Food and Food Purchasing A Role for Health Care

Food
Food is sustenance. But what we eat
and Food
and how we eat can also contribute to
Ecological Thinking
death, disease and rising health care
Purchasing
Ecological thinking means
costs. Obesity, the leading health
looking at things in their whole
concern of the day, is a symptom of
context, while seeking to also
poor eating habits and sedentary
A Role for
understand the interconnections
behavior. Poor nutrition is a risk factor
between parts. It recognizes that
nothing exists in isolation;
for four of the six leading causes of
Health Care
everything is part of a larger
death in the United States—heart
system. This approach is
disease, stroke, diabetes and cancer.1
important for health care food
Nutrition-related chronic diseases are
decision making, because the
placing new demands on an already
production and distribution of
“We have to set an example
overburdened health care system and
food has a multitude of heath
with the food we serve our
taking their toll on human productivity
related impacts often removed
patients and employees.”
and quality of life.
from the immediate hospital
Dr. Toby Cosgrove, heart surgeon
environment.
and current CEO, The Cleveland
Rather than fresh fruits and vegetables,
Clinic on NBC’s Today Show,
whole grains, and other high fiber
December 16, 2004.
foods important for health, our current
the U.S. health care industry can
food system favors the production of
promote health by providing more
animal products and highly-refined,
fresh, good tasting, nutritious food
“What could be more
calorie-dense foods. It is a food system
choices for patients, staff, and the
closely related to health
misaligned with the U.S. dietary
community. And by supporting food
guidelines.2 Hidden behind these
production that is local, humane and
than what we eat?”
nutritional imbalances, is a food system
protective of the environment and
Dr. Preston Maring, a Kaiser
largely reliant on methods of
health, health care providers can lead
Permanente Cardiologist, writing in
production and distribution that hurt
the way to more sustainable
the Spring 2004 issue of the
us and the environment in which we
Permanente Journal.
agricultural practices.
live.
Health Care Without Harm (HCWH)
Hospitals and health systems have
is an international coalition of more
opportunities to help prevent these
than 430 organizations in 52 countries.
food-related health concerns by
We are working with hospitals to
.
modeling good nutrition in their
define and develop food purchasing
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institutions and by influencing how
practices that are consistent with these
food is produced and distributed.
principles.
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Through its food purchasing decisions,
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Dominican Hospital, in Santa Cruz, CA buys produce from a nonprofit,
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Food System and Health:
Air and Water Pollution
supporting the economic viability of
The Problem
Pesticide drift, field dust, waste
communities. Through their
burning, toxic gases from degrading
purchasing practices, health care
Major shifts in the U.S. food system in
manure, and diesel exhaust from
institutions can help achieve the
the last century are having negative
transporting food long distances are all
following:
impacts on human health. While total
TH CARE
factors of food production that
farm acreage has declined, farm size
contribute to air pollution. These types
Promote Nutrition
has increased and is more focused on
of pollution can lead to asthma and
By offering a range of healthy foods
the production of a single crop or
other respiratory illnesses,
and beverages on patient trays, in
animal, contributing to the decline in
cardiovascular disease and lung cancer.
cafeterias, vending machines, and
production of diverse food crops
Commercial fertilizers and pesticides
through onsite farmers markets, health
necessary to meet nutritional needs. In
contaminate ground water in many
care systems can support good eating
the United States, the typical food
locales. Large-scale animal feedlot
habits and model a healthy food
item now travels from 1,500 to 2,400
operations contribute to water
environment.
miles from farm to plate. This system
pollution with biologically active
disconnects the growers from the
hormones, nitrates and other
Reduce Antibiotic Resistance
consumers and increases opportunities
breakdown products of untreated
for food contamination and loss of
By buying meat produced without the
animal waste.
nutrients during transportation. While
routine use of antibiotics, health care
this industrial food system initially
can help ensure that existing
contributed to higher yields,
Worker Health and Safety
antibiotics remain effective for treating
productivity has declined, and serious
Widespread pesticide use in industrial-
human disease.
long-term impacts on human and
scale food production exposes farm
environmental health have become
workers and their families to
Reduce air and water pollution
apparent. These include:
dangerous chemicals, often at levels
By providing fresh, locally grown foods
that exceed established “safety” limits.
whenever possible, health care
Nutrition
Longer-term, low-level pesticide
supports local food systems that avoid
Compared to the early 1900s, the U.S.
