Over the last 20 years, we have witnessed a transformation in the way healthcare buildings are designed and constructed. At the heart of this new sustainable (or green) design movement is a systems approach that recognizes the interconnections between design, operations, and environmental health. We know intuitively, it is not possible to be healthy on an unhealthy planet. As a result, it is logical for the healthcare industry to positively influence human health through the thoughtful design, construction, operation, and maintenance of healthcare facilities.

A similar transformation and ethos is now occurring at another nexus of public health: food. How we produce and distribute food has a profound impact on ecological health, and by obvious extension, on human health. Our recent 40-year failed experiment with global industrialized food production and distribution has made these concerns visible. We have created a system that favors the production of animal products and highly-refined, calorie-dense substances more than healthier, physiologically compatible foods such as fresh fruits and vegetables, whole grains, and meats originating from healthy animals. We now have a food system misaligned with the U.S. dietary guidelines; hidden behind these nutritional imbalances is a system that is largely reliant on methods of production and distribution that negatively affect human and environmental health.

In the United States, the typical food item now travels between 1,500 to 2,400 miles from farm to plate. This energy intensive system disconnects growers from the consumers, increases opportunities for food contamination and loss of nutrients during transportation, and plays a role in climate change emissions. Approximately 70% of antibiotics are given to healthy animals to promote growth and to compensate for poor husbandry practices (http://www.ucsusa.org/food_and_environment/antibiotics_ and_food/hogging-it-estimates-of-antimicrobial-abuse-in-livestock.html); these are linked to MRSA (methicillin-resistant Staphylococcus aureus) and the spread of other antibiotic resistant bacteria (http://www.cdc.gov/eid/content/13/12/1834.htm). Humans now contain, on average, 13 pesticides within our bodies (http://www.panna.org/docsTrespass/chemicalTrespass2004.dv.html), and studies demonstrate that infants are born with pesticides in their bodies (http://lib.bioinfo.pl/pmid:17949707). In communities across the nation, typically poor neighborhoods, there are food deserts—places where mainstream grocery stores are absent or distant and there is no access to healthy food (and yet there is ample access to convenience stores and fast food). Collectively, these elements are indicators of a failed food system design.

Fortunately, we are witnessing a nascent movement that is beginning to address food systems from an ecological health perspective. At the forefront of this sea change is the healthcare community. As of February 2008, more than 100 hospitals have signed the Healthy Food in Healthcare Pledge (see http://www.healthyfoodinhealthcare.org). The pledge represents a commitment to support localized, sustainable food systems. Pledge signers acknowledge that healthy food must be defined not just by nutritional quality, but equally by the creation of a food system that is that is economically viable, environmentally sustainable, and supportive of human dignity and justice.

The role of the healthcare community is important not only because of its moral authority, but also because of its substantial purchasing power, which influences both public policy and the supply chain. Across the country, we find positive examples from institutions of all sizes. Vermont's Fletcher Allen Health Care purchases local hormone-free meat, raised without the use of antibiotics; serves local produce, fair-trade coffee and milk produced without the use of rBGH (a hormone given to increase milk production and banned in most industrialized countries except the United States). The facility composts waste and educates the community about the links between local food, nutrition, and health.

In Connecticut, New Milford Hospital has established a series of community events aimed at supporting local farm producers and educating the public about healthy eating and the connection between local food production and health. The facility is also changing their food service operations to accommodate local, sustainable food. In Chicago, Swedish Covenant is providing organic food, cage-free eggs, local grass-fed beef, and fair trade coffee. The Oregon Health and Science University is contracting directly with producers that will grow for the facility, is composting food waste, and has established an on-site convenience store with “on-the-go” food and produce free of artificial food dye, high-fructose corn syrup, and GMOs (genetically modified organisms).

Across the country, hospitals have begun to introduce on-site farmers' markets, providing local citizens with access to healthy, fresh produce. Research is demonstrating that these markets are increasing uptake of fresh foods, while providing and supporting social networking. Facilities have also designated space for community-supported-agriculture food box programs. In some instances, health insurance companies are now providing rebates for food box participants.

In 2007, the American Planning Association and American Public Health Association adopted policies and positions supporting new approaches and/or necessary interventions required for the transformation to a healthy, sustainable food system. In 2008, the pilot version of the Green Guide for Health Care (GGHC) Operations will include a new series of food-service related credits designed to help the healthcare community support a healthy food system. So, for example, is there access to fresh healthy food in the community a hospital serves, and if not, can we design space for a local farmers market? Does the cafeteria and kitchen design allow food waste collection and composting? What benchmarking and tracking tools are in place to monitor procurement and support of local, sustainable foods? Does a hospital recognize the connection between food production and distribution system and have they formalized this important aspect of health promotion through an internal sustainable food policy?

Across the country hospital and healthcare systems are intentionally changing building design and construction practices to promote health. We must be similarly intentional with how we produce and distribute our food. If experience from the GGHC design and construction holds, the design, planning, and healthcare community will play an important role in building a sustainable food system that is healthier for people and the planet. HD

Jamie Harvie, PE, is Executive Director of the Institute for a Sustainable Future and Co-Coordinator of the Health Care Without Harm “Healthy Food in Health Care Initiative.” He is also a member of the Green Guide for Health Care Steering Committee.

For more information, see http://www.healthyfoodinhealthcare.org.