Health care: Setting the standard

Health Care Without Harm
8 min readApr 11, 2018

Health Care Without Harm created criteria that are now being used by universities, governments, and other sectors beyond health care

By Helaine Alon

It’s surprising, but according to the U.S. Environmental Protection Agency, the average American spends 90 percent of their time indoors. And indoor air pollution can be two-to-five times worse than outside, leading to negative health outcomes. In response to this threat, Health Care Without Harm developed model environmental purchasing criteria to improve indoor air quality in hospitals and to protect the health of patients, staff, and visitors. Those criteria are starting to be adopted by other sectors, extending Health Care Without Harm’s reach and influence.

Working closely with Practice Greenhealth, Health Care Without Harm seeks to transform the health sector worldwide, without compromising patient safety or care, so that it becomes ecologically sustainable and a leading advocate for environmental health and justice. Our commitment to protect the environment and human health extends outside the walls of health care, to include the effects of product manufacturing and disposal.

The Healthy Interiors goal encourages hospitals to ensure that 30 percent of their annual volume of furnishings and furniture purchases (based on cost) eliminate the use of formaldehyde, per- and poly-fluorinated compounds used as stain/water resist treatments, polyvinyl chloride (PVC), antimicrobials, and all flame retardants. The goal was developed in 2012 and updated in 2015 as part of Practice Greenhealth’s Healthier Hospitals Safer Chemicals Challenge. The targeted chemicals were prioritized for elimination based on scientific evidence regarding their persistence in the environment and humans, and their potential negative health impacts. They were also chosen because it was technically feasible for manufacturers to remove these chemicals from their products. A critical tool for the goal to succeed was the development of lists that manufacturers provided detailing products that met the criteria developed by Health Care Without Harm.

As the furnishings criteria were successfully adopted in health care, other sectors, including the private sector, higher education, and local and state governments, took notice and incorporated them into their purchasing specifications and guidelines, increasing the potential market impact.

Beyond the hospital setting

While Health Care Without Harm was working with hospitals to implement the first version of the Healthy Interiors goal, the Center for Environmental Health (CEH) was promoting their “purchaser pledge” through which institutional purchasers could indicate their unified preference for flame retardant-free furniture.

In 2015, the regulatory environment changed to allow furniture without flame retardants in institutional settings, while still meeting fire safety regulations. The changed regulations allowed Health Care Without Harm to introduce the updated healthy interiors goal, which expanded the targeted list of chemicals to include all flame retardants, whereas the original goal only restricted a subset of flame retardants. To increase the potential for market transformation by having one uniform standard, CEH decided to harmonize the next version of its pledge with the updated Health Care Without Harm goal.

According to Judy Levin, Pollution Prevention Director for CEH, Health Care Without Harm’s topical knowledge and ongoing conversations with manufacturers gave her confidence that the Healthy Interiors criteria were both achievable and realistic, and that there were enough products available for purchasers to adopt the criteria successfully. Levin stated,

“CEH recognized that in order to create a ‘race to the top’ for healthier products, market pressure from large scale purchasers from across multiple sectors would expedite the transition to safer products. In many cases, the furniture manufacturers wanted to remove these chemicals of concern from their products, but needed a robust and unified market demand to warrant the investments needed to make these changes.”

Today, there are about 20 pledge signers from diverse backgrounds that are all unified in committing to purchase products that align with the Health Care Without Harm criteria, including Genentech, The Honest Company, the City of Portland, the City and County of San Francisco, the University of California at Santa Cruz, and LinkedIn. Although state governments are not able to officially sign an advocacy group’s pledge, the State of New York has adapted these guidelines to inform their own purchasing habits. In total, these groups represent more than $235 million in purchasing power. CEH was recently awarded the Market Transformation Award by the Sustainable Purchasing Leadership Council for this work.

Entering the halls of the university

Among the initial group of signers to CEH’s Purchaser Pledge in 2015, Harvard University was the first college to commit to preferring flame retardant-free furniture. In October 2017, Harvard went beyond that goal and integrated the Health Care Without Harm Healthy Interiors criteria into its green building standards, requiring the criteria to be met for all furniture purchases. The standards are part of the university-wide sustainability plan that “aligns Harvard’s decentralized campus around a holistic vision and sets clear university-wide goals and priorities in the areas of emissions and energy, campus operations, nature and ecosystems, health and well-being, and culture and learning.” For such a large institution, consisting of some 700 buildings, 13 colleges, 27 million square feet of real estate, and about 45,000 people, this is no small feat.

