Hospitals Look at Food to Strengthen Patient Health, Support Local Farmers and Tackle Climate Change
Not so long ago, bad hospital food was a given. Patients could expect industrially-produced meals that lacked flavor as well as nutritional value. Not only did this food make hospital stays all the more unpleasant for patients and their families, but it also fundamentally failed to support the mission at hand: wellness.
Thankfully, change is underway. Patients and staff in hospitals around the country can now find a variety of nutritious and flavorful food options. Hospitals are also paying attention to how they source their food, purchasing from local farmers, growing produce and herbs on rooftop gardens or eliminating meat raised with antibiotics and hormones. Many of these changes and the evolution of understanding can be attributed to an organization called Health Care Without Harm (HCWH).
A Holistic Understanding of Healthy Food
For HCWH, the foundational medical principle of “do no harm” extends far beyond the individual patient. HCWH looks at the impact of the health care sector on the community, economy and environment and works with hospitals to adopt more sustainable practices – everything from building construction to waste disposal. The organization promotes a holistic understanding of healthy food that goes beyond just the health of patients and the food they eat. It takes into account the broader food systems in which hospitals participate, working from the belief that a healthy food system leads to healthy people. “Health care can invest in the health of the community by supporting regional food systems that are equitable and resilient – that take into account all actors and don’t compromise our ability to produce healthy food in the future,” says John Stoddard, National Program Director. “We have always taken a multi-sector approach.”
Just as the national conversation has heightened around climate change, HCWH has also sharpened its focus on combatting climate change across all program areas, including food. Food offers a clear opportunity for hospitals to decrease their carbon footprint and support climate-resilient systems, while furthering patient health. Their Healthy Food in Health Care program focuses on increasing plant-forward meals and expanding local and sustainable food purchasing.
“Health care can invest in the health of the community by supporting regional food systems that are equitable and resilient."
A growing body of research has demonstrated that reduced consumption of animal-based foods and increased consumption of plant-based foods is critical for both human and environmental health. Livestock, in particular, accounts for a significant portion of greenhouse gas emissions and requires more land and water than plant-based proteins. So, HCWH and its membership-based sister organization Practice Greenhealth are providing a variety of resources to support hospitals that want to introduce more plant-forward options into their food service programs, which include patient dining, cafeterias and retail.
The Cool Food Pledge
One of those resources is the Cool Food Pledge. In 2018, the global research non-profit World Resources Institute launched the Cool Food Pledge to help large institutions reduce their food-based contributions to climate change. It starts with a simple premise: food production accounts for 25 percent of the world’s greenhouse gas emissions. And so the initiative works with hotels, hospitals, universities, restaurants and corporations with dining facilities to collectively reduce their food-related greenhouse gas emissions by 25 percent by 2030. This target is in keeping with the Paris Agreement climate goals, which require a 67 percent reduction in agricultural emissions by 2050.
So far, in the United States, 30 health care institutions have taken the pledge.
Institutions who sign on begin by establishing a baseline for their current purchasing data in order to set targets and then confidentially report data on an annual basis. The Cool Food Calculator allows them to input their purchasing data by weight and receive estimates for key metrics such as food-related greenhouse gas emissions, food-related land use and food-related carbon opportunity costs (the amount of carbon that could be stored were it not for the production of that food). The World Resources Institute continuously updates the science-based calculator to ensure that it reflects the latest data and research, producing more accurate estimates. Health care signatories in the United States also receive individualized reporting and support from Practice Greenhealth.
Amount of the world's greenhouse gas emissions created by food production.
Targeted support for Cool Food pledge-takers allows them to track their progress over time, as well as estimate the impact of the potential menu and sourcing changes – such as the greenhouse gas reductions achieved through meatless Mondays. “This is helpful for looking at our total impact, but also thinking about tradeoffs,” says Dan Henroid, Director of Nutrition and Food Service at University of California-San Francisco (UCSF). “Especially with meat, we can now see what happens if we replace beef with another kind of animal protein.” Henroid hopes to get as close as possible to real-time data analytics to better understand their impact and inform decision-making at every juncture.
While the Cool Food Pledge aims to achieve a collective goal of a 25 percent absolute decrease in food-related greenhouse gas emissions by 2030, individual institutions are also expected to hold themselves to this number. “Our mindset is to definitely meet the twenty-five percent goal, but hopefully surpass it,” says Henroid.
Why Not Say “Vegetarian?”
