Healthy Food in Health Care : A 2008 Survey of Healthy Food in Health Care Pledge Hospitals

Menu of
Men
Change
Healthy Food
in Health
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A 2008 Survey of Healthy Food
in Health Care Pledge Hospitals
Elizabeth Sachs

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Table of Contents
Foreword ....................................................................................................................................... 2
Introduction .............................................................................................................................. 3

Healthy Food in Health Care (HFHC) Initiative ............................................................................3

HFHC Pledge .........................................................................................................................................4

Pledge Signers .....................................................................................................................................5
Key Considerations ................................................................................................................ 6
Background ................................................................................................................................. 8
Survey Findings .................................................................................................................... 11
Facility Profiles ..................................................................................................................... 18
Conclusion ............................................................................................................................... 30
References ............................................................................................................................... 31
Written by HCWH Food Workgroup member Jamie Harvie, P.E., Institute for a Sustainable Future
With contributions from HCWH food workgroup members: Dianne Moore, Women’s Health and Environment Network and
Lena Brook, San Francisco Bay Area Physicians for Social Responsibility. Survey development and data collection coordinated
by Emma Sirois, Oregon Center for Environmental Health.
Thanks to Elizabeth Sachs, University of California Sustainable Agriculture Research & Education Program/UC Davis Agricultural
Sustainability Institute for her contributed photography.
This document and much of the good work it reports on was made possible with generous support from, among others, the Cedar
Tree Foundation, The Claneil Foundation, The Bush Foundation, The California Endowment, The Clarence E. Heller Foundation
A Health Care Without Harm Publication
Health Care Without Harm is a global coalition of more than 473 organizations in 52 countries working to assure that the health
care sector is no longer a source of harm to human health or the environment.
www.noharm.org • May 12, 2008
2008 Survey of Healthy Food in Health Care Pledge Hospitals 1

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F O R E W O R D
Until recently it was rare to find health care professionals who expressed any public
interest in our food system, let alone in the agriculture that produced our food.
Certainly no one from the health community expressed any interest in being involved
in farm policy, like the Farm Bill. All that has changed. Health care professionals and
nutritionists as well as conservationists and environmentalists have all been at the table
proposing changes in the 2007 Farm Bill because they saw themselves having a critical
role to play in shaping our food and health policies. And they now recognize that how
we farm can have a profound effect on the health of the environment and our own
health. In fact they ended up calling the 2007 Farm Bill the Food and Farm Bill. So it
is such a delight to see this report which clearly points out these connections, together
with some practical suggestions for improving our farm, food and health policies that
could benefit all Americans. In fact, given the suggestions in this report, I would not be
surprised if, by 2012, we will be calling it the Farm, Food and Health Bill.
Of course this report is not just about changes we could make in public policy. It is
also about how we can all become involved in crafting a new farm, food, and health
culture that many believe could improve the health of our entire biotic community,
including the human species.
Frederick Kirschenmann
Distinguished Fellow
Leopold Center for Sustainable Agriculture
Iowa State University
2 Menu of Change: Healthy Food in Health Care

