Gary Cohen, Founder and President of Health Care Without Harm

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Mark Masselli: This is Conversations on Health Care, I'm Mark Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Well Margaret looking at another Supreme Court case which is
challenging pa rt of The Affordable Care Act.

Margaret Flinter: This time the High Court decided to accept a group of challenges to
the last mandate that requires coverage for contraception for all National employers,
even those with religious affiliations. Some of the plaintiffs include u niversity and
hospital organizations who object to the contraception mandate.

Mark Masselli: The Court has ruled that family owned companies operating on religious
principles could object to contraception provisions based on their rel igious grounds.
The new case though before , the Supreme Court will strike more closely to the rights of
religious groups to object to the Federal mandates under The Affordable Care Act.

Margaret Flinter: Well, the High Court is not expected to rule on th e case until late
spring and it’s not going to have any major bearing on the overall Healthcare Law, but it
does have the potential to disrupt coverage for those working for religious institutions
across the country.

Mark Masselli: And another event to wa tch , Margaret, is the upcoming UN Climate
Change Summit in Paris. Climate Change is still a heavily debated issue in this country,
as well as around the world, but the evidence is clear, climate change is already having
an impact on global health.

Margare t Flinter: And that’s something that our guest today i s very familiar with Mark.
Gar y Cohen is a 2015 MacArthur Fellow and Founder of Healthcare without Harm.

Mark Masselli: He is also one of President Obama’s C h ampion of Change award
winners for his work in this field looking forward to that conversation.

Margaret Flinter: We have also got a report from Lori Robertson, managing editor of
Factcheck.org, who is always on the hunt for missta tements spoken about Hea lth Policy
in the public domain, but no matter what the topic, you can hear all of our shows by
going to chcradio.com.

Mark Masselli: And as always if you have comments please email us at
[email protected] or find us on Facebook or Twitter ; we love hearing from you

Margaret Flinter: We'll get to our interview with Gary Cohen, founder of Health C are
W ithout Harm in just a moment.

Mark Masselli: But first here is our producer Marianne O'Hare with this week's headline
news.

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Marianne O'Hare: I'm Marianne O'Hare with these Health Care Headlines. A startling
up - tick in the premature deaths of middle aged white Amer icans, particularly men. The
cause maybe even more surprising, the report released by recent Noble Prize winner
for Economics, Angus Deaton revealed the up - tick in death rates is due to a rise in
alcoholic liver disease, suicide , and drug overdoses. The study looked closely at the
demographics of this group finding a direct correlation between lower education status
and higher incidents of premature death. Death rates rose 22% among middle - aged
white males, with a high school ed ucation or less. 400,000 uninsured Kentuckians have
gained coverage under The Affordable Care Act, outgoing Governor Steven Beshear;
the only Southern Governor to expand Medicaid coverage for its citizens living near the
poverty line and creating an onlin e State Insurance Market Place has functioned very
well , b ut that progress could be coming to an end. Kentucky’s incoming Governor and
Tea Party candidate Matt Bevin plans to derail The State Exchange, which means
residents will have to then relay on a Fe deral exchange. He also plans to role back
Medicaid Eligibility for many of those 400 , 000 newly covered. Open enrolment is
underway across the Nation and many folks relaying on coverage through the Federal
market place are finding it harder to secure pla ns that support out of network coverage.
The federal law does not require such coverage and many are paying higher premiums
that allow them more flexibility. Last year, the insurers shrunk the number of providers
within those networks of many plans leaving consumers with fewer options.

Childhood obesity has reached epidemic proportions . T hose signs show a certain
leveling off, but still 30% of American teens qualify as obese. Study shows gastric
bypass surgery in morbidly obese teens does have lasting effects. Not only did the
average weight loss come in at about 27%, it was su stained overtime and other long -
term health benefits presented as well, lower blood pressure, blood sugar, joint disease,
and incidents of adolescent type 2 diabetes. This study reflects the longest and largest
analysis of results from teen bariatric surgery and published online in the New England
Journal of Medicine.

