Healthy Food in Health Care A Menu of Options

Healthy
Current food production and distri-
1. Start a conversation
Food in
bution systems have wide ranging
about healthy food.
impacts on the quality of ecosystems
and their communities. For example,
The health care industry is beginning
Health Care pesticides, large animal feedlot oper- to recognize that healthy food is
ations and fertilizer overuse pollute
defined not only by nutritional quali-
A Menu
our air and water. Agriculture related
ty, but how and where it is raised,
occupational health and socio-eco-
grown, processed and distributed. As
nomic impacts to rural communities
with any other successful initiative, a
of Options
resulting from the decline of family
food program requires a multi-disci-
farms are a growing concern. And as
plinary team including food and
the quantity of calories, fat, salt,
nutrition services, purchasing,
sweeteners, and meat and dairy prod-
administration, nursing and clini-
ucts is increased in our food supply
cians. Other potential members
and quantity of vegetables and grains
include public affairs, ethics and
decreased, nutrition suffers.
quality improvement. Consider the
development of a food “team,” which
Hospitals and health systems have
explores the new understanding of
opportunities to help prevent these
healthy food and how your institu-
and other food-related health con-
tion or system can get involved.
cerns by modeling good nutrition in
their institutions and by influencing
how food is produced and distribut-
2. Contract with a GPO,
ed. Through its food purchasing deci-
Distributor or Food
sions, the U.S. health care industry
can promote health by providing
Service Provider that
more fresh, good tasting, nutritious
Supports Healthy Food.
food choices for patients, staff and
The quality of food available with-
the community. And by supporting
in health care facilities is signifi-
food production that is local,
cantly influenced by Group
humane and protective of the envi-
Purchasing Organizations (GPOs),
ronment and health, health care pro-
food distributors, food service pro-
viders can lead the way in helping
viders and other outside entities.
redefine health food.
While it is always important to
communicate your interests, con-
A variety of health care institutions
tract renewal is an opportune time
.
across the U.S. have begun to adopt
to identify those businesses that
programs, practices and polices to
et a
can best help you achieve your
support a healthy food system.
goals for serving patients and staff
ow to g
Following their model your facility
een.
nutritious, local and sustainably
ggr
can choose one, a few or all of the
d out h
oin
produced foods. For example, facili-
recommendations in this menu to
g/g
ties can use the contracting process
improve the quality of your food
ollution Prevention in Health Care
to distinguish which food service
oharm.or
choices!
or P
e kit, or to fin
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contractors develop seasonal menus
to support local and fresh produce.
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ed in th
eb at www
Health systems can contract with
clu
e W
s in
those GPOs that not only source,
on
but support sustainable food
cati
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options for their member facilities.
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Similarly, health systems and GPOs
e With
can require distributors to fit the
unique needs of a facility's healthy
on is part o
f this or oth
cati
ealth Car
food program. For example, elec-
es o
tronic distributor catalogues might
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be tailored to screen out products
development. Hospitals and health
your distributor, ask suppliers for avail-
ns
such as highly processed foods and
systems host a wide variety of work-
ability and verification methods for
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meats raised with non-therapeutic
shops, conferences and symposia both
rBGH-free dairy products.
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antibiotics. Alternatively, they
onsite and at local facilities. Work
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might be designed to allow a facility
with your local conference center or
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to search for desired criteria such as
hotel and implement contract lan-
6. Buy Organic and other

local, seasonal or Organic, Fair-
guage that would require nutritious,
Trade, Food Alliance and other cer-
local and sustainable food at all or
Certified food.
OF
tified foods. Purchasing tools are
part of your event. Similarly, ask your
Products can be labeled as organic if
available on the HCWH website at
GPO, medical, nursing, dietetic or
they are produced under certain con-
www.hcwh.org/us/food/issue.
other professional organizations to
ditions without synthetic pesticides,
implement nutritious and sustainable
hormones or antibiotics and are certi-
Menu
food contract provisions. Many facili-
fied by the USDA or an independent
A
3. Institute purchasing
ties provide a holiday or seasonal
third party.
policies for meat
meal for their employees. Consider
an all local and/or organic celebra-
Widespread use of pesticides for grow-
and poultry raised tion. See the Society for Nutrition
ing agricultural products has resulted
re:
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without non-therapeutic
Education's "Guidelines To Increase
in exposure to farm workers and resi-
C
antibiotics.
The Use Of Local Foods At
dents in rural communities and con-

