Health Care Without Harm’s Safer Chemicals Program seeks to eliminate dangerous chemicals in the health care setting that can adversely affect patient health and employee safety without sacrificing quality of care. To achieve this goal, we focus on promoting a “green” approach to health care that prevents or reduces exposure to toxic chemicals among patients and staff, while also taking into consideration health care’s impact on the environment. 

To learn more about the leadership role that physicians play when it comes to greening health care, we spoke with Dr. Lawrence Rosen, a pediatrician and founder of The Whole Child Center in Oradell, New Jersey. Taking a more holistic approach to health care delivery, Dr. Rosen set out to practice an integrated style of medicine that takes environmental exposures into consideration when treating his patients. The Whole Child Center is also a leading example of ecological sustainability in health care, designed in a way that minimizes impact to the environment while promoting health for staff and patients. 

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When asked why he decided to found one of the first green pediatric practices in the country, Dr. Rosen’s answer was straightforward: He wanted to practice what he was preaching. “I was interested in the humanistic side of medicine,” Dr. Rosen said. “I wanted to focus on an approach to medicine that took into consideration the mind, body, and spirit.” 

In his early years as a physician, chronic ailments such as asthma, food allergies, autism, and obesity were dramatically on the rise. As the incidence of chronic disease continued to increase, it occurred to him that environmental factors must be involved, and the “one ill, one pill” approach to medicine was not going to address the problem. 

In 2008, Dr. Rosen founded The Whole Child Center in order to practice medicine in a way that prioritized prevention. An integrated clinic focused on deep-seated patient-doctor relationships, The Whole Child Center treats children from birth to age 21 and, in some cases will meet with pregnant women before they deliver. Describing his patient population of pregnant moms and young children as an “opportunity to start from the very, very beginning,” Dr. Rosen explains, “It is much easier to prevent problems from developing in the first place, than having to treat them after.” 

“So many of the complex health problems we see today, such as heart disease and obesity, are the direct result of behaviors and environmental exposures that we encounter early in life,” said Dr. Rosen. “Relatively new research shows that parental environmental exposures can affect epigenetic markers in their children,” adversely influencing gene expression and potentially leading to future health problems.

“Fortunately, if we can prevent certain exposures early on [in combination with healthy behaviors] we have the opportunity to minimize many of the chronic health problems we may experience later in life,” he continued. By treating children from a young age, we can make a lifetime of a difference both for that child’s long-term health outcomes and the next generation of children who will be born to mothers and fathers who are much more attuned to the importance of minimizing toxic exposures during pregnancy and early childhood development.

One of the tools that the practitioners at The Whole Child Center rely on in their delivery of care is an environmental health history. An environmental health history, Dr. Rosen explains, is “an important piece of the medical history,” a way to ask questions about a patient’s lifestyle that allow practitioners to better understand someone’s daily exposures. Common questions that may be asked include: What materials were used to build your home? Does your home contain lead? Does anyone in your home smoke? Do you live near a highway with pollution? Are there green spaces where you live? What type of job do you have, and what exposures may you encounter while working? 

By having this conversation with his patients, Dr. Rosen can help find ways to minimize or eliminate certain environmental exposures that are most detrimental to health. For example, if he learns that a patient may be exposed to a high level of pesticides, he can talk to them about minimizing daily exposure through organic purchases, or finding less toxic ways to address pest problems. If there is concern about secondhand smoke exposure, education for a caregiver who smokes may be needed. While certain aspects of someone’s physical environment may be difficult to modify, even more so for patients who are low-income, small changes, with the potential for immediate improvements to a patient’s health, can often be easily implemented.

"As a physician, it can be easy to prioritize environmental factors you think are most important to consider, but it is equally important to conduct community assessments to find out what patients and their parents are most concerned about” Dr. Rosen shares. Some of the biggest changes surrounding chemical safety have come from consumer demand. The removal of bisphenol A (BPA) from baby bottles was not a physician-led change, but rather, came from consumers who said that they would no longer purchase products containing this chemical.”

In addition to consumer demand helping to slowly shift the practice of medicine toward a preventive approach, Dr. Rosen also points out how incentives in the health care system need to be changed before we see long term sustainable change. “As it stands now, the system does not incentivize wellness and prevention, but instead is driven by a reimbursement system that is focused on disease care,” Dr. Rosen said. “Until we start to create an economic incentive for doctors to help their patients stay well and healthy, we’re not going to see the shift in health care that we need to.”

Putting It Into Practice

One of the central ideas at The Whole Child Center is the circular relationship between the effect of the environment on our health and how the practice of health care can impact the environment. When building the clinic, based on what he learned through his work with the Deirdre Imus Environmental Health Center at HackensackUMC, Dr. Rosen set out to create an ecologically sustainable environment that would be a model for families in his practice. Exam tables that do not contain PVC, waiting room bookcases made from recycled wood free of formaldehyde, and non-toxic paint are just some of the green products that are used in the clinic.

Building design that focuses on large windows that let in natural light and GREENGUARD-certified eco resin waiting room dividers are other ways they considered the environment when constructing the practice. The building materials and the products they use create a healthier space for staff and patients, and often help start a conversation with patients about the importance of making “green” choices at home. With an increase in building costs of just 3-5%, Dr. Rosen is confident that these changes are well worth the slightly higher price tag, allowing his practice to serve as a role model for the community. 

For other medical practices looking to make “greener” changes in their own facilities, Dr. Rosen shares two simple changes that can be easily implemented: safer cleaning products and the take back of unused medications. “Many cleaning products on the market today are full of toxic chemicals,” said Dr. Rosen. By switching to greener cleaners, medical practices can reduce their staff and patients’ exposure to asthmagens, carcinogens, and other harmful chemicals.

Taking back unused medication is another high-impact, low-cost program that can be easily operationalized. By implementing this practice, physicians can educate their patients about the negative environmental impacts of flushing medication down the drain. Lastly, Dr. Rosen shares, “By making these changes and sharing successes within the medical community, we can get the word out about the importance of green health care for our patients, practice staff, and the environment, and inspire others to change.”

To learn more about Dr. Lawrence Rosen’s work, please visit The Whole Child Center’s website. To make the switch to greener products and safer alternatives in your own practice, consider joining the Healthier Hospitals Initiative’s Safer Chemicals Challenge.