Health Care

Blog | Do Hospitals Do More Harm than Good?

Blog post written by Luqman Yesufu; GGHH Campaign Manager, Membership Outreach and Engagement in Africa; groundWork

Posted on: groundWork

The members of the Global Green and Healthy Hospital network aim to ensure that they do no harm while providing health services.

The prevention of illness, injury and disease is an essential part of healthcare. We engage in healthy life style habits such as exercising and not smoking to prevent obesity and lung cancer. We vaccinate our children regularly to stimulate immunity and thus protect them from disease. We educate young boys and girls in order to promote safe sex and thus prevent the spread of HIV and AIDS and other sexually transmitted infections. On the basis of this, there is remarkable evidence to show that prevention works better than treating a disease. If this is the case, the health care sector must lead by example by engaging in more sustainable practices that are aimed at preventing disease and promoting good health without compromising patient care and safety.

Hospitals produce enormous amounts of waste, but only a small portion (about 15%) is actually infectious or poses high risk; 75% – 85% of the waste is categorized as normal municipal waste which has low risk to ill health, except of course if it is burnt. This should be music to the ears of hospital administrators, especially as the bulk of the money spent on treatment and disposal of medical waste is actually spent on the infectious waste. So, since you produce less, you should spend less. Unfortunately this is not the case, as hospitals in South Africa pay over the odds to get their waste treated and disposed of. There are two main reason for this: poor leadership and poor waste management practices.

The acceptable form of treatment and disposal of medical waste in South Africa is to burn it using incineration. This often leads to toxic fumes being released into the atmosphere at concentrations that are harmful to health when inhaled. Often, the incinerators cannot deal with the amount of waste coming, so it is turned away at the gate if it cannot be burnt immediately. Which is how it ends up in a residential area – as in the case of Roodepoort – or on the beach front – as in the case of Durban. The recent discovery of tons of medical waste, packed floor to ceiling in a suburban west Johannesburg house, as well as the tons of medical waste spread across Durban beach last year, has drawn attention to the problems experienced in the disposal of this waste stream. Hospital management needs to take up leadership responsibilities to ensure that waste is properly segregated to ensure that what gets to the incinerator is actually very little.

Those charged with the responsibility to ensure hospital waste is managed properly are the health care waste officers. They are not only trained in managing hospital waste but they are even mentioned in the Health Care Waste Regulations as ”A health officer who is registered and qualified as an environmental health practitioner”. This group of professionals needs to be supported by hospital management so that they can do exactly what they are trained to do, which is ensure that health care waste is managed in such a way that it does not cause harm to the patient, staff and the community.

The idea of prevention of injury and disease is a key reason why health care waste management should be a priority in health care institutions. We don’t want to cause harm to a person in the name of providing care. In fact, it should be considered a violation of a person’s human right and a crime against humanity if the public is still exposed to infectious or hazardous waste from hospitals. Hospital management therefore needs to take more responsible and sustainable actions in dealing with their waste and the people responsible should be given the proper mandate and support to do this.

Just some of the Global Green and Health Hospitals heroes doing amazing work to make their health facilities sustainable, gathered in Pietermaritzburg during groundWork’s community planning meeting. Credit: groundWork

We recently sat down with *Dineo to discuss some of the issues and challenges faced by health facilitators. This is what was discussed:

Luqman: What is your role as a health facilitator and what are the challenges that limit you from adequately doing your job.

Dineo: My role is to develop waste management policies, train the staff and advise management on how to improve our waste systems, better the environment and protect the public. I also do inspections to find out about the hazardous tools we use and I develop corrective action plans. The challenges I face include staff. I was just recently employed and I have no staff to train. If I want to implement a recycling project, I can have all the ideas, identify proper disposal areas and find boxes, but there’s no one here to actually do the proper separation and disposal. I feel there is also lack of support from management. Maybe it’s because they don’t really understand my role, the post is fairly new, maybe it wasn’t introduced to them properly. You find that your immediate supervisor is supporting you, but when you get to finance managers or CEOs, your plans get turned down. They feel support components are not that important.

Luqman: How do you overcome these challenges?

