Food is sustenance. But what we eatand how we eat can also contribute todeath, disease and rising health carecosts. Obesity, the leading healthconcern of the day, is a symptom ofpoor eating habits and sedentarybehavior. Poor nutrition is a risk factorfor four of the six leading causes ofdeath in the United States—heartdisease, stroke, diabetes and cancer.1

Nutrition-related chronic diseases areplacing new demands on an alreadyoverburdened health care system andtaking their toll on human productivityand quality of life.

Rather than fresh fruits and vegetables,whole grains, and other high fiberfoods important for health, our currentfood system favors the production ofanimal products and highly-refined,calorie-dense foods. It is a food systemmisaligned with the U.S. dietaryguidelines.2 Hidden behind thesenutritional imbalances, is a food systemlargely reliant on methods ofproduction and distribution that hurtus and the environment in which welive.

Hospitals and health systems haveopportunities to help prevent thesefood-related health concerns bymodeling good nutrition in theirinstitutions and by influencing howfood is produced and distributed.Through its food purchasing decisions,

the U.S. health care industry canpromote health by providing morefresh, good tasting, nutritious foodchoices for patients, staff, and thecommunity. And by supporting foodproduction that is local, humane andprotective of the environment andhealth, health care providers can leadthe way to more sustainableagricultural practices.

Health Care Without Harm (HCWH)is an international coalition of morethan 430 organizations in 52 countries.We are working with hospitals todefine and develop food purchasingpractices that are consistent with theseprinciples.

Food and FoodPurchasing A Role forHealth Care

Pub

8-01

This

pub

licat

ion

is p

art

of G

oing

Gre

en:

A Re

sour

ce K

it f

or P

ollu

tion

Pre

vent

ion

in H

ealth

Car

e.Fo

r ad

diti

onal

cop

ies

of t

his

or o

ther

pub

licat

ions

inc

lude

d in

the

kit

, or

to

find

out

how

to

get

aco

mpl

ete

kit,

vis

it H

ealt

h Ca

re W

itho

ut H

arm

on

the

Web

at

ww

w.no

harm

.org

/goi

nggr

een.

This

ver

sion

: Ap

ril 6

, 20

06

Ecological ThinkingEcological thinking meanslooking at things in their wholecontext, while seeking to alsounderstand the interconnectionsbetween parts. It recognizes thatnothing exists in isolation;everything is part of a largersystem. This approach isimportant for health care fooddecision making, because theproduction and distribution offood has a multitude of heathrelated impacts often removedfrom the immediate hospitalenvironment.

St. Luke's Hospital in Duluth, MN has introduced organic foods in theircafeteria and to patients. Hospital coffee is Fair Trade certified, that is,bought from small coffee producers guaranteed a just return on their labor.Despite a challenging climate, St. Luke's also will begin to pilotintroduction of local, sustainably grown produce.

Dominican Hospital, in Santa Cruz, CA buys produce from a nonprofit,community-based organic farm program as part of their commitment toinvesting in their local community as well as healing the sick. An onsitegarden provides produce and flowers for the facility.

“We have to set an examplewith the food we serve ourpatients and employees.”Dr. Toby Cosgrove, heart surgeonand current CEO, The ClevelandClinic on NBC’s Today Show,December 16, 2004.

“What could be moreclosely related to healththan what we eat?”Dr. Preston Maring, a KaiserPermanente Cardiologist, writing inthe Spring 2004 issue of thePermanente Journal.

Food System and Health:The ProblemMajor shifts in the U.S. food system inthe last century are having negativeimpacts on human health. While totalfarm acreage has declined, farm sizehas increased and is more focused onthe production of a single crop oranimal, contributing to the decline inproduction of diverse food cropsnecessary to meet nutritional needs. Inthe United States, the typical fooditem now travels from 1,500 to 2,400miles from farm to plate. This systemdisconnects the growers from theconsumers and increases opportunitiesfor food contamination and loss ofnutrients during transportation. Whilethis industrial food system initiallycontributed to higher yields,productivity has declined, and seriouslong-term impacts on human andenvironmental health have becomeapparent. These include:

Nutrition Compared to the early 1900s, the U.S.food supply has more calories, fat, salt,sweeteners, and meat and dairyproducts per person and less vegetablesand grains.3 High-sugar or high-fatfoods including soft drinks, saltysnacks, sweets and desserts comprisealmost 30 percent of all caloriesconsumed by Americans.4 Anemerging body of research suggeststhat soda and fast food consumptionmay be linked to increased risk ofweight gain and diabetes.5,6,7

Antibiotic ResistanceEach year 20 to 30 million pounds ofantibiotics (including relatedantimicrobials) are used in agriculture-by volume, about 7-10 times the totalantibiotics used in human medicine.8

Industrialized food systems that producepoultry, swine, beef, and farmed fishroutinely use antibiotics as growthpromoters rather than to treat identifieddisease. Routinely feeding antibiotics toanimals that are not even sick worsensantibiotic resistance among bacteriathat cause human infections.9

Air and Water PollutionPesticide drift, field dust, wasteburning, toxic gases from degradingmanure, and diesel exhaust fromtransporting food long distances are allfactors of food production thatcontribute to air pollution. These typesof pollution can lead to asthma andother respiratory illnesses,cardiovascular disease and lung cancer.Commercial fertilizers and pesticidescontaminate ground water in manylocales. Large-scale animal feedlotoperations contribute to waterpollution with biologically activehormones, nitrates and otherbreakdown products of untreatedanimal waste.

