In his small office high in the Berkeley hills, Lawrence Berkeley National Lab biogeochemist William Riley laughs too. On his office computer we’ve just witnessed the drama of thermokarst lakes—shallow ponds that form when Arctic permafrost melts and slumps, creating depressions that fill with water. In the winter, those lakes, found in Arctic regions like Alaska and Siberia, freeze over, creating a blanket of ice that traps methane gas bubbling up from decomposing soil on the bottom. Poke a hole in the ice to release the methane, strike a match, and you’ve got tundra pyrotechnics.

But flashy videos aren’t why Riley and colleagues embarked in late 2008 on a five-year quest to model what’s happening up in those Arctic ponds. The fun has dark implications: the methane these lakes release may foreshadow climate change scarier than anything you’ll find in current predictions. That chance is what earned the thermokarst lakes a spot under the (metaphorical) microscope, as part of a US Department of Energy project to measure and simulate natural systems that could have a huge influence on our planet’s climate. Riley and his colleagues at Berkeley, who are translating data about how the methane in the lakes behaves into numbers and equations, represent just one node in a big network of scientists trying to tease out new clues about climate change from the messy chaos of the world.

The $15 million project, called Investigation of the Magnitudes and Probabilities of Abrupt Climate Transitions
(IMPACTS), involves researchers from six national laboratories and collaborators from more than a dozen universities. It should take some of the mystery out of the under-studied but essential field of predicting abrupt climate
change. That’s what researchers call a set of runaway shifts that could happen if the global climate crosses a point of no return, or a point where reducing greenhouse gas emissions (climate change’s cause) would no longer have the power to reduce global warming (its effect). Some experts, including NASA’s top climate scientist James Hansen, fear we may be about to cross the line, though no one can say for sure. Understanding where that threshold is and what might push us past it could mean the difference between slow climate shifts that Earth’s inhabitants might be able to adapt to over the course of the next few centuries, or dramatic, chaotic changes that would transform our world by the time today’s toddlers hit middle age.

If the past is any clue, we could be in for a wild ride. If the past is any clue, we could be in for a wild ride. As far back in the fossil and geologic records as we can see, Earth’s climate has been hopping all over the place; our planet has alternately been an icy snowball, a sweltering sauna, and everything in between. Evidence collected over the past twenty years, ranging from glacial ice cores to sea floor samples to ancient pollens to stalagmites, has convinced scientists that the transitions from one state to another have sometimes been unfathomably quick. Traditional theories assumed that it took thousands of years for large ice sheets to build up during cold phases; newer evidence shows the planet’s climate can drive major changes within just decades. Humanity’s experience of a steady climate is nothing but an historical anomaly. “We don’t have direct human experience of [abrupt climate change],” says William Collins, another Lawrence Berkeley National Lab scientist who leads the IMPACTS project. “That’s biased our thinking about climate change as being something that happens gradually.” In fact, sometimes climate change doesn’t creep up on the planet; it changes the world within a human generation.

One example of abrupt climate shift was a prehistoric doozy of a cold snap known as the Younger Dryas. This “big freeze” started about 12,800 years ago, as the frozen planet was slowly thawing and moving toward conditions much like today’s temperate ones. Suddenly the warming reversed, and within a few decades cold, dry, and windy conditions became the norm for another millennium. Then the cold snap broke, even more rapidly than it began. Greenland’s average temperature
rose by as much as eighteen degrees Fahrenheit in ten years, about the difference between today’s average annual temperatures in Los Angeles and Buffalo, NY.

Scientists are still debating what caused the Younger Dryas’ dramatic swings in climate, which happened under
a very different set of conditions than those we face today. A leading explanation is that a giant lake in central
Canada sent a rush of melting glacial water into the North Atlantic, shutting down the major ocean current that had carried heat north from the tropics. Alternatively, a few researchers posit that the freshwater influx was the product of a comet that exploded above the Earth, melting glaciers. Whatever its cause, the Younger Dryas shows that climate is fickle. The Earth’s climate history features dozens of other known incidents—saddled with abstruse names like the Bolling-Allerod interval and Dansgaard-Oeschger events—of major, lasting, widespread changes that happened within decades.

To understand how the system could change so quickly, imagine the climate as a marble resting in the bottom of a large bowl. Push it a little in one direction with a finger, and it will roll around for a while before it settles on the bottom again. Keep pushing it little by little up the side of the bowl (“forcing” it in a certain direction, in climate terms), and it will climb higher and higher. Let go, and it will eventually settle back where it started. But force it high enough, and the next little nudge could send it over the bowl’s lip and into uncharted territory. That’s an abrupt change. Even if you take the forcing mechanism (your finger) away, the marble won’t roll back to where it started.