Dineo: Trying to get through to management is very difficult. You can only write reports, invite them to meetings and try to communicate with them, but changing their minds is up to them. I just keep writing to them, expressing the challenges that I am facing and recommending that they give me a team to work with. When the feedback is negative, everything comes to a standstill. At some point, you have to go out yourself, because you see that your duties aren’t being carried out. I end up going out to the garden services people, who are contractors and not directly employed by the facility. I ask them to do collections for me. I give them small incentives for this work, like buying them cool drinks or cigarettes. Clinical orderlies are supposed to be doing this job in the interim: this was the decision taken by management. But they don’t see waste management and collection as their duty. So they feel like they are doing it as a favour to me. If one person doesn’t feel like collecting or transporting the waste that day, they don’t do it.

Luqman: Why is it problematic for the garden services people to be doing this job?

Dineo: I think it’s problematic because they are contracted to do other work. They might not be immunized, they are not given proper Personal Protective Equipment (PPE) to do such duties. It’s just not the right thing to do. You have not protected the people but have asked them to do dangerous work. They are also not trained to do this job. I have trained them on a basic level, but I still have fears because they aren’t mandated to do this work. But dangerous medical waste would pile up everywhere if I didn’t have their assistance.

Luqman: Why is it important for there to be better waste management facilities in hospitals?

Dineo: People don’t see the value because it’s things we don’t see with our eyes. People don’t understand that waste can make us sick. The waste generated from health institutions is full of bacteria, bodily fluids, blood; there’s a lot of infected people with HIV or TB. If we don’t manage this waste properly, any person can come and touch this waste and infect themselves. There’s a risk of health workers being infected and there’s also issues of cross contamination. The waste sometimes ends up in general waste and this increases the possibilities of needle prick injuries. Again, we’re trying to look after the environment. We don’t want to pollute the environment, the ground water. We don’t want our waste ending up in our communities and affecting our children and the public. These days you find children playing in dump sites. They might come across needles. If we don’t take care of our needles, our children will play with them and infect each other. Even the workers and the patients here have to be protected. We are also trying to decrease the spread of infectious diseases and the mortality rate.

Luqman: How many needle prick accidents have you had as a result of poor waste disposal?

Dineo: In our hospital, we have near misses. Sometimes when the needle buckets are full, the nurses will remove them from their work-spaces and place them in the passage way. Sometimes you find no one is collecting in the passage; maybe I’m not at work or I’m attending a meeting. Our institutions also have kids. Sometimes you find that they come and fiddle with the needles. Sometimes we find needles in the general waste, but so far we haven’t had any injuries. On average we have about two near misses a month. Last year we had more staff to deal with collection, but we’ve lost those staff members, so the number of near-misses is rising. The near misses are usually reported by the cleaners. Sometimes they find a needle on the floor while they are cleaning. Other times we catch kids while they are playing with medical waste.

Luqman: What would you like to see done differently

Dineo: It would be nice to have waste handlers in our structures and to work with management that understands the importance of waste management. We don’t have people who can be our power when it comes to operations. We have a well-structured waste area but it is not overseen by anyone. It’s not being cleaned. *The name of the health officer has been changed, to protect the identity of the individual

*The name of the health officer has been changed, to protect the identity of the individual

April 10, 2017Global

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Peter Orris Receives Lifetime Achievement Award for Excellence in Global Health

We are proud to announce that Dr. Peter Orris, Senior Adviser to HCWH, has received the Lifetime Achievement Award for Excellence in Global Health by the World Federation of Public Health Associations (WFPHA) during the 15th World Congress on Public Health that took place in Melbourne, Australia, from April 3-7, 2017. This award was given in recognition of Dr. Orris’ work in the context of the WFPHA’s Environmental Health Working Group and in campaigns to improve environmental health.

Dr. Orris, MD, MPH, is a Professor and Chief of Service at the Occupational Health Service Institute within the University of Illinois Hospital and Health Sciences System. The strategic work of Dr. Orris with the WFPHA, the World Medical Association, the World Health Organization and other organizations has been critical to the worldwide environmental health movement.

Dr. Orris has also been a major force for linking the practice of medicine with human rights, equality, occupational safety and environmental sustainability. He was one of HCWH’s founders in 1996 and has advised communities all over the world on the dangers of incineration and other toxic chemical exposures. As one of the leaders in Health Care Without Harm, Dr. Orris attended every negotiating session of the Minamata Treaty on Mercury. He was the critical clinical voice in the negotiations to inform governments about the dangers of mercury, the availability of safer measuring devices, and the momentum of the healthcare sector in eliminating mercury from their facilities. As a result of his advocacy with HCWH staff and allies around the world, the Minamata Treaty contains a provision for the global phase out of mercury based measuring devices by the year 2020.

