The Global Health and Safety Initiative (GHSI), along with industry partners, is currently in the process of developing an ecological footprint calculator expected to provide comparable sustainability measurements within and between healthcare systems. The ecological footprint concept aims to record every input into a system and calculate its demand on the Earth. GHSI, a sector-wide collaboration of healthcare companies and organizations, has inherited the Eco-Health Footprint from Kaiser Permanente, one of the organization’s cofounding companies. Kaiser had developed a direct energy footprint for its system after learning about the National Health System’s sector-wide Material Health study (

What’s an ecological footprint?
An ecological footprint takes into account a system’s demands on the Earth. Humanity, a nation, and an individual all have their own footprint. Mathis Wackernagel, now executive director for the Global Footprint Network, developed the ecological footprint concept in his doctoral dissertation under professor William Rees at the University of British Columbia in 1992. Since then, different calculators have been created, from short online calculators for individuals, to humanity's footprint between 1961-2003.

Every system has a footprint. Even this Web page has a footprint as it is served by computers running on electricity from power plants that generate CO2 emissions. GreenrMe is a recently launched Web site that claims to address the problem of the steadily increasing online carbon footprint. The organization provides a Web widget (as shown below) that calculates the amount of CO2 emissions generated from a Web page being downloaded, such as the page you’re reading now. GreenrMe then purchases enough carbon offsets using sponsor donations to make this page carbon neutral.

After Kaiser’s direct energy analysis resulted in some unexpected and informative findings, the company began looking at footprinting all inputs into its system. The task proved to be expensive, with total costs estimated at more than a quarter of a million dollars, says Christine Malcolm, senior vice-president, Hospital Strategy and National Facilities, Kaiser. GHSI then took on the project to develop a healthcare-specific framework for a system-wide footprint calculator, available for the whole industry. The major consequences of the calculator include the creation of a fair sustainability comparison tool between systems and the ability to identify the most sustainable and cost-saving initiatives within a system.

“There are many different models and calculators out there, but they tend to only look at pieces of what a full footprint would be, like energy or CO2 carbon emissions,” says GHSI Executive Director Bob Eisenman, PhD. “What we are ultimately interested in is tracking most of the ways that hospitals and healthcare impact the environment. So eventually we are trying to pull together energy, carbon, toxic gas emissions, waste stream issues, water, transportation, and more. But we haven’t seen a tool like that yet, particularly with toxic and hazardous materials, which healthcare uses often.”

GHSI and Kaiser are including a variety of existing footprint information, such as W.R. Grace Foundation’s work with clean water and the California Climate Action Registry’s work with emissions. “We’re looking at all of those tools instead of generating them from scratch,” Malcolm says. “Many of these tools are scientifically sound, but we are adjusting them to work for healthcare facilities. We have to measure things that aren’t normally measured: toxic chemicals are very important, and water use, waste, and all of the direct energy use. Even things like how far do your employees and patients travel to get to your facilities, and whether or not they drive, are a huge part of your eco-footprint.”

“There’s an old adage: what gets measured gets managed,” says GHSI Associate Director Michelle Lapinski. Without any measurement and comparison of sustainability initiatives, the decision makers, planners, designers, facility management, and others involved in operations may not know the overall effect on a footprint and whether the initiative is maximizing the company’s investment and resources. “So the first step is measuring and setting a baseline,” Lapinski says. From that baseline, the footprint tool let’s a company run different sustainability scenarios before investing in new design, technology, or operational changes. “At GHSI, we’ve found that healthcare systems could save a lot of money by pooling resources and sharing a tool like this. Then they can redirect more of their resources toward actually making measurable improvements.”

Eco-Health Footprint inputs and outputs

Building and construction
Fuel use
Other consumable items
Financial accounts data

Global hectares
Greenhouse gas (GHG) emissions (SOx, NOx, and CO2)

For example, while Kaiser was studying its direct energy footprint, the company singled out carbon emissions. It found, for its own system, that using biodiesel for its fleet and generators was not going to have a large enough effect on its carbon footprint.

“We could convert to 100% biodiesel and it wouldn’t move our eco-footprint one bit,” Malcolm says. “I learned that my big problem was electricity, and my second biggest problem was natural gas. Having electricity that is generated by coal, like it is with Southern California Edison, is a huge problem for us, so we have to get to renewable sources of energy. The footprint told me where to focus my actions.”

“We will end up showing what a healthcare system’s footprint is. For example, it could say you can use low-flow toilets and that’s a nice help, but not as much of a help as these other options. Because right now it’s like we’re firing a shotgun shot; we’re just spraying,” Malcolm says. “With the footprint calculator, we are trying to minimize the amount of wasted effort.”

The tool also has consequences outside of the industry as well. GHSI and Kaiser see it as a way to help the healthcare industry become a leader in creating a healthy natural environment
and community.

A health system’s eco-footprint is dependent on entities outside the company’s direct control, such as energy suppliers, building material suppliers, and medical device manufactures. Yet GHSI expects that the tool will provide extra leverage in getting manufacturers and suppliers turning to more sustainable sources and operations to meet healthcare’s footprint demands.

“The most important part [of measuring footprints] is that it will give us a prioritized list of the actions we can take to become carbon neutral, achieve water balance, get as close to zero waste as possible, and to get to toxic free,” Malcolm says. “We have to get our suppliers to understand that this is a priority for us and to change their production methods.”

Being 16% of the U.S. gross domestic product, the healthcare industry has an opportunity to reduce the nation’s overall footprint and indirectly improve the health of the population, says Eisenman. The sustainability choices a company takes have ramifications for the broader health of communities and populations. “It’s important for healthcare to play a role in reducing its sector of the economy in terms of its environmental footprint, but also to point out that there is a healthcare argument and need related to global warming and various uses of toxic and hazardous chemicals,” he says.

GHSI is currently receiving and examining proposals from different footprint models that will be absorbed into the Eco-Health Footprint tool. GHSI’s tentative timeline has the tool in beta testing with member organizations in early 2009.

The Global Health and Safety Initiative is a sector-wide collaboration that focuses on transforming the way that healthcare designs, builds, and operates facilities, as well as the products used within those facilities. For more information, visit

According to a Global Footprint Network quiz, if everyone lived like the author of this article, we would need 3.8 Earths to support us. If he begins biking to work (instead of carpooling), his footprint would be reduced to about 3.7 Earths.

Take the same quiz here. Post and discuss your personal and company footprint information below.