Sustainable habits for your health and the planet

Dr. Ellen Beckjord: Stronger communities begin with good health—for everyone. You’re listening to the “Good Health, Better World” podcast, presented by UPMC Health Plan. This season, we’re exploring ways to achieve good health in today’s complex world. I’m your host, Dr. Ellen Beckjord. Let’s get started.

In this episode, we'll hear from Holly Vogt and Dr. Noe Woods about sustainability in our physical spaces: the structures we live in, the air we breathe, the way we move around our towns or cities, and the impact on our health.

Holly is the senior director of the UPMC Center for Sustainability. Holly, welcome to “Good Health, Better World.”

Holly Vogt: Thank you so much for having me today.

Dr. Ellen Beckjord: Dr. Noe Woods serves on the steering committee of the Center, and also serves as assistant dean for sustainability and assistant professor of [obstetrics and gynecology] at the University of Pittsburgh School of Medicine.

Welcome, Dr. Woods, to “Good Health, Better World.”

Dr. Noe Woods: Thanks, Ellen. Great to be here.

Dr. Ellen Beckjord: I'm excited about this conversation. I think it will be great for listeners to hear from both of you about all the ways sustainability is related to health, which is something I'm excited to be educated about from both of you. But I'd like to start with the very general question, which is, how important is the physical environment around us to our overall health and well-being?

Dr. Noe Woods: It's fundamental. I mean, it is what life is about, right? The space you move through, how it makes you feel, what you're breathing. We're all animals on this planet, just like the things we see outside, and that's what sustains us.

Holly Vogt: Yeah, absolutely. We spend the most amount of time in the built environment. And so therefore, our health is dependent upon having healthy spaces to survive within.

From a physical aspect, I think you could kind of connect those dots. But from a mental standpoint, a lot of people are not aware of how important having windows and having clean air within the spaces that they exist [is]. So, you know, having heating and cooling systems that function properly, having windows that open and allow that fresh air in, having plants that are providing oxygen in those spaces, having bright colors, you know, comfortable spaces that you are able to just be yourself in.

Dr. Ellen Beckjord: Well, we'd love to hear you talk about the UPMC Center for Sustainability, the work that you're both doing, how sustainability is relevant to UPMC’s mission and values. So, Holly, if I can start with you and then Noe if you could contribute, tell us all about the UPMC Center for Sustainability.

Holly Vogt: So the Center for Sustainability was created just a little over two years ago. And with that being said, UPMC has always done sustainability. However, they really didn't have a hub for where we were able to storytell, where we were able to collect data, metrics, that actually spoke [to] the work that we were doing to connect those stories. And so by having the center itself, it was very strategically planned.

It was really an exciting initiative that was driven by some of our physicians, Clinicians for Climate Action—they’re 500-plus physicians and clinical staff that saw, you know, we need to be preventative versus just reacting to the diagnosis that we're seeing within our spaces.

UPMC leadership was able to name a chief medical sustainability officer, which was Dr. Boninger, which brought in all of the clinical team to be able to drive change. And then on the flip side of that was John Krolicki, and he's our chief administrative sustainability officer, because we know that facilities and operations are essential to sustainability as well. So the idea was all encompassing.

Driving it from a clinical space helps us as we address waste minimization, anesthetic gas waste, really looking at efficiencies within our treatment spaces, our models of care, operating rooms.

With that being said, we were able to hire staff. So we have an engineer, Kate Zettl, who leads our energy efficiencies in looking at the types of renewable energy that we're working on and our greenhouse gas inventory, as we look at our scope emissions to drive changes in that space with our carbon footprint. We also have Sydney Crum, and she is our program coordinator. Program coordinator really drives all of our data and metrics. And that's what really shows our impacts that we're having with the different projects that we're driving.

Dr. Ellen Beckjord: Dr. Woods, can you tell us about your involvement with the UPMC Center for Sustainability as a member of the steering committee?

Dr. Noe Woods: If you look at the total impact of health care on the greenhouse gas emissions in the United States, it's about 10 percent of the footprint. So in delivering care, we are delivering 10 percent of the greenhouse gas emissions in the U.S. So that's greater than the aviation industry, for example. So for comparison, the food industry is about 30 percent. So it's a pretty big deal.