Read Dr. Orris’ acceptance speech at the 15th World Congress on Public Health.


April 7, 2017Global

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Brazil | Ban of the Sale of Mercury Thermometers

The National Health Surveillance Agency of Brazil (ANVISA) approved, on March 7, 2017, a resolution that bans the sale of mercury thermometers and blood pressure measurement devices that contain mercury.

This measurement will start in 2019, one year prior to the date identified in the Minamata Convention on Mercury, in which 140 countries committed to eliminate the mercury from all medical instruments by 2020. With this resolution, Brazil becomes an example for the entire region.

To read the official resolution (in Portuguese), click here.

For more information on the effects of mercury in health care, click here.

March 28, 2017Global

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Brazil | Ban of the Mercury Containing Medical Devices

In March of 2017, Brazil took an integral and important step towards mercury free health care. A new resolution, published by the National Health Surveillance Agency of Brazil, effectively bans the fabrication, importation, and sale of mercury based thermometers and blood pressure measurement devices in the country as of 1 January 2019.

This resolution demonstrates the commitment of Brazil to the Minamata Convention, a global agreement signed by 140 countries to phase out mercury containing products by 2020.

Proyecto Hospitais Saudáveis, HCWH’s strategic partner in Brazil, has been working towards the ban of mercury since 2008 through the campaign "MercuryFree Healthcare." Created by Health Care Without Harm and the World Health Organization (WHO), this campaign aimed to eliminate the use of mercury containing medical devices and replace them with safe, precise, and affordable alternatives.

For more information (in Portuguese), click here.

March 28, 2017Global

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Interview with Gary Cohen: Global Warming is a Public Health Nightmare

Source: The Real News

Kim Brown from the Real News Network, in Baltimore, interviewed Gary Cohen (HCWH's President and Founder) to discuss the role the healthcare sector can play, in not only mitigating the health impacts from climate change, but also helping communities to adapt to a warmer world.

"At a broad level, the kind of changes that we're seeing, as a result of climate change, will have profound negative impacts on everybody on the planet. We've never really faced, as a global civilization, this level of public health threat. The Lancet, commissioned in the UK, which is a very prominent health journal, has called climate change the greatest public health threat of the 21st century," says Cohen.

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March 6, 2017Global

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India | Health Sector Leaders Launch the Health and Environment Leadership Platform

Call for Urgent Action on Air Pollution

3rd February, 2017, Gurgaon

Representatives of more than 5000 healthcare institutions and several thousand healthcare professionals around the country that form the Health and Environment Leadership Platform (HELP) released a joint statement today calling for concerted action to reduce air pollution in India.

The statement called on "all relevant stakeholders to take immediate and sustainable action to improve India’s air quality and ameliorate its impacts on health". The statement also noted that "if India is to realize the value of its demographic dividend, it will need to tackle the growing menace of air pollution, a task in which the health sector stands ready to assist".

The Health and Environment Leadership Platform was also formally launched today by the Public Health Foundation of India (PHFI) in partnership with Health Care Without Harm (HCWH). The platform aims to bring together health sector leaders to voice their concern and show leadership on the impact of environmental risk factors for ill health. Recognising that environmental degradation threatens to slow or reverse the progress the public health community has made against many diseases in a developing country like India, HELP will aim to:

  1. Advocate for the importance of inter-sectoral, collaborative policymaking to address the health impacts of environmental pollution
  2. Showcasing Leadership in health systems by reducing their environmental and energy burden
  3. Build Capacity of physicians on the health impacts of environmental pollution

Members also agreed that it was imperative to work on capacity building of the health sector on environmental exposures, expand awareness among medical professionals on what constitutes sustainable health institutions, and work to engage on a sustained basis with the general public on environmental exposures and health impacts.

Prof. K. Srinath Reddy (President, PHFI) stated "Health and environment are co-dependant. Just as environmental degradation harms health in many ways, the health sector too contributes to environmental pollution and climate change through its practices. A common platform linking health professionals and environmental guardians will help to adopt a common agenda, align agents of change, amplify advocacy, and accelerate action".

"Environment and health are very closely related, and each has a substantial impact on the other. I’m glad that the Public Health Foundation of India has taken up this important initiative in this crucial area, and I look forward to making progress on this key determinant for health", said Dr. Alexander Thomas, Executive Director – Association of Healthcare Providers of India, and the first elected Chairperson of the platform.

