by Hannah Paul

Hey CO ASDA!

It’s been a minute, but I’m back with another green gab! :) So, I promise, I do have some more dental-specific posts planned for the future, but this topic has been on my mind recently, and I feel it is an important one for people to keep in mind during such a tumultuous time. As we’ve seen with the current pandemic, even environmental/sustainability topics that have little to no direct relation with our lives or career can still impact us profoundly. Though it’s not going away anytime soon, I wanted to capitalize on COVID to look into its emergence, environmental effects and thoughts on how to move forward. I won’t do it justice since this is quite a complicated and multifaceted issue, but I’ll explore it a bit.

Having upended our entire way of life, this pandemic has really brought to light just how vulnerable we are to environmental hazards. In a Guardian article, UN authorities state that it has shown how “current economic thinking does not recognize that human wealth depends on nature’s health.” SARS-CoV-2 is suspected to have originated in bats, then spreading via an unidentified intermediate host to humans in what is called a zoonotic, or animal to human, spillover event. Both its coronavirus predecessors, SARS and MERS, were likewise spillover events along with 60-70% of all emergent diseases since 1990. Climate change, deforestation, and the wildlife trade are significant drivers of vector-borne diseases. Rising temperatures increase the range of vector species, permitting their migration to previously inaccessible habitats. These habitats are often home to humans, thereby increasing the interactions between humans and vectors.

Deforestation broadens the interface between nature and humans...

Deforestation broadens the interface between nature and humans, likewise facilitating more frequent interactions with vectors. Additionally, bats and other common vector animals more readily adapt to disturbed and deforested areas. The international wildlife trade, both legal and illegal, by nature brings foreign species into new environments, exposing both humans and native organisms to unfamiliar pathogens. Thus, the likelihood of future zoonotic spillovers (and by extension, future pandemics) occurring is rising along with these factors. According to Dr. Seth Berkeley, this is an "evolutionary certainty" that we must be prepared for and work to prevent.

            In addition to underscoring this frightening reality, the pandemic has also contributed to rising rates of poaching and deforestation as suffering economies drive food scarcity and decreased government enforcement. The EPA has loosened environmental restrictions, claiming relief for industries during the pandemic, indefinitely opening the door for unreported pollution. China has also invested in more coal power plants to spur a quick economic recovery. And of course, record unemployment and the economic downturn has reached every corner of the globe, especially impacting the poor. COVID-19 has succeeded in highlighting vast socioeconomic inequalities that plague our nation, greatly emphasizing the need to address them. Whether political momentum will be sufficient to respond remains to be seen.

Some positives of the pandemic are that people are spending more time outdoors and in nature, improving emotional wellbeing. Due to drops in air travel, transportation, and economic activity, there was significantly less oil consumption and air pollution was visibly reduced in many areas as this Nasa Earth Observatory photo to the right shows. According to an NPR article, the global carbon emissions are predicted to drop by about 8% this year. This might seem like a disproportionate amount considering how much the economy and our daily lives have suffered, but historically, it’s actually unprecedented. This decrease will take us back to the emissions levels of 10 years ago and is even greater than the drop associated with the 2008 economic recession. If this level of yearly emissions reductions was maintained until 2030, we would be on track to avoid the worst consequences of climate change. Given, this is subject to change depending on the responses of individual countries. Wildlife may also be enjoying a respite from human activity (although a few of the viral instances have been identified as hoaxes). Unfortunately, despite these silver linings, it seems to me that the net environmental impact is more likely negative than positive.

However, for me and many others, being forced to come to terms with a new way of existence in response to one existential threat begs the question of how we might do so in response to another, even more consequential one. The response to COVID-19 has been in a sense a global experiment in human behavior proving that it is possible to enact rapid, sweeping change given an imminent threat to human health. Maybe it’s just naïve optimism, but I see this as proof that we could respond similarly to the climate crisis and environmental degradation. We have before us an opportunity that we really can’t afford to pass up – the chance to make this moment a turning point in our trajectory. Instead of bailing out a suffering fossil fuel industry, why not invest in a green recovery that includes dramatically scaling up renewable energy use to continue on this path of emissions reductions? The obvious need and desire to prevent future pandemics could likewise spur international collaboration to combat deforestation and regulate wildlife trade. After witnessing the indisputable consequences of poverty and inequality on human health, we might finally have the political will to redistribute funding and resources, ensuring that all people are supported in a just transition to a sustainable future. Or, we could repeat the past, opting for short term economic gains based on carbon-intensive practices, prompting an even greater increase in emissions than before the crisis. Thus, we find ourselves at a crossroads facing a choice between a just, sustainable recovery and a regressive, nearsighted stopgap.   

There are some encouraging signs. An Ipsos survey published in June (see above) reflected that the majority of people polled from 16 major countries believed that governments should make environmental protection a priority in COVID recovery. Also, the European Union has not backed away from their Paris Climate commitments and has proposed a recovery package that devotes a fourth of funding toward environmental protections. Though not fully approved, this represents the kind of efforts we need to embrace in order to truly recover and progress to a more resilient society. The World Bank, World Resources Institute and the International Energy Agency have all developed plans and resources to help countries develop a sustainable recovery plan as well. With the current administration, the federal government is not likely to pursue any of these efforts but, personally, I remain hopeful that 2020 elections will bring about a renewed focus on the environment here as well. It is sorely needed. Until then, we as citizens can push for local, grassroots change and demand local governments to invest in a sustainable recovery wherever possible. Especially while experiencing firsthand the devastation of a pandemic, we must understand that without protecting our environment and repairing our relationship with nature, it’s quite likely to happen again.

by Hannah Paul

Hi everyone!

