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Healthy foods advocate fights for sustainably-grown hospital food

When Anne Marie Males became vice president of Patient Experience at Scarborough Hospital, she was appalled to discover that none of the patients’ food was being prepared on-site. She called for help from the Greenbelt Fund, a not-for-profit funded through the Ontario Ministry of Agriculture to encourage public sector institutions to use local foods. That’s when chef and activist Joshna Maharaj got involved.
Known for her pioneering work with The Stop Community Food Centre, Maharaj has become a passionate advocate for hospital food that might actually make people feel better.  She spoke on the issue at last year's TEDxToronto conference. Few hospitals still have on-site kitchens; she describes with distaste the "retherm" system used instead: 
"Food is assembled somewhere else. The staff put these cold plates into hot boxes; ostensibly all the hot food goes on one side and all the cold food is on the other. The number one complaint is that the hot stuff is too hot, crusty and burned, the salad greens are limp, and the milk is warm," she says.
Temperature aside, the nutritional value of the foods being given to patients is also disconcerting.
"Patients generally have unlimited access to jelly desserts, which have 24 grams of refined white sugar in each serving. Dieticians fussed about the extra tablespoon of butter I wanted to put in a biscuit, but [had] no problem giving patients all that refined sugar," she says. "I don’t understand why there isn’t a louder uproar about this disconnect, that the doctors say you should be eating one thing, but when you’re in their care, they give you something very different."
An Ontario hospital bed costs about $1,200 per day, but, says Maharaj, "$7.33 per patient per day is the provincial average for food ingredients for three meals and a snack." Against these odds, Maharaj overhauled Scarborough Hospital’s entire food service system; "new menu, new recipes, new sourcing, and a new service model that continued after I left," she enumerates proudly.
Then she moved on to Sick Kids, where she has helped the hospital find local food suppliers, better communicate its food messages and "animate the hospital space with good food programming," she says, adding that "the folks at Sick Kids are well down the road: they’ve had a farmer’s market for six years and they kicked Burger King out last year."
Besides these projects, the Greenbelt Fund has funded other hospital food initiatives. Along with Scarborough Hospital and Sick Kids, Ross Memorial and St. Michael’s are also exploring local-food menus. St. Mike’s is using a local-ingredient pizza sauce formulated at George Brown College. 
When St. Joseph’s Long Term Care Facility in Guelph asked its Group Purchasing Organization (GPO) to explore local options, "They increased the amount of local purchases by $670 thousand over two years, an increase of about 12 per cent," says Greenbelt Fund Program Manager Franco Naccarato. The same GPO partnered with manufacturer Burlodge to create recipes that hospital staff could cook from scratch using rethermalization.
Local governments in Guelph, Thunder Bay and the South Central Ontario Region (Brant, Middlesex, Elgin, Norfolk and Oxford) have been working to bring farmers and public institutions together. Ottawa’s Queensway Carleton Hospital partnered with the not-for-profit Healthcare Food Services (HFS) to develop local food products for rethermalizers, and institutional caterer Dana Hospitality is helping to expand the ability of hospital staff to provide meals cooked from scratch with Ontario ingredients.
As these trends continue to materialize, patients confirm there are additional benefits to using local ingredients: better taste. 
Naccarato reports that when patients at St. Mike’s were served a dish made with non-local chicken, about 40 per cent rated it as "good," a small handful rated it as "very good" or excellent." When they were given local chicken, more than 40 per cent chose "very good," with "excellent" answers in second place. With the non-local chicken, 40 per cent of the plates were returned uneaten, and fewer than 20 per cent of patients managed to clear their plates. But more than 40 per cent of patients finished the local chicken meal, while less than 20 per cent left it untouched.
The Greenbelt Fund has funded 65 projects, of which 17 are still underway. "The projects that are complete have contributed to an increase of $12 million in Ontario food sales and purchases," says Naccarato. "For every dollar we invested in projects, we saw $3 in food sales increase."
However, local ingredients alone won’t fix everything that’s wrong with our hospital food. First, "We don’t need to spend much more, but we do need to spend more," says Maharaj. "I reject the idea that we are not being creative enough. We’re already asking Weston’s Bakery whether we can shimmy 14 slices out of a loaf instead of 12. The current budgets are so painfully whittled down that even something as modest as a 15 per cent to 20 per cent increase would garner results."
Even more fundamentally, she says, organizational change is called for. "Food Services needs to be reclassified; at the very least it needs to be on par with pharmacy," she says; currently, "Food Services is on par with maintenance and housekeeping."
Ultimately, "the problem with hospital food is that it is not given much of a priority," says Maharaj. "And there is not enough understanding of the therapeutic role that food plays in nurturing a life."

Sarah B. Hood's writing explores the culture of food, fashion, urban life, environment and the arts. Her latest book is We Sure Can! How Jams and Pickles Are Reviving the Lure and Lore of Local Food.

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