Menu of Change: Menu of Change: Healthy Food in Healthy Food in HealthcareHealthcare

Farm to Cafeteria ConferenceMarch 21, 2009Portland, OR

Presenters:Emma Sirois, Oregon Center for Environmental HealthRoberta Anderson, Food AllianceSuzanne Briggs, Kaiser Permanente NorthwestEecole Copen, Oregon Health & Science University

Presentation Objectives

• Overview of the Health Food in Health Care Initiative• An Ecological Approach on Issues• The Oregon Healthy Food in Health Care Project• The Green Guide for Health Care: A Framework for

Implementation• Hospital Case Study: Kaiser• Hospital Case Study: Oregon Health & Science

University• Results and Resouces

When Health Care Does Harm• Medical Waste Incineration: a leading source of dangerous air pollutants, including dioxin and mercury

• Mercury (Hg): a potent neurotoxin found in everything from thermometers to blood pressure cuffs to light fixtures

• PVC Plastic & DEHP: PVC, used in IV bags and other hospital products, produces dioxin when manufactured and incinerated; it also leaches DEHP, a reproductive toxicant.

• Hazardous Chemicals: many pesticides and cleaning products used in hospitals contain toxic chemicals that contribute to indoor air pollution and are poisonous if inhaled or ingested.

• Building Practices: construction of health care buildings consumes millions of tons of raw materials annually and generates significant waste.

• Food: Hospitals often serve pesticide-laden fruits and vegetables and meat from animals fed with unnecessary antibiotics.

Health Care Without HarmMission to protect public health and the environment by

promoting alternatives to the use, manufacture, release and disposal of toxic chemicals.

The food system & Systems thinkingThe food system & Systems thinking

Diet-related health costsDiet-related health costs

Health Care Without Harm and Healthy Food in

HealthcareAs places of healingplaces of healing, hospitals have a natural incentive to provide food that’s healthy for

people and the environment in which we live. Food supplyFood supply can be met in a variety of ways which have consequences in terms of

nutrition, disease risk, public health, environmental health, social and economic well being.

These are linkedlinked in complex ways. From the way food is grown, to the way it’s packaged, shipped, consumed and discarded, hospitals' food purchasing decisions can play an hospitals' food purchasing decisions can play an important role, both directly and indirectly, in our ecological health.important role, both directly and indirectly, in our ecological health.

Health Care Without Harm is working with hospitals to adopt food procurement policies that: provide nutritionally improved foodnutritionally improved food for patients, staff, visitors, and the general

public, and create food systems which are ecologically soundecologically sound, economically viableeconomically viable, and

socially responsiblesocially responsible.

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 environment.

DDemonstrate leadership by sending an important signal to the marketplace and policy makers about their interest in local, nutritious, sustainable food and importantly, beginning to model healthy food practices.

Strategies for Healthier Food in Hospitals

Antibiotic-free meat/poultry rBGH-free milk Organic and other certified

foods Locally-sourcing food Menu Changes Farmers’ markets Hospital gardens Certified coffees Fast-food free zone Compost and Reduction of

food waste Vending machines Hospital food policy

Purchase Sustainable Meat/ Poultry/ Seafood

Issues / BenefitsIssues / Benefits Antibiotic resistant bacteriaAntibiotic resistant bacteria Reducing exposure to artificial growth hormonesReducing exposure to artificial growth hormones Reducing exposure to arsenical compoundsReducing exposure to arsenical compounds Protecting fish stocks and fisheriesProtecting fish stocks and fisheries Reducing exposure to environmental pollutants and Reducing exposure to environmental pollutants and

heavy metals heavy metals Percentage of Total US Antibiotic Use

71%

AAn estimated 71% of all U.S. antimicrobials are fed n estimated 71% of all U.S. antimicrobials are fed routinely to beef cattle, poultry & swineroutinely to beef cattle, poultry & swine

Issues / BenefitsIssues / Benefits Antibiotic resistant bacteriaAntibiotic resistant bacteria Reduce exposure to added growth factor Reduce exposure to added growth factor

(IGF-1)(IGF-1)

Purchase rBGH Free Dairy Products

Purchase Organic and Other Certified Food Issues / Benefits May improve the health of patients; Help protect agricultural workers; Protect our air and water; and land Reduce GHG emissions associated with

petroleum based inputs of conventional agriculture.

Create a market that supports healthy, environmentally-friendly growing practices.

Benbrook B, Zhao X, Yanez J, Davies N, Andrews P. "New Evidence Confirms the Nutritional Superiority of Plant-Based Organic Foods," State of Science Review, the Organic Center. March 2008

Purchase from Local Producers Issues / Benefits Avoids long distance travel;

overuse of plastic packaging; and chemical preservatives required for transporting food long distances.