Of course, the real climate is much more complicated
than a marble in a bowl, and it’s hard to know what factors might send the system past a point of no return. The IMPACTS tasks represent researchers’ best guesses about mechanisms that might start a runaway forcing process very soon, within twenty to thirty years. The lakes are part of the IMPACTS project because they could contribute to a cycle that pushes the climate past its tipping point. Here’s how it could work: First, rising temperatures cause permafrost to melt. In some places, the ground subsides and water pools to form the shallow thermokarst lakes. At the bottom of the lakes, microbes munch on the defrosted soil, producing methane gas. Some of the gas bubbles up through the water into the atmosphere. The process happens year-round, because the layers of water and ice insulate the microbes from the frigid Arctic winter. Methane, which is over twenty times as effective as carbon dioxide at trapping heat in the atmosphere over a hundred-year period, helps warm the climate. Higher temperatures melt still more permafrost, more lakes release more methane, and a nasty feedback loop emerges. It doesn’t help that the Arctic is warming more rapidly than anywhere else.

Collins calls the handful of phenomena that IMPACTS is studying “The Four Horsemen of the Apocalypse.” The project’s scientists are trying to understand how Arctic sources of greenhouse gases, including thawed permafrost and Riley’s thermokarst lakes, might speed up warming worldwide. The surprising dynamics of the Antarctic ice sheet, which is breaking up faster than anyone predicted and could lead to major sea-level rises, and the extent and behavior of frozen methane pellets deep on the sea floor, which could melt, release big stores of the gas, and start a vicious cycle accelerating change. They’re also exploring how factors like dust storms, fires, and plant biology could cause or accelerate mega-droughts in America’s Southwest.

Flammable gas bubbling through frigid, distant lakes doesn’t seem like a big deal in isolation, but then again, neither does driving a car, burning coal, or other human activities that have spewed enough greenhouse gases into the atmosphere to start changing the climate. Yet within the context of our elaborate climate system, which acts in nonlinear, only partly predictable ways, the thermokarst lakes and their methane, or any of the other phenomena that make up the IMPACTS portfolio, could turn out to be the push that puts the marble over the edge of the bowl. “We don’t know what the risks of abrupt climate change are,” Collins explains. “It’s a lot like building an actuarial table. If you smoke, what’s your risk of dying? If you emit carbon dioxide, what’s your risk of breaking up Antarctica?”

And while the scientists are rushing to calculate the risks these factors pose, the driving forces behind climate change aren’t letting up. “There’s this pressure to get an answer,” Riley says. “We’re running as fast as we can, but it’s possible the system is going to get ahead of us.”

The scariest part about the possibility of abrupt climate change is that it could happen faster than many of the planet’s life forms, including us, could adapt. Sudden, long-lasting drops in precipitation, for example, probably contributed to the collapse of the Akkadian empire in Mesopotamia 4,200 years ago and to the disappearance of the Anasazi from the American Southwest in the 13th century. “Mankind has predicated its existence on the stability of climate zones,” says Collins. “That’s where we plant our crops, that’s where we grow our wine, that’s where we base our cities.” Some anthropologists even correlate the beginnings of agriculture with the pause in drastic climate swings we’ve enjoyed for the past ten thousand years.

If an abrupt change in climate occurs again soon, our surroundings could shift faster than even modern societies could handle. Rising sea level could inundate coastal areas, changes in weather patterns could devastate crops, energy and transportation infrastructure, and leave millions of people cut off from reliable drinking water. One only has to think of California’s current drought, or the 1930s dustbowl, or the disruption caused by natural disasters like Hurricane Katrina or the 2004 Indian Ocean tsunami, to realize the stress that weather and climate can put on a region’s food supplies and livelihoods. Climate shifts that come on more slowly would allow time for people to adapt: planting crops that use more or less water, shoring up or moving flood-prone roads and buildings, finding substitutes for dried-up hydroelectric power. Real adaptation would require both foresight and resources.

But even the most progressive governments are only beginning to consider what changes may need to happen, and the planet’s poorest regions may be especially vulnerable to sudden change. “What if Phoenix was no longer viable as a city?” Riley asks. “Even under pretty extreme conditions, Americans will be able to adapt. We have the money. But what are you going to do if you’re in Bangladesh, and you’ve got nothing?” Developed nations wouldn’t be off the hook, though, in the event of a global crisis. If, for example, sea level were to rise twenty feet in a century because Antarctica’s ice sheet collapsed, America’s troubles could extend beyond relocating its coastal population. Major climate change could prompt international conflicts over increasingly scarce natural resources, including food and water. “We have no clue what might happen if something shifts worldwide,” says Susanne Moser, a research associate at the Institute of Marine Sciences at UC Santa Cruz, who studies climate vulnerability. “What if there’s turmoil in seventeen places at the same time?”

Hollywood loves doomsday “bad weather” scenarios (see, for instance, the 2004 disaster flick The Day After Tomorrow in which an ice age sets in over just a few days), but do we really need to worry about a violent climate swing anytime soon? Nobody knows. “People didn’t even know this was happening until recently,” says Riley after we watch the fireball video. He’s talking about the bubbling methane, but he could just as easily be referring to other processes that IMPACTS projects are examining, such as the accelerating breakup of Antarctica’s ice sheet. “It’s complicated because the system’s so complicated. There are so many things that we’re still learning about,” Riley continues.

