By Barbara Haumann
Fall 2009 issue of The Organic Report (Organic Trade Association)
As the debate continues on U.S. health care reform, health care facilities are taking proactive steps to offer healthier options. One result? More and more hospitals and health-related operations are incorporating organic food as part of their offerings.
Giving impetus to this movement has been Health Care Without Harm, an international coalition of more than 430 organizations in 52 countries working to transform the health care industry worldwide, without compromising patient safety or care, so that it is ecologically sustainable and no longer a source of harm to public health and the environment.
Health Care Without Harm (HCWH) is a 13-year-old organization established by environmental advocates who were concerned about hospital practices—such as disposing of toxic medical wastes—that could adversely affect human health. “Our role has been to show the linkages of human health and ecological health,” explains Jamie Harvie, director of HCWH’s Sustainable Food Work Group. HCWH first developed a rating system covering the construction and design of health care facilities to look broadly at ecological health and minimize adverse health effects.
Four years ago, HCWH started to look at local sustainable food systems as a way to improve not only nutritional but also environmental and socio-economic health. By the end of 2005, it launched its Healthy Food in Health Care initiative, and offered its Health Food In Health Care Pledge starting in March 2006. Since then, more than 250 hospitals have signed the pledge (see sidebar box). In doing so, some hospitals are offering organic food to patients. Others are incorporating organic choices in their public cafeterias or restaurants. Still others are growing herbs and produce or hosting farmers’ markets on their grounds.
An important component of the initiative has been education. For instance, Harvie says, hospitals buying conventionally produced food may not have realized that most conventional meat and poultry is produced using antibiotics for non-therapeutic purposes, a practice linked to antibiotic-resistant bacteria. Industrial food production may also increase air and water pollution.
“As soon as you make those linkages clear, hospitals can understand how agricultural food systems are interrelated with human health beyond a strict nutritional perspective,” Harvie says.
HCWH’s menu of options for healthy food in health care encourages the following:
• Start a conversation about healthy food.
• Contract with a Group Purchasing Organization (GPO), distributor, or food service provider that supports healthy food.
• Institute purchasing policies for meat and poultry raised without non-therapeutic antibiotics.
• Model local, nutritious, sustainable food at conferences, meetings and workshops.
• Buy milk produced without recombinant Bovine Growth Hormone (rBGH).
• Buy organic and other certified food.
• Consider establishing an overarching food policy.
• Buy from local producers.
• Become a fast food-free zone.
• Limit use of vending machines and replace unhealthy snacks with healthy choices.
• Host a farmers’ market on hospital grounds.
• Create hospital gardens to grow fresh produce and flowers.
• Compost, divert and reduce food waste.
• Buy certified coffee.
Fletcher Allen Health Care in Burlington, VT, was one of the first signers to the pledge. According to Diane Imrie, Director of Nursing Services, staff already was working on sourcing more sustainable food as a way to address concerns about obesity. The pledge, she says, resonated with what Fletcher Allen was all about.
“We tried to focus on doing something from each option on HCWH’s menu,” says Imrie. This included buying milk produced without the use of rBGH, local beef produced without the use of antibiotics, and organic products whenever possible; adopting more eco-friendly practices in building materials, composting waste, and using compostable or recyclable disposables.
The goal of Fletcher Allen’s public Harvest Café is to become the most sustainable café in health care facilities, Imrie says. Part of the strategy is to talk to local farmers to see if their growing practices are organic and if they respect animal welfare. “Sustainable practices and locally sourced are big components of this effort,” she adds. Fletcher Allen also buys organic and Fair Trade Certified™ coffee, teas, chocolate and hot chocolate.
More recently, the facility has begun a farmers’ market on hospital grounds. It also works with a CSA (community supported agriculture) to have products delivered for its employees as well as staff from nearby University of Vermont.
Fletcher Allen has five retail areas on its two campuses—at its Burlington facilities and a rehabilitation facility in Colchester, VT—where visitors and staff can buy food. It also offers room service, giving in-patients the opportunity to order whenever they are hungry from diet-appropriate menus. These efforts are paying off. In surveys, patients have given the food service an 88 percent satisfaction rating, with an overall score of 91 for food quality.
