Healthcare Food and Environmental HealthAn H2E presentationJamie Harvie, Institute for a Sustainable Future

Is it just personal choice?

It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural, and physical environment conspire against such change.Institute of Medicine

The Food System

Food System - Contributors to Poor HealthOver Production of Unhealthy Food ProductsUse of and Exposure to PesticidesAntibiotic ResistanceFood borne Illness Impaired Drinking WaterRespiratory Illness and Poor Air QualitySocioeconomic Concerns

Nutrition and HealthHigh-sugar or high-fat foods including soft drinks, salty snacks sweets and desserts, comprise almost 30 percent of all calories consumed by Americans.

Research suggests soda and fast food consumption linked to increased risk of weight gain and diabetes.

Top Ten Agricultural Crop Subsidies$34,552,627,460$17,247,966,489$13,018,173,430$10,967,530,537$10,663,566,847$7,795,799,116$3,193,985,171$2,256,567,708$2,018,407,457$1,411,386,1471.Corn subsidies . . . . . . . . . . . . . . . . 2.Wheat subsidies . . . . . . . . . . . . . . .3. Conservation Reserve Program . . .4.Soybean subsidies . . . . . . . . . . . . . 5.Cotton subsidies . . . . . . . . . . . . . . .6.Rice subsidies . . . . . . . . . . . . . . . . .7.Sorghum subsidies . . . . . . . . . . . . .8.Livestock subsidies . . . . . . . . . . . . 9.Dairy Program subsidies . . . . . . . 10.Barley subsidies . . . . . . . . . . . . . . ~ $1 billion; 1985 - 2002

Access to supermarkets increases fruit and vegetable intake

Black Americans reported an average 32% increase in their fruit and vegetable intake for each supermarket in their census tract.

Consumption for White Americans increased by 11%.

(Morland et al., AJPH, 2002)

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Shifting to a More Sustainable Food SystemENV1007_SW Marketing CCG 03/08/05

Ecological ThinkingLooking at things in their whole context, while seeking to also understand the interconnections between parts. Nothing exists in isolation; everything is part of a larger system.

Food Industry ConsolidationTyson Food responsible for 25% or all US chicken salesThe average broiler chicken farm sells nearly one million birds annually. 54 percent of U.S. livestock are now concentrated on 5 percent of livestock farms.5 Seed companies control 75% of global seed sales

Food Industry ConsolidationCargill and Archer Daniels Midland control 75% of global market for cereal grains. 6 cents of every dollar spent on a loaf of bread goes to the wheat farmer about as much as is spent on the plastic, petroleum-based wrapperFour companies control over 80% of beef packing

Use of and Exposure to Pesticides

PesticidesUse of agricultural chemicals known to cause cancer in CA increased 127% from 1991 to 1998.In CA 90% of pesticides used are prone to drift.In CA farmworkers are 59-70% more likely to develop various forms of cancer that the rest of the population.Atrazine, a widely used herbicide is found regularly in rain and drinking water in the USA. EPA estimates over 1 million Americans drink water from agricultural pesticides.Average person has 13 pesticides in their body

PesticidesPotential impacts of fetal exposure include reduced infant birth weight, low sperm counts and other fertility problems later in life, disruption of neurological development infancy, other neurobehavioral problems.

Combined Animal Feedlot Operations (CAFOS)Generate an estimated 575 billion pounds of animal manure yearlyManure uneconomical to transport distance, typically stored in open or covered pits or lagoons Public health problems, including the overuse of antibiotics and food borne illness.

CAFOs Water QualityHuman pathogens from manure applied fields Manure land application can lead to excess nitrogen and phosphorus in soil

CAFOs and Air Quality Dust, molds, bacterial endotoxins and manure generated gases ammonia and hydrogen sulfide, known airway irritants, allergens or respiratory hazardsCAFO Communities - eye and respiratory symptoms similar to more prevalent and severe symptoms experienced by CAFO workers who are exposed at much higher concentrations of mixed emissions,

CAFOs and Community HealthSince 1986 independent hog operations declined by 72% - a loss of 247,500 farms. CAFOs associated with declines in local economic and social indicators which undermine the socioeconomic and social foundations of community health (APHA)

Community and Economic HealthA hospitals long-term vitality depends in large part on the economic health of the broader community. Every step of the food chain where ownership falls outside the community is a potential drain on the health and vitality of the local community.US Family Farmers typically lose money every year. In 2001 alone, income declined by 60%. Suicide is a leading cause of death among farmers.

Antibiotic Resistance U.S. Institute of Medicine /National Academy of Science: Clearly, a decrease in antimicrobial use in human medicine alone will have little effect on the current [antibiotic-resistant] situation. Substantial efforts must be made to decrease inappropriate overuse in animals and agriculture as well.

