Chris Linaman was not aware of the link between the meat industry's use of antibiotics in raising animals and the increase in antibiotic-resistant bacterial infections in humans when he suffered a three-month bout with a virulent, antibiotic-resistant infection. Later, he attended a healthcare sustainability conference at which he learned about the connection.
Those experiences prompted the executive chef at Overlake Hospital Medical Center in Bellevue, Wash., to shift his hospital away from serving meat products derived from animals raised on antibiotics. In 2011, he wrote a food-purchasing policy manual for a new way of purchasing meat. “That keeps me on track to make sure that we are doing the right thing with our food,” Linaman said.
Overlake has become a leader among the growing number of U.S. hospitals serving antibiotic-free or reduced-antibiotic meat and poultry to their patients, staff and cafeteria diners. Nearly 50% of Overlake's meat budget is spent on products from animals raised without the routine use of antibiotics.
Overlake is one of more than 500 U.S. hospitals, mostly on the West Coast and in the Northeast, working with Healthy Food in Health Care, an initiative of the national not-for-profit Health Care Without Harm. Many of these hospitals, including 41 in California, are working to reduce their overall meat purchases and the use of antibiotics in the production of meat they serve, said Kendra Klein, senior program associate for the healthy food program's work in California. Beyond simply serving healthier meats in their facilities, they hope to create more demand for these products and nudge the U.S. agricultural industry to change its practices.
“The dollar leverage that we have in the hospital systems is huge, and that can actually change the industry,” said Eecole Copen, a registered dietitian who is sustainable food programs coordinator at Oregon Health & Science University Hospital in Portland.
The University of Washington Medical Center in Seattle has announced that its pork and poultry products will be 100% antibiotic-free. UCLA Health System announced that its two largest hospitals are serving antibiotic-free beef and chicken. OHSU Hospital has partnered with a local beef producer to source antibiotic-free beef. And 30 California hospitals have asked institutional food vendors US Foods and Sysco to increase the availability of reduced-antibiotic meat and poultry to help them meet their food-purchasing goals.
In many cases, clinicians collaborate with food-service executives to make healthier food purchases an institutional priority. “There is such a clear connection between hospital food service and the hospital's healing mission and role in public health
,” Klein said. “Doctors get why this matters.”
But hospitals going this route face the reality that reduced-antibiotic meat and poultry products are more expensive—as much as 25% more—and finding vendors with an adequate supply is a challenge. Despite demand for reduced antibiotic loads, most U.S. meat producers feed nontherapeutic antibiotics to their animals—and most purchasers buy it. Sysco, a food distributor for many healthcare organizations, reports that antibiotic-free products account for less than 1% of its beef and poultry sales.
Sysco spokeswoman Wendy Olson said that demand from institutional purchasers and supply from a growing number of producers has increased, but that most institutions are unwilling to pay the higher prices.
More than 2 million Americans get antibiotic-resistant infections each year, and at least 23,000 people die from them, according to the report Antibiotic Resistance Threats in the United States, 2013, issued by the Centers for Disease Control and Prevention
. It cited studies estimating that antibiotic resistance adds $20 billion to U.S. healthcare spending each year. “Scientists around the world have provided strong evidence that antibiotic use in food-producing animals can harm public health,” according to the report.
Each year, nearly 30 million pounds of antibiotics are fed to animals in the U.S., four times the amount used in human medicines. Much of the agricultural use of antibiotics is to prevent disease in healthy animals that live in crowded conditions or promote growth.
“When we look at the fact that 80% of antibiotics used in the U.S. are being used in animal agriculture, we have to look at how we could be more responsible and judicious in their use,” said Kathy Pryor, program director for the Washington Healthy Food in Health Care program.
Hospitals interested in serving antibiotic-free or reduced-antibiotic meat have to decide which labels or designations to select. Many USDA-approved and third-party labels are used to indicate that antibiotics have not been used or have been used only for therapeutic purposes. Some hospitals prefer meat products from farms and ranches that never use antibiotics, while others are amenable to therapeutic-only use of antibiotics.
