Tyler Norris - Why our food systems must change
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The high price of poor food
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Tyler Norris - Why our food systems must change
- 1. The High Price of Poor Food: Our Food System and the Public's Health Tyler Norris Vice President, Total Health, Kaiser Permanente The True Cost of American Food ~ San Francisco - April 15, 2015
- 2. What will it be?
- 4. together kp.org/communitybenefit Human Resources Treasury Government Relations Research Health Care ServicesProcurement & Supply Community Benefit Environmental Stewardship Labor Mgmt Partnership National Facility Services Communications Technology From Doing Good Things… …to Accountability for Impact Total Health Impact
- 5. together kp.org/communitybenefit What Creates Health Source: Determinants of Health and Their Contribution to Premature Death, JAMA 1993 Medical Care 10% Drivers of Health Personal Behaviors 40% Socio- Econ + Environmental Factors 20% Family History and Genetics 30%
- 6. together kp.org/communitybenefit Support Individuals Encourage Groups Change Communities Track Outcomes 4 Diseases, 4 Risk Factors* 4 Actions *Aligns with World Health Organization’s framework for non-communicable diseases Integrated Approach to Disease & Risk Factors
- 11. together kp.org/communitybenefit Food Deserts: Market Failure • PIC OF CONVENIENCE STORES
- 12. together kp.org/communitybenefit Place Matters: Food Deserts & Swamps Sacramento Sonoma Placer Orange Riverside San Diego San Joaquin Stanislaus Tulare Ker n Los Angeles Marin San Francisco San Mateo Santa CruzMonterey San Luis Obispo Santa Barbara Ventura Santa Clara Solano Contra Costa Alameda San Bernardino > 5.0 = 4.0 – 4.9 = 3.0 – 3.9 = 2.0 – 2.9 = 1.0 – 1.9 RFEI Index* * RFEI = ratio of fast-food restaurants and convenience stores to supermarkets and produce vendors. For counties with populations >250,000. Source: California Center for Public Health Advocacy. “Searching for Healthy Food: The Food Landscape in CA Cities and Counties.” Jan 2007.
- 13. together kp.org/communitybenefit Increasing Prevalence of Obesity Sources: CDC Behavioral Risk Factor Surveillance System; Wang & Beydoun, The Obesity Epidemic in the United States – Gender, Age, Socioeconomic, Racial/Ethnic , and Geographic Characteristics: A Systemic Review and Meta-Regression Analysis. Epidemiol Rev 2007;29:6-28; Wang, et al, Will All Americans Become Overweight or Obese? 20-24% 25-29% 35-39%30-34% 40-44% 50-54%45-49%15-19%10-14%<10% No Data 2015 Percent of Adults Obesity (body fat 30% or higher) 2030 55-60% >60% 51%41%
- 14. together kp.org/communitybenefit Increasing Prevalence of Diabetes Sources: CDC Behavioral Risk Factor Surveillance System; Narayan, Impact of Recent Increase in Incidence on Future Diabetes Burden, Diabetes Care 2006;29:2114-2116; Institute for Alternative Futures projections 2010 6-7% 8-9% 14-15%12-13%<6% 10-11% Percent of Total Population with Diabetes 20252015
- 15. together kp.org/communitybenefit Equity Is Health’s Frontier
- 16. together kp.org/communitybenefit The (not so) Skinny on Sugar Sweetened Bevs • SSB’s account for 43% of increase in per capita calories 1977. • More than half of adolescents drink 1 or more sodas per day • Adults who drink one or more sodas/day are 27 percent more likely to be overweight or obese Sources: U.C. Berkeley Center for Weight and Health,; UCLA School of Public Health SSB’s are the single largest contributor to obesity
- 17. together kp.org/communitybenefit Obesity and Pregnancy • 1 in 4 pregnant moms are obese. • 27% will get gestational diabetes at some point in their pregnancy. • 8% will develop DM within first year of birth. Elevated risk in subsequent years. Source: KP Member Data, 2013
- 18. together kp.org/communitybenefit Hunger and Health 48 million Americans are food insecure
- 19. together kp.org/communitybenefit CHAMACOS STUDY: Farm Worker Families Center for the Health Assessment of Mothers and Children of Salinas
- 21. together kp.org/communitybenefit Majority of Chemicals Are Not Tested Before Entering the Market
- 22. together kp.org/communitybenefit Where are the Health Concerns? Production Pesticides, chemical fertilizers, antibiotic & hormone use in meat and dairy production, infectious agents, arsenic, environmental degradation Processing Increased reliance on imported, unregulated processed foods; melamine; residual mercury; food-borne illness Packaging & Transport Bisphenol A (BPA), phthalates, perfluorochemicals, air quality, food miles, widespread use of plastics leading to large volumes of waste both in landfills and incinerated, environmental degradation Consump- tion Fast food, sugar-sweetened beverages, high fructose corn syrup, marketing, obesogens,
- 23. together kp.org/communitybenefit Hormones in Beef and Dairy Cattle Robert Gould, MD
- 24. together kp.org/communitybenefit Antimicrobials in Beef, Swine & Poultry A significant contributor to the increased prevalence of antibiotic resistance among human pathogens Robert Gould, MD
- 26. together kp.org/communitybenefit Diet during early development can have long-lasting effects on epigenome Our health is not only determined by what we eat… …But also what our parents ate.
