Healthy Food in Health Care: A New Vision for Hospitals

lena@sfbaypsr.org www.sfbaypsr.org San Francisco Bay Area Chapter Physicians for Social Responsibility

Lena Brook, Senior Program Associate

Healthy Food in Health Care The HFHC program challenges the healthcare sector to

recognize their crucial role in advocating for a healthier and more sustainable food system. We catalyze sustainable

procurement efforts, create clinician advocates, and inspire health care institutions to become leaders in shaping a food

system that is grounded in preventive medicine.

Obesity in Context

¨ Medical costs for diet-related disease is staggering—$147 BILLION for obesity alone per year

¨ Poor nutrition is a risk factor for four of the six leading causes of death in the United States —heart disease, stroke, diabetes and cancer.

Obesity in Context

“It is unreasonable to expect that people will change

their behavior easily when so many forces in the social,

cultural, and physical environment conspire against such change”

Institute of Medicine

Health Care in Context: Why Hospitals?

¨  Primary prevention part of mission ¨  Position to influence behavior

¤  Respected sources of health information ¤  See patients and visitors at key time

¤  Staff members see burden of chronic disease

¨  Many patients, visitors, staff would welcome change ¨  Health care food service: $12 billion market in U.S.1 ¨  Opportunity to influence local markets, distribution networks,

national food distributors

Health Care in Context: Workforce Health

¨  Healthcare one of largest industries in US: expected to create more jobs that any other industry 2008- 2018

¨  Most healthcare workers have jobs that require less than 4 years of college education

¨  Hospitals employ 34.6% of healthcare workforce

¨  2008 University of Minnesota Study1: ¤  25% health service workers obese compared to 8% of

health diagnosing workers like doctors ¤  Black and Latino lower wage workers more likely to be

obese than white counterparts

1 Chou, C., Johnson, P. Journal of Occupational Environmental Med. 2008. June; 50(6):696-704

Modern Industrialized Agriculture

Within 50 years our agricultural system has become almost unrecognizable

Confined Animal Feeding Operations: CAFOs

¨  Require constant use of non-therapeutic antibiotics to prevent disease outbreaks in confined spaces

¨  Factory farms emphasize high volume and profit

¨  Produce millions of animals yearly

¨  Often result in inhumane treatment of animals

¨  Produce 1.3 billion tons of waste/year ¨  Manure spills kill millions of fish and pollute bays and oceans

Pesticides and Human Health: California

¨  California uses nearly 20% of total US pesticides

¨  90% of pesticides used are prone to drift.

¨  Farmworkers are 59-70% more likely to develop various forms of cancer that the rest of the population.

¨  More than half of the 27 pesticides regulated as drinking water contaminants have been detected in California drinking water supplies above “safe” levels; an estimated 16 million people are drinking pesticide-tainted water

¨  Studies show child’s body burden of pesticides ê with organic diet

Food and Climate Change ¨  Different food groups exhibit a large range in GHG intensity ¨  Meat and dairy production primary contributors to GHG

emissions from the agricultural sector; ¨  Eating less meat and dairy has huge impact on reducing GHGs

Pounds of CO2 Produced Per Pound of Product

“Livestock’s Long Shadow,” UN Food and Agriculture Organization, 2006

Community and Economic Health

¨  US family farmers typically lose money every year. In 2001 alone, income declined by 60%.

¨  Farmers receive only 16¢ for every $1 spent at a supermarket

¨  In contrast, for every $1 spent at a farmers’ market generates 3x that amount for the local economy

Pledge: Nearly 350 Signatories

“We pledge to encourage our vendors…to supply us with food that is, among other attributes, produced without synthetic pesticides and hormones or antibiotics given to animals in the absence of diagnosed disease….”

Menu of Options : A Divers i ty of Health Care Food In i t iat ives

¨  Growing food and/or hosting farmers’ markets on-site

¨  Buying local, seasonal, and organic foods

¨  Buying hormone and antibiotic-free foods

¨  Creating a healthy beverages strategy

¨  Preventing waste in food services and composting food waste

¨  Reducing meat protein in favor of plant-based protein

¨  Passing comprehensive food policies

Balanced Menus Challenge: Less Meat, Better Meat

¨  Phase 1: Join Balanced Menus Challenge – goal is 20% reduction in meat within 12 months

¨  Phase 2: With new reduced meat

menus, prioritize purchase of local, sustainably-raised meat and poultry

¨  OR, tackle Phase 1 and 2 simultaneously!

Food Mat ter s : Heal th Care Educat ion and Advocacy

We inspire clinicians to:

¨  Provide anticipatory guidance to patients and families about the importance of healthy foods and a healthy food system.

¨  Work within health care facilities to create a healthy food service model that is recognized as integral to a preventive health agenda.

¨  Work within the community at a local, regional and national level, to promote policies that support the development of a healthy, accessible, and fair food system.

Hospital Leadership Team (HLT)

Leaders in sustainable foods procurement in the Bay Area health care community

Karen Arnold, VA Medical Center Linda Hansen, Santa Rosa Memorial Hospital Jack Henderson, UCSF Medical Center Alison Negrin, John Muir Health Ron Senior, Sequoia Hospital

Stephanie Singer, Sutter Maternity and Surgery Stratis Rozakeas, Alta Bates Medical Center Lorenzo Wimmer, Kentfield Rehabilitation and

Specialty Hospital Kathleen Reed, Kaiser Permanente

John Muir Health System ¨  Source local produce:

Buy Fresh, Buy Local; Brentwood Mix

¨  Partner with local farmers’ market: cooking demos, food education

¨  CSA drop-off point ¨  On-site herb gardens ¨  Host variety of free

classes on cardiac nutrition, healthful eating

John Muir Health System

¨ Source rBGH-free milk, yogurt; local baked goods; some sustainable meat/poultry;

¨ Café and patient menu revamp

¨ Weekly “Healthy Meal Deal”: reduced price for healthy meal for staff

UCSF Medical Center

¨ Cafeteria ~$4.5m/yr ¨ Catering service ~$2m/yr ¨ 1500 patient meals per day

UCSF Medical Center

¨  Increasing purchase of local fruits & vegetables including Brentwood Mix

¨  Serve rBGH-free milk, yogurt (local)

¨  Lead UC sustainability process

¨  Hold sustainable food community education events

¨  Transitioning to 100% cage-free eggs

¨  Host weekly farmers’ market

San Francisco VA Medical Center

Enhanced patient menu: ¨  rBGH-free milk, yogurt ¨  Local whole grain breads ¨  Double vegetable portions for

all meals ¨  Substitutes brown rice for white rice ¨  More dark greens, seeds, nuts,

legumes in salads ¨  6-week cooking class instituted ¨  Community garden on VA campus

240-bed facility, half in long-term care

San Francisco General Hospital Laguna Honda Hospital

Primary Challenges

¨  Many supply chains remained under-developed for local, sustainably produced foods from the perspective of large institutional purchasing

¨  Cost: food service operations under contast pressure to reduce costs yet “good” food costs more

¨  GPOs/Contracts: Does food belong in this type of contract? How can hospitals reclaim power over these?

¨  Complex array of diets for in-patient food service

Resou r ce s ¨  Health Care Without Harm Food website

¤ www.healthyfoodinhealthcare.org ¤ Balanced Menus Challenge

www.noharm.org/us_canada/issues/food ¤ Food Matters

www.noharm.org/us_canada/events/foodmatters ADA’s Hunger and Environmental Nutrition DPG

¤ www.hendpg.org