In Search of Sustainable Products

Published: 11/01/2018 - 16:15
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By John Strong Principal of John Strong, LLC and serves as president of Greenhealth Management

As you shake the sleep off, you realize that the sounds of your 12-year-old daughter’s latest asthma attack woke you. You determine immediately that this is going to require another trip to your local health care provider’s emergency room. When you pull up to the door of the emergency room, housed in a brand-new facility built by the largest integrator of care in your state, you feel palpable relief. There’s no wait—and soon a physician, nurses and others have her situation under control.

No one — neither you nor the healthcare professionals treating your daughter — realizes that this modern emergency room was made with construction materials and furnished with products that contain chemicals known to cause asthma, cancer or reproductive harm. The carpets contain stain-resistance chemicals called perfluorinated compounds (PFCs) that can impair the development of children1, while the flooring adhesives contain Toluene Diisocyanate (TDI), a known trigger for asthma that is linked to lung damage.2 In fact, a study of asthma cases by occupation in the British medical journal The Lancet found that nurses and healthcare facility cleaning staff had the highest rates of asthma of all occupations studied both inside and outside health care.3

Is it possible that the same patient health issues we are treating in our facilities are linked to the construction materials we use to build them and the supplies we purchase for our daily operations? Unfortunately, the answer is yes. That’s why Practice Greenhealth and its sister organization, Health Care Without Harm, created Greenhealth Exchange (GX), a green purchasing organization designed by and for healthcare facilities.

You may be thinking that you don’t have the time or expertise to specify, and ultimately procure, sustainable products for your facility. Staff time is at a premium these days. The Greenhealth Exchange can help your health care facility easily access environmentally preferable products at discounted prices by aggregating the purchasing power of several hospital systems that are committed to purchasing products that meet high sustainability standards.

Greenhealth Exchange was launched on May 16, 2016, at Health Care Without Harm’s annual CleanMed conference in Dallas. It is a Public Benefit Corporation (“B” Corp) being operated as a for-profit cooperative. A “B” Corp is an IRS special-designation organization that requires its board to take an extra measure of fiduciary responsibility, including making decisions based on the welfare of the staff, the customers they serve and the environment. Additionally, the corporation must operate in a highly transparent fashion, and produce an annual public benefit report.

To date, six of the nation’s environmentally leading healthcare systems and Practice Greenhealth have joined GX as “members” (owners). GX is actively seeking other health systems to become founding owners of the effort to more rapidly and completely green the supply chain.

GX is not designed to replace or challenge any health system’s use of their national group purchasing organization. That said, we are pursuing contracts with suppliers of green products, which members can take advantage of. Currently, GX is accepting Member Patron applications. There is a one-time capitalization fee of $150,000 to join, but Member Patrons can sponsor and add an unlimited number of affiliates to the program, and presently receive a seat on the board of directors, the contracting committee and each product sub-committee. Owners and Members have access to the information around a GX contracted product’s sustainability attributes as well as the pricing and terms associated with the contracts.

GX is creating a product catalog that is vetted to the sustainability standards GX, our industry experts and members establish as our requirement for “green”. It will include a wide array of goods that are highly energy-efficient, that have a high percentage of recycled content, and that are devoid of toxic chemicals of concern.

GX is evaluating the sustainability attributes of each supplier’s products as well as the merits of their sustainability programs, including the ability to offer resource- and fuel-efficient packaging and shipping services as well as product takeback and recycling programs.

GX will help purchasers measure the impact they are having through the elimination of chemicals of concern, the reduction of energy and greenhouse gas emissions, that the use of the catalog provides, and report them as public benefits.

Meaningful evaluation of products and the establishment of detailed metrics to measure results takes a team of people with a wide variety of interests and talent. To accomplish this, GX is engaging more than 60 subject-matter experts from Healthcare Without Harm and Practice Greenhealth as well as more than 40 seasoned purchasing agents and sustainability staff from our members. In addition, GX has retained several outside specialists to help inform its work. This includes highly respected environmental organizations such as the Responsible Purchasing Network and the Healthy Building Network.

