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Cohen’s Nonprofit Helps Hospitals Go Green

Gary Cohen and his nonprofit, Health Care Without Harm, have persuaded hospitals around the world to close their medical-waste incinerators, dramatically cutting emissions of dioxin and other toxins.

Gary Cohen is not a doctor or a nurse. He has never worked in a hospital, and, he admits, he thinks hospitals are kind of scary, in part because both of his parents died in one. But when the Environmental Protection Agency released a draft report in the mid-1990s, citing hospital incinerators as the country's No. 1 source of carcinogenic dioxin emissions, Cohen, a longtime environmental activist, simply couldn't abide the irony. How could the industry that existed to heal people be doing so much harm?

In 1996, he and colleague Charlotte Brody founded the nonprofit Health Care Without Harm, and Cohen quietly made his way to hospitals around the country, explaining to aghast administrators how their operations were hurting patients, employees and communities. Then he supplied them with cost-effective steps they could take to remedy the situation, as well as the promise of a lasting partnership.

Some 15 years later, Health Care Without Harm is a coalition of nearly 500 hospitals, universities, health professional organizations and environmental groups working in 52 countries around the world. When Cohen began the work, there were 5,000 medical-waste incinerators in the U.S. By 2006, there were 83. Back then, every nurse carried a thermometer filled with highly poisonous mercury; the instruments lined the shelves of pharmacies and went home from the hospital with new mothers. Today, mercury thermometers are practically obsolete in the United States, and Cohen, partnering with the World Health Organization, is on the cusp of making them disappear around the world. Cohen helped hospitals leverage their massive buying power to get medical supply companies to stock hospitals with greener products. Even as his work with hospitals deepened in the U.S. and expanded worldwide, Cohen has a more ambitious goal. "If the health care sector can clean up its own house," he says, "they can be powerful messengers in the broader society on how we can detox the entire economy."

Cohen calls himself an accidental activist. Before becoming an environmentalist, his great passion was India. He studied Eastern philosophy in college and after graduating spent a couple of years traveling in India on what he describes as a journey to find himself. Then he enrolled in a graduate program in Indian philosophy at the University of California, Berkeley, but when the woman who eventually became his wife moved east, Cohen dropped out and moved with her to Massachusetts, unsure what was next. His best friend from college, John O'Conner, offered him a job at the National Toxics Campaign, which he had just founded. As Cohen made his way around the country meeting with community leaders, the work grew on him.

In December 1984, a Union Carbide factory exploded in Bhopal, India, spewing poisonous chemicals over a sleeping community. Some 5,000 people were killed and a half a million sickened in a single night. "When Bhopal happened, I thought this is the Hiroshima of the chemical industry. This is what it looks like," Cohen says. Cohen would go on to use Bhopal as a rallying cry to push for the passage of a U.S. law, the Emergency Planning and Community Right-to-Know Act, requiring companies operating in American communities to report what chemicals they use and to maintain emergency plans.


In the years after the explosion, Cohen helped Bhopal survivors try to get compensation from Union Carbide, worked on toxics issues in the U.S. and made a trip to Auschwitz. While there, he says, he learned that chemical companies not only sold the gas used to kill the prisoners in the concentration camps but used prisoners as slave labor to build factories. Cohen speaks of Eastern philosophy and the importance of finding humanity in one's opponents when discussing his work in the health care sector. It is a grace he is unwilling to extend to the chemical industry, which, he now believes, is ruled by a "culture of complete immorality." Fighting that mindset, he says, is what it means to be a "good Jew" working for justice. Some industry supporters aren't that fond of Cohen either, dubbing his organization "Health Scare Without Shame." "He has this idea that the chemical industry has been very evil and that it has roots in many of the things that have happened that are wrong in the past 150 years," says Ravi Agarwal, an Indian friend and colleague of Cohen. "I think it is a very strong part of his psychic makeup. When he talks about it, you can see that he is deeply affected by it."

Cohen's work in environmental health was nearly derailed in 1995, when disagreements with O'Conner over the direction of the National Toxics Campaign led to the organization's demise. Cohen and his wife took off for India and seriously entertained the idea of staying there permanently and opening a retreat center for activists. But Cohen says he was asked to support an effort to keep a DuPont nylon factory from locating in the southwest India state of Goa, and he jumped right in, speaking and helping with strategies for opposing the new plant. In 1995, DuPont retreated. "I was amazed at the power of people defending their community against being poisoned," Cohen says. "And I knew I had to get back to doing this work."

Cohen and his wife came back to the U.S., and he immediately organized a series of conferences among leading environmental health activists to assess new science about endocrine-disrupting chemicals. While the meetings were going on, an EPA draft report on dioxins, which are both carcinogens and endocrine disruptors, became public. "We had all these things coming together about endocrine disruptors and dioxins, and everyone was like, 'Oh my God, you have to do something about the health care sector. They are the ones who should most understand this science, and they are the most responsible for dioxin pollution.' How crazy is that? Don't they take this Hippocratic Oath to do no harm?" Cohen says. "And that is how Health Care Without Harm was born."

One of the first stops Cohen made after he and Charlotte Brody launched Health Care Without Harm was Catholic Healthcare West, a large nonprofit hospital chain based in San Francisco. It was 1996, and Cohen explained to the executives that the health care industry was the top dioxin emitter because of the amount of waste it was incinerating, and because much of that waste contained polyvinyl chloride, or PVC, a plastic that releases dioxins when burned.

"I was shocked," recalls Susan Vickers, a vice president of Catholic Healthcare West and a nun in the Religious Sisters of Mercy order. She says she was also sufficiently impressed by Cohen's knowledge and approach that she wanted to be a part of his new coalition. "Here was someone right in front of us who we could tell would be, in a word, a colleague, and lead us gently in the right direction. So after his presentation and the question session, I stood up in front of the group and asked if the group would be willing to endorse HCWH's goals as our own right then and there. Everyone said yes," Vickers said. Soon after, health care giant Kaiser Permanente also became part of the coalition.