Meetings" under Resources and
taminated ground and surface water.
Antibiotic resistant bacteria are an
Relationships at www.sne.org.
Pesticide exposure has been associated
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increasing concern to health care pro-

with chronic neurological problems,
l
fessionals. The scientific consensus is
behavioral problems, impaired repro-
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that antibiotic overuse in food animals 5. Buy milk produced
duction, birth defects and cancer.
contributes to resistance transmitted
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to humans. It is estimated that
without recombinant
By purchasing products that are certi-
approximately 70% of all antibiotics
Bovine Growth Hormone.
fied organic, health care systems may
in
are given to animals for non-therapeu-
be improving the health of their
tic purposes to promote growth or to
Recombinant Bovine Growth
patients while helping to protect agri-
d
prevent infections common in indus-
Hormone (rBGH, also know as
cultural workers and our air and water,
trialized and confined livestock and
rBST) is given to dairy cows to
and creating a market that supports
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poultry facilities.
increase milk production for longer
healthy, environmentally-friendly
periods of time. This practice often
growing practices.
y
Your health care institution can con-
results in increased udder infections
tribute to the solution of reducing
(necessitating the use of antibiotics)
A variety of certification programs
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antibiotic overuse by buying meat
and increases the risk of other
support different aspects of sustainable
l
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raised without the use of non-thera-
adverse health effects in cows.
food production, including but not
peutic antibiotics. Working with your
Treatment with rBGH also increases
limited to water and soil conservation,
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Group Purchasing Organization
levels of growth factor (IGF-1) found
working conditions and wildlife habi-
(GPO), express a preference for buy-
in milk and has raised concerns about tat. Food Alliance Certified, Protected
ing meats produced without antibiotic
human health effects. The use of this Harvest, Certified Humane and Fair
feed additives given to animals in the
hormone is not allowed in Canada,
Trade are examples of certification sys-
absence of diagnosed disease. Chicken
Australia, New Zealand, Japan and
tems which may include these and/or
produced without the use of medically
all 25 nations of the European
other criteria. Good certification sys-
important antibiotics is widely avail-
Union.
tems are verifiable, transparent, avoid
able at no cost premium. Pork is also
conflict of interest and disclose orga-
available to a lesser extent.
Health care systems can purchase non-
nizational structure and funding
rBGH milk from their suppliers. There
sources.
are two categories of non-rBGH milk -
4. Model Local,
organic and non-organic. Organic
milk, in addition to being rBGH-free,
Nutritious, Sustainable
also prohibits the use of pesticides in
Food at Conferences,
feed and antibiotic use in cows. Non-
Meetings and Workshops
organic rBGH-free milk allows the use
of pesticides and antibiotics, and can
Health care professionals frequently
be similarly priced to conventional
attend conferences for professional
milk. Working with your GPO and
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7. Consider establishing
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through local suppliers without violat-
10. Limit use of vending
an overarching food policy. ing their prime contracts. Finally,
machines and replace
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when your contract is up for renewal,
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Few things are more interrelated than
use this as a time to negotiate the off-
unhealthy snacks with
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local food systems and the forces that
contract percentage purchases.
healthy choices.
give rise to them. Health facilities
y
may want to begin their food work by
If you are able to buy from local produc-
Vending machines in hospitals pro-
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laying out a broad, integrated food
ers, take the time to cultivate a relation-
vide a useful service as staff and visi-
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policy. An aspirational policy or goal
ship and communicate your needs to
tors rely on them for snacks when the
may then guide your facility’s future
the growers. Start small by buying only
cafeteria is not open or when they do
d
efforts. Conversely, you may elect to
a few products so a relationship can be
not have time for a full meal.
build excitement and momentum one
developed with the supplier. Some
However, vending machines are
in
step at a time and tackle a broader
health care systems have been able to
another source of fast, cheap and con-
food policy for your facility by build-
plan menus and pre-order their produce
venient, but often unhealthy food.
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ing on your success. Through an
from the growers before the growing sea-
understanding that healthy food
son, providing security for both the
The types of food and snacks offered
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includes more than nutritional quality,
grower and buyer.
in vending machines should be consis-
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healthcare facilities and systems can
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tent with dietary recommendations for
play an important role in supporting
healthy snacking. Vending machine

