An Advocacy Agenda

1. d An Advocacy Agenda Thomas Jefferson University Philadelphia, PA June 11th, 2011 Kendra Klein, PhD (ABD) University of California, Berkeley Department of Environmental Science, Policy & Management

2. Health Care Without Harm would like to thank David Wallinga and the Institute for Agriculture and Trade Policy for contributing many of these slides as well as advocacy resource materials to the Food Matters program.

3. I. Changing Thinking Health behaviors Food environments Farm as factory Healthy food system II. Advocacy

4. Changing Thinking Food Environments Parker et al.,IOM, 2009 Brownell et al., Health Affairs, March 2010

6. Changing Thinking A Systems Perspective Food System Healthier eating environments Farm & food policy . Behavior Change • Intensive water, soil use • Energy use & climate change • Antibiotic, hormone use • Rising, pesticide, fertilizer use Story M, Hamm MW, Wallinga D, eds. Food Systems and Public Health: Linkages to Achieve Healthier Diets and Healthier Communities. Journal of Hunger & Environmental Nutrition, Volume 4, Issues 3 & 4. December 2009

7. and obesity Hunger Military readiness Hunger calorie Production-dominatedagriculture Cheap food policy, 1974 - 2011 1800s 1900s 1950s 2000

8. Farm as Factory • Specialization • Focus on inputs / outputs • Resource intensive • Large-scale “Industrial agriculture views the farm as a factory with ‘inputs’ (such as pesticides, feed, fertilizer, and fuel) and ‘outputs (corn, chickens, and so forth). Union of Concerned Scientists Public health references: Horrigan et al. 2002. EHP; Walker et al. 2005. Public Health Nutrition; Lang and Heasman 2004. Naylor et al. 2005. Science. U.S. Hogs, 2002 1 dot = 15,000

9. Farm as Factory Intensive monocultures

10. Sustainability Biodiversity Human health Animal welfare Soil erosion Food security Local economies Flavor Pesticide pollution Yield Economic Efficiency Greenhouse gas emissions

11. Chronic diseases (cancer, diabetes, obesity) • Antibiotic resistance & food-borne pathogens • Pesticide exposure (cancer, reproductive, neuro-developmental, and endocrine impacts) • Micronutrient deficiency • Asthma and respiratory illness • Food justice (hunger, food deserts) HEALTH EXTERNALITIES

12. Chronic diseases (cancer, diabetes, obesity) • Antibiotic resistance & food-borne pathogens • Pesticide exposure (cancer, reproductive, neuro-developmental, and endocrine impacts) • Asthma and respiratory illness • Food justice (hunger, food deserts) • Local economic development • Labor issues • Water and air quality • Energy use and GHG emissions • Loss of crop and biological diversity • Soil erosion HEALTH SOCIETY ENVIRONMENT

13. Changing Thinking A Systems Perspective Healthy food comes from a food system that is: Ecologically sound Economically viable, and Socially responsible

14. I. Changing Thinking Health behaviors Food environments Farm as factory Healthy food system II. Advocacy

15. Why advocacy? Credibility Influence Expertise

16. Why advocacy? Power

17. Nationally, Globally Regionally Communities Institutions Households Change behavior,Treat disease Reducing disease Promoting health

18. Making change In your practice 18

19. Making change In your practice 19

20. Institutions Promoting health

21. Making change In Hospitals HealthyFoodinHealthcare.org Over 340 Pledge signers in 26 states

22. Making change In Hospitals HealthyFoodinHealthcare.org • Farmers markets and hospital gardens • Healthy vended items • Fast-food-free zones • Composting and food waste reduction • Comprehensive ‘Healthier Food in Health Care’ policies • Local, organic, fair trade and sustainably grown foods in cafeterias and on patient trays • Antibiotic-free meat/poultry; rBGH-free dairy • Cage-free eggs

23. Reducing meat purchasing by 20% in 12 months 4 hospitals reduced on avg. by 28% $402,000 savings on meat purchases in a year Use savings to purchase more sustainably produced meat Over 1,000 tons/year reductions in greenhouse gas emissions Making change In Hospitals HealthyFoodinHealthcare.org 23

24. Communities Promoting health

25. Making change In Communities Founding Co-Signers Richard Conlin, City Council President Denis Hayes, President Bullitt Foundation, James Kelly, CEO, SeattleUrban League Dr. David Fleming, Public Health Seattle-King County Mary Embleton, Exec. Dir., Cascade Harvest Coalition Trudy Bialic, PCC Natural Markets Reverend Dr. Robert L. Jeffrey, Exec. Dir., Clean Greens Siri Erickson-Brown, Co-owner, Local Roots Farm Dr. David R. Montgomery, MacArthur Fellow and author, DIRT: The Erosion of Civilizations Andrew Stout, CEO-Founder, Full Circle Farm