I'm Marianne O'Hare with these Health Care Headl ines.

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Mark Masselli: We're speaking today with Gary Cohen, 2015 MacArthur Fellow and
President and Founder of Healthcare without Harm, an International Coa lition of Health
Professionals, dedicated to eliminating harmful ways and pollutants from He althcare
Industry. He has also earned numerous awards and distinctions including being named

one of president Obama’s Champions of Change, -- the scholar award for social
entrepreneurship He earned his BA from Clark University. Mr. Cohen welcome to
Conversations on Healthc are.

Mr. Cohen : Thank you so much for having me.

Mark Masselli: Yeah and it is 20 years since you have founded Healthcare without
H arm and at that time you have been researching the overall effects of chemical
pollutants on the Worldwide Environment and you uncovered startling fact that nation’s
hospitals were the largest contributors to the spread of industrial pollutants through the
incine ration of millions of tons of medical waste that obviously spur red you into action
and I am wondering if you could tell our listeners about the size and the scope of the
problem of medical waste disposal and what the Healthcare without H arm was able to
do about it?

Mr. Cohen: Well we realized in the mid 1990s that medical waste was an enormous
problem , and it was validated by The US Environmental Protection Agency. They came
out with a report that said Medical waste incinerators were the largest source of dioxin
emissions in United States, and dioxin is linked to cancer, birth defects, learning
disabilities, endometriosis, and there is a whole host of health problems and the idea
that hospitals were a large source of such poisonous emissions was so absurd and
against their mission to do no harm , s o we created this organization and initially focused
on medical waste to heal the pollution from the healthcare sector , and we were able to
show that if you reduce the amount of waste that you produced in the first place , reduce
the amount the infectious waste which is really important s o if you did that , you could
save a lot of money. You could also use alternative technologies to treat the waste , s o
you can render the waste inert and then you could bury as much s maller amount of
waste as opposed to burning it all , and so from 1996 to 2006 , there were 4500
incinerators and then there were 70 incinerators 10 years later.

Margaret Flinter: Pretty impressive. Well Garry you also discovered that the healthcare
indust ry was responsible for the spread of another toxic and deadly pollutant mercury,
which was ubiquitous in healthcare institutions around the world when you started your
work, the mercury from just one broken thermometer having the ability to compromise
an e ntire water supply. You formed alliances to confront the problem with major global
partners . C an you tell us about th e s e partnerships and the dramatic results you were
able to achieve in reducing the threat of Mercury poisoning ?

Mr. Cohen: In the mid 19 90s, healthcare was responsible for about 10% of all mercury
emissions and so we convinced 1 hospital in Boston, Beth Israel Deaconess , to
basicall y offer their employees and their patients to bring their mercury thermometers in
1 day and they gave them di gital ones in replacement and they were the first hospital to

commit to phase out mercury thermometers . W hy, because there were alternatives on
the market place that also measured people’s temperature just as well. We then
convinced the other hospitals i n Boston to follow the lead of Beth Israel and then the
City of Boston basically restricted the sale of mercury thermometers. We set up a
pledge with the American Hospital Association, and the EPA and the American Nurses
Association and eventually got 500 0 ho spitals to commit to go mercury - free and that led
to the pharmacy chains realizing that their market was being restricted , and they should
stop selling mercury thermometers and so 14 large pharmacy chains also agreed to
stop selling mercury thermometer s. We have an office in Europe and because there is
still functional democracy in Europe , we were able to win legislation basically for
phasing out mercury thermometers and t hen blood pressure devices, and then we
started again with one hospital in Manila in the Southeast Asia and Philippines , one
hospital in Buenos Aires and again sort of built it up from 1 hospital to 1 city to 1 country
and then partnered with The World Hea lth Organization to create momentum globally
for the phase out of mercury in healthcare and then along the way came a treaty that
was going to commercially eliminate mercury , and we were able to win in the treaty, the
phase out all mercury measuring device s by the year 2020 , s o it was a great example of
how you can start small with single hospital and move overtime toward global policy,
global treaty , and that the role of the healthcare sector not only in sort of detoxing it’s
own supply chain but showing t he rest of the economy how to do that was very powerful
treaty and a larger source of mercury of course is coal fire power plants and so the next
transformation here is to phase out all coal facilities around the world over the next 5
years.

