A cook at work in the West Bloomfield kitchen. Photograph by Noah Stephens.
A few years ago, a chef named Matt Prentice visited a friend who had recently undergone quadruple bypass surgery. It was mealtime at the hospital, and Prentice caught a glimpse of his friend's first postoperative food: chicken base in water, green Jell-O, applesauce. Prentice, the brains behind trendy Michigan restaurants like Coach Insignia and Shiraz, was appalled. He called Shiraz and asked his staff to whip up a stock with twice the chicken bones and root vegetables, then clarify it into a consommé. After racing to the restaurant, he returned to the hospital with a gallon of broth.
"My friend had a roommate, and he also looked weak," Prentice told me. The chef said to the nurses, "Look, you guys are doing a great job, but the food is terrible. I want you to feed these guys a cup of this broth every hour on the hour." They followed his instructions, and the next day, he brought in another gallon. Even after his friend was discharged from the hospital, Prentice brought him stock at home, slowly cooking him back to health.
Prentice had learned enough about hospital food to know it didn't do recovering patients any favours. So when Gerard van Grinsven, the CEO of suburban Detroit's Henry Ford West Bloomfield Hospital, approached him with the idea of offering better food at the brand-new institution, Prentice was all ears. The Henry Ford Hospital is a non-profit health-care system that provides $180 million annually in uncompensated care at several hospitals and other medical facilities. At the time, West Bloomfield was still on the drafting table, and van Grinsven, formerly of the Ritz-Carlton hotel chain, wanted to do things differently. The two men settled on a consultant fee—$100 per hour, half of what Prentice normally charges—and van Grinsven handed over blueprints to the hospital's kitchen.
"I worked through the night and totally redrafted them," Prentice said. He designed a seven-station cafeteria for a group of twenty chefs and personally oversaw the creation of the deli's menu. Another chef took pasta and risotto, another took Asian and so on, right on through to a pastry chef and a breadsmith. Prentice consulted with Henry Ford physicians and designed dishes that were low in sodium and loaded with vegetables, had no trans fats and relied on whole grains and lean meats. The hospital would use as much local, organic and sustainably-produced food as possible. Prentice even trialled the dishes at his own upscale restaurants. He also decided that patients would have twenty-four-hour room service—and everything except for soups, stocks and sauces would be made fresh to order. Prentice himself wrote 1,300 recipes.
West Bloomfield opened in March 2009, with 191 of its planned three hundred beds ready and a staggering menu on offer. It has no deep fryers, no steam tables and only one freezer. Every Wednesday, the hospital hosts a farmers' market in the main foyer. Staff and visitors eat the same food as patients—though not everyone was keen on the idea at the beginning. "A lot of staff were bitching at me, 'What do you mean I can't get a cheeseburger and fries?'" Prentice said. "Well, you can get the cheeseburger, but we made it ourselves from 100 percent lean meat. And pizza is a big seller, but it's healthy. We don't do pepperoni."
Since his days at Henry Ford West Bloomfield, Prentice has consulted for a number of other hospitals, and things have not always gone smoothly. His standard warning to clients—"You are going to think I'm the Antichrist"—is his way of acknowledging the clash that occurs when hospital bureaucracies go head-to-head with chefs. But he insists on having complete control of the food operations. Administrators know hospitals, and Prentice knows food. "I spent a day in the dish room of a hospital and I saw what gets thrown away," he said. "It made me sick. It was clear that the patients hated what they were getting. But hospitals have been doing it so bad for so long that bad seems right."
I was surprised when I learned that a conference about food was to be held in Detroit. I'd never been to Detroit, and all I really knew about it was what everybody assumes: massive job loss, crime and poverty, a dwindling population. Even the program of Taking Root: 5th National Farm to Cafeteria Conference, held in May 2010, had this to say about its host city: "While it's easy to see just the 60,000 vacant lots scattered across Detroit, a closer look reveals that hundreds of residents are 'Taking Root,' revitalizing their neighborhoods and building communities through local agriculture." It all sounded a bit desperate—the city of Henry Ford and Motown reduced to dimly hoping for a better future.
