Video Friday: DC Mayor’s Health Care Sustainability Pledge

Now posted on the Washington, DC Mayor (@mayorvincegray) YouTube channel.

And yes it was a huge honor to co-introduce him with my Executive Director of the Center for Total Health (@KPTotalHealth).

More photos and info about this event : Sustainable Washington, DC USA

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The new, Green Kaiser Permanente Antelope Valley Medical Offices #GreenHC

Kaiser Permanente – Antelope Valley Medical Offices from J&M Concrete Contractors on Vimeo.

From Kaiser Permanente Share | A New Home for Specialty Care Opens in Antelope Valley


The new Kaiser Permanente Antelope Valley Medical Offices will open with a ribbon-cutting ceremony on Friday Oct. 3. Also at the ceremony, Kaiser Permanente Southern California Community Benefit will present the Antelope Valley Community Clinic with a $250,000 grant to expand its existing space and provide services for an additional 10,000 patients per year. The grant will also support additional Dental Clinic space.

The new Kaiser Permanente Antelope Valley Medical Offices and the expansion of the Antelope Valley Community Clinic are part of Kaiser Permanente’s long-standing commitment to provide high-quality, convenient care for our members and the communities we serve.

I have been learning about Antelope Valley, and now it’s here. I hope to visit some day. Its opening is the perfect compliment to the discussion recently had about designing buildings for health (A bunch of doctors, an architect, and a bridge builder: Designing for Health | Ted Eytan, MD).

Before anyone says this is worshipping bricks and mortar, it isn’t – look at my companion presentation that shows how much of our medical care is shifting out of health care facilities and where our members are (Why a health system cares about the buildings it doesn’t build: Moderating AIA-DC Panel 10/8/14 | Ted Eytan, MD)

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Why a health system cares about the buildings it doesn’t build: Moderating AIA-DC Panel 10/8/14

“Growing Screens” – Kaiser Permanente Westside Medical Center

What’s a doctor doing a moderating a distinguished group of panelists tomorrow evening on Improving Health Through Active Design | AIA DC? Well, come and find out :) .

It’s hosted by American Institute of Architects (@WashingtonDCAIA) at the gorgeous District Architecture Center in Washington, DC, USA (of course).

Here’s the why:

  • Our model of care is changing – 50% of our touchpoints with patients are in person, down from almost 100% in 2003
  • In a model of care like ours, where we are reimbursed for health instead of sickness, we seek out health for our members wherever it is
  • Most human beings spend their time in buildings, and mostly not in health care buildings.
  • Our iconic founder, Sidney Garfield, MD, hoped to be an architect before he was a doctor, so as a result we have a robust facilities innovation program (including the groundbreaking “Total Health Environment” program, where we are leading the way in green building in health care at the same time. (see: Through the eyes of interior architects: The new Garfield Innovation Center + future of healthy building | Ted Eytan, MD )

The photograph in the post above is just one visual example of how any facility can be made healthier. John Kouletsis, AIA, EDAC
Vice President, Facilities Planning & Design, Kaiser Permanente:

Designing for health? We do this a lot, but many of the examples would be invisible to the casual observer. Prohibiting the use of PVC, HDPE (high density polyethylene) piping, and fire retardant chemicals in the furniture that is specified for KP projects are all good examples of the “invisibles.” Visible examples would be some of our building lobbies where we make sure that the stairs are the most prominent feature, leading people to take the stairs rather than the elevator. Westside Medical Center in the NW Region did a very unusual thing with the multi-story parking garage–they have “growing screens” to shield the neighbors from the view of parked cars and light spill over from cars in the parking structure at night. The green screens are watered from rainwater that is collected for that purpose. While being an attractive screen, they also clean the air.

I get to call John my colleague. He and his team are partners in producing health with our doctors, nurses, and members. That’s why a doctor wants to moderate a panel on designing for health!

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Just Read: What physicians (and patients) need to know about Climate Change – JAMA

The facts:

Similar trends can be seen for snowfall and precipitation, both trending down instead of up, in Washington, DC, with a whole host of livability and health effects that will result.

This post is about a pair of papers in this week’s Journal of the American Medical Association about climate change, that are nicely comprehensive and about what climate change means for health. As I have said previously, I am not an environmentalist, I am a health activist – that’s why I can and do go from thinking about medical care for people who are transgender to designing healthy buildings.

In “Climate Change: Challenges and Opportunities for Global Health” you’ll find exactly what colleagues and I had previously been looking for in the published literature – a good accounting, from all health angles, of what happens when CO2 levels rise. A lot of the impacts I am familiar with, some are new, such as increase risk of depression and other mental illness.

If physicians or other people in health care – including patients – have time to read only one article about why this is important, this is a good one. There’s a lot that health care and people who work in health care can do, and a lot that has already been done (see: Just Read: Greening Health Care: How Hospitals Can Heal the Planet | Ted Eytan, MD).

The second piece, “Code Green,” is written by a physician (and a family physician at that), for physicians. Caroline Wellbery, MD, PhD, discusses the role of health practitioners in being a voice for change. That’s something that comes very unnaturally to me if you read this blog :). As I have written previously, physicians are not yet mobilized in a significant way to think about the role of environment in preserving or more likely in the future, destroying the work they do to keep people healthy (Do physicians tweet about environmental stewardship in health care? | Ted Eytan, MD). I think that’s going to change as the health impacts become part of the curricula for physicians in training, as evidenced by this piece itself.

If we are here to keep people healthy, we can’t do it if we sicken their communities at the same time. Enough said. Well almost enough. It’s as simple as your walk to work in the morning. Try it.

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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 ( | 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’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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Healthier hospitals don’t just treat patients, they don’t create them in the first place, here’s how

It’s true – operating a health system in an unhealthy way actually creates illness instead of preventing it, and it actually costs more money. So why do it? Check out this video from Healthier Hospitals Initiative (@hhiorg).

Healthier hospitals has catalyzed a lot of change in the 18% of GDP health care industry, I’ve seen it first hand, and anyone can join.

If you’re operating a physician practice, you’ve got a great resource in MyGreenDoctor (@MyGreenDr) as well.

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