administration made a solid commitment to environmental programs long before such investments were common.

Planning is now under way on the Koop Complex, which will add new teaching and research space for the Medical School to the Lebanon campus. Groundbreaking is slated for 2008, and planners hope to incorporate a number of ecological features in the project. It's too early to know precisely which features will make it into the final design, but among the options being considered are strategic landscaping to minimize heating and cooling costs, low-flow plumbing to reduce water consumption, and bike racks and showers for employees who commute to work on two rather than four wheels. "Everyone thinks energy efficiency is important, because you can save money doing [it]," says DMS's Mannix. "We're going one step further and saying, if we're an educational institution, let's use our buildings as a learning opportunity."

That attitude fits solidly within the environmental commitment made by Dartmouth College. In April 2005, simplicity movement guru James Merkel, author of the 2003 book Radical Simplicity, was named Dartmouth's first sustainability coordinator. Since then, Merkel has championed the creation of a waste-free dining facility that opened last September, involved undergraduates in energy conservation in residence halls and Greek houses, and begun assessing which buildings on campus could be fitted with solar hot-water heaters to reduce fossilfuel consumption. In January 2006, those efforts and others were honored by the Sustainable Endowments Institute, which gave Dartmouth a grade of A-minus. It was the top mark awarded, and only Harvard, Stanford, and Williams joined Dartmouth in earning it.

Laura Brannen—who was DHMC's first waste and recycling coordinator, back in 1990—is now the executive director of Hospitals for a Healthy Environment, a national nonprofit.

"Humanity has really serious issues to face," says Merkel. "We could have a runaway climate system. I'm not a fan of fear-mongering, but I think we really have an imperative to act fairly quickly on these things." Merkel calls himself a "yes . . . and" guy when it comes to making progress. That is, he thinks it's important to combine several strategies to achieve synergistic outcomes.

"Say we want to be carbon neutral by 2027," he posits. To get there, an institution might switch to low-carbon fuels, improve building controls, and change user behaviors—each step a small component of the overall effort. One ambitious strategy alone wouldn't be enough, he says. "But you could get there by doing these things together."

"The principles of trying to minimize the effect that we have on our environment, on our natural resources, are broadly understood in this organization," says Gail Dahlstrom, DHMC's vice president for facilities. This spring, DHMC garnered its fourth environmental leadership
award from H2E.

109%

Increase in the number of prescriptions written in the U.S. between 2000 and 2004

40%

Percentage of medication prescribed in the U.S. but not consumed

1990

Year DHMC established the position of waste and recycling coordinator (making it one of the first hospitals in the country to do so)