The importance of good food for kids in schools and other public institutions was repeated again and again in the conference literature. It bordered on evangelism. Everyone there knew the way we feed people in industrialized countries is wrong. Everyone there knew institutional food is too salty, has too much fat and too much sugar, and stimulates neither the appetite nor the imagination. Everyone there knew we fail to support local producers while ordering vast tonnages of produce from half a continent away. Community groups, many of them represented at the conference, are working to change this in their own small ways, for their local students or their soup kitchens or their neighbourhoods.
My purpose in coming was to see how hospitals—which, as vanguards of public health, should be leading the fight—were trying to turn things around. They were conspicuously absent. While Prentice's crusade proves the situation has begun to change, hospitals have proved remarkably reluctant to embrace healthier food services. When I registered for Taking Root, I was asked to indicate which sector I represented. I could choose from educator, administrator, student or parent. I am a family doctor, but there was no category for health professional. I chose parent.
In 2005, Health Care Without Harm, an international association of health-care professionals and community groups, began working with hospitals to increase the amount of local, sustainable and nutritious foods served in their cafeterias and to patients. HCWH came up with a Healthy Food in Health Care Pledge to give hospitals guidance. Specific directives include: increase your offerings of fruits and vegetables; reduce your use of processed foods and saturated fats; and work with local farmers.
In 2008, HCWH published a report called "Menu of Change: Healthy Food in Health Care," which provided results from the first few years of the pledge. More than 120 hospitals, ranging from twenty-five- to nine-hundred-bed facilities, had signed on; by 2010, that number had risen to over three hundred. Each of the pledging hospitals had increased its fruits and vegetables; 87 percent had increased their offerings of whole-grain breads and cereals; 77 percent had reduced the use of processed foods; 72 percent were using local and/or organic vegetables; and a quarter were now offering a regular farmer's market on hospital grounds.
In 2009, the American Medical Association passed Resolution 407 in support of a sustainable-food policy for hospitals. In a series of formal clauses, the resolution explicitly linked agricultural practices, such as excessive chemical use and factory farming, to human illnesses; acknowledged that "the massive purchasing power of the healthcare industry can influence the direction of US agriculture"; and called on health institutions to sign the Healthy Food in Health Care Pledge.
These were no ninety-five theses nailed to a door in Wittenberg; this came from the American Medical Association, an organization of professionals not exactly known for their radicalism. (The Canadian Medical Association has no such position.) In spite of having to buy dry deli-meat sandwiches dressed with a stick of celery at my own hospital cafeteria in Newfoundland, I was excited that something was happening somewhere.
Tucked among Taking Root's many concurrent sessions on improving the nutrition and environmental impact of school lunches was one tiny workshop about making hospital food better. Lisa McDowell, one of the workshop speakers, carries some heavy credentials. A dietician on staff at the University of Michigan's Department of Medicine, she's also a registered dietician at St. Joseph Mercy Hospital in Ann Arbor, and has been a consultant for the US Olympic team and various endurance athletes. But McDowell mostly deals with people on the other end of the health spectrum: hospital inpatients who are, on average, overweight or obese.
"There are obstacles and barriers wherever you go," McDowell said. "Patients tell us, 'It's really my genetics.' But is it really? If you look at our environment, it's very difficult to find healthy food." She once spearheaded a study that compared the relative prices of consuming a thousand calories through various foods; that amount in berries would set you back $18, while at Krispy Kreme it would cost $1.26. "With these statistics," McDowell noted, "it definitely is time for health care to step up."
In addition to signing the Healthy Foods in Health Care pledge, St. Joseph Mercy recently adopted American Heart Association dietary guidelines and eliminated all trans fats. They've met with their suppliers to find options for buying antibiotic- and hormone-free meat, and for sourcing dairy products without recombinant Bovine Growth Hormone (one thing Canadians don't have to worry about, as Health Canada has banned its use here).
