1. Jonathan Herz, AIA, LEED AP Inova Intersections Symposium, October 11, 2013 - Fairfax, VA Connecting Health & the Environment

2. Waste Management Toxic Materials/Mercury PVC and Phthalates Flame Retardants Electronics Cleaners and Pesticides Safer Chemicals Healthy Food Systems Green Building and Energy Climate and Health Green Purchasing Pharmaceuticals Environment and Health ISSUES: HEALTH CARE WITHOUT HARM

3. OUR CURRENT SUSTAINABILITY PARADIGM

4. THE BRUNDTLAND COMMISSION (1987) “Sustainable development is development that meets the needs of the present without compromising the ability of future generations to meet their own needs. “It contains within it two key concepts: The concept of 'needs', in particular the essential needs of the world's poor, to which overriding priority should be given; and, The idea of limitations imposed by the state of technology and social organization on the environment's ability to meet present and future needs.” THE CURRENT SUSTAINABILITY PARADIGM

5. World Business Council for Sustainable Development (1997) “THE TRIPLE BOTTOM LINE” ENVIRONMENT ECONOMY SOCIETY “Sustainable development involves the simultaneous pursuit of economic prosperity, environmental quality and social equity. Companies aiming for sustainability need to perform not against a single, financial bottom line, but against [this] triple bottom line.”

6. THE CURRENT SUSTAINABILITY PARADIGM BREEAM® (1990) LEED ® (2000) GREEN GLOBES ™ (2000) LIVING BUILDING CHALLENGE (2003) GUIDING PRINCIPLES FOR FEDERAL LEADERSHIP IN HIGH PERFORMANCE AND SUSTAINABLE BUILDINGS (2006) GREEN BUILDINGS STANDARDS

7. “The concept of a Triple Bottom Line in fact turns out to be a “Good old-fashioned Single Bottom Line plus Vague Commitments to Social and Environmental Concerns.” Wayne Norman and Chris MacDonald (2003) THE CURRENT SUSTAINABILITY PARADIGM “There is one and only one social responsibility of business – to use it resources and engage in activities designed to increase its profits so long as it stays within the rules of the game…" Milton Friedman (1970)

8. OUR ENVIRONMENTAL AND SOCIAL IMPACTS

9. OUR ENVIRONMENTAL IMPACTS Mathis Wackernagel and William Rees http://www.footprintnetwork.org/ +

10. 2011 Toxic Release Inventory : More than 22.8 billion pounds of toxic chemical wastes produced, Over 18.6 billion pounds were recycled, burned for energy recovery, or treated, and, Over 4.13 billion pounds released to the environment. OUR ENVIRONMENTAL IMPACTS TOXIFICATION OF THE PLANET

11. BUILDINGS AND THE ENVIRONMENT CONSTRUCTION, RENOVATION AND OPERATIONS: Produce ( Directly or Indirectly ): 49% percent of SO 2, 40% of landfill waste, 35 % of Greenhouse Gases, and, 10% of airborne particulates. Consume: 66% of electricity, 50% of the extracted, natural resources, 33% of the energy, and, 17% of water. “A typical 200-bed hospital in the coal-powered Midwest using seven million kWh is responsible for more than $1 million/year in negative societal public health impacts ($0.14kWh) and $107,000/year ($0.01532/kWh) in direct health care costs.” Practice Greenhealth

12. Asbestos Lead PCB’s Formaldehyde Dioxin Chromium Arsenic VOC’s Mercury Chlorine CFC’s Many others BUILDING MATERIALS AND METHODS DIRECTLY AFFECT WORKER AND COMMUNITY HEALTH BUILDINGS AND THE ENVIRONMENT

13. OUR ENVIRONMENTAL IMPACTS CLIMATE CHANGE KEY ENVIRONMENTAL THREATS: Decreased Availability of Potable Water, Sea Warming, Acidification, and Level Rises, Extreme weather, and. Ecosystems Destruction. KEY HEALTH THREATS: Cumulative Climate and Health Stressors – impacts on young and old, those chronically ill and the poor, Societal System Failures During Extreme Events – impacts on infrastructure, evacuation, response services, power. Emergence of Diseases - shifting pest ranges, lack of immunity & preparedness, inadequate monitoring.

14. OUR SOCIAL IMPACTS UNJUST DISTRIBUTION OF RESOURCES -The poorest 36% of the world’s people get less than 3%, while, -The richest 15.6% of the world’s people (including the U.S.) get more than 80%. ENVIRONMENTAL JUSTICE Vulnerable Communities are seeing: -Increased incidence asthma, cardiovascular disease, stroke, heat- related illnesses and deaths, -Disruption of food and water sources, -Infrastructure impacts.

