Speaking of e-waste: Where gadgets go to die | The Economist

The U.S. and China produce more total e-waste than any other country, according to a new map that tracks e-waste around the world.


Difference engine: Where gadgets go to die | The Economist.

I happened to use the recycling of e-waste as an example in yesterday’s blog post (see: Just Read: Greening Health Care: How Hospitals Can Heal the Planet | Ted Eytan, MD), with the coincidence of this article in The Economist.

What little is known about recycling hazardous waste in America, for instance, suggests that only 15-20% is actually recycled; the rest gets incinerated or buried in landfills, according to the Environmental Protection Agency (EPA). There is no evidence to suggest other countries are any better.

With few audits undertaken, even the EPA has to rely on assumptions and guesswork. Most observers agree that only 20% or so of the 9m tonnes of e-waste collected each year in America is processed domestically—either by reputable firms under controlled conditions, or by prison inmates with few, if any, handling requirements. In other words, the bulk of the waste—up to 80% by weight—gets exported to places in Asia and Africa where health and safety regulations are less onerous.

As I mentioned yesterday, all of Kaiser Permanente’s e-waste is handled by Arrow Value Recovery, which is certified by e-stewards, piloting its global expansion, and also compliant with Responsible Recycling Practices, as mentioned in The Economist article:

people can do their own dirty work by taking the old television set, obsolete computer or broken refrigerator to a recycler who is an accredited member of one of the two voluntary certification schemes: E-Stewards and Responsible Recycling Practices. An interactive map giving details of certified recyclers is on the EPA’s website. In Europe the number of recyclers accredited by E-Stewards is increasing steadily. The Basel Action Network, an environmental pressure group, also lists recyclers. Owning an electronic device now comes with a responsibility for its afterlife.

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Just Read: Greening Health Care: How Hospitals Can Heal the Planet

Gerwig K. Greening Health Care. New York City: Oxford University Press; 2014 (amazon.com | Oxford University Press) – All proceeds from the sale of Greening Health Care: How Hospitals Can Heal the Planet will go to Health Care Without Harm

The US health care industry as a whole spends in excess of $200 billion a year on supplies..it’s equivalent to the annual spending power of the 70 million americans born into the millennial generation, or GenY

There’s a short list of things I didn’t learn about until I came Kaiser Permanente which is a compliment to both health care and Kaiser Permanente. 

One of those things is the importance of a healing health system for people and the planet. I’ve written about environmental stewardship more than a few times on this blog (tag: GreenHC – for “Green Health Care” – get it?). The Greening Health Care book puts it all together in one place.

It may seem obvious that a/the health system should be using that purchasing power to buy products and services that are environmentally friendly and sustainable. However, it had to be worked at/toward.

the $135 billion annual spending now going through the EPP (environmentally preferable purchasing) standardized questions to GPOs and suppliers represents about 80 percent of all the medical products bought in this country.

And by the way $13 billion a year in medical and nonmedical products is purchased by Kaiser Permanente each year.

This is the story of our vice president of Employee Safety, Health and Wellness, and Environmental Stewardship Officer, Kathy Gerwig (@KathyGerwig), Kaiser Permanente, and a movement involving lots of health systems and organizations, including Health Care Without Harm (@HCWithoutHarm),  to have our health system not create patients at the same time it is trying to heal them. 

I’ve known Kathy and the team she supports through her leadership since 2009 and have really seen the promise of paying attention to the way a health system thinks of health in the way it operates. At the same time, as I said above, I didn’t get taught about this part of health in medical school (or public health school). The policies, organizations, and people are as myriad as in any part of clinical medicine and there’s no primer for a doctor, clinician, health system worker/leader/enthusiast, until now. That’s what’s in here.

The stats for things like waste and food are as dramatic as they are for supplies:

health care, together with other large institutions, including school districts, universities, and government agencies, account for about 40 percent of all food purchased in the United States

The US health care sector is second only to the food industry in contributing to waste production.

