Thoughts On the Table

Americans are beginning to understand that buying and eating locally grown food is better for our health, the environment, and our local communities and economies than consuming the monocropped or factory-raised processed foods that we find cheaper, faster, and more readily available..

Local communities support farmers markets across the country. Through outlets known as Comnunity Supported Agriculture (CSAs), small farmers sell shares of their harvests to season-long customers. And after-school gardening programs teach elementary school children how to avoid diabetes and obesity by eating, and often growing their own, fresh vegetables. 

In New York, the Manhattan Borough President has called for the promotion of urban agriculture to help solve issues of hunger, food distribution, and nutrition education.  Michelle Obama has announced plans to use the White House Garden to educate children about healthful, locally grown fruit and vegetables.

As farmers markets and CSAs, community gardens and urban farms, tiny delivery companies and small locally-minded businesses gain ground, they are creating the potential for service to larger institutions.  Forty-one states have operational Farm to School programs, providing children in nearly 9,000 schools across the country with healthy lunches.  Students from nearly 300 colleges and universities report to the Real Food Challenge, and are working to increase the procurement of “real food” on their campuses.

Despite this progress, there remain two major dots we haven’t quite connected: the institutions that are in the business of serving our health, and healthy food.

Fresh, local vegetables are healthier than processed foods.  We should have them in our hospitals.  Access to nutritious food should be factored into policy as preventative care.

There are several significant reasons why this hasn’t happened yet.  First, four companies control 80 percent of America’s beef production.  Two companies process 75 percent of the precut salads in the country.  The voices of such companies are powerful in Washington.  Second, pharmaceutical companies aren’t big on preventative health care.  Hospitals and pharmaceutical companies are in cahoots.  Third, the industrialization of America’s food system destroyed much of the infrastructure that would have allowed large institutions to source locally.  In almost any region of the country (except perhaps California), it is difficult to coordinate the arrival of enough locally grown food at a hospital kitchen.  Fourth, our policymakers aren’t prone to holistic thinking, and so we are left struggling to find something other than band-aids to help heal our environment, our economy, and our health.  We don’t usually consider the complex options that might help cure, all at once, these ailing elements of our society.  And finally, we need a leader.  We need someone in Washington who will commit to introducing healthy food into hospitals, and who will integrate nutritious food into our health care plans.

Undeterred by these obstacles, little groups of ambitious individuals have begun creating models, hard-earned examples, of Farm to Hospital coordination.  One is in New Milford, Connecticut. 

In 2007, three women — a chef, a pediatrician, and a lawyer — came together to bring local, fresh vegetables into the kitchens of New Milford Hospital.  They found a powerful ally in the hospital’s CEO, a specialist in preventative cardiology.  Their hospital signed the Healthy Food in Health Care Pledge, agreeing 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.” They launched their Plow to Plate program with cooking classes for the community and meetings between farmers, community members, and hospital representatives.  They changed their hospital’s contract to include local procurement policies, and made a request for proposals for a new food service provider.  Eighteen long months later, the Plow to Plate program is serving fresh, wholesome foods to their patients; supporting regional farmers through institutional accounts as well as the Plow to Plate farmers markets; and teaching local middle and high school students how to farm sustainably, cook safely, and eat healthfully.

Many institutions are, in fact, working to create similar systems.  A total of 122 health care facilities across the country have signed the Healthy Food in Health Care Pledge.  The majority of these institutions are in California, Oregon, and Washington, but others are in Nevada, Illinois, Iowa, Ohio, Arizona, Wisconsin, Michigan, Delaware, Maryland, Pennsylvania, New Jersey, New York, Connecticut, Massachusetts, Vermont, New Hampshire, and Maine.

Hospitals making the transition to serving healthy food have embarked upon a marathon thick with hurdles.  They face the difficulties of finding a food service provider willing to work specifically with regional sources; of identifying regional farmers who can reliably produce enough product to service a large institution; of competing with the growing strength of direct marketing at retail farmers markets and the higher prices farmers receive selling retail.  They have to find the right farmers, distribution centers, and distributors; to retrain their kitchen staff and perhaps renovate their kitchen facilities; and they have to teach their community of patients why healthy food is important.  They face their most daunting challenge in increasingly tight hospital budgets.

Policy could do a lot to eliminate obstacles.  Washington could require hospitals to source fresh, locally grown vegetables.  The immediate force of hospitals’ enormous purchasing power would find farmers ready to cater to their needs, distribution centers built overnight, processing centers and canneries springing up in every region, and food service providers overhauling their systems in response. 

Until Washington sees the light, locally elected officials can connect some dots on their own.  A representative of the New York State Department of Agriculture and Markets made clear to me this February that the mental and political divide between urban and rural areas is the largest barrier against developing a regional food system in New York City.  Farmers don’t know what hospitals need or how they could propose to service them.  Hospitals don’t know how many farms are nearby or what sort of demand local farmers could meet.  The rural and urban political representatives don’t even realize they have something to talk about.

Hospitals have got to start serving healthy food.  The change will be a challenge, but well worth the effort.  People walk or jog dozens of miles for Breast Cancer, MS, Heart Disease, and HIV/AIDS.  This is a marathon for Diabetes and Obesity, for Soil, for Community, for Local Economy.  We have to run it, for our health, and for the health and future of our kids.