Board of Trustees Update

June 27, 2012

Update Last Updated: 5/30/12

Hospitals listed on this honor roll have committed to accomplishing the first three Stars of the program by January 1, 2013 and Star 4 by January 1, 2020.

Star 1  Default non-select pediatric patient menus for children 2-18 to meet the American Heart Association guidelines.

Star 2  Launch a healthy beverage initiative.

Star 3  Healthy offerings through cafeteria menu labeling.

Star 4    Healthy eating starts with a healthy food system.

Organization Name Star 1 Star 2 Star 3 Star 4 Allegan General Hospital N/A N/A * * Allegiance Health * * * * Alpena Regional Medical Center * * * * Aspirus Grand View N/A ** ** * Aspirus Keweenaw Hospital N/A * ** Aspirus Ontonagon Hospital Baraga County Memorial Hospital * * * * Bronson Battle Creek ** ** ** * McLaren - Bay Region * * * * Beaumont Hospital-Grosse Pointe ** ** ** ** Beaumont Hospital-Royal Oak ** ** ** ** Beaumont Hospital-Troy ** ** ** ** Bell Hospital * * * * Bixby Medical Center Borgess Medical Center * * ** * Borgess-Lee Memorial Hospital N/A ** * * Borgess-Pipp Hospital * * * * Botsford Hospital ** ** ** *

*This hospital has committed to the star. **This hospital has completed the star.

Healthy Food Hospitals Honor Roll Page 2 of 4

Organization Name Star 1 Star 2 Star 3 Star 4 Bronson LakeView Hospital N/A ** ** * Bronson Methodist Hospital ** ** ** ** C.S. Mott Children's Hospital and Von Voigtlander Women's Hospital ** * ** * Caro Community Hospital Carson City Hospital * * * * McLaren - Central * * * * Charlevoix Area Hospital * * * * Cheboygan Memorial Hospital ** ** * * Chelsea Community Hospital N/A ** * * Children's Hospital of Michigan * * * * Community Health Center of Branch County * * * * Covenant HealthCare * * * * Crittenton Hospital Medical Center ** ** * * Detroit Receiving Hospital & University Health Center * * * * Dickinson County Healthcare System * * * DMC Huron Valley-Sinai Hospital * * * * DMC Surgery Hospital * * * * Doctors' Hospital of Michigan Eaton Rapids Medical Center N/A N/A ** * Garden City Hospital * * * * Genesys Regional Medical Center * * Harbor Beach Community Hospital Inc. Harper/Hutzel Hospital * * * * Hayes Green Beach Memorial Hospital * * * * Helen DeVos Children's Hospital ** ** ** ** Helen Newberry Joy Hospital N/A N/A * ** ** ** ** * Henry Ford Macomb Hospitals ** ** ** * Henry Ford Macomb Hospital-Warren Campus ** ** N/A * Henry Ford West Bloomfield Hospital ** ** ** * Henry Ford Wyandotte Hospital ** ** ** * Herrick Medical Center Hills & Dales General Hospital Hillsdale Community Health Center N/A * * * Holland Hospital * * * * * * * * Huron Medical Center McLaren - Greater Lansing * * * * McLaren - Orthopedic Hospital * * * *

*This hospital has committed to the star. **This hospital has completed the star. Healthy Food Hospitals Honor Roll Page 3 of 4