Worker Health and SafetyWidespread pesticide use in industrial-scale food production exposes farmworkers and their families todangerous chemicals, often at levelsthat exceed established “safety” limits.Longer-term, low-level pesticideexposure has been linked to an arrayof chronic health problems including:cancer, birth defects, neurological,reproductive, and behavioral effects,and impaired immune systemfunction.10,11 Industrialized meatpacking is recognized as one of themost dangerous occupations: everyyear, over one quarter of all workersneeds medical attention beyond firstaid.12

Food Supply and Health:The Solution Hospitals and health care institutionscan help improve health outcomes bysupporting the transition to a moresustainable food system. A sustainableagriculture and food system protectsthe environment and human health. Itmeets needs for food and fiber while

supporting the economic viability ofcommunities. Through theirpurchasing practices, health careinstitutions can help achieve thefollowing:

Promote Nutrition By offering a range of healthy foodsand beverages on patient trays, incafeterias, vending machines, andthrough onsite farmers markets, healthcare systems can support good eatinghabits and model a healthy foodenvironment.

Reduce Antibiotic Resistance By buying meat produced without theroutine use of antibiotics, health carecan help ensure that existingantibiotics remain effective for treatinghuman disease.

Reduce air and water pollution By providing fresh, locally grown foodswhenever possible, health caresupports local food systems that avoidthe long-distance travel anddisconnection between rural andurban centers that typifies our currentfossil-fuel intensive food productionand distribution.13 By developing apreference for hormone-free,humanely raised meats from facilitiesin compliance with environmentalregulations, hospitals can help protectclean air and clean water.

Support Farm and WorkerHealth and SafetyHealth care can purchase meats fromprocessors who protect worker healthand safety. Facilities can also buy andserve foods grown without pesticides,such as certified organic foods, andreduce exposure to harmful pesticidesfor those who eat and grow their food,and create a market for healthiergrowing practices.

FO

OD

A

ND

F

OO

D

PU

RC

HA

SI

NG

:

A

RO

LE

F

OR

H

EA

LT

H

CA

RE

2

Farmers Markets & HealthMany Kaiser Permanente facilities feature on-site farmers markets orproduce stands. These markets are one sign of Kaiser’s commitment toprotecting the environment by supporting sustainable agriculture whileimproving access to healthy, affordable food in and around Kaiser facilities.

FO

OD

A

ND

F

OO

D

PU

RC

HA

SI

NG

:

A

RO

LE

F

OR

H

EA

LT

H

CA

RE

3

Support the Local Community A hospital’s long-term vitality dependsin large part on the economic healthof the broader community serving ashome to its staff and patients. Everystep of the food chain whereownership falls outside the communityis a potential drain on the health andvitality of the local community. Every

time a hospital chooses to buy locally,the community benefits from thatchoice.14 By institutionalizing apreference for the purchase of foodsproduced, processed, and distributedlocally, under local ownership,hospitals can use their immensepurchasing power to support socio-economic health.

The Ethics of EatingIn Minnesota, Catholic leadership hasemphasized that the buying and eatingof food involves decisions that areinherently moral.

“….Minnesota’s web of life isthreatened. Our clean air, freshwater and rich soil are beingtainted. Thousands of farmers onsmall- and medium-size farms areforced to leave the land, no longerreceiving an adequate income tocompensate them for labor andcost of production. Some of ourrural communities are dying. Thesechanges have moral and ethicalimplications, which cannot beignored…..”16

Minnesota Bishops’ Statementon the Farm Crisis

Less Local Control of Food ProductionIn recent decades, much less of every food dollar has gone to foodproducers in the community where it is spent, and more has gone to foodprocessing, packaging, shipping and retailing, all typically controlled bydistant corporations. Six cents of every dollar spent on a loaf of breadgoes to the wheat farmer-about as much as is spent on the plastic,petroleum-based wrapper. Control of the food supply has becomeincreasingly concentrated. Two firms, Cargill and Archer Daniels Midland,control about three quarters of the global market for cereal grains.15

Because of its size and purchasing power, the healthcare industry can provide market leadership by adoptingfood purchasing policies and practices that steer theentire food system in more positive directions. Hospitalsand health care systems can buy and provide food intheir facilities in ways that help create a model forwellness at the individual, community, and nationallevels.

Providing access to healthier food promotes wellnessamong patients, visitors and staff. Buying food producedin ways that are ecologically sound, economicallyviable, and socially responsible also supports a foodsystem that ultimately benefits healthier individuals andcommunities.

What Can Health Care Do?Hospitals can adopt food procurement policies thatprovide nutritionally improved food for patients, staff,visitors, and the general public, and support and helpcreate food systems that promote the well being of thewhole community. Institutions can establish foodpurchasing guidelines and set target goals that arerealistic for their institution and geographic area.

