Yum, yum ... hospital food: the institutional menu undergoes a green revolution.

Perhaps nowhere has the devolution of the Standard American Diet (SAD), been as prominent as in hospitals. During the post-World War II era, when state-of-the-art medications like the polio vaccine and antibiotics held sway and food was less understood as the good medicine it is, society seemed more willing to pass off lousy hospital fare with a few jokes. Fast forward a half century, however, and the appetite for change that arose in the 1960s is finally driving change in the health care industry.

Good Shepherd, Good Food

The 49-bed Good Shepherd Hospital in Hermiston, Oregon is a national showcase when it comes to coordinating the way physicians want patients to eat with what's actually served on its trays. Over the past two years, under dietician Nancy Gummer's lead, lean bison burgers have replaced those made from beef--no matter that Hermiston is in the heart of cattle country. Gummer also buys hormone-free milk and uses whole grains.

"Our agreement with local growers of vegetables and fruits is, 'Whatever you have, bring it in,'" Gummer says. "We go with what's in season--the more organic the better--and we get creative. People need to learn that real food will bring them health, so that's why in 2004 we started using fresh vegetables and fruits and more recently in 2006 have been making more of our foods from scratch."

According to Gummer, taking orders from patients when they are hungry instead of dishing up meals on preset schedules was the first link in the chain to moving toward better hospital food. Initially, however, the shift has been more about marketing than getting reasonable food to patients, since hospitals across the nation saw their patient approval scores go up when they allowed patients to order when they were hungry. "We went to room service a few years ago like so many places are doing," Gummer explains. "But most places are still basically just reheating at that point."

Gummer points out that revolutionizing hospital food is easier in a small place like Good Shepherd than it is in larger institutions. But that isn't stopping Kaiser Permanente. In northern California alone, Kaiser produces 5,000 to 6,000 meals daily for patients in 19 hospitals as part of a six-month pilot program it launched last August, working with 10 area farmers. If things go well, Kaiser will expand its reliance on local growers.

Hospital Diet without Harm

The west coast is not alone, although the greening of hospital food is clearly a developing trend. Jamie Harvie, coordinator for Health Care Without Harm's (HCWH) food program, is optimistic. HCWH is a 10-year-old international coalition whose mission is transforming the health care sector so it is no longer a source of ecological harm.

"We don't believe health care is purposely trying to pollute or make people sick," Harvie says. "So we help explain how our food is produced and distributed. Most hospitals don't realize the power they have through their purchasing, and how they really can impact the market. That's why we created the Healthy Food in Health Care Pledge. To help interested hospitals begin conservations with growers and distributors."

Fletcher Allen Medical Center in Burlington, Vermont signed the pledge, since it matches the facility's goal of supporting local communities and lessening its environmental footprint. "We just drafted a letter to one of our suppliers saying that we want to buy food items consistent with the pledge," says Director of Nutritional Services Diane Imrie. "But much of the vendor community isn't really ready to speak to this yet. When we asked our meat purveyors how the cows were treated, they got defensive.

"We did talk to an egg vendor who should be able to supply us from free-range hens," Imrie adds, "and there is a farm within walking distance of the hospital that delivers weekly. Also we are in the planning stages for a healing garden that will grow organic greens and herbs. On the other hand, this fall we had planned to buy only local apples, but apparently we've had the worst apple season in years."

St. Luke's Hospital in Duluth, Minnesota is also on board with the HCHW pledge. In addition to educating food producers and distributors, Food Director LeeAnn Tomcyzk, says her work includes bringing community members into the fold. "One thing we did was use our annual holiday tea to get people to start thinking about sustainability and not getting our food from places like Venezuela. We called it 'Gifting to the Community' and served gouda cheese, smoked fish, carrots and dip, chicken wings from happy chickens, sparkling water and coffee all from local producers. Some complained and said they wanted the old canned soup casseroles back, but one woman in particular who just bought a local grocery story finally got it when I said, 'Don't you want us to shop at your little store?'"

Tomcyzk also points out that there are inherent obstacles to improving the menu on the institutional level. "It's easier to bring in organic fruits and vegetables and milk on the retail side of food service--where staff and visitors eat--because prices can be adjusted to compensate for the added expense. With patient food, you have a set number that is built in as a hospital function. Here it's less than around $2 per tray."

Still, Tomcyzk says patients can order off the retail menu. "If a patient comes in and says, 'I only eat organic' we will accommodate up to a certain limit. It's just like when patients want kosher food. We do what we can."

Seeing the food hospitals serve staff and visitors take a turn toward regional distinctiveness and sustainability is one thing. That patients are poised to access this nutritious fare is definitely a hopeful sign. CONTACT: Health Care Without Harm, [phone], www.noharm.org/us.

JEAN JOHNSON is a freelance writer in Portland, Oregon who cooks what she grows in her garden.