Mark Masselli: And you sort of make it sound simple but I am sure it wasn’t.

Mr. Cohen: It wasn’t simple.

Mark Masselli: It wasn’t simple. If it was simple anybody could do it and you identified
additional toxins within the healthcare system. Plastics in healthcare devices and the
like – tell our listeners who are some of the worst defenders were and how you
campaign to eliminate those harmful products also were received?

Mr. Cohen: We started to learn about some of the plastics that were used in patient
care and P VC plastics are used in a lot in IV bags and tubing and other devices and
PVC is a problematic plastic, probably worst in class . I mean it uses chlorine to be
produced, so you create dioxin in the production, in the middle, when you use it, in order
to ma ke it flexible and pliable you need to add things to it. You need to add chemicals
and what we found is that the chemical industry was adding a chemical that was a
reproductive toxin into the PVC so as you were getting you IV drip you were also being
infu sed with a reproductive toxin , s o how crazy is that. Especially for the most
vulnerable patients, pregnant women, children in the neonatal intensive care unit, the

last thing they need is additional toxic chemicals , a nd so we raised these issues and
said look, we need to move towards safer plastics in the healthcare sector. We need to
phase this out. Initially, we started with the neonatal intensive care unit and put a lot of
pressure on the medical device manufacturers. (a) T o acknowledge that this was a
problem and (b) T o then pressur e them to innovate toward safer products and the way
that we found that ; there was some of those powerful ways by leveraging the demand of
large hospital systems , a nd so Kaiser Permanente which is the largest nonprofit health
system in the country made a system wide commitment to phase out PVC and that
started to create all sorts of momentum and then Dignity Healthcare followed suit , which
was another huge Catholic S ystem a nd so it started to move the market toward safer
plastic , s o healthcare has enormous purchasing power. It’s 18% of the entire economy
and if we can direct that purchasing power toward health and justice and sustainability,
we can change the economy.

Margaret Flinter: Well Gary, I understand that area that is now getting some long
overdue attention and that’s the food that hospitals purchase to fee d their staff and their
patients. You’ve been fostering the growth of relationships between healthcare
o rganizations and local sustainable farmers and again you ’ve cited Kaiser Permanente
as a great example of this policy and action. Tell us about this? How you’re advancing
this locally grown movement through healthcare without H arm?

Mr. Cohen: Well everywhere we looked, we found some other disconnect between the
environment and people’s health , and it was quite egregious when it comes to the issue
of food and so you would have hospital serving doughnuts and sugar sweetened
beverages and junk food, and so it ’s giving a complete wrong message to patients and
employees and so we wanted to get healthcare to model healthy food environments and
so the early efforts were to eliminate sugar sweetened beverages from their facilities , to
serve healthier food , to have fast food free zones in the hospitals , but then we said okay
can you create farmer’s markets in your lobbies, in your parking lots , as a places of
access for the local community. Can you leverage your purchasing power to support
mo re sustainable and local farmers? So it is changing healthcare to acting as an
anchor for not only community wealth and community health together and so what we
have done overtime is working with systems like Kaiser Permanente but many, many,
many others around . T he country is aggregating their purchasing power to create the
demand for safer food, healthier foods, more sustainable food , and in some cases even
linking with school systems now to move the market.

Mark Masselli: We are speaking today with Gary Cohen, 2015 MacArthur Fellow and
President and Founder of Healthcare without Harm, an International Coalition of Health
Professionals, Hospital, Environmental Groups and patient advocates dedicated to
elimina ting harmful waste and pollutants from the healthcare industry . Gary, we are
also very much committed to the environmental movement. We built a few years ago,

50,000 feet LEED Gold B uilding for primary care and, you know , we have had the
opportunity of h aving hospital designer Robin Guenther on the show. Talk to us a little
more about her example and others where sustainable hospital design is really
beginning to have an impact ?

