October 4, 2013

From Agricultural Policy to Sustainable Procurement

By Sapna Thottathil, Senior Program Associate and Lucia Sayre, Co-Executive Director of SF Bay Area PSR.

SF Bay Area PSR coordinates Health Care Without Harm’s Healthy Food in Health Care program in California.

Earlier this year, the American Academy of Pediatrics (AAP) issued updated guidelines for treating acute otitis media – ear infections – in children. These guidelines recommend a more cautious approach to prescribing antibiotics for ear infections, based on the severity of symptoms. The AAP’s recommendations align with a broader trend in clinical settings: the reduction of antibiotic prescriptions for children by doctors to combat increasing antibiotic resistance.

Despite this kind of prudent approach within the medical community, antibiotic resistance continues to be a growing problem. Around the same time the AAP issued its new guidelines, the Centers for Disease Control and Prevention (CDC) released a report acknowledging that Carbapenem-Resistant Enterobacteriaceae – a new family of bacteria with high levels of resistance to antibiotics – may lead to the death of 50 percent of infected individuals. Children and other vulnerable populations are particularly susceptible to such infections. The CDC’s report – as well as other resistance trends well-documented in scholarly research – was alarming, especially given the steps the medical community is taking to combat antibiotic resistance.

Yet, while physicians curb their prescriptions of antibiotics for children, the majority of these medicines are routinely administered to others: food animals.

Animals in our agricultural system are regularly fed low-dosages of antibiotics for the purposes of growth promotion, and to compensate for crowded and unhygienic living environments. In the U.S., 29.9 million pounds of antibiotics are used in animal agriculture annually; this represents 79.5 percent of all antibiotics sold and four times the amount used in human medicine. Two thirds are directly relevant to human medicine, including penicillins, cephalosporins, macrolides, sulfas, and tetracyclines.

Agricultural Policy

Most recently in September 2013, the CDC released yet another report, entitled Antibiotic Resistance Threats in the United States, 2013. Health Care Without Harm (HCWH) and Physicians for Social Responsibility applaud the efforts of the CDC in producing and publishing this report, which finally recognizes that the routine use of non-therapeutic antibiotics in animal agriculture is contributing to the antibiotics resistance crisis.

Now we hope that Congress will read the latest from the CDC as well, heed the CDC’s message, and ban the use of several classes of medically-important antibiotics by passing two bills currently sitting in Congress: the Preservation of Antibiotics for Medical Treatment Act (PAMTA) in the House and the Preventing Antibiotic Resistance Act (PARA) in the Senate. These bills represent comprehensive steps towards combating antibiotic resistance in our country. PAMTA and PARA would sunset FDA approval of eight classes of medically-important antibiotics for use in animal feed, unless the registering companies can submit data showing that continued use would not create a risk to human health. Last month, close to 400 health professionals in SF Bay Area PSR and HCWH’s network sent 1,440 emails to 255 members of Congress in support of these bills.

Sustainable Procurement

As HCWH’s network of hospitals and clinicians wait eagerly to see the status of PAMTA and PARA this year, hospitals continue to demonstrate market leadership on this issue, by actively reducing the amount of meat on their facility menus and procuring meat that has been produced without the routine use of antibiotics.

Earlier this year, in collaboration with faculty and food service staff, the University of California at San Francisco (UCSF) Medical Center’s Academic Senate unanimously passed a resolution to phase out the purchase of meat produced with non therapeutic antibiotics, and it urged all other University of California campuses to do the same. Says Dr. Thomas Newman, SF Bay Area PSR Board member and a member of the Academic Senate who spearheaded the resolution: “The CDC report highlighted the strong scientific evidence that antibiotic use in animal agriculture can harm public health. This practice continues because regulators have failed to prohibit it and because institutional purchasers and individual consumers continue to buy these products.” Adds Newman, “At UCSF, our faculty’s Academic Senate has endorsed a strong statement recognizing this public health threat.”

UCSF now finds itself with a sizable task ahead. With a food budget of close to $7 million, serving over 650,000 meals per year to patients, staff, and the community, where and how will it  source large amounts of sustainably-grown meats close to home?

Balanced Menus: October 7-8

Next week, from October 7-8, 80 people representing hospitals, supply chain distributors, sustainable meat producers, and HCWH will gather together in San Francisco and Berkeley at Balanced Menus: Meeting Health Care’s Demand for Sustainable Meat. Attendees will tackle the issue of supply head on, and hospitals will have the opportunity to strategize with producers who are willing to collaborate with large-scale institutions on changing our food system.

Charles Thieriot of Llano Seco Organic Meats, an organic producer who advocates ecological and healthy practices on his farm, who will be a panelist on October 7, sees the alliance between hospitals and sustainable farmers as a natural: “What better partners could we have than human health care providers? Holistic and sustainable means I put my health first. At Llano Seco Meats, we put the health of our pigs first.”

As the health care sector works on the procurement front, and as we bring together stakeholders to think about and discuss market strategies to address antibiotic resistance and the issues associated with institutional procurement of sustainably-produced meat, SF Bay Area PSR hopes Congress will also act before the 113th session ends. Hospitals and clinicians are doing what they can to protect antibiotics for human medicine within their environments. Congress can assist in these efforts further, by passing PAMTA and PARA.

A version of this blog first appeared on Health Care Without Harm’s website. This is the first in a 3-part series on the health care sector’s efforts to protect antibiotics for human medicine by building a more sustainable agricultural system through policy advocacy and procurement strategies.