Healthy Food in
Healthcare:
Ecological
Health and
Food
Production
David Wallinga, MD
Food & Health Program
Institute for Agriculture
& Trade Policy
[email protected]
www.iatp.org/
Outline
•
•
•
•
•
A Chronically ill Food System
Unhealthy U.S. Agriculture
Nutritional consequences
Ecological health consequences
A role for health care
What’s healthy?
Not our population
•
sin
i
R
e
s
i
gd
e
s
a
Poor nutrition is a risk
factor for four of the six
leading causes of death
in the United States —
heart disease, stroke,
diabetes and cancer.(1)
Source: Anderson RN, Smith BL. (November 7, 2003) “Deaths: Leading Causes
for 2001” National Vital Statistics Reports 52(9):1-85. Centers for
Disease Control & Prevention, National Center for Health Statistics, as
summarized online at Fast Stats A-Z: ww.cdc.gov/nchs/fastats/lcod.htm
What’s healthy?
Not our food system
De
cre
as
in g
qu
ali
ty ?
Unhealthy foods are cheap
• “Obesity tends to be found in higher rates among
those with the highest poverty rates… it is simply
cheaper to eat an unhealthy diet packed with energydense foods than one with lean meats, fish, and
vegetables. ”
Dr. Adam Drewnowski, the director of
the Center for Public Health Nutrition at
the University of Washington
“Good” foods are too expensive
http://www.ers.usda.gov/Publications/CCR14/ccr14.pdf
Outline
• A Chronically Ill Food System
• Unhealthy U.S. Agriculture
– Nutritional consequences
– Ecological health consequences
• A role for health care
Characteristics
Industrial, “modern” agriculture
Characteristics
Specialized vs.
Diverse or resiliant
http://www.ers.usda.gov/publications/EIB3/charts.htm#fig4
Characteristics
Grain overproduction
‰ 25% of all US
farmland – 80
million acres –
grows corn
‰ 1972: One county
in 12-state “corn
belt” has › 85% of
total acreage
in corn & soybeans
‰ 1998: 28 counties
Sources: Wise T. 2005. http://ase.Tufts.Edu/gdae; Christensen 2002. Dr. Paul Porter, University of
Minnesota
Characteristics
Overproduction drives cheap prices
maintained through public policy
R e a l P ric e o f C o rn & S o y b e a n s ,1 9 7 5 - 2 0 0 5
in 1984-86 dollars
$1 2
$1 0
Soybeans
$8
C o rn
$6
$4
$2
$0
1 9 75
1 9 80
1 9 85
1 99 0
19 9 5
20 0 0
S o u r c e : U S D A E c o n o m ic R e s e a r c h S e r v ic e ,
c r e a te d b y IA T P
Characteristics
Overproduce fats, sugars, grains &
meat
Added Sugars
Pyramid Recommendation
2000 Food Supply Servings
Added Fats
Grains
Meat
Dairy
Fruit
Vegetables
0
2
4
6
Servings Per Capita Per Day
Source: USDA ERS FoodReview, Vol. 25, Issue 3.
8
10
12
Characteristics
Feed, not forage (pasture)
• Surplus grain fed to
livestock
⎯ 55-65% of U.S. corn
⎯ 45-50% of soybeans
• Pathogens (E coli
O157:h7)
• Changing nutritive value?
Characteristics
Confinement vs. Pasture-based
• “Confined” = indoors
(poultry, swine, dairy)
9 Limited (no) outdoor
access
9 Closed worker
environment
9 Potentially more biosecurity
Characteristics
Meat production vs. Animal
husbandry
9 Gestation crates
9 Early weaning,
debeaking etc.
9 Growth promoting
synthetic hormones
& feed additives
Characteristics
Geographic concentration vs dispersal
Broiler chicken
production (2003)
Characteristics
Resource (fossil fuel) intensive
• Energy intensive
–
–
–
Chemical fertilizers
Herbicides, pesticides
Indoor fans, lights
• Water intensive
What’s “healthy” food?