Within these areas there are voluntary choices that can be made to make these activities healthier/less harmful. 

The Story of Stuff, Where does your e-waste go

I tend to like this (one of many) example because I meet so many people who don’t know where their electronic waste goes – the PC’s, the tablets, the servers, etc. You can find out by watching this video. At Kaiser Permanente, though, all electronic devices are recycled and none are exported, due to a partnership with Arrow Value Recovery.

In 2010, for instance, Kaiser recycled more than 122,000 pieces of electronic equipment, totaling 748 tons, while avoiding approximately $2.4 million in disposal costs.

Part of a sustainable revolution: Our trip to NPR

I had the pleasure of going with Kathy and colleagues Erin Meade (@erinm81) and Sue Saito (@suekiesaito) to NPR Headquarters in Washington, DC, yesterday.

As I mentioned on a previous trip, the NPR building sits on the border of a census tract, which is on the border of health-challenged DC and thriving DC (see: Photo and Map Friday: The Social Determinants of the NoMa Neighborhood, Washington, DC USA | Ted Eytan, MD). Within this building, NPR is working to provide for a healthy and safe work environment to its employees and its community. Our accountability in health care is to make their job as an employer and as a member of the community easier, by leading and supporting everything they’re doing through our example. I think we can, it’s what they expect of us. 

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Photo Friday: Never Give Up

This week’s photograph was inspired by one taken a year earlier, on the anniversary of September 11, in New York City.

Tom ‘Gator’ Swann, Proud Gay Veteran, Mar 5, 1958 – , “Never Give Up Hope or Give in to Discrimination”View Congressional Cemetery 46870 on Flickr.com

When the Total Health team asked where I would like to go on a Total Health outing, I chose Washington, DC’s Congressional Cemetery, where J. Edgar Hoover is buried. What was unexpected was the statements of hope on the gravestones nearby.

A year ago, I was walking through the streets of New York City learning about our opportunity to create more active cities, and noticing that they are being created (see: A Walk Through New York – Designed to Move – is this our 1968 moment in creating active cities? | Ted Eytan, MD).

Also a year ago, a revolution toward equal treatment and respect was in full swing, with Kaiser Permanente Colorado covering transgender person health services (see: Kaiser Permanente now covering transgender services in plans – The Denver Post).

Unfortunately, in death, J. Edgar Hoover isn’t at rest next to his life partner, Clyde Tolson, who’s a few plots away. Clyde is surrounded by others who will never give up, and our generation won’t either, as it builds the healthiest, most inclusive communities ever.

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Request for Proposal: Can I be your mentor (and vice versa?)

I’m posting a request for proposal for my next mentorship relationship, not because I’m such a fantastic catch, more because I want more people to engage in these relationships.

I’ve enjoyed two awesome mentorship relationships (see: Now Reading: Don’t hand the keys over, collaborate with Gen Y | Ted Eytan, MD and Being a mentor, enjoying colleagues who are millenials. Look at these SMARTER Goals | Ted Eytan, MD). It’s time for the next one.

Why? Because (a) if someone knows how to do something better than me, I’m interested in knowing about it (b) I’m not that smart and my ideas are not that unique and (c) I and others have been conversations lately that confirm I am not the only one who believes in (a) and (b), which is a more important discovery than that any of us knows how to solve a problem.

A little background

I took a look in my electronic files and I remember a time, oh around 2008-2009, when I read stories of other companies who had set up so-called “intergenerational mentoring” programs, iconic places like Time Warner, Cisco, and Booz Allen Hamilton (How Gen Y & Boomers Will Reshape Your Agenda – Harvard Business Review) and wondered if we could be one of those companies and have programs like that. It turns out that we could, we are, and we have such a program, and are listed as one of the … The 10 Companies With The Happiest Young Professionals.

It’s what we wished for, so let’s take advantage/let’s keep it that way/spread it to others. If we did it, you can too.

Here’s what I’m looking for, then. Hint: copy, modify, and create your own (and share the results with me in the comments or via twitter).