- 27. Preimplantation human development Mio 2008 Paolo Rinaudo, MD, PhD Associate Professor, UCSF
- 28. • Low birth weights correlated with increased mortality by ischemic heart disease • Barker: Fetus exposed to poor conditions in utero adapts accordingly in anticipation for a similar extrauterine life Barker & Osmond, 1986 The Barker HypothesisThe Barker Hypothesis Developmental Origins of Health and Disease “Windows of sensitivity”
- 30. together kp.org/communitybenefit Needed Changes A Good Solution Solves Many Problems” -- Larry Cohen, Prevention Institute
- 31. together kp.org/communitybenefit Allen Temple Baptist Church - Oakland
- 32. together kp.org/communitybenefit | © 32 Healthy Sustainable Food Vision: Farmers Markets to Sustainable Food Purchasing to Food Rx Farmers Markets and Farm Box Distribution Healthy Food Criteria Sustainable / Local / Fair Food Purchasing
- 33. together kp.org/communitybenefit • Corporate practices • Distribution practices • Food categories • Non-food categories • Availability of sustainable products • Ability to track and report sustainable spend • Responses key to vendor decisions Sustainable Food Scorecard
- 34. together kp.org/communitybenefit Connecting Markets to Nutrition Rx:
- 35. together kp.org/communitybenefit Impact Investing: California FreshWorks Fund Bringing healthy food to every community. A private-public partnership loan fund that has raised $272 million to invest in bringing grocery stores and other forms of healthy food retailers to underserved communities.
- 36. together kp.org/communitybenefit Policy Opportunities Hospitals and healthcare professionals can be leaders and advocates for a food system that promotes public and environmental health. Healthcare professionals have credibility, influence, and expertise.
- 37. together kp.org/communitybenefit • Healthy Food in Health Care Pledge • Partnership for a Healthier America Scaling Impact for Healthy/Fair/Sustainable Food …via Partnership
- 38. together kp.org/communitybenefit | © 38 "Tell me what you eat, and I will tell you what you are.” Jean Anthelme Brillat-Savarin 1755-1826
Editor's Notes
- Physical & Mental Health Care“Body, Mind and Spirit” Individual/Family Home/School/Worksite Neighborhood/Community Society Purchasing / Procurement / Sourcing Supplier Diversity ($1.3B with women & minority-owned firms) National Facility Services (80 million sq. feet + surrounding area) Environmental Stewardship (materials, energy, toxics) Workforce Development – diversity & inclusion, pipeline , professional societies, training programs, youth potentiation Community engagement / volunteerism (180,000 employees) Charity Care and Coverage – Medicaid expansion Health in all policies – engage physicians Grant portfolio Social Impact Investing (PRI / MRI) Social well-being (violence prevention, community building, housing, transportation….VIA PARTNERSHIP)
- -- Cost of delivering a baby to an obese mom is $4,300 more than healthy weight moms -- Consider that GD has huge implications for both baby and mom -- getting it so young is a new phenomenon
- Yet the overwhelming majority of chemicals, including those identified as animal mammary carcinogens or endocrine disrupting compounds, have never been examined in an epidemiologic study of breast cancer, nor been included in an animal cancer bioassay
