Menu of Change: Healthy Food in Healthcare


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Power point presentation used during the Menu of Change: Healthy Food in Health Care workshop. Presentation given by Roberta Anderson (Food Alliance), Suzanne Briggs (Kaiser Permanente), Eecole Copen (Oregon Health and Science University Food and Nutrition Services) and Emma Sirois (Oregon Center for Environmental Health).

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  • Menu of Change: Healthy Food in Healthcare

    1. 1. 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
    2. 2. Presentation Objectives <ul><li>Overview of the Health Food in Health Care Initiative </li></ul><ul><li>An Ecological Approach on Issues </li></ul><ul><li>The Oregon Healthy Food in Health Care Project </li></ul><ul><li>The Green Guide for Health Care: A Framework for Implementation </li></ul><ul><li>Hospital Case Study: Kaiser </li></ul><ul><li>Hospital Case Study: Oregon Health & Science University </li></ul><ul><li>Results and Resouces </li></ul>
    3. 3. When Health Care Does Harm <ul><li>Medical Waste Incineration : a leading source of dangerous air pollutants, including dioxin and mercury </li></ul><ul><li>Mercury (Hg): a potent neurotoxin found in everything from thermometers to blood pressure cuffs to light fixtures </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>Building Practices: construction of health care buildings consumes millions of tons of raw materials annually and generates significant waste. </li></ul><ul><li>Food : Hospitals often serve pesticide-laden fruits and vegetables and meat from animals fed with unnecessary antibiotics. </li></ul>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.
    4. 4. The food system & Systems thinking Diet-related health costs
    5. 5. Health Care Without Harm and Healthy Food in Healthcare <ul><li>As places of healing , hospitals have a natural incentive to provide food that’s healthy for people and the environment in which we live. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>Health Care Without Harm is working with hospitals to adopt food procurement policies that: </li></ul><ul><ul><li>provide nutritionally improved food for patients, staff, visitors, and the general public, and </li></ul></ul><ul><ul><li>create food systems which are ecologically sound , economically viable , and socially responsible . </li></ul></ul>
    6. 6. Healthy Food in Health Care Pledge <ul><li>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. </li></ul><ul><li>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. </li></ul>
    7. 7. Strategies for Healthier Food in Hospitals <ul><li>Antibiotic-free meat/poultry </li></ul><ul><li>rBGH-free milk </li></ul><ul><li>Organic and other certified foods </li></ul><ul><li>Locally-sourcing food </li></ul><ul><li>Menu Changes </li></ul><ul><li>Farmers’ markets </li></ul><ul><li>Hospital gardens </li></ul><ul><li>Certified coffees </li></ul><ul><li>Fast-food free zone </li></ul><ul><li>Compost and Reduction of </li></ul><ul><ul><li>food waste </li></ul></ul><ul><li>Vending machines </li></ul><ul><li>Hospital food policy </li></ul>
    8. 8. Purchase Sustainable Meat/ Poultry/ Seafood <ul><li>Issues / Benefits </li></ul><ul><li>Antibiotic resistant bacteria </li></ul><ul><li>Reducing exposure to artificial growth hormones </li></ul><ul><li>Reducing exposure to arsenical compounds </li></ul><ul><li>Protecting fish stocks and fisheries </li></ul><ul><li>Reducing exposure to environmental pollutants and heavy metals </li></ul>Percentage of Total US Antibiotic Use A n estimated 71% of all U.S. antimicrobials are fed routinely to beef cattle, poultry & swine 71%
    9. 9. <ul><li>Issues / Benefits </li></ul><ul><li>Antibiotic resistant bacteria </li></ul><ul><li>Reduce exposure to added growth factor (IGF-1) </li></ul>Purchase rBGH Free Dairy Products
    10. 10. Purchase Organic and Other Certified Food <ul><li>Issues / Benefits </li></ul><ul><li>May improve the health of patients; </li></ul><ul><li>Help protect agricultural workers; </li></ul><ul><li>Protect our air and water; and land </li></ul><ul><li>Reduce GHG emissions associated with petroleum based inputs of conventional agriculture. </li></ul><ul><li>Create a market that supports healthy, environmentally-friendly growing practices. </li></ul>Benbrook B, Zhao X, Yanez J, Davies N, Andrews P. &quot;New Evidence Confirms the Nutritional Superiority of Plant-Based Organic Foods,&quot; State of Science Review, the Organic Center. March 2008
