The health care system in Ontario is a major institutional purchaser of food. With 30,000 hospital beds and over 75,000 long term care (LTC) beds at close to 100% occupancy, the Ontario health care system serves an estimated 115,000,000 patient meals every year. The value of this food is over $285,000,000, making this a very attractive market for locally-based food producers and distributors.
In 2010, five researchers from the University of Guelph, the Canadian Coalition for Green Health Care, My Sustainable Canada and Wilfrid Laurier University received a $124,500 grant from the OMAFRA/ University of Guelph Partnership Fund to study the current and future potential use of local food in Ontario's hospitals and LTCs. Entitled Exploring the Feasibility and Benefits of Incorporating Local Foods into Ontario's Health Care System, the project's objectives were to establish the current state of food provision in Ontario's health care system and to gain an in-depth understanding of the opportunities and constraints impacting food provision decisions in Ontario's health care system. Project findings and conclusions were released over three reports.
The first report was issued in March 2012. Entitled Report on Food Provision in Ontario Hospitals and LTCs: The Challenges and Opportunities of Incorporating Local Foods, it analyzed data gathered over October 2010-April 2011 through surveys and discussions with hospital and LTC food service managers and the senior administrators they report to. The key findings were:
- While there is widespread interest in using local food in hospital and LTC food service, there are many factors that must be taken into consideration in making food purchases. Some factors are substantial barriers for local food producers and distributors seeking to make inroads into the Ontario health care market.
- Ontario's hospitals and LTCs purchase the vast majority of their food through distributors or service companies, then supplement as needed with purchases from grocery stores or local growers. Being primarily supplied by large organizations helps ensure that the food brought into their facilities meets government food safety regulations and is available at a price that is affordable within their tight budgets.
- A combination of conventional on-site cooking and outsourced, prepared food is used in health care, but the combination employed varies substantially across the province. The research suggests that, overall, many (and possibly most) facilities have moved away from cooking on-onsite and now use outsourced, prepared food for some or all of the meals they serve to patients.
- Four factors dominate food planning and purchasing decisions: food service budgets, patient needs, food costs/prices, and food safety requirements. As a result, Ontario hospitals and LTCs are sophisticated food purchasers that commonly employ business practices such as using group purchasing organizations (GPOs) and making extensive use of part-time staff to effectively manage limited human and financial resources.
- Most facilities claim to use local food, but few can estimate how much. This is because most facilities do not have a definition for "local food" and most do not track its use. Furthermore, efforts to promote local food by hospitals and LTCs are limited, and few facilities currently plan to increase their use of local food. They believe it has more economic benefits than patient benefits.
The second report, entitled Case Studies in Ontario Health care: The challenges and opportunities of incorporating local foods, was released in November 2012. Whereas the first report uncovered several challenges to increasing the use of local food in Ontario's hospitals and LTCs, the case studies demonstrated that:
- Increases in the use of local food can be achieved very successfully on a facility-by-facility basis. In large part, this is because there are so many different ways to incorporate local food in health care, from hosting a community shared agriculture program to implementing procurement policies.
- Low food budgets can be offset by good management, such as operating cafeterias that generate profits to subsidize food costs, tight menu management, and effective use of group purchasing organizations.
- Although low food budgets in health care can make it difficult for many organizations to consider using local food, lack of internal personnel support may be an even more critical factor. Local food efforts are highly dependent on - and must be customized to the degree of - personnel support within each facility.
- Suppliers are taking important steps that can help health care facilities increase their use of local food. For example, Gordon Food Services (GFS) has changed its ordering system to help customers identify and select local food options.
The third report, entitled Local Food Provision in Ontario's Hospitals and long-Term Care Facilities: Recommendations for Stakeholders, was released in February 2013. This report offers practical recommendations related to Local Food Act Bill 130, which was proposed by the Ontario government in October 2012 and reintroduced with modifications in March 2013. These recommendations are aimed at three key stakeholder groups: relevant Ontario ministries, food producers and distributors, and health care administrators.
While there are many actions that can help create stronger and more resilient local food economies in Ontario, the report's key recommendation is that:
- Ontario-wide procurement targets for the health care sector should not be set. A more appropriate approach to successfully increase the use of local food in Ontario's health care system is facility-by-facility customization/flexibility. Customization/flexibility recognizes that individual facilities have different strategic priorities, different budgetary circumstances and constraints, different human resource capabilities, and different local food supply situations. It also recognizes that, at this point in time, (a) claims that local food is more nutritious or better quality have not yet been supported by scientific evidence, and (b) the antecedents required for any procurement–based legislation, such as the ability to consistently source, purchase, and track local foods, are not yet in place on a broad scale.
The report recommends that the Ontario government, food producers and suppliers and health care personnel undertake the following types of actions to increase the use of local food in Ontario's health care sector:
- The Ministry of Health and Long Term Care (MOHLTC), Ontario Ministry of Agriculture, Food and Rural Affairs (OMAFRA) and Ministry of Finance (MOF) should develop new programs to supplement Ontariofresh.ca and help make local food more accessible, fund investigations into local food claims to provide scientific support for them, and meet to discuss trade agreement conflicts and the role of food and agriculture in creating healthy communities.
- Institutions, Food Service Companies and Distributors should use local food language in public tenders that does not conflict with trade agreements, and take full advantage of programs offered by the Ministries.
- Health care facilities' food service managers and senior administrators should adopt local food language in contracts with their local food suppliers, and endorse initiatives that support local food in health care, such as the Healthy Food in Health care pledge (http://www.healthyfoodinhealthcare.org/pledge.php).
1. Dr. Paulette Padanyi and Dr. Vinay Kanetkar (University of Guelph), Linda Varangu (Canadian Coalition for Green Health Care), Brendan Wylie-Toal (My Sustainable Canada), and Dr. Alison Blay-Palmer (Wilfrid Laurier University).