This post might be a little longer than usual, y’all, but I think (hope) it will be worth the read. Given the current events, or…well… to be more accurate, the greater attention paid to events that have ALWAYS been current, but widely ignored or suppressed by white America, I wanted to take this week to amplify some Black voices who speak to the relationship between racism and environmental justice.

To any white folks reading this post, we have been called out on a national, and now even global scale, and it’s about dang time. It should never have taken so much frustration, sorrow, dehumanization, and death in the Black community to inspire white recognition and action. Now that we are FINALLY here, we cannot allow ourselves to get caught up in the moment only to let justice fall to the wayside as we move on with our lives – again. We must be in it for the long haul – all of us. We’ve got A LOT of (long overdue) work to do in the way of tackling widespread systemic racism and learning to be anti-racists in every aspect of our lives and our society. It can and must be done.

So, that being said, I’d like to challenge all of us, as people who claim to care about sustainability and the environment, to prove our commitment by taking the time to really listen to these and other Black voices and to be inspired to action by their words. I’ve picked out a few quotes from their work, but to really get the full message, I would encourage you all to read the full articles. The truth is, there can be no climate/environmental/sustainability movement without addressing racism and environmental justice. This is an issue that even many major environmental organizations (often white-dominated as well) have often ignored or failed to address, but, considering it is centered around basic human rights, it is one of most, if not the most, important issues we must address as we move forward.

I should also note that Black people only make up one (albeit very significant) portion of the BIPOC (Black, Indigenous, and People of Color) community, and we cannot ignore the voices of rest in this process either. However, in this post I am choosing to highlight Black voices. Also, as a white woman, I am always learning, and my privilege often limits my understanding, so I sincerely apologize if any part of this post is inaccurate or ignorant and therefore detrimental in any way to the Black community. I encourage anyone to call me out if you believe it is warranted and have the emotional capacity and will to do so at this time. Okay, enough from me… now for some words from:

Ayana Elizabeth Johnson Ph.D., Founder and CEO of Ocean Collectiv

Dr. Ayana Elizabeth Johnson, Ph.D. (from ayanaelizabeth.com)

From her Washington Post article: I am a black climate expert. Racism derails our efforts to save the planet.

“As a marine biologist and policy nerd, building community around climate solutions is my life’s work. But I’m also a black person in the United States of America. I work on one existential crisis, but these days I can’t concentrate because of another.”

“How can we expect black Americans to focus on climate when we are so at risk on our streets, in our communities, and even within our own homes?”

“Black people are significantly more concerned about climate change than white people (57 percent vs. 49 percent), and Latinx people are even more concerned (70 percent).” To put that in perspective, it means that more than 23 million black Americans already care deeply about the environment and could make a huge contribution to the massive amount of climate work that needs doing.

“People of color disproportionately bear climate impacts, from storms to heat waves to pollution.”

“Look, I would love to ignore racism and focus all my attention on climate. But I can’t. Because I am human. And I’m black. And ignoring racism won’t make it go away.” 

“So, to white people who care about maintaining a habitable planet, I need you to become actively anti-racist. I need you to understand that our racial inequality crisis is intertwined with our climate crisis. If we don’t work on both, we will succeed at neither. I need you to step up. Please. Because I am exhausted.”

Dr. Robert Bullard, Father of Environmental Justice

Dr. Robert Bullard, Ph.D. (from drrobertbullard.com)

From his website: drrobertbullard.com/

“Today, zip code is still the most potent predictor of an individual’s health and well-being.  Individuals who physically live on the “wrong side of the tracks” are subjected to elevated environmental health threats and more than their fair share of preventable diseases. Still, too many people and communities have the “wrong complexion for protection.” Reducing environmental, health, economic and racial disparities is a major priority of the Environmental Justice Movement.” 

And from his article:  African Americans on the Frontline Fighting for Environmental Justice

“Researchers have found environmental injustice maps closely with Jim Crow housing segregation, bias decision making, and discriminatory zoning and land use practices. America is segregated and so is pollution. The equity lens is a useful frame for understanding the intersectionality of environmental, climate, economic and racial justice issues in the United States.”  

“Polluting industries such as toxic waste facilities, high-risk chemical plants, oil refineries, and coal fired power plants have turned many African American and poor communities into environmental “sacrifice zones.” The nation has 150 refineries located in 32 states.  People of color make up over half of the residents who are at greatest cancer risk from oil refinery pollution.”

Hop Hopkins, Director of Strategic Partnerships at the Sierra Club

Hop Hopkins (from sierraclub.org)

From his Sierra Club article: Racism is Killing the Planet

“It’s no exaggeration to say that racism and white supremacy harm all of us, because in addition to robbing us of our humanity, racism is also killing the planet we all share.”

“An idea—a long-overdue realization—is growing in the environmental movement. It goes something like this: ‘We’ll never stop climate change without ending white supremacy.’”

“You can’t have climate change without sacrifice zones, and you can’t have sacrifice zones without disposable people, and you can't have disposable people without racism.” 