The forecast for our climate is already pretty grim. The United Nations’ Intergovernmental Panel on Climate Change (IPCC), the leading body for compiling climate change science, predicts that continuing greenhouse gas emissions will cause global temperatures to warm by as much as seven degrees Fahrenheit by the year 2099, and that sea level will rise over the next century, with harmful effects on human health, economies, and ecosystems worldwide. Closer to home, a report released earlier this year by the state of California, based on the IPCC’s data, warns that “extreme events from heat waves, floods, droughts, wildfires, and bad air quality are likely to become more frequent in the future and pose serious challenges to Californians.”

The magnitude of the changes we’ll face will likely depend on how much and how quickly we cut our greenhouse
gas emissions. The IPCC bases its scenarios on variables like population growth and fossil fuel use, using them to predict how the climate will react under different conditions. Yet the natural processes the IMPACTS team is studying—like the methane escaping from the thermokarst lakes—are missing from the climate models currently produced by research and government agencies worldwide. These previously unstudied factors could substantially alter the climate outlook even under the same emissions scenarios—though nobody knows exactly to what extent. The science just hasn’t been done. “Representing this type of change in models that can project the future of the climate has been really challenging,” Collins says. “It’s only recently become possible from a scientific and a computational perspective. We’re poised to do this now in kind of a unified framework
that’s unprecedented.

For Riley and his colleagues to include the lakes in future models, the team must attach numbers and formulas to a complicated combination of factors, everything from the geology of how permafrost slumps to the physics of how methane bubbles and the biology of how microbe populations act. Their model has to capture the behaviors of millions of lakes ranging in size from a few yards to a few miles across. To make things harder, because the methane spewing from thermokarst lakes was discovered so recently, the researchers are building models without the benefit of a long history of field data.

The team starts by trying to model an individual site. They test their computer program by comparing what it would predict in past conditions to actual observations. Next they do similar tests at many other sites, trying to refine their lake model to match what happens in the real world. Once the team feels confident that their model works well—Riley expects to have it ready by February, 2010—they will plug it into a general circulation climate model, which takes into account hundreds of other systems and processes, like those included in the IPCC report, to mimic the global climate as a whole. With the models coupled, the IMPACTS researchers can start to predict how likely and how sudden abrupt changes might be under different emissions scenarios, and create projections that could guide policymakers in preventing or reacting to climate change.

What if the models show we’re likely to get a dramatic shift in temperature, sea level, or rainfall over a short period of time? “I can tell you that we are in no way prepared,” says Moser, who has worked with the state of California on its adaptation strategies. “We are barely prepared for our ‘normal’ disasters, as New Orleans showed very well. There’s simply a horrific picture you get in scientists’ eyes, how bad it would be to go to that place, but no one has data on what that would mean. Certainly not for the state of California.”

Despite the scarcity of data-based predictions, there have been a few attempts from the policy side to think seriously about the possibility of abrupt climate change. In 2003, two consultants for the San Francisco-based Global Business Network, which specializes in scenario planning, prepared a report for the Pentagon on its national security implications. “Because of the potentially dire consequences,” the report warned, “the risk of abrupt climate change, although uncertain and quite possibly small, should be elevated beyond a scientific debate to a US national security concern.” The report drew media attention in 2004, but the federal government didn’t react in any visible way. Federal and local policymakers rarely discuss or acknowledge abrupt climate change. “We’re driving with a heavy foot on the accelerator and basically closing our eyes,” Moser says.

Admittedly, it can be hard to distinguish whether a change like a regional decrease in rainfall is a short-term blip or part of a large-scale shift. One hope for the IMPACTS models is that they might help us tell if we’re already in the midst of an abrupt change. “Things are changing so fast, it’s possible that we already are,” Riley muses. Collins is more cautious. “The last thing we want to be is alarmist,” he says. “That said, we want to be realistic and we’ll go where the science leads us.”

Riley is optimistic about the progress his team is making, but it may beyond anyone’s capability to figure out what’s really happening in a system as complex and rapidly changing as Earth’s climate, and assign meaningful numbers to nebulous climate-change factors, many of which we may not even have discovered yet. Like the actuaries they’re emulating, the IMPACTS scientists will do their best to figure out the likelihood these small changes will add up to a big shift, and how soon that shift may happen. The rest will be up to policymakers. Even when this project is complete, we won’t be entirely able to predict our future. “There’s only one real experiment,” Riley says, “and we’re living in it.”

CyberTran International, founded in 1998, is one of a dozen or so companies around the world that hope to make mass transit so much better that it could tip the scales of public sentiment away from favoring personal cars. Each company has its own specific plans, but the basic idea is the same: “You go into a station, you push a button, a vehicle comes and picks you up and takes you to your destination,” explains Neil Sinclair, CyberTran’s CEO and chairman. “You can bypass stops. In an elevator you don’t go from the second floor to the tenth floor and stop at every floor; you zip from the second to the tenth floor. That’s what this does horizontally.”

