Balanced Menus Serve healthy food. Mitigate climate change ...

Balanced Menus Serve healthy food. Mitigate climate change ...

Health Impacts of the Industrialized Food System Food Matters: A Clinical Education and Advocacy Program Insert Presenter Name and Title Insert Date and Location of Presentation Food Matters: A Healthcare Education and Advocacy Program To inspire clinicians to: Provide anticipatory guidance to patients and families about the importance of healthy foods and a healthy food system.

Work within health care facilities to create a healthy food service model that is recognized as integral to a preventive health agenda. Work within the community at a local, regional and national level to promote policies that support the development of a healthy, accessible, and fair food system. Components of the Food Matters Program Clinical advisory group Clinical curriculum development and trainings

Nationwide clinical network Maternal/Child health calendar Video for waiting rooms, clinics, exam rooms, community meetings Healthy Food in Health Care campaign for healthier, more sustainable foodservice Guiding Rationale An Ecological Health Framework The individual in the context of family, community, society and ecosystem Guiding Rationale

A Food Systems Approach Guiding Rationale A Food Systems Approach Healthy food comes from a food system that is ecologically sound economically viable, and socially responsible. Interconnections Between Nutrition and Environment

Barilla Centre for Food and Nutrition www.barillacfn.com Guiding Rationale Healthcare Advocacy Hospitals and healthcare professionals can be leaders and advocates for a food system that promotes public and environmental health. Healthcare professionals have credibility, influence, and expertise. Anti-smoking campaigns can be good models. Farm as Factory The economic

reductionism of modern industrial agriculture subjects the farm to the simplification, standardization and abstraction of a factory. - James/ Scott, 1998 Focus on inputs outputs Specialization

Resource intensiveness Large-scale Externalities of the Industrialized Food System HEALTH SOCIETY ENVIRONMENT Chronic diseases (cancer, diabetes, obesity)

Antibiotic resistance & food-borne pathogens Pesticide exposure (cancer, reproductive, neuro-developmental, and endocrine impacts) Asthma and respiratory illness Food injustice (hunger, food deserts)

Local economic decline Labor issues Water and air quality Energy use and GHG emissions

Loss of crop and biological diversity Soil erosion Where in the Food System do Health Concerns Exist? Production Processing Pesticides, chemical fertilizers, antibiotic and hormone use in meat and dairy production,

infectious agents, arsenic, environmental degradation Increased reliance on imported, unregulated processed foods; melamine; residual mercury; food-borne illness Bisphenol A (BPA), phthalates, Packaging / Transportation perfluorochemicals, air quality, food miles, widespread use of plastics leading to large volumes of waste both in landfills and incinerated, environmental degradation Consumption

Fast food, sugar-sweetened beverages, high fructose corn syrup, marketing, obesogens, nutritionally deplete foods Toxics in the Food System Pesticides Bisphenol A

Phthalates Dioxins PCBs Metals lead, mercury, cadmium, manganese PBDE flame retardants Critical and Sensitive Windows of Development Blastocyst Embryo Fetus

Infant Child Adolescent Childhood Periconception Prenatal Postnatal Environmental Exposures Immediate & Long Term Consequences

Widespread exposure to chemicals with reproductive/developmental toxicity Based on analysis of representative sample of U.S. population by NHANES 2003-2004. Note, not all women were tested for all Body Burden: Pesticide Pollution in Children Pesticide exposure is ubiquitous among pregnant women. Pesticides have been detected in human urine, semen, breast milk, ovarian fluid, cord blood, and amniotic fluid.

Blood from the umbilical cords of 10 infants born in U.S. hospitals in 2004 showed an average of 200 industrial compounds, pollutants, pesticides and other chemicals, including 21 out of the 28 pesticides tested. www.ewg.org/reports/bodyburden Our Chemical Environment Over 85,000 synthetic chemicals in production 3,800 high production volume; used in quantities > 1 million lbs/yr ~900 active pesticide ingredients (EPA) ~ 3,000 in food processing (FDA)

Toxic Substances Control Act of 1976 (TSCA) Health data exists for < 10% of chemicals on the market 62,000 grandfathered in Potential for endocrine disruption is not assessed Cumulative exposures matter Persistent Bioaccumulative Toxicants (PBTs) Toxicity / vulnerable periods of development Bioconcentration

Persistence Mercury PBDEs Dioxins PCBs Pesticides DDT Heptachlor Dieldrin Chlordane National Pesticide Use Cumulative Exposures Add Up ~ 40% of US children may

have OP pesticide levels greater than benchmarks for neurological impacts Payne-Sturges D, Cohen J, Castorina R, et al. Evaluating cumulative organophosphorus pesticide body burden of children: a national case study. Environ Sci Technol. 2009 Oct 15;43(20):7924-30. Carcinogenic Pesticide Use in California CA Department of Pesticide Regulation Pesticide Use Reports, 2008. Mapped by CA Environmental Health Investigations Branch. Pesticides and Cancer Occupational exposure and cancer