Last December, McDowell and some colleagues convinced hospital administrators to revert some of the land on which the hospital sits to its original use as farmland; volunteers are now planting an acre garden that will be half pumpkins and corn, and half intensive crops. They've also erected a type of greenhouse called a hoop house, which will grow produce to be sold at a twice-weekly farmers' market at the hospital. If the project ever reaches its full potential of twelve hoop houses, excess produce not sold to visitors and staff will be provided to the hospital food service.
"It's very tough economically now, so it's a bad time to be asking for funds for new projects," McDowell said. "But we serve over three thousand meals just at the Ann Arbor campus. Hospitals have to walk the walk, to be leaders and to be advocates for providing healthy food environments that promote health, instead of being reactionary with the patients who have heart attacks."
Frank Turner, the current executive chef and director of food and nutrition at West Bloomfield, also spoke on the panel. A corporate chef who oversaw some of Matt Prentice's four-star restaurants, Henry Ford is his first hospital gig—and it shows.
He flipped through a series of slides depicting typical meals. "You're looking at a grilled salmon with a little pile of sprouts there from Maple Creek Farms, feta cheese, roasted fresh beets, oven-roasted tomatoes and organic spring mix." He paused with each menu selection to give tantalizing details; it was a moving sales pitch. "It comes with organic romaine salad with a cherry tomato vinaigrette, some Zingerman's goat cheese, with a few herbs and citrus zest."
Perhaps because he had never before worked in a hospital, Turner never had to labour to shed the hospital-food mentality, the one that seems to say a kitchen must serve the greatest number of people with the least amount of money. When health-care workers discuss improving hospital food, one question comes up again and again: how would we pay for it? But Turner hammered home the point that quality does not necessarily mean breaking the bank. "About three or four years ago I worked at a Salvation Army about two miles from here," he remembered. "I showed them how to redo their food system. We got a quarterly statement ninety days later: they had saved $90,000. There are ways to do this." I almost started to believe him.
For a Canadian family doctor used to some pretty dingy digs, walking into Henry Ford West Bloomfield was like entering Santa's workshop. There is a working fireplace in the lobby, as well as a day spa where one can partake of everything from sports performance advice to a seaweed wrap, Chi Gong classes or hydrotherapy. All of the rooms are private. The hospital is set on 160 acres of woodland, and the three completed patient-care units have been named after trees: Acorn, Birch and Chestnut. The intensive-care unit looks out onto a little indoor grove of trees and cobblestone walkways. I expected someone to come by at any moment with a tray of hors d'œuvres. The word "hotel" kept slipping off my tongue in place of "hospital."
"We've gone for a northern-Michigan lodge look," spokesperson Sally Brown said as she ushered me through the front door. In Henry's Café, the main cafeteria for hospital visitors and staff, one can stop at the Asian food bar for a fresh tuna roll with ponzu sauce, or the American food bar for an "energy turkey sandwich" on artisanal sourdough bread. At the salad bar, I watched two nurses survey the pickings. "I'll do some spinach and some edamame," one said to a woman behind the counter. "And some carrots, I guess. And you'll toss that? What kinds of dressings do you have? What's in the vinaigrette?"
My tour continued with a peek at the pediatrics ward and an obstetrical delivery room: flat-screen TVs, pull-out sofas for family members, washcloths folded into little fan shapes in the handsomely-lit bathrooms. At a nursing station, I picked up a patient menu: miso chicken salad, roasted red pepper soup, teriyaki shrimp wrap, grilled chicken with angel hair pasta, pan-seared scallops with julienned organic carrots and wilted greens, shrimp creole over rice, spicy tilapia with olive and lemon quinoa, maple-roasted portobello mushroom burger. I asked Brown about the prices beside the menu selections, which ranged from three dollars to a high of eight, the same prices charged in the cafeteria. "Oh, those are just for family members; health insurance covers the costs of whatever food patients order," she answered. "We want family to stay here and eat with us because it speeds healing, and we recognize mealtimes are important."