The technology has almost as many names as it does implementations: personal rapid transit (PRT), podcars, group rapid transit, or automated direct transportation. CyberTran calls its variation UltraLight Rail Transit. Sitting in the company’s front window was a scale model: a sleek, bullet-shaped car, like a silver Airstreamtrailer with pointed ends and large windows, running on an elevated guideway.

CyberTran’s late founder, civil engineer John Dearian, first developed the system in the 1990s as a research and development project within Idaho National Laboratory. In 1998, he and Sinclair took the technology out of the lab to form CyberTran, building and testing a full-sized prototype on a track in Alameda. The car held twenty riders in cushy, charter-bus style seats, facing forward in rows. (Other companies have designs that include smaller cars, some holding as few as two riders, and vehicles that hang below an overhead track like a ski lift.)

In a full implementation of the CyberTran system, the automated, driverless electric cars would run on a large network of tracks. Instead of following a preset path, as a train does, onboard computers would decide the optimum route to take you straight to your destination. Stations would be set off the main track, allowing cars to zip past at full speed. “We’ve redesigned the whole idea of a rail-based passenger transportation system,” Sinclair emphasizes. “We’re talking about an integrated network,” one that could include high-speed regional connections along with local service.

Most importantly, the technology is clean. CyberTran calculates that its system would use around 90 percent less energy and create 98 percent fewer greenhouse gas emissions per passenger mile traveled than automobiles (although those figures, of course, depend on how the rail gets its electric power).

Such a system has serious advantages over traditional forms of public transportation. Passengers would be freed from memorizing schedules, long waits at stations or bus stops, or figuring out transfers between routes. Trips could be 14 to 125 percent faster stop-to-stop than on conventional buses or rail, according to calculations in a report on personal rapid transit created for the New Jersey state legislature. Because the vehicles are small, the track infrastructure would take less space and be much less expensive to build than traditional rail, even if tracks were elevated along parts of their routes to avoid interfering with cars. (The New Jersey report estimates a cost of $30 million to $50 million per mile for such systems; by comparison, the BART extension from Fremont to Silicon Valley is projected to cost around $375 million
per mile.) More affordable, smaller tracks allow for more stations, especially because more stops don’t mean slower trips as they do for buses and trains that pause at every one.

Put those factors together, and you begin to see the biggest advantage of systems like CyberTran’s: They might actually lure people out of their cars. “We’ve got an auto-dependent civilization,” Sinclair says, ruefully. “It’s killing us, and it’s killing the planet.” He’s right; transportation is responsible for 28 percent of greenhouse gas emissions in the United States (in California, it’s 38 percent), and 70 percent of American oil consumption. While developing alternative fuels and increasing fuel efficiency play an important role in reducing those numbers, helping people avoid driving altogether is key.

“I can’t tell you how much I want this to happen,” says Peter Calthorpe, the San Francisco-based planning guru and New Urbanist pioneer. “In California, transportation is the 800-pound gorilla. Nothing comes close in terms of energy and carbon footprint.” The state’s successes in other areas (especially in boosting home energy efficiency) leave transportation as the biggest area of energy use that can be cut back. Even though public transit ridership hit an all-time high in 2008, personal vehicles still account for over eighty percent of daily trips nationwide. To make a dent in those numbers, public transportation must become an alluring alternative. “You can’t solve [climate change] without attacking vehicle-miles traveled,” says Calthorpe. “The idea that we’re going to move into the 21st century with 19th century transit technology is absurd to me.”

Though it seems futuristic, the basic ideas behind automated direct transit have been around for decades; the struggle has been in putting the theories into practice. In the mid-’70s, the Nixon administration funded research into the concept. The resulting investment produced a direct-transit line in Morgantown, West Virginia, that connects the three campuses of West Virginia University. The system has run for over thirty years, but cost overruns and construction delays tarnished the technology’s reputation
for decades. No full-scale system has been completed since, though a project is underway at Heathrow Airport in London, and several cities in Sweden are considering systems. Other proposed
projects have ended up in the dustbin because of concerns about costs or the readiness of the technology.

“There’s inertia in the transportation system,” points out Elizabeth Deakin, director of the University of California Transportation Research Center and professor of city and regional planning at UC Berkeley. “Lots of people don’t like big old clunky buses, but we’ve got them, we know how to operate them, we know how they work. It makes it hard to change even if change might be better.”

Despite the obstacles, several local governments think advanced direct transit might have something to offer their communities. The cities of San Jose and Santa Cruz have each begun to explore the possibility of making modern systems a reality in Northern California.

“Like most small communities in America, we’re being choked by the automobile,” explains Mike Rotkin, city councilmember and vice-mayor of Santa Cruz. Getting from the city’s downtown to its University of California campus presents a particular challenge, Rotkin says. “There’s not room for another car on those streets. There’s not another alternative solution, transportation-wise, other than something very much like PRT. It’s something that’s sort of tailor-made for our community.”