I took an oath, as did every physician on the first day of med school. You stand up and you say, I promise to do no harm to my patients, first. And we know that that 10% emissions has measurable human health outcomes. And if you do a bunch of math, what you come up with is the harm we cause by our energy use, our trash production, transportation, is roughly equivalent to the same harm that we produce from medical errors.

Dr. Ellen Beckjord: Wow.

Dr. Noe Woods: Yes. So when we discovered what a big problem medical errors were, we started something called the quality improvement. Quality safety, right? And that has had very measurable reductions in patient errors over the 10, 20 years it's existed. It's really been a very successful movement.

What we're starting at the UPMC Center for Sustainability is the beginning of environmental quality metrics. So where we can say, look, UPMC does not want to harm our air quality and our water quality while we're taking care of these patients. How can we systematically start reducing the impact that we're having on our patients’ health, you know, on a community level? If you took all of global health care and you made it a country, it would be the fifth largest greenhouse gas emitter.

Dr. Ellen Beckjord: Wow, I didn't know any of that. That's fascinating. So there's clearly work happening at the Center for Sustainability that is looking at how UPMC can minimize its carbon footprint or environmental damage that's just a byproduct of the work that gets done in the service of reducing harm to the communities that UPMC serves.

Holly, can you give some examples of work that the UPMC Center for Sustainability is doing, that patients and families are receiving care at UPMC might be able to notice, or even examples that you want to share that might be invisible to patients and families?

Holly Vogt: Sure. So in terms of the invisible stuff that is occurring, in terms of our anesthetic gases that we're utilizing, we're trying to move away from our piped nitrous oxide. Things like lighting—when you're walking in the spaces, you might not realize that we've changed most of our hospitals out to LED lighting for energy efficiency.

We're also looking at our spaces that we provide care. Some of our hospitals have gardens. Those gardens are producing food that's actually served in our cafeteria spaces. Magee's garden is a great example of that. They also have beehives there. So again, many don't see the beehives, but they're there and we are producing the pollinators in the local regions to help farms and other spaces that are growing crops.

We have 14 of our hospitals that are signed up for the Coolfood Pledge. The Coolfood Pledge is really committed to selecting animal-based products and switching those over to plants, fruits, vegetables as alternatives. And we've done a really good job. Shadyside is leading the way in the Pittsburgh region for the highest reduction, moving away from red meats, which has had a very significant impact.

Our Somerset hospital has done an amazing job. And they offer a plant-based menu that has four or five different choices on it that patients as well as staff are able to select from. So they were the first location through Leanpath to be able to start to track those emissions in savings for the greenhouse gas inventory based on switching from red meats over to plant-based options.

In terms of recyclables, that's another area where we're doing a wonderful job. We're composting in the cafeterias as well as our retail spaces, and we're taking all of our plastics and trying to pull those. Plastics one and two in medical waste is pretty significant. And we're also looking at some of our less common materials like our linens, our cooking oils, our hazardous waste, making sure that all of those are recycled properly, so.

Dr. Ellen Beckjord: Wow.

Holly Vogt: Yeah.

Dr. Ellen Beckjord: The work that you're doing, which relates to in large part or at least can always track back to the health of the planet, that's a huge topic. It can feel really overwhelming. Can you talk about ways that you engage in this work and stay hopeful and resilient?

Holly Vogt: So I think that this goes back to a fourth-grade teacher, he assigned us a project, and he said, I'm not going to tell you all the specifics of it, but I want you to connect it with purpose. And so, you know, I…

Dr. Ellen Beckjord: …that's an advanced fourth-grade assignment!

Holly Vogt: Right? Trying to put all the pieces together. And so, you know, my siblings both had paper routes. And on that particular day, as I'm trying to figure out, OK, what is my connection to purpose going to be here? I was filling in on the paper out and I was delivering all the papers. And then I started thinking, but then what happens to all of these papers? I'm delivering something with news that they are going to consume, but at the end, they're going to be throwing all of this away. And as I'm lugging this heavy bag around, I'm thinking, could we go back and collect those back? And could I convince my dad to take us to the recycling center on Saturday and see if we could get a few dollars for it? And that's exactly what happened. And so as I think about sustainability in general, I think, you know, we all are able to do something if we connect it with purpose.