“When we pollute the hell out of a place, that’s a way of saying that the place—and the people and all the other life that calls that place home—are of no value.”

“Devaluing Black and Indigenous people’s lives to build wealth for white communities isn’t new. White settlers began that project in the 15th century, when they arrived in North America.

“How does this all connect to today’s environmental crises? It’s all part of the same story of dehumanization. The pollution-spewing global mega-corporations that created Cancer Alley are just the latest evolution of the extractive white-settler mindset that cleared the forests and plowed the prairies. And just as the settlers had to believe and tell stories to dehumanize the people they killed, plundered, and terrorized, today’s systems of extraction can only work by dehumanizing people.” 

“By dividing us up into racial categories and economic classes, the one-percenters keep us from seeing that 99 percent of us share the same problems.”

“You can choose—we as a society can choose—to live a different way. Indeed, we must. If our society valued all people’s lives equally, there wouldn’t be any sacrifice zones to put the pollution in. If every place was sacred, there wouldn’t be a Cancer Alley. We would find other ways to advance science and create shared wealth without poisoning anyone. We would find a way to share equally both the benefits and the burdens of prosperity.”

Sam Grant, Executive Director of MN350.org

Sam Grant (from MN350.org)

From the New York Times article: Black Environmentalists Talk About Climate and Anti-Racism

“A few days [after Sam Grant called for the prosecution of the officers involved in George Floyd’s death], leaders of national and international groups issued their own statements of solidarity, including the heads of Greenpeace and the Natural Resources Defense Council, followed by the World Wildlife Fund and the World Resources Institute.”

“Mr. Grant called it ‘a positive signal to build on’ but he said he wasn’t convinced that the solidarity would be sustained. ‘It’s not been the norm that mainstream environmental organizations have ever had our backs,’ he said.”

“Police violence is an aspect of a broader pattern of structural violence, which the climate crisis is a manifestation of,” he said. “Healing structural violence is actually in the best interest of all human beings.”

Heather McGhee, Senior Fellow at Demos

Heather McGhee (from demos.org)

From the New York Times article: Black Environmentalists Talk About Climate and Anti-Racism 

“It’s essential to have anti-racism baked into the goals that even white-led organizations are pursuing because both political racism and environmental racism are drivers of our excess pollution and climate denialism,”

“An anti-racist climate movement, Ms. McGhee said, should be led by ‘a real multiracial coalition that endorses environmental justice principles’ and its goals should seek to uplift the most vulnerable. That means, she said, the creation of green jobs, rather than cap-and-trade policies that allow companies to keep polluting in communities of color as they have been able to do for decades.” 

“This conversation is a police brutality conversation on top of a COVID-19 conversation, and it all adds up to a devaluation of black life,” Ms. McGhee said. “That’s what climate change is as well, because of environmental racism. We’ve got to divest from systems that are killing us and costing us, and invest in our people and our planet.”

These are only a handful of the many voices out there, but I hope they offer a good starting point. And, as you keep learning, here are some more resources to learn about environmental justice:

• Intersectional Environmentalism: Why Environmental Justice is Essential for a Sustainable Future

• A Brief History of Environmental Justice (YouTube)

• Our Unequal Earth, a series by the Guardian

• Read Up on the Link Between Racism and the Environment

• Climate Justice Is Racial Justice

• As Scientists, We Have Yet to Close the Racial Disparities

• Read Talia Buford's work on environmental justice in ProPublica

• Look up “racism and environmental justice” on YouTube - lots of great videos there!

• Follow @wastefreemarie, @intersectionalenvironmentalist, and @greengirlleah on Instagram - and keep searching for others because I know these aren’t the only awesome accounts to follow, but they’re a good place to start.

by Jake Holtzmann

The Warmup

This morning, before I sat down at my ‘work from home’ desk to write this piece for my friends and colleagues at CU, the U.S. death toll from the COVID-19 Pandemic officially reached 100,000 lives lost.   To preface my thoughts on the topic of this blog post, I’d like to acknowledge our community during this difficult time.  My thoughts are with each of you, hoping that you’re well, and hoping that those you love are safe.  I hope that today, if even for just a moment, you can free your mind to dream with me – of life after COVID-19, of our future role as oral healthcare providers, and of the lives that we could save with dental administration of critical vaccines – perhaps even a future SARS-CoV-2 vaccine. 

As dental students, we have joined the world on an unprecedented journey into uncharted territory.  A journey that none of us thought we’d ever have to take, but one that requires us to be bold, collaborative, and forward thinking.  If you’re like I was two months before I sat down to write this piece, you’d never considered the possibility of dentists giving the vaccinations that you’re so accustomed to receiving from your primary care provider.  However, as I hope to share with you today, when you dig deeper into the literature, policies, and legislation fueling this growing push to expand our profession’s scope of practice, you begin to consider, “maybe this is possible.”

The Supporting Literature

After reviewing the literature re: Dental Administration of Vaccines, I think it’s important to note the scarcity and specificity of the literature currently available.  Because our current scope of practice already includes preventative screenings for, and education about, head and neck cancer, studies have largely been specific to the potential role of dental providers in HPV (Human Papillomavirus) vaccine administration.  This specificity within the research should help us focus our advocacy efforts in the future as the dental profession takes small steps toward this noted dental scope expansion.