Since 2005, PRT supporters in Santa Cruz have been calling attention to the technology’s possibilities,
and in 2006 the city commissioned a feasibility study. The project is slowly moving forward; last summer, the city sent out a request for qualifications, offering to provide right-of-way to a company willing to build and finance a PRT system to connect the city’s downtown to its busy university area.

There are still many questions that need to be answered before anything gets built, Rotkin says: Would the project require a public subsidy? How much would a ride cost? Could the system handle a huge influx of students in a short period of time? What are the visual impacts? “We have these real serious blocks to moving to the next step,” he admits. “It’s not enough to like the concept in the total abstract. We’re at the point of wanting to know, ‘How would the system work in our town?’”

San Jose is asking the same questions. Spurred by Mayor Chuck Reed’s “Green Vision” initiative, which seeks to establish San Jose as a national leader on environmental issues, the city is considering how it can help get the idea of green mobility off the drawing board and onto the streets. Its “Automated Transit Network Demonstration Project” would start by connecting San Jose International Airport to nearby light-rail, Caltrain, and BART facilities.

Originally, the plan was to build a more traditional people-mover to do the job; it would have cost over $500 million for a two-mile system with three stations. Then it occurred to city planners that an advanced direct system might do a better job, not just of linking the airport to existing transit facilities, but creating a network of transportation to nearby destinations, including hotels, offices, and a planned soccer stadium.

“We see opportunities to create extended transit villages around our BART investments, our high-speed rail station, and our light-rail facilities,” explains Hans Larson, the city’s deputy director of transportation.
Plus, this new technology meshes well with San Jose’s vision of itself as an environmental and technological leader. “It’s innovative. This is the kind of thing that San Jose and Silicon Valley do well,” Larson says.

Last fall, San Jose solicited proposals for the project. An overwhelming seventeen responses arrived from around the world, including one from CyberTran, but none seemed quite shovel-ready. Instead of getting discouraged, though, city planners set their sights even higher. Now they’re seeking partnerships with the federal government, asking it to invest in setting technical standards and demonstrating that a system can work. The city hopes to collaborate with the departments of Energy and of Transportation, NASA Ames Laboratory, and Lawrence Livermore National Lab, as well as the aerospace industry. “We would like to not be behind the rest of the world in developing this,” Larson says. “We think Silicon Valley and San Jose is the place to start this as a national industry.”

There’s still some room for skepticism, though. “San Jose’s a pretty thin market,” warns UC Berkeley’s Deakin. She points out that the city is having a hard enough time paying for its existing transit commitments. And while she agrees that advanced transportation systems sound great on paper, she’s cautious about predicting what might happen in practice: “It’s really hard to say in general if this is going to work or not. The studies about whether there’s enough demand haven’t been done. Do people want this, or would they rather drive their cars? You can’t look at it as a pure technological gee-whiz kind of thing.”

Calthorpe, the urban planner, is glad to see municipalities taking direct transit seriously. But he, too, is cautious, having experienced firsthand how challenging it can be to convince governments to commit to PRT. “I constantly put it into my projects, and it gets constantly booted out,” he says. He thinks part of the problem is that there are still no existing examples of a working system. “People say, ‘We’re not going to be the first ones to test drive this stuff.’”

Another challenge is that these systems raise sticky political issues like land-use planning. “Transit doesn’t work at four units per acre,” a typical suburban layout, Calthorpe explains. And planning for the denser, more urban communities that complement rapid transit is difficult, even in the Bay Area. “In California, some people think the answer [to climate change] is vehicle efficiency; that we don’t need to change our lifestyle, we just need to drive Priuses. There’s going to be a giant political battle,” he predicts.

Still, Sinclair is hopeful that CyberTran’s moment has arrived as more people focus on combating climate change. The company has spent the last year working on its third-generation vehicle and software control, and has plans to use a large warehouse in Oakland as its product development center. “We’ve got the technology. There’s no new science necessary. This is entirely doable,” he says. All they need is funding.

The question is whether anyone with enough money to pay for the crucial next step, a demonstration project, will step forward—the New Jersey report estimates a demonstration of a PRT system would require at least a three-year, $50 million to $100 million investment. Right now, the federal government is about the only entity with enough money to spend, and at press time, none of the federal stimulus funds were heading towards direct rapid transit projects.

Perhaps attention from cities like Santa Cruz and San Jose will change that. “There needs to be a local government, grassroots demand for it,” Sinclair insists. “Little cities can’t do it, but what little cities can do is ask big Sacramento or big Washington to do it.” And if that doesn’t do the trick? Sinclair has a Plan B: “Any of you that have a rich uncle that wants to build a train, come talk to me.”

At home, Wilson had been waste-conscious, choosing products with less packaging to reduce her impact on the environment. At the hospital, she found that approach impossible to maintain. As Samantha’s stay dragged on, the piles of supplies the doctors needed to keep her healthy kept multiplying: diapers, bandages, oxygen tubes, feeding bags. “Everything from gauze squares to little plastic fittings for this or that hose comes packaged in big plastic containers that are sterile,” recalls Wilson.