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Introduction
In 2005, Health Care Without Harm (HCWH) was approached by several of its health care partners
interested in collaborating on healthcare food. Clearly, our industrialized food system, the way in
which we produce and distribute food, is failing to protect public health. 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.
Nutrition-related chronic diseases are placing new demands on an already overburdened health care
system, and taking their toll on human productivity and quality of life.
This industrialized food system favors the production of animal products and highly-refined, calorie-
dense foods, rather than fresh fruits and vegetables, whole grains, and other high fiber foods important
for health. It is a food system misaligned with the US dietary guidelines. Moreover, hidden behind these
nutritional imbalances and inextricably linked to them, is a food system largely reliant on methods of
production and distribution that negatively affect human and
environmental health.
As we began work together, a consistent theme began to
“Another [way for hospitals and health care
emerge. The voice of the individual hospital calling for
facilities to become “greener”] is by serving
more nutritious, local sustainable foods was lost in the din
fresh, local, or organic foods to patients, staff
of the business as usual supply chain. The Healthy Food in
members, and visitors. Hospitals should buy
Health Care Pledge was introduced as a means to aggregate
meat and poultry raised without non-thera-
this clarion call for change and to demonstrate to society
peutic antibiotics, use milk produced without
at large healthcare’s willingness and commitment to build
recombinant bovine growth hormone, and re-
models for change. We are now witnessing this change. As
place unhealthy snacks found in many vending
of May 2008, over 122 hospitals have signed the Pledge. We
machines with healthy choices. Hosting farmers
are witnessing hospitals that have removed their deep fryers,
markets, either on hospital grounds or nearby,
others that have established farmers’ markets, and others that
is another appealing option.”
are buying fresh, local, sustainably grown produce to serve to
their patients, staff and visitors. In the apparent absence of
Ron Davis, M.D., AMA President
legislation protecting our antibiotic toolkit, hospitals have
AMA eVoice • April 24, 2008
begun sourcing meat and poultry produced without the use of
unnecessary antibiotics. Others are providing milk and other
dairy products produced without the use of the hormone
rBGH (recombinant bovine growth hormone), banned for use in almost all other industrialized countries.
The elimination of processed foods and the addition of whole grains are now evident on some hospi-
tals’ menus. Across the country, health care organizations are implementing policies and programs that
demonstrate a commitment to “First, do no harm” by treating food and its production and distribution as
preventive medicine that protects the health of patients, staff, and local and global communities.
This first report provides a snapshot of what these leaders have accomplished. Their stories and data were
submitted voluntarily. Unfortunately, size limitations precluded us from profiling all the facilities submit-
ting stories. Those profiled were selected based on criteria which included geographic representation,
hospital size, and unique programs. Not all hospitals implementing these favorable changes decided to
submit a profile.
Without question, other hospitals and health systems that have not yet taken the Pledge are making
similarly important changes in food service operations. And as we learn more about their work, we will
highlight it and share their stories and progress. This report is designed to draw attention to and praise
those that have made a public commitment by signing the Pledge and to recognize the strength of a
shared voice. They are demonstrating leadership by sending an important signal to the marketplace and
policy makers about the link between food, food production, and health; they are building and realizing
models for us all.
Please join us in acknowledging them for their leadership.
2008 Survey of Healthy Food in Health Care Pledge Hospitals 3

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Healthy Food in
Health Care Pledge
The Healthy Food in Health Care Pledge is a framework that outlines steps to be taken by the health care industry
to improve the health of patients, communities and the global environment.
As responsible providers of health care services, we are committed to the health of our patients, our staff and the
local and global community. We are aware that food production and distribution methods can have adverse impacts
on public environmental health. As a result, we recognize that for the consumers who eat it, the workers who produce
it, and the ecosystems that sustain us, healthy food must be defined not only by nutritional quality, but equally by a
food system that is economically viable, environmentally sustainable, and supportive of human dignity and justice.
We are committed to the goal of providing local, nutritious and sustainable food.
Specifically, we are committed to the following healthy food in health care measures for our institution. We pledge to:
Increase our offering of fruit and vegetables, nutrition-
Communicate to our Group Purchasing Organizations
ally dense and minimally processed, unrefined foods
our interest in foods whose source and production prac-
and reduce unhealthy (trans- and saturated) fats and
tices (i.e. protect biodiversity, antibiotic and hormone
sweetened foods.
use, local, pesticide use, etc) are identified, so that we
may have informed consent and choice about the foods
Implement a stepwise program to identify and adopt
we purchase.
sustainable food procurement. Begin where fewer bar-
riers exist and immediate steps can be taken, such as
Develop a program to promote and source from produc-
the adoption of rBGH free milk, fair trade coffee, or
ers and processors which uphold the dignity of family,
selections of organic and/or local fresh produce in the
farmers, workers and their communities and support
cafeteria.
sustainable and humane agriculture systems.
Work with local farmers, community-based organiza-
Educate and communicate within our system and
tions and food suppliers to increase the availability of
with our patients and community about our nutritious,
fresh, locally-produced food.
socially just, and ecologically sustainable healthy food
practices and procedures.
Encourage our vendors and/or food management com-
panies to supply us with food that is produced in systems
Minimize and beneficially reuse food waste and support
that, among other attributes, eliminate the use of toxic
the use of food packaging and products that are ecologi-
pesticides, prohibit the use of hormones and non-
cally protective.
therapeutic antibiotics, support farmer and farm worker
health and welfare, and use ecologically protective and
Report annually on implementation of this Pledge.
restorative agriculture.