During his time in India — much of it spent reflecting on the implosion of the National Toxics Campaign — Cohen became convinced that the success of the environmental justice movement depended not on building a single organization but on creating a network or "ecosystem of collaboration." That ecosystem needed to include industry, and to get businesses involved, Cohen felt the movement needed a new approach. "I knew it was important to create a situation where everyone could save face, so we could get beyond shame and blame and find ways to succeed. So it was a conscious choice not to blame the health care sector. We said the sector is environmentally illiterate, and if we can make them literate and make them understand the issues, they will change," Cohen says.

Cohen helped hospitals move away from incineration by demonstrating that autoclaving medical waste — that is, sterilizing it — and then disposing of it in a landfill was safer and cheaper than burning. Then he helped them reduce the amount of plastic waste they discarded via recycling and paying attention to the packaging of items, pre-purchase.

Cohen's soft spoken, solutions-oriented approach also appealed to Arthur Mombourquette, vice president of Brigham and Women's Hospital in Boston. "He's an educator who figures out what the problems are and finds solutions. He never shows up without the facts or examples of how things can be done," Mombourquette says. "I think the secret to his success is that he finds common ground and then sells it effectively."

The health care industry accounts for 17 percent of U.S. gross domestic product; Cohen felt that environmental reforms in the health care industry would create a multiplier effect. And he says Health Care Without Harm's work on thermometers is proof of principle. His group invested a few thousand dollars to switch out mercury thermometers for digital ones at a single hospital in Boston. As he worked with more hospitals on the issue, Cohen also was able to convince the largest drug store chains in the nation that it wasn't in their interests to continue stocking such a dangerous product. (At the time, mercury spilled from broken thermometers was the No. 1 reason behind calls to poison control lines across the country, Cohen says.) Next he worked to get cities, then some states and even entire countries to ban mercury thermometers.

Now, Cohen is partnering with the World Health Organization to eradicate mercury from health care worldwide. And the United Nations is considering a treaty that would eliminate mercury from commerce, everywhere on Earth. "In that treaty process, the progress of the health care sector in eliminating mercury is being held up as the leading edge," Cohen says. "That's exactly what we had in mind from the beginning."

Cohen also helped hospitals wield their vast purchasing power to bring safer products onto the market. Many hospital supplies contain PVC, which isn't only an environmental problem when it's burned but when it is manufactured and sent to a landfill. Cohen wanted hospitals to start moving away from PVC, but there were few alternatives. "We told our suppliers if you can bring us a good alternative, we are going to be really interested," says Kathy Gerwig, vice president for workplace safety and environmental stewardship officer at Kaiser Permanente. "It might take some time, but eventually we make those changes, and they are baked in and then they affect other industries, then you've expanded beyond health care." Kaiser Permanente launched a carpet challenge, promising a big contract for the company that successfully invented an industrial-strength carpet that did not include PVC. "Now there is a healthier carpet on the market that can be used by anybody," she says.

As hospitals in the coalition eliminated mercury and incinerators and switched to safer plastics, Cohen started talking to them about greening their cleaning supplies, serving healthy and sustainably grown food, reducing energy use and building with environmentally friendly materials and designs. If Cohen started out trying to get hospitals to do less harm, now he thinks they can evolve into promoters of personal and environmental health. For instance, numerous hospitals working with him hold community farmers markets on their grounds and are purchasing renewable energy.

Changing the culture of the health care industry has the potential to affect policy, as well. As a glimpse: Gerwig recently testified before Congress to show Kaiser Permanente's support of legislation that would reform the Toxic Substances Control Act, a law that is notorious among environmentalists for allowing companies to hide chemical ingredients of products from consumers, based on the concept that those ingredients constitute confidential business information.

"He is working with an industry that is present in every community all across America," says Lois Gibbs, an environmental justice activist known for her work on Love Canal. "Now we have these doctors, these nurses, these health care practitioners — who in the general public are seen as God and totally credible — on our side. That's pretty remarkable."

Cohen's biggest strengths are, perhaps, his ability to bring people together under one tent and to raise the funds to bankroll the tent. He runs a second environmental group, the Environmental Health Fund, out of the first floor of his Victorian home in Jamaica Plain, just outside Boston, where he lives with his wife and daughter. The fund has served as an incubator for four large, and effective, national campaigns for safer chemical policies and safer products. Yet relatively few people know of the group, which was founded in 1998 but didn't set up a website until last year.

The extreme low profile of the organization mirrors Cohen's overall approach. He's shunned the limelight, preferring to toil away backstage, building networks, strategizing and raising money. The Environmental Health Fund never had a website, he says, because part of the group's mission was to support the emergence of new leaders.

"Cohen is a great organizer, and great organizers are people who are almost invisible, who give others the idea that they have done this," says environmental health activist Michael Lerner, who has partnered with Cohen on many projects. "HCWH is the ship from which he has navigated, but the command he has over the entire field must not be overlooked."

Cohen, of course, continues to support efforts to seek justice in Bhopal and sits on the board of the clinic he helped establish to treat Bhopal survivors and their children. In a folder in his office, in fact, he has a picture of the hulking, rusty armature of the Bhopal plant, towering above the rubble created by the explosion there 25 years ago. "Then within half a mile of that image of death and destruction is this," he says, taking another photo out of the folder, this one of an open and airy clinic surrounded by green gardens. He holds a photo in each hand and says, "These two images represent the poles I travel between." Then he puts them back in the folder, the photo of the clinic on top.