Organophosphate Pesticides NHL, Leukemia Arsenical Pesticides Lung, Skin cancer Triazine herbicides Ovary Epidemiologic studies associate pesticide exposure with cancer in children Leukemia, neuroblastoma, Wilms' tumor, soft-tissue sarcoma, Ewing's sarcoma, non-Hodgkin's lymphoma, and cancers of the brain, colorectum, and testes

Non-Cancer Adverse Health Effects Prenatal Exposure to Organophosphate Pesticides Decreased Bayley MDI and PDI scores at 36 months (Rauh et al Pediatrics 2006) Greater likelihood of behavioral issues on CBCL (Rauh et al Pediatrics 2006) Abnormal primitive newborn reflexes (Brazelton

NBAS) (Engel et al. Am J of Epid 2007) Decreased birth weight and length (Whyatt et al. EHP 2004) Smaller Head Circumference (Berkowitz et al. EHP 2004) Decreased Bayley MDI at 24 mo. (Eskanazi et al, EHP Effects of Preconception and

Prenatal Exposure more Eskenazi B et al. Basic Clin. Pharmacol. Toxicol. 2008. OP Exposure in Children and ADHD 1139 children ages 8 15 (NHANES) Examined Urinary OP metabolites Diagnosis of ADHD by DISC-IV or Med use 10-fold in urinary DMAP associated with an adjusted OR of 1.55 (1.14 2.10) for ADHD

Children with dimethyl thiophosphate > median had OR of 1.93 (1.23 - 3.02) for ADHD compared with children with ND levels Bouchard et al. Pediatrics, 125(6), 2010 Agri-chemicals in surface water and birth defects in the United States 25 Winchester et al. Acta Paediatr. 2009 April; 98(4): 664669 Effects of Adult Male Pesticide Exposure

Sterility Altered semen quality Prostate cancer Women Hauser R. Semin Reprod Med. 2006; Swan SH. Semin Reprod Med. 2006; Effects of Postnatal Female Pesticide Exposure Men Men Age at puberty

Women and menarche Menstrual and ovarian function Fertility and fecundity Menopause Breast cancer Mendola P, Messer LC, Rappazzo K.. Fertil Steril. 2008; Diamanti-Kandarakis E et al. Endo Rev 2009 Farm Workers and Pesticides rates of many cancers &

respiratory illness Mills and Kwong 2001, Linaker and Smedley 2002, Zahm 1997 rates of birth defects & childhood leukemia Wigle et al. 2009, Van Maele-Fabry et al. 2010. 10,00020,000 acute poisonings per year in the U.S. EPA 1992, Blondell 1997, Calvert Magnitude of Exposure Prenatal OP exposure in a farm worker

cohort associated with lower mental development index scores at 24 months Median Maternal Urinary MDA level 0.82 mcg/L (Eskenazi at al EHP 2007) Child exposure through conventional produce diet Median Child Urinary MDA level 1.5 mcg/L (Lu et al EFP 2006) ----------A bit of apples and oranges? Pesticide Exposure Reduction OP residues dramatically reduced

(malathion, chlorpyrifos) in elementary school children with organic diets substituted for conventional diets for 5 days in a longitudinal designLu et al, EHP 2006 Choosing Produce to Reduce Pesticide Exposure www.ewg.org/ foodnews

Recombinant Bovine Growth Hormone (rBGH) Used to increase milk production in dairy cows udder infections, necessitating the use of antibiotics levels of insulin-like growth factor (IGF1) found in milk Banned in

Canada, Australia, New Zealand, Japan, all 25 countries of the Arsenic Use in Poultry Production Arsenic is fed to ~70% of US broilers Chicken meat can carry arsenic residues Chicken waste contains of arsenic dose 90% applied to cropland as fertilizer Fed as a protein source to beef cattle Water Contamination 13 million Americans drink water contaminated with arsenic beyond the safety standard of 10 ppb Never approved for use in all 25 countries of the European

Health Concerns Related to Arsenic Exposure Cancer (even at low levels of exposure) Neural tube defects Neurodevelopmental effects Diabetes Heart disease The Antibiotic Resistance Crisis Without effective action, treatments for common infections

will become increasingly limited and expensive and, in some cases, nonexistent. Source: www.cdc.gov/ drugresistance/actionplan/ United States Antibiotic Use 30 25 20 15 NonRx Animal

Rx Animal Human Rx ~80% is nontherapeutic use in livestock production Antibiotics widely used in livestock production: Erythromycin Tetracycline 10 Bacitracin

Penicillin 5 Other Sulfathiazole (soaps,pe Sulfamethazine 0 ts) Tylosin (macrolide) Millions of Virginiamycin pounds (streptogramin) Fluroquinolones Source: Union of Concerned Scientists, "Hoggin' It" 2001

(withdrawn in 2000) Agricultural Use of Antibiotics There is consensus among independent experts that antibiotic use in agriculture contributes to resistant bacteria affecting humans. Banned in Denmark and restricted in the European Union Routes of human exposure to resistant bacteria Via FOOD Antibiotics

Slaughter, Handling, Consumption (undercooked meat, cross-contamination) Animals Via WORKERS HUMANS (General Populace) Handling of Feed, Manure; transfer to family, community Via ENVIRONMENT