exposure has been linked to an array
the long-distance travel and
food supply has more calories, fat, salt,
of chronic health problems including:
disconnection between rural and
sweeteners, and meat and dairy
cancer, birth defects, neurological,
urban centers that typifies our current
products per person and less vegetables
reproductive, and behavioral effects,
fossil-fuel intensive food production
and grains.3 High-sugar or high-fat
and impaired immune system
and distribution.13 By developing a
foods including soft drinks, salty
function.10,11 Industrialized meat
preference for hormone-free,
snacks, sweets and desserts comprise
packing is recognized as one of the
humanely raised meats from facilities
almost 30 percent of all calories
most dangerous occupations: every
in compliance with environmental
consumed by Americans.4 An
year, over one quarter of all workers
regulations, hospitals can help protect
emerging body of research suggests
needs medical attention beyond first
clean air and clean water.
that soda and fast food consumption
aid.12
may be linked to increased risk of
Support Farm and Worker
weight gain and diabetes.5,6,7
Food Supply and Health:
Health and Safety
Health care can purchase meats from
Antibiotic Resistance
The Solution
processors who protect worker health
FOOD AND FOOD PURCHASING: A ROLE FOR HEAL
Each year 20 to 30 million pounds of
Hospitals and health care institutions
and safety. Facilities can also buy and
antibiotics (including related
can help improve health outcomes by
serve foods grown without pesticides,
antimicrobials) are used in agriculture-
supporting the transition to a more
such as certified organic foods, and
by volume, about 7-10 times the total
sustainable food system. A sustainable
reduce exposure to harmful pesticides
antibiotics used in human medicine.8
agriculture and food system protects
for those who eat and grow their food,
Industrialized food systems that produce
the environment and human health. It
and create a market for healthier
poultry, swine, beef, and farmed fish
meets needs for food and fiber while
growing practices.
routinely use antibiotics as growth
promoters rather than to treat identified
disease. Routinely feeding antibiotics to
Farmers Markets & Health
animals that are not even sick worsens
Many Kaiser Permanente facilities feature on-site farmers markets or
antibiotic resistance among bacteria
produce stands. These markets are one sign of Kaiser’s commitment to
that cause human infections.9
protecting the environment by supporting sustainable agriculture while
improving access to healthy, affordable food in and around Kaiser facilities.
2

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FOOD AND FOOD PURCHASING: A ROLE FOR HEAL
The Ethics of Eating
Less Local Control of Food Production
In Minnesota, Catholic leadership has
In recent decades, much less of every food dollar has gone to food
emphasized that the buying and eating
producers in the community where it is spent, and more has gone to food
of food involves decisions that are
processing, packaging, shipping and retailing, all typically controlled by
inherently moral.
distant corporations. Six cents of every dollar spent on a loaf of bread
goes to the wheat farmer-about as much as is spent on the plastic,
“….Minnesota’s web of life is
petroleum-based wrapper. Control of the food supply has become
threatened. Our clean air, fresh
increasingly concentrated. Two firms, Cargill and Archer Daniels Midland,
water and rich soil are being
control about three quarters of the global market for cereal grains.15
tainted. Thousands of farmers on
small- and medium-size farms are
forced to leave the land, no longer
Support the Local Community
time a hospital chooses to buy locally,
receiving an adequate income to
compensate them for labor and
A hospital’s long-term vitality depends
the community benefits from that
cost of production. Some of our
in large part on the economic health
choice.14 By institutionalizing a
rural communities are dying. These
of the broader community serving as
preference for the purchase of foods
changes have moral and ethical
home to its staff and patients. Every
produced, processed, and distributed
implications, which cannot be
step of the food chain where
locally, under local ownership,
ignored…..”16
ownership falls outside the community
hospitals can use their immense
is a potential drain on the health and
purchasing power to support socio-
Minnesota Bishops’ Statement
vitality of the local community. Every
economic health.
on the Farm Crisis
Model for Wellness: The Role for Health Care
Because of its size and purchasing power, the health
Specific solutions that hospitals and health care systems
care industry can provide market leadership by adopting
have already instituted or explored include:
food purchasing policies and practices that steer the
entire food system in more positive directions. Hospitals
?
Create weekly farmer’s markets on hospital grounds;
and health care systems can buy and provide food in
?
Create hospital gardens to grow fresh produce as
their facilities in ways that help create a model for
well as provide patient exercise opportunities;
wellness at the individual, community, and national
?
Institute policies to buy only meat/poultry raised
levels.
TH CARE
without non-therapeutic antibiotics or hormones;
?
Set goals and explore new relationships designed to
Providing access to healthier food promotes wellness
increase the purchase of locally-produced, fresh
among patients, visitors and staff. Buying food produced
produce;
in ways that are ecologically sound, economically
viable, and socially responsible also supports a food
?