Signed Date
4 Menu of Change: Healthy Food in Health Care

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Healthy Food in Health Care
Pledge Signers
As of May 12, 2008
A total of 122 facilities have signed the Pledge. They are:
Bartels Lutheran Retirement Community - IA
Christiana Care Health Systems
Catholic Healthcare West
Fletcher Allen Health Care - VT
Christiana Hospital - DE
System Facilities
Good Shepherd Medical Center - OR
Wilmington Hospital - DE
Arroyo Grande Community Hospital - CA
St. Luke’s Hospital - MN
Bakersfield Memorial Hospital - CA
Hackensack University Medical Center - NJ
Covenant Health Systems
Barrow Neurological Institute - AZ
Oregon Health and Science University Hospital - OR
St. Joseph Manor Health Care - MA
CA Hospital Medical Center - CA
Fairview Hospital - MA
Youville Hospital & Rehabilitation Center - MA
Chandler Regional Hospital - AZ
Cooley Dickinson Hospital - MA
Youville House - MA
Community Hospital of San Bernardino - CA
Sinai Hospital - MD
Mary Immaculate Health/Care Services - MA
Dominican Hospital - CA
Baystate Health - MA
Youville Place Assisted Living Residence - MA
French Hospital Medical Center - CA
Advocate Lutheran General Hospital - IL
Maristhill Nursing & Rehabilitation Center - MA
Glendale Memorial Hospital and Health Center - CA
The Center for Discovery - NY
St. Mary Health Care Center - MA
Marian Medical Center - CA
Spaulding Rehabilitation Hospital - MA
St. Joseph Healthcare Nashua - NH
Mark Twain St. Joseph’s Hospital - CA
Littleton Regional Hospital - NH
St. Andre Health Care Facility - ME
Mercy General Hospital - CA
Swedish Covenant Hospital - IL
St. Mary’s Villa - PA
Mercy Gilbert Medical Center - AZ
Carroll Hospital Center - MD
Sisters of Charity Health System - MA, including:
Mercy Hospital of Folsom - CA
Holy Redeemer Health System - PA
St. Mary’s Regional Medical Center
Mercy Hospitals of Bakersfield - CA
Thomas Jefferson University Hospital - PA
St. Marguerite d’Youville Pavilion
Mercy Medical Center Merced Community
Abington Memorial Hospital - PA
Marcotte Congregate Housing
Campus - CA
Children’s Hospitals and Clinics of Minnesota - MN
Aurora Health Care
Mercy Medical Center Merced Dominican
Children’s Hospital and Regional Medical Center - WA
Campus - CA
Aurora St. Luke’s Medical Center - WI
Parkview Adventist Medical Center - ME
Mercy Medical Center Mt. Shasta - CA
Aurora Sinai Medical Center - WI
Berkshire Medical Center - MA
Mercy Medical Center Redding - CA