    11. 11. Purchase from Local Producers <ul><li>Climate Change Impact of Food System </li></ul><ul><li>Livestock for meat and dairy production account for 18 percent of the world’s greenhouse gases , more than all forms of transportation combined. </li></ul><ul><li>Problem expected to grow as developing countries adopt western, animal based protein intensive diets. </li></ul><ul><li>Issues / Benefits </li></ul><ul><li>Avoids long distance travel; overuse of plastic packaging; and chemical preservatives required for transporting food long distances. </li></ul><ul><li>Reduces fuel consumption and air and water pollution associated with long-distance transport as well as GHG emissions. </li></ul><ul><li>Builds relationships between the urban and rural community; supports local economy. </li></ul>
    12. 12. <ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>Oregon Tilth : Mission to support and promote biologically sound and socially equitable agriculture through education, research, advocacy and product certification. </li></ul><ul><li>Local Hospitals : OHSU, Kaiser, Legacy, Providence, Shriners, SW Medical Center, Good Sheppard, St. Charles, and others. </li></ul>Oregon Healthy Food in Healthcare: Project Partners
    13. 13. Oregon Healthy Food in Healthcare <ul><li>Educational and Networking </li></ul><ul><ul><li>Opportunities for hospital food service </li></ul></ul><ul><ul><li>Roundtables </li></ul></ul><ul><ul><li>Facility trainings </li></ul></ul><ul><ul><li>Website and listserve </li></ul></ul><ul><li>Workgroups </li></ul><ul><li>Sustainable Food Supply Chain Strategies and Tools </li></ul><ul><li>Case Studies </li></ul><ul><li>Sustainable Food Procurement Policy Guide </li></ul><ul><li>Marketing and Media Tools </li></ul><ul><li>Project Measurement and Evaluation Tools </li></ul>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:
    14. 14. Roberta Anderson Business Development Manager The GGHC Operations Food Service Credits: a framework for measuring and tracking sustainability
    15. 15. What is Green Guide for Health Care <ul><ul><li>An educational guide for early adopters of sustainable design, construction, and operations practices </li></ul></ul><ul><ul><li>A best practices guide for the healthcare industry </li></ul></ul><ul><ul><li>A voluntary, self-certifying metric toolkit of best practices to guide and evaluate progress </li></ul></ul><ul><ul><li>Intended to encourage continuous improvement and provide market signals </li></ul></ul><ul><ul><li>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. </li></ul></ul>
    16. 16. GGHC Operations Section Overview <ul><ul><li>Integrated Operations and Education </li></ul></ul><ul><ul><li>Sustainable Sites Management </li></ul></ul><ul><ul><li>Transportation Operations </li></ul></ul><ul><ul><li>Facilities Management </li></ul></ul><ul><ul><li>Chemical Management </li></ul></ul><ul><ul><li>Waste Management </li></ul></ul><ul><ul><li>Environmental Services </li></ul></ul><ul><ul><li>Food Service </li></ul></ul><ul><ul><li>Environmentally Preferable Purchasing </li></ul></ul><ul><ul><li>Innovation </li></ul></ul>
    17. 17. Our focus: food service credits Intent: Create, promote and implement sustainable food purchasing policies and plans that support human and ecological health.
    18. 18. Our focus: food service credits <ul><ul><li>Sustainable Food Policy and Plan </li></ul></ul><ul><ul><li>Food Nutrition </li></ul></ul><ul><ul><li>Sustainable Food Education and Promotion </li></ul></ul><ul><ul><li>Local, Sustainably Produced Food Purchasing </li></ul></ul><ul><ul><li>Reusable & Non-Reusable Products </li></ul></ul><ul><ul><ul><li>Reusable Food Service Ware </li></ul></ul></ul><ul><ul><ul><li>Non-Reusable Food Service Ware and Take Out Containers </li></ul></ul></ul><ul><ul><ul><li>Non-Food Service Ware Items </li></ul></ul></ul><ul><ul><li>Hospital Supported Agriculture: Food and Farm Linkages </li></ul></ul><ul><ul><li>Food Waste Reduction, Donation and Composting </li></ul></ul><ul><ul><li>Food Services Recycling </li></ul></ul><ul><ul><li>Food Vendors </li></ul></ul><ul><ul><li>Chemical Management for Food Services </li></ul></ul>
