Food Matters: In Hospitals and For Prenatal Health
This essay is in response to: How is the developing fetus vulnerable to toxic chemical exposures, and how can our regulatory system more effectively protect our health in the prenatal period?
A recent study shed light on the dismal the quality of cafeteria food
in California’s children’s hospitals.
The study, published in Journal of the American Pediatric Association,
assessed the quality of food based on calorie content, fruit and vegetable
availability, sugar, soda, and price of the healthy entrees compared to the
unhealthy ones. The researchers found that the quality of hospital cafeteria
food varied widely in nutritional value across the state and made suggestions
for improving it.
What the research and the suggestions did not factor in was the
additional health impacts of how the food was produced: the use of pesticides,
chemical fertilizers, hormones, antimicrobials, and fossil fuels that support
our industrialized food system. These and other environmental chemicals that
are integral to our industrialized food system contaminate our air, water, and
food. Pregnant women and women who may become pregnant are especially
vulnerable to the health impacts of exposure to environmental chemicals present
in our food system.
A woman’s nutrition and the environmental chemicals a woman is exposed
to before and during pregnancy can impact the health of the child. Exposure to
environmental chemicals can have negative health consequences ranging from
immediate effects, such as preterm birth and low birth weight; to short term
effects, such as learning disabilities and childhood cancers; to long term
effects such as diabetes, cardiovascular disease, and cancers later in
Humans are more susceptible to the benefits and harms of nutrition and
the environment during periods of development which extend from the time of
conception through pregnancy, childhood, and puberty. This vulnerability is in
part because these are times of dynamic growth, a high metabolic rate, and
immature liver detoxifying mechanisms.2
The proof of principle that exposure to chemical exposure in-utero can have delayed effects is the
case of diethylstilbestrol or DES. DES, prescribed in up to 10 million
pregnancies from 1938 to 1971 to prevent miscarriage, was later found to be a
“transplacental carcinogen” causally linked to post-pubertal benign and
malignant reproductive tract abnormalities in the daughters and sons of DES
exposed mothers. The harm manifested decades
Environmental chemicals commonly make their way into our food. Some,
like bisphenol A (BPA), found in food packaging and in the lining of cans,
break down quickly, but our exposure is so continuous that it is almost always
found in human samples. Other environmental chemicals found in our food such as
dichlorodiphenyltrichloroethane (DDT) and Polychlorinated
Biphenyls (PCBs) were banned long ago, but persist in the environment and build
up over time in our bodies.
In 2011 the University of California, San Francisco Program on
Reproductive Health and the Environment (PRHE) published the first study
documenting the extent of multiple chemical exposures to pregnant women in the
on a national survey conducted by the Centers for Disease Control and Prevention,
PRHE researchers found that found virtually all pregnant women have measurable
levels of all of the following chemicals that can be harmful to human
reproduction and/or development in their bodies: lead, mercury, BPA, phthalates,
pesticides, perfluorochemicals (PFCs), and polychlorinated biphenyls (PCBs).
Our food is an important pathway of exposure for all of these chemicals.
Since many environmental chemicals that are harmful to human
reproduction and development are directly related to our industrialized food
system, intervening to improve the health of the food system can improve the
health of pregnant women and children.
This is where Food Matters comes in.
Food Matters, a project of San Francisco-Bay Area Chapter of Physicians
for Social Responsibility (SF Bay Area PSR), Health Care Without Harm (HCWH),
and PRHE, offers CME-accredited trainings that explore the health and
environmental implications of our industrialized food system, provides advocacy
training to equip healthcare providers with the skills to lend their powerful
voices to crucial food and health policy debates, and provides tools and
resources to help physicians advise patients on making healthy food choices
that include taking into account how the food was produced.
Along with CME courses and lectures to increase awareness among
clinicians, the Food Matters project is working with hospitals across the
country to help improve the sustainability of their food services. The aim is
to leverage the significant purchasing power of the health care sector -- $12
billion dollars devoted annually to health care system food purchasing -- to
spark food system change within and beyond hospital cafeterias.
To date, over 350 hospitals and health care systems across the US have
taken up the challenge and signed the HCWH Healthy Food Pledge. This pledge
commits health care facilities to take steps such as procuring food produced in
systems that eliminate the use of toxic pesticides, prohibit the use of
hormones and non-therapeutic antibiotics, support farmer and farmworker health,
and use ecologically protective and restorative agriculture.
Health care institutions can also support the development of urban
agriculture programs, farmers markets, and local food sourcing outlets to
increase accessibility to healthier foods in their communities. To this end, Kaiser Permanente hosts or
sponsors 40 farmers markets at hospitals and medical centers across
Our food system impacts nutrition and the environment, two key drivers
of reproductive and developmental health. So policy improvements directed to
the food system can make a big difference. 4 For example, action is needed to address the shortcomings of Toxic
Substances Control Act and Congress will begin work on the Farm Bill in 2012.
By improving our food system we can ensure good nutrition and a
healthy environment -- key determinants of healthy pregnancies, healthy
children and healthy future generations.
If you would like more information on Food Matters and how you can be
involved please visit http://bit.ly/prhefood or Food
1. Lesser LI, Hunnes DE, Reyes P,
et al. Assessment of Food Offerings and Marketing Strategies in the
Food-Service Venues at California Children's Hospitals. Acad Pediatr
2. Miller MD, Marty MA, Arcus A,
Brown J, Morry D, Sandy M.
Differences between children and adults: implications for risk assessment at
California EPA. International journal of toxicology 2002;21:403-18.
3. Woodruff TJ, Zota AR, Schwartz JM.
Environmental chemicals in pregnant women in the US: NHANES 2003-2004. Environ
Health Perspect 2011;119:878-85.
4. Sutton P, Wallinga D, Perron J,
Gottlieb M, Sayre L, Woodruff
T. Reproductive Health And The Industrialized Food System: A Point Of
Intervention For Health Policy. Health Aff (Millwood) 2011;30:888-97.
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