA Watkins Hamilton Ross Architects, Inc.

Toxic mold, high-energy costs, rolling blackouts, global warming, nursing shortages, poor air quality...the headlines of today are all issues that can be addressed through sustainability or green design. Sustainability, as defined in 1987 by the United Nations World Commission on Environment and Development, is "development that meets the needs of present generations without compromising the ability of future generations to meet their own needs." This is a definition that easily equates with the credo of every healthcare professional, primum non nocere: First, Do No Harm.

The holistic framework of sustainability took root in Sweden in 1989 when Dr. Karl-Henrik Robèrt, an oncologist who noticed a significant increase in childhood leukemia cases and the connection between human illness and toxins. On a cellular level, he observed that there are limits within which a living cell will properly function. He was concerned that so much of the environmental debate was focused on downstream issues and so little on systemic causes of problems. With the help of 50 Swedish scientists, Robèrt developed a consensus document that describes the basic knowledge of the biosphere's functions, how society influences natural systems, humans as a part of natural systems, how humans are threatening themselves by deteriorating natural functions, and the many possibilities to change the situation. In the early 1990s, Robèrt worked with Swedish physicist John Holmberg to define a set of system conditions for sustainability that are based on laws of thermodynamics and natural cycles. Together, the ideas behind the consensus document and the four system conditions are the foundation of The Natural Step, which has become the backbone for building an ecologically and economically sustainable society.

The value of sustainability has been recognized by governments, academic institutions, and a growing number of corporations and commercial developers. Healthcare, on the other hand, has been slow to realize its rewards. While the industry has made considerable strides on the operational side through energy-efficient operation and the improved handling and reduction of solid waste, these account for only a portion of the benefits that can be achieved from a holistic approach to the design, construction, and commissioning process.

In 2000, $19.67 billion was spent on healthcare construction. While healthcare buildings are among the least prevalent commercial building types--105,000 by the EPA's estimate--they are the fourth highest consumer of energy for all building types. At 561 trillion BTUs, they account for 11% of all commercial consumption. The healthcare industry also contributes 5 million tons of solid waste annually to the nation's landfills. Nationally, the healthcare industry employs 4.5 million workers, accounting for 6% of the total commercial workforce. National health expenditures account for 13.4% of the gross domestic product and 31.8 million people (inpatients) were discharged from the nation's hospitals in 1998.