Josh Karliner (International Director of Program and Strategy, HCWH) noted that "By establishing HELP, India's health sector is joining tens of thousands of hospitals, health systems and health organizations around the world committed to reducing their own environmental footprint and leading society toward a greener, healthier future."

  1. The platform Steering Committee consists of eminent leaders from various organizations including: Health Professional Bodies – Indian Academy of Paediatrics (IAP) and National Neonatology Forum of India (NNF), Delhi Medical Association (DMA)
  2. Healthcare Associations – Association of Healthcare Providers of India (AHPI), Healthcare Federation of India (NATHEALTH), and Catholic Health Association of India (CHAI)
  3. Healthcare Accreditation Bodies – National Board of Examinations (NBE) and National Accreditation Board for Hospitals and Healthcare Institutions (NABH)
  4. Private organizations – Apollo Hospitals, Dr. Lal Path Labs, SRL Diagnostics Ltd., PSG Institute of Medical Sciences

The Centre for Environmental Health at the Public Health Foundation of India will host the secretariat for the Platform.


India's Environmental Health Burden India’s remarkable growth story of the last 30 years has resulted in sustained economic expansion, but has also resulted in a dwindling and degraded ecosystem, and a growing cloud of pollution. Environmental pollution (unclean air, water and chemical contamination) contribute significantly to India’s burden of disease, and rank among the top risk factors for ill health. The growing threat of climate change with changing disease patterns and increased risk of natural disasters has only added to the urgency of tackling these important determinants of health.

How does the Health sector contribute to this?

India’s healthcare carbon footprint is not clearly marked or defined, but we know it is substantial. The requirement for consistent and reliable energy, clean water and its large waste generation capacity means that the health sector bears a considerable environmental footprint. With its poor grid connectivity and frequent power cuts, the proliferation of diesel use in the health sector has been phenomenal, with rural areas suffering from a lack of connectivity altogether. With the annual energy consumption per bed in a Multi-specialty hospital bring almost 14,000 kWh per year, the need to examine energy use as well as other aspects including waste management, and water use at an institutional level. At a sectoral level, the increased burden of disease necessitates the capacity building of physicians to address these exposures.

Why the Health sector needs to show Leadership

Health care practitioners worldwide made a pledge to “First, do no harm,” as articulated in the millennia-old Hippocratic Oath. With the growing threat of environmental exposures to human health, health care practitioners need to take a firm stand on the causes behind these exposures and in articulating the path to addressing them in a sustainable manner. Because of its size and influence, the health sector can play a unique leadership role in mitigating and educating the general public on the consequences of environmental degradation. The health care sector is well-positioned to "lead by example" in terms of reducing its environmental footprint, and by demonstrating how mitigation can yield tangible, immediate health benefits.


For further information on the platform please contact Bhargav Krishna (+91 99585 82769) and Shriram Manogaran (+91 8588844365) or write to [email protected]

February 3, 2017Global

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HCWH, China Health Ministry Research Center, UK Organization Sign Green Hospital Pact

On January 17, 2017, as Chinese new year is approaching, an "International Symposium on Developing Green Health Care System and Facilitating the Implementation of Healthy China Strategy" was held in Beijing, China by the China National Health Development Research Center (NHDRC), which showcased a multilateral and cross-sector dedication to green health care system development in China. Health leaders from China, the U.S, Korea and UK got together to share research and practical experience on green hospitals and health management. As a milestone of the three parties' cooperation, NHDRC, HCWH and SDU International have signed a Memorandum of Understanding for an International Collaboration to build a green health care system in China at the conference.

Since 2015, NHDRC has been conducting a project entitled “Strategic Research on the Construction and Development of Green Heath and Care System” in partnership with the British Embassy’s China Prosperity Fund, England’s Sustainable Development Unit for the health and care sector and HCWH. The project aims to establishing China’s green health care system framework and laying the groundwork for piloting and scaling up this approach. On the basis of previous cooperation, the three parties signed a long-term cooperation plan from 2016 to 2021, continuously promoting the development of China's green health care system through activities such as research, piloting and exchanging.

In addition to presentations from HCWH and SDU International, representatives of GGHH members, Kaiser Permanente (USA), Yonsei University Health System (South Korea) and Gundersen Health System (USA) were invited to present at the conference, sharing experience on integrating sustainability into hospital and health management. Leaders from China National Health and Family Planning Commission and local health departments have also introduced China’s policies and practices on green health care development. The conference not only brought together leaders in the field of health, but also invited leaders and experts from Department of Climate Change, National Development and Reform Commission and Ministry of Environmental Protection, to introduce international climate change negotiations and China's low-carbon development strategy, as well as China's environmental health problems and countermeasures.