You need to start small and do those everyday tasks that are manageable. So yes, big problems seem very large. And where do we even start? But if we're tackling it, one small project that we know can be completed successfully and that there can be outcome or impact, we need to continue on that path and then take the next step for the next project.

As we look at a lot of the work that we're doing, two years ago, I didn't know that some of them were even possible. As we look at our anesthetic gas waste, in our first year, we were able to ban desflurane, which is huge in terms of when we look at our scope emissions. That was a big change. Now this year we're looking at piped nitrous oxide. And we've been able to move it across, you know, six hospitals.

So again it's really possible. I'm seeing that that outcome, what are we going to look like in three years, we'll be able to speak to some of these beginning stages that we put in place.

Dr. Ellen Beckjord: That's fantastic. Dr. Woods?

Dr. Noe Woods: It's a really common question to be asked: How do you keep hope? So if you work in sustainability or anything relating to planetary health, you get asked that question a lot.

So through my two decades of doing this, my own emotional reaction to planetary threats has really evolved. One of the things that turns people away is the magnitude of planetary changes and our culpability in it. Right now we know that the rate of species loss is equivalent to a great extinction. That's what's happening as we speak. As a scientist, as a learner, as a professor, although we can't predict the future, we can certainly make really educated guesses about what's going to happen with coral reefs, for example; what's going to happen with human populations that live near the ocean or live in places of drought. Those future eventualities are fairly clear and are happening now. I am not hopeful that we're going to change all of those things, but it doesn't stop me one tiny bit from this work because of what Holly said, which is that it's the right path to be on.

The Navajo have this expression called “walk in beauty.” I got to be a physician there [in Navajo Nation] for two years, and my understanding of it is that it's about maintaining yourself on the path that is right, and that that's not always easy, that you will fall off of it, but that walking in beauty is the goal. And the work I do in sustainability brings me joy and brings me a sense of peace. A lot of times when you ask people in this field, what do they do to feel better? Almost all of them say, go out for a walk, go into nature, right? When I go out there, I want to feel like I'm part of it…just for me as a human being. So when I feel like I have stepped—have walked the path of beauty, like I've done the right thing—it brings me, in my short little lifespan, the, a feeling of joy. And that's really what life's about.

Dr. Ellen Beckjord: What are some sustainable actions that listeners can take to improve or positively affect their health?

Holly Vogt: So I think that it's essential to find that joy, what brings them that happiness. Because again, I think that what works for one person may not work for the next person. I can honestly say that when the Center for Sustainability was created, when I interviewed for the position, it was the senior director for environmental initiatives, and I questioned, I said, environmental initiatives? Why isn't it sustainability? And they said, well, why do you think it needs to be? I mean, you're here to do environmental work. And I said, I 100 percent agree with that, but sustainability has a social component to it, and people are the ones that are going to be involved in making the work happen.

And so I think that when we ask each person from a social impact [perspective], maybe it's eating healthy, you know, that's, they enjoy the fresh fruits, the fresh berries, the vegetables that come from their garden. Maybe even having the garden and working in that space brings them joy. And the next person is going to say, absolutely not I'm not getting my hands dirty and I don't want to have a garden, but I really enjoy the opportunity to do water management. And so, I have a rain garden. I work in that space or I volunteer someplace that has impact for me. So I think it's going to look differently for what works for that person to keep their space healthy and good for them.

Dr. Noe Woods: I'll give some really concrete specifics for your listeners. So number one: Indoor air quality. Pittsburgh has a failing grade from the American Lung Association for air quality. However, it is getting better. Our air quality is determined by local transportation (so diesel trucks within our city), pollution coming from the Midwest, and then industrial sources here in our Mon Valley. Inside your home has much better air quality than outside. So getting a really good air filter in your home and keeping your home sealed is very important for indoor air quality. My children, when they sleep at night, have a little air purifier in their rooms.