One of the first medical product areas on which GX is focusing are systems to “scavenge”, or  collect and remove harmful vented gases in the OR. “Most anesthetic gases—including N20 and halogenated inhalation gases—employed in hospital operating rooms are permitted to escape to the atmosphere during use, a serious problem considering that these gases are extremely potent greenhouse gasses (especially the halogenated gases); some have a global warming impact 1,900 times that of C02. Capturing and recycling these gases reduces these emissions.11

Another product area being explored are disposable food service ware products, which includes plates and bowls made from sugarcane, wheat straw and other agricultural waste products. While these products are certified as compostable, the GX team discovered that unacceptable additives were typically added to the “slurry” before it is molded into food service ware products. With help from the Green Science Policy Institute and a lab at Hope College in Michigan, GX had several products tested to confirm whether they contain concentrated amounts of fluorine, which points to the use of PFCs. Perfluorinated compounds are used to make many food service ware products resistant to grease. These chemical additives, which are similar to chemicals often found in non-stick cookware, are highly persistent and have been linked to reproductive harm in developing fetuses, infants and children.9

There is a pervasive feeling in health care that green and sustainable products need to cost more. We believe just the opposite: By effectively aggregating their volume and contracting for better products, we can actually bring the price down below those of less-desirable products and those manufactured with chemicals of concern.

Over the past 20 years, HCWH and Practice Greenhealth have made tremendous strides in telling the story of healthcare’s impact on the health of patients, visitors, and staff—as well as offering solutions. Yet, as Gary Cohen – founder and president of Healthcare Without Harm and Practice Greenhealth – says, “We’re just getting started.” The mission of GX is to create an ecologically sustainable, equitable and healthy world by accelerating the adoption and use of safer, greener products by leading healthcare systems; catalyzing innovation in next-generation product development, and inspiring similar action in other sectors.

Healthcare providers and suppliers can learn more by registering on the GX website:

John Strong is a principal of John Strong, LLC and serves as president of Greenhealth Management, a limited liability company owned by Practice Greenhealth designed to operate GX. You can reach him at



1”Chemicals of Concern Identified by the U. S. EPA at http://safer


3Lancet. “Exposures to substances in the workplace and new-onset asthma: an international prospective population-based study (ECRHS-II). July 28, 2007; 370: 336-41. Available at


5Wolff, Jessica and Sheehan, Kaleigh, ”A Greener Operating Room”, blog at

6U.S. Department of Energy: 2003 Commercial Building Energy Consumption Survey

7Wharton School of Business of the University of Pennsylvania, “Greener Hospitals: Building Consensus for Health Care Sustainability”, February, 2015

8Cited in Rossi, Mark, PhD and Lent, Tom: “Creating Safe and Healthy Spaces: Selecting Materials that Support Healing” by The Center for Health Design, September, 2006

9McMichael, Anthony, et. al., “Climate change and human health: present and future risks” at www.the 11, 2006

10ILO: The Institute for Innovation in Large Organizations: “The Business Case for Green Healthcare Facilities”, January 10, 2008

11Health Care Without Harm and Practice Greenhealth: “Addressing Climate Change in the Health Care Setting”

Healthcare’s impact on the environment (percent of total U.S.)

  • Energy consumption: 10 percent of U.S. consumption annually, and twice as much as traditional office space6
  • Waste generation: 5.9 million tons annually
  • Greenhouse gas emissions: 8 percent annually

Greenhealth Exchange Owners

Dartmouth-Hitchcock Health System, Lebanon, NH

Dignity Health, San Francisco, CA

Gundersen Health, LaCrosse, WI

Marshfield Clinic Health System, Marshfield, WI

Partners HealthCare, Boston, MA

Practice Greenhealth, Reston, VA

University of Vermont Health Network, Burlington, VT

Virginia Mason Hospital & Seattle Medical Center, Seattle, WA 

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