The waste bothered Wilson, but it seemed inevitable. “How can you not [create trash]?” she asks. “Because of course you can’t reuse this. They [the doctors] are there to fix kids, so they’re going do whatever the protocols say they have to do.” Because Wilson’s first priority was her daughter’s health, her environmental unease slipped into the background. Besides, she didn’t have solutions. “My thinking didn’t go much beyond, ‘This is a situation that needs to change at some point.’”

Many people who work within the hospital system agree that things need to change. Because of their efforts, a new, greener mindset has been creeping through the bright corridors of California’s healthcare establishment, as administrators reconsider everything from the trash hospitals create to the cleansers on their floors to putting solar panels on the roof. But reducing the ecological footprint of healthcare isn’t easy; hospitals’ efforts to treat the sick can affect the world beyond their walls in many ways. For one thing, hospitals are big energy users: An average hospital consumes twice as much energy per square foot as a commercial office building. Hospitals deal with toxic substances including pharmaceuticals, medical waste, laboratory chemicals, and radioactive waste that take extra work to dispose of and that can contribute to environmental pollution. Hospitals buy and use vast quantities of supplies—not just specialized medical equipment, but electronics, paper goods, food, and bed linens. To prevent disease, they use chemicals and packaging to keep things sterile.

All these aspects of a hospital operation add up to a big environmental footprint, and it’s one that is likely to grow. Nationwide, more than 100 million square feet of medical building space are constructed every year, and experts predict that healthcare’s share of the economy will continue to expand. In 2004, spending on hospital care made up almost four percent of California’s total economy.

Hospitals have an important role to play as California works to cement its status as a leader in environmental responsibility. But can they get there?

An uphill climb
As Wilson experienced, hospitals often face conflicts between reducing their environmental impact and delivering state-of-the-art care. “Patients are the top priority, so whatever we do we have to make sure to protect quality, to always have the patients in mind,” says Dominican Sister Mary Ellen Leciejewski, the ecology program coordinator for Catholic Healthcare West (CHW), a San Francisco-based nonprofit that operates the state’s largest system of hospitals.

Other challenges to going green include hospitals’ tendency to operate on tight budgets without a lot of wiggle room for extra costs or investments, the sheer size and complexity of hospital operations, and the tangled web of health-related regulations hospitals must navigate. Then there’s mindset: “There’s a high burden of proof for us,” explains Dr. Preston Maring, a gynecologist and administrator with Oakland-based nonprofit healthcare giant Kaiser Permanente. Health providers make decisions based on proven science, and that same way of thinking can permeate decisions about running hospitals. Even a facility that’s actively working to be more sustainable is likely to shy away from any unproven, cutting-edge ideas, like an eco-friendly flooring material that one hospital rejected because administrators doubted it would last long enough. “Within a healthcare institution, you have to know ahead of time that what you’re doing is the right thing to do,” says Maring. With such a risk-averse attitude, hospitals tend to lag behind when it comes to making green choices.

Healthy earth, healthy people
Despite the obstacles, over the past decade a growing number of hospitals have begun to view a concern for the environment as inseparable from their main mission of promoting good health. Because of their position in the community, hospitals can play a leadership role. “As a healthcare facility we have the opportunity to model health and healing,” agrees CHW’s Leciejewski. “We help people continuously make the connection that our health is aligned with good soil, pure water, clean air.”

Spurred by the largely successful campaign in the late ‘90s to eliminate toxic mercury from hospital waste, several national organizations have made cleaning up healthcare their mission, including Health Care Without Harm, a global coalition working to reduce pollution in the healthcare sector, and Practice Greenhealth, a nonprofit that provides information and support on topics such as clean energy, green building, and waste management. These organizations, both based in Arlington, Virginia, serve as clearinghouses for ideas percolating through the hospital community: that health extends beyond the hospital doors; that what hospitals do affects the larger world; that the environment matters.

In California, those ideas have received a warm reception, and a number of local institutions are working towards sustainability. “These are our recycling bins,” says a smiling Sister Leciejewski, pointing at the large containers lined up along a back driveway at Dominican Hospital, a CHW affiliate in Santa Cruz and Leciejewski’s home base. The bins are standard blue trash containers, but Leciejewski is clearly proud of them. “We recycle all our paper, after we print it double-sided,” she says. Next she points out the spots for collecting metal furniture, light bulbs, food waste, batteries, electronic waste, and plastic wrap.

There’s nothing unique to a hospital about these waste streams, even though they can make up 95 percent of what a facility throws out. But managing it right is important, something Dominican recognized in the ‘90s when employees pushed for recycling programs like the ones they used at home. (Today, Dominican has won almost a dozen awards for waste reduction and environmental leadership.)