Bacteria Contamination of ground & surface water, spray fields by resistant bacteria AND undigested antibiotics from manure David Wallinga, Institute for Agriculture and Trade Policy Food Borne Illness in the U.S. >47.8 million cases annually

~ 3,000 deaths annually ~128,000 require hospital care 1/3 are from tainted meat Multiple routes of exposure The Isolation of Antibiotic-Resistant Salmonella from Retail Ground Meats 20% of supermarket samples in Washington

D.C. were contaminated with salmonella 84% of these isolates were resistant to at least one antibiotic Volume 345:1147-1154 October 18, 2001 Emerging Evidence Bisphenol-A (BPA) Widespread Human Exposure Over 90% of Americans have residues in their urine (CDC)

> 6 billions lbs produced / year Health Concerns Endocrine disruption Neurodevelopmental impairment Developmental toxicity Cancers Cardiovascular disease &

diabetes Obesogen/Insulin Resistance BPA and Phthalate Exposure: Findings from a Dietary Intervention 3 day fresh foods intervention Urine levels of BPA and DEHP metabolites significantly of mean concentrations of

BPA by 66% and DEHP by 53-56% Rudel RA, et al. 2011. Environ Health Perspect. 119(7):914-920 Chemical Structure Estradiol Endocrine Disrupting Chemicals Bisphenol A, PCBs, PBDEs, phthalates, organochlorine pesticides, atrazine Chemical compounds with the capacity to interfere with development, behavior, fertility and maintenance of homeostasis

Health concerns include: reproductive problems, early puberty, brain and behavior problems, impaired immune functions, various cancers Obesogens Bisphenol A, phthalates, non-stick PFOAs, and certain organophosphate pesticides Chemical compounds hypothesized to disrupt normal development or

homeostasis of metabolism of lipids, ultimately resulting in obesity Interplay between genes and fetal and early postnatal exposures National Academy of Sciences on Animal Data Studies of comparison between developmental effects in animals and humans find that there is concordance of developmental effects between

animals and humans and that humans are as sensitive or more sensitive than the most sensitive animal species. A Precautionary Approach An ounce of prevention is worth a pound of cure. When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically. -Wingspread Conference on the Precautionary

Principle HEALTH AND ENVIRONMENTAL COSTS ARE NOT REFLECTED IN THE PRICE OF FOOD OR ACCOUNTED FOR IN THE FOOD SYSTEM Nationally, Globally Regionally Communities Institutions Households Promoting health

David Wallinga, Institute for Agriculture and Trade Policy Making change In your practice Calendars available at www.HealthyFoodinHealthCare. org 51 Making change In Hospitals

Increase procurement of healthy food for healthy bodies, farms, communities and environment Make food a part of the healing process Lead by example and educate patients, visitors, and the community about healthy, sustainable food

Pool purchasing power to move the marketplace www.HealthyFoodinHealthcare.org Making change In Hospitals Over 380 Pledge signers in 26 states

www.HealthyFoodinHealthcare.org What Health Care Facilities Are Doing Buying local, organic, fair trade, rBGH-free, Procurement antibiotic and hormone-free, grass-fed, cageCafeteria & free Patient trays Reducing meat & sugar sweetened beverages Contracting with local and regional vendors,

farmers, distributors and processors On-site Farmers markets & hospital gardens Waste reduction - composting & reusable dishes Policy Healthy Food in Health Care Pledge Making change

In Hospitals Balanced Menus Challenge 4 Pilot Hospitals: Reduced meat by 28% in 12 months Achieved $402,000 savings Used savings to purchase more

sustainably-produced meat Saved the equivalent of over 1,000 tons/year reductions in greenhouse gas emissions 55 Making change In Communities Farm to School Farmtoschool.org Sustainable Table Sustainabletable.org

Community Food Security Coalition Foodsecurity.org Making change Nationally The Farm Bill Facebook - A Citizens Guide to a Better Food System Literature: Wallinga D. Contribution of Agricultural Policy to Childhood Obesity. Health Affairs. March 2010

Imhoff. Food Fight: The Citizens Guide to a Food and Farm Bill Webinars: www.HealthyFoodAction.org Sign the Charter at www.HealthyFoodAction.org Making change Nationally Healthy Food Action Making Health the Future of Food and Farming www.healthyfoodaction.org

Safer Chemicals, Healthy Families Reform Toxic Substances Control Act (TSCA) to keep toxins out of food www.saferchemicals.org Preservation of Antibiotics for Medical Treatment Act Sign the Health Care Without Harm Petition www.protectantibiotics.org Principles of a Healthy, Sustainable Food Food Matters Clinical Advisory Team Judy Focareta, RN Joel Forman, MD Sarah Janssen, MD

Preston Maring, MD Joanne Perron, MD Naomi Stotland, MD David Wallinga, MD Food Matters is made possible with generous support from: Rose Foundation Stonyfield Organics Profits for the Planet Program The Cedar Tree Foundation The Orchard Foundation W.K. Kellogg Foundation

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