Organization Name Star 1 Star 2 Star 3 Star 4 Kalkaska Memorial Health Center N/A * * * Lakeland Community Hospital, Watervliet * * * * Lakeland Community Hospital-Niles * * * * Lakeland Regional Medical Center-St. Joseph * * * * McLaren - Lapeer Region Mackinac Straits Health System, Inc. * * * * Marlette Regional Hospital Marquette General Health System ** ** ** * McKenzie Health System * * * * McLaren - Flint N/A N/A ** Mecosta County Medical Center N/A ** ** * Memorial Healthcare * * * * Memorial Medical Center of West Michigan Mercy Health Partners, Hackley Campus * * * * Mercy Health Partners, Mercy Campus N/A N/A * * Mercy Health Partners, Muskegon General Campus * * * * Mercy Hospital Cadillac * * * * Mercy Hospital Grayling * * * ** Mercy Memorial Hospital System * * * * Metro Health Hospital ** ** ** ** MidMichigan Medical Center-Clare * * * * MidMichigan Medical Center-Gladwin * * * * MidMichigan Medical Center-Gratiot * * * * MidMichigan Medical Center-Midland * * * * McLaren - Macomb * * * * Munising Memorial Hospital * * * * North Ottawa Community Hospital * * * * Northern Michigan Regional Health System ** ** ** * NORTHSTAR Health System O.S.F. St. Francis Hospital and Medical Group * * * * Oaklawn Hospital * ** ** * Oakwood Annapolis Hospital * * * * Oakwood Heritage Hospital * * * * Oakwood Hospital & Medical Center-Dearborn * * * * Oakwood Southshore Medical Center * * * * Otsego Memorial Hospital N/A ** * * Paul Oliver Memorial Hospital * * * * Pennock Health Services ** ** * * McLaren - Oakland

*This hospital has committed to the star. **This hospital has completed the star. Healthy Food Hospitals Honor Roll Page 4 of 4

Organization Name Star 1 Star 2 Star 3 Star 4 Port Huron Hospital * * * * Portage Health * ** * * Providence Hospital Medical Center ** ** ** * Providence Park Hospital ** ** ** * Saint Mary's Health Care N/A * * * Scheurer Hospital Schoolcraft Memorial Hospital * * * * Sheridan Community Hospital N/A N/A * * Sinai-Grace Hospital * * * * South Haven Health System * * * * Sparrow Clinton Hospital * * * * -Main Campus ** ** ** ** Sparrow Hospital-St. Lawrence Campus ** ** ** ** Sparrow Ionia Hospital N/A * * * Spectrum Health Blodgett Hospital ** ** ** ** Spectrum Health Butterworth Hospital ** ** ** ** Spectrum Health Gerber Memorial * * * * Spectrum Health Kelsey Hospital * * * * Spectrum Health Reed City Hospital N/A N/A ** ** Spectrum Health United Hospital * * * * Spectrum Health Zeeland Community Hospital * * * ** St. John Hospital & Medical Center ** ** ** * St. John Macomb-Oakland Hospital ** ** ** * St. John River District Hospital ** ** ** * St. Joseph Health System St. Joseph Mercy Hospital ** ** ** ** St. Joseph Mercy Livingston Hospital ** ** ** ** St. Joseph Mercy Oakland ** ** ** ** St. Joseph Mercy Port Huron * * * * St. Mary Mercy Hospital N/A N/A ** ** St. Mary's of Michigan St. Mary's of Michigan Standish Hospital N/A N/A * * Sturgis Hospital * * ** * Three Rivers Health * * * * University of Michigan Hospitals & Health Centers ** * ** * War Memorial Hospital * * * * West Branch Regional Medical Center * * * * West Shore Medical Center N/A ** ** *

*This hospital has committed to the star. **This hospital has completed the star. Introduction

Becoming the Model

Michigan hospitals and health systems have made more than $3 billion, and it has implications that consistent and significant strides to offering led the MHA to ask Michigan hospitals to make exemplary food service choices and nutritional serving the healthiest food choices a priority. This selections. In fact, the voluntary, collaborative initiative also aligns well with Governor Rick and successful efforts of Michigan hospitals and Snyder’s health proposal to “work with Michigan's health systems are being exported to other states, farmers to alleviate the state's obesity problem.” allowing hospitals across the nation to bring healthier foods to all patients.