the health of their staff, patients and
9. Become a fast-food
options could include whole fruit, low
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local and global communities.
fat and low sugar snacks and water or
A
free zone.
juice beverages. Hospitals can draft a
re:
Although fast-food restaurants provide
policy that outlines the types of food
8. Buy from local food that is fast, cheap and conve-
that would be acceptable in vending
machines (i.e. no trans-fat, low in pro-
producers.
nient, it often has little nutritive
A
value, is high in fat, sugar, salt and
cessed sugars and fats, no artificial
By providing fresh, locally grown foods
calories, and does not promote a
ingredients and no preservatives) as
Menu
health care systems can support food
healthy dietary pattern. Ironically,
well as outlining food packaging stan-
systems that avoid the long distance
thirty eight percent of the sixteen hos-
dards and energy efficiency of
travel, overuse of plastics packaging
pitals that were listed as “Honor Roll”
machines. This type of policy can be
and chemical preservatives required for
hospitals by the 2001 US News &
used in negotiations when vending
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transporting food long distances.
World Report ranking of “America’s
machine contracts come up for review.
Buying locally produced foods avoids
Best Hospitals” currently have one or

the massive fuel consumption and air
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more fast food chains located in their
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and water pollution associated with
institutions. Although these establish-
11. Host a farmers’
long-distance transport. Buying local
ments may provide revenue for your
market on hospital
i
also helps to build relationships
facility and “comfort food” for patients
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between the urban and rural communi-
grounds.
and staff, their typical menu sends a
ns
ty and supports the local economy.
strong message in contradiction to
On-site farmers’ markets and farm
good eating habits.
stands provide fresh produce to staff,
Some health care systems purchase
visitors and patients. Farmers’ markets
their food through a supplier or con-
Hospitals can review the food service
support efforts to incorporate healthy
tract with a private food service com-
operations within their facilities
foods into diets by increasing avail-
pany distributor. In either case, it is
(patient food, cafeteria food, catering,
ability of fresh, locally grown foods.
worth learning what locally produced
vending machines and coffee carts)
Farmers markets also generate good-
foods your vendor currently provides.
and evaluate whether the food choices
will in a community, support local
Express a preference for purchasing
offered are consistent with the promo-
growers and create new
fresh, locally grown and sustainable
tion of healthy dietary patterns for
community partnerships.
food from your vendors and ask them
patients, staff and the larger commu-
to provide these options.
nity. Food service operations and dis-
Ideally, the market or farm stand sup-
tributors that do not meet the criteria
ports sustainable agriculture systems
If you currently have a contract with a
set forth by the hospital can be
by providing only locally grown foods
prime vendor, investigate the percent-
removed and replaced with those
that have been produced using sustain-
age of foods that can be purchased
companies that can commit to offer-
able methods such as organic produc-
outside the contract. Some health
ing high quality, nutritious food that
tion. In addition, the market can be
care systems are able to buy vegeta-
does not compromise the health of
authorized to accept food stamps and
bles, dairy, coffee and other products
visitors and staff.
WIC coupons, thereby increasing
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accessibility to healthy food in low-income
While not strictly “food waste,” the pur-
Resources
populations. More information on health-
chase of recycled napkins, the use of
care farmers markets is available at www.
paper or compostable dishware for “take-
Health Care Without Harm
noharm.org/food/issue.
out” and recycling of kitchen cans and
The Health Care Without Harm - Healthy
bottles are other ways in which hospitals
Food in Health Care Website contains a
are improving their environmental