An Ecological Approach
Outline
• A Chronically Ill Food System
• Unhealthy U.S. Agriculture
– Nutritional consequences
– Other ecological health consequences
• A role for health care
Nutrient decline in conventionally grown crops
Davis DR. Presentation at the AAAS
Annual Meeting, February 2006
‰ Recent studies of vegetables,
fruits and wheat find median
declines since the mid-20th
century of about 5% to 35% in
concentrations of some vitamins,
minerals and protein.
– Mayer AM, 1997
– Davis DR et al., 2004
– White & Broadley, 2005
http://php.aaas.org/meetings/MPE_01.php?detail=1034
Davis DR 2006
Significant declines in Fe, Ca, Cu
Trends in 16-50 U.S. crops, 1930s to 2004
www.ingentaconnect.com/content/jhsb/jhsb/2005/00000080/00000006/art00003
Davis DR 2006
The “dilution effect”
“Dilution effect” – Yieldenhancing methods tend to
decrease nutrient
concentrations
Source: Jarrell WM, Beverly RB. Advances
in Agronomy, 1981; 34:197–224
Emerging evidence:
Declines in secondary plant metabolites
“There is a growing concern that the levels of some
phenolics may be lower than optimal for human health
in foods grown using conventional agricultural
practices.”
Source: Assami DK et al., 2003. J Agr Food Chem.
http://www.mindfully.org/Food/2003/Phenolic-Ascorbic-Acid25jan03.htm
Davis DR 2006
Organic strawberries superior
at suppressing colon & breast cancer cells
Cell
growth
Cell
growth
We eat more corn and soybean
products than is healthy
Added Sugar Consumption Nearly Doubled,1909 -1998
Soy oil available for food consum ption
1909-1999, USA (lbs/person/y).
30
25
lbs/person/y
20
15
10
NIH scientist, Dr.
Joseph Hibbeln,
estimates the
average
American eats
10% of total
calories as
soybean oil
25 lbs/person/y (1999)
0.02 lbs/person/y (1909)
5
0
1900
1920
1940
1960
1980
2000
NIH. Hibbeln et al. http://efaeducation.nih.gov/sig/efa2.html
Overconsume fats, sugars, grains &
meat
Underconsume fruits
and veggies
Added Sugars
Pyramid Recommendation
2000 Food Supply Servings
Added Fats
Grains
Meat
Dairy
Fruit
Vegetables
0
2
4
6
Servings Per Capita Per Day
Source: USDA ERS FoodReview, Vol. 25, Issue 3.
8
10
12
Outline
• A Chronically Ill Food System
• Unhealthy U.S. Agriculture
– Nutritional consequences
– Other ecological health consequences
–
–
–
Toxic residues
Antibiotics and hormones
Concentration of manure, pollution
• A role for health care
Pesticide use
Residues on food
Percent
USDA Testing Program Pesticide Detections:
Fruit and Vegetables
80
70
60
50
40
30
20
10
0
Any residue
Multiple residues
Conventional
IPM
Organic
http://www.consumersunion.org/food/organicsumm.htm
Pesticides in children’s diets
Urine monitoring for organophosphates
‰ Dimethly OP insecticide
metabolite found in 87% of 39
Washington children, ages 2-5,
consuming 75% organic or
“conventional” juices and
produce
‰ 24-hr urine collection:
− 9-fold higher mean
insecticide concentrations in
children eating
“conventional” diets
Curl CL, Fenske RA, Environ Health Perspect. 2003;111(3):377-82.
http://www.ehponline.org/docs/2003/5754/abstract.html
Pesticides exposure begins in the womb
(Whyatt et al. 2001)
• Meconium (first stool) assayed in 20 newborns (NYC):
N
O
R
M
A
L
DEP (range 0.8-3.2 ug/g)
– 20 of 20 exposed to DETP
(range 2.0-5.6 ug/g)
T
– 19 of 20 fetuses exposed to
O
• Detections:
N
– Looked for DEP & DETP, 2 ethylmetabolites common to several
organophosphate insecticides:
chlorpyrifos, diazinon, parathion
Nearly all newborns tested had in utero exposure to neurotoxic
organophosphate insecticides. In animals, these exposures (for
chlorpyrifos, diazinon) have been linked to adverse effects on brain
development and behavior
Pesticide Use
Worker Impacts
• “Average” person has
13 pesticides in their
body
• Use of agricultural
chemicals known to
cause cancer in CA
increased 127% from
1991 to 1998.