Specifically, HPV continues to be implicated in oropharyngeal cancer oncogenesis (Pinatti et al., 2018).  Following the development of the new Gardasil-9 HPV vaccine, which is expected to protect against the “HPV types that cause ∼93% of head and neck cancers” (Zhai & Tumban, 2016), Primary Care Providers (PCPs) have been taking steps to educate and vaccinate their patients using recommended dosing schedules – which, depending on the patient’s age, typically involves two or three separate doses administered within a much shorter timeframe than a typical yearly check-up at their PCP’s office.

As of 2015, high rates of HPV vaccination had not yet been achieved despite strong endorsements by the medical community (Sussman et al., 2015). While completion rates of the scheduled dosing sequences are already thought to be low (Elsamadicy et al., 2019), completion rates have been found to be significantly lower in racial and ethnic minority populations (Agenor et al., 2020, Spencer et al., 2019), serving as yet another striking example of the systemic inequality in our healthcare system that contributes to the disparate health outcomes of marginalized communities. Studies have found that challenges associated with healthcare delivery (Sussman et al., 2015) such as the consistent scheduling of patients to complete their HPV vaccination dosing outside of their yearly check-ups remains the greatest barrier to community HPV vaccination.

Current literature specifically related to the dental profession has explored the dental community’s willingness to be educated and integrated into the effort to vaccinate against the virus. Promisingly, “a majority of oral health students may be open to receiving training to administer the HPV vaccine and to administer the HPV vaccine once they are trained” (Kepka et al., 2019).  The literature also notes that any such expansion of our scope of practice “would require a strong statement of support by professional organizations” (Young et al., 2015) like the American Dental Association and, yours truly, the American Student Dental Association.

Before moving on, as studies have concluded that some dentists might be hesitant to administer HPV vaccines due to a perceived increase in liability (Daley et al., 2014), I wanted to note that after rigorous analysis, the CDC concluded that there is no evidence to suggest any causal link between the Gardasil-9 vaccine and any deaths reported to the Vaccine Adverse Event Reporting System (VAERS).

The Policies and Legislation

Figure 1

Following publication of the noted literature, the American Dental Association acted accordingly in 2018 by authoring a new policy designed to push dentistry forward into the space of HPV vaccinations (see Figure 1).  To date, the American Student Dental Association has not yet put forth their own policy encouraging dental schools to include vaccination sciences and training into their curriculums.

While no push has been made at the federal level to educate, equip, and empower dentists to provide HPV vaccines to our patients, so far three states have passed such legislation.  To date, the states of Minnesota (150A.055 Administration of Influenza Immunizations) and Illinois (1220.403 Dentists Administering Flu Vaccines) allow licensed dentists, who undergo additional training, to administer Influenza vaccines to patients that are 19 years or older and 18 years or older, respectively. 

In response to their state’s low vaccination rates, the state of Oregon set the bar even higher in 2019 by passing House Bill 2220, enabling qualified dentists to administer any type of vaccine.  In order to implement this legislation, the Oregon Board of Dentistry is expected to develop rules and guidelines, while the sole dental school in Oregon (Oregon Health & Science University) is expected to provide training to dentists interested in administering in-office vaccinations.  As a sponsor of House Bill 2220, the Oregon Dental Association President James McMahan stated that “We sponsored House Bill 2220 to increase access to care, providing additional opportunities for patients to receive life-saving vaccines from highly trained practitioners they already know and trust.”

The Challenges Ahead

While appreciating the progress that some states have made in passing promising legislation, it would be irresponsible of us to ignore the challenges that must certainly be overcome before a nationwide effort to include the dental profession in vaccine administration is realized.

As noted in an opinion piece published by Dr. Joseph Kwan-Ho in the ADA News, “statewide implementation of a dental vaccine program poses several barriers.”  Most notably, I’ve reasoned that a few such barriers could include: a lack of standardized training to address the logistical and financial difficulties of supplying, storing, and administering vaccines in a “cold chain”, whether warranted or not, perceived liability resultant from vaccine administration, and lastly, a lack of universally standardized medical record interoperability, which was exacerbated by the high number of different digital record companies born from the Health Information Technology for Economic and Clinical Health Act of 2009.

The Endgame

Progress on this scale – implementing vaccination protocols, infrastructure, and practices in dental offices all around the country – is slow.  So where can we start?  The literature, American Dental Association, and expert testimony all point us in the same direction: HPV vaccination.

As healthcare providers that claim the oral cavity as “our” domain, and as healthcare providers that have the unique opportunity to build trusting relationships with our patients through more frequent appointments than Primary Care Providers, no one should be more qualified and equipped to discuss, recommend, and administer HPV vaccines to prevent the future development of oral cancer than us.  Every year, around 10,000 Americans die from oral or oral pharyngeal cancer (The Oral Cancer Foundation).  Of those that die from oropharyngeal cancer, 70% die due to the Human Papillomavirus (National Cancer Institute).  A strong, collective commitment by dental organizations, dental schools, and dental practices to future advocacy efforts at the state and federal levels could change that.