I kept thinking: Of course a place like this can do wonderful things with food, but there's no way we could pull this off in Canada. I can explain American health-care economics about as well as I can nuclear fission, so I wasn't even sure how to ask about money. This is the only food model the non-profit West Bloomfield has ever known, so I couldn't inquire how much more such service costs, or how much the hospital has saved.
"We do incur a higher cost, but it's for higher quality. We reduce our costs by giving people the food they want; less waste means lower cost," said Brown. "We also reduce costs by partnering with local community colleges with culinary programs. It saves on retraining staff who are used to the old way of doing things, while the students get work experience in our kitchen." Because the food is so good, retail sales at West Bloomfield to visitors and staff are also higher than usual, and the hospital hopes to open its own culinary institute down the line.
Does it matter to patients, I asked, whether their applesauce comes from Michigan or from Washington?
"With the decline in the auto industry here, we're very much aware of supporting industry in our own state," Brown responded. "Our patient satisfaction rates have been in the high ninetieth percentiles. That's unheard of for a hospital in its first year."
If there are ways to do this, then which hospitals in Canada are doing it? The short answer is none—yet. The Canadian Coalition for Green Health Care is currently conducting a survey of 250 hospitals in Ontario to determine their interest in incorporating local foods, so any real improvements are likely years in the making. But other public institutions are already starting to change.
Local Food Plus is a Toronto-based non-profit organization whose mandate is to link sustainable farmers with provincial or regional buyers—both individual consumers and large institutions. For Lori Stahlbrand, LFP founder and president, this goes beyond simply providing healthy food. At the conference in Detroit, she flipped up an aerial photo of a new suburb in Wellington County, Ontario, bisected by a road that comes to a dead end at the edge of a farmer's field. "This picture was taken a few years ago. I'll bet that field is not there anymore.
"We have three pockets of Class I farmland in Canada: the Fraser Valley in BC, southern Ontario and the Annapolis Valley in Nova Scotia," Stahlbrand continued. As farmers age and housing developments creep closer to their fields, she said, they're more likely to sell their land in a bid for stable retirement. "Then that land gets taken out of production for good. In terms of food security, when we've lost that land, we've lost the ability to feed ourselves."
Realizing how much leverage institutions can have over food-distribution systems, LFP has focused on bringing large operations on board to help small farmers infiltrate the market. It's currently working with the University of Toronto—one of the biggest universities in North America—and spent about a year negotiating a food-procurement contract. "In the first year," Stahlbrand said, "10 percent of their food came from our farmers and processors; second year, 15 percent; third year, 20 percent, and this year we're aiming for 25 percent."
That's a lot of local food. What's more, the University of Toronto has a contract with multinational food distributor Aramark; as Stahlbrand put it, when the university says it wants local, Aramark does local. Because the company's supply chains are global, that's not easy, but if it wants to keep U of T's business, Aramark has to play by its rules. And once Aramark has found a local product for one client, that product is also made available to other regional customers. Working with large institutions like hospitals and schools, in other words, helps create new markets for sustainable produce.
Serving bad food in hospitals is not only a question of nutrition; it is a failure on the part of powerful institutions to do better. Hospitals cling to the notion that investing in fresh food would mean having to get rid of a wound-care nurse or say no to that new ventilator. But history has shown us that boring old preventive health measures like sanitation and immunization—rather than sexy, interventional stuff like heart surgery—have always done the heavy lifting. We know from rising rates of food-related illnesses such as diabetes and heart disease that the effects of trashy food will be medicine's greatest burden for the foreseeable future. Food-procurement decisions are political and, increasingly, medical choices. We can either continue to support a global food machinery largely responsible for our biggest health problems, or we can stop, and make food good again.
Originally published in December 2010. See the rest of Issue 38 (Winter 2010).
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