Why Buy Local?

By Health Care Without Harm

The health care sector can increase access to delicious, healthy, fresh foods while addressing the social and environmental determinants of health in their communities, by creating jobs and contributing to a strong and equitable food economy.

“Local food” has become a priority for individuals and institutions alike. Data from the USDA, shows that from 2006–2014 the number of farmer’s markets increased by 180 percent, sales to food hubs (local food aggregators) increased by 288 percent, and farm to school programs increased by 430 percent. Local food sales in the US were estimated to be $6.6 billion in 2012. Despite this increasing interest and demand for local foods, our food system is largely consolidated geographically, with ownership in the hands of fewer and fewer food companies. This consolidation has lead to the economic decline of rural communities, fewer opportunities for small and mid-sized farmers and food companies, a general lack of control and connection to food production, and environmental degradation.

Compounding this trend, diet-related diseases have become the leading causes of death in the U.S., disproportionately impacting low-income and minority communities. While we produce an abundance of food, a great deal of it is highly processed, which is counter to dietary guidance from the USDA and contributes to poor health outcomes. Rebuilding local and regional food systems can address these interrelated, complex issues by giving communities greater control over food production, providing jobs and opportunities, and increasing access to healthy, fresh foods.

In 2017, Health Care Without Harm and Practice Greenhealth found that 82 percent of health care survey respondents spent, on average, 15% of their budgets on local foods, using a variety of supply chain pathways. This is consistent with 2015 findings from Becker’s Hospital Review which state, “While some [hospitals] are even setting up gardens to grow their own produce, others are buying locally grown products because they tend to be fresher, more nutritious, and boost the local economy.”

There is an opportunity to further connect health care’s mission and services to increase the production of local and regional food, and expand the benefits this may have on patients, staff and the community. This paper presents the current research on a number of considerations in three key areas:

  • Internal operations: Employee and patient health and satisfaction
  • Addressing the Social and Environmental Determinants of Health
  • Community Resiliency

A focus on health impact shifts the rationale for local food from reducing food miles to emphasizing the multiple benefits the health care sector helps to influence when choosing to buy local and regional food.

Internal operations: Employee and patient health and satisfaction

Improves Nutrition and Taste
Produce picked at peak ripeness tastes better and may be more nutritious. Food that is harvested in anticipation of a long transport is often picked underripe, reducing its nutritional value and compromising taste. The longer a food spends off the vine, the greater the loss of vitamins, minerals and other nutrients. One study showed a range of nutrient losses from 15% for green peas to 77% for green beans when stored at 39 degrees for 7 days. Another study found that the nutrient content of broccoli was cut in half when it was purchased out-of-season from national markets, compared to when it was sourced locally while in season. Foods consumed in the US can spend anywhere from two days to multiple weeks in transport depending on the point of origin. In a local food system, the supply chain and distance traveled is shortened, which enables foods to be picked riper and consumed closer to harvest. This provides the consumer with better tasting foods at their peak of nutritional value. With just 1 in 10 adults meeting the federal fruit or vegetable recommendations, better tasting fruits and vegetables can encourage increased consumption, thereby reducing the risk of many leading causes of illness and death, including heart disease, type 2 diabetes, some cancers, and obesity.

Improves employee and patient satisfaction
Individuals are increasingly interested in knowing where their food comes from and are showing a preference for local foods. Surveys show that 87 percent of grocery shoppers say the availability of local food is either “very” or “somewhat” important in choosing a primary grocery store, and two-thirds of respondents said that they choose a restaurant based on local food options. Consistently listed as a “hot trend” by the American Restaurant Association and as health care food service trend, this preference is not limited to “high end” establishments but is reported among casual, fast-casual, and quick service dining as well. This broad interest across food establishments demonstrates that local food is not a priority of a select group, but relevant to the population at large. Further, many report that when given a choice, they would select menu items featuring local ingredients at a slight price premium.

This preference for local foods is reflected in the Press Ganey score improvements among hospitals who have increased their service and marketing of local foods. In 2006, New Milford Hospital in Connecticut was in the 30th percentile, nationally, for their food service. After reconcepting their dining services to highlight local, fresh foods, the hospital’s scores shot up to the high nineties. Cottage Health in California experienced a similar score increase when they began using organic, local ingredients. They went from a Press Ganey ranking of 43 percent to 83 percent for their meals. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, which are factored into Medicaid and Medicare reimbursements, can also be improved by a patient’s food experience.

Cooking with fresh local ingredients also improves food service employee satisfaction due to the skills they learn and the sense of fulfillment they gain from serving food with purpose. For employees at Mercy Medical in Cedar Rapids Iowa, allocating the extra labor required to cook with fresh ingredients was challenging at first but after seeing the reaction from the individuals they served, employees felt “proud of what they were producing”.

Addressing the Social Determinants of Health

Creates Community Wealth and Jobs
A meta-analysis of nearly 50 studies, revealed that social factors, including education, income, and poverty accounted for over a third of total deaths in the United States in a year. When hospitals buy local they address these social and environmental determinants of health by creating jobs and building community wealth. The USDA reports that every $1 million spent on local foods, supports thirteen on-farm jobs — this is compared to three farm jobs per $1 million spent with agricultural operations selling nationally and internationally. In addition to jobs in agriculture, buying local supports related businesses like processors, aggregators, distributors, cold storage facilities, and equipment manufacturers — all of which provide additional jobs. A review of five different foods sold locally versus the national market, found that farmers earned 50–649% more for their products due to a shortened supply chain, and that nearly all of the wage and proprietor income remained in the local economy.