‰ In CA farmworkers are 59-70%
more likely to develop various forms
of cancer that the rest of the
population.
Estimated U.S. atrazine use:
74-80 million pounds per year
Tyrone Hayes et al. 2002
Testes
N
O
1,000,000
T
ATRAZINE
N
O
R
M
A
Ovaries
Recommended
application level
L
Testis
10,000
Rivers
1.0
Safe short term
Surface water
Safe for drinking water,
3ppb
Rain anywhere
0.1 PPB
Hermaphroditic frogs
100
Ovaries
Run-off
Midwest streams
Rain
Toxic residues
Arsenic
• Uses
„
Growth promotion
„
Pigmentation
„
“Prophylaxis” - compensate
for growing conditions
‰ Not approved in Europe
70 percent or more of 8.7
billion broiler chickens annually
are fed arsenic (EPA)
and arsenic
‰ “We see [inorganic arsenic] emerge in less than 10 days,
which is much faster than previously observed.” John
Stoltz, author of the study.
‰ “I am concerned about the potential contamination of
groundwater with inorganic arsenic in my local region [in
Maryland], because we have a lot of poultry farms and
most people here get their drinking water from
groundwater,” says Ellen Silbergeld of the School of
Public Health at Johns Hopkins University
A Chronically Ill Food System
Playing ChickenUnhealthy
(IATP, U.S.
2006)
Agriculture
Nutritional consequences
‰ 55% of raw, supermarket
Ecological health consequences
chicken tested had
detectable
Toxic
residues
arsenic
Antibiotics and hormones
Effects of concentration
‰ Nearly three-quarters
of care
A role for health
breasts, thighs and livers from
conventional producers
carried detectable arsenic
(LOD 2 ppb).
www.iatp.org
Outline
•
•
•
•
A Chronically Ill Food System
Unhealthy U.S. Agriculture
Nutritional consequences
Ecological health consequences
– Toxic residues
– Antibiotics and hormones
– Effects of concentration
• A role for health care
Antibiotics in Agriculture
•Therapeutic Use
– Treat sick animals or
those likely to get sick
because of illness in the
herd or flock
• Non-therapeutic Use
– Given to healthy livestock &
poultry on routine basis
„
Growth Promotion
„
“Prophylaxis” - compensate for
unsanitary, stressful growing
conditions
– Added to feed
– Use of antibiotics important
to human medicine
Antibiotics are routinely added to feed in
conventional, industrial-style meat
production
Livestock feed use accounts for
more than 70% of all antibiotic use in US. (UCS 2001)
The More We Use ‘Em….
….The Faster We Lose ‘Em
“[B]ecause we share pathogenic and
benign bacteria with other humans
and animals
and because
“We exist
in the bacteria
readilybacterial
transfer genes
among
world,
not
themselves
…. once
multiresistant
bacteria
in ours.”
bacteria
proliferate
a clinical or
Source:
Levy 2000.in
Presentation
at the Emerging
Infectious they can
agricultural
ecosystem,
Diseases Conference. Available via
spreadwww.cdc.gov;
to other ecosystems.”
Source: Nandi et al. 2004. PNAS
We’re running out of working
antibiotics
• Without effective action,
treatments for common
infections “will become
increasingly limited and
expensive – and, in some
cases, nonexistent.”
www.cdc.gov/drugresistance/actionplan
Most agree on what needs doing
Institute of Medicine
“Clearly, a decrease in the
inappropriate use of antimicrobials
in human medicine alone is not
enough. Substantial efforts must
be made to decrease inappropriate
overuse of antimicrobials in animals
and agriculture as well."