26. Making change In Communities Farm to School Farmtoschool.org Sustainable Table Sustainabletable.org Community Food Security Coalition Foodsecurity.org Food Policy Councils

27. Nationally

28. Making change Nationally Uniting health professions in a common vision ADA, ANA, APA, APHA, www.APA.org

29. Making change Nationally

30. Understanding the Farm Bill Summary at: www.ers.usda.gov/farmbill/2008 • $284 billion, 673 pages • Re-authorized every 5 yrs • 15 Titles • Title I: Commodities • Title II: Conservation • Title IV: Nutrition • Title VI: Rural Development • Title VII: Research • Title IX: Energy • Title X: Hort & Organic Ag • Title XII: Crop Insurance

31. Understanding the Farm Bill • FacebookA Citizen’s Guide to a Better Food System • Literature: Wallinga D. Contribution of Agricultural Policy to Childhood Obesity. Health Affairs, March 2010 • Webinars: Healthy food, Healthy farms www.HealthyFoodAction.org

32. Making change Nationally Sign the Charter @ www.HealthyFoodAction.org Philip R. Lee, MDHoward Frumkin, MD, DrPH Walter C. Willett, MD, DrPH  Robert S. Lawrence, MD David O. Carpenter, MDJames Krieger, MD, MPH Victoria Maizes, MDAndrew Weil, MDDick Jackson, MD, MPH Kelly D. Brownell, PhDMary Story PhD, RD  Philip J. Landrigan, MD, MScand over 500 more

33. Making change Nationally • Preservation of Antibiotics • for Medical Treatment Act • S. 619: Senator Feinstein • (17 cosponsors) • HR 1549: Rep. Slaughter (108 sponsors) • Endorsed by: • American Medical Association • American Nurses Association • American Academy of Pediatrics • American Public Health Association • More than 350 other organizations • www.SaveAntibiotics.org • www.ProtectAntibiotics.org • www.HealthyFoodAction.org

34. Making change Nationally Sign the Health Care Without Harm Petition • www.noharm.org • www.protectantibiotics.org Please let Congress know that I, _____________________________ support the Preservation of Antibiotics Medical Treatment Act and that I would like to know what they are doing to protect antibiotics.

35. Making change Nationally Reform TSCA to keep toxins out of food Alliance of Nurses for Healthy Environment American Nurses Association The CRS Institute DrGreene.com Health Care Without Harm Mount Sinai Children's Environmental Health Center Nurses for Global Health North Carolina Chapter of the American Academy of Pediatrics Physicians for Social ResponsibilityPhysicians for Social Responsibility - Austin Physicians for Social Responsibility - Chicago Physicians for Social Responsibility - Colorado Physicians for Social Responsibility - Greater Boston Physicians for Social Responsibility - Los AngelesPhysicians for Social Responsibility - Oregon Physicians for Social Responsibility - Sacramento Physicians for Social Responsibility - San Francisco Bay Area Physicians for Social Responsibility - Tampa Bay Science & Environmental Health Network Washington Physicians for Social Responsibility Washington State Association of Occupational Health Nurses Washington State Nurses Association Yale School of Medicine, Environmental Health Group

36. Making change Nationally

38. Provide anticipatory guidance to patients and families about the importance of healthy foods and a healthy food system. Work within health care facilitiesto create a healthy food service model that is recognized as integral to a preventive health agenda. Work within the community at a local, regional and national level, to promote policies that support the development of a healthy, accessible, and fair food system. Making change Food Matters HealthyFoodinHealthcare.org

39. Making change Food Matters HealthyFoodinHealthcare.org • Clinical advisory group • Clinical curriculum development and • trainings • Nationwide clinical network • Maternal/child health calendar • Video for waiting rooms, clinics, exam • rooms, community meetings • Healthy Foods in Hospitals • national campaign

40. Food Matters Action To Date • 2,000 Food Matters calendars distributed in SF Bay Area • Food Matters Grand Round series planned with • development of local faculty • New collaboration with County Maternal/Child Health program • Translation of Food Matters materials into Spanish, and training • with Promotorasprogram • National Food Matters Webinar Series (AMA/Kaiser) • Follow-up intensive Food Matters Train-the-Trainer planned

42. Food Matters Clinical Advisory TeamJudy Focareta, RNJoel Forman, MDSarah Janssen, MD PhDPreston Maring, MDJoanne Perron, MDNaomi Stotland, MDTed Schettler, MD MPHDavid Wallinga, MD MPA Food Matters is made possible with generous support from: The Cedar Tree Foundation The Claneil Foundation The Orchard Foundation Rose Foundation Stonyfield Organics Profits for the Planet Program W.K. Kellogg Foundation