Twenty-six centuries ago, a Greek physician urged his medical colleagues to remember that a doctor does “not treat a fever chart [or] a cancerous growth, but a sick human being” who has a life and responsibilities outside of a hospital wing. That level of care — a tenet of the Hippocratic Oath — is already difficult to realize, but Gary Cohen, a travel writer turned healthcare advocate, is pushing medical centers to think even bigger, realizing the connections between a patient’s sickness and its roots in an unhealthy community.
Cohen, one of this year’s recipients of the MacArthur Foundation’s “genius” fellowships, co-founded the global nonprofit Healthcare Without Harm (HWH), which is headquartered in the Washington, D.C. suburb of Reston, Va., in 1996. As the organization campaigned to eradicate toxic chemicals from medical equipment — mercury in thermometers, dioxins in incinerated plastic IV bags and tubes — Cohen argued that healthcare providers shouldn’t be making people sick. After significant victories, Cohen recently decided to broaden the focus of HWH from “do no harm” (another classical dictum) to actively bettering community health. With more than 500 partner organizations in 53 countries, including three of the largest nonprofit hospital systems in the U.S.: Catholic Health Initiatives, Kaiser Permanente and Dignity Health, Cohen’s raison d’être is to help doctors heal their profession.
“When we started, we were trying to get hospitals to take the Hippocratic Oath internally, applying the same set of values to their environmental footprint: to reduce the use of fossil fuels, detox the supply chain, get rid of sugar-sweetened junk food,” Cohen says. “But the bigger questions are, ‘How can you be an anchor for community and planetary health? How can you move from being these cathedrals of chronic disease to being centers of community wellness and sustainability? How can you leverage your incredible moral authority, your mission and economic clout to support healthier communities?'”
Cohen’s first job after college was writing guidebooks for top tourist destinations — London, Paris, New York — until a friend asked if he would write a primer on toxic chemicals. Not knowing anything about the topic, Cohen conducted interviews to learn more. “I sat around kitchen tables with mothers and fathers. They had no political power, no money, no technical expertise, but they were fighting for their family’s lives,” he recalls. “Their kids were sick. ‘Why does my daughter have this rare form of cancer? Why does my son wake up in the middle of the night choking for air? Why does the water taste so bad?’” The political organizing manual Cohen subsequently wrote, “Fighting Toxics,” launched what has turned into a lifelong fight for environmental safety. In 1986, he helped pass the first national right-to-know law, alerting consumers about possible chemical exposure.
A decade later, a report by the U.S. Environmental Protection Agency that warned of on-site medical incinerators (which burn a portion of the 26 pounds of waste generated daily by each patient in a staffed hospital bed) turned Cohen’s attention to hospitals. Incineration removes one biohazard by burning pathogens, but the burning plastic sends other dangerous chemicals into the atmosphere. Tests found dioxin in children’s body fat and traces of mercury in infants’ blood. “The healthcare system is a major polluter,” Cohen says, realizing that, “the very institution devoted to healing people is poisoning them.”
Starting with a team of 28 organizers, Cohen’s advocacy has helped reduce the number of on-site medical waste incinerators in the U.S. from a high of 5,600 to just 70 a decade later. And those hazardous measuring devices containing mercury? HWH’s work has resulted in them, for all practical purposes, being eliminated from hospitals and pharmacies.
What’s unique about HWH’s approach is that these reforms went into effect “without basically any legislation at the federal level,” Cohen says. “We started, you might say, in the basement,” talking with the facility managers and architects. As the cause gained momentum and sustainability worked its way into hospital chains’ strategic priorities, Cohen now has access to meet with vice presidents and CEOs.
Recently, HWH worked with hospitals to reduce their greenhouse gas emissions, convincing medical facilities not only to buy solar panels for hospital rooftops, but also to subsidize them for employees’ homes. The organization has also helped school systems and hospitals partner to generate demand for local, sustainably produced food. And it’s demonstrated that the construction of new hospital wings can strategically promote economic development in poorer parts of a city.
HWH has also been bolstered by President Barack Obama’s signature healthcare legislation, the Affordable Care Act, which requires hospitals to conduct community health needs assessments (essentially tabulating why people come to the emergency room). “What conditions in the community are contributing to diseases? Is there food insecurity? Is there pollution? Is there poor housing, violence and poverty? These are the things that are making people sick in the first place,” Cohen says. He adds that the same principles apply to climate change. After witnessing Hurricane Katrina and Superstorm Sandy, doctors can’t avoid seeing that global warming’s added risk of flooding or extreme heat as essential to their work. “If you’re a person in Cleveland and you think climate change is all about polar bears and melting ice caps, then you’ve got other stuff to worry about. But when you understand that it has to do with [a patient’s] asthma, the spread of West Nile virus or dengue fever, that reality can no longer be ignored. Now I’m paying attention.”
Cohen’s larger hope is that changes in the healthcare profession, which accounts for $2.9 trillion in spending, resonates throughout the broader economy. Because hospitals must prioritize a patient’s wellbeing, they can invest the extra dollars needed to drive innovation and scale greener practices. Once they prove the business model is viable, other corporations might take notice.
If you ask American citizens which profession they trust most, as Gallup has since 1976, doctors and nurses consistently rank among the most honest and ethical. Eighty percent report high trust in nurses; compared to just 7 percent for members of Congress. Cohen believes medical professionals must live up to this respect by watching out for our health — even when we ourselves don’t want to. Not just whether we’re running a high temperature or have a cough, but the broad influences on the health of our cities.
“I will apply, for the benefit of the sick, all measures which are required,” doctors pledge in the Hippocratic Oath. “I remain a member of society,” they add, “with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.” Cohen will be holding them to their word.