Examples from Georgia and Ohio illustrate the power of local foods in community development. Researchers found that if Georgia residents spent just $10 of their weekly food budget on local foods, it would generate $2 million in sales revenue for the state’s producers. A study of agriculture in northeastern Ohio found that if farmers met just 25% of the demand for food in their region, 27,664 new jobs would be created, providing work to about one in eight unemployed residents, and annual regional sales would rise by $4.2 billion.

The University of Vermont’s Center for Rural Development examined the effect of the University of Vermont Medical Center’s (UVMMC) local purchasing on the economy. In 2012, UVMMC spent $1.784 million on local food, resulting in a total economic output ranging between $3.530 million and $4.713 million, creating 24–30 jobs. UVMMC’s purchasing had an economic multiplier ranging from 1.98 to 2.64, meaning that for every dollar spent on local food by the hospital an additional $0.98-$1.64 was added to the local economy.

Creates Equitable Communities and Addresses Food Insecurity
The federal Office of Disease Prevention and Health Promotion’s Healthy People 2020 framework states that health disparities adversely affect groups of people with “characteristics historically linked to discrimination or exclusion” such as racial or ethnic group, religion, and socioeconomic status. These populations also experience disproportionately high rates of food insecurity, lower incomes, lack of social capital, and lack of land and home ownership. In two separate reports, the USDA and the St. Louis Federal Reserve Bank both found that investment in local food systems can combat structural inequalities and increase food equity. Many organizations addressing food inequity are looking beyond the charitable feeding model, and are utilizing local food markets to provide job training and education, and to develop pathways for underserved communities to build and acquire capital resources. Local food markets can be easier to access in comparison to national or international which require greater capital investment. When health care invests in local food systems they can provide opportunities for populations that have historically been excluded, and subsequently address the social and environmental determinants of health.

Community Resiliency

Protects Farmland and the Environment
According to American Farmland Trust, over 40 acres of farmland are lost each hour in the US due to urban sprawl. Further, 91 percent of fruits and 77 percent of vegetables are grown on “urban edge” farms that are under threat of development. Pressure to develop farmland is strong as property values rise, particularly lands in relatively close proximity to metropolitan areas, because development brings higher revenues than farming. However, well managed farmland provides services to the community that are not captured in an analysis based solely on revenue from the land. Not only do farms grow food, but farm’s using ecologically sustainable practices also perform ecosystem services like preserving and building topsoil which absorbs carbon from the atmosphere; protecting water sources; maintaining open spaces like fields, forests, and meadows; and preserving genetic diversity to ensure we are able to produce the food we need to live a healthy life now and into the future. Farms growing for local markets often maintain genetic diversity because they grow a wider variety of crops than farms growing for national markets which grow for standardization and a long route to the plate. Maintaining farmland also keeps taxes lower because farms generate more public revenues than they receive in public services, whereas residential use requires far greater public services. Health care can help to preserve farmland and maintain the services farms provide by buying food produced sustainably, locally and regionally.

Ensures Resilient Food Supply
Over the past 50 years food and agribusiness companies have prioritized efficiency in food production, processing, storage, and distribution. Diversified farms growing multiple food items have given way to specialization, and fewer and fewer companies are producing, processing, and distributing our food. This consolidation is also seen geographically, with particular states or regions producing the bulk of what we eat, and other states and regions producing very little. In successful regionally-based food systems of the past, food was grown in surrounding rural areas and processed and warehoused in cities. Cities often had weeks of food on hand. While this move toward consolidation has lowered prices and increased profits for food companies, it has made our system more vulnerable to events such as a bacterial outbreak, livestock or poultry disease, and extreme weather events.

In 2013, Superstorm Sandy flooded New York City grocery stores, and road closures left some stores without food for two weeks. Flooding in Houston in 2017 left Ben Taub Hospital, the city’s largest Level 1 trauma center, running critically low on food for days. Natural disasters are expected to continue to disrupt our food system. Compounding this vulnerability, major food distributors and fuel suppliers have moved towards “leaner supply chains”, with oil refinery closures and food storage warehouses stocking less food to increase profitability. The supply chains to population centers are getting longer, with fewer goods and fuel on hand locally. A 2017 Johns Hopkins Center for a Livable Future report on the City of Baltimore’s food system resilience found that the geographic concentration of food processing and food distribution/warehouses, and the specialization in crop production could compromise their ability to access food in a crisis. The report recommended balancing their reliance on national and global food markets with local and regional food systems. Health care can play an important role in building food system diversity and resiliency, and ensuring a reliable food supply for their communities by supporting local and regional food producers.

Take Action

Regional food systems are important for the health of our communities. By purchasing regionally grown foods from sustainably managed farms, health care has access to a wider variety of tastier, fresh foods that can be enjoyed seasonally and at their peak of nutritional value. Buying regional foods can also contribute to community development, providing jobs and opportunity for disadvantaged communities, and can support the local economy, building community wealth. Health care can take action now to provide healthier food to patients and staff, while preserving farmland, protecting our environment, and ensuring a reliable food supply.