When I chose to pursue a career in healthcare, just like you, I did so to care for my future patients.  Every day, I’m inspired by our colleagues and our mentors that care for their whole patient, not just their teeth.  During a pandemic of such devastating proportions, we’re reminded of the importance of public health.  While we scramble to keep up with our clinic requirements and stay “Safer at Home” for online learning, I hope that we can all renew our commitment to the public health of, and advocacy for, our communities and the public healthcare system that was so nearly overrun by COVID-19.  In the event that an effective vaccine is developed for the SARS-CoV-2 virus, I believe that policies like the one put forth by the ADA and legislation similar to what has been passed in Oregon could serve as a foundation for us to supplement and alleviate the stress on our public healthcare system by administering SARS-CoV-2 vaccines.

So, is the dental profession ready today to partner with our medical colleagues to distribute life-saving vaccines?

Not yet.  But we can change that.

About the Author

As a former University of Denver Pioneer and current second-year dental student at CU, Jake Holtzmann currently serves in several capacities within the American Student Dental Association.  In one of his roles, a Legislative Coordinator for the Council on Advocacy, Jake employs his passions for public health, research, and organized dentistry to coordinate advocacy efforts by dental schools in Colorado, Texas, Oklahoma, Nebraska, Missouri, Iowa, and Minnesota.  A Colorado native, Jake loves to ski, travel, and visit breweries in his free time.  Oh, and one time he attempted to eat a massive cheeseburger made of eight half-pound patties… he failed.

by Hannah Paul

Hello again!

So, not being the most efficient and organized person, these posts have turned out to be a bit more time consuming than I originally expected. I’ll be delivering them every other week from now on to allow myself more time. I know that’s a disappointment for the two people that wait excitedly on the edge of their seats every Sunday to read my posts, so I’m truly sorry for the bad news, but I’m hoping you can forgive me!

This post will briefly cover what I’ve found on the healthcare sector’s environmental impacts. Our national emissions are often organized into the 5 categories shown in this figure. Like most systems, healthcare involves 4 of these 5 categories. Hospitals and other healthcare facilities are included in the “commercial and residential” sector, the supply chains they depend on fit into the “industry” sector, vehicles driven by employees as well as helicopters and ambulances contribute to the “transportation” sector, and electricity needed to run all heath facilities and operations account for a portion of the “electricity” sector. It’s easy to see how complicated achieving sustainability can become when you consider how multifaceted so many of our systems are. I am of the opinion that both top-down and bottom-up efforts are necessary to achieve sustainability and mitigate climate change, but I think the complex nature of our systems is is why the grassroots approach is so important. It is difficult to make effective generalized rules and regulations for such multifaceted issues. Therefore, changes initiated at the local and individual level are also essential in addressing the overarching problem. They may be small impacts on their own, but added together, they are significant. This obligation is especially relevant to us as future healthcare providers, where our entire profession is centered on maximizing the well-being of our communities.

Dentistry, on its own, is responsible for a small portion of the health burden of emissions and pollution. However, we are continually pushing for better integration of oral health and the dental sector into overall health and healthcare. If we want that recognition, we must also assume the corresponding responsibility to mitigate the negative impacts of the healthcare system as a whole, not limiting ourselves to our little dentistry bubble. General healthcare issues are now our issues, as much with sustainability, GHG emissions, and pollution, as with issues like nutrition, health equity, health literacy, or the increasing costs of healthcare.

Considering the public health benefits of sustainable development, I would also argue that we have a duty as healthcare providers to be educated on and advocate for policies and practices that promote sustainability in all levels and sectors of society. It might seem like a lot of extra responsibility, but with our positions in society, I think it’s fair to say we can be more influential than the average Joe. However, as with most things, determining a level of involvement that is sustainable for you personally is important in avoiding burnout and maximizing your contribution.

Below, I’ve picked out a few important points from two peer-reviewed articles to give you a general picture of the environmental impacts of our systems on public health.

1. Environmental Impacts of the U.S. Health Care System and Effects on Public Health: published in 2016 in the journal PLoS ONE

• The US is second largest GHG emitter globally

• If the US healthcare sector were a country, it would rank 13th in the world for GHG emissions.

• The majority of carbon emissions is associated with suppliers of energy, goods, and services, and only 2.5% associated with direct operation of health care facilities (which is good, since we can change these things!)

• Air pollution: US health care was responsible for the following fractions of national air pollution in 2013

  • 12% of acidification

  • 10% of smog formation

  • 9% of respiratory disease from particulate matter

• Environmental impact of U.S. healthcare accounted for 470,000 life years lost in 2013 (which they mentioned was comparable to the life years lost to preventable medical error)

2. The Harm We Do: The Environmental Impact of Medicine: published in 2017 in the Journal of Hospital Medicine 

• Healthcare is responsible for 9.8% of GHG emissions

• Healthcare is responsible for 9% of particulate matter emissions

  • Including from incineration of hazardous wastes producing CO2, nitrogen oxides, and other volatile substances

• Conventional water treatment systems cannot remove heavy metals, pharmaceuticals, and disinfectants in wastewaters, which have been detected in rivers and streams, and drinking water throughout the US

• Exposure to toxic wastes and particulate matter is linked to increased rates of developmental and reproductive disorders, cancer, respiratory disease.

  • PM2.5 (particulate matter smaller than 2.5 micrometers) can diffuse through alveoli into the bloodstream – contributing to heart disease, stroke, and lung disease.

