UW Health Integrative Medicine, the University of Wisconsin School of Medicine and Public Health, the office of Continuing Professional Development in Medicine and Public Health, and faculty within the Department of Family Medicine present:

Pathways to Health and Healing - Green Medicine: Healthy People, Healthy Planet

This two-day conference (April 14-15, 2008) will focus on improving/enhancing/greening your internal and external environments.

• Conference Brochure

Green Medicine: A Primer

By Luke Fortney, MD, Rian Podein, MD, & Michael Hernke, PhD

What is Green Medicine?

This is the question asked by many, and it is a good question to ask. It comes down to the simple idea of the Precautionary Principle, which was officially put forward right here in Wisconsin in the 1990's, and it states simply:

The Precautionary Principle is included in the American Public Health Association which has put forth a resolution that explicitly endorses the precautionary principle.

What does this have to do with health?

Over the past 50 years society has created a milieu of more than 82,000 chemicals documented under the EPA Toxic Substances and Control Act that have been developed, used, distributed, and discarded into the environment with about 700 new chemicals emerging each year. Alarmingly, the vast majority of these chemicals have not been tested for potential toxic effects in humans or other forms of life. The bioaccumulative effects of this toxic milieu have been evaluated with disconcerting results. In one study of newborns, researchers found an average of 200 industrial chemicals and pollutants in umbilical cord blood from 10 babies born in U.S. hospitals. A recent study by the World Health Organization reported that environmental risk factors (limited to include pollution of air, water, or soil with chemical or biological agents, and human-made climate change) play a significant role in more than 80% of the diseases monitored by the WHO; and that nearly one quarter of deaths and total global disease burden can be attributed to environmental exposures alone.

How does this pertain to us right here in Madison, WI?

One objective measure of consumption and sustainability is the Ecological Footprint. This tool is an accounting method that documents the extent to which individual and collective human economies stay within the regenerative capacity of the planet. Recent measurements using this method demonstrate that the average US resident requires over 9.6 hectares (23.7 acres) to provide for her/his consumption levels. In contrast, as of 2007 there were only 1.8 hectares (4.5 acres) of biologically productive land and sea area available per person globally. When the demand on nature exceeds the biosphere's supply or regenerative capacity, this global ecological deficit (overshoot) leads to a depletion of Earth's life supporting systems (natural capital) and a build up of waste. In 2002, global society operated in a state of overshoot, demanding over 20% more biological capacity than the Earth's ecosystems could regenerate in that year.

What can we do about it?

A working definition for sustainable development emerged in 1987 when the World Commission on Environment and Development published a report entitled Our Common Future. The document came to be known as the Brundtland Report, named after the Commission's chairwoman, Gro Harlem Brundtland. It provided the guiding principles for sustainable development, defined as meeting the needs of the present without compromising the ability of future generations to meet their own needs.
A very practical example of an inclusive and effective framework for global sustainable development is The Natural Step (TNS). Created in the late 1980s by Swedish physician and oncology researcher Karl-Henrik Robèrt, TNS was derived by a scientific consensus process and has been adopted by businesses (eg Interface, Ikea, Electrolux, HydroPolymers, Nike, Starbucks, CH2M Hill, DuPont, Alcan, etc) and communities around the world, including Madison, WI. TNS entered health care directly when it was integrated with an initiative addressing sustainable construction of the Princess Margaret Hospital (PMH) in the United Kingdom. PMH formed a partnership with TNS with the specific aim of setting benchmark sustainability standards in the design, construction and maintenance of a major hospital project. Further, the Department of Family Medicine and Integrative Medicine is hosting a CME conference on Green Medicine that addresses the interplay between healthcare, the care of patients and ourselves, and how sustainable development can factor into the practice of medicine.

How can sustainable development be implemented?

The basic framework of TNS, founded on universally accepted scientific principles and systems thinking, forms a compass to guide organizations toward sustainability and can be applied at any level or scale, including medicine. These principles, which can be translated into practical and meaningful forms for organizations and communities, are described as follows:

1. Eliminate our contribution to increasing concentrations in nature of substances extracted from the earth's crust.
2. Eliminate our contribution to increasing concentrations in nature of substances produced by society.
3. Eliminate our contribution to increasing degradation of nature by physical means.
4. Eliminate our contribution to the systematic undermining of people's capacity to meet their needs.

How can we take action and learn more?

The health care industry is deeply embedded with the environment, planet, and all its inhabitants. If the earth's ecosystem is to continue supporting human activity, we need to provide health care and conduct research in ways that enhance and sustain ecological systems and maintain public health. Health care management and practice that continues with unsustainable business-as-usual will compound environmental and climate degradation with subsequent adventitious human illness, suffering, and ecological destruction, making further medical advances irrelevant. The Hippocratic Principle of Do No Harm requires that we develop sustainable practices and prevent harm to humans, our community, and the natural world. There are numerous reasons to pursue sustainability within health care, including; responsibility toward the environment for both nature and ourselves, ethical duty for the welfare of future generations, just and equitable allocation of resources, financial benefits of avoiding increasing costs and missed market opportunities, improved public health and health care delivery, and a spiritual call to stewardship. Regardless of the intention, the time to decide what really matters is now. Health care professionals and administrators, at all levels, can become actively involved in balancing environmental responsibility with clinical services; and The Natural Step offers a proven and effective tool to facilitate this requisite transformation.

To learn more about The Natural Step consider the following resources:

• Website: www.naturalstep.org
• Book: The Natural Step Story: Seeding a Quiet Revolution Karl-Henrik Robèrt.
• Curriculum: To take part in The Natural Step curriculum visit www.naturalstep.ca