Mr. Cohen: Yeah, if we can build hospitals that have more natural light, th at use safer
building materials, that are resilient, in particular to climate change impacts , w e can
change hospitals from being places that actually make us feel sick to places that
actually promote healing. We need our hospitals and our clinics to be th e last building
standing in extreme weather event . They need to function even if the grid is down , s o if
they have onsite power, they can stay open to address the injuries and health issues
related to the next hurricane Sandy or Katrina. If they put the electrical equipment on
the roof, they don’t have to be evacuated , s o there is a whole new reality that healthcare
is facing that requires us to rethink, our buildings and our supply chain in a way that
makes them much more places of refuge in operations i n the coming storms of climate
change and I think Robin Guenther has been absolutely the leader globally in
articulating this vision and just recently she worked with the D epartment of H ealth and
H uman S ervices to develop a tool kit for how to design climate resilient healthcare
facilities.

Margaret Flinter: And you know you’ve noted as we all have that healthcare itself needs
some healing and you’ve particularly made the point that the healthcare system is still
trying to treat patients out of the context of their environments and that we’ve got to take
the healthcare system as far upstream as possible. Share with us your prospective on
how the healthcare system can do a better job of going upstream of preventing disease
in the first place?

Mr. Cohen: We still as a nation spend 70 cents on the dollar for treating patients and 4
cents on the dollar in preventing disease, and we spend twice as much as any country
on the planet on healthcare and yet 1 in 2 men will get cancer, 1 in 3 women will get
cancer, 1 in 6 kids have learning disabilities . Y ou know, we are spending all this money
and yet we don’t have very positive health impacts. Our people are not healthy, and so
the only way that we are really go ing to stop this epidemic is to address the social and
environmental conditions that are making people sick in the first place. We have to
detox the economy, the carcinogenic chemicals in our mattresses, in our food, in our
daily products, and our cosmeti cs. Burning of fossil fuels kill more people around the
world than AIDS, TB, and malaria combined , s o if we can get healthcare to move out
into the community and support healthy housing, support healthy food, and support
resilient energy systems , w e’re g oing to make dramatic improvements in reducing
chronic disease.

Mark Masselli: And that’s what’s really taking you to think broadly about climate change
because we can’t disassociate human health from the health of the global environment
and you’ve been d esignated a C hampion of C hange by the Obama Administration for
your work in climate change and you’ve been partnering with The World Health
Organization and other global groups to tackle this challenge. How did the goals of
Healthcare 20/20 Climate Challenge address that?

Mr. Cohen: Yeah, so, I mean, I think, we are realizing that climate change is a public
health emergency. If we move away from the imagery of climate change as polar bears
on melting ice caps to the imagery of people in Beijing that can’t go outside because the
air is too poisoned or asthma for people who are living down stream from coal plants or
heat stress because if there is going to be so many more extreme heat days. We are
learning so much about how people will experience climate change in their daily lives in
the health of their families and themselves and so the healthcare sector is so critical to
help bring that new knowledge to the public and that the solutions will also improve our
health, so if we can stop using fossil fuels , we will clean up the air , and we will support
healthier communities and actually will support development of renewable energy
economy, by having healthcare leaders become the messengers for policies that will
usher in this renewal ener gy economy . T hey are the most trusted messengers in our
society. They can lead the effort to detox the economy and show by example how they
themselves can power their facilities by low carbon technologies and then, third, they
can be powerful advocates f or saying yeah we need a price on carbon and that price
should include all the public health damage th at we are experiencing. We need
renewable energy standards and that’s going to have health co - benefits , s o there is a
very powerful role for healthcare p rofessionals to play. Physicians, nurses, public
health officials around the world, to lead this effort and that’s what we are trying to
instigate around the world in partnerships to play this fundamental leadership role.