• Climate change is linked to adverse cardiovascular, respiratory, infectious, and mental health outcomes (not to mention the ecological destruction that will imperil health in other ways)  

Many of the solutions to these issues are centered around reducing use of fossil fuel derived energy, reducing water consumption, sustainable construction, waste management and reduction, supply chain revisions, and reduction of chemical use. Many hospitals and health care centers are already making an effort to reduce their impact (and are saving money doing so) through programs and organizations like the Healthier Hospitals Initiative , Health Care Without Harm and its Green Guide for Health Care, Practice Greenhealth, and the Sustainability Roadmap For Hospitals. All of these resources could also be useful for you if you hope to incorporate sustainability into your future practice. It looks to me that the concepts and strategies it outlines can be applied just as easily to dental offices, so I recommend you check it out!

In accordance with our goal to Do No Harm, we have a duty to implement, advocate for, and support sustainable practices in our healthcare systems and beyond to both save money and save lives. I hope these resources and information are helpful for you either now or in your future as dental professionals!

by Hannah Paul

Hi again!

Just as a quick disclaimer, I’m definitely using this blog as an opportunity to educate myself along with others, so please know I am no expert in the field, nor is any of the information I provide a comprehensive overview of the subjects I address! But I still hope they’re interesting and informative for you all! :)

As aspiring healthcare professionals, we have all vowed to live by the statement of “Do No Harm.” While we strive to uphold this pledge in every aspect of our work, we must also protect human health by minimizing the climate impacts of our higher education institutions and our healthcare sector. In 2005, higher education institutions accounted for 2% of national greenhouse gas (GHG) emissions. In 2013, the U.S. healthcare industry accounted for 9-10% of total national GHG emissions. Based on these numbers, together, they constitute around 11-12% of the country’s emissions. To meet the goal of carbon neutrality, we must push for our education and healthcare institutions to reduce that footprint.

To expand on the impact of higher education, I figured I could let you all know what the CU Auraria and Anschutz campuses are doing to address their ecological footprint. Below is a brief list of 10 current efforts, but if you’re just dying for more information, it can all be found here on the UC Denver website.

1. The university is a member of the Association for the Advancement of Sustainability in Higher Education (AASHE) and you can use your university email to access all their resources!

2. In 2010, a Climate Action Plan was developed to establish a goal of reducing GHG emissions by 80% by 2050. According to the 2019 update, the university has already reduced emissions by 38% since 2006, putting us ahead of schedule!

3. It has succeeded in reducing its Energy Use Index by 48% through the construction of 7 LEED (Leadership in Energy and Environmental Design) Certified buildings – including our dental school - and investment in facility optimization projects for many of its older buildings.

4. A contract with Waste Management allows for the recycling of certain plastics, glass, aluminum, and paper waste - I’m sure you’ve all used the receptacles on campus! Also, a specialized program through Alpine Recycling enables collection of a variety of research lab materials.

5. As of 2012 (seems it needs updating) we have a Silver rating in the self-reported Sustainability Tracking, Assessment, and Rating Systems (STARS). That is the third best ranking after Platinum and Gold, so we definitely have room for improvement!

6. There are currently 55 electric vehicle charging stations installed at Anschutz, as well as 5 parking spaces for the utilization of a car sharing network called Zipcar.

7. These Anschutz campus organizations dedicate part or all of their efforts to sustainability:

• Gold Humanism Honor Society | School of Medicine

• CU Consortium on Climate Change and Health

• CU-Climate and Health Advocacy, Sustainability, and Education (@CUCHASE)

• AMC Student Health Promotion Committee

8. The university offers a number of programs and courses with a sustainability focus in six of its schools and colleges.

9. The Auraria Sustainable Campus Program works to reduce the ecological footprint of the Auraria campus through efforts focused on 7 pillars of Alternative Transport, Education and Outreach, Energy Efficiency, Food and Gardens, Renewable Energy, Water Conservation, and Waste Diversion.

10. The President’s Sustainable Solutions Challenge – I know we’re already crazy busy…but…IF any of you have an innovative sustainability idea for CU, this is your chance to propose it! This challenge was supposed to align with Earth Day’s 50th anniversary this past April but, due to COVID-19, it has been postponed to next Spring! Winner gets up to $3,000 in cash.

And if you’d like to learn about the commitments of other universities, check out:

• collegeconsensus.com/rankings/best-green-universities/

• secondnature.org

• saveonenergy.com/learning-center/post/top-green-universities/

• bestcollegereviews.org/top/green-colleges/

My goal for the next post is to explore sustainable efforts in the healthcare sector, so we’ll see what I come up with! Thanks for reading y’all!

by Rita Chandki

My mother used to say that nothing is constant but the change. My life has witnessed this in more than one way. After every five years or so, I saw myself in a different role and setting. Each of them was an absolute learning experience and played a crucial role in shaping my personality and made me what I am today.

I was born and raised in a humble family in central India. It was my liberal upbringing that spurred my interest in various extracurricular activities in addition to academic excellence. From being a passionate national level skater and roller hockey player in the middle school, a focused debater in high school, to a dental student and then a growing clinician, to finally becoming an educator and researcher for Endodontics, life has been an inevitable change.