You can also get an app through the EPA to look at air quality. I use that for running and biking if I'm going to go outside. When you smell the air in Pittsburgh, that does correlate to what we call PM 2.5, which is a measure of pollution. It is a very sensitive way to detect air pollution. If you notice that it's smelling outside, you can open one of these apps on your phone, and you can look at the air quality and see, is it safe for me to be exercising outside. And sometimes it's not, particularly if you're somebody with asthma, COPD or any kind of pulmonary condition.

So air quality is something you can control in your home, if you own your home. If you live in an apartment and you don't have the option to control those things, you can make a really cheap air filter out of a fan where you literally duct tape a MERV 15 filter to it. There is an organization called GASP that has their website, they have instructions on how you can make an air filter for very cheap in your own home, even if you're an apartment.

Second is your water quality. You should be filtering your water. A Brita pitcher is perfectly fine. You can get super fancy. We have a filter that filters everything that comes into our kitchen. So anything we drink, we filter. Lead is a problem in some of the pipes in Pittsburgh and so it's really important to filter your water as well.

And the third category is the energy you use for your home. So even if you don't have the means to get a geothermal system or electric heat pump or something—if you do have the means, you should do that—if you don't have the means, you can actually switch your electricity to renewable energy. So if you can switch to solar and wind with a single phone call.

We know that eating plant-based food is really good for your health and good for the planet. It's going to be better for your digestive tract, better for all sorts of things in your body. It reduces multiple risks of various cancers, heart disease, hypertension, obesity. As much as you can cook your own food, buy your own vegetables, go to farmer's markets, really try to have [a] colorful plate where you have as many different colors of different vegetables on your plate as you possibly can. That's going to be a win-win for the planet and for your health.

So you want to try to make whatever mode of transportation you use as energy friendly as possible. So if you can use your own body to get to work, that's your best option. If you can use public transportation, that's your next best option. If you can use an electric vehicle, if you have the means for that, that's a wonderful option.

And then the last category is you really need to move your body. So our bodies are musculoskeletal systems that are designed to be used. If you don't use them, you will lose the function. Patients say, oh my gosh, but it hurts so much. And I say, your body's going to hurt. It's either going to hurt from exercise or it's going to hurt from not exercising. Right? Exercise for a lot of people is a little bit uncomfortable. And moving your body is essential as you get older in life—walking up your stairs, carrying your groceries, getting around your place. We know sitting for long periods of time is really bad for your health. So if you work at a desk, I really encourage people, if they can, to get a standing desk. If you can't get a standing desk, you can get a little lift that you put on your desk where you can stand. It's bad for our backs to be in a seated position all day. So you want to be moving your body as much as you can. You can have a reminder on your watch every hour to do some stretching, do some walking. All those things maintain the functionality of the musculoskeletal system that you're so lucky to have.

Dr. Ellen Beckjord: Those are all really great suggestions. And some of them specifically, we can make sure to reference in the show notes, because you mentioned some specific tools and things that people can use. So thank you for that.

What are one or two things that you'd like listeners to know about either the work UPMC is doing in sustainability or how they can think about sustainability in relationship to their health? Holly, if I can start with you.

Holly Vogt: I think that sustainability means resiliency within your community. And so I think that as we look at some of the offerings that the health plan has with the affordable housing, the job training programs, food as medicine, UPMC and the Health Plan itself have really focused on treating the whole patient. We're not just treating the condition that walks in the doors to our emergency rooms or into our clinical spaces. But we're saying what more can be done to build that strength within our communities?

We have a lot of community partners that we work with. Tree Pittsburgh, Bike Pittsburgh, even just our Oakland energy master plan as we look to see how do we free the grid up to make sure that there is enough energy for new industry to come in or new opportunities for that space to be utilized for green spaces and things like that. So our built environments, how they're constructed—all of these things play into the resiliency that we are trying to create within our communities.

Dr. Ellen Beckjord: I love that link between sustainability and resiliency. Thank you for that.

Dr. Noe Woods: It feels really good to take care of your body. And one of the things I've noticed as an ob-gyn is that at some point in people, across the lifespan, there's a time when people start feeling their body turns against them and they start feeling like their body is their enemy and they're fighting it. And I see this all the time in the women I take care of. And there's a group of women that don't have that happen. And I think it's the result of a lifetime of considering your own personal health your responsibility.