Margaret Flinter: We have been s peaking today with Gary Cohen, 2015 MacArthur
Fellow and President and Founder of Healthcare without Harm. You can learn more
about their work by going to noharm.org. Gary, thank you so much for joining us today
on Conversations on Healthcare.

Mr. Cohen: Thanks for having me.

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Mark Masselli: At Conversations on Healthcare we want our audience to be truly in the
know when it comes to the facts about healthcare reform and policy. Lori Robertson is
an award winning journalist and managing editor of FactCheck.org a nonpartisan, non -
profit consumer advocate for voters that aim to reduce the level of deception in US
politics. Lori what have you got for us this week?

Lori Robertson: A t the late October Republican Presidential Debate , Carly Fiorina said
that 400 ,000 small businesses form every year while 470 ,000 go out of this and why
she asked? They c ite Obama C are b ut business deaths o utnumbered business births
and roughl y the number Fiorina cited in 2009, a year before The Affordable Care Act
was even signed in July. That year according to data from the Census Bureau
Business Dynamic Statistic, there were 409 ,000 firm births and 499 ,000 firms deaths .
The s ituation was highlighted in a B rooking s Institution Report from May 2014 that said,
“Business Deaths now exceed Business Birth for the first time in the 30 plus year history
of our data.” The report said that the trend could reverse in the future and that ’s exactly
what has happened. The gap between Business Births and Deaths was at it’s largest in
2009 . T he latest census figure show s that in 2010, Business Births surpassed Business
Deaths. There were about 36 , 000 more firm born than had died. The birt h also
outnumbered deaths in 2013 ; the latest data available. The major provisions of the
A ffordable C are A ct such as the insurance market places and requirement to have
insurance or pay a fine didn’t take effect until 2014. As for why business deaths
outnumbered births from 2009 to 2011 , the Brookings report didn’t determine that but
did say that the trend Fit into a larger narrative of business consolidation occurring in
the US Economy , a nd that’s my fact check for this week; I 'm Lori Robertson Managing
Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players , a nd is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact that you'd like checked , email us at
chcradio.com . W e'll have FactCheck.org's Lori Robertson check it out for you here on
Conversations on Healthcare.

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Mark Masselli : Each week Conversations highlights a bright idea about how to ma ke
wellness a part of our communities and everyday lives. Of the 6.6 million births per year
in this country , over half are unattended , and among teens, those rates are even higher.
Colorado has been conducting an experiment for several years to examine what might
happen if sexually active teens and poor women were offered t he option of long - term
birth control such as IUDs or implants?

Dr. Larry Wolk : What was so striking was the word of mouth amongst these young
women to each other in the network of sup port that was built to access this program
through these clinics really did than result in the significant decreases in unintended
pregnancies and abortion.

Mark Masselli: Dr. Larry Wolk , M edical D irector of the Colorado Depa rtment of Health
and Environment.

Dr. Larry Wolk : The resultant decrease is 40% plus or minus in both categories,
pregnancy and abortion , and preliminary data for 2014, it looks like those reductions
may be even more dramatic to more than 50%, even approa ching 60% reduction .

Mark Masselli: T he results showed not only a dramatic decrease in unintended
pregnancies, there was a significant economic benefit to the state as well.

Dr. Larry Wolk : We have seen a significant decrease in the number of young moms
and kids applying for and needing public assistance whether that is public insurance,
The WIC Program, you know, we helped them in longer term. This will translate into
better social and economic outcomes for these folks and amongst young women 15 to
24, we’ve seen a decrease in sexually transmitted infection and the rates are now below
the national average.

Mark Masselli: A free , long - term contraception program offered to at risk teens and
women trying to avoid the economic hardship of unplanned pregnanc ies leading to a
number of positive health and economic outcomes , now that's a bright idea.

(Music)

Margaret Flinter: This is Conversations on Healthcare, I'm Margaret Flinter.

Mark Masselli: And I'm Mark Masselli, peace and health.

Female: Conversations on Healthcare broadcast from the campus of WESU at
Wesleyan University. Streaming live at WESUFM.org and brought to you by The
Community Health Center .