Reduces fuel consumption and air and water pollution associated with long-distance transport as well as GHG emissions.

Builds relationships between the urban and rural community; supports local economy.

Climate Change Impact of Food Climate Change Impact of Food SystemSystem

Livestock for meat and dairy production account for 18 percent of the world’s greenhouse gases, more than all forms of transportation combined.

Problem expected to grow as developing countries adopt western, animal based protein intensive diets.

Oregon Center for Environmental Health: Mission to protect public health and the environment by promoting alternatives to the use, manufacture, release and disposal of toxic chemicals.

Oregon Physicians for Social Responsibility, Campaign for Safe Food: Mission to promote an agricultural and food system in Oregon that does not use genetically modified organisms.

Food Alliance: Mission to create market incentives for adoption of sustainable agricultural practices while educating food businesses and others in the food system about the benefits of sustainable agriculture.

Oregon Tilth: Mission to support and promote biologically sound and socially equitable agriculture through education, research, advocacy and product certification.

Local Hospitals: OHSU, Kaiser, Legacy, Providence, Shriners, SW Medical Center, Good Sheppard, St. Charles, and others.

Oregon Healthy Food in Healthcare: Project Partners

Oregon Healthy Food in Healthcare

Educational and Networking Opportunities for hospital food service Roundtables Facility trainings Website and listserve

Workgroups Sustainable Food Supply Chain Strategies and Tools Case Studies Sustainable Food Procurement Policy Guide Marketing and Media Tools Project Measurement and Evaluation Tools

In 2005, OCEH began the Oregon Health Food in Health Care Project. Currently 9 healthcare systems from across Oregon and SW Washington are participating.

The project provides:

Roberta AndersonBusiness Development Manager

www.FoodAlliance.org

The GGHC Operations Food Service Credits: a framework for measuring and tracking sustainability

What is Green Guide for Health Care• An educational guide for early adopters of sustainable design,

construction, and operations practices

• A best practices guide for the healthcare industry

• A voluntary, self-certifying metric toolkit of best practices to guide and evaluate progress

• Intended to encourage continuous improvement and provide market signals

• Its organizational structure is borrowed by agreement from the U.S. Green Building Council’s Leadership in Energy and Environmental Design (LEED®) Green Building Rating System.

GGHC Operations Section Overview• Integrated Operations and Education• Sustainable Sites Management• Transportation Operations• Facilities Management• Chemical Management• Waste Management• Environmental Services• Food Service• Environmentally Preferable Purchasing• Innovation

Our focus: food service credits

Intent: Create, promote and implement

sustainable food purchasing policies and plans that support human and ecological health.

Our focus: food service credits• Sustainable Food Policy and Plan• Food Nutrition• Sustainable Food Education and Promotion• Local, Sustainably Produced Food Purchasing• Reusable & Non-Reusable Products

• Reusable Food Service Ware• Non-Reusable Food Service Ware and Take Out

Containers• Non-Food Service Ware Items

• Hospital Supported Agriculture: Food and Farm Linkages

• Food Waste Reduction, Donation and Composting• Food Services Recycling• Food Vendors• Chemical Management for Food Services

Sustainable Food Policy & Plan• Develop a policy that

• Involves support from key stakeholders• Links desired outcomes/values to the institution's mission• Option: adopt the Healthy Food in Health Care Pledge

• Develop a plan with • Strategies for executing aligned with these food service

credits• Goals indicating what metrics will be tracked and how

success will be defined• An action plan• An evaluation plan

Food Nutrition• Patient meals to include fresh fruit, salad and non-starch

fresh vegetable• Whole grain options• Protein-balanced vegetarian menu• Wholesome soups from scratch• Meat-free patient food 1x per week• Eliminate trans-fats, increase healthy oils• Eliminate artificial food colors and additives• Eliminate fried foods• Eliminate nanotech foods• Healthy vending and snacks

Sustainable Food Education and Promotion

• Education• Train new food service employees on facility’s

sustainability initiatives• Annual educational event for other employees

• Healthy Sustainable Food Promotion• Post Policy/Plan, Healthy Food Pledge in hospital and on

web site• Inform customers of healthy/local/sustainable food

options available in cafeteria• Inform patients of healthy/local/sustainable food options

available on menu• Host special events for employees• Host special events for broader community

Hospital Supported Agriculture:Food and Farm Linkages

• Connect with local farms and processing for season extension

• Food service procurement through direct procurement• Farmers markets• Food box / CSA pick up location• Hospital garden or farm• Urban garden program• Conference and meeting food contract requirements

Local, Sustainably Produced Food Purchasing

• Annual combined food /beverage purchases (% of total purchases)

• Approved to carry one or more independent third party certified eco-labels

• Carry one of the label claims allowed by USDA or FDA

• Farms, ranches, and production/processing facilities located within a 200-mile radius of the facility

Local, Sustainably Produced Food Purchasing

“Raised without antibiotics” or ”No antibiotics administered” “Raised without added hormones” or “No hormones added” ”rBGH/rBST-free” or “From cows not treated with the growth hormone rBGH/rBST”“Grass-fed” “No genetically engineered ingredients”

Thank you!