- Talking Points - Key Health Concerns Here is a list of key concerns related to our food system, grouped according to where along the line we typically find them. The bolded issues are the ones covered in this presentation. We’ll be talking about pesticides, the impacts of antibiotic and hormone use in livestock and dairy production, arsenic use in chickens, increases in food-borne illness, as well as looking at a particular chemical, BPA, and some emerging research on obseogenic chemicals that may be contributing to rising rates of obesity. For More Information Redefining Healthy Food http://www.noharm.org/lib/downloads/food/Redefining_Healthy_Food.pdf References Fertilizers Bhumbla D. Agriculture practices and nitrate pollution of water. West Virginia University Extension Service Web site. Ward MH, deKok TM, Levallois P, Brender J, Gulis G, Nolan BT, et al. Workgroup report: Drinking-water nitrate and health--recent findings and research needs. Environmental health perspectives. 2005 Nov;113(11):1607-14. Ward MH, Kilfoy BA, Weyer PJ, Anderson KE, Folsom AR, Cerhan JR. Nitrate intake and the risk of thyroid cancer and thyroid disease. Epidemiology. 2010 May;21(3):389-95. Genetically Modified Crops Benbrook C. Impacts of Genetically Engineered Crops on Pesticide Use in the United States: The First Thirteen Years: The Organic Center 2009. Gurian-Sherman D. Failure to yield. Evaluating the Performance of Genetically Engineered Crops: Union of Concerned Scientists 2009 April 2009. Transportation / Food Miles Gehring U, Wijga AH, Brauer M, Fischer P, de Jongste JC, Kerkhof M, et al. Traffic-related air pollution and the development of asthma and allergies during the first 8 years of life. Am J Respir Crit Care Med. 2010 Mar 15;181(6):596-603. Neff RA, Chan IL, Smith KC. Yesterday&apos;s dinner, tomorrow&apos;s weather, today&apos;s news? US newspaper coverage of food system contributions to climate change. Public Health Nutr. 2009 Jul;12(7):1006-14. Suwanwaiphatthana W, Ruangdej K, Turner-Henson A. Outdoor air pollution and children&apos;s health. Pediatr Nurs. 2010 Jan-Feb;36(1):25-32. Weber CL, Matthews HS. Food-miles and the relative climate impacts of food choices in the United States. Environ Sci Technol. 2008 May 15;42(10):3508-13. Woodruff TJ, Darrow LA, Parker JD. Air pollution and postneonatal infant mortality in the United States, 1999-2002. Environ Health Perspect. 2008 Jan;116(1):110-5.
- Hormones are in widespread use by US beef cattle producers to increase meat production or maintain yield - a practice restricted in the EU for over 2 decades Residues can be measured in meat There are no definitive data are the health impacts of this practice - the concern is because it is well documented in human and animal studies that environmental exposure to hormones or chemicals that interfere with the normal functioning of hormones can have adverse impacts on human reproduction and development
- Up to 70% of total antimicrobial use is given at non-therapeutic doses to otherwise healthy beef cattle, swine, and poultry to promote more rapid growth, or to offset the risk of infection among animals raised in confined animal feeding operations (CAFOs); This practice is recognized as a significant contributor to the epidemic of antibiotic resistance among human pathogens; Arsenic compounds are also used extensively in the U.S. in feed consumed by conventionally raised poultry and swine for disease prevention, meat pigmentation and growth promotion This practice results in arsenic residues in food and the introduction of large volumes of arsenic-bearing wastes into the environment Emerging data suggest that early-life exposure to arsenic in drinking water is linked to liver, lung, and kidney cancer in adult humans. (46) Arsenic has also been linked to spontaneous abortion in animal studies. (47)
- Your mother&apos;s diet during pregnancy and your diet as an infant can affect your epigenome in ways that stick with you into adulthood. Animal studies have shown that a diet with too little methyl-donating folate or choline before or just after birth causes certain regions of the genome to be under-methylated for life. For adults too, a methyl-deficient diet leads to a decrease in DNA methylation, but the changes are reversible when methyl is added back to diet.