To get there, the Office of Sustainability facilitated a two-year participatory process, bringing scientifically backed information to the university body. Heading up this process is the director, Heather Henriksen, who says they brought in administrative groups, schools, and departments, and had a collaborative process to translate the big ideas and research into practical standards, goals, and commitments that are measurable and attainable. They then focused on getting a clear roadmap and creating tools and policies to help make this happen.

Throughout Harvard’s process, the approach Health Care Without Harm took when developing the Healthy Interiors criteria helped shape the conversation.

“Our process evolved. We started by addressing flame retardants but recognized the systemic approach taken by Health Care Without Harm’s Healthy Interiors criteria and decided to adopt it. Health Care Without Harm had a larger vision: They asked, what ingredients are in furniture that we typically use? And from a health perspective, what are we most concerned about?” Henriksen says. “Let’s address all of these chemicals with one set of criteria. We want furniture that is not only safe and healthy, but also does not cost more, is beautiful, and readily available. Why add toxic chemicals into our spaces that are not necessary and may be ineffective?” asked Henriksen.

In practice, the Healthy Interiors criteria worked well for their pilot projects and were easy for their preferred vendors to follow and fulfill without any negative impact to schedule, cost, or beauty, she says. “This is an example of a broader opportunity to drive the entire built environment and supply chain system to respond to the demand for safer products.”

“If Kaiser Permanente can remove antimicrobials, surely we can too.”

For both the Harvard Office of Sustainability and CEH, knowing health care institutions had adopted the Healthy Interiors criteria provided reassurance that the criteria were both important and attainable.

“Health Care Without Harm provided a foundation and is an important voice and validator because it is driven by health and science. And I always like to say, if Kaiser Permanente can ban antimicrobials in their space, then surely, anyone can,” Henriksen says.

This collaboration and cross-sector buy-in on a common set of criteria saved resources and the need to reinvent the wheel. By unifying the demands of different sectors, it created a strong and united market signal for manufacturers. Market transformation can be sped along when a large number of consumers want the same things and demand it both with their dollars and voices. That’s why the CEH purchaser pledge asks signers not only to prefer non-toxic furnishings when they are ordering but also to actively voice their preference directly to manufacturers.

Levin says working with Health Care Without Harm to standardize these criteria “has been really helpful in getting the message out, making sure the message is accurate, and getting it implemented. With Health Care Without Harm focusing on health care and CEH focusing on government, higher education, and private business, we are trying to reach as many significant purchasers as possible. That strategic alignment has meant real market movement, and Health Care Without Harm’s work on this has been instrumental to moving all of this forward.”

If you teach it, they will want it

Education is essential when it comes to shaping consumer demand and changing purchasing practices. “Getting people to change their thinking after the chemical industry has done such a good job advertising false benefits can be a challenge, but most people, when they learn the facts, prefer not to have toxic and unnecessary chemicals in their products,” says Levin.

“It is through education, explaining the science, and providing data and research that change occurs,” Henriksen says. “No one wants these chemicals of concern in their factories, exposing their workers, or ending up in their products — there is risk in that. So there can be incredible alignment when manufacturers understand that these chemicals are being used in their supply chain unnecessarily or that there are safer, cost-effective alternatives.”

“Large organizations with enough buying power eventually will get what they ask for from furniture manufacturers. It is fundamentally market forces at work, so I think by tapping into market forces, and aligning the demands of health care, higher education, and the private sector, we can drive change more quickly. If everyone specified furniture that meets the Healthy Interiors standard, it will eventually switch from something you need to specify to being the only thing you can purchase,” Henriksen says.

“But there is more work to do,” warns Henriksen.

“We need to make sure that one chemical of concern isn’t going out while another is going in. We need to remain focused and vigilant, making sure that this is systemic change. We also need to focus on transparency. I believe large organizations that purchase furniture today should demand material transparency from the manufacturer, and should reward those manufacturers that provide it. There are a number of very large and reputable furniture manufacturers that are fully transparent and that make furniture that is beautiful and comfortable while also meeting the Healthy Interiors standard. Let’s reward them, purchase from them, and use them. You do not have to give up on anything — not cost, aesthetics, choice, schedule. I am confident that since we have been able to do this so rapidly, any large organization that gets alignment internally should easily be able to accomplish this,” says Henriksen.

With these collaborative, cross-sectoral initiatives, and with increasing consumer demand for such products, our market impact will continue to grow.



Health Care Without Harm

Health Care Without Harm seeks to transform health care worldwide so the sector reduces its environmental footprint and becomes a leader in the global movement.