As a national level skater, I had the opportunity to travel to different parts of my country, interact and make friends with people from all over India: a conglomeration of multiple cultures, religions and regional languages. This fostered my team spirit and inculcated in me the sense of oneness in spite of the uniqueness of each one of us. I learnt a few life skills that shaped my outlook towards everything. Satisfaction obtained from putting in the best of my efforts became more important to me than the grades. The only person I was competing with was myself. I tried to be a better version of myself with each passing day. My dental education involved studying in four different states in India, and I carry with me some essence of each of them, be it about the culture, linguistics or even food habits. Each of them left an indelible mark in my life that I am proud of.

“I ventured into…teaching clinical Endodontics to undergraduate dental students, lecturing and conducting hands-on workshops on contemporary Endodontic strategies,…and practicing as an Endodontic consultant”

After finishing dental school I ventured into tutoring graduate dental students for post-graduate entrance tests, teaching clinical Endodontics to undergraduate dental students, lecturing and conducting hands-on workshops on contemporary Endodontic strategies including regenerative Endodontics across the globe, and practicing as an Endodontic consultant. I worked as an associate professor for a little over two years during which I had the opportunity to interact with eminent dentists from various countries in international conferences. My decision to pursue advanced dental education in United States was largely influenced by eminent colleagues in India and United States. My friend, philosopher, and guide Dr. Sai Kalyan S., an accomplished Endodontist from India was my guiding source and has been a constant support in all my professional endeavors.

Moving to United States marked a significant change in my professional life as my role reversed from a teacher to a student. The responsibilities that need to be fulfilled before moving to a different country for considerable duration metamorphosed me into a much experienced person. The first few months were a fun filled rollercoaster ride. From landing at the airport on a snowy day, to finding a residence, to food arrangements and to keep up with the fast pace of the program, everything seemed like a daunting task at first glance. It would not be an overstatement that learning never stops in this dynamic, ever changing and ever growing profession. Each day I discover there is so much more to learn and the curriculum is so designed to keep up to the challenges of current state of the art in dental practice. The faculty do an amazing job of making us feel comfortable with the DDS curriculum. Their knowledge, clinical skills, unique ways of teaching, and above all, the ease and humility in their behavior is highly admirable and deserves hearty appreciation.

Being part of an international student program made me meet people from various countries with different cultural backgrounds. Exposure to such diverse set of students gave me the opportunity to not only know their culture and their thought process, but also to try out their culinary specialties. Authentic regional delicacies cooked and served with love in the potluck parties made way into my heart. It felt like a home away from home and made it an unforgettable experience.

The year 2020 will always be remembered in history for COVID-19. Just when we were about to embark on our much desired spring break, COVID-19 was in its full strength and growing stronger. Lock downs were in effect in several parts of the world including the United States. Virtual world with whole array of online classes and exams replaced classroom sessions. These were challenging times and required us to stay strong and not lose ones’ sanity. The faculty kept a constant check on our well being via emails and Zoom meetings. They shared their tips on how to stay focused and make best use of these days. I am proud to be a part of the School of Dental Medicine family and would forever be grateful for this lifetime experience. I look forward with all my heart to make best use of this opportunity that will help me broaden my horizon and be a significant cornerstone in fulfilling my ambition of meeting the global standards in dental health care.

About the Author

Rita Chandki is an ISP-1 student. She has completed her Masters in Endodontics and PhD in Conservative Dentistry and Endodontics from India. Previously, she worked as an Associate Professor at Pravara Institute of Medical Sciences, India and served as an Associate Editor to Endodontology Journal, the official publication of the Indian Endodontic Society. She was actively involved in continued professional development strategies as a key opinion leader for Coltene Whaledent, India.

Rita thrives on learning and new experiences. She strongly believes that every person you meet is a unique source of learning opportunity. She also has keen interest in sports and loves to experiment with cooking. She is embracing this change in her life with zeal and looks forward to her personal and professional growth at the School of Dental Medicine, University of Colorado.

by Hannah Paul

Hey CU ASDA!

Congrats on finishing another semester of dental school, and good luck with the next! With exams in our past (for a brief moment) I wanted to start up a little blog feed focused on various sustainability topics to fit into the Sustainability section of ASDA Health and Wellness. As you can see, I’ll be calling it Sustainability Sunday (because it’s cheesy and I like alliteration) and will do my best to submit a new post every week (maybe every two weeks, we’ll see how this goes), so I hope you guys enjoy them! I’ll try to keep them short and sweet. This is the first time I’ve ever done a blog post, so bear with me as I figure it out… This week, to start it off, I’ll give a brief overview of the concept of sustainability and a quick action item at the end.

So... what is Sustainability?

We typically think of sustainability as responsible resource use that allows the environment to remain in a balanced state. As the idea has gained more traction in recent years, what it means for society has been expanded upon and interpreted in several ways.

The 1987 United Nations Brundtland Commission Report - Our Common Future:

In a move to gather the world’s nations in a collective effort to recognize and address environmental degradation, this report was the first to officially define sustainable development as “development that meets the needs of the present without compromising the ability of future generations to meet their own needs.” This emphasized the importance of looking forward and considering the impacts of today’s consumption patterns on the lives of people tomorrow.

