Hospitals can do more for their communities’ environmental health

This is a guest column by Dr. David A. Paul. He is the chair of the Department of Pediatrics, ChristianaCare, Newark, Del., and professor of pediatrics at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia

From its origins in the Catskill Mountains, the Delaware River flows through many urban, rural and suburban areas surrounded by large and well-known healthcare systems. 

Most people think of a hospital as a place to go when needing emergency care, surgery or an overnight stay for an illness that can’t be managed at home.

Hospitals certainly play an important role in providing this level of care but also function as important community anchor institutions. Many hospital systems in the Delaware Valley are starting to focus on health, including the social determinants of health, and not just the delivery of healthcare. 

Over the past several years, nonprofit hospitals have been incentivized to pay more attention to environmental issues to meet their requirements for community benefit and utilize resources in a more sustainable way. 

Under the Affordable Care Act, nonprofit healthcare systems are required to perform a Community Health Needs Assessment at least once every three years and develop strategies to meet these needs, including investing in the communities that they serve. 

Community expenditures can be wide-ranging, including financial assistance of the uninsured, support of community programs and expenditures on environmental improvements. 

Over the past decade, it has become recognized that most of the factors that influence health occur outside of the walls of the hospital. The phrase “ZIP code over genetic code” is frequently used to express the myriad ways in which the environment of a community or neighborhood strongly influences health. 

These social determinants of health, including housing, education, transportation, the built environment, along with environmental issues, play a dominant role throughout the life course in influencing health and well-being.  

The infant mortality rate in the United States is higher than many developed countries and characterized by marked racial disparities with Black babies being 2-3x more likely to die before their first birthday compared to white babies. 

People of Black race and those of Hispanic ethnicity are more likely to reside in counties unable to meet air quality standards for particulate matter and ozone compared to those who are white. 

Higher concentrations of carbon monoxide, nitrogen dioxides and particulate matter are associated with increased risks of premature birth and low birthweight births. Increased contamination of water with cadmium, lead, trihalomethane and other substances has been associated with an increased risk of hypertensive disorders of pregnancy which is a leading cause of premature birth. 

Hospital systems have a growing appreciation for the need to invest in communities.

As the focus has turned to improving the social determinants of health, most hospital systems have leaned toward working on issues such as housing and food security with less emphasis on environmental issues including environmental justice.

There are a few examples of hospitals focusing on environmental issues that may serve as a template for Delaware Valley systems to emulate.

Kaiser Permanente has worked on a sustainable food project to combat obesity and climate change. Cleveland Clinic has also supported the growth of locally sustainable food and solar energy. Gunderson Health System in Wisconsin helped to create an unused medication collection program to reduce drinking water contamination. Finally, Hurley Medical Center in Flint, Mich., developed numerous initiatives to mitigate the effects of the well-known concerns for lead contamination of the drinking water in that community. 

Community benefit funding is not the only ways in which hospital systems are focusing on the environment and developing sustainable practices.

Many large hospitals serve as the largest employer in a community and often require high energy utilization to run daily operations. Large hospitals systems throughout the country and region are working to decrease waste, purchase electric vehicles as part of their vehicle fleet, grow their own produce, and increase recycling of hospital waste. 

Given the fact that healthcare is responsible for 17 percent of the U.S. GDP, such programs have the potential to meaningfully contribute to our country’s efforts to combat climate change.