The MHA continually provides a strategic assessment of emerging health care trends to help Michigan hospitals have the opportunity to help its members develop a framework to meet current prevent food-related health concerns by and future needs of their communities. The influencing how food is produced and by association's strategic plan is divided into five modeling good nutrition within their institutions. "platforms," including Patient Access, Quality of This initiative encompasses four stars. The first Care, Community Health Improvement, Mission- two stars are focused on children while the last driven Funding and Best Information. two are geared toward adults. It is under the Community Health Improvement platform that the MHA has asked Michigan’s community hospitals to voluntarily adopt smoke- free campus policies and eliminate foods “The commitment to the Healthy Food containing trans fats from their cafeteria, vending Hospital initiative was one of the machines and patient nutrition. Combating obesity is an absolute must, as obesity has reasons that we redesigned all of our become among the nation’s most costly and patient menus.” complex public health threats, giving rise to massive increases in health care. At present, the __ costs associated with obesity in Michigan total Alison Waske, Sustainable Business Officer, Metro Health Hospital, Wyoming

Diagram represents Michigan Health & Hospital Association’s Community Health Improvement’s (orange, bottom) strategic platform in response to the direction for Population Health Management (lower left).

3 At its core, Healthy Food Hospitals is a product of collaboration. The Ecology Center, a Michigan-based environmental non-profit organization and the MHA worked together to create the four-star approach. The Ecology Center facilitated conversations with dietitians, food service managers and directors, clinical nutrition managers and MHA senior directors of Hospitality Services from MHA-member hospitals to serve as the Healthy Food Work Group — functioning as a sub-group of the MHA Green Health Committee (MGHC Committee) — to guide, Healthy polish and perfect the campaign. This Work Group shares the same mission as the MGHC Committee by recognizing the interconnection Food Work between health and the environment and strives to encourage sustainability initiatives that improve human health as well as environmental health. The Healthy Food Work Group takes it one step Group further stating by “working with health care for a sustainable foods system.”

MHA Healthy Food Work Group An advisory group representing hospitals, dietitians and community organizations provide leadership and strategic guidance. The members of the 2010-2012 MHA Healthy Food Advisory Committee are thanked for their service:  Christa Byrd, MA, RD (Chair), Sparrow Hospital  Christine Eagle, MS, RD, CDE (Chair-elect), Beaumont Hospital- Royal Oak  Hillary Bisnett (Committee Coordinator), Ecology Center  Lisa McDowell, MS, RD, CNSD, St. Joseph Mercy Hospital  Paige Hathway, MS, MHA  Michele Nikolai, MS, RD, CSP, Sparrow Hospital  Susanne Gunsorek, RD, St. John Providence Park Hospital

 Carol Holman, RD, MHA, Marquette General Hospital  Tracey Easthope, MPH, Ecology Center  Linda Ward, McLaren-Northern Michigan  Donna Morrison, MS, RD, CNSD, MBA, Beaumont Hospital- Grosse Point  Craig Luck, University of Michigan Hospitals & Health Centers  Lynn Noder-Love, Aramark, University of Michigan Health System  Michael Rowe, Bronson Methodist Hospital  Grant Fletcher, Bronson Methodist Hospital

Four-Star Overview MHA Prepares Hospitals Star 1: Default non-select pediatric patient menus for children 2- The Healthy Food Hospitals Initiative was announced 18 to meet the American Heart Association guidelines. to all hospitals in January of 2011. Following this (Recommendations should be met as guidelines for the day.) announcement, the MHA hosted three Healthy Food To be completed by Jan. 1, 2013

