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7 secrets for healthful hospital food, from asparagus to tomatoes

Hillary Bisnett grew up on a farm in Dowagiac, Mich., that grew asparagus, raspberries, strawberries and 16 varieties of heirloom tomatoes. Her father tried practices to reduce his family's pesticide exposure and protect the water and soil. He believed the unique flavor, especially of tomatoes and strawberries, was a result in part of his nearly organic farming practices.

Now, as the healthy food program director for the Ecology Center in Ann Arbor, she is spearheading a regional approach that connects Michigan farmers to hospitals in the state, and helping others to connect food systems with the environment, climate change and public health.

While pursuing a degree in sustainable business at Aquinas College, Bisnett held a 2007 internship with Metro Health Hospital in Grand Rapids, which tasked her with starting up the hospital farmer’s market. She gained the experience needed to land a job at the Ecology Center, funded by WK Kellogg Foundation and Kresge Foundation, to make the critical link between how food is grown and distributed and public and environmental health.

On a national level, Health Care Without Harm’s Healthy Food in Health Care Program was gaining traction. It held its third FoodMed conference in Detroit 2009 just as Bisnett began her new position with the Ecology Center.

The Michigan Healthy Food in Health Care Program took off and continues to work at all levels from supporting healthier food systems in Detroit to creating a cross-sector institutional purchasing initiative called Cultivate Michigan. Metro Hospital is one of 25 Michigan hospitals that host farmer’s markets and half of them accept food assistance programs, such as double-value coupons and SNAP, as forms of payment.

Understanding the health care food landscape

Hospitals are an anchor in many communities, often the largest employer. They are huge purchasers, consisting of 18 percent of the gross domestic product (GDP). Cafeterias and retail operations are revenue streams for hospitals, leaving some constraints on food service staff to fulfill the mission, while balancing the labor and time it takes to prepare a meal made with fresh, minimally processed ingredients.

Both nationally and in Michigan, there are “self-operated” food service departments and “contract-managed” food service departments. These food service models have different requirements and motivators for adopting operations for local and sustainable food procurement. In-house food service departments tend to have more autonomy. Hospitals also have contracts with group purchasing organizations, often dictating which distributors they must buy from.

A desire for local and sustainable foods isn’t the only battle. Those tackling the health care food purchasing and distribution systems are finding that when purchasing fruits and vegetables or even processed foods, the ordering systems may not identify which products are local or sustainable and are often limited to a special order only. This line-by-line investigation is time-consuming and to date, is only done by leaders in the sector — those who have a personal passion. Making it easier to identify and track the product is key to success.

The Michigan approach: asparagus, blueberries, tomatoes and apples

One approach is to leverage all institutional buyers to make local, good food available to eaters and expand markets for food grown, raised and processed in Michigan. In turn, this approach, now called Cultivate Michigan, aims to support local farms, the state’s economy and the well-being of its residents by helping bridge the gap between growers and institutional purchasers.

While any region may have its own strategy for success, here are tips from Michigan for getting things underway at a regional level:

1. Create a space for learning: The Ecology Center and Michigan State University’s Center for Regional Food Systems created the Michigan Farm to Institution Network as a space for learning, sharing and working together to get more local food to institutions, with an aim to meet a state vision of 20 percent of Michigan foods sold and purchased by 2020 — a goal set by stakeholders in 2010.

2. Leverage collective capacity and define structure: Three subcommittees address engagement; education and technical assistance; and research and impacts. An advisory committee provides stakeholder oversight with representation from all along the supply chain including farmer, national distributor, regional distributor and processor to K-12 school, health care and university.

3. Further develop the strategy or focus: The regional strategy identified four food items annually. Promotion materials label and promote the four products to their customers and eaters. This year’s focus is on foods that Michigan is already or nearly already a leading producer in the country — asparagus (ranked first), blueberries (first), tomatoes (ranked ninth for freshness) and apples (third).

4. Stay connected and celebrate successes: provides inspiration through spotlighting stories, news and events.

5. Track progress: Institutions can create an account to log purchases by either their total food budget or by major food categories such as produce, meat and dairy. The dashboard also offers the ability to track the yearly promoted products and reminds the institution of the dollar amount needed to get to the annual goal of spending 20 percent of its food budget on Michigan grown and/or processed food items. In return, the campaign will know more about the economic impact, Michigan residents reached (or meals served) and be able to continue to research barriers or limitations for farm to institution programs.

6. Identify strategic opportunities: As the first year of the campaign focuses on understanding the total annual spend on Michigan foods and the four product promotions are centered on fresh produce, six years are left until 2020 to make new opportunities become a reality. In Michigan, a limiting factor from moving food from the farm to the table has been the constant decline of processing companies; institutions more often than not need products minimally processed, meaning washed or cut. The Network will focus on executing behind-the-scenes plans to align institutional demand with business opportunities. Understanding the logistics of expanding current processing for frozen blueberries or asparagus or even canning tomatoes, both of which are in high demand by institutions, would help support local producers.

7. Connect to a national strategy: The Michigan strategy is only one regional example and connects to the national strategy at Health Care Without Harm and the Healthier Hospitals Initiative’s Healthier Food Challenge (HHI). The national initiative engages hospitals through goal setting and the use of data to drive change. The strength in numbers brings together major health systems to articulate the desire for local and sustainable foods including meat raised without the routine use of antibiotics. Other partners have been identified to further add to the momentum including the School Food Focus and Real Food Challenge. The business partners are at the table, including contract management companies, purchasing groups and distributors. The stakeholder list continues to be identified to ensure all key groups are represented.

Health Care Without Harm’s Healthy Food in Health Care program has regional organizers, each with their own story to tell in Maryland, Oregon, Philadelphia, New England, Washington and throughout California.

Healthier Food in Health Care covers many bases. These include the opportunity to reduce food miles and address the impact of freight and trucks on climate change. Then there's the overuse of antibiotics related to multi drug-resistant organisms and the cost to treat multi drug resistance.

The purpose is to model healthier behavior in health care facilities in an age of chronic diseases connected to diet; to nourish soil by avoiding chemicals for fertilizer and pest management; and to impact the local economy positively through supporting local agriculture and connecting growers to consumers.

It may take some heavy lifting at first, but it will only be a matter of time before communities demonstrate that fiscally and socially responsible strategies are possible. Never underestimate the power of fruits, vegetables and a farmer’s daughter.

Top image by Adisa via Shutterstock

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