    19. 19. Sustainable Food Policy & Plan <ul><ul><li>Develop a policy that </li></ul></ul><ul><ul><ul><li>Involves support from key stakeholders </li></ul></ul></ul><ul><ul><ul><li>Links desired outcomes/values to the institution's mission </li></ul></ul></ul><ul><ul><ul><li>Option: adopt the Healthy Food in Health Care Pledge </li></ul></ul></ul><ul><ul><li>Develop a plan with </li></ul></ul><ul><ul><ul><li>Strategies for executing aligned with these food service credits </li></ul></ul></ul><ul><ul><ul><li>Goals indicating what metrics will be tracked and how success will be defined </li></ul></ul></ul><ul><ul><ul><li>An action plan </li></ul></ul></ul><ul><ul><ul><li>An evaluation plan </li></ul></ul></ul>
    20. 20. Food Nutrition <ul><ul><li>Patient meals to include fresh fruit, salad and non-starch fresh vegetable </li></ul></ul><ul><ul><li>Whole grain options </li></ul></ul><ul><ul><li>Protein-balanced vegetarian menu </li></ul></ul><ul><ul><li>Wholesome soups from scratch </li></ul></ul><ul><ul><li>Meat-free patient food 1x per week </li></ul></ul><ul><ul><li>Eliminate trans-fats, increase healthy oils </li></ul></ul><ul><ul><li>Eliminate artificial food colors and additives </li></ul></ul><ul><ul><li>Eliminate fried foods </li></ul></ul><ul><ul><li>Eliminate nanotech foods </li></ul></ul><ul><ul><li>Healthy vending and snacks </li></ul></ul>
    21. 21. Sustainable Food Education and Promotion <ul><ul><li>Education </li></ul></ul><ul><ul><ul><li>Train new food service employees on facility’s sustainability initiatives </li></ul></ul></ul><ul><ul><ul><li>Annual educational event for other employees </li></ul></ul></ul><ul><ul><li>Healthy Sustainable Food Promotion </li></ul></ul><ul><ul><ul><li>Post Policy/Plan, Healthy Food Pledge in hospital and on web site </li></ul></ul></ul><ul><ul><ul><li>Inform customers of healthy/local/sustainable food options available in cafeteria </li></ul></ul></ul><ul><ul><ul><li>Inform patients of healthy/local/sustainable food options available on menu </li></ul></ul></ul><ul><ul><ul><li>Host special events for employees </li></ul></ul></ul><ul><ul><ul><li>Host special events for broader community </li></ul></ul></ul>
    22. 22. Hospital Supported Agriculture: Food and Farm Linkages <ul><ul><li>Connect with local farms and processing for season extension </li></ul></ul><ul><ul><li>Food service procurement through direct procurement </li></ul></ul><ul><ul><li>Farmers markets </li></ul></ul><ul><ul><li>Food box / CSA pick up location </li></ul></ul><ul><ul><li>Hospital garden or farm </li></ul></ul><ul><ul><li>Urban garden program </li></ul></ul><ul><ul><li>Conference and meeting food contract requirements </li></ul></ul>
    23. 23. Local, Sustainably Produced Food Purchasing <ul><ul><li>Annual combined food /beverage purchases (% of total purchases) </li></ul></ul><ul><ul><ul><li>Approved to carry one or more independent third party certified eco-labels </li></ul></ul></ul><ul><ul><ul><li>Carry one of the label claims allowed by USDA or FDA </li></ul></ul></ul><ul><ul><ul><li>Farms, ranches, and production/processing facilities located within a 200-mile radius of the facility </li></ul></ul></ul>
    24. 24. 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”
    25. 25. Thank you! Roberta Anderson [email_address]
    26. 26. Kaiser Permanente Comprehensive Food Policy and Programs Kaiser Permanente Farm to Cafeteria Conference March, 2009 Presented by Suzanne Briggs
    27. 27. The Convergence of Interests, Opportunities, and Imperatives <ul><li>Community Health Initiatives/HEAL </li></ul><ul><li>Environmental Stewardship Council </li></ul><ul><li>Care Management Institute Weight Management Initiative </li></ul><ul><li>Employee Wellness Policy </li></ul><ul><li>HEAL Advocacy by KP Physicians & Employees </li></ul><ul><li>KP Farmers Markets </li></ul><ul><li>THRIVE Campaign </li></ul>
    28. 28. Comprehensive Approach: 5 P’s <ul><li>Partners </li></ul><ul><li>Policy </li></ul><ul><li>Program </li></ul><ul><li>Promotion </li></ul><ul><li>Physical Project </li></ul>