Source: Smolinski MS, Hamburg MA, Lederberg J, editors. Microbial threats to health:
emergence, detection, and response. Washington: Institute of Medicine; 2003.
Human impacts: resistant Salmonella
– Antimicrobial use in food animals
results in resistant Salmonella
(accounting for as much as 90% of
resistance, by IOM estimates), and
these are transmitted to humans,
usually through the food supply.
Angulo F et al. 2000; IOM 1989
– White et al, NEJM (2001)
⎯200 samples of ground meat
⎯20% with salmonella
ƒ 84% resistant to 1 abx
ƒ 53% resistant to 3 abx
ƒ 16% resistant to ceftriaxone
Keokuk County Children & Asthma
Merchant et al. 2005. EHP
Prevalence of 1 or more
asthma outcomes:
‰ Doctor-diagnosed
asthma
‰ Doctor-diagnosed
asthma/medication for
wheeze
‰ Current wheeze
‰ Cough with exercise.
Hormones in Agriculture
Recombinant Bovine Growth Hormone
(rBGH)
•
Banned in Canada,
Western Europe,
Japan, and Australia
•
Animal welfare
concerns
•
Antibiotic resistance
concerns
•
Economic impacts
•
Cancer risks
Outline
•
•
•
•
A Chronically Ill Food System
Unhealthy U.S. Agriculture
Nutritional consequences
Ecological health consequences
– Toxic residues
– Failing antibiotics
– Effects of concentration
• A role for health care
Effects of Concentration
•
Of manure
•
Of pollution
•
Of ownership
Food Miles
• Typical produce item
now travels about 1,500
miles from farm
9 Trucks moving food freight
account for 40% of road
freight in UK
9 Head of CA lettuce
shipped to Washington
D.C.require 36x fuel
energy to transport than
food energy it provides.
• Indirect impacts
9 Diesel air pollution
9 Oil dependence
Concentration of untreated waste
‰ Sheer Volume
– 2.7t lbs. of animal waste
yearly (575b lbs. of
manure dry matter –USDA
2001)
– 3 times volume of human
waste (68 Federal
Register 7180, 2003)
‰ Disposal issues
– Impossible to store longterm
– Uneconomical to transport
– Sprayed or land-applied,
often to excess
Degrading manure, animal bedding:
A hazardous mixture
‰ Toxic gas mixtures (VOCs,
ammonia, H2S)
‰ Airborne particles (dust,
animal dander, hair, feces,
endotoxins)
‰ Antibiotic-resistant bacteria,
pathogens
‰ Feed additives (antibiotics,
heavy metals)
Manure-related air pollutants
Known risks to workers:
“Extensive literature documents acute
and chronic respiratory diseases and
dysfunction among workers, especially
swine and poultry workers, from
exposures to complex mixtures of
particulates, gases and vapors within
CAFO units.”
– Iowa Air Quality Study (2002): Iowa State
University & University of Iowa Study Group
Concentration & Water
Quality
“[S]ome members felt more
strongly on this issue… These
members feel the present
system of CAFO production
disposes of too much manure
in too small an area exposed
to uncontrolled meteorological
conditions to realistically
expect acceptable water
quality.”
Iowa Air Quality Study 2002
Water pollution concerns
•
Nutrients. According to the EPA,
hog, chicken and cattle waste has
polluted 35,000 miles of rivers in 22
states and contaminated
groundwater in 17 states.
•
Pfisteria
•
Nitrates
⎯ Linked by limited human data to
elevated risks for non-Hodgkins
Lymphoma, diabetes (Weyer et al.
2001; Kostraba et al., 1992; Parslow et
al. 1997)
Can food be produced another way?
