Lucia Sayre is not a doctor, although she helms the San Francisco Bay Area Chapter of Physicians for Social Responsibility. Before taking that post as the group’s co-director and only full-time employee, Sayre lived and worked on the Arizona-Mexico border. For two decades, she was involved in community development, and she met many fourth- and fifth-generation farmers with “food in their blood.” But when they came to the United States, there was no local agriculture available to these people.
“I got really interested in the food system and how unhealthy it is in this country,” Sayre says.
For the last six years, the 49-year-old has turned her activist’s eye and experience toward a unique nexus of environmentalism and food work: hospitals.
While the sustainable, local and organic food craze may be old news to many, Sayre has helped the local health care industry get on the bandwagon.
“Traditionally, food service in health care systems has been primarily about nutrition,” she says. “One of the big goals of our project is to integrate the nutrition but also the environmental effects of how we grow our food, package it, transport it.”
Hospital food service is a $12 billion-per-year industry. Most of its food is purchased through group purchasing organizations, or GPOs, from which a hospital may get up to 90 or 95 percent of what they serve to patients, staff, at catering events and in vending machines, Sayre says. Several hospitals in an area will join a single GPO.
GPOs, in turn, obtain most of their food from a small group of food distributors. Nationally, two companies dominate food distribution: U.S. Foods and Sysco. Sayre’s main long-term goal is to increase the accessibility of sustainable and locally grown food in these contracts.
It’s a tough mission, because the current model “flies in the face” of local and sustainable food service says Michelle Gottlieb, the national co-coordinator and New England regional coordinator for Healthy Food in Health Care. Healthy Food in Health Care is an initiative of Health Care Without Harm, an international coalition of people and organizations dedicated to implementing ecologically sound and healthy alternatives to traditional health care practices.
“[Group purchasing] is really efficient with beds and IV bags, but when you’re talking about vegetables it doesn’t work so well,” Gottlieb says.
Sayre has partnered with HCWH, as well as major hospitals and health networks around Northern California on a variety of programs, including one of SF-PSR’s biggest initiatives, the Balanced Menus program.
While Physicians for Social Responsibility’s national organization has been around for several decades, Sayre was the first person to focus her 4,000-member chapter on environmental health — i.e. the ways our living environment and the Earth’s condition affect our health — and specifically hospital food service.
That the initiative arose in the Bay Area isn’t totally surprising; “We’re in a hotbed of food work,” Sayre says.
Sustainable food is healthier for humans and better for the environment on several levels. Meat, poultry and eggs from pastured animals have less fat and fewer calories than feedlot meat, for example. Locally grown produce requires less fuel for transportation than industrial food.
Livestock produced in large industrial feedlots require antibiotics that lead to drug-resistant bacteria. Overcrowded conditions also lead to waste that pollute the air and water. And livestock production is a key contributor to global climate change; it generates an estimated 18 percent of global greenhouse gases, according to a Johns Hopkins School of Public Health study of the Balanced Menus program.
Hospitals that participate in the program aim to reduce the amount of meat they serve by 20 percent over 12 months while increasing their use of sustainable meat and produce. SF-PSR developed and piloted the program and nationally launched it with HCWH.
Sayre and her colleagues say hospitals buy so much food that if they collectively change their buying habits, hospitals could shape the way food is produced in America.
“If we can get those kinds of businesses to start demanding sustainably grown food,” Sayre says, “I think we can really move the market.”
In the Bay Area, Sayre created the Hospital Leadership Team, a collection of food service directors from nine major healthcare providers. The group works to raise awareness, network and also harness their collective purchasing power.
Through a survey, Sayre discovered the group, which includes Kaiser Permanente, Alta Bates Summit Medical Center and John Muir Medical Center and others, goes through half a million pounds of chicken each year.
“We’re starting to understand that we can affect how things are grown,” says Alison Negrin, the executive chef at John Muir.
Negrin is a member of the leadership team and is at the forefront of improving the taste, healthiness and environmental consciousness hospital food. Before moving to John Muir, she worked at Berkeley’s legendary Chez Panisse restaurant. Now, her menu is a delicious mishmash of old favorites like burgers and fries and healthier choices such as homemade soup, Massa rice and butternut squash casserole. The local press has also praised her skills.
“[We] became aware that it’s not only healthy food we want to pay attention to, but where it comes from.” Negrin says.
On a national scale, Gottlieb mentions Fletcher Allen Health Care in Burlington, Vt., as another shining example of innovative food work. The medical center has a rooftop garden, its own honeybees, composting facilities and relationships with local farmers.
Even at less dramatic levels, it’s difficult to create the institutional change Sayre seeks. Beyond the contractual struggles, hospital officials worry about cost: buying sustainable products is, in itself, more expensive than getting more mass-produced food. The people holding the checkbooks don’t like hearing that.
But, Sayre says, there’s a way around that hurdle. Meat is generally a huge chunk of a hospital’s food budget; “It is the most expensive thing that food service departments buy.” Produce tends to be about 18 percent of the budget.
If hospitals follow Balanced Menus and buy less meat overall, they should have more money available for healthier meat and produce. To this end, Sayre helps hospitals rewrite their purchasing contracts.
Perhaps most importantly, Sayre works to build support for a different food system across entire organizations — especially from physicians, nurses and other clinical staff. But environmental health only plays a miniscule role in most medical school educations, she says. As a consequence, many doctors are less aware of the importance of sustainable food than they should be.
“It’s totally outside the model of traditional education,” Gottlieb adds.
Sayre knows her work is made more difficult because she is not a doctor, but that only drives her to work harder to bring them on board.
“The clinical voice is really, really influential,” she says. “What we’re trying to do is maximize the clinical voice and get clinicians involved.”
Sayre frequently meets with medical staff, and she helps create hospital-wide sustainability committees at organizations such as John Muir.
“It’s been a long process, and a lot of people helped,” Negrin says about the work she’s done with her committee. “You find out a lot of people are interested.”
Sayre is also expanding her food work, hoping to reach families through the medical community. She collaborated on a white paper article, “Food Matters: What Clinicians Need to Know About Our Food System To Help Ensure Healthy Pregnancies, Children and Future Generations,” with the University of California, San Francisco, and is working to have it placed in a peer-reviewed journal. She wants to show clinicians the need to teach their patients about sustainable food.
“My voice isn’t nearly as influential,” she says. “The idea is to really get those people trained and get them out there so that they’re the ones providing a voice.”