 The Triple Bottom Line: People, Planet, and Profit

Coined by British entrepreneur John Elkington in 1994, the term Triple Bottom Line further describes sustainable development, placing it within the intersection of society, the economy, and the environment. Each sector is dependent upon the other and sustainability cannot be achieved without fully accounting for them all.

dunedingov.com

Nested Sustainability Framework (Future Oxford):

This adaptation of sustainability created by Future Oxford in 2015 depicts the economy as a social construct nested within the human community, which is itself a part of the natural environment. Therefore, the environment sustains the human community which then sustains the economy - the big emphasis here being that the environment is the foundation of it all.

burlingtongreen.org

UN Sustainable Development Goals

Link to photo

With sustainability as the ultimate target, the United Nations General Assembly met in 2015 to establish 17 objectives to address the major challenges we currently face world-wide. With the aim of fulfilling them by the year 2030 the UN called for action on a global, local, and individual scale. For the past next 10 years, the focus will be on addressing poverty, empowerment of women, and the climate emergency. The number and diversity of these 17 goals goes to show just how much is involved in sustainability, and how developing solutions can often be quite complicated. Visit their website below and click on the photos to learn about each specific goal!

About the Sustainable Development Goals

And, if you want to take some easy action locally:

Anschutz Campus Composting Petition

CU – Climate and Health Advocacy, Sustainability, and Education (CHASE) and Student Health Promotion Committee are pushing to bring composting to the Anschutz Campus, and we would love to have your support in this! If you’d like to see this happen, please sign the Anschutz Campus Composting Petition here!

I hope this quick intro was at least slightly helpful and informative for y’all! Please feel free to reach out to me at hannah.paul@cuanschutz.edu if you have questions, concerns, or want to hear about a specific sustainability topic in a future post!

Thank you!

by Rhiti Chatterjee

When I moved to the USA, I knew that to pursue a career in dentistry, I would have to overcome many obstacles and jump through several hoops. But my passion to continue working as a dentist didn’t let me back down from accepting this challenge. Hence, I set forth on a journey to dental school with an open mind and welcomed whatever opportunity that came my way.

Volunteering with fellow SDM students

Clearing the National Boards demanded discipline and hard work. But what challenged me more was the phase which followed. I was looking fervently for a chance to venture into the dental healthcare ecosystem. In my search for that opportunity, I must have made several hundred phone calls, written scores of mails and gotten turned away by many. But a chance phone call to the Community Health Systems was the turning point of my life as a dental care provider in this country.

The dental clinic at the Community Health Systems in Beloit, Wisconsin was set to start their annual outreach dental health program called Seal-A-Smile, and they were looking for a volunteer. Despite having limited know-how of how public health care programs function, I jumped at the offer and reported to their office the very next day.

Seal-a-Smile (SAS) is a program which enables a team of dental professionals to provide preventive dental care to school-going children in the semi-urban and rural areas of Wisconsin. The team is comprised of dental hygienists, assistants and a program coordinator, who travel to various schools in and around Beloit. They examine patients in make-shift dental set-ups, apply fluoride varnishes and also place sealants.

During my time there, I helped them organize their documentation, collect data when out at the schools and helped take care of the children who were enrolled in the program. Slowly but surely, I created a place for myself on the team and soon found that the team was beginning to count on me. Accompanying the team to the schools gave me valuable insights about the disparity in the accessibility of dental services for the rural and semi-urban communities in Wisconsin. Sometimes these outreach programs were the only dental care available to them. I witnessed the hard work the Seal-a-Smile team was putting in, in order to improve the oral health status amongst children and adolescents. Going out to the schools, I obtained some profound understanding about how the education and the health care systems came together to ensure children had the wholesome development they deserved, irrespective of the socio-economic background they came from and how important it is to play a part in that.

The program gave me the perfect platform to learn about how a State funded public health program operated and changed my perception about community dentistry and its nuances.

It also helped me integrate into my community as I was beginning to bridge the cultural gap. I met many wonderful people from diverse backgrounds in a very short span of time. Some became great friends who opened up their homes and hearts to welcome me. The warmth of the community was growing on me and the feeling of being an outsider was slowly fading away. The charm of the Midwest was beginning to leave an impression on me. This was a time of immense personal growth for me and helped me set my goals as a future dentist, to be able to return to the community and give something. There are so many public health projects waiting to hit the ground and so many policies that need to be executed. One day I hope to be able to take the reins of one of these projects in my hands and experience the change firsthand.

With the hope to make a difference and touch many lives during my time in school, I began to actively participate in various volunteering opportunities and have been elected to become a board member in organizations like ASDA and Student National Dental Association (SNDA). I would like to take this opportunity to reach out to my fellow students and pre-dental students and urge them to become active participants in community service and become leaders of change during these times of turmoil.

About the Author

Rhiti Chatterjee is an ISP student from India where she graduated as a dentist and went on to obtain a Masters in Oral Medicine and Radiology. Following her tryst in a teaching hospital, she entered private practice and worked as an associate General Dentist at a multi-specialty dental clinic for 2 years.

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She is passionate about traveling to new countries and learning about new cultures. Soon after she graduated with her Masters, she travelled to Australia, Bali, and the United Kingdom. She hopes after she completes dental school, she can follow her passion and resume jet setting around the USA and other countries.

She is trying to return to her old ways of being a bibliophile, but now she can only afford to read textbooks. She loses self-control at stationary outlets and likes to explore painting with and on different media like paper, wine bottles and yoghurt jars. Art helps her calm her nerves, and playing with colors gives her exhilaration.