Report on the "Health Care Without Harm" Workshop

Ottawa,October 21st, 2000

This workshop was organized by CAPE with support primarily from Great Lakes United. Additional funding was received from Health Care Without Harm. A total of 27 people participated in the workshop, which also constituted the educational day for the Annual General Meeting of the Canadian Association of Physicians for the Environment.

In addition to members of CAPE, participants included representatives from a number of major national health care organizations including

• the Canadian Medical Association
• the Canadian Nurses Association
• the Canadian College of Health Service Executives
• the Canadian Public Health Association
• the Canadian Pediatrics Society
• the Canadian Institute for Child Health

Although unable to attend because of a conflicting board meeting, the Canadian Health Care Association (formerly the Canadian Hospital Association) also expressed strong interest in being involved in on-going developments.

In addition to these major national health care organizations, representatives from a number of major environmental organizations also participated, including

• Pollution Probe
• the Canadian Centre for Pollution Prevention
• the Toronto Environmental Alliance/Health Care Without Harm

The workshop began with an overview of the environmental impact of health care by Dr. Trevor Hancock, Chair of the Board of CAPE; an overview of healthcare wastes by Chris Wolnik, Senior Advisor at the Canadian Centre for Pollution Prevention; and a brief discussion of dioxins by Rich Whate (Health Care Without Harm) and Bruce Lourie (Pollution Probe).

Following a coffee break, four presentations were made on ways to reduce health care’s environmental impact. These included energy efficiency (Kent Waddington, Coordinator of the Energy Innovators Program (the Canadian College of Health Services Executives), pollution prevention (Chris Wolnik), mercury reduction (Leah Halgreen and Bruce Lourie, Pollution Probe), PVC alternatives (Rich Whate) and the greening of health care (Dr. Trevor Hancock).

Following lunch, two concurrent workshops were held. Both workshops included a discussion of the issue and suggestions for further action. The dioxin and mercury reduction workshop stressed the importance of creating information packages for dioxin and mercury reduction that were distilled to the essence of the issues, tailored to the audiences (physicians, surgeons, nurses, administrators, etc.), linked to websites and provided concrete examples through case studies and best practices. A "ten steps to a PVC- and mercury-free hospital" approach was recommended. The participants also stressed the importance of information systems that could monitor and show the reductions in mercury and PVC use. The group also suggested the establishment of a steering committee to further pursue this project, while recognizing that funding was required for this.

The second work group, which addressed energy efficiency and pollution prevention, suggested a number of strategies including

• education and awareness at a national level, targeted to specific groups (eg., physicians, nurses, boards, managers, etc.) based on what interests them. Posters were suggested as a possible component of this approach.
• the importance of directives from the top level (CEO, Board of Directors, Public Health Unit, City Council, etc.) to confer both importance and legitimacy to the task of improving energy efficiency and preventing pollution.
• performance measures or some form of scorecard that would enable people to monitor progress. These performance measures should stress the financial benefits of energy efficiency and pollution prevention.
• education of service providers such as pesticide applicators about the correct use of pesticides and the need to find suitable alternatives.
• the use of existing federal and/or provincial mechanisms to promote this agenda within the health care system. Mechanisms such as Health Canada’s sustainable development strategy or the Ontario Ministry of Health’s "Statement of Environmental Values" (required under the Environmental Bill of Rights) were pointed out.
• the establishment of a national "Green Health Care" award was suggested.
• an effort should be made to persuade the Canadian Council for Health Services Accreditation to include environmentally-responsible management as part of the criteria for accreditation. Hospitals might be required to meet ISO-14000 standards, have an environmental management system in place and have mechanisms of accountability for monitoring their environmental performance.

Following reports back from each of the two work groups, the workshop concluded with a discussion of next steps. It was agreed that a key strategy was to establish a National Coalition on Green Health Care and the participants, including those from major national health care organizations and national environmental groups, agreed that they would participate in the development of such a coalition. Other key participants were identified who should be approached to become part of the initial start-up group for the National Coalition. These include the Canadian Health Care Association, the College of Family Physicians of Canada and the Canadian Healthcare Engineering Society.

A discussion of priority tasks for such a Coalition included the following:

1. consciousness raising in the health care system
2. the inclusion of the environment in all health care decision making
3. Including environmentally-responsible management in the accreditation process
4. a campaign to eliminate dioxin and mercury pollution
5. a campaign to have the health care sector meet the Kyoto targets for greenhouse gas emission reductions.

Other possible tasks for the Coalition include

• making presentations or conducting seminars or workshops at all major national health care conferences
• putting up displays or exhibits (possibly shared by multiple Coalition members) at all major national health care conferences
• doing the same at as many provincial health care conferences as possible
• promoting research on the environmental impacts of health care
• establishing a "Green Health Care" award
• working with/on Health Canada, Environment Canada, provincial Ministries of Health and provincial Ministries of Environment to encourage the development and implementation of policies requiring environmentally-responsible management.

Finally, participants suggested a number of more immediate tasks that need to be undertaken to get the Coalition up and running. These include

• obtain formal commitment from the potential member organizations present at the workshop to participate in a National Coalition
• develop a vision, mission, objectives, etc.
• seek funding (almost certainly, project funding) to enable the Coalition to develop and undertake some of the activities listed here. Potential funders include Health Care Without Harm, the Laidlaw Foundation, medical and health care foundations (CMA, PSI, HSC), Environment Canada, Health Canada and Natural Resources Canada.
• one immediate task is to establish a list serve (and later a website) to enable participants to be in touch with each other. The Canadian Centre for Pollution Prevention, which manages the Health Care Enviro Net, will look at establishing this list serve.

A number of other groups and organizations were suggested as future coalition members, including:

• Canadian Council for Health Services Accreditation
• Canadian Federation of Nurses Unions
• EcoLogo Program
• Canadian Standards Association
• Québec organizations
• Health Canada
• Environment Canada
• Natural Resources Canada
• Medical supply industry
• Pharmaceutical industry
• Waste management industry

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