Thanks for the use of this template that I modified slightly.

Request for Proposal: Mentorship relationship

Project Description

  • Mentorship relationship: Structured, ongoing connection with another person who seeks to perform at their best for Kaiser Permanente members and help our organization produce total health for our members, their families, and communities, and maybe change the world also.

Requirements – Mentee

  • Must be an employee of a Kaiser Permanente entity (medical group, health plan, doesn’t matter) – need to support the home team!
  • Must plan to stay employed by a Kaiser Permanente entity during the mentorship term
  • Ability to drive the relationship, which includes setting goals, sharing experiences, arranging times and venues to communicate – that’s the recommended approach, it has worked so far
  • Ability to break the relationship, if a good fit is not achieved – suffering is optional
  • Ability to place a focus on the mentee’s goals and wishes for the future – we won’t make this about me, that’s for my mentor :)
  • Open to experiences that connect you to the member experience more closely and in different ways – we are here for them, after all
  • Able and interested in promoting mentorship to others

Technical and infrastructure

  • Work location flexible, California or Washington, DC preferred – greater likelihood of in person checkins – in person is the new online
  • #activetransportation strongly encouraged, walking meetings will be involved

Assumptions and Agreements

Estimated Duration, Frequency, Type of Contact

  • 1 year
  • Contact approximately every 3-4 weeks, more frequently as needed
  • Any and all modalities (experimentation encouraged, we’ve broken every high tech meeting device already): in person, phone, video, text, tweet

Submission information

Basis for Award of Contract

  • Everyone is awarded a mentor and vice versa, if it’s not me, I’ll help find you one

Here’s my mentorship profile to see if it fits your RFP

My Profile

LinkedIn Profile Ted’s LinkedIn Profile
Last Updated: 09/09/2014
First name Ted
Last name Eytan
Gender (optional) M
Social networks all of them. Try @tedeytan first
Office phone (does anyone have one anymore?)
Preferred contact method Email, Text, Tweet, if I can walk to it, I’ll do it
Current job title Physician Director, Kaiser Permanente Center for Total Health
Job Level Director/Sr. Director
Department/Functional Area The Permanente Federation, LLC
Regional Affiliation The Permanente Federation, LLC
Office location Washington, DC
Year I started at Kaiser Permanente 2008
I want my role to be: Both
Number of Mentees I’m willing to Mentor 1
  ✓ Click to Read Expectations of Mentors and Mentees       I have read, understand and agree to the ‘Expectations of Mentors and Mentees’
As a Mentor…
  ✓ I want to share my knowledge and help KP be the Best Place to Work
  ✓ I want to know what others are doing to be more patient and member-focused
  ✓ I want to improve my performance in relationship to the value compass
  ✓ I want to expand my network
I have subject matter expertise (SME) and/or experiences in the following areas: Information Technology, Clinical Medicine, Diversity
I Have These Skills Being more productive
Developing career path
Discover and develop my strengths, talents, abilities
Interviewing for a new position or Interviewing others
Navigating Kaiser
Setting goals
Time management
I Have These Behaviors Champions Innovation and Change
Communicates Effectively
Deals with Ambiguity
Develops Self/Others
Drives for Results
Focuses on the Customer
Takes Accountability
Highest level of education Medical School
Schools attended University of California, University of Washington, University of Arizona
Employee Resource Groups GenKP
KP Pride: Lesbian, Gay, Bisexual, Transgender and Intersex employees
Other groups I belong to and other projects/activities in which I am involved with at Kaiser Permanente Transgender Member Health Equity; Transportation/Food/Physical Activity and Health; Kaiser Permanente Center for Total Health – part of the Kaiser Permanente Innovation System
Activities or groups I am involved in outside of Kaiser Permanente ActionDesignDC, ActionDesigner.net

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Photo Friday: Washington, DC Sunset with Air Force Memorial

Isn’t Washington, DC beautiful?