15. SOCIAL EQUITY AND ETHICS

16. “It is a question whether a man has a moral right to destroy the riches of the earth, no matter how they come to his hands, with the purpose of gaining more than he can eat and be comfortable with and be responsibly helpful to those about him.” Chase Osborn, Governor of Michigan Wasted Resources–Pollution (1908)

17. WHAT IS EQUITY? SOCIAL EQUITY AND ETHICS Respect Well-being Quality of Life

18. RESPECT AND WELL-BEING - LIVING WAGES - “Neither we, nor any other people, will ever be respected till we respect ourselves and we will never respect ourselves till we have the means to live respectfully.” Frederick Douglass The North American Review 1881 SOCIAL EQUITY AND ETHICS

19. QUALITY OF LIFE - TOXICS ELIMINATION - By finding alternative and substitute products for hazardous materials used in industrial processes and by consumers, we reduce the overall harmful effects both to human health and to the environment. National Association of County and City Health Officials. SOCIAL EQUITY AND ETHICS

20. OUR CURRENT ECONOMIC PARADIGM

21. THE TRADITIONAL ECONOMIC PARADIGM THE ENVIRONMENT IS A SUBSET OF THE ECONOMY

22. TRADITIONAL ECONOMICS: “THE INVISIBLE HAND” “ Socially optimal” conditions emerge when there is equilibrium between production and consumption, which occurs when: 1.Consumers are perfectly informed about all products, 2.There is competition, 3.Households maximize their well-being and firms maximize their profits, and, 4.Production and consumption of goods and services affects only those directly involved, with no indirect impacts on others, such as waste or pollution. Price Supply Demand Quantity P* Q* Supply & Demand

23. TRADITIONAL ECONOMICS – MARKET FAILURES EXTERNALITIES – positive or negative consequences of economic activity, prevent commodities from being produced at a socially optimal level. PUBLIC GOODS - No free market incentive to supply them so government intervention is often necessary.

24. COST-BENEFIT ANALYSIS - An economic decision-making approach to decide whether a proposed investment or policy is worth pursuing, or to choose between several alternative ones by comparing expected costs against expected benefits. LIFE CYCLE COST ANALYSIS - The cost of a capital asset, including all direct and indirect costs for planning, procurement, operations and maintenance, and disposal.” ECONOMIC DECISION-MAKING

25. ENVIRONMENTAL AND RESOURCE ECONOMICS Look at the lifecycle of our economic activities, Monetize ecosystem benefits and costs of environmental problems, Use taxation and other market-based mechanisms to correct externalities TRADITIONAL ECONOMICS “The market cannot tell us how much clean air, clean water, healthy wetland, or healthy forests we should have, or what risk is acceptable when the welfare of future generations is at stake.” Herman E. Daly and Joshua Farley (2004)

26. There are economic, environmental, and social issues associated with every choice we make. ECONOMIC DECISION-MAKING

27. 02-02-11 IT’S TIME FOR A NEW PARADIGM

28. WHAT DOES “SUSTAINABLE” MEAN? SUSTAINABLE (adj.) – Capable of being carried on for a prolonged duration, or for the foreseeable future, and beyond.

29. DEFINING THE GOAL SUSTAINABILITY : “to create and maintain conditions, under which humans and nature can exist in productive harmony, that permit fulfilling the social, economic, and other requirements of present and future generations.” NEPA (1969), EO 13514 (2009) ENVIRONMENTAL SUSTAINABILITY: life-supporting ecosystems are maintained, toxics are eliminated, renewable resources are consumed below their regeneration rate, and non- renewable resources are recycled or replaced by renewable substitutes. SOCIAL SUSTAINABILITY: resources are distributed justly, allowing people to live with dignity.

30. THE WORLD IS A CLOSED SYSTEM….

31. THE ECONOMY exists within the environment as a construct of society Principles Sustainable Scale Just Distribution Efficient Allocation Ecological Economics ENVIRONMENT ECONOMY SOCIETY THE NEW ECONOMIC PARADIGM:

32. An environmentally sustainable world: Maintains critical ecosystems that provide essential life support, Reduces or eliminates generation of toxics, Uses non-renewable resources at rates below that at which they can be replaced by renewable substitutes, consumes renewable resources at rates below their regeneration rate, and Generates all wastes al levels below the ecosphere’s assimilative capacity. A socially sustainable world: Has a just distribution of resources that allows people to live with dignity. WHAT DOES A SUSTAINABLE WORLD LOOK LIKE?

33. START THINKING SUSTAINABLY

34. John R. Ehrenfeld Executive Director of the International Society for Industrial Ecology “REDUCING UNSUSTAINABILITY WILL NOT CREATE SUSTAINABILITY.” THINKING SUSTAINABLY

35. Reconsider Forecasting => Likely development pathway => Status Quo Outline of a likely future Vision of a desirable future <= Necessary development pathway <= Status Quo Apply Backcasting THINKING SUSTAINABLY Involve multi-disciplinary stakeholders directly in decision- making. Use qualitative as well as quantitative measuring scales Resolve problems with multiple values systems and objectives. Consider Multi-criteria decision-making

36. RESOURCES - THINKING SUSTAINABLY Health Care Without Harm Green Guide for Health Care LEED® Version 4 The Pharos Project Cradle-to-Cradle FGI Sustainable Design Guidelines for Hospitals and Outpatient Facilities (Draft) Comparative effectiveness Analysis Sustainable Return on Investment Health Impact Assessments and NEPA

37. www.gsa.gov/sustainabledevelopment The New Sustainable Frontier Sustainable Development & Society EVEN MORE RESOURCES