Menu of Change: Healthy Food in Healthcare Farm to Cafeteria Conference March 21, 2009 Portland, OR Presenters: Emma Sirois , Oregon Center for Environmental Health Roberta Anderson , Food Alliance Suzanne Briggs , Kaiser Permanente Northwest Eecole 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

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 Harm Mission to protect public health and the environment by promoting alternatives to the use, manufacture, release and disposal of toxic chemicals.

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.

The food system & Systems thinking Diet-related health costs

Health Care Without Harm and Healthy Food in Healthcare As places of healing , hospitals have a natural incentive to provide food that’s healthy for people and the environment in which we live. Food 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 linked 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 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 food for patients, staff, visitors, and the general public, and create food systems which are ecologically sound , economically viable , and socially responsible .

As places of healing , hospitals have a natural incentive to provide food that’s healthy for people and the environment in which we live.

Food 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 linked 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 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 food for patients, staff, visitors, and the general public, and

create food systems which are ecologically sound , economically viable , and socially 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. D emonstrate 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.

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.

D emonstrate 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

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 / Benefits Antibiotic resistant bacteria Reducing exposure to artificial growth hormones Reducing exposure to arsenical compounds Protecting fish stocks and fisheries Reducing exposure to environmental pollutants and heavy metals Percentage of Total US Antibiotic Use A n estimated 71% of all U.S. antimicrobials are fed routinely to beef cattle, poultry & swine 71%

Issues / Benefits

Antibiotic resistant bacteria

Reducing exposure to artificial growth hormones

Reducing exposure to arsenical compounds

Protecting fish stocks and fisheries

Reducing exposure to environmental pollutants and heavy metals

Issues / Benefits Antibiotic resistant bacteria Reduce exposure to added growth factor (IGF-1) Purchase rBGH Free Dairy Products

Issues / Benefits

Antibiotic resistant bacteria

Reduce exposure to added growth factor (IGF-1)

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

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.

Purchase from Local Producers Climate Change Impact of Food System 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. 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 System

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.

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.

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 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 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:

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

Roberta Anderson Business 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.

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

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 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

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

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

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

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

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 [email_address]

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

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

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

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)

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.

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

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

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

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 Market www.oregonfarmersmarkets.org Seek out Physicians and Health Providers to become Your Policy and Program Advocates Build Diverse Healthy Eating Community Partners

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 Market www.oregonfarmersmarkets.org

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

Build Diverse Healthy Eating Community Partners

Eating is an Agricultural Act Wendell Berry

Sustainability at OHSU Food & 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

Cedar Grove Composting

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

Final Product

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

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