Absolutely
‰ No or drastically fewer
antibiotics
‰ No arsenic
‰ More local
‰ Less concentrated
‰ Less subsidized, with living
wages for farmers and
workers
We did it for millenia
Denmark’s phase –out
WHO Experts’ Evaluation (2003)
–
Dramatic decrease in resistant bacteria
•
in animals
•
in meat
•
in humans
– Eliminating the routine use of antibiotics in
livestock reduces human health risks without
significantly harming animal health or farmers’
incomes
Sources: Wegener HC. Current Opinion in Microbiology 2003; World Health Organization. Impacts of
antimicrobial growth promoter termination in Denmark: The WHO international review panel’s
evaluation of the termination of the use of antimicrobial growth promoters in Denmark. 2003.
Davis DR 2006
Organic production enhances
antioxidant, CLA qualities of foods
‰ Organically grown produce offers
significantly enhanced healthpromoting qualities, contributing
to the achievement of important
national public health goals.
– Higher consumption of
antioxidants possible without
increasing caloric intake
http://php.aaas.org/meetings/MPE_01.php?detail=1034
Organic diet lowers pesticides in children to
non-detectable levels
Lu et al. 2006. Environ Health Perspect 114:260–263
“Organic diets significantly lower children’s dietary
exposure to organophosphorus pesticideds”
‰ “We found that the median urinary
concentrations of the specific metabolites
for malathion and chlorpyrifos decreased
to the nondetect levels immediately after
the introduction of organic diets and
remained nondetectable until the
conventional diets were reintroduced.
Feeding beef, dairy cattle on grass
improves the fat profile of the beef, dairy
Grass-fed or pasture raised cattle:
‰ Almost always produce steak,
ground beef lower in total fat
than conventional
‰ Tend to have steak with higher
levels of the omega-3 fat, ALA,
and sometimes with higher
levels of EPA/DHA.
‰ Tends to produce milk with
higher levels of ALA
Clancy K. 2006. UCS. www.ucsusa.org/
Nutrients – CLA
Pasture vs. Grain-fed
Grass-fed or pasture raised cattle:
‰ Produce milk with consistently
higher levels of CLA.
‰ Produce ground beef usually
with higher levels of CLA.
Clancy K. 2006. UCS. www.ucsusa.org/
Outline
•
•
•
•
•
A Chronically Ill Food System
Unhealthy U.S. Agriculture
Nutritional consequences
Ecological health consequences
A role for health care
A strategic role for health care
• Provide “healthier” food to staff, patients
• Create markets
– The average hospital serves more than a million
meals each year.
– Hospital and nursing home food expenditures
combined exceed $6 billion. (conservatively)
• Exert leadership within health care by
advocating for more sustainable food
production systems
April 28, 2006
“[Mayor Menino] urged … health centers, and community-supported agriculture
groups to become partners in order to bring more locally grown fruits and
vegetables directly to the city’s neighborhoods….
Those in attendance at today’s conference included representatives from
Massachusetts General Hospital, Brigham and Women’s Hospital, The
Food Project, Project Bread, Blue Cross/Blue Shield of Massachusetts, the
Conference of Boston Teaching Hospitals, Boston After School and Beyond,
and the Boston Public Health Commission.”
Kaiser Permanente
Comprehensive Food Policy
Vision:
Kaiser Permanente aspires
to contribute to the
creation of healthy food
systems reflecting
practices that are
ecologically sound,
economically viable,
culturally appropriate and
socially responsible.
“Eating is a Moral Act”
“The right to food includes a
right to safe, healthy, nutritional food and a system which
will protect health. We need to
support a sustainable food
system which does not distort
food quality and safety
provisions. Eating is a moral
act, our food should be good to
eat!”
--
United States Catholic Bishops, Report of the
Ad Hoc Task Force on Food, Agriculture, and
Rural Concerns, November 18, 1988
David Wallinga, MD
Food & Health Program
Institute for Agriculture
& Trade Policy
[email protected]
www.iatp.org/