Buy more certified organic food products, or buy
system that ultimately benefits healthier individuals and
from producers who have reduced synthetic
communities.
pesticide use;
?
Turn hospital campuses into “fast-food-free zones;”
?
Purchase foods that provide fair prices and living
What Can Health Care Do?
wages to the people who produce them;
Hospitals can adopt food procurement policies that
?
Buy milk produced without the use of synthetic
provide nutritionally improved food for patients, staff,
hormones, like recombinant Bovine Growth
visitors, and the general public, and support and help
Hormone (rBGH, also referred to as rBST);
create food systems that promote the well being of the
?
whole community. Institutions can establish food
Buy coffee certified as Fair Trade; and
purchasing guidelines and set target goals that are
?
Implement sustainable food credits in the Green
realistic for their institution and geographic area.
Guide for Healthcare (www.gghc.org).
3

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Notes
1. Anderson RN, Smith BL. (November
6. Pereira MA, Kartashov AI, Ebbeling
Communications/Current%20Issues/
7, 2003) “Deaths: Leading Causes for
CB, and others. (January 1, 2005)
Pesticides/Final%20Paper%2023APR2
2001” National Vital Statistics Reports
“Fast-food habits, weight gain, and
004.pdf.
52(9):1-85. Centers for Disease
insulin resistance (the CARDIA
12. “Highest incidence rates of total
Control & Prevention, National
study): 15-year prospective analysis.”
nonfatal occupational injury and
Center for Health Statistics, as
The Lancet 365: 36-42.
illness cases, private industry, 1999.”
summarized online at Fast Stats A-Z:
7. Schulze MB, Manson JE, Ludwig DS,
(December 2000). U.S. Department of
www.cdc.gov/nchs/fastats/lcod.htm
and others (2004) “Sugar-sweetened
Labor, Bureau of Labor Statistics,
2. Dietary Guidelines for Americans.
beverages, weight gain, and incidence
Occupational Safety and Health
(2005) published jointly by U.S.
of type 2 diabetes in young and
Administration, Injuries, Illnesses, and
Department of Health and Human
middle-aged women.” Journal of the
Fatalities.
Services and U.S. Department of
American Medical Association (JAMA)
13. Garbarino JR, Bednar AJ, Rutherford
Agriculture. www.health.gov/dietary
292: 927-934.
DW, and others. (April 15, 2003)
guidelines/dga2005/document/
8. Mellon et al. Hogging It: Estimates of
“Environmental fate of roxarsone in
3. Gerrior S, Bente L. (2002) Nutrient
Antimicrobial Abuse in Livestock. Union
poultry litter. I. Degradation of
Content of the U.S. Food Supply, 1909-
of Concerned Scientists: Cambridge,
roxarsone during composting.”
99: A Summary Report. U.S.
MA. 2000.
Environmental Science & Technology
Department of Agriculture, Center for
9. Wegener HC. (2003) “Antibiotics in
37(8):1509-14.
Nutrition Policy and Promotion,
animal feed and their role in
14. New Economics Foundation. (August
Home Economics Research Report
resistance development.” Current
7, 2001) “Local food better for rural
No. 55.
Opinion in Microbiology 6: 439-445.
economy than supermarket shopping”,
4. Block G. “Foods Contributing to
10. Owens K. (2003) Healthy Hospitals:
News Release, Caroline Hill.
Energy Intake in the US: Data From
Controlling Pests Without Harmful
15. Halweil B. (2004) Eat Here: Reclaiming
NHANES III and NHANES 1999-
Pesticides, published jointly by Beyond
Homegrown Pleasures in a Global
2000” (June 2004) Journal of Food
Pesticides and Health Care Without
Supermarket. published jointly by W.W.
Composition and Analysis 17(3-4):
Harm. www.norharm.org/
Norton and the Worldwatch Institute,
439-447.
pesticidescleaners/issue.
p54.
5. Ludwig DS, Peterson KE, and
11. Sanborn, M, Colle, D., Kerr, K.,
16. “Minnesota Bishops’ Statement on the
Gortmaker SL. (2001) “Relation
Vakill, C., and others, “Pesticides
Farm Crisis.” Bishop Statements,
between consumption of sugar-
Literarture Review”, The Ontario
online at: www.ncrlc.com/RCS-
sweetened drinks and childhood
College of Family Physicians, Toronto,
minn.html.
obesity: a prospective, observational
Ontario, April 23, 2004
analysis.” The Lancet 357: 505-508.
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