In the United States, the four leading causes of death are directly linked to food: stroke, diabetes, cancer, and cardiovascular disease. In San Diego County, these diet-related chronic diseases, along with smoking and physical inactivity, result in more than 50 percent of deaths in the region.

Many hospitals and health care facilities across the nation are recognizing that they can combat chronic diseases through their institutional role as leaders in health care by promoting a healthier food system. Palomar Health is among the local health care champions adopting Healthy Food in Health Care practices through its Food and Nutrition Services department.

Getting Started
In 2010, Palomar Health signed Health Care Without Harm’s Healthy Food in Health Care Pledge to improve the health of patients, communities, and the environment through healthy food procurement. Barbara Hamilton, Sustainability Manager and Jana Markley, then Director of Food and Nutrition Services, joined together to put pledge into practice. The following year, Palomar Health joined the Nutrition in Healthcare Leadership Team (NHLT), a regional collaborative aimed at advancing this work. Founded in 2011 and facilitated by Community Health Improvement Partners, the NHLT provided a venue to gain support and share information on best practices from across the nation that helped Palomar Health set up its own internal Healthy Food Council. Today Hamilton, Jim Metzger, Director of Hospitality, and Javier Guerrero, Food and Nutrition Operations Manager, are leading the Healthy Food Council to guide Palomar Health in making food a key part of the hospital’s preventive medicine practices.

Shifting the Menu
About half of the produce Palomar Health purchases is local, sustainable, or organic. As they reduce their meat purchasing, this percentage grows. Hamilton explains that the goal is not to provide an entirely vegetarian menu, but instead to focus on purchasing higher quality meats (e.g., grass fed, raised without antibiotics) in lower amounts. Across the U.S., our food system is producing more meat than the average person should eat, according to U.S. Dietary Guidelines.

“Diet is the biggest thing people can do to protect their health and it’s our responsibility to purchase products that do not cause additional harm to our patients, employees, and communities,” said Hamilton.

Community Engagement
Palomar Health recognizes that food procurement and similar shifts in company policies, systems, and environments are most successful if employees and customers embrace them.

In March 2016, the Sustainability team planned an EcoChallenge, a campaign that engaged employees in making lifestyle changes to promote personal and/or environmental health. The 30-day EcoChallenge was promoted internally and engaged employees in choosing a personal sustainability goal to track for the month. The challenge culminated in an Earth Day event, where employees celebrated the collective impact of their individual changes, their challenges, and their accomplishments.

“Inspiring and motivating people to make changes can be challenging. Seeing that they were already doing a lot gave them confidence to take on new challenges, too,” said Hamilton.

The Earth Day event also provided an opportunity to showcase a sustainable, plant-based menu to raise awareness among employees and customers about the relationship between food and sustainability, and of course, demonstrate that “healthy” and “sustainable” can taste really good.

“We’re really lucky in Southern California because of our number of small farms. We always buy sustainable, locally-grown items for our cafeteria menu, because we’re a local hospital, and community farms are community jobs,” Metzger said.

Financial Returns
There is a perception that terms like “sustainable”, “local”, and “organic” mean higher expenditures, but Palomar Health has seen the return on investment. As they have gradually incorporated more produce into their menus, sales have gone up, and so has the demand in the marketplace, allowing for Palomar Health to purchase more variety from more growers. Metzger explains that the program pays for itself, and the real benefit is improved health and wellness. Patients have a better chance of staying well and employees can use their sick days as well time.

Generally, plant-based recipes also tend to be simpler, and preparation is streamlined. This has allowed the Food Services and Nutrition team to implement Healthy Food in Health Care practices with few costs in terms of equipment changes.

Joining the Movement
Metzger and Guerrero advise other hospitals interested in adopting these practices to start now, and start small. Changing food procurement practices, and all of the points of sale these changes affect, does not happen overnight. However, one small, institutional change can have a snowball effect. It’s creative thinking – one item leads to the next and opens up the conversation among employees. There are so many ways to promote wellness and with dedicated staff, and investment from leadership, the program grows.

“At Palomar Health, we are part of a wave of health care leaders who are shaping a food system that supports prevention-based practices,” said Bob Hemker, Palomar Health CEO.

What’s Next?
Palomar Health is continuing into its next quarter with a push to sample more sustainable, local, and organic products and ultimately, procure more of these foods.