ABX

ABXUsed for growth promotion and disease preventionMedically important and non-medically importantFloroquinolone useAMA and AAP Contribute to resistance and create a danger to humans.

Recombinant Bovine Growth Hormone (rBGH)Banned in Canada, Western Europe, Japan, and AustraliaCancer risks Antibiotic resistance concernsAnimal welfare concerns Economic impacts

Food MilesTrucks moving food freight account for 40% of road freight in UKHead of CA lettuce shipped to Washington D.C.require 36x fuel energy to transport than food energy it provides.Typical food item now travels from 1,500 to 2,400 miles from farm Resultant air pollution

EcolabelsMeaningful and Verifiableverifiable by the certifier or another independent inspection organization. Consistent and Clearsame meaning if used on other products. can be verified.Transparentorganizational structure, funding, etc pulicNo Conflict of InterestOpportunities for Public CommentInput from stakeholdersExamplesFood AllianceTransfairUSDA Organic

Healthcare ExploresCreating weekly farmers markets on hospital groundsCreating hospital gardens to grow fresh produce as well as provide patient exercise opportunitiesInstituting policies to buy only meat raised without non-therapeutic antibiotics or hormones. Setting goals and exploring new relationships designed to increase the purchase of locally-produced, fresh produceBuying more certified food products Making hospital campuses fast food-free zones Purchasing foods providing fair prices, and a living wage, to the people who produce them Buying milk produced without use of synthetic hormones, like rBGHBuying coffee certified as Fair Trade

Recently a lot of the attention about food has been focused on overweightIts a symptom of poor eating habits and sedentary behavior linked to chronic diseaseWith six million kids overweight, the health profession is realizing that the solution is not up to families alone. We need to take a serious look at what has been driving poor eating and sedentary behavior in our culture and address those factors at their root causes.In fact it is difficult for families to follow through on the education & counseling they receive in health care settings, when this food is what this is what they see when they look around their schools, neighborhood, and workplaces is it really any wonder that people are eating too much fat, sugar, and calories and not enough nutrients. We need to ask ourselves, Is this just lifestyle? is it just a matter of personal choice? or is there something systemic going on that needs to be addressed. The Institute of Medicine has recognized that changing behavior is not solely a matter of personal choice; (read slide) The Institute has acknowledged that the surrounding environment plays a key role in shaping behaviors.

Today we will be discussing the interrelationship between the food system and health the whole process from farm to table and how it is impacting our healthThere are a number of ways the dominant industrial (what term do we want to use) food system affects healthAs we have already discussed, this is what the bulk of our food supply looks likeHighly processed foods, that have lost a lot of their nutrientsWhen this is the food that is most easy to get is it surprising that:Part of the reason food is cheap has to do with agricultural subsidies which have helped bring down the cost of certain commoditiesThe issue of cheap corn has been in the news; subsidies have driven down the price of corn syrup which has made it possible to have low-cost, supersized soda

However cheap production has come with a very steep price in terms of our environment and non-nutritional ways our health is affected.Approach is important for healthcare food decision making, because the production and distribution of food has a multitude of health related impacts often removed from the immediate hospital environment.

Another area of mutual concern is the use of and exposure to toxins. Current food system practices contribute to the bioaccumulation of toxins by using synthetic pesticides and fertilizers. Some of these are implicated in cancer, birth defects, poisonings, and nervous system disorders.Farmers and agricultural workers are the most impacted they develop occupation-induced health problems because of the higher concentration and duration of exposure to pesticides. generated manure has constituents andbyproducts of health concern including heavymetals, antibiotics, pathogen bacteria, nitrogenand phosphorus, as well as dust, mold,bacterial endotoxins and volatile gases;later spread or sprayed untreated on nearbycropland, posing additional risks to publichealth; and

A United Kingdom study found that every $10 spent at a local food business generates $25 for the local economy, while spending that money in a supermarket generates just $14, or about half as much.[9]Canadian Veterinary Medical Association stated that there are a number of legitimate animal welfare concerns associated with the use of rBST, and recommended against approval

Diesel fuel emissions are perhaps a less obvious by product of our current food system. Rather than building a system providing the freshest food possible to urban and rural areas around farms, our current food system is built around transporting food long distances.And lets face it Fresh Food tastes much better. People are much more likely to eat their fruits and vegetables when they were picked at 5:00 am from a nearby farm.Note: Ill try to find data about percent of diesel fuel expended for food transport. Ive heard anywhere from 10-80% -- unless you have a number, LMWhat its all about.