Consider signing Health Care Without Harm's letter to the Food and Drug Administration's Commissioner Hamburg, encouraging the agency to reduce the overuse and misuse of antibiotics in food animal production by requiring meaningful veterinary oversight on farms and by addressing disease prevention.

Join hospitals across the country and take action to protect antibiotics by passing a resolution to phase out the purchases of meat raised with non-therapeutic antibiotics within your hospital, medical center, or medical school. Download resources on how to develop a resolution online.

Interested in reading more about the issue? The Abstinence Method is a new piece out from Food & Environment Reporting Network that explains why and how Dutch farmers are eliminating the routine use of antibiotics, and it also discusses lessons for the U.S.

News from the Field: Palomar Health System, CA

Palomar Health is an 800 bed, three hospital health system located in San Diego County, California that has been reducing the amount of meat on its menus and tracking its progress for the past three years. To date, Palomar Health's downtown campus has reduced the pounds of meat it serves per meal by 19 percent.

"But what we found was that even though we had reduced the amount of meat we were buying and preparing, rising prices - especially for beef at a 17 percent cost increase in this three year period - had eliminated the savings we had planned to use to purchase more sustainably-raised meats," shares Barbara Hamilton, Sustainability Manager at Palomar Health.

Given that the system prepares over two million meals annually, Palomar Health has to employ several creative strategies to find cost savings. These include plant-based and seasonal menu planning that are changed according to the availability of fresh vegetables and fruits, along with more appropriate portion sizes. Says Hamilton, "weekly menus are planned with the flexibility to use seasonal produce for best flavor and price...Pomerado Hospital café increased sales by 39 percent from September to December 2013....Some staff [are ordering] an extra serving to take home

Kitchen staff serving customers at Palomar Health

for dinner!"

Marketing has been an additional strategy Palomar Health System has pursued to increase sales, and it sends out emails and newsletters, and puts up signs around the cafeterias to advertise its sustainable food offerings. "Marketing is so important; it could make or break your programs," comments Hamilton. It is also important to engage food service staff, Hamilton points out: "It gives them greater buy-in to see good sales data." Palomar Health also provides tastings so that staff can see the food and then talk about the meals being served and ingredients to customers.

Ultimately, "these [meat] issues are too big for us to roll out on our own," admits Hamilton. As such, through Health Care Without Harm, Palomar Health is working with hospital teams in the San Diego area and throughout California to aggregate demand for sustainable meat and is now scheduled to purchase grass-fed, Animal Welfare Approved beef from Estancia at a reduced cost over the summer. To learn more about hospitals buying Estancia beef in California, read our recent blog from Health Care Without Harm (One Year Later: Hospitals move from ideals to action on "antibiotic-free" meat).

Clinician Champion: Aparna Bole, MD

Aparna Bole, MD, FAAP is the systemwide Sustainability Manager for University Hospitals (UH) and a pediatrician at UH Rainbow Babies & Children's Hospital. She originated the Sustainability Manager role in 2010, and has been charged with building a multidisciplinary sustainability program at UH that engages leaders across the system and focuses on waste reduction, energy management, green building, sustainable procurement, and education & outreach. As a practicing pediatrician at Rainbow, she continues to be active in patient care and pediatric resident and medical student education. In her dual roles, she is particularly interested in the relationship between sustainability and pediatric public health. Healthy Food in Health Care caught up with Dr. Bole to talk about her environmental health advocacy efforts.

Q. Could you describe your advocacy efforts surrounding environmental health and food?
A. At University Hospitals, we have assembled a multidisciplinary Nutrition Committee that includes dietitians, Supply Chain & Operations leaders, Nutrition Services professionals, and physicians. We advocate with our food suppliers to increase the availability of locally and sustainably produced foods, and work to integrate our health and wellness goals with sustainable procurement goals in menu planning and food purchasing. Our priorities include decreasing our total meat purchasing, investing in sustainably sourced meat products, and increasing our purchase of locally grown items. I represent UH in the City of Cleveland's sustainability initiatives, including efforts to establish a local foods business cluster. For our pediatric and women's clinic patients, we have begun a produce delivery and nutrition education program (called Healthy Harvest) that features fresh, locally grown, direct-from-farmers produce as well as practical shopping and preparation tips. Finally, I have developed content related to sustainability and public health, with a special focus on sustainable food systems, for our pediatric resident advocacy rotation at UH Rainbow Babies & Children's Hospital. On a national level, I participate in advocacy with the American Academy of Pediatrics related to regulating the use of antibiotics in animal agriculture.

Q. When and how did your interest in the intersection between human and environmental health begin?
A. I have been interested in environmental issues for much of my life, but began to be interested in the intersection between the environment and health while I was a medical student. I perceived environmental factors impacting my patients' health (for example, poor air quality affecting patients with asthma), and also perceived opportunities within my hospital system to reduce waste, operate more efficiently, use safer cleaning chemicals, and improve food offerings. At that point, I began to reflect about the fact that our hospitals' negative environmental impacts were contrary to our mission to enhance our patients' and communities' health.

Q. In what ways are you able to integrate environmental health education and advocacy into your traditional schedule?
A. Our Healthy Harvest program occurs while I am in clinic seeing patients, and resident education is part of my job. In regards to advocacy in other arenas, I am in the unusual position of holding both a sustainability title and being a physician, so environmental health education and advocacy are natural ways to combine my roles.

Q. Any recommendations on how other clinicians can become more involved in advocating for a healthy food system?
A. Any clinician who works in an institution that serves food can and should ask questions about how that food is sourced, and express to their organization's leadership the importance of increasing locally and sustainably sourced food. The purchasing power of our health care institutions can play a significant role in transforming our national food system. In addition, for a typical organization, a significant contribution to the organization's environmental impact is its food purchasing, especially meat (and particularly beef) purchasing - so achieving more sustainable food procurement can dramatically decrease an organization's environmental impact and carbon footprint. Clinicians can also provide advice to their patients about how to shop for healthy and sustainably sourced food on a budget and model healthy and sustainable purchasing practices in their personal lives. There are also opportunities to participate in policy advocacy around, for example, antibiotic use in animal agriculture, through our professional organizations and other national organizations such as Health Care Without Harm and the Pew Charitable Trusts.