Healthy Food in Healthcare: The Role for Healthcare in Food and Agriculture Policy

Transcription

1 Healthy Food in Healthcare: The Role for Healthcare in Food and Agriculture Policy September 9th, 2010 Webinar sponsored by the American Medical Association, in partnership with Health Care Without Harm and Kaiser Permanente Moderator: Preston Maring, M.D., Associate Physician-in-Chief, Kaiser Permanente Medical Center Oakland Presenter: Robert Lawrence, M.D., Professor, Johns Hopkins Bloomberg School of Public Health and founding director, Johns Hopkins Center for a Livable Future Presenter: Eecole Copen M.S., R.D., L.D., Sustainable Food Programs Coordinator and Farmers Market Manager, Oregon Health and Science University Presenter: Jamie Harvie, P.E., Health Care Without Harm Food Coordinator, Institute for a Sustainable Future

2 The Food System and Human Health September 9, 2010 Robert S. Lawrence, MD Director, Center for a Livable Future Johns Hopkins University

3 There Is No Connection between Food and Health There is no connection between food and health. People are fed by a food industry which pays no attention to health and are healed by a health industry that pays no attention to food. Wendell Berry

4 Today s Industrialized Agriculture Within 50 years our agricultural system has become almost unrecognizable

5 From Diverse and resilient to Specialized

6 Intensive Animal Production From Animal husbandry To Meat Production Gestation crates, Early weaning, debeaking, Growth promoting synthetic hormones & feed additives From Geographically dispersed to highly concentrated From Pasture-based to Confinement based

7 IFAP Achievements, with Costs Environmental, public health, economic, and social concerns Reliance on inputs exacts a heavy cost in pollution and environmental degradation Our society and the natural environment bear the cost of these unintended consequences in the form of environmental and public health impacts. Keeney and Kemp, 2003

8 Global Meat Demand Doubling in 30 Years Since 1961 U.S. per capita meat consumption has increased by 70% from 141 pounds to 223 pounds (100 kg) Average for industrialized countries is 77 kg/person For non-industrialized countries 27 kg/person Global demand for meat will double from the 1990s to 2020

9 Plant-Based Diets vs. Diets with Animal Protein billion people A grain-based diet could feed 6.2 billion people An American-style diet high in animal protein could feed 2.5 billion people billion people Height of each world = Number of people that could be fed on a plant-based diet in 1990 and 2020 Height of each hamburger = Number of people that could be fed on a diet with 30% of calories from animal protein Height of red line = actual world population to 2004, then estimated to 2050

10 Externalities Not included in retail price or in analyses of productivity Externalities include Depletion of resources e.g., fossil fuel, water, soil, and biodiversity Pollution of resources by the products of fuel combustion, pesticides and fertilizers Economic, social and health costs to communities e.g., lost property values, lost QALYs External costs seldom accounted for in the food s price

11 Other Health Impacts of Industrial Food Production Environment Water Air Methods Chemicals, hormones, endocrine disrupters, pesticide residues Antibiotics and Ab-resistant bacteria Loss of social capital in rural America Global climate change

12 Environmental Impacts Water consumed at unsustainable rates Synthetic chemical pesticides and fertilizers pollute soil, water, and air Soil eroding much faster than it can be replenished Monocultures erode biodiversity among both plants and animals

13 Water Use Approximately two-thirds of water use worldwide is devoted to irrigation Worldwide, aquifers being depleted for irrigation faster than they can be replenished (e.g., Ogallala Aquifer, the northern plain of China, etc.) Direct relationship between the availability of water and the world s ability to meet the nutrition requirements of the population (Stockholm 2004 International Water Institute)

14 Use of Chemicals Heavy reliance on chemical fertilizers, pesticides, and herbicides 137 million metric tons of chemical fertilizers used worldwide in 1998 (U.S. agriculture 20 million tons) Crops absorb only one-third to one-half of the nitrogen applied to farmland (Tilman)