Sonia Roschnik, Sustainable Development Unit of NHS England and Public Health, United Kingdom; Fu Wei, Director of NHDRC, China; and Josh Karliner, International Director of Program and Strategy, Health Care Without Harm signed a Memorandum of Understanding for an International Collaboration to build a green health care system in China at the conference. For more photos of the event, visit the image gallery.

Environment is a key health influencing factor and health sector will benefit from the collaboration and integration of its core function with sustainable environmental development. Health sector can contribute to this integration by reducing its environmental impacts and stimulating green transformation of its upstream industries. Building green and sustainable health care system will also bring important opportunities for China to cope with climate change, and contribute to the realization of a number of sustainable development goals.

"A green health care system should recognize the connection between human health and environment, and demonstrate that understanding through its governance, strategy and operations." said by Josh Karliner, International Director of Program and Strategy, Health Care Without Harm. FU Wei, Director of NHDRC said, "The development of health care system should be compatible with social environment and development goals. Green and sustainable health care system is an indispensable element for the construction of Healthy China".

The conference provided an opportunity for summarizing the previous efforts and achievements. It also marks the start of a new step for the partnership of NHDRC, HCWH and SDU International. The three parties have begun to develop the details of their strategic plan, and are expecting a robust implementation in the year of the rooster.

Visit the image gallery of the event

January 26, 2017Global

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Blog | Redefining Safer Chemical Procurement for Global Development

Blog post written by Susan Wilburn for United Nations Informal Interagency Task Team on Sustainable Procurement in the Health Sector (SPHS).

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Hazardous Chemicals of Concern List

Photo credit: SPHS

In 2007, recognizing the global environmental realities of the 21st century, United Nations (UN) Secretary General Ban Ki-moon called on all UN organizations to become climate neutral by 2020. One opportunity for reducing the carbon footprint of the UN itself is through procurement. The United Nations purchases billions of dollars’ worth of products every year for global health projects. A problem occurs when products procured to promote health and development have unintended consequences that contribute to disease and environmental degradation.

To achieve this goal, the UN Sustainable Procurement initiative provides guidance and tools to support green procurement by UN agencies. However, these recommendations do not apply to health products and services. To address this gap, five UN agencies came together to create an Informal Interagency Task Team on Sustainable Procurement in the Health Sector (SPHS). The SPHS brings together UN agencies and global health funding institutions to evaluate criteria for procurement to reduce greenhouse gases, conserve resources, select less toxic products and publish tools and resources.

As a partner in this effort, Health Care Without Harm (HCWH), an organization whose mission is to transform health care worldwide so that it reduces its environmental footprint, becomes a community anchor for sustainability and a leader in the global movement for environmental health; is working together with UNDP, who holds the secretariat for SPHS, to develop guidance for green procurement of the health products purchased for global health programs. Supported by the UN Foundation in collaboration with the Skoll Foundation for Social Entrepreneurs, a critical component of this partnership is to conduct research identifying a list of hazardous chemicals to be avoided in health products procured by the UN for global and national programs. In partnership with UNDP, HCWH conducted a systematic evidence review to identify chemicals of high concern to be eliminated or substituted with less toxic chemicals.

UNDP and HCWH are working together to support UN procurement officers by developing criteria to reduce the environmental footprint of the products that they purchase. In addition to the joint HCWH/UNDP publication of the list of chemicals of high concern, guidance documents and training programs are in development for UN and national procurement officers as well as for hospitals who are active in HCWH’s network of Global Green and Healthy Hospitals to further their understanding of how to implement sustainable procurement of health products and services. The systematic evidence review used to evaluate harmful chemicals can also form the basis for the development of evidence-based norms and standards.

This guidance will assist Member States of the United Nations in fulfilling their obligations to achieve the Sustainable Development Goals (SDGs) adopted in September 2015 by the UN General Assembly. Three of the 17 SDGs directly relate to the sustainable procurement project including: Good Health and Well-Being (Goal 3), Clean Water and Sanitation (Goal 6) and especially Responsible Consumption and Production (Goal 12) whose target 12.4 is: By 2020, achieve the environmentally sound management of chemicals and all wastes throughout their life cycle, in accordance with agreed international frameworks and significantly reduce their release to air, water and soil in order to minimize their adverse impacts on human health and the environment.

January 24, 2017Global

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