Creating Healthy Healthcare Environments

The choice of products can affect the health of staff and patients in healthcare facilities
[ Page 6 of 6 ]        
Sponsored by Forbo Flooring Systems
Peter J. Arsenault, FAIA, NCARB, LEED AP
This test is no longer available for credit

At the end of their life, usually after 25 to 40 years, linoleum floors need to be replaced and disposed of. The two common options include incineration or landfill processing. When burned in an energy-recycling incineration plant, linoleum products produce a residual energy value that is comparable to that of coal (18.6 Mj/kg). It is significant to note that since linoleum does not contain any toxins, its incineration does not release any into the environment the way that other materials can. Incineration of linoleum does not release any “chemicals of concern” because there are none present to begin with or formed by incineration. Further, the amount of CO2 released during incineration is roughly equivalent to that already taken up by the natural raw materials (flax plants, trees and jute plants). Therefore, linoleum is a closed loop system: the energy obtained from incinerating linoleum is roughly equivalent to, or even more than, that which is used in production – and it is toxin free. If incineration is not employed, then linoleum can be safely added to landfill refuse sites, where natural decomposition takes place. Linoleum is fully biodegradable and does not release harmful substances or gases such as chlorine and dioxins. As linoleum's raw materials are provided by nature, and decomposition returns linoleum to nature, this is essentially the ultimate form of recycling. An additional advantage is that the recycling of other floor coverings is usually associated with high levels of energy consumption, with very negative implications in an accurate LCA.

As the previous discussion points out, there is clearly growing recognition and use of EPDs for addressing the environmental impact of building products and materials. Still missing, though, is the attention needed to ecotoxicity and human toxicity in those products. In response, a group of leading architects, building managers and product manufacturers have banded together to create a whole new standard for product hazard reporting that responds more responsibly to concerns of human health and environmental toxicity. The new standard is called the Health Product Declaration (HPD), and it represents a major step forward in product transparency. HPDs build on and incorporate the data from the EPD but goes on to combine it with trustworthy and verifiable measures of ingredients that impact ecotoxicity and human toxicity. As such, it creates a disclosure document that truthfully indicates the toxicity impact of a product on the people who live with it, and the natural environment that it exists within. As envisioned, the HPD will create a single standard that can be used to create an apples-to-apples comparison of products based on their ingredients.


There are no simple answers, but there are solutions that work. The only challenge is to identify those solutions, then gather the organizational and philosophical will power to put them into practice. As a design professional you have the opportunity to make needed changes happen. Every time you select and specify building materials, the means to determine the best and healthiest direction include three actions. First, examine the alternatives with a critical eye. Don't be too quick to embrace a new technology as a magic bullet until the long-term environmental effects are known. The same caveat applies to some well-established solutions like synthetic rubber floor tile, that masquerade as environmentally sustainable when they are actually synthetic products that release lead, mercury and a host of other carcinogens into the environment.

Second, look for the natural payoff. It is important to look at both the short-term cost of installation and the long-term cost of ownership when considering an environmentally friendly solution. The best option is often a product made from natural materials which can provide both the lowest occupancy-ready cost while also delivering the added benefit of low-toxicity, bio-based and biodegradable performance in the future.

Third, don't miss the easy opportunities. Some of the best ideas for improving infection control are also among the simplest. Hands need to be washed, staff members need to wear personal protective equipment and need to be trained in infection control. In design, eliminate areas where harmful bacteria are likely to breed, like the cracks that develop between tiles in a vinyl floor.

We all have a professional interest in protecting the public from indoor toxicity and infection. More importantly, if we are parents, personal caregivers or concerned members of our community there can also be a deeply personal interest. By designing and specifying safe, healthy, indoor environments, we help ensure the well-being of the public, our children, and grandchildren for generations to come.

Peter J. Arsenault, FAIA, NCARB, LEED AP, practices architecture, consults on green and sustainable design, writes on technical topics, and presents nationwide on all of the above.



1. The Biocidal Products Regulation (EU 528/2012). For more information:

2. “Chemicals and Our Health: Why Recent Science is a Call to Action”, a report published by the Safer Chemicals Healthy Families coalition.

3. “The Future of Fabric – Health Care,” published by the Healthy Building Network, October 2007 in conjunction with Health Care Without Harm's Research Collaborative.


5. Sathyanarayana, S. (2008) Phthalates and children's health. Current Problems In Adolescent Health Care, 38, 34-39. doi:10.1016/j.cppeds.2007.11.001

6. “Toxic Chemicals in Building Materials; An Overview for Health Care Organizations” Kaiser Permanent and the Healthy Building Network/Healthcare Without Harm, May, 2008

7. Pharos Product Category Descriptions – Resilient Flooring,

8. America's Children and the Environment, U.S. Environmental Protection Agency, 2008.

9. Holly L. Howe, et al., “Annual Report to the Nation on the Status of Cancer (1973 through 1998), Featuring Cancers with Recent Increasing Trends,” Journal of the National Cancer Institute, 93, no. 11 (June 2001): 824–42.

10. Janet Gray, ed, State of the Evidence: The Connection Between Breast Cancer and the Environment (San Francisco: Breast Cancer Fund, 2008).

11. Tracey J. Woodruff , et al., “Trends in Environmentally Related Childhood Illnesses,” Pediatrics, 113, no. 4 (April 2004): 1133-1140.

12. Jeanne E. Moorman, et al., “National Surveillance for Asthma, United States 1980–2004,”Centers for Disease Control and Prevention, (November 1, 2009).

13. Anjani Chandra and Elizabeth Hervey Stephen, “Impaired Fecundity in the United States:1982-1995,” Family Planning Perspectives, 30, no 1, (1998): 34-42.

14. Anjani Chandra, et al., “Fertility, Family Planning and Reproductive Health of US Women: Data from the 2002 National Survey of Family Growth,” Vital and Health Statistics, 23, no. 25 (2005).

15. Kate Brett, “Fecundity in 2002 National Survey of Family Growth Women 15–24 Years of Age” (personal communication), Hyattsville, MD, National Center for Health Statistics (2008)

16. Leonard J. Paulozzi, “International Trends in Rates of Hypospadias and Cryptorchidism,” Environmental Health Perspectives, 107, no. 4, (1999): 297-302.

17. National Institute of Mental Health, “NIMH's Response to New Autism Prevalence Estimate,”

18. Scientific American “The Baffling Link Between Autism and Vinyl Flooring,” Marla Cone, Environmental Health News 2009

19. Linoleum Life Cycle Assessment:

20. HPD Open Standard developed by Health Product Declaration Collaborative


Forbo Flooring Systems

Forbo Flooring Systems has been creating better environments with its beautiful, durable flooring products for over 100 years. Forbo is committed to complete transparency in its products and the industry, and has included its eco-toxicity and human health and toxicity impacts in the publication of its EPDs in support of full disclosure and transparency.



[ Page 6 of 6 ]        
Originally published in Architectural Record