The launch of the U.S. Green Building Council's LEED for Healthcare in April signaled a defining moment for hospitals and other healthcare facilities. Once touted as the stepchild of green building, over the past decade the healthcare sector has decidedly hit its stride. What today seems axiomatic—that healthcare facilities should be healthy buildings—was, only a decade ago, considered an edgy and challenged notion.
As we look ahead, the benefits of and commitment to greening healthcare facilities need to be matched by an aligned effort to tackle this country's persistent and mounting public health challenges: 75% of every dollar spent on healthcare in the U.S. is associated with the treatment of chronic diseases, many associated with the built environment. Fueled by cancer and looming epidemics of obesity and asthma, among other diseases, healthcare expenditures are projected to climb to 25% of the gross domestic product in 2025, from about 17% today, according to the Congressional Budget Office.
Healthcare facilities also must be the civic sanctuaries that survive disaster—places where people can reliably go when unforeseen needs are greatest. They are uniquely positioned to demonstrate how location, design, construction and operations are essential to a broader public health mission, underscored by disease prevention, wellness and resilient design strategies. Greening them is central to this strategy.
What we know today is sobering and redefines the critical dialogue: Green healthcare facilities are where people want to work and where patients want to go when they have a choice; they report improved patient outcomes and reduced staff turnover; they operate more efficiently and effectively than their predecessors designed in the past century; and they can be designed and constructed without breaking the bank. Indeed, a 2008 study of 13 LEED-certified healthcare facilities concluded that first cost premiums ranged from zero to 5% before incentives, and from zero to 3.8% with incentives.
As testament to their viability, today there are more than 40 million square feet of green healthcare new construction, renovations, additions and operational facilities in the U.S. and abroad, and another 200 million square feet under development. These projects include 295 Green Guide for Health Care registered projects, 240 LEED-certified and 1,188 LEED-registered healthcare projects—and include seven projects registered with LEED for Healthcare, the newest guidelines for healthcare facilities. Together these projects represent the vanguard of visionary leadership that positions healthcare's 21st century building environment as tangible evidence of its fundamental mission and values of stewardship and “do no harm.”
While the momentum is impressive, the promise of greening the healthcare sector is challenged by a spectrum of operational and contextual realities that require attention as we imagine healthcare's future:
Climate change has been declared the biggest global health threat of the 21st century. Yet hospitals in the U.S. are prodigious energy users with enormous carbon footprints, the second most energy-intensive building type behind food service and twice that of commercial office buildings. Green healthcare facilities' customary 15% to 25% energy reductions fall short of approaching benchmark energy standards such as the 2030 Challenge, and energy use intensity is significantly higher than even code-compliant facilities in Europe. Challenges associated with integrated use of natural ventilation strategies at U.S. hospitals, for example, hinder more substantial energy reductions.
Hospitals also are extraordinarily water intensive, averaging about 300 gallons per patient bed per day. Water quality and quantity challenges throughout the U.S. and, particularly, the current drought conditions across most of the southern states, call for heightened efforts to reduce healthcare's water footprint and undertake research to safely take advantage of reclaimed water sources cognizant of infection-control concerns.
Transportation dependencies are often overlooked though emerge as significant contributors to a hospital's carbon footprint and to health risks. Analysis by the U.K.'s National Health Service found that transportation represented 18% of its carbon footprint, only 4% less than for direct building energy. Shifting to smaller, decentralized community-based facilities close to public transit and accessible by pedestrians and cyclists is a logical response, coupled with e-based doctor/nurse-patient communications, co-located healthcare/retail facilities, and home-based care options.
Design buildings for people, not technologies. Hospitals should emerge as models of humanistic design and materials, reverting to forms that acknowledge daylight and views to the outside are essential elements of good design, and the importance of using nontoxic materials. Numerous studies correlate access to views and daylight with reduced patient length of stay, pain medication and medical error rate. Staff and patients deserve “a room with a view,” while everyone benefits from materials and cleaning practices that ensure healthy air quality.
In a paper published in 2000, Nobel Prize laureate Paul Crutzen and ecologist Eugene Stoermer introduced the word anthropocene to describe our current geological epoch. They noted the profound influence human activities have had at the global scale. So, in this unprecedented era shaped by humans, let us evoke a commitment to create the conditions for health for all, with the healthcare sector's built environment serving as a beacon of leadership.
Gail Vittori was founding chair of the USGBC's LEED for Healthcare committee.