Systemic interventions are needed to address the “broad spectrum” of issues and challenges facing the food system in the United States, according to a policy forum article published in the AMA Journal of Ethics. The paper’s authors called on healthcare professionals to advocate for and implement strategies that contribute to a more healthful, equitable, and sustainable food system.

Authors Sarah Reinhardt, MPH, RD, and Ricardo J Salvador, PhD, MS, noted that physicians and other healthcare professionals are in a unique position to develop relationships with private and public sector organizations to promote disease prevention and push for changes in systems that currently have a role in diet-related chronic diseases.

They argue that the current food system works at cross purposes with public health and is a resource-intensive industry that relies on unsustainable practices that threaten the availability of food in the future and exploits a large labor force, many of whom have inadequate access to food themselves. Furthermore, the current food system exacerbates existing racial and socioeconomic inequities.

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The authors also noted that healthcare professionals have input into the food procurement practices of noncommercial food service operations such as hospitals, senior care centers, and other healthcare facilities that altogether purchase approximately $120 billion worth of food each year, providing food to some of our most vulnerable populations. These institutions can leverage their buying power to increase access to more nutritional and environmentally sustainable foods, giving priority to the purchase of locally grown food. Moreover, they may be able to lessen the impact of food production on the environment and climate by serving more plant-based proteins and reducing meat portion sizes. Schools and city or county government departments also present opportunities to implement better procurement practices.

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The Good Food Purchasing Policy (GFPP) has been successfully implemented by a number of public institutions. The authors note that there are 5 key “value categories” that comprise the procurement structure: (1) local economies, (2) environmental sustainability, (3) nutrition, (4) valued workforce, and (5) animal welfare. The Los Angeles Unified School District adopted GFPP in 2012 and was subsequently able to direct 20% of its purchases to local producers, develop healthier school menus, reduce its carbon footprint and water use, and improve working conditions and wages for workers in a major food distribution company.

The authors contend that implementing GFPP strategies in healthcare institutions can result in reductions in healthcare costs. They also argue that healthcare professionals have a responsibility to act as leaders to transform the food system into one that works with health care to prevent disease rather than one that works against it.


Reinhardt S, Salvador RJ. Health professionals as partners in values-based food procurement. AMA J Ethics. 2018;20:E974-E978.