- A Bee&apos;s Royal Diet Royal jelly is a complex, protein-rich substance secreted from glands on the heads of worker bees. A larva destined to become a queen is fed large amounts of royal jelly inside a compartment called a queen cup. The larvae that develop into workers and queens are genetically identical. But because of her royal jelly diet, the queen will develop ovaries and a larger abdomen for egg laying, while the worker will be sterile. She&apos;ll also develop queenly behaviors: the instincts to kill rival queens, make communication sounds known as &quot;piping,&quot; and go on &quot;mating flights.&quot; The queen is fed only royal jelly for her entire life. In a series of experiments, scientists determined that royal jelly silences a key gene (Dnmt3), which codes for an enzyme that silences a group of queen genes. When Dnmt3 is turned &quot;on,&quot; the queen genes are epigenetically silenced, and the larvae develop into the default &quot;worker&quot; variety. But when royal jelly turns Dnmt3 &quot;off,&quot; the queen genes jump into action, turning the larvae into queens.
- As leaders – organizational practice change and institutions As professionals – engaging our professional associations As parents – working in schools, in community and at home As individuals – walking our talk
- Our sustainable and healthy food journey started with our farmers markets in 2003. Then our Healthy Picks Program began in 2005. Our farmers markets inspired our first local produce sourcing initiative in 2006. We also began purchasing only rBST-free milk that year. And most recently have expanded our sustainable food purchasing to include animal proteins for patient meals and cafeterias.
- The Sustainable Food Scorecard was scored based on responses to three sets of questions: Distribution practices questions Corporate practices questions Availability of sustainable products The ability to track and report on sustainable spend was key. We felt this was essential for us to be able to track and report on our spend in order to measure our progress over time. Responses to the scorecard were one part of a broader food contract RFP process, which included other considerations unrelated to sustainability per se, such as availability of products, cost, service and other factors. However, all other factors being equal across potential vendors, the sustainable food scorecard responses were key to our decision.
- Transition -- Directly linking this to healthcare could look like doctors prescribing F&V to patients, and providing some coupons for a nearby market where the coupons could be spent. Connects the advice of the clinician to the specific action they want the patient to take What: Clinicians write patients a prescription for fruits and vegetables Give coupons (~$1 a day/family member) to spend at market. F&V consumption and BMI collected at follow up visits. Where: Being used in 3 health centers in MA (not in KP) What could you do? Find out where & when local farmers markets operate, share info when discussing F&V with patients. Special focus on those that offer EBT if cost is issue. Write a formal prescription for F&V consumption to patients. Discuss at follow up visits. Engage markets to ensure they have EBT if not already in place. Offer to make the “health case” if needed. In practice…. Doctors at three health centers in Massachusetts have begun advising patients to eat “prescription produce” from local farmers’ markets, in an effort to fight obesity in children of low-income families. Now they will give coupons amounting to $1 a day for each member of a patient’s family to promote healthy meals. Doctors will track participants to determine how the program affects their eating patterns and to monitor health indicators like weight and body mass index, he said. The pilot project plans to enroll up to 50 families of four at three health centers in Massachusetts that already have specialized children’s programs called healthy weight clinics. A foundation called CAVU, for Ceiling and Visibility Unlimited, sponsors the clinics that are administering the veggie project. The Massachusetts Department of Agriculture and Wholesome Wave each contributed $10,000 in seed money. (Another arm of the program, at several health centers in Maine, is giving fresh produce vouchers to pregnant mothers.) The program is to run until the end of the farmers’ market season in late fall. http://www.nytimes.com/2010/08/13/business/13veggies.html
- Society-wide policy actions are essential to creating a healthy food system because: many of the environmental impacts of the industrialized food system are not controllable at the individual level (e.g. food, air and water pollution) food system-related environmental justice issues cannot be sufficiently redressed by individual action.
- KP has made external commitments to support these three sustainable and health food initiatives. 1) In 2009, we signed onto the Healthy Food in Health Care Pledge, an external commitment to sustainable food purchasing. 2) We are a founding member of the Healthier Hospitals Initiative (HHI), and have committed to: a) Balanced Menus (less meat on the menus and using sustainable meats) b) Increase sustainable produce spend c) Reduce sugar sweetened beverages 3) In 2012, we signed onto the Partnership for a Healthier America (PHA) is focused primarily on healthier food, while HHI is focused on sustainable food.