Every Last Drop

Health care food purchasing can avert a water (and climate) crisis.

By April Galarza, Communications Coordinator, Health Care Without Harm, Healthy Food in Health Care Program on October 25, 2016

Hospitals are on the front lines of the water crisis. These facilities account for 7 percent of the commercial and institutional water use in the United States, using an average of 49 gallons of water per square foot—a vast improvement from the nearly 70 gallons per square foot that was normal a decade ago.

Hospitals are taking solid steps to reduce their water footprints, such as installing low-flow fixtures and avoiding the use of potable water for landscape irrigation.1 However, there is another significant way the health sector can help prevent water scarcity and resultant food insecurity—one it may already be engaged in—and that’s through hospital food purchasing.

Climate Change, Water and Agriculture

According to Ted Schettler, MD, MPH, science director of the Science & Environmental Health Network and science advisor for Health Care Without Harm (HCWH), the agricultural system in the United States is based on assumptions of cheap energy, climate stability and plentiful water. However, as temperatures rise, rain patterns change and water scarcity affects more and more people, it is becoming increasingly evident that these assumptions are no longer valid, especially when it comes to water availability.

Worldwide, two-thirds of the population—around four billion people—are experiencing severe water shortages2 during at least one month every year. According to the World Health Organization, 1.6 million deaths each year3 can be attributed to diseases associated with lack of access to safe drinking water, inadequate sanitation and poor hygiene.

In addition to these direct health impacts, water scarcity often results in food scarcity. Only 3 percent of the world’s water is fresh water, but 70 percent of it is used in agriculture.4 Water scarcity has the potential to double the effect of climate change on crops5 and threatens farmers’ ability to produce the food needed to nourish communities. In Haiti, where a three-year drought has been exacerbated by El Niño and rising temperatures, the number of people who are food insecure has doubled,6 and millions are at risk of starvation because without water, they cannot grow food.

“Climate stability and plentiful water are no longer assumptions that we can hold onto. We’re seeing the consequences of the changes, and the impacts on agriculture are profound,” said Schettler.

Climate change and associated rising temperatures are causing the zones where food is grown to travel north or south (depending on the hemisphere). It is causing changes to precipitation patterns so seasonal rains can no longer be relied on, and in some areas of the world, there are lengthy, seemingly unending “100-year” droughts.

Here in the United States, our food system is dependent upon domestic and global food marketplaces, and clearly, both are threatened. For example, California—where a sizable majority of the nation’s fresh fruit and vegetables is grown7—is experiencing its fifth year of unprecedented drought, affecting the availability and price of produce nationwide. And according to the U.S. Government Accountability Office, 40 out of 50 states are expected to face some kind of water shortage8 in the next decade.

Groundwater, the underground bank of water that farmers have relied upon for hundreds of years, is quickly being depleted, far faster than is possible to regenerate. The Ogallala Aquifer, the immense 174,000-square-mile freshwater basin that enabled the development of America’s breadbasket, is being rapidly consumed.9 Approximately one-fifth of all U.S. cattle, corn, cotton and wheat depend on the water from this aquifer alone. However, around 30 percent of the water within it has been pumped, and an additional 39 percent is expected to be depleted in the next 50 years. Replenishing it would take a millennium.

The Water We Eat: More Meat, More Water

On average, it takes more than 15,000 liters of water to produce one kilogram of beef in the industrial production system, using grains, hay and silage for animal food.10 To put that into perspective, most people drink about two liters per day. There is an invisible water footprint for all food products that is comprised of the water used to produce the food. This includes the water used to grow the food (in the case of animal agriculture, water is used to grow fodder and hydrate livestock), along with the water used to produce the fuel needed to transport it.

The average water footprint per calorie for beef is 20 times larger than for cereals and starchy root vegetables. Diets rich in plants, alternative proteins and smaller portions of meat, as recommended by health professionals for proven health benefits, contribute to mitigating water scarcity and climate instability due to their smaller water and carbon footprints.

With growing water scarcity, increasing demands in many countries and the impact of climate change on water supply, Schettler and many other experts recommend that limited water supplies be used more judiciously.

A key example offered by Schettler is a re-evaluation of water-intensive beef and dairy production taking place in the water-scarce Central Valley of California. “California is now the number-one dairy-producing state in the country, and many of the dairy operations are huge megadairies that are planted in the Central Valley of California, where there is very limited water and the groundwater is being rapidly depleted. Feed and water need to be brought to the animals in those confined operations to produce milk,” he said. “There are numerous opportunities for water savings, including growing more diversified crops that are less water-intensive and pasturing the cattle where rain is sufficient to support a largely grass-based system.11 It is time to re-evaluate where best to grow and raise food in relation to available resources.”