Specific solutions that hospitals and health care systemshave already instituted or explored include:

■ Create weekly farmer’s markets on hospital grounds;

■ Create hospital gardens to grow fresh produce aswell as provide patient exercise opportunities;

■ Institute policies to buy only meat/poultry raisedwithout non-therapeutic antibiotics or hormones;

■ Set goals and explore new relationships designed toincrease the purchase of locally-produced, freshproduce;

■ Buy more certified organic food products, or buyfrom producers who have reduced syntheticpesticide use;

■ Turn hospital campuses into “fast-food-free zones;”

■ Purchase foods that provide fair prices and livingwages to the people who produce them;

■ Buy milk produced without the use of synthetichormones, like recombinant Bovine GrowthHormone (rBGH, also referred to as rBST);

■ Buy coffee certified as Fair Trade; and

■ Implement sustainable food credits in the GreenGuide for Healthcare (www.gghc.org).

Model for Wellness: The Role for Health Care

Notes1. Anderson RN, Smith BL. (November

7, 2003) “Deaths: Leading Causes for2001” National Vital Statistics Reports52(9):1-85. Centers for DiseaseControl & Prevention, NationalCenter for Health Statistics, assummarized online at Fast Stats A-Z:www.cdc.gov/nchs/fastats/lcod.htm

2. Dietary Guidelines for Americans.(2005) published jointly by U.S.Department of Health and HumanServices and U.S. Department ofAgriculture. www.health.gov/dietaryguidelines/dga2005/document/

3. Gerrior S, Bente L. (2002) NutrientContent of the U.S. Food Supply, 1909-99: A Summary Report. U.S.Department of Agriculture, Center forNutrition Policy and Promotion,Home Economics Research ReportNo. 55.

4. Block G. “Foods Contributing toEnergy Intake in the US: Data FromNHANES III and NHANES 1999-2000” (June 2004) Journal of FoodComposition and Analysis 17(3-4):439-447.

5. Ludwig DS, Peterson KE, andGortmaker SL. (2001) “Relationbetween consumption of sugar-sweetened drinks and childhoodobesity: a prospective, observationalanalysis.” The Lancet 357: 505-508.

6. Pereira MA, Kartashov AI, EbbelingCB, and others. (January 1, 2005)“Fast-food habits, weight gain, andinsulin resistance (the CARDIAstudy): 15-year prospective analysis.”The Lancet 365: 36-42.

7. Schulze MB, Manson JE, Ludwig DS,and others (2004) “Sugar-sweetenedbeverages, weight gain, and incidenceof type 2 diabetes in young andmiddle-aged women.” Journal of theAmerican Medical Association (JAMA)292: 927-934.

8. Mellon et al. Hogging It: Estimates ofAntimicrobial Abuse in Livestock. Unionof Concerned Scientists: Cambridge,MA. 2000.

9. Wegener HC. (2003) “Antibiotics inanimal feed and their role inresistance development.” CurrentOpinion in Microbiology 6: 439-445.

10. Owens K. (2003) Healthy Hospitals:Controlling Pests Without HarmfulPesticides, published jointly by BeyondPesticides and Health Care WithoutHarm. www.norharm.org/pesticidescleaners/issue.

11. Sanborn, M, Colle, D., Kerr, K.,Vakill, C., and others, “PesticidesLiterarture Review”, The OntarioCollege of Family Physicians, Toronto,Ontario, April 23, 2004http://www.ocfp.on.ca/local/files/

Communications/Current%20Issues/Pesticides/Final%20Paper%2023APR2004.pdf.

12. “Highest incidence rates of totalnonfatal occupational injury andillness cases, private industry, 1999.”(December 2000). U.S. Department ofLabor, Bureau of Labor Statistics,Occupational Safety and HealthAdministration, Injuries, Illnesses, andFatalities.

13. Garbarino JR, Bednar AJ, RutherfordDW, and others. (April 15, 2003)“Environmental fate of roxarsone inpoultry litter. I. Degradation ofroxarsone during composting.”Environmental Science & Technology37(8):1509-14.

14. New Economics Foundation. (August7, 2001) “Local food better for ruraleconomy than supermarket shopping”,News Release, Caroline Hill.

15. Halweil B. (2004) Eat Here: ReclaimingHomegrown Pleasures in a GlobalSupermarket. published jointly by W.W.Norton and the Worldwatch Institute,p54.

16. “Minnesota Bishops’ Statement on theFarm Crisis.” Bishop Statements,online at: www.ncrlc.com/RCS-minn.html.

This publication is part of Going Green: A Resource Kit for PollutionPrevention in Health Care. For additional copies of this or other publi-cations included in the kit, or to find out how to get a complete kit, visitHealth Care Without Harm on the Web at www.noharm.org/goinggreen.

1901 North Moore St. Suite 509Arlington, VA 22209Phone: 703.243.0056Fax: 703.243.4008www.noharm.orginfo@hcwh.org

The PCF certification mark and term are the sole property of the Chlorine FreeProducts Association and are only used by authorized and certified users.