Healthy Food in Health Care and a Media Case Study

How can hospitals improve the food everyone eats? Kendra Klein is a 2011 Switzer Fellow working at the intersection of public health and sustainable agri-food systems. In this video she explains what hospitals can do to advance the agenda of healthy food and sustainable food production systems for everyone.

Ms. Klein's work also recently appeared in The Nation, in an article she wrote called A New Prescription for the Local Food Movement.  It starts with a vivid scene that highlights the problems facing hospitals that want to serve locally produced food:

At dawn, at the loading dock behind the kitchen at St. Joseph Mercy Hospital of Ann Arbor, Michigan, small lift loaders and handcarts trundle boxes from food trucks to storage rooms. The perishables go straight to immense walk-in refrigerators packed with processed produce—buckets of cubed melons, bags of pre-washed lettuce, packages of onions diced by the quarter-, half-, and three-quarter inch.

That St. Joe’s executive chef can peel open a three-pound bag of diced onions and dump it into the steel cauldron he calls a soup pot is an efficiency triumph of no small consequence. Preparing the soup du jour from whole ingredients—all sixty-five gallons of it—would take hours of chopping.

When you’re making soup for 600, changing your grocery list can quickly get complicated. Hospitals like St. Joe’s are emerging as the next frontier of the local food movement, but they are struggling to navigate the tensions between their new food goals and their reliance on standardized, low-cost products delivered dependably day in and day out. The question is, Can the local food movement scale up to meet institutional demand without losing sight of its original values?

Last fall, as part of the hospital’s sustainable food efforts, St. Joe’s loading dock had a new visitor. Farmer Richard Andres arrived from just down the road with 200 pounds of his green beans—local, organic, and grown by a family farmer. They were a point of pride for the hospital’s good food advocates, including CEO Rob Casalou and chief clinical dietitian Lisa McDowell. Like Farm to School initiatives, which are flourishing with support from Michelle Obama’s anti-obesity campaign, St. Joe’s sees enthusiasm for fresh local produce as a way to encourage healthier eating while supporting local farm economies.

In the kitchen, however, Andres’s superbly fresh beans meant eight hours of washing, snipping and slicing. Even St. Joe’s food purchasing coordinator sidled out from behind her computer to help get the job done. “Nobody understands how long it takes to prepare certain things,” says Executive Chef Ryan Kendall. “If it’s from a major food distributor, it comes in ready to rock and roll.”

We recently asked Ms. Klein to tell us how the article in The Nation came about and to share any advice she has for Fellows and other scientists who are interested in spreading the word about their work:

1. How did this article come to be? Did you contact The Nation? Did they contact you? Did the original idea for the piece change along the way?

This article is an outgrowth of my dissertation research and professional work with the Health Care Without Harm Healthy Food in Health Care Project. In collaboration with Health Care Without Harm, my research explored the supply chain challenges to farm to hospital initiatives. This article frames some of the key outcomes of that work for a public audience.

I had the theme of the article in mind and happened to be in Michigan for a work trip so took the opportunity to profile St. Joseph Mercy Hospital of Ann Arbor. I work with many leading hospitals in the San Francisco Bay Area, but felt that a story about a Midwestern hospital was more compelling. St. Joe's is also particularly interesting given that the hospital has hired a farmer and has plowed under 20 acres of their own land to grow organic produce. However, in writing the piece, I realized that on-site food production is tangential to the key question of the article regarding the 'missing middleground' of the food system needed to bring local farmers' food into institutions.

I've been very lucky to have the opportunity to take three environmental and science writing courses at the UC Berkeley School of Journalism during the course of my PhD. I initially began working on this piece during one of those courses and got the contact for an editor at The Nation from my professor. I initially envisioned the piece as a ~4,000 word feature, but those are much harder to place. My editor at The Nation asked me to cut it to ~2,000 words.

2. You used what journalists refer to as a "feature" format, starting with a scene and moving later into the point of your story. Why did you decide to do that? (It's very effective as grabbing a reader's attention!)

I chose to start with a scene in order to draw readers in and also to 'show, not tell' a sense of the scale of institutional food procurement. Scaling up is the crux of the challenge facing the local food movement, and I hoped to convey this through showing some of the realities of hospital food prep. My other aim was to distinguish the topic explored here from other pieces about local food - a hospital kitchen with cauldron-sized soup pots is not the typical scene for an analysis of the local food movement.

3. You use facts and figures very fluidly in the piece. How did you learn to combine storytelling with facts to get your point across?

I learned this technique from paying attention to good journalistic writing and getting a sense of how writers hold readers' attention while conveying detailed factual information.

4. What kind of editorial assistance did The Nation offer, if any?

I learned the hard way that magazine editors may offer very little editorial assistance, if any. In fact, some mistakes emerged through the editing process, and I had to bug the magazine to fix the mistakes even after the piece was live on the web. As one of my professors said, writers increasingly need to take the editing process into their own hands in the same way medical patients need to advocate for themselves within the medical system.

5. How long did the article take you to write? Please break down time needed for research, interviews, drafts, final edits, corrections, etc.

The on-the-ground work for the piece took just two days. I visited Richard Andres' farm in the morning and St. Joseph Mercy in the afternoon. The following day I conducted phone interviews with other key people in the area. I didn't have to do any additional research for this piece since I've been working on this topic for the past couple years.

Writing took the bulk of my time, approximately two weeks if taken all together. The final editing process with the magazine was minimal and took just a couple hours. Thankfully, I was advised to track my contacts and citations as I wrote, which made the factcheck process efficient.

6. What advice would you offer Fellows who are interested in writing a long-form piece like this for the web or print version of a popular magazine like The Nation?

Without the School of Journalism, my process would have included a great deal more trial and error and hunting down information about how to approach editors, how to shape a long-form piece, and what to expect throughout the process. If folks aren't able to take a course focused on magazine writing, I recommend finding any writing class. The structure of a course can provide the impetus to dive into a piece and a forum to get feedback early on.