© 2000 Kaiser Permanente. All rights reserved. Food Policy at KP H2E Teleconference Lynn Garske, Environmental Stewardship April 8, 2005

© 2001 Kaiser Permanente. All rights reserved. 0092wbh_ALPpresent022001v1.ppt 1 Presentation Objectives, Outcomes and Agenda Agenda HFood Policy HImplementation Work HCommunity Food Group HKP Food Group Objectives HDescribe food policy, rationale and implementation work at Kaiser Permanente Outcomes HIdeas and processes shared with other health care organizations.

© 2001 Kaiser Permanente. All rights reserved. 0092wbh_ALPpresent022001v1.ppt 2 Kaiser Permanente Comprehensive Food Policy Vision: Kaiser Permanente aspires to contribute to the creation of healthy food systems reflecting practices that are ecologically sound, economically viable, culturally appropriate and socially responsible.

© 2001 Kaiser Permanente. All rights reserved. 0092wbh_ALPpresent022001v1.ppt 3 Food Policy, Slide 1  We will accomplish this by aligning our food policies and practices with patient, member and employee wellness and health education programs, the expansion of Kaiser Permanente farm stands and farmers markets, and through our contracts with food suppliers and distributors.  We recognize our special responsibility as a health promotion organization. We will become a model for the industry and the nation by promoting healthy food choices in our inpatient food services, cafeterias, vending machines, food carts and catered meals.  We will be guided by a precautionary approach to take action when substantial evidence indicates that a process, technology or substance may be harmful to humans and/or the environment, even if cause and effect relationships are not fully established scientifically. Statement of Principles

© 2001 Kaiser Permanente. All rights reserved. 0092wbh_ALPpresent022001v1.ppt 4 Food Policy, Slide 2  We will work with local farmers and community-based organizations to maximize the availability of locally-sourced food. We will be proactive in the creation of local food systems that promote sustainable agriculture and biodiversity.  We will work with food suppliers to influence practices around food sourcing and transportation. We will encourage our vendors to supply us with food that is, among other attributes, free of pesticides and unnecessary antibiotics.  We will promote an agricultural system that protects the health of farm workers and the communities they live in, and that treats farm workers fairly and justly.  Taken together, these actions will promote a healthy environment and thriving communities by increasing access to fresh, healthy food in and around KP facilities. Statement of Principles continued

© 2001 Kaiser Permanente. All rights reserved. 0092wbh_ALPpresent022001v1.ppt 5 Environmental Stewardship Council Food Work Structure Community Food Group Food Steering Committee External Partners External Partners KP Food Group Tracks policy progress – reports to Environmental Stewardship Council Tracks projects crossing both workgroups Community Benefit, Env. Stewardship, Nutritional Services, WPS, External partners Farmer’s Markets/Farm Stands Community Supported Agriculture Projects Physician champion Community Benefit External partners  Employee/Patient/Visitor Food  Tools/Guidance Documents  Environmental Stewardship, Health Education, Employee Wellness, Care Mgmt. Institute, Workplace Safety, External partners Health Care Without Harm Center for Food & Justice Prevention Institute Broadlane Community Alliance with Family Farmers Sustainable Food Lab

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© 2001 Kaiser Permanente. All rights reserved. 0092wbh_ALPpresent022001v1.ppt 9 Policy Objectives 1. Education. Successful foodservice educate customers about what they are doing and why. Signage, table tents, menu notes, newsletters, and can be potent tools for helping customers understand the rationale behind changes being made in the name of sustainability. One firm offers a monthly "Lunch with the Chef," where diners can talk directly with dining staff about sustainability and other issues. 2. Locally sourced foods. A large number of foods are grown within 200 miles of most cities, many of which are suitable and appropriate for institutional foodservice use. At certain times of year, these foods can be delivered cheaper or fresher than their conventional counterparts. Other foods are produced locally, such as baked goods. Using such vendors can be tricky: not all can deliver with the reliability or in the forms required by a large foodservice operation. But some of the problems aren't the farmers: foodservice firms need to be open and flexible about working with locals. 3. Hormone- or antibiotic-free. This applies to poultry, livestock, and dairy products. Most claims in this area are specific to synthetic hormones and to "subtherapeutic" antibiotics -- that is, those used preventively, as opposed to cure a specific illness. 4. Reduced or zero-waste practices. There are many things foodservice operations can do, including reducing or eliminating disposable serviceware. (One company does this by placing it far from the reusable serviceware, making it slightly inconvenient to access.) Recycling of boxes, bottles, cans, and containers and donating or composting unused or waste food (as appropriate) are essential waste-reduction practices. Some firms donate unneeded kitchen equipment, dishes, pots and pans, and utensils to local shelters, soup kitchens, and the like.

