Purchasing for Mealtime

By Gretchen Miller and Kathy Pryor Health Care Without Harm, Healthy Food in Health Care Program on December 3, 2012

Accessing sustainably produced food: strategies and tools for hospitals and GPOs

For nearly 10 years, Health Care Without Harm’s (HCWH) Healthy Food in Health Care program has worked with hospitals across the country to help them purchase and serve more sustainably produced food. As they transform their food service, hospitals are asking their distributors for organic and local produce, humanely raised eggs, sustainably harvested seafood, meat and poultry raised without the routine use of antibiotics or arsenic, and dairy raised without artificial hormones.

Demand for Sustainable

Hundreds of hospitals are using sustainable products in their patient and cafeteria menus, supporting local agriculture by serving regionally produced food, and creating food-service policies that make sustainable procurement an official mandate of their facilities. HCWH’s 2011 national survey of participating hospitals found that nearly 25 percent of produce, 63 percent of dairy, and 24 percent of beef purchased and served came from sustainable sources (Menu of Change, 2011). Hospitals are continuously striving to increase these numbers. Additionally, just over 400 hospitals from across the country have signed the Healthy Food in Health Care Pledge, demonstrating their commitment to actively support a sustainable, safe, and fair food system.

Defining Sustainability

When hospitals ask for a sustainable product, what exactly do they mean? “Sustainable” has become quite a buzzword, and everyone has a different definition of what it means. This can be frustrating for hospitals, distributors, and group purchasing organizations (GPOs) alike.

Ultimately, third-party certifications and label claims provide the most reliable way to tell whether a product is sustainable. Third-party certifications are rules, compliance methods, and measurements that are developed by external, independent groups. Products holding a third-party certification are evaluated by an external organization to ensure that they are in compliance with the certification standards.

USDA/FDA-approved label claims have a consistent definition and have been approved by either the United States Department of Agriculture (USDA) or Food and Drug Administration (FDA). Producers are required to provide documentation that demonstrates claim compliance to the appropriate regulatory agency.

As the demand for sustainable products grows, so does the field of third-party certifications and label claims. Examples of some meaningful third-party certifications and USDA/FDA-approved label claims that address environmental, health, and animal welfare issues include:

  • USDA Organic
  • Food Alliance Certified
  • Fair Trade Certified
  • Animal Welfare Approved
  • Certified Humane Raised & Handled
  • Rainforest Alliance Certified
  • Protected Harvest
  • Salmon Safe
  • Raised without Antibiotics
  • Raised without Hormones
  • rBGH/rBST-Free
  • 100 percent Grass-Fed

You can learn more about these and other meaningful certifications and labels on the Healthy Food in Health Care website: noharm.org/lib/downloads/food/EcoLabels_Matrix.pdf.

Hospitals Create Sustainable Purchasing Policies

Increasing numbers of hospitals are communicating their desire for sustainable products by creating sustainable food purchasing policies and priorities. Two standout examples from the Northwest region include Overlake Hospital Medical Center (OHMC) and Oregon Health & Science University (OHSU). OHSU Sustainable Food Program Manager Eecole Copen notes, “A sustainable food policy is a guiding light, helping the food and nutrition department stay the course toward building the infrastructure of a sustainable food system.”

Sustainable Food Policy Case Studies

Oregon Health & Science University

OHSU’s purchasing priorities guidelines operationalize its sustainable food purchasing policies by clarifying the minimum qualifications a product must have to be considered a sustainable purchase. The following excerpt demonstrates the types of guidelines that have been developed for various food products:

Poultry (turkey, chicken) and Pork: Major health issue: Antibiotics (abx) used to prevent infection of animals in conventional production may decrease abx effectiveness in humans. Arsenic, found in poultry feed and used for growth promotion, feed efficiency, and improved pigmenta­tion in conventional poultry production, may increase risk of cancer in humans.

  • Ultimate goal: Organic/Food Alliance Certified and regionally grown and processed.
  • 1st priority: Certified Organic (because prohibits abx in pork production). Ask supplier about arsenic use—no label claim addresses this.
  • Next priority: Food Alliance Certified.
  • Next priority: Certified Humane Raised and Handled or Animal Welfare approved.
  • Next priority: No antibiotics added (check with supplier to make sure no arsenic was used in production). Minimum requirements to be considered “sustainable.”
  • Next priority: Regionally grown and processed.
Overlake Hospital Medical Center

Recognizing its responsibility as a health-promoting organization, Overlake Hospital Medical Center’s sustainable food policy “seeks to improve the health of our patients, employees, our communities, and the environment by increasing access to fresh, healthy food in the hospital environs” and “promote agricultural practices that are ecologically sound, fiscally viable, culturally appropriate, and socially responsible.”

The hospital’s policy includes the following goals:

  • Become a model for the industry and the nation by encouraging healthy food choices in our inpatient food services, cafes, vending machines, and catered meals.
  • Work with local farmers, community-based organizations, and food suppliers to increase the availability of locally sourced food (within 200-mile radius of Overlake Hospital campus).
  • Encourage our vendors to supply us with food that is produced without synthetic pesticides and hormones or antibiotics given to animals in the absence of diagnosed disease, including foods and/or ingredients produced using genetically modified organisms (GMOs).
  • Work toward a 20 percent reduction in meat purchases through wider implementation of Meatless Mondays and similar initiatives.
The Role of GPOs

As a nation, we have witnessed the movement of “sustainable food” from the fringe to the mainstream. Today, the availability of this type of food is at an all-time high, a vastly different picture than just 10 years ago. No longer do hospitals need to cobble together many different distributors and vendors to access sustainable products. With current supply levels, hospitals should be able to purchase these products through their broadline distributors. Yet, hospitals continue to struggle to procure sustainable food. With a sluggish economy and the threat of layoffs and budget cuts looming, hospitals are looking for the cost benefits and efficiencies that contracted broadline distributors offer.

GPOs can play a significant role in helping hospitals serve more sustainable products. These entities leverage the collective purchasing power of a group of hospitals to obtain lower prices from vendors. By negotiating the inclusion of sustainable products into food service contracts, hospitals can have reliable, affordable access to products that support the health of individuals and the environment.

In partnership with Practice Greenhealth (PGH), the Healthy Food in Health Care program has created a set of environmentally preferable purchasing guides that help GPOs incorporate questions about sustainability criteria related to food in their RFP/RFI (Request for Proposal/Request for Information) processes.

These guides were designed for use by GPOs but may also apply to national food service contractors or distributors. Please consider sharing these resources with your sales representatives or GPO advisory team. These resources are free and available on both the Healthy Food in Health Care website, www.healthyfoodinhealthcare.org/resources.php and under Food in Practice Greenhealth’s EPP Specifications and Resources Guide, www.practicegreenhealth.org/epp/spec/food.

Moving Forward Together

Ultimately, the rising demand for sustainable products comes from a desire to enhance the health of individuals, communities, and the environment. With their enormous purchasing power, hospitals have a significant opportunity to help shift the food system in a more sustainable, equitable, and healthy direction. Distributors, group purchasing organizations, and the hospitals they serve must work together to create market options that support good food choices and a healthy, sustainable bottom line.


The Healthy Food in Health Care Program is a national initiative of Health Care Without Harm, which works with hospitals across the country to help improve the health and sustainability of their food services. For more information about the Healthy Food in Health Care Program, and to access a variety of tools and resources, visit healthyfoodinhealthcare.org.