Physicians, nurses and other faculty members at the University of California San Francisco Medical Center spearheaded the passage of a 2013 resolution calling on the UCSF food service to phase out purchases of meat produced with the use of nontherapeutic antibiotics and urging all University of California campuses to follow its lead. That led to the UCLA Health System serving only antibiotic-free beef and chicken in its two biggest hospitals. “Since our mission is advancing health worldwide as a university and a health system, we decided to put our money where our mouth is,” said Dan Henroid, director of nutrition and food services and sustainability officer for UCSF Medical Center.
But one hurdle for hospitals that want to change their food-sourcing policy is that large suppliers do not always have antibiotic-free or reduced-antibiotic meat products available.
OHSU Hospital addressed that challenge by partnering with Carmen Ranch, a local producer that raises only antibiotic-free, grass-fed beef. The ranch was selling just 15 head of cattle wholesale in 2010 when the hospital approached its owners about buying antibiotic-free beef. Today, Carmen Ranch sells 400 cattle wholesale and supplies 45% of OHSU Hospital's beef each year.
“We were able to collaborate and construct the infrastructure that was needed to get locally grown grass-fed and grass-finished beef to our hospital here in Portland,” Copen said.
OHSU also worked with Carmen Ranch to find a butcher that would keep the antibiotic-free meat separate from meat from conventionally raised animals. The hospital's purchasing commitment to Carmen Ranch persuaded a local food distributor to carry the ranch's products, which increased its customer base and allowed it to expand production.
UCSF Medical Center took a different approach to create a reliable source of antibiotic-free beef. It collaborated with six health systems, representing eight hospitals, to agree on specifications for three products—beef patties, bulk ground beef and stew meat. The six organizations have a combined annual demand of 80,500 pounds for the three products. That pooled purchasing convinced a major distributor, U.S. Foods, to start carrying products from Estancia Beef, an antibiotic-free meat producer based in South America.
Hospitals are finding creative ways to offset the higher price of reduced-antibiotic meat and find vendors with an adequate supply.
Whether they are working with institutional distributors, international meat producers or small local ranches, hospitals that want to serve antibiotic-free or reduced-antibiotic meat must make a long-term purchasing commitment to create a reliable supply, Copen said. “If (health system) leadership sees that patient health is at stake, the commitment of resources toward sustainable meat purchases makes sense,” she said.
Also, reduced-antibiotic meat and poultry products are generally more expensive than traditional meat products. To offset the higher cost, in California about 65 hospitals participating in the Healthy Food in Health Care initiative have adopted “less meat, better meat” programs, in which they pledge to reduce meat servings by 20%. They use the savings to purchase healthier products, including reduced-antibiotic meat.
At UCSF Medical Center, each week starts with “meatless Monday,” featuring meatless options at the entrée and chef stations in the cafeteria, and meatless options at the grill, deli, pizza and soup stations. Beyond that, a vegetarian option is available for every patient meal, and breakfast meat is served only if a patient requests it.
UCSF also raised its burger prices—from $3.50 to $4.50—to offset the higher costs of antibiotic-free beef and launched a marketing campaign to make sure that cafeteria diners understood why. Henroid wants patrons to know that the beef patties taste different because they come from grass-fed cattle, and that the healthier food warrants a higher price.
Overlake Hospital reduced portion sizes for the more expensive antibiotic-free meats. Linaman and his colleagues now serve 4-ounce burger patties and chicken breasts—smaller than in the past. “Four ounces of protein is plenty, at least in the healthcare world where we are dealing with patients,” Linaman said. “We know people aren't going to come here expecting a quadruple burger like they would at a burger place. And it's not our goal to serve that kind of food anyway.”
Lola Butcher is a freelance journalist based in Springfield, Mo.