15 Use of Chemicals (Continued) Over 1,600 chemicals used in the manufacture of pesticide most have not been tested Worldwide, 3 million tons of pesticides per year Human health Poisonings; long-term effects on the immune, reproductive, and nervous systems; increased cancer risk

16 Pesticides in Produce (EWG) 12 Most Contaminated Peaches Apples Sweet Bell Peppers Celery Nectarines Strawberries Cherries Pears Grapes (Imported) Spinach Lettuce Potatoes 12 Least Contaminated Onions Avocados Sweet Corn (Frozen) Pineapples Mango Asparagus Sweet Peas (Frozen) Kiwi Fruit Bananas Cabbage Broccoli Papaya

17 Pesticides and Pollinators 1/3 of the human diet is from plants that require pollination from honeybees 60% of pollen and wax samples from 23 states had at least one systemic pesticide 121 different types of pesticides within wax, pollen, bee and hive samples.

18 Antibiotic Use in U.S. Food Animal Production Antibiotic use in food animal production United States, 2002 Growth Promotion 3.1 million lbs/yr (AHI) 27.6 million lbs/yr (UCS) Prophylaxis and disease treatment 14.7 million lbs/yr (AHI) 2.0 million lbs/yr (UCS) Compared to human uses 32.3 million lbs/yr (AHI) 4.5 million/lbs/yr (UCS)

19 Antibiotics, Animals, and Biosolids: A Nexus of Concern All uses of antibiotics inevitably select for resistance Antibiotic-resistant infections are an increasingly serious clinical problem The same classes of drugs are used in food animal production as in clinical medicine

20 Conditions Promoting Resistance in Agriculture A) Failure of infection control Crowding Often sub-optimal hygiene B) Exposure to antibiotics Widespread Prolonged Sub-lethal doses Often little dose control C) Stress reaction Increases bacterial shedding

21 Drug Misuse in Food-Animal Production Arsenicals used in poultry production for growth promotion and for controlling intestinal parasites Two million pounds of arsenic are introduced into the environment from U.S. poultry operations (Garbarino, 2003) 25 million pounds of antibiotics are used in U.S. food-animal production (Mellon et al., 2001) About 75% of antibiotics are excreted in waste (Kummerer, 2004) 95% of feedlot cattle receive hormones used for growth promotion Source: Chapman. (2002). Arsenic has antimicrobial properties and is also used as a growth promoter.

22 Antibiotic Use: Feed Additives vs. Human Medicine

23 Conclusions High levels of multi-drug-resistant bacteria are present in CAFO air and in surface and ground waters downstream CAFO workers and growers are at high risk of exposure to airborne isolates Neighbors could be exposed to both airborne and waterborne resistant bacteria through inhalation or ingestion Air and water contaminated by swine CAFOs may serve as exposure pathways for the transfer of resistant bacteria from swine to humans

24 Preservation of Antibiotics and Medical Treatment Act (PAMTA) S. 619/H.R PAMTA directs FDA to phase out medically impt. antibiotics unless demonstrated not to promoted resistance Hospital Petition Health Practitioner Petition MDs, RDs, RNs, CDM, etc www. Protectantibiotics.org

25 Climate Change Industrial agriculture system produces greenhouse gases (United Nations 2005 Millennium Ecosystem Assessment Synthesis Report) Livestock sector is a major player in climate change, responsible for 18 percent of greenhouse gas emissions measured in CO 2 equivalents (FAO Report, Livestock s long shadow Environmental issues and options)

26 Already Happening Earlier spring leaves, bird migration, egg laying Poleward/upward shifts in species geographic ranges Extreme weather, drought Pests, invasive species Biodiversity loss Broccoli in Greenland

27 New Plant Hardiness Zones

28 A CASE STUDY Building a Sustainable Food Service Presented by: Eecole Copen MS, RD Sustainable Food Programs Coordinator OHSU Food & Nutrition Services, September 9 th, 2010

