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Welcome to PSR's Environmental Health Policy Institute, where we ask questions -- then we ask the experts to answer them. Join us as physicians, health professionals, and environmental health experts share their ideas, inspiration, and analysis about toxic chemicals and environmental health policy.


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Food Matters: In Hospitals and For Prenatal Health

Posted on February 2, 2012

By Jessica Trowbridge, MPH

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 life. 

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 after exposure. 

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 US.3 Based 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 the country. 

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 or Food Matters

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 2012;12:62-67.

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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