Sometimes it can be really frustrating if you go to the doctor, you have back pain, for example—you know, the most common reason people come, and they can't help you. I myself had low back surgery and was in excruciating pain during the day. I would see a patient then have to lay on the floor, see a patient; it was it was really painful. And, I learned through this journey of discovering how to take care of my back, all sorts of things I was doing that were damaging to my back, and the way I could change my physical space, my chairs, the way I sit, the way I lift things in order to take care of my back. And now it's doing great! I can do all the things I could do before, and no doctor could have done that for me. That was, I needed to educate myself, learn about how to take care of my body and not just your physical body, but your connections with other humans.

There's this Harvard Health study where they looked at people's health over 80 years. They started with the class at Harvard where John F. Kennedy was enrolled. And over the time, they've expanded it to include all sorts of more diverse groups than just a group of Harvard students. And, the thing that correlates the most to “success,” more important than anything you do, is your connections to other humans. And, this work that we do is really connecting with other people. We enjoy the people we work with. We make sure that all of our events, for our sustainability events, [that] we serve healthy food, we connect with each other, and that's something, no matter what pursuit you're trying to do, if it's feeding your needs as a human to want to connect with other people, it's something you'll be able to sustain going forward.

Dr. Ellen Beckjord: That's wonderful. So I want to see if I can quickly tie that to a couple of things. One is, coincidentally, I think I am exactly at that age that you just described. I've started to have a couple of pretty minor physical issues that I'm attending to, and my first instinct was to feel pretty impatient and frustrated. And then I thought, wait a minute, like this body has done literally everything I've ever asked it to do, and if right now it's asking me to make some changes and take better care of it and accommodate it a little bit, like that's something that I should feel entirely good about doing.

And as you were saying that it just made me think about, do we think about our own environments, our home, our planet like that? And it reminds me, have you both read Braiding Sweetgrass by Robin Wall Kimmerer?

Dr. Noe Woods: Yeah, yeah.

Dr. Ellen Beckjord: …and she talks in the beginning about how she poses a question to her students, which she asks both what can the earth give us and what can we give the earth? And that students can talk a whole lot about what the earth can give us, but when she asks, well, what can we give the earth, that it's a harder question for them to answer. And I—you know, whether it's our own body, our sort of limited environment or our bigger environment, asking what we can give back is I think a really important question that changes the dynamic of instead thinking about our bodies or our environments or things that we just take things from.

And it seems like you're really doing that at the Center for Sustainability, just looking at the processes that are involved in executing all of the tasks and care that UPMC delivers and thinking, what are some changes or adjustments we can make in these processes that actually allow us to nurture the environment that these things are taking place in, rather than just continuously sort of taking from it.

Holly Vogt: Just to add to that, we all come from very different backgrounds. We come from different age groups, we come from different ethnic backgrounds. But the thing that's common between all of us is we're all living on this planet. And so when it comes to sustainability, what I've learned and love about this career choice that I've made is that everybody wants to join hands and figure out how do we solve these problems. It's not like a race in industry, the first one that figures out the technology is going to get the big reward. It's like if each person is able to bring what they can in that capacity to what they can achieve, we're all heading towards the same finish line of really changing. You know, better air quality is not something that is going to be tackled by one organization. We each need to do our own part to give back to the planet, just as you were speaking to, to get where we need to go.

Dr. Noe Woods: JAMA just published an article about the health benefits of biking to work. And what they found is that your hippocampus, the part of your brain that helps you navigate geography, is measurably bigger if you bike to work, and your risk for dementia is much, much lower. And the things that sustain the planet are good for you, and they feel good. And that's really the bottom line.

Dr. Ellen Beckjord: Yeah, absolutely.

Well, I want to thank you both for taking the time to talk with us on “Good Health, Better World,” and thank you for the work that you and others are doing in the UPMC Center for Sustainability. It's so exciting to know even a little bit about what's going on that there's more to come. And, just really grateful that you shared some of that with us today. So thank you very much.

Dr. Noe Woods: Thank you.

Holly Vogt: Thanks, Ellen.

Dr. Ellen Beckjord: We hope you enjoyed this episode of “Good Health, Better World.”

Be sure to tune in next time and visit upmchealthplan.com/goodhealth for resources and show notes.  

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