THE AUTHORS OF the lead articles in this offer important insights into key questions that frame the integration of sustainable principles in the healthcare sector-namely, why should healthcare engage in sustainable building and operation and how do organizations begin the journey? Their important work is part of a dispersed but exponentially growing movement among healthcare organizations in the United States and beyond that deserves a broader context. movement centers around these fundamental questions: should healthcare lead health-based initiatives? What is driving the green tsunami in business (and in particular, the business of healthcare)? Where is the healthcare sector at this moment in time? isn't everyone doing it? and What lies ahead that may shape future responses? short, why bother? On Earth Day, 2008 the writer Michael Pollan (2008) had a provocative essay titled Why Bother? published in New York Times. He posed this challenge: Sometimes you have to act as if acting will make a difference, even when you can't prove that it will. hospitals profiled in this issue, and the growing list of institutions that share their vision and goals, embarked on a sustainability journey in the absence of business case data or proven operational models, motivated by mission and led by individuals who cared enough to make a difference. Through their success, they have become unintentional leaders for this industry. WHY SHOULD HEALTHCARE LEAD HEALTH-BASED GREEN INITIATIVES? For the CEO of St. Mary's, the organization's explicit stewardship mission lies at the core of its decision making-a common trend for religious-based healthcare organizations. Many non religious healthcare organizations-lacking a reference to stewardship in their mission-approach initiatives through a community benefit lens. A third compelling reason to go is the connection between buildings and human health-a connection recognized by the healthcare industry that is increasingly adopted by other market sectors. American Society of Healthcare Engineering (ASHE 2002) first framed building initiatives around protecting at three scales: the immediate of building occupants, of the surrounding community, and of the larger global community and natural resources. Environmental scholar David Orr (2004) writes: The standard for ecological design is neither efficiency nor productivity but health; beginning with that of the soil and extending upward through plants, animals, and people. It is impossible to impair at any level without affecting it at other levels. Green Guide for Health Care, the first voluntary self-certification metric tool for ranking sustainable building strategies in Healthcare, indudes specific issue statements that introduce each construction and operation topic (GGHC 2006). Green Guide has become the foundation for the U.S. Green Building Council's Leadership in Energy and Environmental Design (LEED) for Healthcare rating system. Providence Health and Services CEO John Koster, MD, describing their new LEED Gold Certified hospital in Newberg, Oregon, summed it up this way: In healthcare, sustainable building represents a bold move toward precaution and prevention. building stands for health. creating it, the organization is essentially saying, 'We're investing in keeping people healthier.' Being attentive to sustainability, wellness, and resource stewardship presents a holistic view of Healthcare that has an impact. We may not be able to measure or test, but I'm convinced it has a tremendous impact on a person's ability to attain health. Not just to be not sick, but to be in health (Guenther, Vittori, and Atwood 2006). Finally, the healthcare sector is realizing that construction and operation makes business sense. authors of the feature articles delineate three major benefits: reduced operating cost, avoided risk, and tangible impacts on employee satisfaction, recruitment, and retention. …