© 2001 Kaiser Permanente. All rights reserved. 0092wbh_ALPpresent022001v1.ppt 10 Policy Objectives 5. Seasonal and sustainably harvested foods. Reducing or eliminating the purchase of fresh produce from around the world simply to have year-round availability is another worthy goal. Produce purchased locally will, by definition, be seasonal. This can be problematic, since customers may come to expect year-round availability of some foods. Also in this category are sustainably harvested fish -- those that come from fisheries not being threatened with depletion from overfishing. Several lists of "good" fish exist, including a popular one from the Monterey Bay (Calif.) Aquarium's "Seafood Watch" program ( which produces pocket cards and other educational materials about which fish to eat, and which to avoid. 6. Pesticide-free and other certifications. A number of helpful food-related standards exist. In the U.S. "organic" is now governed by federal law, but there are other useful certification labels (such as fair trade and shade-grown coffee), as well as certification organizations, such as the Food Alliance, which certifies farms on both environmental and social conditions. Several foodservice operators, mostly in the Pacific Northwest, use the Alliance's standards to govern their own purchases. 7. Energy- and water-efficiency practices. As with most businesses, the opportunities are ripe, from energy- and water-efficient appliances to energy-efficient lighting to cleaning filters and coils to ensure that appliances work as efficiently as possible.

© 2001 Kaiser Permanente. All rights reserved. 0092wbh_ALPpresent022001v1.ppt 11 Patient Food  Environmental aspects to be focused on: free from pesticides, non-therapeutic antibiotics, and hormones. Need to determine what to do with GMOs if anything.  Communicate our policy intent to Entegra and Sysco. Request information on what they are already doing to support our policy (e.g., origins of foods we buy) and learn their perspectives on opportunities.  Inventory origin of food currently purchased; fully understand local supplementation of Sysco and Entegra contracted foods.  Document measures already taken, e.g., PVC-free enteral systems, BGH-free milk, purchase of local produce, baked goods and dairy.  Pursue contracting for antibiotic-free poultry; request antibiotic-free meat and pork.  Explore cost and reliability issues associated with local sourcing (e.g., can we “make the market?”)  Seasonal/local menu planning.  Reduce waste associated with patient food Examples of Action Items

© 2001 Kaiser Permanente. All rights reserved. 0092wbh_ALPpresent022001v1.ppt 12 Employee/Visitor Food CAFETERIA and COFFEE CARTS  Obtain feedback from Food and Nutritional Services Directors/Managers regarding short-term actions to be taken to support healthy food selections through THRIVE campaign and in future for national food policy.  Communicate with cafeteria contractors intent to bring healthier foods to facilities; ask what they are doing now to support availability of healthy food.  Post nutritional information on selected menu selections.  Consider pricing incentives for healthier food.  Evaluate opportunity to offer fair trade and organic coffee.  Provide local concessions access to local supply.  Reduce waste associated with food service. Examples of Action Items

© 2001 Kaiser Permanente. All rights reserved. 0092wbh_ALPpresent022001v1.ppt 13 Employee/Visitor Food VENDING  Work with vending contractors to promote healthier food selections; determine efforts already underway.  Adopt standards to limit availability of sodas/candy near pediatric waiting rooms and other sensitive locales, e.g., near weight management group meeting locations.  Provide signage educating the public on how to make healthier food selections e.g., post stickers on best choices. CATERING  Establish preference for caterers that source locally and provide healthy, organic food.  Reduce waste associated with catering. EDUCATION  Create target-appropriate tools to educate nutrition employees, physicians, facility designers, employees and patients regarding nutrition, sustainable food and health impacts of popular processed food options. Examples of Action Items

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