TOWARD TOTAL COMMUNITY HEALTH Kaiser Permanente’s Comprehensive Food Policy Loel Solomon, Ph.D., National Director, Community Health Initiatives and Evaluation CFSC Annual Conference Vancouver, BC October 10, 2006

About Kaiser Permanente Founded in 1945 America’s oldest and largest private nonprofit health care system 8.6 million members — 6.5 million members in California Over 13,000 physicians representing all specialties and 153,000+ additional employees Operations in 9 states and Washington, D.C. with 37 Medical Centers and 431 Clinics

Key Elements of KP’s Food Policy Ensure healthy food in and around KP facilities Inpatient food Cafeterias and coffee carts Vending machines Catering Farmers markets Twin goals Promote a healthy food environment for our members, employees, physicians and KP communities Promote a healthy environment through sustainable agriculture Build on KP’s heritage in health promotion and success of environmental stewardship in “making the market”

Why Focus on Food? Importance of the food and physical environment on overweight and obesity-related disease Increased attention to food practices of healthcare organizations Nexus of issues/opportunities Community food security Environmental health Personal health for farmworkers and consumers Activity-promoting urban forms

How We Got Here: A Convergence of Interests, Opportunities and Imperatives Healthy Eating, Active Living (HEAL) Initiatives Thrive Campaign Weight Management Initiative KP Farmers’ Markets KP’s Comprehensive Food Policy Grassroots advocacy by KP physicians, employees Environmental Stewardship Council CA Gov’s Obesity Summit Procurement And Supply Employee Wellness

Who Is Leading the Charge? Physicians RDs and health educators Community benefit leaders Food service directors Procurement managers Administrative assistants

The Environmental Stewardship Council has brought the pieces together Food Policy Steering Committee Develop vision, guiding principles Ensure coordination Support implementation KP Food Workgroup Inpatient food Cafeterias, vending, catering Community Food Workgroup Farmers’ markets Community gardens Vending Subgroup Technical Assistance and Support Healthcare Without Harm Broadlane Prevention Institute Center for Food and Justice Community Alliance with Family Farmers IATP PSR Food Alliance

Who We’ve Engaged Food and Nutritional Service managers National Procurement and Supply Environmental Health and Safety managers Operations Support Leaders Weight Management Network and CVD Advisory Group Food policy leads designated by med group leaders (ongoing) Permanente Federation leaders Employee Wellness Inter-Regional Peer Group CHI Inter-Regional Workgroup Labor-Management Partnership Leadership Team Inter-Regional Nursing Council Health Education Peer Group Chairs National Materials Leadership Team NFS/Capital Projects and Planning and Design Group Other interested groups and individuals

Progress to Date: Community Food 32 farmers markets in 5 states Clinical integration Farm-to-facility initiatives Interstate Farmers Market (Portland) Produce Packs (Oakland)

Progress to Date: KP Food Healthy Picks vending program Sustainable and healthy cafeteria food rBGH free dairy Seasonal menu planning Northern California local sourcing pilot RFI/RFP for KP’s national food contract

KP/CAFF Local Sourcing Pilot: Preliminary Data Northern CA Inpatient Food Stats: 250 tons of fresh produce/year 6,000 meals/day; 1/3 fresh produce Environmental Impact: Carbon emissions: 11.12 tons/6.34 tons “overshoot” Carbon footprint: 260 acres Estimated emissions reduction from modest seasonal menu shift: 20%

National Food Purchasing and Labeling Guidelines: RFI/RFP Offer Third Party certified foods? COOL labeling? State/county of origin or preferential local sourcing program? Seasonality, by state? Threatened fish stocks? Annual reporting on OSHA, CWA, CAA violations for meat and poultry producers? Plans to track environmental and community health impacts of suppliers (e.g., non-therapeutic antibiotic use, hormone use, violations, labor practices)? % of hog and cattle needs purchased on open market? Nutritional content/screening of products? Description of bio-based packaging and food service supplies?

The Road Ahead Release of RFI/RFA Completion of local sourcing pilot Fiscal impacts Scalability Reliability Farmers market evaluation/sustainability plans Systematic learning about innovative practices