One Year Later: Hospitals move from ideals to action on “antibiotic-free” meat

Last spring, the Academic Senate at the University of California at San Francisco (UCSF) Medical Center passed a groundbreaking resolution: To stop purchasing meat that had been raised with non-therapeutic antibiotics. 

The Department of Nutrition and Food Services at UCSF Medical Center then faced a formidable challenge: How and from where could it purchase enough “antibiotic-free” meat to feed thousands of patients, staff, and visitors daily? Available supplies of such meat were limited, and hospitals’ existing supply chains offered few options. 

One year later, the hospital’s food service staff is at the helm of a coordinated effort to aggregate the sustainable meat demand of several health care facilities throughout California. Thus far, they have identified interest in purchasing over 80,000 pounds of antibiotic-free beef, representing 320,000 servings for hospital patients and cafeteria patrons, and this number is expected to increase.

As stewards of antibiotics, doctors (and the hospitals in which they practice) have created rigorous new guidelines to end overuse of antibiotics in human medicine. Last year, for example, the American Academy of Pediatrics (AAP) issued updated guidelines for treating acute otitis media – ear infections – in children. The AAP cautiously and simply advised medical practitioners not to dispense antibiotics so readily. The AAP’s recommendations align with a broader trend in the clinical setting to reduce antibiotic prescriptions in order to combat ever-evolving bacterial resistance to antibiotics.

The vast majority of antibiotics in the U.S., however, are not used in human medicine. According to government estimates, approximately 30 million pounds of antibiotics are sold for use in industrial animal agriculture. This is four times the amount used by the health care sector. Seventy percent of these include antibiotics identical to those used to treat human infections, such as penicillins and macrolides. These antibiotics are given routinely to otherwise healthy chickens, pigs, and cattle to compensate for overcrowded and unsanitary living conditions. There is widespread expert consensus from the U.S. Centers for Disease Control to the World Health Organization that this non-therapeutic practice breeds antibiotic-resistant bacteria that threaten human health and undermine the efficacy of modern medicine’s miracle drugs. In the U.S. alone, close to 19,000 deaths already occur on an annual basis from methicillin-resistant Staphylococcus aureus (MRSA). 

To combat this antibiotic resistance crisis, forward-thinking hospitals like UCSF are expanding their roles as stewards of antibiotics within the larger community, using their purchasing power to support ranchers and farmers who don’t misuse these medicines. 

According to a survey conducted by Health Care Without Harm, over forty California hospitals were already purchasing antibiotic-free meat in 2012. A new model aimed at increasing this number emerged from a Balanced Menus: Less Meat, Better Meat conference held last October at UCSF. Ninety stakeholders, including researchers, ranchers, food distributors, hospitals, and schools, gathered for a two-day workshop convened by Health Care Without Harm and San Francisco Bay Area Physicians for Social Responsibility, two non-profit organizations that are spearheading this cause in the health care sector. Participants addressed a set of challenging issues related to the institutional-level procurement of sustainable meat, from tight food service budgets to food safety requirements, and from federal dietary guidelines to existing contracts with vendors. 

“That meeting acted as a crucible,” explains Jack Henderson, retired Associate Director of Nutrition and Food Services at UCSF. “Each sector involved in meat production was able to meet and converse with the others in the business.” Henderson met a representative from a ranch called Estancia Beef over the course of those two days. “It became clear that Estancia was able to provide the necessary beef products in the volumes needed, and do so safely and consistently.” Estancia Beef’s cattle are grass-fed, raised without antibiotics and hormones, certified by Animal Welfare Approved, and affordable. However, the company’s products were not available for hospitals to purchase through the major food distributors that they rely on, like US Foods and Sysco.

With the goal of leveraging the combined purchasing power of multiple health facilities in order to secure Estancia Beef at an affordable price through US Foods, UCSF Medical Center reached out to hospitals statewide through Health Care Without Harm’s network. By March, UCSF had identified over 80,000 pounds of potential demand for Estancia Beef, and had successfully brought in three of the company’s products through US Foods: hamburger patties, ground beef, and stew beef. Says Henderson, “US Foods was able to enter the Estancia products and their specifications into their system and slot them in their warehouse. It took patient collaboration from all parties involved, but with determination and focus, it has proved to be eminently possible.”

UCSF’s work opens the door for other US Foods’ customers. The University of California at Los Angeles Medical Center (UCLA), for example, quickly followed suit, and is now serving Estancia hamburgers and ground beef. As more California hospitals join this initiative, pushing the total purchasing volume to 80,000 pounds and beyond, each facility that is purchasing meat from Estancia will receive a discount from the company, thanks to the combined demand. 

“We are pleased to be serving these sustainably-raised products to our patients and customers,” says Dan Henroid, Director of Nutrition and Food Services at UCSF Medical Center. In addition to Estancia’s beef – which the hospital is now using in recipes like tamale pies and meatloaf – UCSF Medical Center is also purchasing Harvestland antibiotic-free chicken breasts and Wilcox Farms cage-free eggs raised without the use of antibiotics by Wilcox Farms.

UCSF’s efforts are part of a growing movement in the health care sector nationwide. Just one year after UCSF passed its resolution, the University of Washington Medical Center (UWMC) in Seattle announced a similar commitment, stating that it would serve only antibiotic-free poultry and pork. UWMC’s neighbor, Overlake Hospital in Bellevue, Washington, recently switched over fifty percent of its meat purchases to antibiotic-free. On the east coast, Union Hospital of Cecile County, Maryland reduced the amount of red meat on its menus by thirteen percent and is using the cost savings to source sustainably-raised beef from local ranchers. 

Not only do these shifts in purchasing create new markets for sustainable ranchers and farmers, but they are also a strong symbolic statement about the stake that doctors and their colleagues have in healthy, sustainable food production. A growing cadre of health professionals understand that truly healthy food must come from a food system that protects public goods like clean water, healthy soils, and the efficacy of antibiotics. Says Dr. Daniel Uslan, Director of the UCLA Antimicrobial Stewardship Program: “Antibiotics are a resource like fisheries or a forest. If we don’t protect them, they will be gone, just like our forests.”