Hospitals educational sessions in Lansing, Novi and Star 2: Transition to healthy beverages. The default choice on Gaylord during the month of March. Each training pediatric patient menus/trays should be milk. When juice is served, session involved overviews of each of the four stars to only 100 percent juice should be served. When serving milk, serve inform hospitals about the commitments in the recombinant bovine growth hormone (rBGH) free milk and non fat initiative, while providing them with the tools and (skim) milk or low-fat when deemed medically appropriate; use Bisphenol A (BPA) free containers and/or reusable cups. The healthy educational resources for implementation. beverage transition should also be applied to adults when applicable. To be completed by Jan. 1, 2013 MHA staff, teamed with members of the Healthy Food Work Group, conducted perform the trainings, giving Star 3: Label nutritional content in cafeteria offerings. key advice to hospitals on their experiences in To be completed by Jan. 1, 2013 implementing components of the initiative. Star 4: Healthy eating starts with a healthy food system. In an effort to provide an ongoing evolving resource to hospitals to Public Announcement of Healthy continue modeling healthy food environments, the following commitment is recommended. Sign the resolution of support for the Food Hospitals Michigan Good Food Charter challenging institutions, and thus The initiative was publically announced at a press hospitals, to commit to purchase at least 20 percent Michigan grown and produced and processed foods. It is also recommended that your event hosted by Sparrow Hospital in May 2011. Olga hospital sign onto the Health Care Without Harm Healthy Food Dazzo, director, Michigan Department of Community Pledge if it has not done so already. Health; highlighted her support of the MHA initiative, To be completed by Jan. 1, 2020 and was joined in the kick off by Joe Ruth, chief operating officer at Sparrow Health System; Christa Several media outlets attended the event, resulting in Byrd, registered dietitian at Sparrow Health System numerous news articles lauding the effort. (See the and co-chair of the Michigan Healthy Food Work “news section” of www.healthyfoodhospitals.org for Group, and Brian Peters, MHA Executive Vice copies of the articles.) President, Operations.

Default non-select pediatric patient menus for children 2-18 to Star 1 meet the American Heart Association guidelines. (Recommendations should be met as guidelines for the day.)

Rationale Status

With childhood obesity on a steady incline, As of June 1, 2012, 28 hospitals have submitted America’s First Lady, Michelle Obama, helped proof of completion for Star 1. Representing 29% of launch a Let’s Move campaign. In a similar vein, the the hospitals committed to fulfilling this star. MHA recognized that an equally important element Several hospitals have submitted pediatric menus was the consumption of the healthiest food choices following the guidelines of this star. and has advocated for use of the American Heart Association Guidelines. Michigan Model Hospitals

Numerous Michigan hospitals are leading the way by following the AHA dietary guidelines in their “[Although] we have a low pediatric facilities. St. Joseph Mercy Ann Arbor Hospital’s Service Delivery Leader for Nutrition Services, Lisa patient census, we decided that we McDowell, MS, RD, CNSD stated, “We began should still be in line with the MHA following the AHA guidelines January 1, 2010 for guidelines. All of our patient orders all of our cafeteria meals. In September [2010], we go through room service which will adopt the guidelines for our default regular diet insures that we have control of what and pediatric patient meals.” all of our patients receive.” Another such example is Helen DeVos Children’s Hospital, a member of the Spectrum Health System. – DeVos Children’s Hospital uses an automatic Mark Pittillo, Portage Health, Hancock electronic menu order system for non-select pediatric menus, which are written to comply with AHA guidelines. (Photo courtesy of Helen DeVos Children’s Hospital)

Transition to healthy beverages. The default choice on pediatric patient menus/trays should be milk. When juice is served, only 100 percent Star 1 juice should be served. When serving milk, serve recombinant bovine Star 2 growth hormone (rBGH) free milk and non fat (skim) milk or low-fat when deemed medically appropriate; use Bisphenol A (BPA) free containers and/or reusable cups. The healthy beverage transition should also be applied to adults when applicable.

Rationale Michigan Model Hospital According to the American Academy of Metro Health’s Guest Service Representatives Pediatrics, drinking too much juice can ensure that patients have been educated on contribute to obesity, the development of healthy eating and drinking menu options dental cavities, and gastrointestinal problems. during the meal selection period. In the future, In addition, juice also ruins the appetite of a they also are considering limiting milk options child. Nutrients provided through fruit are to low-fat or skim milk and eliminating soda better obtained from whole fruit and when from patient menus, while crafting a new juice is a choice, these nutrients are more policy that reflects these changes and ensures readily available in 100 percent juice. that the policy is implemented hospital wide. Metro Health Hospital recognizes that the The MHA’s recommendation also states, if American Heart Association giving children milk, it must be r-BGH free recommendations protect and support the which can increase antibiotic resistance in health of all of their patients. While the humans, elevate levels of another growth pediatric population at Metro Health Hospital hormone, IGF-1, which increases the is small, the hospital decided all patients incidence of at least 16 harmful diseases or would benefit from the Healthy Food Hospital conditions in cows. recommendations and therefore have Another toxin to be aware of is Bispheno A expanded this program to the adult population (BPA). Many scientific studies have linked as well. even low-level exposure of BPA to obesity. Further, a report presented at the Endocrine Society’s annual meeting linked BPA to heart disease. Hospitals are recommended to ask vendors about the brands of BPA-free products that they carry.

