1. Healthy Food in Health Care:
A New Vision for Hospitals
Lena Brook, Senior Program Associate
lena@sfbaypsr.org
www.sfbaypsr.org
San Francisco Bay Area Chapter
Physicians for Social Responsibility

2. Healthy Food in Health Care
The HFHC program challenges the healthcare sector to
recognize their crucial role in advocating for a healthier and
more sustainable food system. We catalyze sustainable
procurement efforts, create clinician advocates, and inspire
health care institutions to become leaders in shaping a food
system that is grounded in preventive medicine.

3. Obesity in Context
¨ Medical costs for diet-
related disease is staggering
—$147 BILLION for obesity
alone per year
¨ 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.

4. Obesity in Context
“It is unreasonable to expect
that people will change
their behavior easily when
so many forces in the social,
cultural, and physical
environment conspire
against such change”
Institute of Medicine

5. Health Care in Context: Why Hospitals?
¨ Primary prevention part of mission
¨ Position to influence behavior
¤ Respected sources of health information
¤ See patients and visitors at key time
¤ Staff members see burden of chronic disease
¨ Many patients, visitors, staff would welcome change
¨ Health care food service: $12 billion market in U.S.1
¨ Opportunity to influence local markets, distribution networks,
national food distributors

6. Health Care in Context: Workforce
Health
¨ Healthcare one of largest industries in US: expected to create
more jobs that any other industry 2008- 2018
¨ Most healthcare workers have jobs that require less than 4
years of college education
¨ Hospitals employ 34.6% of healthcare workforce
¨ 2008 University of Minnesota Study1:
¤ 25% health service workers obese compared to 8% of
health diagnosing workers like doctors
¤ Black and Latino lower wage workers more likely to be
obese than white counterparts
1 Chou, C., Johnson, P. Journal of Occupational Environmental Med. 2008. June; 50(6):696-704

7. Modern Industrialized Agriculture
Within 50 years our agricultural
system has become almost
unrecognizable

8. Confined Animal Feeding Operations: CAFOs
¨ Require constant use of non-therapeutic antibiotics to prevent
disease outbreaks in confined spaces
¨ Factory farms emphasize high volume and profit
¨ Produce millions of animals yearly
¨ Often result in inhumane treatment of animals
¨ Produce 1.3 billion tons of waste/year
¨ Manure spills kill millions of fish and pollute bays and oceans

9. Pesticides and Human Health: California
¨ California uses nearly 20% of total US pesticides
¨ 90% of pesticides used are prone to drift.
¨ Farmworkers are 59-70% more likely to develop various forms of
cancer that the rest of the population.
¨ More than half of the 27 pesticides regulated as drinking water
contaminants have been detected in California drinking water
supplies above “safe” levels; an estimated 16 million people are
drinking pesticide-tainted water
¨ Studies show child’s body burden of pesticides ê with organic diet

10. Food and Climate Change
¨ Different food groups exhibit a large range in GHG intensity
¨ Meat and dairy production primary contributors to GHG
emissions from the agricultural sector;
¨ Eating less meat and dairy has huge impact on reducing GHGs
Pounds of CO2 Produced
Per Pound of Product
“Livestock’s Long Shadow,” UN Food
and Agriculture Organization, 2006

11. Community and Economic Health
¨ US family farmers typically
lose money every year. In
2001 alone, income declined
by 60%.
¨ Farmers receive only 16¢ for
every $1 spent at a
supermarket
¨ In contrast, for every $1 spent
at a farmers’ market generates
3x that amount for the local
economy

12. Pledge: Nearly 350 Signatories
“We pledge to encourage our
vendors…to supply us with
food that is, among other
attributes, produced without
synthetic pesticides and
hormones or antibiotics given
to animals in the absence of
diagnosed disease….”

