by Carolyn Raffensperger*
[Continued from Rachel's #761.]
Greening the Clinic
Healthcare practitioners have a special obligation to provide
healthcare services that do not in themselves add to
environmental degradation, which can cause illness. The use of
polyvinyl chloride (PVC) plastics, mercury thermometers, and
other hazardous materials can be phased out and comparable
tools of less dangerous materials may be substituted. A
coalition called Health Care Without Harm is a good resource
for information about problematic healthcare practices and
Alternative healthcare practitioners, particularly those who
use herbal remedies, have an opportunity to promote the
preservation of biodiversity. Any herbs should be sustainably
grown and harvested. The United Plant Savers posts a list of
plants that are at risk because of human activity. They
have a precautionary goal: "Our intent is to assure the
increasing abundance of the medicinal plants which are
presently in decline due to expanding popularity and shrinking
habitat and range. UpS is not asking for a moratorium on the
use of these herbs. Rather, we are initiating programs designed
to preserve these important wild medicinal plants."
Plants from other countries are generally governed by the 1992
Convention on Biological Diversity, an international treaty
that seeks to conserve biological diversity and compensate
developing countries who have the most biologically rich
ecosystems. Unfortunately, the United States has not endorsed
the treaty and continues to seek free trade in plants that
might be otherwise protected under the Convention. It is
important to know the source of botanical herbs and promote
just financial arrangements with countries that are the sources
of these medicinal plants.
But every aspect of a medical care facility can be evaluated
for its contribution to the environmental burden, and that
burden can be reduced. How much waste goes to landfills or
incinerators? Are bike racks as available as car parking? Can
energy use be reduced at the facility?
Observing Emerging Health Patterns
Healthcare practitioners are also in a unique position to
monitor emerging patterns of environmental health problems. The
analogy is that of the alert practitioner who is charged with
observing and reporting adverse drug reactions or unusual
infectious diseases. Are you seeing unusual patterns in your
practice and your community that may have an environmental
link? Are there places to report these connections?
Dr. Allen Parmet is one such alert practitioner who observed
that workers at a microwave popcorn plant developed a rare lung
disease, bronchiolitis obliterans, that appears to have been
caused by breathing particulates from artificial butter
flavoring. Occupational diseases like this are reported to the
National Institute for Occupational Safety and Health. There
are few places to report environmental health problems if the
disease is not occupational, however.
The Minnesota Department of Health recognized the issue of
environmental health problems and created a precautionary
principle committee based on the model of the alert
practitioner. Its goals were to examine science and policy
related to specific emerging issues and to consider prudent
Similar kinds of committees can be set up on the local, state,
and national level. It is possible to include in these
committees wildlife biologists, teachers, veterinarians, and
healthcare practitioners, among others. Such committees are
designed to monitor the health of the public, see patterns that
may not have been predicted, and take precautionary action to
prevent further harm.
Setting Health Goals
Most states keep statistics on many current, pressing health
issues, including cancer, birth defects, and the number of
children in special education. Hospitals and other institutions
maintain their own records of problems, such as emergency room
visits for asthma. These statistics can be used by communities
and states to set environmental health goals. The U.S.
Department of Health and Human Services (DHHS) sets generic
health goals, such as reducing obesity or cardiovascular
disease. The DHHS has never set environmental health goals.
Nevertheless, setting such goals could steer public health
policy in new directions. Goals could include reduced incidence
of asthma, learning disabilities, and cancers.
Examples of Implementation
Implementing the precautionary principle is a tall order. But
several jurisdictions in the United States, Europe, and Canada
are trying to implement it. The following initiatives are of
particular interest to those working on environmental health
In 1999, the Los Angeles Unified School District adopted the
precautionary principle to govern pesticide use in schools. The
district's policy affirms that the "principle recognizes that
1) no pesticide product is free from risk or threat to human
health, and 2) industrial producers should be required to prove
that their pesticide products demonstrate an absence of [human
health risks] rather than the government or the public prove
that human health is harmed."
Verizon Wireless sent a brochure in July 2001 to its U.S.
cell-phone customers describing the potential harm to children
from radio frequencies emitted by cell phones. Verizon
described the precautionary principle by name in its brochure
and suggested that parents adopt the principle and limit
children's use of cell phones. Similar wording, without
acknowledgment of the precautionary principle, may be found on
the company's Web site.
The City of San Francisco appointed an ad hoc precautionary
principle committee that began meeting in early 2002 to
identify methods by which city departments could apply the
principle. The committee stated the following :
Towards that end, the Committee will:
a. Develop and update a Q&A for the general public
b. Develop Precautionary Principle guidelines, forms, and
criteria for departments such as purchasing
c. Suggest initial near term goals
d. Develop indicators to help monitor progress
e. Develop trainings for city staff
The Secretary of the Commission on the Environment will
establish and update a library of key documents and maintain a
binder of letters commenting on the Precautionary Principle.
Both the library and the binder are available to the public.
Past environmental decision making predicated on measuring and
managing risk has failed to stave off environmental health
damage. Many chronic and debilitating diseases are on the rise,
and many of these diseases are rooted in ecological damage.
This new and emerging set of problems requires new methods for
considering and preventing further ecological injury and
thereby preventing human illness. The precautionary principle
provides a new way of thinking about environmental health that
invites healthcare practitioners to become knowledgeable about
the issues and observe and report environmental health links
that arise in their own practice. Healthcare professionals also
can take environmental action to the workplace by reducing
waste and finding alternatives to environmentally harmful
medical supplies and therapies.
There is so much suffering in the world. Every child who cannot
learn to read because she was exposed to mercury or lead, every
child who cannot draw a breath of air because of asthma, every
child who was born with a deformed penis because of exposure to
an endocrine disruptor suffers for a lifetime. We can envision
a healthy world where the offspring of all species are healthy
and vibrant. And we can act. We can implement the precautionary
principle, which urges us to take precautionary action even in
the face of uncertainty. Frogs, white pelicans, sea otters,
humans, and Monarch butterflies are worth our every effort. May
we not only bear witness to and alleviate suffering but may we
bear witness to beauty.
This article first appeared in the Sept./Oct. issue of
Alternative Therapies in Health and Medicine. Copyright 2002.
Used with permission.
Carolyn Raffensperger, M.A., J.D., is the executive director of
the Science and Environmental Health Network in Ames, Iowa.
14. Campaign for Environmentally Responsible Health Care.
Health care without harm. Available at: http://www.noharm.org.
Accessed July 24, 2002.
15. United Plant Savers Web site. Available at:
http://www.plantsavers.org. Accessed July 24, 2002.
16. United Nations Environment Programme. Convention on
Biological Diversity convention text; 1992. Available at:
http://www.biodiv.org/convention/articles.asp. Accessed July
17. Associated Press. Popcorn plant workers develop rare lung
disease; artificial butter flavoring is blamed. October 4,
2001. Available at: http://abcnews.go.com/wire/Living/
ap20011004_893.html. Accessed July 24, 2002.
18. Kriebel D, Tickner J. Reenergizing public health through
precaution. Am J Pub Health. September 2001;91(9):1351-1355.
19. Verizon Wireless Consumer Disclosures. Available at
August 5, 2002.
20. San Francisco Commission on the Environment. Available at
Accessed August 5, 2002.