Aurora West Allis Medical Center - WI
Anne Arundel Medical Center - MD
Mercy San Juan Medical Center - CA
Aurora St. Luke’s South Shore - WI
Michael R. Myers Hospital - IA
Mercy Southwest Hospital - CA
Aurora BayCare Medical Center- WI
Overlake Hospital Medical Center - WA
Methodist Hospital of Sacramento - CA
Aurora Lakeland Medical Center- WI
Children’s Hospital of Pittsburgh of UPMC - PA
Northridge Hospital Medical Center - CA
Aurora Medical Center, Hartford - WI
University of Washington Medical Center - WA
Oak Valley District Hospital - CA
Aurora Medical Center, Two Rivers - WI
Regis Care Center - NY
Saint Francis Memorial Hospital - CA
Aurora Medical Center, OshKosh - WI
Cooper University Hospital - NJ
San Gabriel Valley Medical Center - CA
Aurora Medical Center, Kenosha - WI
Northeastern Vermont Regional Hospital - VT
Sequoia Hospital - CA
Aurora Memorial Hospital of Burlington - WI
Dartmouth-Hitchcock Medical Center - NH
Sierra NV Memorial Hospital - CA
Aurora Psychiatric Hospital - WI
New Milford Hospital - CT
St. Bernardine Medical Center - CA
Aurora Sheboygan Memorial Medical Center - WI
Cancer Treatment Center of America at Midwestern
St. Elizabeth Community Hospital - CA
Regional Medical Center – IL
St. Joseph Health System,
St. John’s Pleasant Valley Hospital - CA
Northwest Hospital & Medical Center – WA
Sonoma County
St. John’s Regional Medical Center - CA
Drake Center – OH
Santa Rosa Memorial Hospital (3 campuses) - CA
St. Joseph’s Behavioral Health Center - CA
Mercy Medical Center – MD
Petaluma Valley Hospital - CA
St. Joseph’s Hospital and Medical Center - AZ
Bronson Methodist Hospital – MI
St. Joseph’s Medical Center - CA
John Muir Health System
St. Mary Medical Center - CA
Mid Coast Health Services
John Muir Health, Concord Campus - CA
St. Rose Dominican Hospitals - Rose de Lima
Mid Coast Hospital - ME
John Muir Health, Walnut Creek Campus - CA
Campus - NV
Mid Coast Senior Health Center - ME
John Muir Behavioral Health Center - CA
St. Rose Dominican Hospitals - San Martín
Thornton Oaks Retirement Community - ME
Campus - NV
Cascade Healthcare Community
St. Rose Dominican Hospitals - Siena Campus - NV
MultiCare Health System
St. Charles Medical Center - Bend, OR
Woodland Healthcare - CA
Tacoma General Hospital - WA
St. Charles - Redmond, OR
Mary Bridge Children’s Hospital - WA
Allenmore Hospital - WA
Covington Outpatient Center – WA
2008 Survey of Healthy Food in Health Care Pledge Hospitals 5