Keeping track of which waste goes where is especially crucial when it comes to “the bloody stuff,” as Leciejewski puts it. Disposing of medical waste is expensive and energy-intensive; anything that goes in one of the red biohazard bags has to be treated as possibly infectious and either sterilized or incinerated. Dominican makes sure that employees know exactly what goes in the red bags (used bandages, for example) and what shouldn’t (pizza boxes). “The first year we started emphasizing that we saw a real drop in cost and waste. Now it’s just how we do business,” says Leciejewski.

Being mindful of what comes into the hospital is just as important as dealing with what leaves it. “We’ve been trying to redesign things, talking to vendors to figure out what comes through the front door,” Leciejewski explains. A hospital system of CHW’s size has enough leverage to influence the marketplace. For example, when nurses at Dominican got sick of opening three separate packages of supplies every time they delivered a baby, they convinced their supplier to consolidate the packs into one, reducing the amount of trash.

Still, challenges abound. In 2001, Dominican set up a program to recycle the special “blue wrap” plastic packaging that keeps surgical and medical supplies sterile before use. It was a great success, diverting eight tons of the stuff from the landfill in its first year, but the company Dominican had been working with shut down. The hospital couldn’t find a replacement that wouldn’t ship the waste to China, something Leciejewski is reluctant to do. Now it goes back in the trash.

In spite of the setbacks, Leciejewski remains optimistic. “We realize we can’t do everything. Sometimes it’s baby steps, and we just keep on the journey. Sometimes it’s leaps of faith, and we move ahead.”

An apple a day
One place where Leciejewski is moving ahead fast is in Dominican’s vegetable garden. Tucked on a small plot of land bordered by the cafeteria and a parking lot, the garden, now in its sixth year, offers a touch of serenity amidst the bustle of the busy hospital complex. By summer, the thirty raised beds will brim with onions, tomatoes, eggplants, pepper, carrots, cauliflower, and herbs, lovingly tended by volunteers from the staff and the local community. The organic bounty will head straight to the plates of employees and visitors. (The garden isn’t big enough to provide for patient meals.)

The idea of serving fresh, organic, locally grown foods is one that’s gaining popularity throughout the hospital community. In 2007, the California Medical Association passed a resolution encouraging hospitals to promote a healthier and more sustainable food system. As of May 2008, over a hundred healthcare facilities had signed a pledge, sponsored by Health Care Without Harm, committing to the goal of providing local, nutritious, and sustainable food. Local signers include all of CHW’s facilities, the St. Joseph Health System in Sonoma County, and the John Muir Health System hospitals in Concord and Walnut Creek.

The idea behind both the resolution and the pledge is that the negative impacts of industrial farming—pesticides, overuse of antibiotics in livestock, land degradation, high fuel use for transporting food, to name a few—are not just an environmental but a public health issue, and one in which hospitals need to take an active role. For many hospitals, though, that’s a big leap: A 2005 survey by the Physicians Committee for Responsible Medicine found that only sixteen percent of hospitals used organic ingredients, and fewer than a third were even consistently offering meals that were healthful for people, much less the environment.

But change is on its way. The Kaiser hospital system, for example, is working to source food for patient meals from small and mid-sized local growers, to provide hormone-free milk, and to offer healthy options in its vending machines. “There’s so much room for connecting people to good healthy food,” says Kaiser physician Preston Maring.

Maring is also working to bring locally grown food to the larger community; in 2003 he started a weekly farmer’s market at Kaiser’s Oakland Medical Center, where he practices. Staff, patients, visitors, and the community so appreciated having organic, farm-fresh produce at their fingertips that Kaiser has expanded the program to include weekly markets at 32 hospitals in four states. Kaiser found that 71 percent of people who attended the markets said they were eating more fruits and vegetables as a result. “What people eat is the most important thing for their health,” he emphasizes.

Green from the ground up
Changing what goes on inside the hospital, however, is only part of the solution. Hospitals are also starting to consider integrating green designs and technologies into the buildings themselves. For example, green building standards encourage use of interior materials that don’t emit high levels of volatile organic compounds (VOCs). Such materials help keep indoor air healthy, especially important for vulnerable patients. Similarly, buildings designed to provide lots of access to daylight help reduce the energy used for lighting and have been shown to speed patient recovery and improve mood.

Yet certified green buildings have been slow to catch on in the hospital sector. “Part of the issue is that the timeframes are so long,” says Larry Koller, program manager for the Mills-Peninsula Hospital Replacement Project in Burlingame, a new building set to open in 2010. “The idea of green is relatively new to the construction industry, and in 2000-2003,” when the team was designing the project, “a lot of the products were not around.” As an example, Koller points out that if they were designing the hospital today they might include solar panel technology that was prohibitively expensive in 2000.