wide variety of in depth health care specific
12. Create hospital performance.
news, purchasing tools, educational materi-
gardens to grow fresh
als, case studies, reports and related links.
produce and flowers.
14. Buy certified coffee.
www.healthyfoodinhealthcare.org
Vegetable and herb gardens on hospital
Coffee is the US’s largest food import and Green Guide For Health Care
grounds not only provide healthy foods
second most valuable commodity after
A best practices guide for healthy and
but also much-needed, thriving green
oil. Most coffee is grown in developing
sustainable building design,
spaces. Cut flowers can be sold or used in
countries under conditions that require
construction and operations for the
your facility. Hospital gardens can help
clear-cutting and heavy use of pesticides
health care industry. Includes a variety
to foster a sense of community and pride
and where agricultural workers toil for
of food and food waste strategies.
in hospital staff, offer a place of respite
little pay. There are many different types
www.gghc.org
for patients and staff and create opportu-
of certified coffee that can address these
nities for community members (students,
issues, like fair trade, shade-grown and
society for nutrition education
seniors or others) to be involved.
organic. Buying certified coffee supports
“Guidelines To Increase The Use Of
Hospital gardens can also serve as dem-
community development, health and
Local Foods At Meetings” can be found
onstration gardens to educate the com-
environmental stewardship.
on this web site under Resources and
munity about organic growing methods,
Relationships. There is also a download-
integrated pest management and the
able brochure entitled “A Sense of Place:
incredible variety of foods that can be
Conclusion
Serving Local Food at Your Meeting.”
cultivated in a small urban space.
Across the country, hospitals are improv-
www.sne.org
ing their food purchasing choices to
reflect a broader understanding of healthy
Journal of Hunger &
13. Compost, divert and
food and increased public awareness about environmental nutrition
reduce food waste.
food quality is providing institutions with
This peer-reviewed professional quarter-
ly examines factors that govern how
Food waste comprises approximately 10
the motivation to highlight their
people produce, procure, and consume
percent of a hospital’s waste stream.
“healthy” food programs. Hospitals are
food and the implications for nutrition
Food and other organic waste can be
promoting their a la carte menus, organic
and health. It examines hunger and
diverted, composted or otherwise benefi-
food offerings and food policies through
environmental nutrition issues including
cially reused instead of being land-filled.
their website and marketing materials.
sustainable food systems, poverty, social
Fresh but unwanted food can be donated
Through procurement of locally produced
justice, and human values. www.
to local soup kitchens or food “pantries.”
food, health care facilities are returning
haworthpress.com/web/JHEN/
A la Carte programs are reducing food
economic benefits to their local citizens
purchase and disposal costs. Through
and communities. And through educa-
reductions in food waste volumes, com-
tion to staff and patients about the rela-
posting has been demonstrated to be
tionship between health and how our
cost-effective.
food is produced and distributed, hospitals
are modeling strong leadership for healthy
Space limitations will dictate what type
communities and ecosystems.
of composting method a health care facil-
ity can adopt. For those with limited
space, food waste can be picked up by
This publication is part of Going Green: A Resource Kit
for Pollution Prevention in Health Care. For additional
local haulers and sent to off-site compost-
copies of this or other publications included in the kit,
1901 North Moore St.
or to find out how to get a complete kit, visit Health
ing facilities or used as animal feed.
Suite 509
Care Without Harm on the Web at www.noharm.org.
Those with more space may be able to
Arlington, VA 22209
compost their waste on-site using an in-
Phone: 703.243.0056
Fax: 703.243.4008
vessel composting unit.
The PCF certification mark and term are the sole property of the
www.noharm.org
Chlorine Free Products Association and are only used by authorized
info@hcwh.org
and certified users.

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