“Farm to School” and

“Healthy Hospitals Initiative”: Change Agents in

Food System Reform

Marydale DeBor JD, Lecturer, Yale School of Medicine, Department

of PsychiatryManaging Director, Fresh Advantage™ LLC

New Haven, CT

Farm to Cafeteria ConferenceAugust 2-5, 2012

Overview• Solving “Weight of the Nation” NEJM, August

2, 2012• Health Care Sector- Where are We?• One Model: Plow to Plate• National Hospital Initiative: HHI.org• Partnership with Farm to School Movement• Key points of possible collaboration identified

at this conference

We all know what the problem is……………starting with those ubiquitous sugary beverages .

1 out of 3 children born in 2000 or after will develop Type 2 Diabetes

The Moral Dilemma

• Given the evidence of harm done by consumption of food and beverages that contribute to obesity and related disease,

How do we, as health care professionals….reconcile our mission, the oath that physicians take, with this:

“Food served in children's hospitals rated largely unhealthy”

UCLA News December 1, 2001

Two Interdependent Systems: Food and Health Care are Broken• Illness (physical and mental), hunger,

malnourishment, comprising ability to learn and function

• Require leadership to be fixed

• Health care sector should be leading, not absent..BUT

• Farm to School is the true Pioneer

One Hospital’s ExperienceSee: “Plow to Plate: The Hospital as Change AgentSustainability: The Journal of Record, April, 2012

Caveat:

• Plow to Plate is far from the norm. The model is premised upon the notion that hospitals (and physicians) must become public health practitioners---foreign to how system works now, but will be compelled by the economics of current situation and the implementation of reform policy and regulation. It will take generations of hard work and advocacy.

• Fletcher Allen is the goal, but it is exceptional

Start with the Basics: Think…

“[Local] Food is Primary Care™”

Use the resources available: Local, Regional Farms.. Supporting local economy

Community Coalition

Hospital as

LEADER

Physicians & APRNs

Local/State Policymakers

Media

FarmersFIRST!

Farmers’ Markets

Restaurants / Chefs

Schools

Social Service

Agencies (Youth & Seniors)

Department of Agriculture

Churches

Local Department of Health Farmland

Preservation Advocates

Parks and Recreation

Copyright 2012 Marydale DeBor 11

RFP process, new vendor, community and hospital programs with health objectives

• Make it a “food movement”• Make it fun, delicious, engaging• Don’t preach, don’t use the “N” word• Ingredient, calorie count and weight watcher data

on all menus (nobody cared, or read them)• Make it taste good, and look beautiful, above all

• Engage the media

FACULTY: Doctor, Chef and Fisherman

New Milford Youth Agency Program: after

schoolwww.youthagency.org

Consumer Supported Agriculture- Our

Employees30 Shares Guaranteed by

HospitalSold Out in Less Than 1 Week

Healing/Learning Culinary Garden

Building a Food Learning Hub, Not Just a Food Service

Success Documented Widely

• April, 2012 “Gold Award” Connecticut Quality Improvement Partnership

• In May 2011: CHANGE COMES TO DINNER by Katie Gustafson

• 2011 –Connecticut Magazine; NY Times

• 2010 –Greening Food and Beverage Services, by Cheryl Baldwin, GREEN SEAL Guide to Transforming the Industry

• 2009 Planetree Award for Nurturing Foods

• 2009 Glynwood Center for Sustainability/Good Food for Health Award

Poster Presentation: Institute for Health Care Improvement National Convention-2011

What still needs work

• Supply and Distribution

• Knowledge deficit on part of physicians

• Cardiologist insists we put soda back in cafe…….a matter of individual “choice”See NEJM article re : food industry messaging strategy

• Vending machines; 24/7 healthy food service

Opportunities for Hospital-School Collaboration

• Establish and Foster dialogue with local hospitals and physicians, nursing organizations: The Communication/Relationship Imperative! Saturday plenary

• Tell your story: to physician groups in your states (state and local chapters of American Academy of Pediatrics, Family Medicine, Psychiatry, Internal Medicine….) Friday session

FTS and Health Care Sector:Collaboration Opportunities

• Supply/Distribution/Procurement– Include hospitals in

• your purchasing coops (Friday sessions: Jeremy West, Greely CO)

• Clean, cut, prep processing centers (Doug Davis, Burlington)

• Long term storage facilities

• Training of food service workers

Hospital-School Collaboration: Metrics

• We don’t need (only)high tech interventions to fix this!– But let’s get distributors to adoptllicense Black

River’s tracking methodologies! Saturday plenary

– HHI has data collection system; join forces– Health care has resources: they have to measure

everything! Maybe can help with metrics, esp if academic center

Collaboration Opportunities

• Advocacy, Advocacy, Advocacy !!!!

• Join New England Farmers Union—or your

state chapter of National Farmers Union– Progressive policy platform– advocates at federal level for family farms and

all of the policies and programs upon which Farm to School depends!

www.nfu.org newenglandfarmersunion.org

Our Future: Our Children

Plow to Plate Youth Chef Advocates, 2009

To learn more….• Contact: Marydale DeBor JD, Founder, Managing Director

• MDeBor@freshadvantage.com 203-745-1796 Cell: 860-248-9854