13. Menu of Options: A Diversity of Health
Care Food Initiatives
¨ Growing food and/or hosting farmers’
markets on-site
¨ Buying local, seasonal, and organic
foods
¨ Buying hormone and antibiotic-free
foods
¨ Creating a healthy beverages strategy
¨ Preventing waste in food services and
composting food waste
¨ Reducing meat protein in favor of plant-
based protein
¨ Passing comprehensive food policies

14. Balanced Menus Challenge:
Less Meat, Better Meat
¨ Phase 1: Join Balanced Menus
Challenge – goal is 20% reduction
in meat within 12 months
¨ Phase 2: With new reduced meat
menus, prioritize purchase of local,
sustainably-raised meat and
poultry
¨ OR, tackle Phase 1 and 2
simultaneously!

15. Fo o d M a t t e r s : H e a l t h C a r e E d u c a t i o n a n d
A d vo c a c y
We inspire clinicians to:
¨ Provide anticipatory guidance to patients and
families about the importance of healthy foods and
a healthy food system.
¨ Work within health care facilities to create a
healthy food service model that is recognized as
integral to a preventive health agenda.
¨ Work within the community at a local,
regional and national level, to promote policies
that support the development of a healthy,
accessible, and fair food system.

16. Hospital Leadership Team (HLT)
Leaders in sustainable foods procurement in the
Bay Area health care community
Karen Arnold, VA Medical Center Stephanie Singer, Sutter Maternity and Surgery
Linda Hansen, Santa Rosa Memorial Hospital Stratis Rozakeas, Alta Bates Medical Center
Jack Henderson, UCSF Medical Center Lorenzo Wimmer, Kentfield Rehabilitation and
Alison Negrin, John Muir Health Specialty Hospital
Ron Senior, Sequoia Hospital Kathleen Reed, Kaiser Permanente

17. John Muir Health System
¨ Source local produce:
Buy Fresh, Buy Local;
Brentwood Mix
¨ Partner with local
farmers’ market: cooking
demos, food education
¨ CSA drop-off point
¨ On-site herb gardens
¨ Host variety of free
classes on cardiac
nutrition, healthful eating

18. John Muir Health System
¨ Source rBGH-free milk,
yogurt; local baked
goods; some sustainable
meat/poultry;
¨ Café and patient menu
revamp
¨ Weekly “Healthy Meal
Deal”: reduced price for
healthy meal for staff

19. UCSF Medical Center
¨ Cafeteria ~$4.5m/yr
¨ Catering service ~$2m/yr
¨ 1500 patient meals per day

20. UCSF Medical Center
¨ Increasing
purchase of local fruits
& vegetables including Brentwood
Mix
¨ Serve rBGH-free milk, yogurt
(local)
¨ Lead UC sustainability process
¨ Hold
sustainable food community
education events
¨ Transitioning to 100% cage-free
eggs
¨ Host weekly farmers’ market

21. San Francisco VA Medical Center
240-bed facility, half in long-term care
Enhanced patient menu:
¨ rBGH-free milk, yogurt
¨ Local whole grain breads
¨ Double vegetable portions for
all meals
¨ Substitutes brown rice for white rice
¨ More dark greens, seeds, nuts,
legumes in salads
¨ 6-week cooking class instituted
¨ Community garden on VA campus

22. San Francisco General Hospital
Laguna Honda Hospital

23. Primary Challenges
¨ Many supply chains remained under-developed for
local, sustainably produced foods from the
perspective of large institutional purchasing
¨ Cost: food service operations under contast pressure
to reduce costs yet “good” food costs more
¨ GPOs/Contracts: Does food belong in this type of
contract? How can hospitals reclaim power over
these?
¨ Complex array of diets for in-patient food service

24. Re s o u r c e s
¨ Health Care Without Harm Food website
¤ www.healthyfoodinhealthcare.org
¤ BalancedMenus Challenge
www.noharm.org/us_canada/issues/food
¤ Food Matters
www.noharm.org/us_canada/events/foodmatters
ADA’s Hunger and Environmental Nutrition DPG
¤ www.hendpg.org