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Key Considerations
Industrialized Agriculture and Health
??
A comprehensive literature review of pesticides by the
Ontario College of Family Physicians has determined
??
Our industrialized food system, the way in which we
that, “The results of the systematic review do not help
produce and distribute food, is failing to protect public
indicate which pesticides are particularly harmful.
health. Poor nutrition is a risk factor for four of the six
Exposure to all the commonly used pesticides … has
leading causes of death in the United States—heart
shown positive associations with adverse health effects.”
disease, stroke, diabetes and cancer. Nutrition-related
The literature does not support the concept that some
chronic diseases are placing new demands on an already
pesticides are safer than others; it simply points to
overburdened health care system, and taking their toll on
different health effects with different latency periods for
human productivity and quality of life. A wide variety of
the different classes (Sanborn et al, 2004).
less appreciated health crises resulting from current
industrialized agricultural practices are equally at play.
??
According to the US Environmental Protection Agency
(EPA), approximately 70 percent of the 8.7 billion
??
The World Health Organization (WHO) has stated
broiler chickens produced annually are fed arsenic
that, “There is clear evidence of the human health
(Wallinga, 2006).
consequences due to resistant organisms resulting from
non-human usage of antimicrobials” (WHO, 2003). Yet,
??
The distance from farm to market has increased about
it is estimated that more than 70 percent of all
20 percent in the last two decades, with much food
antibiotics consumed in the United States are used as
traveling between 2,500 and 4,000 miles before it
feed additives for poultry, swine, and beef cattle for
reaches the plate (Pirog et al, 2001).
nontherapeutic purposes (Mellon, Benbrook, and
Benbrook, 2001).
Visions of a Healthy Food System
??
The US Institute of Medicine/National Academies of
??
If we are looking at food production per acre in tons,
Science states, “Clearly, a decrease in antimicrobial use
calories, or dollars, the polycrop is far more productive
in human medicine alone will have little effect on the
for all farm sizes (US Department of Agriculture 2002).
current situation. Substantial efforts must be made to
??
Studies have demonstrated that farms that rely on fewer
decrease inappropriate overuse in animals and
inputs (petroleum-derived fertilizer, pesticides, etc.) are
agriculture as well” (Institute of Medicine, 2003). More
more efficient in use of land, nutrients, and energy and
than 300 organizations, including the American
cost less to maintain than chemical-intensive
Medical Association and American Public Health
monocultures (Halweil 2004).
Association have advocated ending the nontherapeutic
use of medically important antibiotics as feed additives.
??
A recent study revealed detectable metabolites of
organophosphate pesticide (OP) residues in children
??
In 2003, the American Public Health Association
eating a conventional diet. Once these children were
(APHA) passed a resolution urging federal, state, and
placed on an organic diet, there were no detectable
local governments and public health agencies to institute
metabolites. Placed back on a conventional diet, the
a “precautionary moratorium” on the construction of
metabolites were again detected. (Lu et al. 2006)
confined animal feedlot operations (CAFOs) because of
health concerns (APHA, 2003). These included runoff,
??
In the World Health Organization review of Denmark’s
community impacts, air-quality concerns, worker health
elimination of nontherapeutic antibiotic use, a dramatic
and safety, and issues of antibiotic resistance.
decrease in resistant bacteria was observed in animals,
meat, and humans. In addition, eliminating the routine
??
Pesticide contamination begins in the womb, where
use of antibiotics in livestock reduced human health
metabolites to common pesticides have been found in
risks without significantly harming animal health or
meconium (Whyatt and Barr, 2001) and in fetal cord
farmers’ incomes (Wegener 2003).
blood (Houlihan et al., 2005). Pesticides and their
metabolites are now routinely part of the human body
??
A comprehensive review of scientific studies
burden, the load of chemical contamination carried by
demonstrates higher nutrient levels in organic produce
human populations.
(Benbrook et al, 2008).
??
Concentrations of atrazine, alachlor, and broadleaf
??
Grass-fed cattle almost always produce steak and ground
pesticide 2,4-D in rainwater have been reported to
beef lower in total fat than conventional beef and tend
exceed the safe drinking-water standards (Gilliom,
to result in steak with higher levels of omega-3 fatty
Alley, and Gurtz, 1995). A 1994 study estimated that
acids and other beneficial nutrients. Pasture-raised dairy
14.1 million Americans drank water contaminated with
cows similarly tend to produce milk with higher levels
the pesticides atrazine, cyanazine, simazine, alachlor,
of essential fatty acids. (Clancy 2006)
and metolachlor (Wiles et al, 1994).
6 Menu of Change: Healthy Food in Health Care