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Just Read: In DC, there’s up to a 14 year life expectancy gap between blacks and whites that hasn’t changed in 15 years

The life expectancy of a black male in Washington, DC as of 2009 is the same as a man in North Korea as of 2012. For a white male, the life expectancy is higher than Israel, lower than Switzerland.

Sources: World Health Organization; Harper S, MacLehose RF, Kaufman JS. Trends In The Black-White Life Expectancy Gap Among US States, 1990-2009. Health Aff. (Millwood). 2014;33(8):1375–82. View Life Expectancy World and DC – Male – 46576 on Flickr.com

The life expectancy of black females in Washington, DC as of 2009 is in between The Russian Federation and Syria or Iran as of 2012. It’s higher than North Korea, which is 73 years. For white females in Washington, DC, it’s just below the highest life expectancy in the world, Japan.

Sources: World Health Organization; Harper S, MacLehose RF, Kaufman JS. Trends In The Black-White Life Expectancy Gap Among US States, 1990-2009. Health Aff. (Millwood). 2014;33(8):1375–82. View Life Expectancy World and DC – Female – 46577 on Flickr.com


This article caught my eye because of my recent trip to Anacostia, in Washington DC’s Ward 8, where health disparities are extremely tangible (underscore): The People of Washington, DC’s Anacostia are Building a Culture of Health | Ted Eytan, MD

They are not just tangible in Anacostia, they’re visible on my walk to work through the city, where I pass through about 8 years of life expectancy. Just do a search of “#activetransportation” on my Twitter feed to see photos of what this looks like; it’s obvious.

This paper, published in this month’s Health Affairs (Harper S, MacLehose RF, Kaufman JS. Trends In The Black-White Life Expectancy Gap Among US States, 1990-2009. Health Aff. (Millwood). 2014;33(8):1375–82) is an analysis of the disparity in life expectancy between whites and blacks in all 50 states and the District of Columbia, using census data.

It confirms what I see on my walk to work, and adds another piece of data that I don’t see, which is that this disparity has continued, unchanged, for the last 15 years:

The estimated state-specific racial gap in life expectancy among males in 1990 ranged from 14.4 years (95% CI: 13.3, 15.4) in the District of Columbia to 0.0 years (95% CI: −5.2, 5.3)

For females, the District of Columbia and New Hampshire also had the largest (10.4 years; 95% CI: 9.5, 11.2) and smallest (1.2 years; 95% CI: −3.9, 6.2) gaps, respectively, in 1990. In 2009, despite overall improvement at the national level, the enormous racial gap in the District of Columbia remained almost completely unchanged for both males (+0.4 years; 95% CI: −1.1, 1.8) and females (+0.2 years; 95% CI: −1.1, 1.6). Life expectancy there remained dramatically more unequal than in every other state.

And then if you compare the change in life expectancy for women (men show the same trend), it’s been constantly disparate since 1990.

And then there was New York

New York State has shown a different trajectory, as you can see from this chart. There has been a massive upgrade in life expectancy for black men and women compared to their white counterparts, narrowing the gap the greatest.

The largest decrease in the gap for males occurred in New York (−5.6 years; 95% CI: −6.0, −5.1), largely because of a dramatic increase in black life expectancy, from 63.9 years to 75.4 years. This was a gain of 11.5 years; the national average gain was 6.5 years.

I’ve written about this previously (New Yorkers Living Longer Than Ever, Outpacing National Trend, a look at the data | Ted Eytan, MD). It’s real. And since I’ve written about it, a review of what happened in New York has been published just this year (Preston SH, Elo IT. Anatomy of a Municipal Triumph: New York City’s Upsurge in Life Expectancy. Popul. Dev. Rev. 2013). A lot of New York’s success has come from identification and treatment of HIV, as well as the same for drug and alcohol related injury/death. It’s worth a read for sure.