Still, the new Peninsula Medical Center will incorporate a few green elements. The team worked hard to design a climate control and ventilation system that could pipe outside air into each room separately (to prevent germs from spreading between rooms) without using much extra energy. The system now serves as a model for other facilities.
Kaiser Permanente has also been working to incorporate green elements into its new buildings. In October 2008, Kaiser opened a facility in Modesto that features sustainable details such as a small rooftop solar array, permeable
pavement in the parking area that allows rainwater to filter through it, and low-VOC carpet made with recycled materials, a product that didn’t exist until Kaiser asked manufacturers to design it. Kaiser plans to incorporate green elements into many of its new hospitals.

Money matters
Moving forward, hospitals are bound to profit from the innovations in sustainable technology, from renewable energy to green cleaning products. As more hospitals develop green solutions, even the most conservative institutions will have solid models to follow. For example, the US Green Building Council is currently in the pilot phase of LEED green building certifications designed specifically for healthcare.

Yet the hospital sector is subject to the all the perils of the current economy. While sustainability advocates have worked hard to couch their arguments in terms of long-term cost savings (Practice Greenhealth even has a publication called The Business Case for Greening the Health Care Sector), many sustainability changes require an initial investment that may be unpalatable during a recession.

Even if the progress that many institutions have demonstrated expands, there’s a long way to go before the entire industry is as green as it could be. No matter what percentage of its trash a hospital recycles, or how local its food is, or how sustainable the building, the uncomfortable truth is that modern medical practices have a big impact on the environment, as Wilson saw during her stay with Samantha. Possibly the best way for each of us to reduce the impact of hospitals on the environment is to do our best to avoid using them. That means making lifestyle choices like eating well and exercising, and advocating for better access to good food and laws that clean up our air and water. Environmental illnesses are becoming endemic in our society, and in many cases, the way we treat illness is still bad for the Earth. In the end, the greening of hospitals will need to extend far beyond their walls.

Towards a Greener Practice

Even as many hospitals work to reduce their environmental impact, some activists say the medical community is just scratching the surface. “Primarily the green is going on between the administrators and the support staff, and it’s leaving out the clinicians,” declares Dr. Joel Kreisberg, founder and executive director of Berkeley’s Teleosis Institute, a nonprofit that advocates an eco-conscious medical system.

Kreisberg’s idea is that reducing healthcare’s footprint has to go beyond efficient buildings and recycled paper, straight to the heart of what goes on between doctor and patient. If doctors can help keep people from getting sick in the first place, they can prevent a lot of harm to the environment. That means asking patients about their lifestyle—diet, exercise, exposure to chemicals—and helping them make positive changes.

Doctors can also help reduce pharmaceutical pollution by trying alternative treatments when appropriate and prescribing only as much of a drug as a patient needs. Simply being aware that medicines might someday end up in the ecosystem is a big step for some clinicians. Teleosis offers courses in green healthcare to help practitioners understand how they can protect the environment: “We have to connect all the dots,” Kreisberg says.
To find out more, including how you can safely dispose of unused medicines, visit www.telosis.org

Squish Not

In 2006, Grinage was facing a squishy, messy problem. Despite making as many jams, jellies, and pies as she could manage, most of apples, plums, oranges, and blackberries in her backyard was going to waste. There had to be a way to get that food to the people that she knew really needed it.
The Alameda County Community Food Bank would only take the fruit if Grinage harvested and bagged it herself. But like many busy homeowners, she didn’t have the time to make that happen. What she really wanted was an organization she could call to come gather the fruit and distribute it to those in need. No such organization existed—so Grinage started one herself.

Hiring Harvesters

Rather than relying on volunteer labor, Grinage decided she’d pay young people to harvest and deliver the fruit, creating jobs in a city that desperately needs them. For three weeks during the summer of 2007, and six weeks in 2008, Urban Youth Harvest worked with the Mayor’s Summer Jobs Program; donations paid four young staffers to gather the fruit. The harvesters spent around twenty hours a week on the job, which included training about nutrition, gardening, and food justice issues. When possible, they rode bikes to the harvest sites. “It’s a much better summer job than filing or flipping burgers,” Grinage says.

Mike Saechao, age 23, liked everything about his summer working with Urban Youth Harvest. He credits the program for helping him get over his shyness; after spending the summer talking to the strangers whose trees he was harvesting, he’s much more comfortable in such situations. And he liked that his work was helping his community: “Every time I was picking I felt happy to be doing something for someone out there. That’s why I loved it.”

Fruit Moments

Once they gathered the fruit, Mike and his co-harvesters delivered it to local organizations that serve low-income seniors. They tried to find suitable takers as close to the harvest sites as possible, in order to minimize the impact of transporting the food. They hope the fruit will help combat the growing health crisis among seniors, whose lack of access to fresh produce contributes to high rates of diet-related illnesses such as hypertension, obesity, and diabetes.

This summer alone, Urban Youth Harvest workers delivered over a ton of fruit to seniors. For Grinage, that’s just a start. If she can find the funding, she plans to keep expanding the program. Future plans include mapping the city’s fruit trees using aerial photographs, harvesting year-round, and hiring more young people. “There’s more fruit out there than anybody ever realized,” says Grinage. “At this point, we don’t really know how big this could be.”