Status

As of June 1, 2012, 31 hospitals have submitted proof of completion for Star 2. This amounts to nearly 28% completion at this time. Several hospitals have submitted photos and statements from their vendors as proof to meet this star. Photo courtesy of Aspirus Grand View Hospital. It shows their milk source label stating, “Milk from farmers who pledge to not use artificial growth hormones.” Label nutritional content in cafeteria offerings. Star 3 Star 1 Rationale Status

It is increasingly clear that both patients and patrons Approximately 27%, or 32 hospitals committed want nutrition information. The University of to Star 3, have completed the star with proof as California at Berkeley’s Center for Weight and of June 1, 2012. Health conducted a study at five Kaiser Permanente cafeteria sites to see how cafeteria patrons would Michigan Model Hospital react to nutrition labeling. More than 80 percent felt Kaiser was helping them improve their health by System offers three separate providing them with nutrition information. methods for labeling cafeteria offerings. Nutrition fact information is posted on the internal web page At Sparrow Hospital, Lansing, “Patients are for cafeteria foods where employees can access contacted during routine discharge and comment on this information from any internal computer. our hospital’s menu symbols and how helpful they Additionally, nutrition information is posted in the are for making meal choices that are compliant with cafeteria for items that are made in house. Most diets for diabetes and heart health,” says Christa importantly, healthier options are denoted by the Byrd, MA, RD Sparrow Hospital Room Service logo, mHC or my Healthier Choice (see below). Supervisor. This designation is part of the organization’s overall wellness program and is consistent with designationApproximatelys for other27%, programs.32 hospitals, The whowellness have committed to Star 3 have completed the star (Photo courtesy of Beaumont Health System) program is well established and supported by seniorwith proof management as of June and 1 has 2012. become part of the culture to encourage a healthful lifestyle and to provide the necessary information to be able to make informed choices.

Items denoted with this logo fit the following criteria:  <35% total calories from fat  0 trans-fat  2 or less grams of saturated fat  500 or less milligrams sodium for entrees  300 or less milligrams sodium for side dishes

Healthy eating starts with a healthy food system. In an effort to provide an ongoing evolving resource to hospitals to continue modeling healthy food environments, the following commitment is recommended. Sign the resolution of Star 4 support for the Michigan Good Food Charter challenging institutions, and thus hospitals, to commit to purchase at least 20 percent Michigan grown and produced and processed foods. It is also recommended that your hospital sign onto the Health Care Without Harm Healthy Food Pledge if it has not done so already. Rationale Michigan is the second most agriculturally diverse producers and processors. As of June 1, 2012, 11 state in the nation, and yet 59 percent of our residents hospitals have completed and submitted proof for live in communities that have inadequate access to the food they need for a healthy daily diet. Only about 14 percent of Michigan’s farmers markets Status accept Bridge Cards for food purchases, making it easier to buy food from another continent than from a Star 4; that is about 10% of the hospitals who have farmer in your own community. Thus, the Michigan agreed to accomplish this star by 2020. Good Food Charter has developed a vision for Michigan's food and agriculture system to increase