Our cities are changing, we just need to make the change happen for all

A few more really important DC datapoints:

  1. Population in 1950: 802,178
  2. Population in 1990: 606,900, 70 % black
  3. Population in 2010: 601,723, 50 % black
  4. Population in 2013: 646,449

In this map you can see where the black and white population live. The green color represents black residents, the blue represents white residents:

You can grab and manipulate this map yourself at the continually awesome CommunityCommons.org (@CommunityCommon)

I cross the “dividing line” in the middle when I walk to work. Ward 8 (Anacostia) is in the lower right. Every other map you could draw, from bikeshare rentals to income to education is going to show the same disparity. With this visual, it’s not hard to tell why an “enormous” disparity still exists between black and white people.

I still see proclamations of Washington, DC as the “third thinnest” state, which badly misrepresents the huge disparities here and harms our ability to understand the health of our community.

Why this is not good

There is good news, which is that life expectancy for both black and white men and women has increased in Washington, DC (by 4+ years for both black and white women, by 8+ years for black and white men).

A significant inequality still exists and that’s a problem. This means that the opportunity of black men and women to achieve their life goals starting with a long life is blunted compared to white men and women.

Diversity brings with it a torrent of innovation. If this trend does not change, we’ll learn less every day, and enjoy our community and the world a lot less. And why would we want to do that?

We share our community with incredible leaders who don’t support the status quo:

I’m with Ruby. We are going to change everything :) .

Permission to reproduce the images courtesy Health Affairs (@Health_Affairs)

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Photo Friday: Our generation is changing everything for people who are LGB and Transgender

In the end, we were all inspired by Mother Teresa.

I got to accompany the first runner up Stonewall Darts Team, part of Stonewall Sports (@StonewallSports) “Tall Dart and Handsome” to present the second prize winnings to their selected charity, Casa Ruby DC (@casarubyDC) this week, in the amount of $2500.00. Although my team didn’t win in the playoffs, we also won $463.00 for Ruby’s team earlier in the season, which makes 2 teams this time that played for Ruby.

Stonewall Sports is an LGBTQ & Ally community-based, non-profit sports organization that strives to raise funds for local non-profit organizations through organized sports. Our league values each player for who they are and what they bring to the each league’s community.

I learn something new every time I see Ruby. See: Being Real, Producing Health and Wellness: Ruby Corado and Janet Mock | Ted Eytan, MD for my first visit.

On our tour, she told us how she was inspired by the nuns in an AIDS hospice she worked in previously in Washington, DC. She said they wore very little clothing, and no shoes. “All they had to give was love,” she said, which is her model at Casa Ruby.

I went online and found out more about Gift of Peace, which was indeed founded by Mother Theresa almost 30 years ago. I read that in the early 1980’s local homeowners protested the home because it was believed AIDS could be spread through the air.

Missionaries of Charity Gift of Peace Hospice

This is not unlike some of the comments I hear, today, from some of my medical colleagues, about people who are transgender; things like, “what will they want next, cross-species transplants?”

Fortunately those voices are rapidly fading into irrelevance as a new generation changes the world to become a more loving place. It’s inevitable, you know, love always wins :) .

A visit to Casa Ruby always includes the tour, a story or two, and a vision for the future. There’s a lack of services for LGBTQ individuals in Washington, DC, who find themselves in crisis, either because of lost homes or domestic violence, not to mention lack of employment. Even though it’s illegal to deny employment to a person because they are transgender in Washington, DC, their unemployment rate is 50%, compared to 7% for the general population.

As an example, Ruby noted that shelters and other services exist for opposite sex partners, but not same sex partners in our city, and it’s her intention to change that, for all LGBTQ people in our city. I have a feeling she’s going to, because as she said, “I get stuff done.”

Which she does, she has a lot more help, and we are continuing to change everything.

More photos below, including awesome hug sequence. Thanks to Stonewall Sports for connecting inclusion in sport to inclusion in life, and Washington, DC, for being the hub of social innovation in the United States.

the unfulfilled need for love and feelings of rejection and loneliness are a far greater suffering than starvation and poverty. – Mother Teresa

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