Because of the health harms of smoking, the sale of tobacco products has been effectively banned on hospital campuses for more than three decades. If one of those hospitals suddenly began selling cigarettes to their patients again, the public would be outraged. Yet, these same institutions sell soda, candy, and processed meats, and no one bats an eye.
Like cigarette smoking, habitual intake of foods high in salt, sugar, and saturated fats can lead to poor health, diminished quality of life, and severe complications from chronic illnesses. Despite unhealthy diets surpassing smoking as the leading cause of death in the US, hospitals consistently fail to serve food that meets national dietary guidelines. Many hospital vending machines offer drinks containing more than a day’s worth of sugar. And most of the nation’s teaching hospitals still contract with fast-food restaurants to provide cafeteria meals. These practices not only contradict the mission of health care institutions but undermine patient care. Hospitals don’t sell cigarettes, and they shouldn’t sell junk food either.
Food Served In Hospitals Undermines Commitments To Food Is Medicine
The contrast between health care organizations’ stated goals (recognizing food as critical to health) and their practices (the ubiquity of junk food on hospital campuses) is stark. This dissonance becomes even more pronounced amid the Trump administration’s Make America Healthy Again movement—as well as the health care sector’s recent commitment to Food Is Medicine that encompasses a range of activities that integrate nutrition services into health care practice. The Food Is Medicine philosophy was a key component of the 2022 National Strategy on Hunger, Nutrition and Health, motivating an astounding amount of investment from government, philanthropists, academics, and private industry.
During the past three years, more than $350 million has been committed to Food Is Medicine research, universities have established Food Is Medicine initiatives, and several congressional hearings have been held to cement these programs as key to tackling diet-related diseases. Many hospitals have publicly committed to Food Is Medicine by offering culinary education, connecting patients to nutrition assistance programs, and offering food “prescriptions” that can be redeemed for meals or groceries.
Yet, these same health care institutions continue to serve foods of poor nutritional quality in their vending machines, cafeterias, and patient meals. If they are really committed to supporting better access to nutritious foods, then they need to remove junk food from their campuses.
Serving Nutritious Foods Makes Financial Sense
Serving nutritious foods in health care settings is not only consistent with a mission to support health, but it is also a good business decision. In nonprofit hospitals, improving the health care food environment could potentially fulfill the community benefit requirement, in which benefits to community health must be demonstrated for tax-exempt status. What is more, better hospital food can improve patient satisfaction, which can improve patient retention and may be used as a performance indicator in value-based reimbursements. Eliminating junk foods may also improve employee health, and therefore productivity. When the University of California, San Francisco banned sugary drinks from their campuses, employees saw significant reductions in waist circumference, a marker of abdominal obesity.
Food Is Medicine Programs Should Include Healthy Hospital Food Procurement And Service Policies
Voluntary programs such as the Healthy Hospital Food Initiative; the Hospital Healthier Food Initiative; and the Good Food, Healthy Hospitals Initiative provide nutrition standards designed specifically for the health care sector and have been adopted by multiple public and private institutions. Now, we believe Food Is Medicine programs in hospitals should also include a commitment to serving healthy foods to patients and their families. This can be achieved by applying nutrition standards—already developed by federal, state, and local agencies—to food purchased and served by public institutions, including public hospitals.
The Department of Health and Human Services (HHS) recently launched a congressionally funded Food Is Medicine Initiative, which should be leveraged to solicit public commitments from hospitals to comply with nutrition standards for foods purchased and served. If hospital kitchens are ill-equipped for scratch cooking, Congress should appropriate funds for infrastructure and training to HHS, much like the US Department of Agriculture’s Healthy Meals Incentives for schools. If voluntary programs are unsuccessful, The Joint Commission could incorporate stronger nutrition standards for foods served to patients and staff into their accreditation requirements.
Improvements In Health Care Institutions Can Create Healthier Food Environments For All
If hospitals change their procurement practices, they may also improve the food supply for everyone. The health care sector is one of the nation’s largest purchasers of food, spending $15 billion on food in 2022. By setting nutrition standards for the foods they purchase, hospitals can incentivize food companies to offer healthier items.
We saw this happen when governments have mandated stricter nutrition standards for packaged snacks in schools, leading companies to quickly reformulate chips, cereals, and crackers to be lower in sugar and salt. In New York City, the Department of Health worked with more than 40 hospitals to adopt nutrition standards for the foods they purchased and served. This led large distributors, including US Foods and Sysco, to highlight those healthier items for their foodservice clients.
Approach Big Food Like Big Tobacco
Through the 1980s, it was not uncommon for hospitals to sell cigarettes on their campuses, even though the health risks of smoking were well-established. The tobacco-free campus policies of the 1990s have completely transformed the health care environment, contributing to significant improvements in cardiovascular and respiratory health outcomes.
Health care food policies could do the same for diet-related illnesses by giving patients, their loved ones, and the workers who care for them access to fresh, nutritious food that supports health. If the US government and health care sector are really committed to the idea that Food Is Medicine, then they need to start by improving foods served in health care settings.