29 Hospital Stats o Approximately 542 beds o 1250 patient meals per day o 8000 retail transactions per day o 12,000 employees o $8 million food budget o $12 million in retail & catering sales o Self Op since1996

30 Health Care Without Harm (HCWH) Pledge Signed in 2007

31 OHSU Sustainability in Action o o o o o o Sustainable Food Procurement: Retail Foods & Natural Foods Store Farmers Market/ Market Basket Garden of Healthy Delights Campus Wide Sustainability Survey OHSU Sustainable Food Policy and Action Plan Legislation & Letter writing

32 Retail Foods Kobos - local roaster, Fair-trade, organic. Includes Café Feminino line: $1 per pound goes back to battered women from Peru. Dave s Killer Bread - Locally made, Organic Bread Sunshine Dairy- Bovine Growth Hormone Free milk. Renewable energy from wind and biogas used to make their products.

33 Composting

34 Sustainable, Local Meat and Poultry o o o Carmen Ranch Beef, Wallowa, OR: Food Alliance Certified, Grass-fed & finished, No added hormones or antibiotics. Sudan Farms Lamb, Canby, OR: Grass-fed & finished; No added hormones or antibiotics. Draper Valley Chicken, Mt. Vernon, WA: No added antibiotics. 100% vegetarian diet.

35 It s All Good Natural Food Store Offering Healthy Options Preference for Fair Trade, Organic and locally grown products. Gluten-Free offerings GMO-Free High Fructose Corn- Syrup Free Vegan offerings rbgh-free Trans-Fat Free Coloring & Dye-Free Low Sodium ~ 425 square feet ~475 different products ~$550,000 per year

36 Farmers Market & Market Basket SNAP & WIC Accepted

37 Locally grown.. On campus Garden of Healthy Delights

38 Food Sustainability Survey Question 3 Not important Neutral Somewhat important Very Important

39 Sustainable Food Policy & Plan o o Utilized Green Guide for Health Care Food Service Credits as Framework for comprehensive sustainable food policy and action plan Created a Vision: The goal of this Policy & Plan is to provide a framework in which OHSU Food and Nutrition Services will: o o o o o Purchase and provide foods which prevent disease and promote health and healing, based on scientific research. Make purchasing choices which demonstrate an understanding of the inextricable links between human, public and ecosystem health. Establish ecologically sound, economically viable and socially responsible purchasing principles and practices. Provide patients, staff, students and visitors with information regarding the sustainable and healthy purchasing practices Food and Nutrition supports. Integrate health, research and service through ethically sound practices, doing no harm.

40 Sustainable Food Policy & Plan o o o Developed a Sustainable Purchasing Steering Committee whose participants co-create a 5-year plan and establish: o o o Goals indicating what metrics will be tracked and how success will be defined. Expectations of everyone involved in implementation. An evaluation plan that specifies a means and process for evaluating effectiveness and for making adjustments to the plan when necessary. Policy covers all areas of food service Establishes Procurement Priorities: Minimum standards to protect the eater s health: o o o o No non-therapeutic antibiotics used No added hormones Limit pesticide, herbicide, fungicide exposure Limit mercury intake from seafood

41 OHSU Supports Sustainable Food Policies PAMTA o Congress introduced the Preservation of Antibiotics for the Medical Treatment Act (HR 1549), which would require the FDA to re-review the approvals it previously issued for animal feed uses of the seven classes of antibiotics that are important to human medicine. o OHSU signs-on to letter from health institutions and professionals (organized by HCWH) urging legislative support.