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??
A study by the Leopold Center has demonstrated that,
they purchase 10-40% of their produce annually from
by eating five half-cup servings of local vegetables daily,
these sources.
Iowans would not only fulfill the requirements of the
??
81% are purchasing rBGH-free milk. Ninety percent of
food pyramid, but would provide a net economic
those reporting purchase 80-100% of their fluid milk
stimulus of more than 4,000 jobs to the State of Iowa
from rBGH-free sources. Twenty-eight percent plan to
(Swenson 2006).
increase their purchases of rBGH-free milk.
Public Health and Health Care Call for
??
25% purchase rBGH-free yogurt. Forty-eight percent
reported that they buy 60-100% of their yogurt rBGH-
Change
free and 36% plan to begin or increase purchases of
rBGH-free yogurt.
??
A 2007 American Public Health Association policy
urges support of environmentally sound agricultural
??
44% of the facilities report that they are purchasing
practices to reduce contamination, resource use, climate
meat produced without the use of hormones or
change, in addition to improved food labeling for
antibiotics, and another 47% have plans to do so.
country-of-origin and genetic modification, and a ban
??
39% are purchasing sustainably harvested seafood, and
on nontherapeutic antimicrobial and arsenic use. It
another 33% intend to do so. Some facilities are testing
recognizes the urgency of transforming our food system
or serving fish known to be low in mercury.
to promote environmental sustainability, improve
??
36% of respondents reporting that they are purchasing
nutritional health, and ensure social justice.
third party certified eggs, primarily certified cage-free
??
A 2007 California Medical Association resolution
eggs and that 46% purchase eggs almost exclusively
encourages hospitals to adopt policies and implement
from these sources.
practices that increase the purchasing and serving of
??
67% of respondents reported that they are purchasing
food that promotes health and prevents disease.
third party certified coffee. For the purposes of this
Included are meat and dairy products produced without
survey, we recognized four third party certification
nontherapeutic antibiotics, meats derived from non-
systems. These included Bird Friendly, Organic, Fair
CAFO sources such as free-range animals, food grown
Trade and Rain Forest Alliance certifications. Of those
on non-industrial agricultural operations such as small
reporting, 42% reported that 80-100% of the coffee that
and medium-sized local farms, and food grown according
they purchase falls under these criteria.
to organic or other methods that emphasize renewable
resources, ecological diversity, and fair labor practices. It
??
Where disposables are needed, 50% of facilities have
calls on physicians and other health care professionals
implemented a partial transition to biobased food
to serve as models and educators by participating in and
serviceware for disposable needs and another 47% have
promoting a healthier and more sustainable food system.
future plans to make the transition to biobased, from
petroleum derived disposable products. Of those using
??
As of March 2008, over 119 hospitals have signed The
biobased food service ware, 83% of the facilities are
Healthy Food in Health Care Pledge, recognizing that
using compostable products, yet only 22% of those
for the consumers who eat it, the workers who produce
facilities are composting these items.
it and the ecosystems that sustain us, healthy food must
be defined not only by nutritional quality, but equally by ?? 100% of facilities reported that they have increased
a food system that is economically viable,
fresh fruit and vegetable offerings, reducing use of
environmentally sustainable, and supportive of human
processed foods (77%) and reducing products with high
dignity and justice. They commit to the goal of
fructose corn syrup (43%). 87% of facilities are
providing local, nutritious and sustainable food.
increasing their whole grain menu offerings by adding
organic and whole grain cereals, breakfast bars, and
Healthy Food in Health Care Pledge
whole-wheat pizza.
Survey Results
??
25% of facilities surveyed run a farmers’ market or farm
stand on their campus. Community supported
??
Facilities range in size from 25-900 bed facilities and
agriculture (CSA) distributions are another way for staff
represent both hospitals and long term care facilities.
and/or community members to have access to farm fresh
Geographically, pledged facilities represent facilities
produce. 25% of responding facilities currently host a
stretching across nineteen states from California, the
CSA site, while 53% of respondents are introducing
Northwest through to the Midwest, Mid-Atlantic and
either a farmers market or CSA program.
Northeast. These facilities serve from 40 to 2000 patient
??
Of the 60% of facilities that are composting food waste,
meals per day and from 70 to 7000 meals daily to staff.
34% compost pre-consumer kitchen waste, 20%
??
72% reported that they are purchasing local and/or third
compost post-consumer patient tray and 17% compost
party certified produce for their food service operations.
cafeteria food waste. The remaining facilities surveyed
Seventy-seven percent of these facilities reported that
have future plans to begin a compost program.
2008 Survey of Healthy Food in Health Care Pledge Hospitals 7

