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The declining condition of the natural environment is beginning to affect the health of populations in many parts of the world.'-" As a result, health care professionals and organizations need to consider the long-term environmental costs of providing health care and to reduce the material and energy consumption of the health care industry. This may seem a surprising conclusion, given that average human health has, for the most part, improved in recent decades despite environmental decline. As indicated in the World Health Organization's 50th anniversary report,12 the average life expectancy at birth worldwide has increased rapidly (from 46 years in 1958 to an unprecedented 66 years in 1998), the rate of death among children under 5 has decreased, more people than ever before have access to at least minimal health care services, safe water and sanitation, and new vaccinations and medications await wide distribution.
Yet, these achievements are fragile. In the long term, human health requires a healthy global ecosystem.13-17 About 25% of health problems are already environmental in origin.18 There is no realistic way or current technology available to replace declining natural ecosystem services (e.g., climate stabilization, water purification, waste decomposition, pest control, seed dispersal, soil renewal, pollination, biodiversity and protection against solar radiation) that are essential to health.'9 Although public health experts increasingly recognize the significant role the environment plays in public health, it is less well recognized that personal health care services also depend significantly on and have consequences for the environment. Linking health care and the environment
Health care figures both as a solution to environmental decline and as a problem. Increasing health problems generated by environmental decline will require medical treatment. At the same time, health care services also damage the environment. In the United States such services generate over 3 million tons of solid waste per year. As with other service industries such as hotels and restaurants, hospitals consume energy in heating, cooling, manufacturing and transportation; they occupy large, complex buildings surrounded by concrete and asphalt surfaces; they use high-volume food services, laundry, high-speed transportation, and paper, packaging and disposable supplies, and so on. Health services also pose unique problems, including the use of pharmaceutical and biological products with complex manufacturing processes, environmentally significant precursors and potentially toxic bodily...