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Executive Summary

Key lessons learned

The 1,493 community hospitals and VA hospitals/medical centers in the north central U.S.—Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio and Wisconsin—spend an estimated $718 million to 1.3 billion each year on food and beverages.

There is ample evidence that hospitals throughout the north central region are interested in buying food and beverages produced by sustainable farmers/producers (see Key Project-Related Definitions section of this report). Seventy percent of respondents to the Institute for Agriculture and Trade Policy (IATP) 2012 Sustainable Agriculture Research and Education (SARE) project Health Care Collaborator Food Service Survey believe that the purchase and use of sustainable foods is in line with the mission of their hospital.

In addition, 136 north central region hospitals have demonstrated their interest in supporting sustainable farmers/producers by signing the Healthy Food in Health Care (HFHC) Pledge and/or taking the Healthier Hospitals Initiative (HHI) Healthier Food Challenge. Combined, these hospitals spent an estimated $74.8 to $220.6 million on food and beverages in 2012, and averaged between $106.3 and $146.5 million.

The VHA Healthy Diet Guidelines also support VA hospital/medical center purchase of sustainable food and beverages, and federal procurement guidelines generally encourage support of small businesses, including farms. The 37 VA hospitals/medical centers in the north central region spend an estimated $29.4 million or more each year on food and beverages.

Like the SARE project health care collaborators, many hospitals are just getting started and likely only use 10 percent or less of their current budgets to support sustainable farmers/producers, but numerous hospitals have reported larger percentages following a period of concerted effort. For instance, the results from the latest HFHC survey show that among the hospitals that reported this data an average of 21 percent of their total food budgets went to sustainably-produced foods in 2012; up from 16.6 percent in 2010.

In addition, HFHC 2013 Sustainable Food Procurement Award winners reported even higher results. For instance, first place winner Fletcher Allen Health Care, a 500-bed facility in Burlington, Vt., has been working to procure more sustainably-produced food for more than a decade and, as of 2012, 30 percent of their purchases were sustainable, 37 percent were locally grown or raised, and 48 percent of meat and poultry purchases were produced with “reduced antibiotic use.”

Though geographically limited in scope, the 2012 and 2013 IATP SARE project farmer surveys demonstrate that sustainable farmers/producers, including producer groups, are interested in selling to hospitals. In addition, of the 34 respondents to the IATP SARE project farmer surveys, including a representative from at least one producer group, who expressed interest in selling to hospitals, four were already selling to one or more hospitals. Not including the producer cooperative, nearly 86 percent of these farms/operations are small to medium-sized and average gross annual revenue less than $500,000. They sell a variety of products including apple cider, beef, bison, butter, cheese, eggs, honey, farmed fish, maple syrup, pork, poultry, produce and more.

Whether trying to buy food produced by sustainable farmers/producers through their existing supply chain partners or directly from individual or groups of sustainable farmers/producers, hospitals face several key challenges such as pressure to purchase most hospital food through a prime vendor, limited availability of local, sustainable products via current suppliers, sustainable food pricing and time demands on staff.

In time and with persistence, all of these challenges are surmountable to some degree and can certainly make a significant difference in the livelihoods of north central region sustainable farmers/producers.

In addition, hospitals have the potential to yield many benefits for themselves, their patients and staff, and rural communities both near and far including but not limited to:

  • Increased patient and employee satisfaction
  • Improved public image
  • Reduced farm worker exposure to health-threatening chemicals
  • Improved rural water quality
  • Improved soil health
  • Reduced use of antibiotics for routine, nontherapeutic agricultural purposes
  • Improved economic health for rural communities.

Other lessons learned

  • Further clarity is needed around the term sustainable: Use of third-party certifications and USDA and U.S. Food and Drug Administration (FDA)-approved label claims to identify sustainably-produced food is simple, and leaves little room for misapplication. However, solely applying a mileage-based criterion can, and will often, have unintended consequences—purchasers giving an preference to highly processed food items that are manufactured within the mileage radius or conventionally raised food items, such as turkey, chicken, eggs, beef , cheese, fluid milk, and pork, processed and sold by large, often multi-national, food companies headquartered within the mileage range.
  • Hospitals need more information on product availability via farmers/producers: Many hospitals focus on buying produce from area farms, and either forget or do not seem to know that many other types of products are available. Knowledge is also very limited in regards to the types of produce items that can be available long past harvest, such as crops that store well for long periods. There is also a bit of a misperception about volume availability and the amount of time it takes to scale-up production in response to buyer interest.

Next steps and opportunities

Leading hospitals have shown that it is possible over time, and with a conscious effort, to have 50 percent or more of their annual food and beverage purchases produced by sustainable farmers. Ideally, most of these purchases would be made from sustainable farmers/producers located in the hospital’s community.

In the near-term, to maximize procurement of food produced by sustainable farmers, hospitals are encouraged to:

  • Set a goal of 15 percent sustainable, and once reached, set a new goal. This is the baseline percentage outlined in Green Guide for Health Care (GGHC) Food Service Credit 3 and IATP SARE project health care collaborators see this as doable within three years. Subsequent GGHC goals include 25 and 50 percent.
  • Support sustainable farmers/producers via current supply chain partners by purchasing food and beverage items that are most easily identifiable as produced by sustainable farmers/producers from existing supply chain partners, e.g., USDA Organic products and fluid milk and yogurt produced without use of rBGH/rBST.
  • Establish a purchasing relationship with at least one sustainable farmer/producer, producer group or food hub in your community by:
  • Making a formal commitment that includes direct procurement from sustainable farmers/producers
  • Focusing on food-prep neutral options commonly available from one or more north central region farms.
  • Starting with purchase of one type of product
  • Rethinking use of current procurement flexibility
  • Use the resources in the IATP Sustainable Farm to Hospital Toolkit at
  • Financial Strategies for Incorporating Sustainable Food into a Hospital’s Budget
  • Food and Beverage-Related Eco-labels/Label Claims
  • The Health-Based Rationale for Hospital Purchase of Sustainable Food
  • Hospital Food Purchasing: A Primer for Sustainable Farmers/Producers
  • Iowa, Minnesota and Western Wisconsin Sustainable Farmers, Producers Interested in Selling to Hospitals
  • Local, Sustainable Product Availability through Distributors Serving Minnesota and Western Wisconsin
  • Online Resources for Hospitals Interested in Connecting to Sustainable Farmers, Producers
  • Online Resources for Sustainable Farmers, Producers Interested in Selling to Hospitals
  • Seasonal Availability of Produce and Other Foods Produced in Minnesota and Wisconsin
  • Sustainable Food Procurement: Working with Current Supply Chain Partners
  • Ten Steps to Creating Mutually Beneficial Relationships with Local, Sustainable Farmers, Producers
  • Using Written Protocols to Guide Direct Procurement of Food from Sustainable Farmers, Producers

Over the long-term, all north central region hospitals are encouraged to:

  • Increase the types and amounts of products purchased directly from sustainable farmers/producers.
  • Increase procurement flexibility by reducing percentage based commitments to purchase from mainline distributors.
  • As opportunities arise, participate in the development/expansion of alternative food distribution models, such as regional food hubs.
  • Avoid contractual food service management arrangements that prevent purchase of food directly from sustainable farmers.

In addition, north central region VA hospitals/medical centers are encouraged to implement the VA-specific recommendations outlined in the Next Steps and Opportunities section of this report.

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