its current contribution to the state's economy, Michigan Model Hospital protect our natural resource base, improve our residents' health and help generations of Michigan Bronson Methodist Hospital started their youth to thrive. Even more promising is the purchasing campaign in 2008 by signing onto governor’s pledge to work with Michigan’s farmers Health Care Without Harm's Healthy Food in to alleviate the state’s obesity problem. The Health Care Pledge. Each year following, the consumption of more Michigan produce will help the hospital increased local food purchases. In 2011, state of our economy and our health. the local food purchases totaled 21.5% of total food purchases based on paid invoices from their The charter includes this ‘Star 4’ goal for hospitals to local farmers and producers. The hospital also use their collective purchasing power to influence the receives reports of Michigan grown food from food supply chain and to provide healthier food and their mainline distributor. Bronson has a long- more foods grown, raised and processed in term goal to procure 50% of their food from Michigan. By 2020, institutions will be expected to Michigan. meet or exceed the goal of sourcing 20 percent of their food products from Michigan growers,

Fresh, locally sourced foods promote healthy lifestyle choices and nurture healthy individuals, and healthy communities, which are the fundamental building blocks of a strong and vibrant healthcare system. __ Grant Fletcher, Bronson Methodist Hospital, Kalamazoo

Photo courtesy of University of Michigan Health System The Healthy Food Hospitals Program is helping to achieve two of the most important goals for health care: improving patient health and reducing health care costs. The Healthy Food Hospitals Program is helping to achieve two of the most important goals for health care: improving patient health and reducing health care costs. Maintaining a healthy diet and sustainable food systems, and improving the health Starof Starcommunities 2 are critical to avoiding costly chronic diseases. Increasing consumption of local and sustainable food has another important benefit -- helping to support the Michigan economy. Present Issues That’s why the work of the Healthy Food Hospitals Program is both important and innovative. Michigan government, for-profit, and non-profit entities, health care providers, and the agricultural community are joining forces to improve the health of residents, increase farm revenue and keep dollars in the local economy, & Future where they stimulate growth. Michigan is not only leading the nation in hospital- based farm stands, farmers’ markets and community supported agriculture (CSA) food share boxes programs, but it is also fortunate to have new and promising Opportunities approaches to connecting individuals and families to innovative access and affordable fresh food programs.

Programs like Fair Food Network’s Double Up Food Bucks that increase dollars available for fresh fruit and vegetable purchases, and Washtenaw County’s Prescription for Health Program, which issues food prescriptions to patients allowing them to buy Michigan produce at farmer’s markets, are examples of the many opportunities to improve food environments, while shifting to local, healthier food production and distribution systems and in doing so further support economic development and improve public health.

Health care in Michigan is the largest private-sector employer, providing direct jobs to more than 555,400 Michigan residents. As Michigan’s hospitals and health systems become models of good food and nutrition for their patients, they also serve as models for their employees and their surrounding communities. Expanding efforts to these populations means health care can be an even more powerful driver for improving Michigan’s economy and supporting smart economic growth.

The Healthy Food Hospitals Program also furthers Governor Rick Snyder’s health priorities which include improving access to healthy, local foods. The program goals include the need to work with Michigan farmers to alleviate the state’s obesity problem. Governor Snyder’s efforts include the earmarking of $1 million dollars for new regional food hub development. Food hubs are critical in fostering more locally grown and raised foods, while offering an aggregation and distribution point specially for Michigan food products.

The health care sector continues to be a strong economic engine for the state, and their shift to purchasing local, healthier foods is similarly helping to create a healthier population. The fourth star or component of the Healthy Food Hospitals campaign gives great evidence of this shift. Eleven hospitals have already completed the fourth component and several more are beginning to demonstrate the institutional purchasing power of the health care sector, providing new and promising markets for producers. As evidence, one study of twelve hospitals found they had an aggregated annual food budget greater than $17.1 million, or nearly 9.5 million meals served. If this group of hospitals were to shift just 10 percent of their food purchases to Michigan produced foods, it would result in the reinvestment of nearly $1.8 million in the local economy. In addition, new research has demonstrated that there is an additional multiplier effect from this support of local businesses -- applying this effect would mean that an additional $5.4 million would stay in the local economy.