Already, some California ranchers and dairy producers are sending their operations out-of-state to locations with more plentiful water.

Ripple Effects

Addressing water scarcity through hospital food purchasing improves the food and water supply, and helps mitigate climate change.

“There are [many] opportunities to redesign food systems,” said Schettler. “One of the ways to do that is to get grazing animals back on grassland. When you do this, there are several effects: The animals are taken off most—or even all—corn and soy, and other food grown with large inputs of fossil fuels and chemicals. If you put animals back on grass and into integrated cropping systems where possible, you reduce the need for the grain inputs, and if done with proper grazing techniques, you actually improve the capacity of the grass-covered soil to hold carbon and water. So, with proper animal agriculture, you can help solve the problems that the industrial model of production has created.”

Health care facilities can support this effort through their purchasing. Water is one more reason—and a significant one—to use HCWH’s “Less Meat, Better Meat”12 strategy.

“Helping hospitals see the connection to climate change and the opportunities for using agriculture to help sequester carbon in soil and reduce greenhouse gas emissions is something that we really want to stress in the coming months and years,” said Schettler. “It is important to recognize that agriculture can be part of the solution and doesn’t have to be a major contributor to the problem.”

Schettler recommends that hospitals continue to change their purchasing practices in ways that support healthier agricultural systems. “This constitutes a public health intervention that we should applaud and support,” he said. “I think the hospital’s role is very clear, and while they’re doing that, they can help create a more robust market for the healthier foods that mitigate some of these problems.”


  1. Anne DiNardo, “Healthcare’s Water Conversation Efforts Have Ripple Effect,” Healthcare Design, July 13, 2016. Retrieved from www.healthcaredesignmagazine.com/article/healthcare-s-water-conversation-efforts-have-ripple-effect.
  2. N.S. Fleur, “Two-Thirds of the World Faces Severe Water Shortages,” The New York Times, Feb. 12, 2016. Retrieved from www.nytimes.com/2016/02/13/science/two-thirds-of-the-world-faces-severe-water-shortages.html.
  3. The World Health Organization, “Health through safe drinking water and basic sanitation.” Retrieved August 11, 2016, from www.who.int/water_sanitation_health/mdg1/en.
  4. Pacific Institute, “Water, Food, and Agriculture [nonprofit].” Retrieved August 11, 2016, from pacinst.org/issues/water-food-and-agriculture.
  5. J. Elliott, D. Deryng, C. Müller, K. Frieler, M. Konzmann, D. Gerten and D. Wisser, “Constraints and potentials of future irrigation water availability on agricultural production under climate change,” Proceedings of the National Academy of Sciences, 111(9), 3239–3244 (2014). Retrieved from doi.org/10.1073/pnas.1222474110.
  6. Beenish Ahmed, “Millions Face Starvation as Haiti’s Drought Stretches into Its Third Year,” ThinkProgress, April 15, 2016. Retrieved from thinkprogress.org/millions-face-starvation-as-haitis-drought-stretches-into-its-third-year-e0f2dfb6558f#.fj41dla1m.
  7. B. Palmer, “The C-Free Diet,” Slate, July 10, 2013. Retrieved from www.slate.com/articles/health_and_science/explainer/2013/07/california_grows_all_of_ our_fruits_and_vegetables_what_would_we_eat_without.html.
  8. Ellie Kincaid, “California isn’t the only state with water problems,” Business Insider, April 21, 2015. Retrieved from www.businessinsider.com/americas-about-to-hit-a-water-crisis-2015-4.
  9. Alan Bjerga, “The Great Plains’ Looming Water Crisis,” Bloomberg Business Week, July 2, 2015. Retrieved from www.bloomberg.com/news/articles/2015-07-02/great-plains-water-crisis-aquifer-s-depletion-threatens-farmland.
  10. M.M. Mekonnen and A.Y. Hoekstra, “The green, blue and gray water footprint of farm animals and animal products,” Value of Water Research Report Series No. 48, UNESCO-IHE, 2010. Retrieved from waterfootprint.org/en/water-footprint/product-water-footprint/water-footprint-crop-and-animal-products/.
  11. Robin Madel and Kai Olson-Sawyer, “The Water Footprint of Beef: Industrial vs. Pasture-Raised,” GRACE Communications Foundation, Oct. 21, 2014. Retrieved from www.gracelinks.org/blog/4712/the-water-footprint-of-beef-industrial-vs-pasture-raised.
  12. HCWH, www.noharm-uscanada.org/content/us-canada/less-meat-better-meat.