42 How are health practitioners involved? Supporting Programs o Visit the Market o Purchase available sustainable options On Green Team o Waste reduction Policy o Sustainable Living Day o Earth Day Advocate for Programs o Medical voice to support FS in attaining administrative support o As the customer, advocate for compost in cafes o Answer surveys about these issues

43 Resources & Contacts Health Care Without Harm Green Guide For Healthcare Practice GreenHealth Eecole Copen Sustainable Food Programs Coordinator OHSU Food Service Emma Sirois Oregon Program Director Health Care Without Harm

44 Healthy Food in Healthcare: The Role for Healthcare in Food and Agriculture Policy September 9 th, 2010 Webinar Jamie Harvie, P.E. Institute for a Sustainable Future harvie@isfusa.org

45 Health Costs of Biological Manufacturing Human Health Nutrition Related Sugars / oils/ commodities Heart disease, stroke, diabetes, etc Social Health Community Health Loss of Family Farms, Food Access Moral Ethical Concerns Humane Treatment, Child Labour, Working Conditions Environmental Health Climate Change Water Pollution Habitat Loss Toxics

46 Ecological Model of Health / Disease Progressive nesting of individuals within families within communities and finally within ecosystems. Variables at any level can directly or indirectly influence measures of health at any level. Influences may be identifiable as individual markers or as community level markers GBPSR Healthy Aging Report

47 American Medical Association Resolution 405, A That our AMA support practices and policies in medical schools, hospitals, and other health care facilities that support and model a healthy and ecologically sustainable food system, which provides food and beverages of naturally high nutritional quality. That our AMA encourage the development of a healthier food system through the US Farm Bill and other federal legislation. That our AMA consider working with other health care and public health organizations to educate the health care community and the public about the importance of healthy and ecologically sustainable food systems

48 Farm Bill or Food Bill? USDA

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51 Climate change is the largest health threat in the 21 st century The Lancet

52 Global Greenhouse Gas Emissions* 30.9% anthropogenic (human-caused), CO 2 -equivalent IPCC

53 Balanced Menus Challenge: Less Meat, Better Meat Reduce meat purchases by 25% Serve smaller quantities of sustainable meat to promote healthy eating habits Hospitals saving money and mitigate climate

54 The Healthy Food in Health Care Pledge More than 300 hospitals recognize that healthy food must be defined not only by nutritional quality, but equally by a food system that is economically viable, environmentally sustainable, and supportive of human dignity and justice

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60 FS Credit 1: Sustainable Food Policy and Plan FS Credit 2: Sustainable Food Education and Promotion FS Credit 3: Local, Sustainably Produced Food Purchasing FS Credit 4: Reusable & Non-Reusable Products FS Credit 5: Hospital Supported Agriculture: Food and Farm Linkages FS Credit 6.1: Food Donation and Composting FS Credit 6.2: Food Services Recycling FS Credit 7: Food Vendors FS Credit 8: Chemical Management for Food Services Food Service Credits Food Service Operational Credits

61 Preservation of Antibiotics and Medical Treatment Act (PAMTA) S. 619/H.R PAMTA directs FDA to phase out medically impt. antibiotics unless demonstrated not to promoted resistance Hospital Petition Health Practitioner Petition MDs, RDs, RNs, CDM, etc www. Protectantibiotics.org

62 Fresh Food Access Government investment can provide financing for supermarkets, grocery stores, and other healthy food retailers that plan to operate in underserved communities. This initiative, known as Fresh Food Financing, Can provide loans, grants and technical assistance to retailers. The first statewide policy, passed in Pennsylvania in 2004, committed $21.9 million in grants and loans.

63 Policy Engagement Voice support at institution with decision makers/administrators/ board Provide and model examples at meetings/ conferences Offer time / voice to sustainable agriculture, food access, similar organizations Meet and/or write with/to legislators

64 RESOURCES Health Care Without Harm Food Workgroup American Dietetic Association Hunger and Environmental Nutrition Dietary Practice Group Healthy Food Pledge GGHC Food Service Credits National Sustaianable Agriculture Coalition AMA Council on Science and Health Report Kaiser Institute for Health Policy s/in_focus_5-09%20sustainable%20food%20procurement.pdf