Preventing the causes of the causes of poor health : Healthy Institutions, at Bipartisan Policy Center Nutrition and Physical Activity Initiative

This blog is written with the premise that i learn something new every day, and last week, I learned so much my head is reeling.

After presenting on (and learning about) climate change and health care (many posts on that), I immediately emerged at a two day roundtable event held by the Bipartisan Policy Center (@BPC_bipartisan) on Healthy Institutions, as part of their Nutrition and Physical Activity Initiative:

Large institutions play an influential role in the eating habits of the American public. Places like hospitals, hotels, schools, workplaces and sports venues procure and serve millions of meals annually. These institutions are uniquely positioned to make changes in concessions, vending and catering that can have significant impact on the food choices, and health, of millions of Americans. Leaders in delivering healthy foods are emerging in both the government and private sector. How can we use these examples to engage more leaders to do the same?

To get ready for this event, I needed to learn about key areas where Kaiser Permanente is creating and supporting healthy institutions. I wrote out my comments, because I get nervous when I am representing the hard work of others :). Here’s what I said, on the panel covering “hospitals and hospitality.” Note the theme of recognizing the leadership of individuals.

I’ll post what I learned from the other impressive organizations I sat with and watched separately. Comments welcome.

Kaiser Permanente is the largest non-profit health care system in the United States. We have a lot in common with everyone here in what we do, and a lot of overlap as well. We are a large employer, with 178,000 employees, 16,000 physicians, 46,000 nurses. We are a large health plan, with $48 billon in revenue, We are a large health system, providing care for 9 million members.

We can be looked to as an institution where incentives are aligned. Because we provide pre-paid, integrated care, there are strong partnerships between our physicians, nurses, health plan, AND members! In our situation, we benefit from people using hospitals less and using hospitality more, health and life happens outside the health care system – that’s the way our model works the best.

I am a family physician in The Permanente Federation, which supports the 9 medical group of Kaiser Permanente and Group Health Cooperative. My presence here is an example of that partnership, thanks to Loel Solomon from Kaiser Permanente Community Benefit, which provides $1.8 billion in support of the connection between health care and the places where people live work and play.

I want to talk about what we do as an organization, and will also mention some of the areas we are active in related to the other priority issues of this work, so that we can be a resource moving forward as needed. We are one of the original supporting organizations along with Inova health care of Healthier Hospitals, and are planning to sign the pledge at our Center for Total Health not far from here.

In the area of nutrition, I think one of the most important investments we’ve made is in a person. We actually have a Sustainable Food Program Manager, her name is Kathleen Reed, and she has a masters’ in sustainable food systems. She works in National Nutrition Services and she’s been with us since, 2008, which says how new this field is. We have had a Comprehensive Food Policy since 2006, which connects the health of the food to the health of the system that delivers it – a food system that is ecologically sound, economically viable, and socially responsible.

There are three milestones in our journey that I’d like to share, and the first one is about the recognizing and supporting the passion of individuals. Preston Maring, MD, is an OB/Gyn at Kaiser Permanente, Oakland, and is a force of nature. In 2003, he started the first Friday Fresh Famer’s Market outside the Oakland Medical Center. There are now 39 more, from Hawaii to Maryland. This program is still managed in a grass-roots kind of way, with champions at each market who work with Kathleen. A survey of patrons was done in 2010. 50 percent of the respondents were KP physicians and staff, 31 percent patients, 12 percent people who work and live in the neighborhood. 74 % said they eat more fruits and vegetables as a result of shopping at farmer’s markets, 33 % said they sometimes schedule appointments around the Farmers’ markets schedule. Preston is that food guy – he brings table top cooking demonstrations to medical meetings and teaches us that cooking and eating healthy is easy. I’ve learned a few things!

Second, we have a program called Healthy picks, which brings healthy foods, sustainably sourced, to all Kaiser Permanente cafeterias, 50% of the choices in vending machines across Kaiser Permanente, 100% in pediatric waiting areas, and now inpatient care. With regard to menu labeling, we did a controlled study in 2008 in six hospital cafeterias and found a 10% shift to healthier choices for side dishes and snacks when we examined register receipts after just one month. If patrons changed nothing about their eating outside the cafeterias, we calculated up to a 5 pound difference after a year.

Third, sustainable purchasing. It is not enough for us to get the healthiest food for ourselves and our members if we undermine the environment around all of us. In 2006, we began purchasing local produce from family farms through a partnership with the Community Alliance of Family Farmers. We set a 3 year goal in 2010 to increase sustainable purchases from 7 percent to 15 percent. We met the goal in 10 months. Now, 50 % of our fruits and vegetables are sustainably produced, 190 tons worth. Going from frozen vegetables and fruit to fresh is a huge satisfier for patients, among the most vulnerable in society. For dairy, we currently purchase growth-hormone free milk and yogurt, with a goal of sourcing within 200 miles, humanely produced, and expanding to include other dairy products. And…we are working to support a food system capable of supplying not just us, but all of health care.

And a +1, healthy meetings. We have created a nutrition guide for healthy meetings, publicly available, because we also work with the hospitality industry and shape the food that is served at our events. This is an example of us bringing our medical, nutritional, environmental expertise to all of the community.
In the area of physical activity, again I want to point out the value in all of us in recognizing and harnessing passion. Bob Sallis, MD, is a family physician in San Diego, a national expert on physical fitness, and pioneered “Exercise as a Vital Sign” . It’s codified in our electronic medical record, so we’ve changed the definition of what vital signs are – they now include blood pressure, temperature, pulse, weight, respirations, and exercise minutes per week. That alone changes the medical definition of what health “is.”

We created “Everybody Walk” which is a national commitment to support walking across America, with funded walking projects, including the completion of the Metropolitan Branch trail in Washington, DC. And if you want to see a high tech version of this commitment, come to the Kaiser Permanente Center for Total Health, which has this 80 foot touch wall devoted to walking. Not to cardiac care, not to joint replacement, walking. We have a national walking program for our employees and team based competitions. My absolute favorite, though is “walk with a doc’ which is starting to happen at medical offices all over the United States. PS I walked here!

I wanted to highlight a few of the guests’ work here that relate to the other topic areas of the BPC’s initiative: Geri from Food Research and Action Center, and DC Hunger Solutions, to help DC Schools implement the DC Healthy Schools act, to make healthy meals available to all schoolchildren ( Gus Schumacher from Wholesome Wave, who works with Kaiser Permanente as an employer to take worksite wellness incentives and deliver them in the form of double value coupons at farmers’ markets. Also Ryan and Susan from Partnership for a Healthier America, which we are one of the founders of – related to the other issues that BPC is looking at, we have committed to all of our hospitals being baby-friendly for breastfeeding mothers by Jan 1, 2013. Jonathan and Katie from the Y who you’ll hear from tomorrow and who’s work we admire. I got to see Matt Longjohn, MD their medical director present to us last October and they are doing impressive work in obesity treatment and prevention. I know we collaborate with a lot of organizations, so if I have missed anyone please let me know!
This is a lot of interaction within our system and as a community citizen, which is what really excites me about being a physician here. I am around for the next two days and can provide more information as part of the other topics discussed, AND I plan to tweet and blog what I learn here because we always want to perform better for our members and society.

I’m now going to speak on behalf of all health professionals (if I may!) and that is to say that when we walk out of our medical offices, hospitals, and other facilities, we don’t want to feel undermined or defeated by the environment around us, and it turns out we don’t have to be. This is really an opportunity for us to feel supported where we live, work, and play, too. Thank you!


Ted Eytan, MD