Roberta Anderson

roberta@foodalliance.org

Kaiser Permanente Comprehensive

Food Policy and Programs

Kaiser Permanente Farm to Cafeteria Conference

March, 2009 Presented by

Suzanne Briggs

The Convergence of Interests, Opportunities,

and Imperatives

• Community Health Initiatives/HEAL• Environmental Stewardship Council • Care Management Institute Weight Management Initiative • Employee Wellness Policy • HEAL Advocacy by KP Physicians & Employees • KP Farmers Markets • THRIVE Campaign

Comprehensive Approach: 5 P’s

• Partners• Policy • Program • Promotion • Physical Project

Partners of the Comprehensive

Food Policy

• KP Food Policy Steering Committee – Develop Vision, Guiding Principles, Supported Implementation

• KP Food Workgroup – Inpatient Meals, Cafeterias, Vending, Catering

• KP Farmers Market Initiative – Farmers Markets, Farm Stands

• Techchnical Assistance and Support – Health Care without Harm, Broadlane, Center for Food and Justice, Food Alliance, Oregon Tilth, Community Alliance of Family Farms

Kaiser Permanetne Comprehensive Food Policy:

Foundation for

Policy and Programs • Vision and Statement of Principles • Minimum Nutrition Standards for Food & Beverages

• Vending Machines • Cafeteria and Coffee Carts • Catering • Inpatient Food • Guidelines for Healthy Meetings

• Request for Information (RFI)

Healthy Picks Vending Machines

→ Fit Picks

– Change behavior by creating choices, not mandates – 35% of Slots offer Healthy Foods – Minimum Standards Criteria is an Education Tool – Countywide Collaboration with Schools and Government – The Discovered Gatekeepers - Vending Company Drivers– Develop Healthy Foods Demand to Support Suppliers– Partnership with National Automated Merchants Assoc.

Fit Picks in

Time Square

www.fitpicks.org

Bring Fresh Produce to

Campus

Comprehensive Food Program: Implementation

Successes and Challenges

• Farmers Market vs Farm Stand – Parking Considerations – Location on Campus – Vendor/Customer Ratio– Number of Days Offered– Management of Farmers Market – Collecting Data - Dot Surveys and Crowd Counts

• www.oregonfarmersmarkets.org

Comprehensive Food Program: Implementation

Successes and Challenges

• Cafeteria and Coffee Carts – Sourcing Products – Push Demand Up the Chain – Convenient Kitchens vs Prep Kitchens– Seasonal Menus – Promotional Signage – Frontline Employee Education Classes – Borrow Ideas from Unusual Sources

Comprehensive Food Program: Implementation

Successes and Challenges

• Inpatient Food – Focus on Healthy Comfort Food – In Patient Order Preference Survey – Connect the Patients to the Food Source – Room Service – Order on Demand

Comprehensive Food Policy:

Resources

• Healthy Food in Health Care Pledge http://www.noharm.org/us/food/pledge

• HCWH Website and Publications http://www.noharm.org/us/food/gettingstarted

• How to Create A Farmers Marketwww.oregonfarmersmarkets.org

• Seek out Physicians and Health Providers to become Your Policy and Program Advocates

• Build Diverse Healthy Eating Community Partners

Eating is an Eating is an Agricultural Act Agricultural Act

Wendell BerryWendell Berry

Sustainability at OHSUFood & Nutrition

OHSU Farm to Cafeteria Conference

March, 2009 Presented by

Eecole Copen

Sustainable Food

Sustainable Food Vegetarian and Vegan menu

Sustainable Food Health Food Convenience Store

Sustainable Food Farmer’s Market

Community Building

Sustainable Practices We use biodegradable dishes

Sustainable Practices Composting

What Happens to the Compost?

Cedar Grove Composting

What Happens to the Compost?Final Product Plant food and start

the cycle again!

Results and Resources

• Menu of Change Report• 2008 Survey of Oregon Hospital Partners• Health Care Without Harm, Healthy Food in

Health Care www.noharm.org• Green Guide for Health Care www.gghc.org • Sustainable Food Procurement Policy Guide

(Food Alliance) www.sustainablefoodpolicy.org