In addition, Fletcher Allen has two garden areas for produce and has set up two bee hives at its rehabilitation center. Next year, it plans to establish a roof garden.
At the southern end of Vermont, Brattleboro Memorial Hospital (BMH) signed the pledge this past spring.
Jamie Baribeau, Director of Nutrition Services there, says BMH signed the pledge “to incorporate locally produced foods (sustainability) into our food production, to support local farms and producers in our community, and increase the health and nutrition benefits to our patients and staff showcasing a variety of seasonal items lower in fat and sodium that taste and look great.” In addition, foodservice has reduced fried foods choices to no oftener than once a month. It currently purchases some eco friendly disposable products and relies more on regular china and flatware.
BMH also has started a rooftop organic herb garden for use in its Maple View cafe and patient food services.
In July, the hospital began hosting a farmers’ market on the front lawn every other Friday during the growing season. Eighty-five percent of the vendors are certified organic. Customers at the market are BMH employees, medical staff, and visitors.
During the spring and summer months, the hospital’s Maple View Cafe offers organic locally grown produce, organic beef, organic poultry, breads, local cheeses. During the fall and winter months, some of the locally produced items are organic, said Baribeau, adding, “All foods prepared at BMH have an emphasis on ‘made from scratch’ as opposed to canned products. We prepare our own soups, gravies, and marinara sauce from scratch. Recently, we started preparing our own individual chicken pies with Vermont naturally raised chicken and locally produced organic vegetables for sale in the Maple View cafe and patient services.”
As a sideline, the hospital sends its compostable material to a local small farm.
“We will continue to purchase organic when products are available and feasible to buy within our budgets,” Baribeau adds.
On the other side of the country, Stanford Hospital & Clinics in Stanford, CA, in August announced it was launching Farm Fresh, a new menu for inpatients developed in collaboration with chef Jesse Cool that features organic, locally grown, sustainable ingredients primarily sourced from within a 200-mile radius of Stanford Medical Center. The menu is offered at the same cost as traditional hospital fare and includes a wide selection of organic, locally produced food for all meals. Patients can also get recipe cards so they can prepare the same dishes at home.
Hospitals such as Swedish Covenant Hospital in Chicago have begun seeking institutional-sized packages of organic products, such as Nature’s Path cereal. Oregon Health & Science University (OHSU) has local sourcing and organic products, and a store where staff can pick up products. St. Luke’s Hospital in Duluth offers milk produced without the use of rBGH, organic fruits and vegetables, and such products as organic yogurts. Among others that have endorsed the pledge are Cleveland Clinic and Kaiser Permanente.
Several years ago, the American Nurses Association endorsed a resolution calling on nurses to advocate for local, sustainable food production, said Harvie, adding “Nurses are one of our biggest advocates.”
Even the American Medical Association (AMA) is recognizing the need for medical facilities to connect to healthy food options. At its 2009 annual meeting in Chicago in mid-June, AMA approved a policy resolution supporting practices and policies within health care systems that promote a healthy and ecologically sustainable food system. The new sustainable food policy builds on a report from AMA’s Council on Science and Public Health, which favored the use of locally produced and organic foods.
“Medical schools and health care facilities are uniquely qualified to take a lead role in promoting the consumption of healthy and sustainable food,” said AMA Board Member Dr. Joseph Annis in AMA’s press release issued after the approval.
“We’re at the cusp of this new revolution, and are close to honing this movement,” says HCWH’s Harvie. “As a result, hospitals and health care facilities are sending signals to the marketplace.”
He adds, “Hospitals are moving toward sustainable foods and, where they can, organic. They are starting to realize that organic foods are not always more expensive. Seventy percent of food in hospitals is generally sold in the hospital cafeterias. As such, the cafeterias should be considered restaurants, with similar price flexibility.”
This can provide opportunities for organic food manufacturers. “Although hospitals may have very tight budgets for patient menus, they have more flexibility for their cafeterias. Manufacturers can change their mindset on how to market to hospitals,” Harvie says, adding, “Hospitals are really starting to understand broad public health issues such as pesticides—how they can contaminate children’s bodies and the planet, ultimately impacting human health.” As a result, pediatric and cancer centers are communities where this understanding is beginning to take hold, and should recognize the importance of promoting more organic offerings.