1. Changing waste to a commodity Identify your potential commodities (re- use, compost, recycling, take-back potential) Investigate community programs Communicate with your colleagues Negotiate with your suppliers / vendors

2. Staff Commuting Footprint 34,000,000 km/yr 4,278,450 liters of fuel 10,097,142 kg CO2 This is equivalent to ¼ of the CO2 associated with all the utilities consumed by LHSC 700,000 trees are needed to absorb this CO2 !

3. Transit Alternatives to Solo Drivers Quebec: Allégo subsidies for health institutions Car-pooling Active Transport Car-sharing Public Transport Combos!

4. Nutrition Local produce commitments –Kaiser Permanente’s farmers markets Increased vegetarian menu and focus Composting – pilot project at Douglas Psychiatric hospital Organic agriculture commitments –Catholic Healthcare West

5. Ecological Practice Low consumption medicine –Nutrition –Exercise and physical therapies –smaller amounts of pharm at one time (e.g NSAIDS.) Durable tools Environmentally safe microbial decontamination of surfaces –sodium hypochlorite)

6. Ecological Purchasing Looks at General Environmental Management of Suppliers (e.g. ISO 14000, Eco Logo Program) Product Composition (heavy metals, reusable, recyclable components, etc) Manufacturing Processes/Practices (hazardous wastes?) Packaging and Distribution Use and Service (off-gasing, leaching, durability) End of Use (Cradle to cradle)

7. Toxics Reduction Mercury phase out Lead and cadmium recycling and ban Computer reuse and recycling Xylene, Formadehyde reduction Low or Zero VOC finishes Low toxicity, biodegradable cleaning agents, microfibre systems

9. Ecological Design: LEED created to accomplish the following: * Define "green building" by establishing a common standard of measurement * Promote integrated, whole-building design practices * Recognize environmental leadership in the building industry * Stimulate green competition * Raise consumer awareness of green building benefits * Transform the building market

10. Ecological Design: LEED for Healthcare system addresses six major areas: * Sustainable sites * Water efficiency * Energy and atmosphere * Materials and resources * Indoor environmental quality * Innovation and design process LEED certified hospitals (Can): St. Paul's Hospital 9A Mental Health Unit (BC) Upper River Valley Hospital (NB)

11. Go Green! (BOMA Best) Resources (waste reduction and recycling; site) Emissions, Effluents and Other Impacts – air emissions; ozone depletion; water effluents, hazardous materials, hazardous products, health & safety Indoor Environment (indoor air, lighting, noise) Environmental Management Energy –energy consumption, features, management, transportation Water (efficiency)

12. ADVOCACY Comprehensive EMS in hospitals Green purchasing Clean air measures/ Incentives Phase-out of known/suspected toxics Healthy urban housing/communities Ecosystem/biodiversity preservation Greenhouse gas reduction measures Renewable energy sources

13. Conservation/Restoration

15. Common Tools Healthcare Without Harm (www.noharm.org) Green Guide for Health Care (www.gghc.org) Hospitals for Healthy Environment (www.h2e.org) Practice Greenhealth Canadian Coalition for Green Health Care (www.ccghc.ca) Synergie Santé Environnement (www.synergiesanteenvironnement.org)

16. Special thanks to the team at the the London Health Sciences Centre

17. In a decade Green Healthcare: From Oddity to Advantage From Unknown to Desired From Laughed-at to Legislated From Qualitative to +Quantitative From Internal to Communal From Isolation to Network From Dream to Urgency From Effective to Powerful