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Background
Over the last sixty years or so, we have witnessed a tremen-
2003). Yet, it is estimated that more than 70 percent of all
dous shift in the nature of farming. Today, agricultural prac-
antibiotics consumed in the United States are used as feed
tices follow an industrial model, divorced from the feedback
additives for poultry, swine, and beef cattle for nontherapeu-
loops regulating natural ecological processes and systems.
tic purposes (Mellon, Benbrook, and Benbrook, 2001). That
We have seen a shift from animal husbandry to meat pro-
is, they are used to promote growth and to compensate for
duction, diverse farms to highly specialized monocultures,
diseases caused by poor animal husbandry, the very condi-
pasture-based livestock management to confinement-based
tions provided by Confined Animal Feedlot Operations
feedlot operations. This industrial agricultural experiment
(CAFOs). There is a strong consensus that agricultural usage
has fundamentally interrupted natural ecological processes
of antibiotics contributes to antibiotic resistance in humans.
and disrupted ecological health. The result is a food system
The World Health Organization (WHO) has stated that,
with a predominance of large single farms producing single
“There is clear evidence of the human health consequences
commodities requiring intensive inputs of pesticides, artifi-
due to resistant organisms resulting from non-human usage
cial hormones, antibiotics, water, electricity and petroleum
of antimicrobials” (WHO, 2003) and the Infectious Diseases
based fertilizers. Moreover, our society has been transformed
Society of America states that a “perfect storm is blowing in
from one in which most people ate whole local foods to a
the field of infectious diseases” (Infectious Diseases Society of
one that eats highly processed and packaged foods trans-
America, 2004). More than 300 organizations, including the
ported over great distances.
American Medical Association and American Public Health
Association have advocated ending the nontherapeutic use
We are now experiencing the strains of this experiment
of medically important antibiotics as feed additives. While
throughout our healthcare system. While obesity is one
some producers have begun to reduce their use, this is dif-
health crisis, a wide variety of hidden health crises resulting
ficult to independently verify, as there are no regulations that
from current industrialized agricultural practices are equally
track usage. Moreover, because as much as 75 percent of an
at play. These impacts to human health from current food
antibiotic may pass undigested through an animal, its waste
production and distribution methods are both direct and
can contain antibiotics as well as antibiotic-resistant bacteria
indirect, and include impacts to socio-economic health,
and their genes (Campagnolo and Rubin, 1998). Further-
exposure to toxic pesticides, air and water pollution, high
more, antibiotic-resistant bacteria can move off the produc-
sugar and high fat foods.
tion facilities into communities via food, water, direct animal
contact, and other pathways.
In the fall of 2007, the American Public Health Association
passed a policy statement “Towards a Healthy, Sustainable
Water Pollution:
Food System” (APHA, 2007) which clearly laid out some of
these public health concerns. They included, but were not
Animal Wastes and Nutrients
limited to:
The concentration and relocation of animal production to
the Southeast and Western regions have created extreme
Antibiotic Resistance
manure problems in those areas, and the loss of pastures,
and crop rotations has depleted soil fertility in the Midwest.
One of the most important advances in treating infectious
In response, petroleum-derived nitrogen and other fertilizers
disease has been the development of antibiotics. Alarmingly,
are often added to soils, frequently in excess amounts. Poor
these compounds are now threatened by a global crisis of an-
nitrogen retention by corn and soy rotation results in con-
tibiotic resistance. Currently, 60,000 Americans die annually
taminated surface waters that migrate to the Gulf of Mexico,
from resistant infections (Centers for Disease Control, 2004). where nitrogen creates massive annual algae blooms. These
The Congressional Office of Technology Assessment calcu-
blooms metabolize all available oxygen, leaving a 20,000
lated that, as of 1995, resistance by just six types of bacteria
square kilometer dead zone in the Gulf (Rabalais, Turner,
increased hospital treatment costs by $1.3 billion annually
and Scavia, 2002). Thirteen percent of domestic drinking-
(Shea, Florini, and Barlam, 2001). It is estimated that $30
water wells in nine Midwestern states had nitrates exceeding
billion is spent on the cumulative effects of antimicrobial
the safe drinking-water level of 10 mg/l (Henderson 1998).
resistance each year, including multiple-drug regimens, extra
According to the EPA, hog, chicken, and cattle waste has
hospital days, additional medical care, and lost productivity
polluted 35,000 miles of rivers in twenty-two states and
(American College of Physicians, 1999). The US Institute
contaminated groundwater in seventeen states (Environ-
of Medicine/National Academies of Science states, “Clearly,
mental Protection Agency and US Department of Agricul-
a decrease in antimicrobial use in human medicine alone
ture, 1998). Runoff includes hormones, antibiotics, arsenic
will have little effect on the current situation. Substantial
and other additives. According to the US Environmental
efforts must be made to decrease inappropriate overuse in
Protection Agency (EPA), approximately 70 percent of the
animals and agriculture as well” (Institute of Medicine,
8.7 billion broiler chickens produced annually are fed arse-
8 Menu of Change: Healthy Food in Health Care

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