Five Questions with Gary Cohen, CEO of Health Care Without Harm

MacArthur Fellow Gary Cohen explains how the healthcare sector contributes to public environmental health hazards and what hospitals are doing about it.

Twenty years ago, Gary Cohen began to take action against a glaring contradiction: healthcare, an industry made up of professionals who have taken the Hippocratic oath to do no harm, was one of the biggest contributors to environmental pollution impacting the public’s health. This year, Cohen is the recipient of a MacArthur “Genius Grant” for his efforts to transform global healthcare into a leading sector for environmentally related health and sustainability.

Emerson Collective’s Lucas Oliver Oswald spoke with Cohen about how Health Care Without Harm is addressing a range of issues, from toxin contamination, climate change and inefficient energy use, to unsustainable, unhealthy hospital food.

Health Care Without Harm operates on a global scale. As part of the Global Green and Healthy Hospitals, Mohammed VI University Hospital plants trees in Marrakesh, Morocco.

How did Health Care Without Harm begin?

A few things happened at once. One is that in the mid-1990’s the emerging environmental health science was telling us that low dose exposure to toxic chemicals in the first thousand days of life could have a profound impact on a developing child’s health later in life; toxic chemical exposure was being linked to cancer, learning disabilities, reproductive toxicity, and neurological development.

At the same time, the Environmental Protection Agency was reporting that hospital waste incineration was the largest source of dioxin emissions in the United States and a significant source of mercury. Dioxins are a known carcinogen and linked to a whole set of negative health impacts — learning disabilities, brain damage, endometriosis, reproductive toxicity, infertility. It was the poster child chemical for these low dose exposures, it was ubiquitous, and it was present in children being born, even in mothers’ breast milk. The fact that healthcare — hospitals — were the largest source of dioxin emissions in the country was astounding. How are we going to support healthy people and healthy communities if the very sector of our society that’s committed to healing is itself one of the largest polluters?

So we said, “Okay, let’s partner with healthcare, let’s bring this latest science to them around toxic chemicals and health, climate change and health, food systems and health, and get them to clean up their facilities, their supply chain, and their energy use.”


A lot of your work addresses climate change. Can you explain how climate change and healthcare are linked?

The vast majority of the U.S. healthcare system is powered by fossil fuels. Hospital facilities are the second most energy intensive buildings in the economy. If U.S. hospitals were a country, they would have larger greenhouse gas emissions than the country of France.

The other huge area is the supply chain of goods and services. The production of many chemically intensive goods like pharmaceuticals, the transportation of products across the world, the waste created, the packaging; the footprint of the supply chain is 60% of healthcare’s total greenhouse gas emissions.

Fossil fuels are not only the leading driver of climate change but they are also killing us and massively contributing to chronic diseases. Indoor and outdoor air pollution kill twice as many people globally–7 million annually–than AIDs, TB and malaria combined.

Industrial food production is also a big contributor, especially meat. All the over consumption of meat, all the methane produced by the animals and the overall foot print of their production — all of that is adding to the Greenhouse gas emissions.

Solar arrays at the Kaiser Permanente Santa Clara Medical Center are part of a growing clean energy portfolio. Kaiser Permanente is adding 70 megawatts of onsite solar energy to its hospitals and other buildings in California. Combining exiting onsite solar arrays with wind and solar energy it purchases from offsite farms, Kaiser Permanente is one of the largest users of clean energy in the country.

Addressing these climate change drivers all have co-benefits though. Switching to clean renewable energy reduces air pollution and asthma. Moving toward local and sustainable food systems reduces food transportation emissions and increases access to healthy, local foods. Active transportation, bike trails, and hospitals subsidizing public transportation all increase physical activity and reduce transportation emissions, obesity, and diabetes.

The good news is that addressing climate change is actually going to be the greatest public health opportunity of the 21st century. It has these co-benefits and, might I add, provides millions of jobs!


You’ve scaled to become an incredibly broad organization, both geographically and in the diversity of things you are doing. How did you manage that growth?

The imperative to scale internationally was obvious to us from the beginning. Global toxic pollutants and climate change transcend all borders. Even if we closed all the medical waste incinerators down in the U.S. — there were 4,500 when we started, now there’s around 50 — but India and China build 1000 each, we would have failed in our mission. Transforming the mission of healthcare and transforming the economy require global movements.

In places like Europe we phased out mercury through policy at the European union level. In other places like Latin America, we started with one hospital, used it as leverage to onboard others, and replicated from there. Through that work we built partnerships with hospitals and healthcare networks. “Oh, this is great,” we thought. “We made this improvement around eliminating mercury, what’s next?” We started with mercury and wastes, but after that we laid out the next set of things they could do.


In what ways do you utilize data?

A few years ago we partnered with 12 large hospital systems to create an initiative called the Healthier Hospital Initiative. We picked six core sustainability strategies with very clear goals and metrics and then developed an agenda with them and offered it for free to every hospital in America. In the end 1,500 hospitals adopted it. The only thing we asked for in exchange was, “Give us data on your performance.”

We collect data on recycling rates, how much of their food is local and sustainable, energy efficiency, greenhouse gas reductions, to name a few, and then we use it in several ways.

One is to benchmark facilities against each other. “Hospital A has 70% energy efficiency, and this other hospital in your system has only 20%. What’s that about?” It allows executives to look inside their system, deal with variation, bring up the laggers, and also gets them to compete with other systems and hospitals.

Then we roll up the data across the whole sector. For example, we showed that 450 hospitals had diverted around 450,000 tons of waste from landfills in just three years with the Healthy Hospital Initiatives’ waste pledge. That’s a huge number, and it’s a signal to the companies that are supplying hospitals that they need to invest in R&D and the next generation of healthcare products that have a much better environmental footprint. We’re creating the demand for market shift and innovation.

The Kaiser Permanente Antelope Valley Medical Offices in Lancaster, Calif. are landscaped with native plants that require less water than traditional landscaping and regional materials, including boulders and decomposed granite sourced locally. The desert campus includes a public fitness garden, natural playground, and community amphitheater for educational events. The campus is designed to be a net-zero energy campus and is LEED Gold certified.

How are you using data to address the effects of climate change?

We’re also looking at government data bases around climate change and health: sea level rise, heat stress, spread of infectious disease, flooding potential. With this data, we can educate hospitals about the kinds of climate related health impacts they’re going to see in their patient populations and how to address them. We’re trying to incorporate the latest climate science into healthcare’s DNA as it starts to move upstream and address the populations they serve.

The Surgeon General, the World Health Organization, the Lancet Commission, they are all saying that climate change is the greatest public health threat of the 21st century, and if we don’t address it head on, climate change will undo 50 years of public health gains all around the world. Healthcare really needs to wake up and realize that of all the sectors of the economy, it has a central role to play in addressing climate change.

Health Care Without Harm stresses the importance of public outdoor spaces to its partners, which keeps communities active and healthy. Volunteers at Kaiser Permanente, one of HCWHs partners, weed and mulch at Oakland’s Mosswood Park, which is adjacent to the Kaiser Permanente Oakland Medical Center. The medical center plans to eventually connect the urban medical campus to the neighborhood park and nearby Glen Echo Creek, as well as restore basketball and tennis courts in the park and to build a new playground.

What’s Next?

  • Learn about HCWH’s presence at COP22 in Marrakech in this interview with Nick Thorp, Global Green and Healthy Hospitals (GGHH) Community Manager.
  • Watch the HCWH Sundance-supported short film Do No Harm.
  • Keep up with Environmental Health News at the HCWH blog.
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