Across the country, hospitals are buying more sustainable food and passing internal policies in support of sustainable food procurement. This reflective essay describes the results of the sustainable procurement goals and policy of the University of California’s five health systems from 2009 to 2021. Based on my observations as a staff person in the University of California and my participation in internal meetings with foodservice and sustainability staff, I discuss the evolution of the University of California’s sustainable food procurement policy goals and its definition of “sustainable.” I describe staff and programmatic support for purchasing environmentally sustainable food and beverages and the growth of the University of California’s sustainable food purchases as a percentage of its hospitals’ food budgets. This essay also explores staff debates about the sustainability of sourcing poultry with the label of “no antibiotics ever” after a 2020 COVID-19 outbreak at a poultry processing facility in California that led to the deaths of several workers. These debates about labor and working conditions in poultry supply chains from the five University of California health systems offer insights into ongoing challenges and opportunities for institutional food procurement and policy to change the food system utilizing existing supply chains and third-party certifications and label claims. The University of California’s experiences also illustrate the ongoing need for farm-to-institution and farm-to-hospital efforts to better integrate values around working conditions in supply chains into sustainable procurement goals.
Climate change poses a threat to healthcare systems; at the same time, healthcare systems contribute to a worsening climate. Climate-induced disasters are predicted to increase both the demand for healthcare services while also posing a threat to the integrity of healthcare systems' infrastructures and supply chains. Many healthcare organizations have taken initiatives to prepare for such disasters through implementing carbon emission–reduction practices and infrastructure reinforcement, through globally recognized frameworks and strategies known as Scopes 1, 2, and 3, and decarbonization. We explored the efforts of these early adopters to understand how they are thinking about and addressing climate change's impacts on healthcare. Through a process of reviewing the peer-reviewed literature, publicly available published documents, annual sustainability reports, conference presentations, and participation in a national decarbonization collaborative, we (1) provide a diverse set of examples showcasing the variety of ways healthcare systems are responding; (2) identify a set of emergent key themes to implementing decarbonization practices, such as the role of an organizational culture of iterative improvement and building systems of cross-organizational collaboration; and (3) synthesize the identifiable set of driving factors for long-term sustainability of these decarbonization efforts.
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