In the goal of sustainability, we try to do the “right thing,” but sometimes the right thing is a moving target. The very thing we once thought was okay suddenly becomes a Big No-No. Often, we find ourselves without a clear “good choice/bad choice” scenario but one in which we must choose the lesser of two, or even several, environmental evils.

Case in point: mercury-containing compact fluorescent lightbulbs which eco-activists are urging Americans to use in place of incandescent bulbs.

Mercury is one of the environmental toxins we know a lot about. It is neurotoxic, and prenatal exposure can result in permanent neurological damage, affecting memory and motor skills. In 1998, following a report to Congress on mercury pollution from medical waste incinerators, the American Hospital Association and the Environmental Protection Agency signed a Memorandum of Understanding, calling on healthcare providers to voluntarily eliminate mercury from their facilities, to identify other persistent bioaccumulative toxins, and to reduce the overall volume of waste.

Okay, so mercury is bad—we get it. Out go the mercury thermometers; out go the mercury blood pressure devices. But how did the compact fluorescent light bulb squeeze past the bouncer and get into the Eco Club when it contains significant amounts of mercury—the very thing we’ve been tasked with eliminating?

	Photo: Jose Gil; Agency: Dreamstime.com.

Although fluorescent bulbs contains mercury and regular “old school” bulbs do not, a fluorescent uses 75% less energy and lasts six times longer. That, to most eco-minded folks, strongly outweighs the risk posed by the mercury.

The reality is that coal-fired power plants are the major source of mercury in the environment today. While the mercury in fluorescent lamp bulbs may create small amounts of vapor, this is a far smaller problem than the mercury generated in coal-burning plants. So, by the logic of eco-triage, use of fluorescent bulbs would substantially reduce demand for electrical power, which would, hopefully, reduce the need for more mercury-spewing coal burning plants. That makes the fluourescents the much lesser of two evils, and a better choice despite the mercury content.

The Green Guide for Health Care (www.gghc.org) can provide you with a lot of help in navigating these nuances and making the “right” choices for your practice. In the case of mercury, for example, the Green Guide explains that not all fluorescent lamps are equal, mercury-wise, and provides maximum mg of mercury for each lamp type. It gives info on vendors selling low-mercury bulbs, and addresses recycling of the spent bulbs, which not only recycles the mercury, but the glass, aluminum and other materials, as well. All fluorescent bulbs should be recycled, no matter how “low” the mercury level.

Okay, so the bulb question is just one simple example. What about choosing the right cubicle curtain, flooring, wall coverings, and carpeting? Each of these choices has a “life cycle” to consider, from manufacturing, to impact on the indoor air quality, exposure, and disposal. Healthy Building Network’s Pharos Project (http://www.pharosproject.net/), now in its beta phase with a planned kick-off next summer, will provide guidance. Pharos calls for transparency, comprehensiveness, independence, accuracy and fairness in analyzing the environmental and health impact of building materials. Pharos is grant-funded and does not accept money from manufacturers. Pharos’ website includes a blog for questions and discussions on safer materials in the healing environment.

There are situations where toxic materials cannot be easily avoided. Cold sterilants and disinfectants, for example, are essential for quality care. Unfortunately, they are also health hazards. But certain things can be done to safeguard staff and reduce ecological impact. Adequate ventilation, proper personal protective equipment, and training personnel for spill response can all help reduce risk. Hospitals for a Healthy Environment’s website www.h2e-online.org offers technologies and strategies for creating a safe and efficient healthcare setting.

We can’t always predict the enviro-scientists’ next No-No. Certainly, as we learn more, we’ll identify more bad guys and, hopefully, safer alternatives. The public is increasingly eco-conscious and demanding safer alternatives. There are more “green building” projects than ever before, and manufacturers are rushing to market with supposedly safer alternatives to meet those demands. In some cases, there is no truly good choice, and the best we can do is to choose the least toxic, lowest-impact option.

All the while, let our choices be guided by the Precautionary Principle, which implies an ethical imperative to prevent rather than merely treat disease, even in the face of scientific uncertainty. This principle can be understood as: “when an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically.”

The current chemical burden on individuals is unprecedented in human history. There are approximately 100,000 chemicals now used in energy production, manufacturing, and consumer products. Almost all are manmade, with 15,000 of them produced annually in quantities greater than 10,000 pounds; 2,800 are produced in quantities greater than 1 million pounds a year. Of those 2,800, only 7% have been tested for developmental effects, and only 43% have been tested for any human health effects (Louisville Charter for Safer Chemicals).

Confusing and difficult as the choices may be, we all need to look much more seriously and critically at what we use, what it’s made from, where it goes when we throw it out, and how we can slow the flood of potentially toxic chemicals in our lives.

Janet Brown is Partners Coordinator for Hospitals for a Healthy Environment (H2E), an organization dedicated to creating a national movement for environmental sustainability in health care. www.h2e-online.org.