Balanced Menus

By Sapna E. Thottathil, PhD, Lucia Sayre, MA, and Kendra Klein, PhD of Health Care Without Harm's Healthy Food in Health Care program on June 4, 2014

Health care food service revolutionizing menus with "Less Meat, Better Meat."

McDonald’s, Whole Foods, and Chipotle are not the only ones making announcements about meat these days. Hundreds of hospitals across the country are buying more sustainably raised meat and are including vegetarian and reduced-meat options on their menus to help protect the environment and improve public health. With foodservice budgets often running in the millions, hospitals are influencing markets, supply chains, and production practices by prioritizing sustainably raised meat.1

Meat production contributes to the degradation of both the environment and human health. Industrial meat operations—known as confined animal feeding operations, or CAFOs—produce large amounts of air and water pollution from animal waste, use huge amounts of water and land for feed production, contribute to the spread of human and animal diseases, and play a major role in climate change and biodiversity loss.2

Of particular concern to the medical community, close to 30 million pounds, or 80 percent of all the antibiotics sold in the U.S. on an annual basis, are used in animal agriculture. The vast majority of antibiotics are given routinely to otherwise healthy animals to compensate for overcrowded and unsanitary living conditions. These include antibiotics within the same classes that we use to treat human infections, such as penicillins, sulfas, and macrolides. Many of these drugs are available over the counter and are used without veterinary oversight. This nontherapeutic practice contributes to the growing antibiotic-resistant bacteria crisis that threatens human health and costs health care millions of dollars annually.3

Creating Change in the Marketplace: Sustainable Meat Policies and Purchasing in the Health Care Sector

Hospitals nationwide are taking action to protect antibiotics for human medicine and to reduce the impact of industrial meat production. Many facilities within Health Care Without Harm’s network are participating in the Balanced Menus: Less Meat, Better Meat initiative, which is grounded in a substantial body of scientific evidence demonstrating that industrial meat production is currently unsustainable. Hospitals are using food as a part of prevention-based medicine, not only for their patients, but for the environment and the communities they serve, by opting for meals with less meat and better meat.

Hospitals interested in buying more sustainable meat may be wondering how and where to begin. Here are some tips:

  1. Look for products that carry one or more of the following certifications of label claims:
    • USDA Organic
    • American Grass-fed
    • Animal Welfare Approved
    • Certified Humane Raised & Handled
    • Food Alliance Certified
    • "Raised Without Antibiotics"
    • "No Antibiotics Added"
  2. Utilize creativity in your menus—cut and substitute
    • Rely on less meat and utilize the cost savings to purchase sustainably raised meat
    • Develop recipes utilizing less-expensive cuts of sustainably raised meat, introduce more vegetarian options, and use meat as a "condiment" rather than the main attraction on a plate
  3. Demonstrate power in numbers
    • Distributors and supply chain partners are responding to growing demand—work with hospital peers and pool your demand for sustainable meat
  4. Learn more about Health Care Without Harm’s Balanced Menus initiative, and how you can use less meat and better meat in your facilities. Visit Health Care Without Harm’s website for recipes, marketing materials, and more: http://www.healthyfoodinhealthcare .org/ balancedmenus .php

For example, this April, the University of Washington Medical Center in Seattle joined a list of early-adopter hospitals by committing to serve only antibiotic-free poultry and pork. Another regional leader, Overlake Hospital in Bellevue, Washington, has switched over 50 percent of its meat purchases to antibiotic-free. Over on the east coast, several hospitals in the mid-Atlantic region are currently purchasing $55,000 worth of pasture-raised chicken produced without antibiotics and growth hormones. One leader, Union Hospital of Cecile County, Maryland, reduced the amount of red meat on its menus and is using the savings to source sustainably raised beef from local ranchers.

In California, a resolution to phase out the purchase of meat produced with the routine use of antibiotics, which passed in April of 2013 at the University of California at San Francisco Medical Center, kicked off statewide efforts to combine the purchasing power of several hospitals in order to bring antibiotic-free products in through a major food distributor, US Foods. From San Francisco to Los Angeles to San Diego, eight facilities have aggregated over 80,000 pounds of demand to date for Estancia Beef products, representing upwards of 320,000 servings of better meat for hospital patients and cafeteria patrons. Estancia’s beef, which was not previously available through US Foods, is grass-fed, produced without antibiotics and growth hormones, and is third-party certified by Animal Welfare Approved. This innovative and statewide collective purchasing strategy builds on the ongoing efforts of over forty California hospitals to purchase antibiotic-free meat and poultry.

Taking Institutional Meat Purchasing to the Next Level

As the momentum for sustainable meat purchasing grows within the health care sector, and as hospitals in places like California come together to aggregate their demand, Health Care Without Harm is reaching out to partners across sectors to join forces. Universities and K-12 schools often utilize the same foodservice contractors, distribution companies, and other supply chain intermediaries like processors and slaughterhouses. Health Care Without Harm is working with two other nonprofit groups, School Food FOCUS in the K-12 arena and Real Food Challenge in universities, to develop cross-sector collaboration in sustainable meat procurement. Together, these three organizations represent approximately 700 hospitals, 34 K-12 public school districts (about four million students), and over 350 colleges and universities across the country. The aim of this collaborative effort is to dramatically increase institutional-level procurement of meat raised without nontherapeutic antibiotics, and in turn, to bring other major supply chain players on board through the effort. These shifts in procurement will create significant new markets for sustainable producers and demonstrate to conventional meat producers that they will need to change their production practices in order to meet the growing demand for antibiotic-free meat.

Along with these market-based strategies, Health Care Without Harm brings the voice of health professionals to the halls of power to create public policy that protects human health and the environment. To learn more about health care’s sustainable meat efforts, as well as how hospitals can get involved through Health Care Without Harm’s Balanced Menus initiative, visit: http://www.healthyfoodinhealthcare .org/ balancedmenus.php.


  1. Food Service Director Magazine (2011). 2011 Hospital Census.
  2. Food and Agriculture Organization of the United Nations (2006). Livestock’s Long Shadow.
  3. Pew Charitable Trusts (2014). Antibiotics and Industrial Farming 101.