So what does “plant-forward” mean exactly? HCWH is very deliberate in its messaging and generally prefers “plant-rich” and “plant-forward” over “vegetarian” and “vegan.” Their goal is not to eliminate meat wholesale, but to reduce meat consumption overall through individual and institutional changes. And they see serving good food – with an emphasis on taste, quality and customer satisfaction – as the best way to get there. While this messaging might sound like an attempt to downplay the importance of climate change, the organization finds that it’s just what is most effective.
“People get upset if you tell them what they can and cannot eat,” explains Kyle Tafuri, Director of Sustainability at Hackensack-Meridien Health. Tafuri favors marketing foods for what they have, instead of what they lack. “Especially in a health care setting, we can talk about certain foods in terms of personal health and wellness, as well as clinical and population health.”
For Dan Henroid at UCSF, it’s simple: “We work every day to put the best products on the plate that look great, taste great and have a great value for price point.” This approach also makes good business sense. Health care foodservice operations generally include patient meals, cafeterias, retail and catering. When hospitals offer quality meals and snacks, sales go up. Henroid pioneered the first blended burger (70% grass-fed beef and 30% mushrooms) in health care, but notes that the burger was so good, and so well-received, that his beef sales actually went up. He’s interested in developing other, equally delicious blended burgers, but with turkey meat or a plant-based protein.
Local and Sustainable Food Purchasing
While working to reduce food-based greenhouse gas emissions, HCWH simultaneously seeks to build more climate-resilient, community-based food systems. Over the past year, HCWH launched a Regenerative Farm to Hospital Initiative in four pilot sites to build relationships between health care institutions and local food producers using regenerative agricultural practices.
Erin Meyer, Executive Director of Basil’s Harvest in central Illinois, is leading the Midwest pilot. Basil’s Harvest is part of ReGenerate IL, a collaborative group of non-profits, farmers and other advocates who seek to promote regenerative agriculture across the state. Over the course of the 18-month pilot, OSF Saint Francis Medical Center will purchase all of its oats from Janie’s Farm Organics, a grain farm that uses regenerative practices. The hospital is entirely new to local purchasing, but the Food Service Director is eager to get involved. Meyer explains that the pilot satisfies a number of criteria, beginning with the crop itself, “I’m really excited about what oats provide not just in terms of a food product, but also in terms of regenerative agriculture and soil health – oats are an important cover crop.” Janie’s Farm also has a mill, which allows them to process the grains locally and retain more value. At the hospital, the oats will be used for oatmeal and granola and, in designing the pilot, Meyer was sensitive to the hospital’s needs. “Oats are a small, shelf-stable grain that are easy to use and not cost-prohibitive, unlike pasture-raised beef, which would be cost-prohibitive at this point.”
Meyer sees the pilot as a critical first step. “The goal is to build a long-term relationship where the hospital will continue to procure their oats from the farmer,” says Meyer. However, she is already thinking about how the pilot can inform larger changes. “We are looking at this from a systems perspective,” says Meyer. “We are starting by learning about small grains and we can build from there.”
Intermediaries like Meyer (on behalf of Basil’s Harvest) can play an important role in connecting health care institutions to local producers. Anthony Verona, Director of Culinary Services at University Hospitals (UH) Health System in Cleveland, OH and a Cool Food Pledge member, explains that working with the local food logistics company Azoti, along with Maumee Valley Growers and the Oberlin Food Hub, was a game-changer. “We are [the food services management company] Sodexo, so we cannot go buy food from the farmer down the street,” explains Verona. “We have to go through a purchaser.” UH Health now procures about 7% of its food from local (within 250 miles) producers. While Verona would love to do more local procurement, he says that cost is often a barrier. Verona allows himself some wiggle room (no more than four percent higher than the alternative) for local foods, but has to watch the bottom line. “Like every other system, the health care system is looking to save money.”
But these hospitals — who are successfully buying and serving local and sustainably-produced foods and who are reducing emissions through menu changes — are demonstrating that it is possible to meet their goals (healthier patients, keeping costs down) while also contributing to a healthier system overall. “Hospitals want to be good global citizens and members of the community,” says John Stoddard at HCWH. “They are also in a position to be modeling good behavior.” The opportunity to become part of a bigger movement – and inspire others – is a large part of Dan Henroid’s enthusiasm about the Cool Food Pledge: “More than anything, it is sharing our work and letting the rest of the country know that it is possible to do this.”