    29. 29. Partners of the Comprehensive Food Policy <ul><li>KP Food Policy Steering Committee – Develop Vision, Guiding Principles, Supported Implementation </li></ul><ul><li>KP Food Workgroup – Inpatient Meals, Cafeterias, Vending, Catering </li></ul><ul><li>KP Farmers Market Initiative – Farmers Markets, Farm Stands </li></ul><ul><li>Techchnical Assistance and Support – Health Care without Harm, Broadlane, Center for Food and Justice, Food Alliance, Oregon Tilth, Community Alliance of Family Farms </li></ul>
    30. 30. Kaiser Permanetne Comprehensive Food Policy: Foundation for Policy and Programs <ul><li>Vision and Statement of Principles </li></ul><ul><li>Minimum Nutrition Standards for Food & Beverages </li></ul><ul><ul><ul><li>Vending Machines </li></ul></ul></ul><ul><ul><ul><li>Cafeteria and Coffee Carts </li></ul></ul></ul><ul><ul><ul><li>Catering </li></ul></ul></ul><ul><ul><ul><li>Inpatient Food </li></ul></ul></ul><ul><ul><ul><li>Guidelines for Healthy Meetings </li></ul></ul></ul><ul><li>Request for Information (RFI) </li></ul>
    31. 31. Healthy Picks Vending Machines -> Fit Picks <ul><ul><li>Change behavior by creating choices, not mandates </li></ul></ul><ul><ul><li>35% of Slots offer Healthy Foods </li></ul></ul><ul><ul><li>Minimum Standards Criteria is an Education Tool </li></ul></ul><ul><ul><li>Countywide Collaboration with Schools and Government </li></ul></ul><ul><ul><li>The Discovered Gatekeepers - Vending Company Drivers </li></ul></ul><ul><ul><li>Develop Healthy Foods Demand to Support Suppliers </li></ul></ul><ul><ul><li>Partnership with National Automated Merchants Assoc. </li></ul></ul>
    32. 33. Fit Picks in Time Square
    33. 34. Bring Fresh Produce to Campus
    34. 35. Comprehensive Food Program: Implementation Successes and Challenges <ul><li>Farmers Market vs Farm Stand </li></ul><ul><ul><li>Parking Considerations </li></ul></ul><ul><ul><li>Location on Campus </li></ul></ul><ul><ul><li>Vendor/Customer Ratio </li></ul></ul><ul><ul><li>Number of Days Offered </li></ul></ul><ul><ul><li>Management of Farmers Market </li></ul></ul><ul><ul><li>Collecting Data - Dot Surveys and Crowd Counts </li></ul></ul><ul><ul><ul><li> </li></ul></ul></ul>
    35. 36. Comprehensive Food Program: Implementation Successes and Challenges <ul><li>Cafeteria and Coffee Carts </li></ul><ul><ul><li>Sourcing Products – Push Demand Up the Chain </li></ul></ul><ul><ul><li>Convenient Kitchens vs Prep Kitchens </li></ul></ul><ul><ul><li>Seasonal Menus </li></ul></ul><ul><ul><li>Promotional Signage </li></ul></ul><ul><ul><li>Frontline Employee Education Classes </li></ul></ul><ul><ul><li>Borrow Ideas from Unusual Sources </li></ul></ul>
    36. 37. Comprehensive Food Program: Implementation Successes and Challenges <ul><li>Inpatient Food </li></ul><ul><ul><li>Focus on Healthy Comfort Food </li></ul></ul><ul><ul><li>In Patient Order Preference Survey </li></ul></ul><ul><ul><li>Connect the Patients to the Food Source </li></ul></ul><ul><ul><li>Room Service – Order on Demand </li></ul></ul>
    37. 38. Comprehensive Food Policy: Resources <ul><li>Healthy Food in Health Care Pledge </li></ul><ul><li>HCWH Website and Publications </li></ul><ul><li>How to Create A Farmers Market </li></ul><ul><li>Seek out Physicians and Health Providers to become Your Policy and Program Advocates </li></ul><ul><li>Build Diverse Healthy Eating Community Partners </li></ul>
    38. 39. Eating is an Agricultural Act Wendell Berry
    39. 40. Sustainability at OHSU Food & Nutrition OHSU Farm to Cafeteria Conference March, 2009 Presented by Eecole Copen
    40. 41. Sustainable Food
    41. 42. Sustainable Food Vegetarian and Vegan menu
    42. 43. Sustainable Food Health Food Convenience Store
    43. 44. Sustainable Food Farmer’s Market
    44. 45. Community Building
    45. 46. Sustainable Practices We use biodegradable dishes
    46. 47. Sustainable Practices Composting
    47. 48. What Happens to the Compost ? <ul><li>Cedar Grove Composting </li></ul>
    48. 49. What Happens to the Compost ? <ul><li>Final Product </li></ul>Plant food and start the cycle again!
    49. 50. Results and Resources <ul><li>Menu of Change Report </li></ul><ul><li>2008 Survey of Oregon Hospital Partners </li></ul><ul><li>Health Care Without Harm, Healthy Food in Health Care </li></ul><ul><li>Green Guide for Health Care </li></ul><ul><li>Sustainable Food Procurement Policy Guide (Food Alliance) </li></ul>