Research Agenda for Sustainable Healthcare: A Work in Progress

Healthcare buildings are intimately interwoven with the human experience. As such, they express societal values around health and healing, wellness and disease. The healthcare sector and its practitioners have a legacy of coupling individual health and public health-and of honoring the sanctity of environmental health. However, its buildings have become largely distanced from these values. Resetting the design and regulatory parameters that shape these significant civic structures is both urgent and necessary in light of contemporary global environmental and public health realities. A coordinated research agenda is an essential part of this pursuit. While by no means exhaustive, this paper presents important research topics intimately tied to these 21st-century environmental and public health challenges.Research ContextAs contextual underpinnings for research into sustainable healthcare design, construction, and operations, the precautionary principle and life-cycle multiscale thinking are points of alignment:The Precautionary Principle: "Where there are threats of serious or irreversible damage, lack of full scientific certainty shall not be used as a reason for postponing cost-effective measures to prevent environmental degradation" (United Nations, 1992).In many cases environmental degradation leads to direct or indirect public health burdens. For instance, a polluted stream can contaminate drinking water; air pollution can lead to more asthma cases. Many of the products and systems incorporated into today's buildings have not been tested for their environmental or health impact. However, the built environment plays a significant role in determining environmental and public health. According to the U.S. Environmental Protection Agency, the U.S. population, on average, spends 90% of its time indoors, where there is direct exposure to these potentially polluting products. Building construction consumes more materials by weight than any other industry in the United States (Horvath, 2004) and constitutes 25% to 40% of the national solid waste stream annually (Whole Building Design Guide, 2007). Recognizing the scale of the building industry's involvement in environmental degradation and its associated public health burden, both the Green Guide for Health Care and the U.S. Green Building Council have adopted the Precautionary Principle as a guiding principle, as have numerous other healthcare systems and environmental health organizations.Life Cycle and Multiscale Thinking: Building-related decisions have consequences both inside and outside the building walls. For example, the choice of grid-connected fuel sources (e.g., coal, natural gas, wind, photovoltaics) results in vastly different environmental and health impact profiles.The Green Guide for Health Care addresses life cycle and multiscale thinking by basing its voluntary credits on three scales:1. Protecting the immediate health of building occupants2. Protecting the health of the surrounding community3. Protecting the health of the global community and natural resourcesVerifying the impact of sustainable practices on several scales ensures that healthcare institutions realize their related missions of providing a healing environment inside the facility and to safeguard natural resources and the environment outside the facility. Toxic chemicals procured and used by healthcare institutions in the course of clinical care and facilities operations can result in the decline of environmental systems and public health even when they are far removed from the waste source, if they are improperly disposed of. Based on the research of 119 pilot projects representing more than 30 million square feet of construction, the Green Guide for Health Care found that connecting sustainable design practices and human health was instrumental in establishing these practices' relevance to the healthcare industry. Since the Green Guide's release in 2003, many healthcare institutions have made the connection between stewardship of the environment and stewardship of the community outlined in their mission statements. …